1
|
Draaisma F, Leenders EKSM, Erasmus CE, Braakman HMH, Burgers MCJ, Coppens CH, Rinne T, Zenker M, Tartaglia M, Reintjes W, Voermans NC, van Engelen BGM, van Alfen N, Draaisma JMT. Nerve enlargement in patients with Noonan syndrome: A retrospective cohort study. Am J Med Genet A 2024; 194:e63810. [PMID: 38958480 DOI: 10.1002/ajmg.a.63810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/08/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
Noonan syndrome (NS) is an autosomal dominant condition characterized by facial dysmorphism, congenital heart disease, development delay, growth retardation and lymphatic disease. It is caused by germline pathogenic variants in genes encoding proteins in the Ras/mitogen-activated protein kinase signaling pathway. Nerve enlargement is not generally considered as a feature of NS, although some cases have been reported. High-resolution nerve ultrasound enables detailed anatomical assessment of peripheral nerves and can show enlarged nerves. This retrospective cohort study aims to describe the sonographic findings of patients with NS performed during a 1-year time period. Data on the degree of enlargement, the relation to increasing age, pain in extremities, genotype on the gene level and clinical features were collected. Twenty-nine of 93 patients visiting the NS Center of Expertise of the Radboud University Medical Center Nijmegen underwent high-resolution ultrasound. In 24 patients (83%) nerve enlargement was found. Most of them experienced pain. We observed a weak correlation with increasing age and the degree of nerve enlargement but no association with pain, genotype at the gene level or clinical features. This study shows that patients with NS have a high predisposition for sonographic nerve enlargement and that the majority experience pain.
Collapse
Affiliation(s)
- Fieke Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Erika K S M Leenders
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Hilde M H Braakman
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Melanie C J Burgers
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Catelijne H Coppens
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Tuula Rinne
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Wesley Reintjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Yang JX, Zhao WN, Jiang YY, Ma Y, Chen DD, Lin ZH, Yin MB, Ren KP. Caveolin-1 is essential for the increased release of glutamate in the anterior cingulate cortex in neuropathic pain mice. J Neuropathol Exp Neurol 2023; 82:806-813. [PMID: 37478479 DOI: 10.1093/jnen/nlad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
Neuropathic pain has a complex pathogenesis. Here, we examined the role of caveolin-1 (Cav-1) in the anterior cingulate cortex (ACC) in a chronic constriction injury (CCI) mouse model for the enhancement of presynaptic glutamate release in chronic neuropathic pain. Cav-1 was localized in glutamatergic neurons and showed higher expression in the ACC of CCI versus sham mice. Moreover, the release of glutamate from the ACC of the CCI mice was greater than that of the sham mice. Inhibition of Cav-1 by siRNAs greatly reduced the release of glutamate of ACC, while its overexpression (induced by injecting Lenti-Cav-1) reversed this process. The chemogenetics method was then used to activate or inhibit glutamatergic neurons in the ACC area. After 21 days of injection of AAV-hM3Dq in the sham mice, the release of glutamate was increased, the paw withdrawal latency was shortened, and expression of Cav-1 in the ACC was upregulated after intraperitoneal injection of 2 mg/kg clozapine N-oxide. Injection of AAV-hM4Di in the ACC of CCI mice led to the opposite effects. Furthermore, decreasing Cav-1 in the ACC in sham mice injected with rAAV-hM3DGq did not increase glutamate release. These findings suggest that Cav-1 in the ACC is essential for enhancing glutamate release in neuropathic pain.
Collapse
Affiliation(s)
- Jun-Xia Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Wei-Nan Zhao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Yan-Yu Jiang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Yu Ma
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Dan-Dan Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Zhi-Hua Lin
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Meng-Bing Yin
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Kun-Peng Ren
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
3
|
Ocay DD, Larche CL, Betinjane N, Jolicoeur A, Beaulieu MJ, Saran N, Ouellet JA, Ingelmo PM, Ferland CE. Phenotyping Chronic Musculoskeletal Pain in Male and Female Adolescents: Psychosocial Profiles, Somatosensory Profiles and Pain Modulatory Profiles. J Pain Res 2022; 15:591-612. [PMID: 35250304 PMCID: PMC8892739 DOI: 10.2147/jpr.s352607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Purpose A major limitation in treatment outcomes for chronic pain is the heterogeneity of the population. Therefore, a personalized approach to the assessment and treatment of children and adolescents with chronic pain conditions is needed. The objective of the study was to subgroup pediatric patients with chronic MSK pain that will be phenotypically different from each other based on their psychosocial profile, somatosensory function, and pain modulation. Patients and Methods This observational cohort study recruited 302 adolescents (10–18 years) with chronic musculoskeletal pain and 80 age-matched controls. After validated self-report questionnaires on psychosocial factors were completed, quantitative sensory tests (QST) and conditioned pain modulation (CPM) were performed. Results Three psychosocial subgroups were identified: adaptive pain (n=125), high pain dysfunctional (n=115), high somatic symptoms (n=62). Based on QST, four somatosensory profiles were observed: normal QST (n=155), thermal hyperalgesia (n=98), mechanical hyperalgesia (n=34) and sensory loss (n=15). Based on CPM and temporal summation of pain (TSP), four distinct groups were formed, dysfunctional central processing group (n=27) had suboptimal CPM and present TSP, dysfunctional inhibition group (n=136) had suboptimal CPM and absent TSP, facilitation group (n=18) had optimal CPM and present TSP, and functional central processing (n=112) had optimal CPM and absent TSP. A significant association between the psychosocial and somatosensory profiles. However, no association was observed between the psychosocial or somatosensory profiles and pain modulatory profiles. Conclusion Our results provide evidence that adolescents with chronic musculoskeletal pain are a heterogenous population comprising subgroups that may reflect distinct mechanisms and may benefit from different treatment approaches. The combination of screening self-reported questionnaires, QST, and CPM facilitate subgrouping of adolescents with chronic MSK pain in the clinical context and may ultimately contribute to personalized therapy.
Collapse
Affiliation(s)
- Don Daniel Ocay
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Cynthia L Larche
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Natalie Betinjane
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Alexandre Jolicoeur
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Marie Josee Beaulieu
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Neil Saran
- Department of Pediatric Orthopedics, McGill University, Montreal, QC, Canada
| | - Jean A Ouellet
- Department of Pediatric Orthopedics, McGill University, Montreal, QC, Canada
| | - Pablo M Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Research Institute-McGill University Health Centre, Montreal, QC, Canada
- Alan Edwards Research Center for Pain, McGill University, Montreal, QC, Canada
| | - Catherine E Ferland
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Research Institute-McGill University Health Centre, Montreal, QC, Canada
- Alan Edwards Research Center for Pain, McGill University, Montreal, QC, Canada
- Correspondence: Catherine E Ferland, Shriners Hospitals for Children-Canada, 1003, Decarie Blvd, Montreal, H4A 0A9, Canada, Tel +1 514 842-4464, extension 7177,Fax +1 514 842-8664, Email
| |
Collapse
|
4
|
Ocay DD, Loewen A, Premachandran S, Ingelmo PM, Saran N, Ouellet JA, Ferland CE. Psychosocial and psychophysical assessment in pediatric patients and young adults with chronic back pain: a cluster analysis. Eur J Pain 2022; 26:855-872. [PMID: 35090183 PMCID: PMC9304192 DOI: 10.1002/ejp.1912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Identifying subgroups with different clinical profiles may inform tailored management and improve outcomes. The objective of this study was to identify psychosocial and psychophysical profiles of children and adolescents with chronic back pain. Methods One hundred and ninety‐eight patients with chronic back pain were recruited for the study. Pain assessment was mainly conducted in the form of an interview and with the use of validated pain‐related questionnaires assessing their psychosocial factors and disability. All patients underwent mechanical and thermal quantitative sensory tests assessing detection and pain thresholds, and conditioned pain modulation efficacy. Results Hierarchal clustering partitioned our patients into three clusters accounting for 34.73% of the total variation of the data. The adaptive cluster represented 45.5% of the patients and was characterized to display high thermal and pressure pain thresholds. The high somatic symptoms cluster, representing 19.2% of patients, was characterized to use more sensory, affective, evaluative and temporal descriptors of pain, more likely to report their pain as neuropathic of nature, report a more functional disability, report symptoms of anxiety and depression and report poor sleep quality. The pain‐sensitive cluster, representing 35.4% of the cohort, displayed deep tissue sensitivity and thermal hyperalgesia. Conclusions This study identified clinical profiles of children and adolescents experiencing chronic back pain based on specific psychophysical and psychosocial characteristics highlighting that chronic pain treatment should address underlying nociceptive and non‐nociceptive mechanisms. Significance To our current knowledge, this study is the first to conduct cluster analysis with youth experiencing chronic back pain and displays clinical profiles based on specific physical and psychosocial characteristics. This study highlights that in a clinical context, chronic pain assessment should include multiple elements contributing to pain which can be assessed in a clinical context and addressed when pathoanatomical symptoms are unidentifiable.
Collapse
Affiliation(s)
- D D Ocay
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada
| | - A Loewen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - S Premachandran
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada
| | - P M Ingelmo
- Chronic Pain Services, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - N Saran
- Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - J A Ouellet
- Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - C E Ferland
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Walfish L, Sbrocchi AM, Rivera G, Ricaurte Gracia YLN, Mohamed N, González Cárdenas VH, Stoopler M, Ingelmo P. Use of bisphosphonates in a retrospective case series of children and adolescents with complex regional pain syndrome. Paediatr Anaesth 2021; 31:871-877. [PMID: 33999470 DOI: 10.1111/pan.14207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is increasing evidence for the use of bisphosphonates to treat Complex Regional Pain Syndrome in adults. However, there are scarce data for their use in children with Complex Regional Pain Syndrome. AIM This retrospective case series aimed to analyze the effects of intravenous bisphosphonate use in children and adolescents with Complex Regional Pain Syndrome enrolled in a multidimensional pain treatment program. METHODS We analyzed the data of 16 patients (15 females and 1 male, mean age 14 ± 3 years) who received infusions of zoledronic acid (0.015 ± 0.0044mg/kg), pamidronate (0.72 ± 0.17mg/kg), or both depending on their initial response between October 2014 and December 2019. The primary endpoint of the study was the patient's global impression of change. Secondary outcomes included pain intensity, physical function, role function (school attendance), need for pain medications, and adverse effects. RESULTS Nine of 16 patients reported meaningful improvements (global impressions of change of 84% or higher) at a median follow-up time of 16 (8-21) months after their last infusion of bisphosphonates. There were also meaningful reductions in pain intensity and the need for pain medications. There was an increase in the proportion of patients with minimal or without physical disability, and almost all patients normalized their school activities. Thirteen patients (81%) reported adverse effects, mostly flu-like symptoms, for a few days after the infusion. CONCLUSION The use of bisphosphonate infusions may represent an effective treatment option for children with Complex Regional Pain Syndrome, not responding to multidisciplinary pain treatment programs.
Collapse
Affiliation(s)
- Laurel Walfish
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Anne Marie Sbrocchi
- Department of Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Gonzalo Rivera
- Chronic Pain Unit, Department of Anesthesia, Clínica Las Condes, Santiago, Chile
| | | | - Nada Mohamed
- Department of Pediatric Anesthesia, Edwards Family Interdisciplinary Centre for Chronic Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Víctor Hugo González Cárdenas
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Anesthesia, Department of Anesthesia, Pain & Palliative Care, Los Cobos Medical Center, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | | | - Pablo Ingelmo
- Department of Pediatric Anesthesia, Edwards Family Interdisciplinary Centre for Chronic Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.,The Alan Edward Centre for Research on Pain, McGill University, Montreal, QC, Canada
| |
Collapse
|
6
|
Sigalla J, Duparc Alegria N, Le Roux E, Toumazi A, Thiollier AF, Holvoet L, Benkerrou M, Dugue S, Koehl B. Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis. CHILDREN-BASEL 2021; 8:children8020084. [PMID: 33530318 PMCID: PMC7911240 DOI: 10.3390/children8020084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
The majority of hospitalizations of patients with sickle cell disease (SCD) are related to painful vaso-occlusive crises (VOCs). Although the pain of VOC is classically nociceptive, neuropathic pain (NP) has also been demonstrated in SCD patients. The aim of our study is to specify the prevalence of NP during VOCs in SCD children using a dedicated scale and to measure its characteristics. We performed a prospective study that included SCD children hospitalized for an acute VOC. The presence of NP was sought with the DN4 scale on the second and fourth days of hospitalization. A total of 54 SCD children were included in the study. Overall, 41% of the patients (n = 22) experienced neuropathic pain during the VOC, mostly at an early stage (Day 2). The median age, the sex ratio, the location of the pain, and the morphine consumption were similar for patients with and without NP. Our study shows that neuropathic pain is very common during VOCs in SCD children. The absence of identified risk factors should prompt us to be vigilant regardless of the patient's age, sex, and clinical presentation.
Collapse
Affiliation(s)
- Jeanne Sigalla
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Nathalie Duparc Alegria
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Enora Le Roux
- Unité d’Épidémiologie Clinique, Inserm, CIC 1426, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France; (E.L.R.); (A.T.)
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010 Paris, France;
| | - Artemis Toumazi
- Unité d’Épidémiologie Clinique, Inserm, CIC 1426, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France; (E.L.R.); (A.T.)
| | - Anne-Françoise Thiollier
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Laurent Holvoet
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
| | - Malika Benkerrou
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010 Paris, France;
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
| | - Sophie Dugue
- Pain Management Unit, Trousseau Hospital, AP-HP, Sorbonne Université, F-75012 Paris, France;
| | - Berengere Koehl
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
- INSERM UMRS 1134, Red Blood Cell Pathophysiology, F-75015 Paris, France
- Correspondence:
| |
Collapse
|