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Jalkh E, Abi Doumit C, Schakal A, Nehme J, Sukkarieh G, Jalkh A. A case of choroidal neovascularization as a first manifestaion of systemic lupus erythematosus. Int Ophthalmol 2024; 44:212. [PMID: 38698249 DOI: 10.1007/s10792-024-03120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND To report a rare occurrence of pigment epitheliopathy associated with choroidal neovasculization as a first manifestation of systemic lupus erythematosus. CASE PRESENTATION A 54-year-old female, with no prior medical history, sought a second opinion due to sudden drop in vision in her right eye to 20/80. Slit lamp examination was normal. Fundus examination revealed the presence of a subretinal hemorrhage in the macular area. Fundus imaging including optical coherence tomography and fluorescein angiography showed multifocal retinal pigment epitheliopathy associated with choroidal neovascularization (CNV). The patient had received an intravitreal injection of Bevacizumab 2 weeks ago. It was decided to complete the loading dose regimen with two additional Bevacizumab injections, and the first injection was done 2 weeks after her presentation. Two weeks later, the patient reported a rash on her cheeks, painful joints, and purpura. Systemic workup revealed positive ANA, anti-cardiolipin antibodies, and decreased complement levels, with negative anti-histone antibodies. This led to the diagnosis of systemic lupus erythematosus (SLE) based on the "Systemic Lupus International Collaborating Clinics" criteria. The patient was treated with 50 mg of prednisolone which was then tapered. 1 month after the third injection, an showed a total resolution of the sub-retinal fluid with an improvement of vision to 20/20. No recurrence was observed during follow-up. CONCLUSION Based on the findings from the fundus exam and imaging, systemic symptoms and the blood work-up, we postulate that the pigment epitheliopathy associated with choroidal neovascularization was related to the vaso-occlusive disease at the level of the choroid that can be part of SLE vasculopathy. To our knowledge, this represents the first case in which pigment epitheliopathy and CNV were the primary manifestations of SLE.
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Affiliation(s)
- Edmond Jalkh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Department of Ophthalmology, Eye and Ear International Hospital, Naccache, Lebanon
| | - Carla Abi Doumit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- Department of Ophthalmology, Eye and Ear International Hospital, Naccache, Lebanon.
| | - Alexandre Schakal
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Department of Ophthalmology, Eye and Ear International Hospital, Naccache, Lebanon
| | - Joseph Nehme
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Department of Ophthalmology, Eye and Ear International Hospital, Naccache, Lebanon
| | - Georges Sukkarieh
- Department of Ophthalmology, Eye and Ear International Hospital, Naccache, Lebanon
| | - Alex Jalkh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Department of Ophthalmology, Eye and Ear International Hospital, Naccache, Lebanon
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Daher A, Banjak M, Noureldine J, Nehme J, El Shamieh S. Genotype-phenotype associations in CRB1 bi-allelic patients: a novel mutation, a systematic review and meta-analysis. BMC Ophthalmol 2024; 24:167. [PMID: 38622537 PMCID: PMC11017593 DOI: 10.1186/s12886-024-03419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE The goal of the study was to search for novel bi-allelic CRB1 mutations, and then to analyze the CRB1 literature at the genotypic and phenotypic levels. APPROACH We screened various variables such as the CRB1 mutation types, domains, exons, and genotypes and their relation with specific ocular phenotypes. An emphasis was given to the bi-allelic missense and nonsense mutations because of their high prevalence compared to other mutation types. Finally, we quantified the effect of various non-modifiable factors over the best-corrected visual acuity oculus uterque (BCVA OU) using multivariate linear regression models and identified genetic interactions. RESULTS A novel bi-allelic missense in the exon 9 of CRB1; c.2936G > A; p.(Gly979Asp) was found to be associated with rod-cone dystrophy (RCD). CRB1 mutation type, exons, domains, and genotype distribution varied significantly according to fundus characteristics, such as peripheral pigmentation and condition, optic disc, vessels, macular condition, and pigmentation (P < 0.05). Of the 154 articles retrieved from PubMed, 96 studies with 439 bi-allelic CRB1 patients were included. Missense mutations were significantly associated with an absence of macular pigments, pale optic disc, and periphery pigmentation, resulting in a higher risk of RCD (P < 0.05). In contrast, homozygous nonsense mutations were associated with macular pigments, periphery pigments, and a high risk of LCA (P < 0.05) and increased BCVA OU levels. We found that age, mutation types, and inherited retinal diseases were critical determinants of BCVA OU as they significantly increased it by 33% 26%, and 38%, respectively (P < 0.05). Loss of function alleles additively increased the risk of LCA, with nonsense having a more profound effect than indels. Finally, our analysis showed that p.(Cys948Tyr) and p.(Lys801Ter) and p.(Lys801Ter); p.(Cys896Ter) might interact to modify BCVA OU levels. CONCLUSION This meta-analysis updated the literature and identified genotype-phenotype associations in bi-allelic CRB1 patients.
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Affiliation(s)
- Ahmad Daher
- Medical Testing Laboratory, Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Malak Banjak
- Rammal Hassan Rammal Research Laboratory, PhyToxE Research Group, Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Jinane Noureldine
- Rammal Hassan Rammal Research Laboratory, PhyToxE Research Group, Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Joseph Nehme
- Faculty of Medicine, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Said El Shamieh
- Medical Testing Laboratory, Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon.
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Nehme J, Karam MA, Haber C, Hanna NG, Farhat R, Sahyoun M, Schakal A, Samaha A, Azar G, Jalkh A. Proliferative diabetic retinopathy: Role of bevacizumab in decreasing the occurrence of vitreous hemorrhage after panretinal photocoagulation. J Fr Ophtalmol 2024; 47:103946. [PMID: 37833204 DOI: 10.1016/j.jfo.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 06/30/2023] [Accepted: 08/16/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To investigate the beneficial effect of bevacizumab injection one week prior to panretinal photocoagulation (PRP) on the occurrence of vitreous hemorrhage (VH) following PRP in high-risk proliferative diabetic retinopathy (PDR). METHODS This was a case-control pilot study conducted on two groups: an anti-VEGF treatment group, treated with bevacizumab injection one week prior to the first PRP session, and a control group of treatment-naive PDR patients who underwent PRP treatment and were not given an intravitreal bevacizumab injection, consecutively recruited. In both groups, a complete ophthalmological examination was conducted prior to PRP and at 4, 9, and 16 weeks following treatment. The primary endpoint studied was the occurrence of VH. RESULTS The control group included 69 patients (mean age 63±12.3 years) with high-risk PDR who received PRP treatment only, and the anti-VEGF treatment group included 67 patients (mean age 63.13±10.3 years). None of the demographic variables or comorbidities showed any significant difference between the two groups. The number of PRP sessions was not significantly correlated to the occurrence of VH in either of the groups (P=0.167). Vitreous hemorrhage within 16 weeks following laser treatment occurred in 10 patients (14.5%) in the control group and in only 3 patients (4.5%) in the anti-VEGF group (P=0.047). CONCLUSION Our case-control pilot study demonstrates that a bevacizumab injection preceding the initial PRP session might be beneficial in reducing the occurrence of VH in the first 16 weeks following PRP.
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Affiliation(s)
- J Nehme
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon.
| | - M Abi Karam
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
| | - C Haber
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon
| | - N G Hanna
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
| | - R Farhat
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
| | - M Sahyoun
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
| | - A Schakal
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
| | - A Samaha
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
| | - G Azar
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
| | - A Jalkh
- Faculty of Medicine, Holy Spirit University, Kaslik, Jounieh, Lebanon; Eye and Ear University Hospital, Naccash Road, Dbayeh, Metn, Lebanon
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Etu EE, Miller J, Bissonette A, Masoud S, Arslanturk S, Emakhu J, Tenebe T, Wilson C, Nour M, Monplaisir L, Nehme J. 117 Impact of Air Pollutants on Deep Learning Forecasting of Emergency Department Patient Arrivals. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Nehme J, Sahyoun M, Saad M, Slim E, Farhat R, Azar G, Jalkh A, Samaha A. Secondary intraocular lens implantation with absence of capsular support: Scleral versus iris fixation. J Fr Ophtalmol 2018; 41:630-636. [PMID: 30172383 DOI: 10.1016/j.jfo.2017.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/27/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the outcomes of iris fixated (IF) posterior chamber (PC) intraocular lens (IOL) versus scleral-fixated (SF) PC IOL implantation, and compare them with the results reviewed from the literature. SETTING The study took place in the ophthalmology department of the Eye and Ear Hospital (Lebanon). DESIGN This is a retrospective institutional study that collected the records of patients admitted for secondary IOL implantation between January 2007 and December 2016. METHODS A total of 28 eyes that underwent PC IOL fixation were included, 13 of which underwent trans-scleral PC IOL fixation and 15 of which underwent iris PC IOL fixation. Data were analyzed over a period of 3 years. RESULTS Of the 28 patients, 18 (64.3%) were male and 10 (35.7%) were female (mean age at intervention 36.78±23.47 [standard deviation, SD] years). There were no significant intergroup differences with regard to baseline values and demographic characteristics. Trauma was the most common etiology for posterior capsule insufficiency (82.1%). The mean preoperative baseline BCVA was 0.58±0.27 logMAR for SF and 0.27±0.20 logMAR for IF (P=0.07). Both groups had significant improvement in vision during the follow up period. No significant differences were noted regarding early or late postoperative complications between the two groups. CONCLUSION SF and IF techniques for PC IOL have similar outcomes and result in a significant improvement in BCVA. When compared to AC (anterior chamber) IOL, both techniques seem to yield fewer complications.
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Affiliation(s)
- J Nehme
- Saint-Esprit University, Faculty of Medicine, P.O.Box 70933 Naccash, Lebanon; Eye and Ear International Hospital, Naccash, Lebanon.
| | - M Sahyoun
- Saint-Esprit University, Faculty of Medicine, P.O.Box 70933 Naccash, Lebanon; Eye and Ear International Hospital, Naccash, Lebanon
| | - M Saad
- Saint-Esprit University, Faculty of Medicine, P.O.Box 70933 Naccash, Lebanon
| | - E Slim
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - R Farhat
- Saint-Esprit University, Faculty of Medicine, P.O.Box 70933 Naccash, Lebanon; Eye and Ear International Hospital, Naccash, Lebanon
| | - G Azar
- Saint-Esprit University, Faculty of Medicine, P.O.Box 70933 Naccash, Lebanon; Eye and Ear International Hospital, Naccash, Lebanon
| | - A Jalkh
- Saint-Esprit University, Faculty of Medicine, P.O.Box 70933 Naccash, Lebanon; Eye and Ear International Hospital, Naccash, Lebanon; Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - A Samaha
- Saint-Esprit University, Faculty of Medicine, P.O.Box 70933 Naccash, Lebanon; Eye and Ear International Hospital, Naccash, Lebanon
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Chelala E, Nehme J, El Rami H, Aoun R, Dirani A, Fadlallah A, Jalkh A. EFFICACY OF INTRAVITREAL RANIBIZUMAB INJECTIONS IN THE TREATMENT OF VITREOUS HEMORRHAGE RELATED TO PROLIFERATIVE DIABETIC RETINOPATHY. Retina 2018; 38:1127-1133. [DOI: 10.1097/iae.0000000000001673] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Massoud M, Kerbage F, Nehme J, Sakr R, Rached L, Zeghondy J, Nasr F, Chahine G. Survival Pattern of Hodgkin Lymphoma Patients in the Last 25 Years in Lebanon. Clin Lymphoma Myeloma Leuk 2017; 17S:S88-S91. [PMID: 28760307 DOI: 10.1016/j.clml.2017.03.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT After the emergence of combination chemotherapy in 1960s, survival of patients with Hodgkin lymphoma (HL) has dramatically improved worldwide. We lack studies that document the favorable evolution of survival regarding this disease in Lebanon. OBJECTIVE To compare the overall survival in HL over 3 different decades in Lebanon. METHODS We retrospectively reviewed the charts of 196 patients diagnosed with HL, treated and followed from 1990 to 2015 in our center. Patients were divided into 3 groups according to period of analysis: group A (1990-1999), group B (2000-2009), and group C (2010-2015). We studied the characteristics and survival patterns of patients in each group. RESULTS The male-to-female sex ratio was 1.06. The median age at diagnosis was 33 years in group A, 30.4 in group B, and 33.12 in group C (P = .6). Results showed variations in the subtypes of the disease according to the following: nodular-sclerosis HL 59.5% in group A, 76.2% in group B, and 85.4% in group C. Mixed cellularity HL 21.6% in group A, 2.4% in group B, and 73.7% in group C (P = .0001). Patients presented with localized disease in 58.6%, 73.7%, and 56.4% in groups A, B, and C, respectively (P = .173). Complete remission was achieved in 76.5% in group A, 85.3% in group B, and 69.5% in group C (P = .007). The survival rate at 5 years in group A was 91%, 94% in group B, and 100% in group C. CONCLUSION The survival of patients with HL has dramatically improved over the past 25 years in Lebanon. These results resemble those achieved in Western countries due to the fast adoption of new molecular imaging technologies at diagnosis and follow-up and the rapid approval of new drugs for relapse in the Lebanese market.
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Affiliation(s)
- Marcel Massoud
- Holy Spirit University of Kaslik, Medical School, Jouneih, Lebanon, and CHU-Notre Dame Des Secours, Jbeil, Lebanon
| | - Fouad Kerbage
- Holy Spirit University of Kaslik, Medical School, Jouneih, Lebanon, and CHU-Notre Dame Des Secours, Jbeil, Lebanon.
| | - Joseph Nehme
- Holy Spirit University of Kaslik, Medical School, Jouneih, Lebanon, and CHU-Notre Dame Des Secours, Jbeil, Lebanon
| | - Riwa Sakr
- Holy Spirit University of Kaslik, Medical School, Jouneih, Lebanon, and CHU-Notre Dame Des Secours, Jbeil, Lebanon
| | - Layale Rached
- Holy Spirit University of Kaslik, Medical School, Jouneih, Lebanon, and CHU-Notre Dame Des Secours, Jbeil, Lebanon
| | - Jean Zeghondy
- Holy Spirit University of Kaslik, Medical School, Jouneih, Lebanon, and CHU-Notre Dame Des Secours, Jbeil, Lebanon
| | - Fady Nasr
- Saint Joseph University, Medical School, Beirut, Lebanon
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Balderrama M, Nehme J. B-45Neurocognitive Differences Between Monolingual and Bilingual Adolescents Following Sport-Related Concussion. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ambroisine ML, Milliez P, Nehme J, Pasquier AL, De Angelis N, Mansier P, Swynghedauw B, Delcayre C. Aldosterone and anti-aldosterone effects in cardiovascular diseases and diabetic nephropathy. Diabetes & Metabolism 2004; 30:311-8. [PMID: 15525873 DOI: 10.1016/s1262-3636(07)70122-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cells in the cortical collecting duct of distal nephron have been considered for a long time as the unique cellular targets of aldosterone. However, it is now clear that other cell types in non-epithelial tissues are also potential targets for aldosterone. The functions that this hormone controls in non-epithelial tissues are still a matter of debate. Clinical and experimental studies have established that aldosterone plays a major role in the pathophysiology of cardiovascular and renal diseases. The aldosterone receptor antagonists spironolactone and eplerenone have demonstrated specific effects not related to their hypotensive properties in hypertension or cardiac diseases. It appears that a key action of these molecules is related to prevention or treatment of end-organ damage. The latter fact, and the recognition of aldosterone escape on long-term treatment of heart failure, diabetic nephropathy and some forms of hypertension with ACE inhibitors, justify the clinical use of aldosterone receptor antagonists provided that kaliemia is controlled. Experimental studies have allowed to draw a still incomplete but comprehensive scheme of aldosterone cardiovascular actions in pathological conditions. When elevated, aldosterone has deleterious effects in blood vessels, in the heart and in kidney, which are secondary to the induction of inflammatory and oxidative processes and necrosis, that induce the increased synthesis of extracellular matrix proteins.
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Heymes C, Garnier A, Fuchs S, Bendall JK, Nehme J, Ambroisine ML, Robidel E, Swynghedauw B, Milliez P, Delcayre C. Aldosterone-synthase overexpression in heart: a tool to explore aldosterone's effects. Mol Cell Endocrinol 2004; 217:213-9. [PMID: 15134820 DOI: 10.1016/j.mce.2003.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clinical observations indicate that elevated aldosterone impairs cardiovascular function. The mechanisms, however, are not totally understood although total and cardiovascular mortality are decreased by aldosterone antagonists. Experimentally, increased plasma aldosterone induces pericoronary inflammation and cardiac fibrosis. Our laboratory has discovered that aldosterone is synthesized in the rat heart, and has demonstrated that this cardiac aldosterone is involved in post-infarction cardiac remodeling. In man, activated cardiac aldosterone production has been described in patients with heart failure. In transgenic mice that overexpress aldosterone-synthase in the heart, we observe a normal cardiac function but a major coronary dysfunction, more pronounced in males. These observations converge to a potential physiological and pathological relevance of this system. Beneficial effects of anti-aldosterone treatment in heart failure may thus be secondary in part to blockade of cardiac aldosterone action.
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Affiliation(s)
- C Heymes
- IFR Circulation, INSERM U527, Hopital Lariboisiere, Université Paris 7, 41 Boulevard de la Chapelle, 75475 Paris cedex 10, France
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