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Li YJ, Zhang ZY, Liu TY, Liu HY, Shi LL, Cao RX, Lv CR, Zhang ZH. Retinal Structure and Microcirculation Alterations in Patients With Papillary Thyroid Carcinoma: An Optical Coherence Tomography and Angiography Study. Invest Ophthalmol Vis Sci 2025; 66:73. [PMID: 40272368 PMCID: PMC12032848 DOI: 10.1167/iovs.66.4.73] [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: 12/04/2024] [Accepted: 03/28/2025] [Indexed: 04/25/2025] Open
Abstract
Purpose This study aimed to compare the retinal thickness, vessel density, and perfusion density in patients with papillary thyroid carcinoma (PTC) and healthy controls using optical coherence tomography (OCT) and OCT angiography. And investigating the influence of serological parameters and carcinoma signs with retinal structural and microcirculatory in PTC patients. Methods This cross-sectional study included 174 PTC patients (345 eyes) and 179 healthy subjects (358 eyes). Serological parameters (complete blood count, thyroid function, and lymphocyte subsets) and retinal thickness and flow parameters were compared between the two groups, and the correlations of retinal parameters with serological parameters in the PTC group. We investigated the effect of carcinoma signs (tumor size, focus location, lymphatic metastasis, surrounding tissue invasion, and BRAF mutations) on retinal parameters. Results PTC patients exhibited significantly thinner retinal thickness and reduced vessel density and perfusion density in the macular superficial vascular plexus compared with healthy controls. Platelet-to-lymphocyte ratios and thyroglobulin were inversely correlated with retinal parameters, and CD4+ T cells were positively correlated. Aggressive carcinoma signs thicken the retinal thickness more than nonaggressive cases. Conclusions The findings indicate a trend toward macular thinning and retinal microcirculatory dysfunction in the PTC patients, and these changes may be related to chronic inflammation and immune dysregulation secondary to cancer progression. OCT and OCT angiography show potential as noninvasive tools for detecting subclinical retinal abnormalities in PTC patients, and retinal alterations may serve as a surrogate marker for systemic inflammation. However, further studies are needed to address confounders and establish causality.
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Affiliation(s)
- Yan-Jie Li
- Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zeng-Yu Zhang
- Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Tian-Yue Liu
- Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hai-Yan Liu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China
| | - Lu-Lu Shi
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Rong-Xia Cao
- Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chao-Ran Lv
- Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zeng-Hui Zhang
- College of Educational Science and Technology, Jinzhong University, Jinzhong, China
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Levinger N, Erdinest N, Abu Rmeileh A, Mouallem E, Zahran S, Shabat S, Kolben Y, Aviv T, Kuint R, Tiosano L, Khateb S. Evaluation of Retinal and Posterior Segment Vascular Changes Due to Systemic Hypoxia Using Optical Coherence Tomography Angiography. J Clin Med 2024; 13:6680. [PMID: 39597827 PMCID: PMC11594346 DOI: 10.3390/jcm13226680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 11/01/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024] Open
Abstract
Background/Objectives: Retinal vascular occlusions are a significant cause of visual impairment in older adults, resulting in ischemic retinal damage and sudden vision loss. This study evaluates the retinal, optic nerve head (ONH), and choroidal capillary networks in chronic and acute-on-chronic hypoxia compared to normal controls using optical coherence tomography angiography (OCT-A). Methods: We evaluated a prospective study including twenty patients in the hypoxic group (mean age 61.2 ± 10.2) in two phases, chronic hypoxia and acute-on-chronic hypoxia, and 21 control subjects (mean age 59 ± 9.4 years). All patients underwent a comprehensive eye examination, OCT, and OCT-A imaging. The data were analyzed using OCT-A analysis software (Zeiss OCT-A software 2.1.0.55513) and Fiji software (1.51a). Vascular density of the retina and ONH, choriocapillaries, and foveal avascular zone (FAZ) size were measured. Results: The superficial peripapillary vascular density was higher for the control group (0.387 ± 0.03) compared to the hypoxic patients with (0.383 ± 0.03) and without O2 supplementation (0.383 ± 0.03; p = 0.018). No retinal angiographic differences were identified between the two study groups. The ganglion cell layer (GCL) was thinner in the hypoxic group. Both hypoxic subgroups demonstrated denser choriocapillaries (mean 13,073 ± 1812 and 12,689 ± 1815, with and without O2 supplementation, respectively) compared to the control group (mean 9749 ± 2881, p < 0.001 for both groups). Hypoxic patients demonstrated increased area size of choriocapillaries (+O2 supplementation-mean 44,347 ± 10,563; -O2 supplementation-mean 46,984 ± 12,822) compared to the control group (mean 30,979 ± 9635; p < 0.01 and p < 0.001, respectively). Conclusions: Chronic and acute-on-chronic hypoxia did not affect the retinal vascular network, most probably due to the strong autoregulation of vascular function of the retina. However, compared to the control group, GCL, ONH vasculature density, and most choriocapillaries indices were significantly altered among hypoxic patients.
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Affiliation(s)
- Nadav Levinger
- Department of Ophthalmology, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Nir Erdinest
- Department of Ophthalmology, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Ayman Abu Rmeileh
- Institute of Pulmonary Medicine, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Eisa Mouallem
- Internal Medical Daycare, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Shadi Zahran
- Department of Medicine B, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Sheer Shabat
- Department of Physical & Medical Rehabilitation, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Yotam Kolben
- Department of Medicine A, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Talmon Aviv
- Department of Medicine C, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Rottem Kuint
- Institute of Pulmonary Medicine, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Liran Tiosano
- Department of Ophthalmology, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Samer Khateb
- Department of Ophthalmology, Hadassah University Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
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Chua J, Tan B, Wong D, Garhöfer G, Liew XW, Popa-Cherecheanu A, Loong Chin CW, Milea D, Li-Hsian Chen C, Schmetterer L. Optical coherence tomography angiography of the retina and choroid in systemic diseases. Prog Retin Eye Res 2024; 103:101292. [PMID: 39218142 DOI: 10.1016/j.preteyeres.2024.101292] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Optical coherence tomography angiography (OCTA) has transformed ocular vascular imaging, revealing microvascular changes linked to various systemic diseases. This review explores its applications in diabetes, hypertension, cardiovascular diseases, and neurodegenerative diseases. While OCTA provides a valuable window into the body's microvasculature, interpreting the findings can be complex. Additionally, challenges exist due to the relative non-specificity of its findings where changes observed in OCTA might not be unique to a specific disease, variations between OCTA machines, the lack of a standardized normative database for comparison, and potential image artifacts. Despite these limitations, OCTA holds immense potential for the future. The review highlights promising advancements like quantitative analysis of OCTA images, integration of artificial intelligence for faster and more accurate interpretation, and multi-modal imaging combining OCTA with other techniques for a more comprehensive characterization of the ocular vasculature. Furthermore, OCTA's potential future role in personalized medicine, enabling tailored treatment plans based on individual OCTA findings, community screening programs for early disease detection, and longitudinal studies tracking disease progression over time is also discussed. In conclusion, OCTA presents a significant opportunity to improve our understanding and management of systemic diseases. Addressing current limitations and pursuing these exciting future directions can solidify OCTA as an indispensable tool for diagnosis, monitoring disease progression, and potentially guiding treatment decisions across various systemic health conditions.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Xin Wei Liew
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Emergency University Hospital, Department of Ophthalmology, Bucharest, Romania
| | - Calvin Woon Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France
| | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France; Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.
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Zhang M, Sun J, Wang C, Su L, Chen J, Wang Y, Sun X, Gong Y, Yu S. Spectrum of retinal microvascular ischemia in patients with COVID-19 based on multimodal imaging. Heliyon 2024; 10:e38535. [PMID: 39430536 PMCID: PMC11489334 DOI: 10.1016/j.heliyon.2024.e38535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/17/2024] [Accepted: 09/25/2024] [Indexed: 10/22/2024] Open
Abstract
Purpose To describe and evaluate the multimodal imaging findings in retinal microvascular ischemia associated with COVID-19 infection. Methods Patients with COVID-19 associated retinal microvascular ischemia and visiting the outpatient Department of Ophthalmology, Shanghai General Hospital from December 2022, to February 2023, were documented and their multimodal images were retrospectively reviewed. Retinal microvascular ischemia was defined as the presence of isolated or multiple focal retinal whitening(s) on color fundus images. Patients with retinal vessel occlusion or retinopathies secondary to systematic disorders diagnosed before infection were excluded. Results A total of 32 eyes from 21 patients were included, 24 (75.00 %) eyes with multiple retinal whitenings, while 8 (25.00 %) eyes with isolated lesions. When divided by the types of ischemia, 9 (28.13 %) eyes had only inner retinal involvement (known as cotton wool spot, CWS), 4 (12.50 %) eyes had only middle retinal involvement (known as paracentral acute middle maculopathy, PAMM), and 19 (59.38 %) eyes had both. In addition, 4 (12.50 %) eyes had coincident angular sign of Henle fiber layer hyperreflectivity (ASHH). Patients with hypertension tended to have multiple lesions rather than isolated lesion of retinal microvascular ischemia (P = 0.008). Transient uncontrolled high blood pressure or acute kidney injury was simultaneously detected in some cases. Conclusions Ocular manifestation of COVID-19 associated microvascular ischemia can be variable, including CWS, PAMM and ASHH. Multimodal fundus imaging technologies are useful tools to reveal involved retinal layers, extent, and severity. Moreover, ocular manifestations may serve as a window of COVID-19 related microcirculation in other systems throughout the body.
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Affiliation(s)
- Min Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junran Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chanchan Wang
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Li Su
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieqiong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimin Wang
- Zhongshang Hospital of Fudan University, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Yuanyuan Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suqin Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Koutsiaris AG. A Blood Supply Pathophysiological Microcirculatory Mechanism for Long COVID. Life (Basel) 2024; 14:1076. [PMID: 39337860 PMCID: PMC11433432 DOI: 10.3390/life14091076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The term "Long COVID" is commonly used to describe persisting symptoms after acute COVID-19. Until now, proposed mechanisms for the explanation of Long COVID have not related quantitative measurements to basic laws. In this work, a common framework for the Long COVID pathophysiological mechanism is presented, based on the blood supply deprivation and the flow diffusion equation. METHODS Case-control studies with statistically significant differences between cases (post-COVID patients) and controls, from multiple tissues and geographical areas, were gathered and tabulated. Microvascular loss (ML) was quantified by vessel density reduction (VDR), foveal avascular zone enlargement (FAZE), capillary density reduction (CDR), and percentage of perfused vessel reduction (PPVR). Both ML and hemodynamic decrease (HD) were incorporated in the tissue blood supply reduction (SR) estimation. RESULTS ML data were found from 763 post-COVID patients with an average VDR, FAZE, CDR, and PPVR of 16%, 31%, 14%, and 21%, respectively. The average HD from 72 post-COVID patients was 37%. The estimated SR for multiple tissues with data from 634 post-COVID patients reached a sizeable 47%. This large SR creates conditions of lower mass diffusion rates, hypoxia, and undernutrition, which at a multi-tissue level, for a long time, can explain the wide variety of the Long COVID symptoms. CONCLUSIONS Disruption of peripheral tissue blood supply by the contribution of both ML and HD is proposed here to be the principal cause of the mechanism leading to Long COVID symptoms.
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Affiliation(s)
- Aristotle G Koutsiaris
- Medical Informatics and Biomedical Imaging (MIBI) Laboratory, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis Campus, 41500 Larissa, Greece
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Sideratou CM, Papaneophytou C. Persisting Shadows: Unraveling the Impact of Long COVID-19 on Respiratory, Cardiovascular, and Nervous Systems. Infect Dis Rep 2023; 15:806-830. [PMID: 38131885 PMCID: PMC10742861 DOI: 10.3390/idr15060072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), instigated by the zoonotic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), rapidly transformed from an outbreak in Wuhan, China, into a widespread global pandemic. A significant post-infection condition, known as 'long- COVID-19' (or simply 'long- COVID'), emerges in a substantial subset of patients, manifesting with a constellation of over 200 reported symptoms that span multiple organ systems. This condition, also known as 'post-acute sequelae of SARS-CoV-2 infection' (PASC), presents a perplexing clinical picture with far-reaching implications, often persisting long after the acute phase. While initial research focused on the immediate pulmonary impact of the virus, the recognition of COVID-19 as a multiorgan disruptor has unveiled a gamut of protracted and severe health issues. This review summarizes the primary effects of long COVID on the respiratory, cardiovascular, and nervous systems. It also delves into the mechanisms underlying these impacts and underscores the critical need for a comprehensive understanding of long COVID's pathogenesis.
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Affiliation(s)
| | - Christos Papaneophytou
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, 2417 Nicosia, Cyprus;
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Lam WY, Au SCL. Interpretating retinal microvascular changes in patients recovered from COVID-19 compared to healthy controls: A meta-analysis. Photodiagnosis Photodyn Ther 2023; 44:103824. [PMID: 37783256 DOI: 10.1016/j.pdpdt.2023.103824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Wai Yan Lam
- Department of Ophthalmology, Grantham Hospital, Hong Kong
| | - Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong.
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Reiss AB, Greene C, Dayaramani C, Rauchman SH, Stecker MM, De Leon J, Pinkhasov A. Long COVID, the Brain, Nerves, and Cognitive Function. Neurol Int 2023; 15:821-841. [PMID: 37489358 PMCID: PMC10366776 DOI: 10.3390/neurolint15030052] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). Long-term complications are an increasing issue in patients who have been infected with COVID-19 and may be a result of viral-associated systemic and central nervous system inflammation or may arise from a virus-induced hypercoagulable state. COVID-19 may incite changes in brain function with a wide range of lingering symptoms. Patients often experience fatigue and may note brain fog, sensorimotor symptoms, and sleep disturbances. Prolonged neurological and neuropsychiatric symptoms are prevalent and can interfere substantially in everyday life, leading to a massive public health concern. The mechanistic pathways by which SARS-CoV-2 infection causes neurological sequelae are an important subject of ongoing research. Inflammation- induced blood-brain barrier permeability or viral neuro-invasion and direct nerve damage may be involved. Though the mechanisms are uncertain, the resulting symptoms have been documented from numerous patient reports and studies. This review examines the constellation and spectrum of nervous system symptoms seen in long COVID and incorporates information on the prevalence of these symptoms, contributing factors, and typical course. Although treatment options are generally lacking, potential therapeutic approaches for alleviating symptoms and improving quality of life are explored.
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Affiliation(s)
- Allison B Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | - Caitriona Greene
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | - Christopher Dayaramani
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | | | | | - Joshua De Leon
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
| | - Aaron Pinkhasov
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Long Island, NY 11501, USA
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