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Xu GM, Hu MX, Li SY, Ran X, Zhang H, Ding XF. Thyroid disorders and gastrointestinal dysmotility: an old association. Front Physiol 2024; 15:1389113. [PMID: 38803365 PMCID: PMC11129086 DOI: 10.3389/fphys.2024.1389113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
Gastrointestinal motility symptoms may be closely related to thyroid diseases. Sometimes, such symptoms are the only thyroid disease-related clue although the degree of the symptoms may vary. The exact mechanism of action of thyroid hormones on gastrointestinal motility is not completely understood, however, a clue lies in the fact that muscle cell receptors can be directly acted upon by thyroxines. Both hypo- and hyperthyroidism can cause impairment of gastrointestinal motility, modifying structure and function of pharynx and esophagus, and regulating esophageal peristalsis through neuro-humoral interaction. In hyperthyroid patients, alterations of postprandial and basic electric rhythms have been observed at gastro-duodenal level, often resulting in slower gastric emptying. Gastric emptying may also be delayed in hypothyroidism, but an unrelated gastric mucosa-affecting chronic modification may also cause such pattern. Hyperthyroidism commonly show malabsorption and diarrhoea, while hypothyroidism frequently show constipation. In summary, it can be stated that symptoms of gastrointestinal motility dysfunction can be related to thyroid diseases, affecting any of the gastrointestinal segment. Clinically, the typical thyroid disease manifestations may be missing, borderline, or concealed because of intercurrent sicknesses. Motility-linked gastrointestinal problems may easily conceal a misdetected, underlying dysthyroidism that should be carefully analyzed. Here, we aim to elaborate on the associations between thyroid disorders and GI dysmotility and the common clinical manifestations associated with GI dysmotility.
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Affiliation(s)
- Guang-Meng Xu
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Ming-Xin Hu
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Si-Yu Li
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Xuan Ran
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Hao Zhang
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Xiang-Fu Ding
- Department of Thyroid Surgery, The Second Hospital of Jilin University, Changchun, China
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Maghsood AH, Kayedimajd S, Motavallihaghi S, Abedian R, Kordi S, Davoodi L, Faizi F, Soleymani E. Irritable Bowel Syndrome Associated with Blastocystis hominis or Without Relationship to It? A Case-Control Study and Minireview. Acta Parasitol 2024; 69:639-647. [PMID: 38300499 DOI: 10.1007/s11686-023-00787-7] [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: 10/04/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Blastocystis hominis (B. hominis) is a protozoan parasite that has a worldwide distribution. Some studies have suggested a link between B. hominis and the development of irritable bowel syndrome (IBS). The objective of this study was to determine the prevalence of B. hominis in patients with IBS compared to healthy individuals. MATERIAL AND METHODS A total of 65 stool samples from patients with IBS and 65 samples from healthy individuals in northern Iran were examined. The samples were tested using various methods including direct smear, formalin ether sedimentation and culture to detect the presence of B. hominis. Additionally, polymerase chain reaction (PCR) was performed on all culture-positive isolates to confirm the results and identify the genotype. RESULTS B. hominis was detected in 15.38% of IBS patients and 9.2% of the healthy group. The culture in RPMI1640 was found to be better than the formalin ether and direct smear methods. Positive samples were confirmed using the molecular method. No significant difference was observed in the order of B. hominis infection between the two groups. CONCLUSIONS The results of our study indicate that no significant difference was observed in the order of B. hominis infection between IBS patients and healthy groups. Therefore, further study is necessary to determine the potential pathogenic effects of this parasite and its role in causing IBS.
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Affiliation(s)
- Amir Hossein Maghsood
- Department of Medical Mycology and Parasitology, School of Medicine, Hamadan University of Medical Science, Hamadan, Iran
| | | | - Seyedmousa Motavallihaghi
- Department of Medical Mycology and Parasitology, School of Medicine, Hamadan University of Medical Science, Hamadan, Iran
| | - Rohallah Abedian
- Department of Infectious Diseases, Antimicrobial Resistance Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shirafkan Kordi
- Department of Infectious Diseases, Antimicrobial Resistance Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Lotfollah Davoodi
- Department of Infectious Diseases, Antimicrobial Resistance Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fariba Faizi
- Department of Medical Mycology and Parasitology, School of Medicine, Hamadan University of Medical Science, Hamadan, Iran
| | - Eissa Soleymani
- Department of Medical Mycology and Parasitology, School of Medicine, Hamadan University of Medical Science, Hamadan, Iran.
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Ramírez Aranda JM, Martínez Gutiérrez CM, Fuentes Ramírez MM, Escobedo Ríos MR, Delgado Cuevas FDR. [Familial aggregation in Irritable Colon Syndrome in Mexican patients. A case-control study]. Aten Primaria 2024; 56:102794. [PMID: 37950999 PMCID: PMC10682529 DOI: 10.1016/j.aprim.2023.102794] [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: 06/23/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVE To determine a family aggregation pattern of Irritable Bowel Syndrome (IBS). DESIGN it is a case-control study with a 1.2 ratio. SETTING External consultation of a general family medicine practice. PARTICIPANTS men and women from 18 to 60 years old. Cases (40): people with IBS according to the Rome IV criteria, and Controls (80): relatives without gastrointestinal disease. MAIN MEASUREMENTS Sociodemographic variables, related stressful events, predominant evacuation patterns, and family repetition patterns for IBS. Data were analyzed with descriptive and inferential statistics. Chi-square for categorical data (< p.05 as significant) estimate of ORs with 95% confidence interval. The institutional ethics committee approved it. RESULTS The IBS presentation pattern was repeated in relatives, mainly first-degree. The risk of suffering from IBS was higher when the father reported it (OR 11.2 (95% CI; 1.2 -100.1), than the mother OR 3,7 (95% CI; 1.4 - 9.9), sibling OR 2.8 (95% CI; 1.1 - 6.6. In both groups, the relative who most frequently presented IBS was in the collateral line (sibling) (37.5% in cases vs. 17.5% in controls (p=0.023). In both groups, the predominant gender was female, with 80. 0% in cases and 57.5% in controls. CONCLUSION SII has a familial recurrence pattern in the Mexican population. The disease is more frequent in first-degree relatives. It is important to elucidate the importance of the role that plays genetic background vs. the influence of the family environment in SII.
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Jiménez Candel MI, Salvador Pinto T, García Peris M, Crehuá Gaudiza E, Jovaní Casano C, Moreno Ruiz MA, Hernández Bertó T, Largo Blanco E, Martínez Costa C. Rendimiento de las pruebas complementarias en el estudio de pacientes con dolor abdominal crónico. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpedi.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Jiménez Candel MI, Salvador Pinto T, García Peris M, Crehuá Gaudiza E, Jovaní Casano C, Moreno Ruiz MA, Hernández Bertó T, Largo Blanco E, Martínez Costa C. Usefulness of complementary test in the study of patients with chronic abdominal pain. An Pediatr (Barc) 2021; 95:26-32. [PMID: 34092539 DOI: 10.1016/j.anpede.2020.04.021] [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: 01/29/2020] [Accepted: 04/11/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Chronic abdominal pain (CAP) in children is a symptom that frequently leads to a visit to the paediatrician, which affects family life and occasionally requires the need to perform diagnostic studies (DS). The objective was to carry out a qualitative, quantitative, and economic analysis on the tests requested. MATERIAL AND METHODS An observational, prospective and multicentre study was conducted that included children between 4-15 years old affected by CAP. The difference between organic and functional disorders was taken into account. The following variables were collected: history, warning signs and symptoms, DS, and the cost of these. RESULTS The study included 235 children with CAP (Age; mean 9.7 ± 2.7 SD). The large majority (79%) were functional disorders and 21% organic disorders. Almost half of the patients had some warning sign or symptom, but urinary symptoms were only associated with organic disorders. The abdominal ultrasound, faecal parasites, breath test, and endoscopy were the most associated with organic disorders. There was a difference between the costs of the DS according to each centre. The total economic cost was 52,490.80 euros, with 195 euros per patient for functional disorders and 306 euros for organic disorders. CONCLUSION Signs and symptoms of alarm in CAP were very frequent, but had low discriminative capacity. The abdominal ultrasound and faecal parasites are innocuous DS, and could be useful as a first level study. The endoscopy and the breath test were the most discriminative of organic disease. The economic cost of DS arising from the diagnosis of exclusion in CAP was high.
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Affiliation(s)
| | - Tatiana Salvador Pinto
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital de la Marina Baja, Villajoyosa, Spain
| | - Mónica García Peris
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Lluís Alcanyís, Xátiva, Valencia, Spain
| | - Elena Crehuá Gaudiza
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Carmen Jovaní Casano
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Tomás Hernández Bertó
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital General Universitario de Albacete, Albacete, Spain
| | - Esther Largo Blanco
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital General Universitario de Valencia, Valencia, Spain
| | - Cecilia Martínez Costa
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
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Salvador F, Lobo B, Goterris L, Alonso-Cotoner C, Santos J, Sulleiro E, Bailo B, Carmena D, Sánchez-Montalvá A, Bosch-Nicolau P, Espinosa-Pereiro J, Fuentes I, Molina I. Blastocystis sp. Carriage and Irritable Bowel Syndrome: Is the Association Already Established? BIOLOGY 2021; 10:biology10040340. [PMID: 33921803 PMCID: PMC8072823 DOI: 10.3390/biology10040340] [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: 02/24/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022]
Abstract
Simple Summary The intestinal protist Blastocystis sp. is one of the most common intestinal parasites observed in humans, and has a worldwide distribution, being more prevalent in developing countries. Although this parasite has been described decades ago, the pathogenic potential it is still not understood completely. It has been suggested that Blastocystis sp. could be related with irritable bowel syndrome, a functional gastrointestinal disorder characterized by abdominal pain, discomfort with defecation, and changes in the frequency or form of stool. In our study, we compare a group of patients with irritable bowel syndrome with a group of healthy volunteers; no differences regarding the occurrence of Blastocystis sp. detection was found between both groups. Abstract Background: The aim of the present study is to describe the occurrence of Blastocystis sp. detection among asymptomatic subjects and patients with irritable bowel syndrome in order to evaluate the potential association between irritable bowel syndrome and the parasitic infection. Methods: Cross-sectional study where adult patients with irritable bowel syndrome diagnosed according to Rome IV criteria were included. A control group was formed by asymptomatic subjects older than 18 years. Exclusion criteria were: immunosuppressive condition or having received any drug with demonstrated activity against Blastocystis sp. within the last 6 months before study inclusion. Epidemiological and clinical information was collected from all included participants. Two stool samples were obtained from all participants: one sample for microscopic examination and one sample for Blastocystis sp. PCR detection. Blastocystis sp. infection was defined by the positivity of any of the diagnostic techniques. Results: Seventy-two participants were included (36 asymptomatic subjects and 36 patients with irritable bowel syndrome). Thirty-five (48.6%) were men, and median age of participants was 34 (IQR 29–49) years. The overall rate of Blastocystis sp. carriage was 27.8% (20/72). The prevalence assessed through microscopic examination was 22.2% (16/72), while the prevalence measured by PCR was 15.3% (11/72). When comparing the presence of Blastocystis sp. between asymptomatic subjects and IBS patients, we did not find any statistically significant difference (36.1% vs. 19.4% respectively, p = 0.114). Conclusions: regarding the occurrence of Blastocystis sp., no differences were found between asymptomatic participants and patients with irritable bowel disease irrespective of the diagnostic technique performed.
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Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Pº Vall d’Hebron 119-129, 08035 Barcelona, Spain; (A.S.-M.); (P.B.-N.); (J.E.-P.); (I.M.)
- Correspondence: ; Tel.: +34-93-274-60-90; Fax: +34-93-489-40-91
| | - Beatriz Lobo
- Digestive System Research Unit, University Hospital Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain; (B.L.); (C.A.-C.); (J.S.)
| | - Lidia Goterris
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (L.G.); (E.S.)
| | - Carmen Alonso-Cotoner
- Digestive System Research Unit, University Hospital Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain; (B.L.); (C.A.-C.); (J.S.)
| | - Javier Santos
- Digestive System Research Unit, University Hospital Vall d’Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain; (B.L.); (C.A.-C.); (J.S.)
| | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (L.G.); (E.S.)
| | - Begoña Bailo
- National Centre of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (B.B.); (D.C.); (I.F.)
| | - David Carmena
- National Centre of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (B.B.); (D.C.); (I.F.)
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Pº Vall d’Hebron 119-129, 08035 Barcelona, Spain; (A.S.-M.); (P.B.-N.); (J.E.-P.); (I.M.)
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Pº Vall d’Hebron 119-129, 08035 Barcelona, Spain; (A.S.-M.); (P.B.-N.); (J.E.-P.); (I.M.)
| | - Juan Espinosa-Pereiro
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Pº Vall d’Hebron 119-129, 08035 Barcelona, Spain; (A.S.-M.); (P.B.-N.); (J.E.-P.); (I.M.)
| | - Isabel Fuentes
- National Centre of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (B.B.); (D.C.); (I.F.)
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, Pº Vall d’Hebron 119-129, 08035 Barcelona, Spain; (A.S.-M.); (P.B.-N.); (J.E.-P.); (I.M.)
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Perna A, Hay E, Contieri M, De Luca A, Guerra G, Lucariello A. Adherent-invasive Escherichia coli (AIEC): Cause or consequence of inflammation, dysbiosis, and rupture of cellular joints in patients with IBD? J Cell Physiol 2020; 235:5041-5049. [PMID: 31898324 DOI: 10.1002/jcp.29430] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022]
Abstract
There are many factors contributing to the development of gastrointestinal diseases, grouped into genetic, environmental, and lifestyle factors. In recent years attention has fallen on pathogens; in particular, Bacteroides fragilis, Fusobacterium nucleatum, Escherichia coli (E. coli) and Helicobacter pylori have been studied. Several points remain to be clarified, and above all, as regards the adherent-invasive E. coli strains of E. coli, one wonders if they are a cause or a consequence of the disease. In this review, we have tried to clarify some points by examining a series of recent publications regarding the involvement of the bacterium in the pathology, even if other studies are necessary.
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Affiliation(s)
- Angelica Perna
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Eleonora Hay
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcella Contieri
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio De Luca
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Angela Lucariello
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
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Hauser RA, Sutherland D, Madrid JA, Rol MA, Frucht S, Isaacson S, Pagan F, Maddux BN, Li G, Tse W, Walter BL, Kumar R, Kremens D, Lew MF, Ellenbogen A, Oguh O, Vasquez A, Kinney W, Lowery M, Resnick M, Huff N, Posner J, Ballman KV, Harvey BE, Camilleri M, Zasloff M, Barbut D. Targeting neurons in the gastrointestinal tract to treat Parkinson's disease. Clin Park Relat Disord 2019; 1:2-7. [PMID: 34316590 PMCID: PMC8288812 DOI: 10.1016/j.prdoa.2019.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022] Open
Abstract
Background Parkinson's disease (PD) is associated with α-synuclein (αS) aggregation within the enteric nervous system (ENS) and constipation. Squalamine displaces proteins that are electrostatically bound to intracellular membranes and through this mechanism suppresses aggregation of αS monomers into neurotoxic oligomers. Objective We sought to evaluate the safety of ENT-01 oral tablets (a synthetic squalamine salt), its pharmacokinetics, and its effect on bowel function in PD patients with constipation. Methods In Stage 1, 10 patients received escalating single doses from 25 to 200 mg/day or maximum tolerated dose (MTD). In Stage 2, 34 patients received daily doses escalating from 75 to a maximum of 250 mg/day, a dose that induced change in bowel function or MTD, followed by a fixed dose for 7 days, and a 2-week washout. Primary efficacy endpoint was defined as an increase of 1 complete spontaneous bowel movement (CSBM)/week, or 3 CSBM/week over the baseline period, as defined by FDA guidelines for prokinetic agents. Safety was also assessed. Results Over 80% of patients achieved the primary efficacy endpoint, with the mean number of CSBM/week increasing from 1.2 at baseline to 3.6 during fixed dosing (p = 1.2 × 10−7). Common adverse events included nausea in 21/44 (47%) and diarrhea in 18/44 (40%) patients. Systemic absorption was <0.3%. Conclusions Orally administered ENT-01 was safe and significantly improved bowel function in PD, suggesting that the ENS is not irreversibly damaged in PD. Minimal systemic absorption suggests that improvements result from local stimulation of the ENS. A double-blind, placebo-controlled study is now ongoing.
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Affiliation(s)
- Robert A Hauser
- USF Parkinson's Disease & Movement Disorder Ctr., Tampa, FL, United States of America
| | - Dean Sutherland
- Sarasota Memory Hospital Clinical Research Ctr., Sarasota, FL, United States of America
| | - Juan A Madrid
- Chronobiology Laboratory, University of Murcia, CIBERFES, Spain
| | | | - Steven Frucht
- New York University Langone Medical Ctr, New York, NY, United States of America
| | - Stuart Isaacson
- Parkinson's Disease and Movement Disorder Ctr. of Boca Raton, Boca Raton, FL, United States of America
| | - Fernando Pagan
- Department of Neurology, Georgetown University Medical Ctr., Washington, DC, United States of America
| | - Brian N Maddux
- Riverhills Healthcare, Inc., Cincinnati, OH, United States of America
| | - George Li
- MEDSOL Clinical Research, Port Charlotte, FL, United States of America
| | - Winona Tse
- Parkinson's and Movement Disorders Ctr., Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Benjamin L Walter
- Parkinson's & Movement Disorders Ctr., University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rajeev Kumar
- Rocky Mountain Movement Disorder Ctr., Englewood, CO, United States of America
| | - Daniel Kremens
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Mark F Lew
- Keck Hospital of USC, Los Angeles, CA, United States of America
| | - Aaron Ellenbogen
- Quest Research Institute and Michigan Institute for Neurologic Disorders, Farmington, MI, United States of America
| | - Odinachi Oguh
- Neuroscience Research, University of Florida, Jacksonville, FL, United States of America
| | - Alberto Vasquez
- Suncoast Neuroscience Associates, Inc., St. Petersburg, FL, United States of America
| | - William Kinney
- Enterin, Inc., Philadelphia, PA, United States of America
| | - Matt Lowery
- Enterin, Inc., Philadelphia, PA, United States of America
| | - Maria Resnick
- Enterin, Inc., Philadelphia, PA, United States of America
| | - Nicole Huff
- Enterin, Inc., Philadelphia, PA, United States of America
| | - Jerry Posner
- Memorial Sloan-Kettering Cancer Ctr., NY, NY, United States of America
| | | | - Brian E Harvey
- Enterin, Inc., Philadelphia, PA, United States of America
| | | | - Michael Zasloff
- Enterin, Inc., Philadelphia, PA, United States of America.,Medstar-Georgetown Transplant Institute, Washington, DC, United States of America
| | - Denise Barbut
- Enterin, Inc., Philadelphia, PA, United States of America
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