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Wang S, Yu XJ, Li DY, Xu J, Wang SX. Concurrence of leukocyte chemotactic factor 2-associated amyloidosis and autoimmune diseases: A case report. Front Immunol 2022; 13:966591. [PMID: 36059556 PMCID: PMC9437290 DOI: 10.3389/fimmu.2022.966591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Leukocyte chemotactic factor 2-associated (ALECT2) amyloidosis is one of the recently reported types of amyloidosis, which is caused by the extracellular deposition of leukocyte chemotactic factor 2 (LECT2). There have not been any reports involving the concurrence of ALECT2 amyloidosis with Sjögren’s syndrome (SS) or systemic lupus erythematosus (SLE)s. Herein, we report a case of a 68-year-old Chinese woman presenting with long duration of sicca symptoms. The clinical evaluation and laboratory findings showed that she had SS overlapped with SLE. Kidney biopsy revealed a membranoproliferative glomerulonephritis (MPGN) with glomerular deposition of dominant IgG3-kappa by immunofluorescene, which was related to SS/SLE. Furthermore, patchy congophilic amyloid deposits in the tubulointerstitium were detected, which were positive for LECT2 protein by immunohistochemical staining and immunoelectron microscopy. This is the first case of ALECT2 amyloidosis that coexisted with SS/SLE, and the causal relationship between ALECT2 amyloidosis and autoimmune diseases remain unclear.
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Affiliation(s)
- Shuang Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Chronic Kidney Disease (CKD) Prevention and Treatment, Ministry of Education of China; Key Laboratory of Renal Diseases, Ministry of Health of China, Beijing, China
| | - Xiao-juan Yu
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Chronic Kidney Disease (CKD) Prevention and Treatment, Ministry of Education of China; Key Laboratory of Renal Diseases, Ministry of Health of China, Beijing, China
| | - Dan-yang Li
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Chronic Kidney Disease (CKD) Prevention and Treatment, Ministry of Education of China; Key Laboratory of Renal Diseases, Ministry of Health of China, Beijing, China
| | - Jin Xu
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
| | - Su-xia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
- Renal Division, Department of Medicine, Peking University First Hospital; Renal Pathological Center, Institute of Nephrology, Peking University; Key Laboratory of Chronic Kidney Disease (CKD) Prevention and Treatment, Ministry of Education of China; Key Laboratory of Renal Diseases, Ministry of Health of China, Beijing, China
- *Correspondence: Su-xia Wang,
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Kim J, Kim YS, Lee HJ, Park SG. Pulmonary amyloidosis and multiple myeloma mimicking lymphoma in a patient with Sjogren’s syndrome: A case report. World J Clin Cases 2022; 10:1016-1023. [PMID: 35127915 PMCID: PMC8790440 DOI: 10.12998/wjcc.v10.i3.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/05/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sjogren’s syndrome (SS), which affect salivary gland function, is an autoimmune disease. SS may involve extraglandular organs. Approximately 10 to 20 percent of SS patients have clinically significant lung disease, but presentation of pulmonary amylodosis is extremly rare. The incidence of benign monoclonal gammopathy in SS patients is high, but multiple myeloma is rare. No case involving the simultaneous occurrence of two rare diseases, pulmonary amyloidosis and multiple myeloma, in the same patient with SS has been reported so far.
CASE SUMMARY A 41-year-old male patient was referred to our hematology department due to incidentally detected gastric plasmacytoma. He had been diagnosed with SS four years earlier. Multiple miliary nodules, ground glass opacity in both lung fields, and enlargement of both inguinal lymph nodes was observed on chest and abdomen computer tomography. Based on the pathological findings of lung and lymph node biopsied specimens, the patient was diagnosed with pulmonary amyloidosis and multiple myeloma. Pulmonary amyloidosis and multiple myeloma associated with SS has rarely been reported.
CONCLUSION This is an extremely rare case of simultaneous pulmonary amyloidosis and multiple myeloma in the same patient with SS.
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Affiliation(s)
- Joa Kim
- Department of Internal Medicine, Rheumatology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Yun Sung Kim
- Department of Internal Medicine, Rheumatology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Hee Jeong Lee
- Department of Internal Medicine, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Sang Gon Park
- Department of Internal Medicine, Hemato-Oncology, Chosun University Hospital, Gwangju 501-717, South Korea
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Kukuy OL, Beckerman P, Dinour D, Ben-Zvi I, Livneh A. Amyloid storm: acute kidney injury and massive proteinuria, rapidly progressing to end-stage kidney disease in AA amyloidosis of familial Mediterranean fever. Rheumatology (Oxford) 2021; 60:3235-3242. [PMID: 33291151 DOI: 10.1093/rheumatology/keaa772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/20/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Amyloid A nephropathy of FMF usually progresses over many years to end-stage renal disease (ESRD). We aim to describe an acute condition, termed here 'amyloid storm', typically manifesting with a rapid (≤2 weeks) increase in serum creatinine and urine protein, that has never been characterized in FMF amyloidosis. METHODS This retrospective analysis features amyloid storm by comparing between FMF amyloidosis patients who have experienced an episode of amyloid storm (study group) and matched patients who have not (control group). The primary outcome was ESRD or death within 1 year from study entry. Featured data were retrieved from hospital files. RESULTS The study and control groups, each comprising 20 patients, shared most baseline characteristics. However, they differed on the time from FMF onset to reaching serum creatinine of 1.2 mg/dl [26.5 years (s.d. 15.15) vs 41.55 (10.98), P = 0.001] and the time from the onset of proteinuria to study entry [8.8 years (s.d. 6.83) vs 15.75 (13.05), P = 0.04], culminating in younger age at study entry [39.95 years (s.d. 16.81) vs 48.9 (9.98), respectively, P = 0.05] and suggesting an accelerated progression of kidney disease in the study group. Within 1 year from study entry, 16 patients in the study and 3 in the control groups reached the primary endpoint (P = 0.000). The major triggers of amyloid storm were infections, occurring in 17 of 20 patients. CONCLUSION Amyloid storm is a complication of FMF amyloidosis, induced by infection and associated with poor prognosis and death.
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Affiliation(s)
- Olga L Kukuy
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan
| | - Pazit Beckerman
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - Dganit Dinour
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ilan Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv.,Medicine F, Sheba Medical Center.,Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Avi Livneh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv.,Medicine F, Sheba Medical Center
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Costa M, Greenfield H, Pereira R, Chuva T, Henrique R, Cunha C. A Rare Case of Renal AA Amyloidosis Secondary to Sjogren's Syndrome. Eur J Case Rep Intern Med 2019; 6:001226. [PMID: 31583215 PMCID: PMC6774652 DOI: 10.12890/2019_001226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/12/2019] [Indexed: 11/14/2022] Open
Abstract
AA amyloidosis is a rare complication of chronic inflammatory disorders and has been associated with rheumatoid arthritis and ankylosing spondylitis. We present a case of AA amyloidosis secondary to Sjogren’s syndrome (SS). A 79-year-old woman presented with rapidly progressive renal failure and complaints of asthenia, anorexia and generalized oedema. She had severe renal failure (creatinine 6.0 mg/dl), with microscopic haematuria, nephrotic proteinuria and low serum albumin levels, and an increased erythrocyte sedimentation rate. Serum protein electrophoresis revealed a peak in the gamma globulin zone. The patient was started on haemodialysis and corticosteroids. Clinical results showed the patient met the diagnostic criteria for primary SS, and neoplastic haematological disease was excluded. Renal biopsy revealed a diagnosis of AA amyloidosis. Renal AA amyloidosis is a rare condition in patients with primary SS. However, in patients with proteinuria and/or renal failure, it should be included in the differential diagnosis and a renal biopsy should be performed.
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Affiliation(s)
- Mylene Costa
- Internal Medicine, Hospital Pedro Hispano, Porto, Portugal
| | | | | | - Teresa Chuva
- Nephrology, Instituto Português de Oncologia do Porto, Portugal
| | - Rui Henrique
- Pathological Anatomy, Instituto Português de Oncologia do Porto, Portugal
| | - Cátia Cunha
- Nephrology, Hospital Pedro Hispano, Porto, Portugal
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Nephrotic Syndrome due to Focal Segmental Glomerulosclerosis Complicating Sjögren's Syndrome: A Case Report and Literature Review. Case Rep Rheumatol 2019; 2019:1749795. [PMID: 31511795 PMCID: PMC6714328 DOI: 10.1155/2019/1749795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/30/2019] [Indexed: 11/26/2022] Open
Abstract
Background Renal tubular acidosis and tubulointerstitial nephritis constitute the primary renal complications associated with Sjögren's syndrome (SjS), and glomerulonephritis and nephrotic syndrome are rare. Case Presentation A 79-year-old Japanese woman presented with bilateral leg edema and weight gain and was diagnosed with nephrotic syndrome. In addition, she reported a 5-year history of dryness of mouth and was diagnosed with SjS. Renal biopsy revealed segmental glomerulosclerosis, with some specimens showing collapse of the glomerular capillary loops, proliferation of glomerular epithelial cells, and sclerotic lesions at the tubular poles, without spike formation, double contour lesions, or any other changes of the glomerular basement membrane. Immunofluorescence staining showed no immune complex (immunoglobulin IgG, IgA, or IgM) or complement (C3) deposition in the glomerular capillary walls. Based on these findings, she was diagnosed with focal segmental glomerulosclerosis (FSGS). The administration of steroid and cyclosporine achieved complete remission of nephrotic syndrome. Conclusion Although glomerular diseases are rare, a variety of glomerular lesions including FSGS are reported in patients with SjS. Therefore, renal biopsy is warranted in patients with SjS presenting with severe urinary abnormalities.
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Fujimoto S, Kawabata H, Kurose N, Kawanami-Iwao H, Sakai T, Kawanami T, Fujita Y, Fukushima T, Masaki Y. Sjögren's syndrome manifesting as clinicopathological features of TAFRO syndrome: A case report. Medicine (Baltimore) 2017; 96:e9220. [PMID: 29390349 PMCID: PMC5815761 DOI: 10.1097/md.0000000000009220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE TAFRO syndrome is a newly proposed disorder that manifests as thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. In this report, we describe the development of severe TAFRO syndrome-like systemic symptoms during the clinical course of juvenile-onset Sjögren's syndrome in a 32-year-old woman. PATIENT CONCERNS The patient was admitted due to dyspnea, fever, polyarthralgia, and generalized edema. She had been diagnosed with Sjögren's syndrome at the age of 14 years, based on histopathological examination of a biopsy of the minor salivary glands and the development of Raynaud's phenomenon, with no follow-up treatment required. On admission, she presented with anemia, elevated C-reactive protein levels, anasarca, and hepato-splenomegaly. A bone marrow examination revealed increased megakaryocytes with reticulin fibrosis, and the histopathology of an axillary lymph node was consistent with mixed-type Castleman disease. Eventually, she developed thrombocytopenia. INTERVENTIONS Her symptoms fulfilled all of the major and minor categories of the diagnostic criteria for TAFRO syndrome. However, considering her prior diagnosis, we assumed that the clinical presentation was consistent with an acute exacerbation of Sjögren's syndrome. Unlike typical cases of TAFRO syndrome, the administration of relatively low-dose prednisolone relieved her symptoms. LESSONS Differentiation between TAFRO syndrome and exacerbation of an autoimmune disease is clinically important, although this can be challenging. Identification of specific biomarkers for TAFRO syndrome would be clinically beneficial.
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Affiliation(s)
- Shino Fujimoto
- Department of Hematology and Immunology, Kanazawa Medical University
| | - Hiroshi Kawabata
- Department of Hematology and Immunology, Kanazawa Medical University
| | - Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Daigaku, Uchinada, Ishikawa-ken, Japan
| | | | - Tomoyuki Sakai
- Department of Hematology and Immunology, Kanazawa Medical University
| | - Takafumi Kawanami
- Department of Hematology and Immunology, Kanazawa Medical University
| | - Yoshimasa Fujita
- Department of Hematology and Immunology, Kanazawa Medical University
| | | | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University
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Kronbichler A, Mayer G. Renal involvement in autoimmune connective tissue diseases. BMC Med 2013; 11:95. [PMID: 23557013 PMCID: PMC3616816 DOI: 10.1186/1741-7015-11-95] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/11/2013] [Indexed: 01/04/2023] Open
Abstract
Connective tissue diseases (CTDs) are a heterogeneous group of disorders that share certain clinical presentations and a disturbed immunoregulation, leading to autoantibody production. Subclinical or overt renal manifestations are frequently observed and complicate the clinical course of CTDs. Alterations of kidney function in Sjögren syndrome, systemic scleroderma (SSc), auto-immune myopathies (dermatomyositis and polymyositis), systemic lupus erythematosus (SLE), antiphospholipid syndrome nephropathy (APSN) as well as rheumatoid arthritis (RA) are frequently present and physicians should be aware of that.In SLE, renal prognosis significantly improved based on specific classification and treatment strategies adjusted to kidney biopsy findings. Patients with scleroderma renal crisis (SRC), which is usually characterized by severe hypertension, progressive decline of renal function and thrombotic microangiopathy, show a significant benefit of early angiotensin-converting-enzyme (ACE) inhibitor use in particular and strict blood pressure control in general. Treatment of the underlying autoimmune disorder or discontinuation of specific therapeutic agents improves kidney function in most patients with Sjögren syndrome, auto-immune myopathies, APSN and RA.In this review we focus on impairment of renal function in relation to underlying disease or adverse drug effects and implications on treatment decisions.
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Affiliation(s)
- Andreas Kronbichler
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Anichstraße 35, Innsbruck, 6020, Austria
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Baqir M, Kluka EM, Aubry MC, Hartman TE, Yi ES, Bauer PR, Ryu JH. Amyloid-associated cystic lung disease in primary Sjögren's syndrome. Respir Med 2013; 107:616-21. [PMID: 23402779 DOI: 10.1016/j.rmed.2013.01.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/20/2012] [Accepted: 01/10/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cystic lung disease can be seen in patients with Sjögren's syndrome (SS) and is generally thought to be due to lymphocytic interstitial pneumonia. METHODS Using computer-assisted search we identified patients with primary SS seen at Mayo Clinic, Rochester, MN during a 14-year period from 1997 to 2010 who were diagnosed with pulmonary amyloidosis confirmed on lung biopsy. Clinical records, imaging studies, and pathologic specimens were reviewed to delineate presenting features, diagnostic evaluation, and clinical course. RESULTS Eight patients (7 women, 1 man) with primary SS were diagnosed with pulmonary amyloidosis by lung biopsy (7 surgical, 1 bronchoscopic). Their median age was 55 years (range, 32-75 years) and all were nonsmokers. Presenting symptoms included dyspnea and cough but 4 patients presented with radiologic abnormalities in the absence of respiratory symptoms. CT findings included cystic lesions and nodular opacities in all eight patients. PET scan performed in six patients did not reveal (18)F-2-deoxyglucose (FDG) uptake except in one nodule with borderline uptake. Lung biopsy demonstrated the presence of amyloid in all patients and was associated with mucosa-associated lymphoid tissue (MALT) lymphoma in three patients. Pulmonary function results were normal in five patients and revealed mild impairment in a mixed pattern in one patient. CONCLUSIONS We conclude cystic and nodular lung lesions seen in patients with primary SS can represent amyloidosis which can be associated with MALT lymphoma in some of these patients.
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Affiliation(s)
- Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Meijer JM, Schonland SO, Palladini G, Merlini G, Hegenbart U, Ciocca O, Perfetti V, Leijsma MK, Bootsma H, Hazenberg BPC. Sjögren's syndrome and localized nodular cutaneous amyloidosis: Coincidence or a distinct clinical entity? ACTA ACUST UNITED AC 2008; 58:1992-9. [DOI: 10.1002/art.23617] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ramos-Casals M, Brito-Zerón P, Font J. Lessons from diseases mimicking Sjögren's syndrome. Clin Rev Allergy Immunol 2008; 32:275-83. [PMID: 17992594 DOI: 10.1007/s12016-007-8006-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects the exocrine glands and usually presents as persistent dryness of the mouth and eyes because of functional impairment of the salivary and lacrimal glands. The histological hallmark is a focal lymphocytic infiltration of the exocrine glands, and the spectrum of the disease extends from an organ-specific autoimmune disease (autoimmune exocrinopathy) to a systemic process with diverse extraglandular manifestations. In the absence of an associated systemic autoimmune disease, patients with this condition are classified as having primary SS. The differential diagnosis includes processes that specifically involve the exocrine glands. On the one hand, some chronic viral infections may induce lymphocytic infiltration of the exocrine glands, in some cases indistinguishable from that observed in primary SS. On the other hand, some processes may mimic the clinical picture of SS through nonlymphocytic infiltration of the exocrine glands. This review focuses on these two groups of diseases that mimic SS (infections and infiltrating processes).
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Affiliation(s)
- Manuel Ramos-Casals
- Servei de Malalties Autoimmunes, Hospital Clínic, C/Villarroel, 170, 08036 Barcelona, Spain.
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Lymphadenopathy due to amyloidosis secondary to Sjögren syndrome and systemic lupus erythematosus detected by F-18 FDG PET. Clin Nucl Med 2008; 32:881-2. [PMID: 18075429 DOI: 10.1097/rlu.0b013e318156bb56] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Fuertes I, Espinosa G, Ramos-Casals M, Cervera R. Asociación de síndrome de Sjögren, tiroiditis autoinmune, sarcoidosis, cirrosis biliar primaria y amiloidosis primaria en una misma paciente. Rev Clin Esp 2007; 207:376. [PMID: 17662210 DOI: 10.1157/13107956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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