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Ray A, Rowbotham E. Radiosynovectomy in haemophilic synovitis and arthropathy of the knee: A scoping review. Haemophilia 2024; 30:617-627. [PMID: 38439131 DOI: 10.1111/hae.14966] [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: 08/07/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Radiosynovectomy is an established treatment for chronic synovitis in patients with haemophilia. Although its role in rheumatological diseases has diminished, it remains an accepted therapy for haemophilic synovitis. AIM The aim of this scoping review was to map and summarise the evidence surrounding radiosynovectomy in haemophilic knees, identify gaps in the literature and inform future research. RESULTS Forty-three manuscripts and abstracts were identified for this review. Evidence was limited to observational studies and Yttrium-90 was the most studied licensed radioisotope. Radiosynovectomy was associated with a reduction in bleeding frequency and pain, improvements in range of motion and a reduction in the use of factor replacement. CONCLUSION The literature reviewed lacks studies of sufficient methodological quality to permit systematic review and meta-analysis. Systematic review using risk of bias assessment for observational studies should be undertaken to better evaluate the efficacy and safety of radiosynovectomy. A causal relationship between RSV and key clinical outcomes remains undetermined.
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Affiliation(s)
- Aaron Ray
- Department of Radiology, York Hospital, York and Scarborough Teaching Hospitals NHS Trust, York, UK
| | - Emma Rowbotham
- Musculoskeletal Radiology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Rodriguez-Merchan EC. The role of intraarticular injections of hyaluronic acid in joint pain relief in hemophilic arthropathy. Expert Rev Hematol 2023; 16:811-817. [PMID: 37837349 DOI: 10.1080/17474086.2023.2271660] [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: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Chronic pain in hemophilic patients is due to joint degeneration associated with hemophilic arthropathy. In addition to appropriate hematological treatment (primary prophylaxis), pharmacologic management and Physical Medicine and Rehabilitation should be indicated. When such measures are not sufficient, intraarticular injections (IAIs) of hyaluronic acid (HyA) may be considered. AREAS COVERED In order to determine whether IAIs of HyA are effective in terms of pain relief in individuals with painful moderate hemophilic arthropathy, a PubMed and Cochrane Library search using 'hemophilia hyaluronic acid' as keywords was performed on 18 July 2023. EXPERT OPINION In a study of individuals with hemophilic arthropathy (elbows, knees and ankles), 91% of them improved pain after a mean follow-up of 6 years. In another study of individuals with knee arthropathy, after a 7-year follow-up 82% reported an improvement in pain. As for hemophilic ankle arthropathy, in a study 67% of patients showed relief of joint pain at 6-month follow-up. Although the literature on the subject is very heterogeneous and difficult to interpret, it appears that IAIs of HyA can relieve the joint pain of painful moderate hemophilic arthropathy for months. Moreover, the IAIs can be repeated every 6-12 months.
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Han Z, Zheng L, Luo D, Pang N, Yao Y. Ferroptosis: a new target for iron overload-induced hemophilic arthropathy synovitis. Ann Hematol 2023; 102:1229-1237. [PMID: 36951967 DOI: 10.1007/s00277-023-05190-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/19/2023] [Indexed: 03/24/2023]
Abstract
Iron deposition is closely related to developing haemophilic arthropathy (HA). Studying the relationship between ferroptosis signal expression and iron overload in HA synovium facilitates understanding the pathogenesis of joint synovial hyperplasia in bloodborne arthritis and the development of new protective methods. The knee synovium was collected from HA and osteoarthritis (OA) patients, and pathological changes were analysed by HE and Prussian blue staining. Ferroptosis phenotypes were examined by immunohistochemistry and western blotting. Moreover, ferric ammonium citrate (FAC)-induced was used to construct an in vitro iron overload model to investigate the relationship between iron overload and ferroptosis in synovial fibroblasts (FLS). Furthermore, the factors influencing ferroptosis in FLS were explored. Iron deposition, cell proliferation, and vascular proliferation in the synovium of HA were more obvious. Ferroptosis in HA synovium appears to inhibit. FLS ferroptosis increased with iron accumulation, malondialdehyde (MDA) in cells, and glutathione (GSH) depletion. TNF-α plays a protective role in this process. Blocking the action of TNF-α and inducing ferroptosis significantly reduced synovial proliferation. TNF-α inhibitors combined with a ferroptosis inducer may be a new therapeutic method for HA synovitis.
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Affiliation(s)
- Zhiwei Han
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui, China
| | - Liujie Zheng
- Department of Orthopaedic Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.473 Hanzheng Street, Wuhan, HuBei, China
| | - Dasheng Luo
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui, China
| | - Nanyu Pang
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui, China
| | - Yunfeng Yao
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, Anhui, China.
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Abstract
BACKGROUND The risk of developing cancer increases with age and also adverse environmental conditions. The same holds true in the aging people with hemophilia (PwH). Furthermore, cancer is an important challenge for physicians working in multidisciplinary hemophilia care centers. AIM Here, the authors report 7 hemophiliacs with malignancies diagnosed and managed at our center. STUDY DESIGN Hemophilia A and B were included. METHOD Patients with mild, moderate, or severe hemophilia A or B, who were followed-up in our center between January 1999 and December 2018 were included in the study. A total of 470 PwH (391 Hemophilia A and 79 Hemophilia B) were followed in this time period. RESULTS With a minimum 1 and maximum 20 years (median: 11.5 y) of the following time, 7 of 470 (1.48%) PwH were diagnosed with cancer. The diagnosed cancer types were acute lymphoblastic leukemia, acute myeloid leukemia, thyroid cancer, rectum cancer, malign melanoma, basal cell carcinoma, and gastric cancer. All patients except patients with leukemia had major surgical intervention and the hemostasis control was provided on the basis of institutional protocols. At the end of the study, all of the patients were alive besides the patient with acute myeloid leukemia. CONCLUSIONS Nowadays, the management of PwH has improved immensely and the life span has progressively become similar to healthy male individuals. For accurate improvement and standardizing care, prospective data collection on the epidemiology of cancer in PwH is an important tool.
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Torres Berdeguez MB, Thomas S, Oliveira SM, Vasconcellos de Sá L, Lopes de Souza SA, Milián FM, Xavier da Silva A. Individual dose planning in radiosynoviorthesis treatment: Step by step. Appl Radiat Isot 2020; 163:109177. [PMID: 32392162 DOI: 10.1016/j.apradiso.2020.109177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/30/2019] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
Radiosynoviorthesis (RSO) is a minimally invasive treatment aiming for the necrosis of the pannus tissue by the use of radionuclide. The method suggested here starts with the segmentation of the joint effusion, synovial thickness, and area of the synovial membrane using the 3D Slicer software. The last step is the estimated value of the activity to be injected without considering the leakage of the radiopharmaceutical into the articular cavity. It includes the S-values obtained by Monte Carlo simulation coupled with the calculated therapeutic distance (ST90).
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Affiliation(s)
| | - Sylvia Thomas
- Department of Nuclear Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Susie Medeiros Oliveira
- Department of Nuclear Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lidia Vasconcellos de Sá
- Institute of Radiation Protection and Dosimetry, Brazilian Nuclear Energy Commission, Rio de Janeiro, RJ, Brazil
| | - Sergio Augusto Lopes de Souza
- Department of Nuclear Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Felix Mas Milián
- Research Center for Radiation Sciences and Technology, State University of Santa Cruz, Ilhéus, BA, Brazil
| | - Ademir Xavier da Silva
- Department of Nuclear Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Torres Berdeguez MB, Thomas S, Medeiros S, de Sá LV, Mas Milian F, da Silva AX. Dosimetry in Radiosynoviorthesis: 90Y VS. 153Sm. Health Phys 2018; 114:1-6. [PMID: 28990969 DOI: 10.1097/hp.0000000000000730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although there are several radionuclides suitable for radiosynoviorthesis (RSO), not all of them can irradiate deeper synovium. Yttrium-90 (Y) is the beta radionuclide with more penetration range; therefore, it is predominantly used to treat knees. The aim of this paper is to highlight several dosimetry concepts to compare Y and Sm, also discussing the feasibility of implementing a dose planning methodology for both in RSO. The MCNPX Monte Carlo nuclear code version 2.6 was used for calculating S-values from which the activity to be injected into the joint was obtained. This activity is considered sufficient to deliver a 100-Gy absorbed dose in 1 mm of synovial tissue. The simulated mathematical model consisted of a system formed by several cylindrical slabs of 1-mm thickness, aligned consecutively. The different areas of the cylinder base simulate several synovial membrane sizes. The effective treatment range for each radionuclide was also calculated. Quantification of the synovial joint features (synovial thickness and synovial surface) by diagnostic imaging, such as magnetic resonance (MRI) combined with a Monte Carlo simulation, can be used to achieve a treatment planning strategy in RSO with the available radionuclides.
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McGuinn C, Cheng D, Aschman D, Carpenter SL, Sidonio R, Soni A, Tarantino MD, Wheeler AP, Dunn AL. Radionuclide synovectomy/synoviorthesis (RS) in patients with bleeding disorders: A review of patient and procedure demographics and functional outcomes in the ATHNdataset. Haemophilia 2017; 23:926-933. [DOI: 10.1111/hae.13318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- C. McGuinn
- Weill Cornell Medical College; New York NY USA
| | - D. Cheng
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | - D. Aschman
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | | | - R. Sidonio
- Emory University/Children's Healthcare of Atlanta Comprehensive Bleeding Disorder Clinic; Atlanta GA USA
| | - A. Soni
- Center for Comprehensive Care and Diagnosis of Inherited Blood Disorders; Orange CA USA
| | - M. D. Tarantino
- Bleeding and Clotting Disorders Institute; University of Illinois College of Medicine-Peoria; Peoria IL USA
| | - A. P. Wheeler
- Vanderbilt University Medical Center; Nashville TN USA
| | - A. L. Dunn
- Nationwide Children's Hospital/Ohio State University; Columbus OH USA
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Abstract
Radioisotope synovectomy has been extensively used to treat patients with chronic inflammatory joint disease but has moved to a less prominent position since the introduction of new and highly effective drugs. Remaining indications are refractory synovitis, pigmented villonodular synovitis as an adjunct to surgery, and hemophilic arthropathy. The three main radioisotopes used are yttrium-90, rhenium-186, and erbium-189. Radioisotope synovectomy should be performed only by highly experienced professionals, to minimize the risk of injection-related complications. The available safety data, in particular regarding the risk of malignancy, are reassuring. The efficacy of yttrium-90 in chronic inflammatory joint disease remains controversial.
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Sharma R, Dunn A, Aschman D, Cheng D, Wheeler A, Soni A, McGuinn C, Knoll C, Stein DT, Young G, French J, Sanders J, Davis JA, Tarantino M, Lim M, Gruppo R, Sidonio R, Ahuja S, Carpenter S, Pipe S, Shapiro A. Radionuclide synovectomy/synoviorthesis (RS) in persons with bleeding disorders: A review of impact of national guidance on frequency of RS using the ATHNdataset. Haemophilia 2017; 23:e385-e388. [DOI: 10.1111/hae.13273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- R. Sharma
- BloodCenter of Wisconsin; Milwaukee WI USA
| | - A. Dunn
- Nationwide Children's Hospital; Columbus OH USA
| | - D. Aschman
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | - D. Cheng
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | - A. Wheeler
- Vanderbilt University Medical Center; Nashville TN USA
| | - A. Soni
- Center for Comprehensive Care and Diagnosis of Inherited Blood Disorders; Orange CA USA
| | | | - C. Knoll
- Arizona Hemophilia and Thrombosis Center; University of Arizona Health Sciences Center; Tucson AZ USA
| | - D. T. Stein
- Northwest Ohio Hemophilia Treatment Center; Toledo OH USA
| | - G. Young
- Childrens Hospital Los Angeles; Los Angeles CA USA
| | - J. French
- Palmetto Health Richland; Columbia SC USA
| | - J. Sanders
- Cook Children's Hospital; Fort Worth Bleeding Disorders Program; Fort Worth TX USA
| | - J. A. Davis
- University of Miami Comprehensive Pediatric Hemophilia Treatment Center; Miami FL USA
| | - M. Tarantino
- Bleeding and Clotting Disorders Institute; University of Illinois College of Medicine-Peoria; Peoria IL USA
| | - M. Lim
- UNC Comprehensive Hemophilia Diagnostic and Treatment Center; Chapel Hill NC USA
| | - R. Gruppo
- Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - R. Sidonio
- Emory/Children's Healthcare of Atlanta Comprehensive Hemophilia Program; Atlanta GA USA
| | - S. Ahuja
- Rainbow Babies & Children's Hospital; University Hospitals Case Medical Center; Cleveland OH USA
| | | | - S. Pipe
- Department of Pediatrics and Pathology; University of Michigan; Ann Arbor MI USA
| | - A. Shapiro
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
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Lim MY, Cheng D, Aschman D, Dunn A. Radionuclide synovectomy in patients with bleeding disorders: a review of malignancy and myeloproliferative neoplasms from the ATHNdataset. Haemophilia 2017; 23:e160-e162. [PMID: 28111845 DOI: 10.1111/hae.13179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M Y Lim
- Comprehensive Hemophilia Diagnostic and Treatment Center, University of North Carolina, Chapel Hill, NC, USA
| | - D Cheng
- American Thrombosis and Hemostasis Network, Riverwoods, IL, USA
| | - D Aschman
- American Thrombosis and Hemostasis Network, Riverwoods, IL, USA
| | - A Dunn
- Nationwide Children's Hospital/Ohio State University, Columbus, OH, USA
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Martínez-esteve A, Álvarez-pérez R, Núñez-vázquez R, Tirado-hospital J, García-jiménez R, Povedano-gómez J, Borrego-dorado I. Radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia. Rev Esp Med Nucl Imagen Mol 2016; 35:12-16. [DOI: 10.1016/j.remnie.2015.11.002] [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: 11/19/2022]
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Martínez-Esteve A, Álvarez-Pérez RM, Núñez-Vázquez R, Tirado-Hospital JL, García-Jiménez R, Povedano-Gómez J, Borrego-Dorado I. Radioisotope synoviorthesis in paediatric and adolescent patients with haemophilia. Rev Esp Med Nucl Imagen Mol 2015; 35:12-6. [PMID: 26521998 DOI: 10.1016/j.remn.2015.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/05/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the outcome and adverse-effects of the radioisotope synoviorthesis in paediatric and adolescent patients with haemophilia. MATERIAL AND METHODS Prospective study of historical cohort was conducted. A total of 20 consecutive haemophiliacs with a mean age of 13.1 years (range 4-17) were included with a mean follow-up of 64.9 months (range 18-109). The diagnosis of synovitis was established on the basis of clinical follow-up including radiological images (radiography and/or MRI). For evaluation, the classification proposed by Fernandez-Palazzi was used. INCLUSION CRITERIA Patients aged less than 18 years old with haemophilia and more than one haemarthrosis in less than 3 months remaining a chronic synovitis despite prophylactic therapy intensification. EXCLUSION CRITERIA Any contraindication for radionuclide synoviorthesis. Twenty-seven radioisotope synoviorthesis with (90)Y-citrate-colloid and/or (186)Re-sulphide-colloid were done. The effectiveness of the procedure was assessed through pre and posttreatment clinical comparison at 6 months after radioisotope synoviorthesis. RESULTS Nineteen of the 27 synoviorthesis (70.3%) had a good or excellent response and 8 joints (29.7%) had partial response. It was necessary to repeat the procedure in 3 joints in 3 different patients, obtaining in all cases a good or excellent response. We appreciated inflammatory reaction after procedure in 4 cases (14.8%), which improved with analgesics and nonsteroidal anti-inflamatory drugs. None of the patients presented malignant or premalignant lesions during the follow-up. CONCLUSION The radionuclide synoviorthesis is a very effective procedure in paediatric and adolescent patients with hemophilia, being a minimally invasive procedure, easy to perform, safe and with minimal side effects.
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Affiliation(s)
- A Martínez-Esteve
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R M Álvarez-Pérez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Núñez-Vázquez
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L Tirado-Hospital
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R García-Jiménez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J Povedano-Gómez
- Servicio de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Borrego-Dorado
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
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Abstract
This article provides a critical view of the current state of the development of nanoparticulate and other solid-state carriers for the local delivery of antibiotics in the treatment of osteomyelitis. Mentioned are the downsides of traditional means for treating bone infection, which involve systemic administration of antibiotics and surgical debridement, along with the rather imperfect local delivery options currently available in the clinic. Envisaged are more sophisticated carriers for the local and sustained delivery of antimicrobials, including bioresorbable polymeric, collagenous, liquid crystalline, and bioglass- and nanotube-based carriers, as well as those composed of calcium phosphate, the mineral component of bone and teeth. A special emphasis is placed on composite multifunctional antibiotic carriers of a nanoparticulate nature and on their ability to induce osteogenesis of hard tissues demineralized due to disease. An ideal carrier of this type would prevent the long-term, repetitive, and systemic administration of antibiotics and either minimize or completely eliminate the need for surgical debridement of necrotic tissue. Potential problems faced by even hypothetically "perfect" antibiotic delivery vehicles are mentioned too, including (i) intracellular bacterial colonies involved in recurrent, chronic osteomyelitis; (ii) the need for mechanical and release properties to be adjusted to the area of surgical placement; (iii) different environments in which in vitro and in vivo testings are carried out; (iv) unpredictable synergies between drug delivery system components; and (v) experimental sensitivity issues entailing the increasing subtlety of the design of nanoplatforms for the controlled delivery of therapeutics.
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Affiliation(s)
- Vuk Uskoković
- Advanced Materials and Nanobiotechnology Laboratory, Richard and Loan Hill Department of Bioengineering, College of Medicine, University of Illinois at Chicago, 851 South Morgan St, #205 Chicago, Illinois, 60607-7052
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