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Azem K, Fein S, Zribi B, Iluz-Freundlich D, Neuman I, Livne MY, Kaplan O, Aranbitski R, Heesen P, Statlender L, Gorfil D, Barac Y, Peysakhovich Y, Mangoubi E. Additive value of superficial parasternal intercostal plane block and serratus anterior plane block in lung transplantation surgery: a retrospective exploratory study. Reg Anesth Pain Med 2024:rapm-2023-105137. [PMID: 38286738 DOI: 10.1136/rapm-2023-105137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Adequate pain control following lung transplantation (LTx) surgery is paramount. Thoracic epidural analgesia (TEA) is the gold standard; however, the potential use of extracorporeal membrane oxygenation (ECMO) and consequent anticoagulation therapy raises safety concerns, prompting clinicians to seek safer alternatives. The utility of thoracic wall blocks in general thoracic surgery is well established; however, their role in the context of LTx has been poorly investigated. METHODS In this retrospective exploratory study, we assessed the effect of adding a superficial parasternal intercostal plane (sPIP) block and serratus anterior plane (SAP) block to standard anesthetic and analgesic care on tracheal extubation rates, pain scores and opioid consumption until 72 hours postoperatively in LTx. RESULTS Sixty patients were included in the analysis; 35 received the standard anesthetic and analgesic care (control group), and 25 received sPIP and SAP blocks in addition to the standard anesthetic and analgesic care (intervention group). We observed higher tracheal extubation rates in the intervention group at 8 hours postoperatively (16.0% vs 0.0%, p=0.03). This was also shown after adjusting for known prognostic factors (OR 1.18; 95% CI 1.04 to 1.33, p=0.02). Furthermore, we noted a lower opioid consumption measured by morphine milligram equivalents at 24 hours in the intervention group (median 405 (IQR 300-490) vs 266 (IQR 168-366), p=0.02). This was also found after adjusting for known prognostic factors (β -118; 95% CI -221 to 14, p=0.03). CONCLUSION sPIP and SAP blocks are safe regional analgesic techniques in LTx involving ECMO and clamshell incision. They are associated with faster tracheal extubation and lower opioid consumption. These techniques should be considered when TEA is not appropriate. Further high-quality studies are warranted to confirm these findings.
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Affiliation(s)
- Karam Azem
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Fein
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benjamin Zribi
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Iluz-Freundlich
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Neuman
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Y Livne
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Kaplan
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roussana Aranbitski
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Liran Statlender
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Intensive Care, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
| | - Dan Gorfil
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiothoracic Surgery, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
| | - Yaron Barac
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiothoracic Surgery, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
| | - Yuri Peysakhovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiothoracic Surgery, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
| | - Eitan Mangoubi
- Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Azem K, Mangoubi E, Zribi B, Fein S. Regional analgesia for lung transplantation: A narrative review. Eur J Anaesthesiol 2023; 40:643-651. [PMID: 37232676 DOI: 10.1097/eja.0000000000001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Lung transplantation (LTx) is the definitive treatment for end-stage pulmonary disease. About 4500 LTxs are performed annually worldwide. It is considered challenging and complex surgery regarding anaesthesia and pain management. While providing adequate analgesia is crucial for patient comfort, early mobilisation and prevention of postoperative pulmonary complications, standardising an analgesic protocol is challenging due to the diversity of aetiologies, surgical approaches and the potential use of extracorporeal life support (ECLS). Although thoracic epidural analgesia is commonly considered the gold standard, concerns regarding procedural safety and its potential for devastating consequences have led physicians to seek safer analgesic modalities such as thoracic nerve blocks. The advantages of thoracic nerve blocks for general thoracic surgery are well established. However, their utility in LTx remains unclear. Considering paucity of relevant literature, this review aims to raise awareness about the literature gap in the field and highlight the need for further high-quality studies determining the effectiveness of available techniques.
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Affiliation(s)
- Karam Azem
- From the Department of Anaesthesia, Rabin Medical Centre, Beilinson Hospital, Petah Tikva (KA, EM. BZ, SF) and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (KA, EM. BZ, SF)
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Azem K, Kaplan O, Zribi B, Elliston J, Mangoubi E, Orvin K, Fein S. Reverse takotsubo cardiomyopathy induced by adrenaline-containing irrigation solution during shoulder arthroscopy. Anaesth Rep 2023; 11:e12235. [PMID: 37426055 PMCID: PMC10323721 DOI: 10.1002/anr3.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/11/2023] Open
Abstract
Takotsubo cardiomyopathy is characterised by reversible systolic dysfunction resulting from catecholamine-induced vasospasm, mainly triggered by intense emotional or physical stress. Adding adrenaline to arthroscopic irrigation solution enhances visibility by minimising bleeding. However, there is a risk of complications due to systemic absorption. Several severe cardiac consequences have been described. Here, we present a case of a patient who underwent elective shoulder arthroscopy involving an adrenaline-containing irrigation solution. Forty-five minutes after surgery began, he developed ventricular arrhythmias with hemodynamic instability, necessitating vasopressor support. Bedside transthoracic echocardiography revealed severe left ventricular dysfunction with basal ballooning, and emergent coronary angiography revealed normal coronary arteries. These findings correspond to a reverse variant of takotsubo cardiomyopathy. The patient was transferred to the intensive cardiac care unit sedated, ventilated and hemodynamically supported. Three days following the procedure, he was successfully weaned from vasopressors and mechanical ventilation. Transthoracic echocardiography 3 months after surgery demonstrated complete left ventricular function recovery. Although complications due to adrenaline-containing irrigation solutions are rare, a growing body of case reports should prompt consideration of the safety of this practice.
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Affiliation(s)
- K. Azem
- Department of AnaesthesiaRabin Medical Centre, Beilinson HospitalPetah TikvaIsrael
| | - O. Kaplan
- Department of AnaesthesiaRabin Medical Centre, Beilinson HospitalPetah TikvaIsrael
| | - B. Zribi
- Department of AnaesthesiaRabin Medical Centre, Beilinson HospitalPetah TikvaIsrael
| | - J. Elliston
- Department of AnaesthesiaRabin Medical Centre, Beilinson HospitalPetah TikvaIsrael
| | - E. Mangoubi
- Department of AnaesthesiaRabin Medical Centre, Beilinson HospitalPetah TikvaIsrael
| | - K. Orvin
- Cardiac Intensive Care UnitRabin Medical Centre, Beilinson HospitalPetah TikvaIsrael
| | - S. Fein
- Department of AnaesthesiaRabin Medical Centre, Beilinson HospitalPetah TikvaIsrael
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Orbach‐Zinger S, Lekar Leibzon M, Gonen O, Zribi B, Wazwaz SA, Binyamin Y, Heesen M, Matatov Y, Shimon O, Eidelman LA. Flouroscopic versus conventional epidural blood patch in obstetrics: A retrospective cohort study. Acta Anaesthesiol Scand 2022; 66:563-568. [PMID: 35184286 DOI: 10.1111/aas.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidural blood patch is a common effective treatment for postdural puncture headache after accidental dural puncture during labor and may be done in conventional or fluoroscopy-guided methods. The aim of this study was to compare intensity of headache at the time of discharge from the hospital and to compare blood volumes injected in conventional epidural blood patches versus fluoroscopic-guided blood patches and evaluate the side effects of both method of treatment. METHODS Between the years 2010 and 2020, 84 patients who were diagnosed with postdural puncture headache received either a conventional epidural blood patch or a fluoroscopic-guided blood patch. Blood volumes were compared and evaluation of side effects was made based on data collected during and after the procedure. RESULTS Eighty-four patients were included in this study. Fifty-two women in the conventional epidural blood patch group and 32 in the fluoroscopic-guided blood patch group. Women in the conventional epidural blood patch group received statistically significantly higher doses of blood than women in the fluoroscopic-guided blood patch group: conventional method 29 ml IQR [23-36] versus fluoroscopic method 16 ml, IQR [12-18], p < .001 with no difference in headache pain intensity at hospital release. There was no difference between groups in hospital length of stay, or persistent PDPH. There was also no difference chronic headache or backache between the two groups. CONCLUSIONS Women who received fluoroscopic epidural blood patch required a much lower volume of blood injected while there was no difference between groups in headache pain intensity at discharge.
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Affiliation(s)
- Sharon Orbach‐Zinger
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Margarita Lekar Leibzon
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Ophir Gonen
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Benjamin Zribi
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Susan A. Wazwaz
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Yair Binyamin
- Department of Anaesthesiology Soroka University Medical Center and the Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Michael Heesen
- Department of Anaesthesiology Kantonsspital Baden Baden Switzerland
| | - Yuri Matatov
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Orit Shimon
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
| | - Leonid A. Eidelman
- Department of Anaesthesiology Rabin Medical Centre and Sackler Faculty of Medicine Tel Aviv University Israel
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Rattanachaiwong S, Zribi B, Kagan I, Theilla M, Heching M, Singer P. Comparison of nutritional screening and diagnostic tools in diagnosis of severe malnutrition in critically ill patients. Clin Nutr 2020; 39:3419-3425. [PMID: 32199698 DOI: 10.1016/j.clnu.2020.02.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE While various nutritional assessment tools have been proposed, consensus is lacking with respect to the most effective tool to identify severe malnutrition in critically ill patients. METHODS We conducted a retrospective study in an adult general intensive care unit (ICU) comparing four nutritional assessment tools: Nutrition Risk Screening (NRS), Nutrition Risk in Critically Ill (NUTRIC), and malnutrition criteria proposed by European Society of Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN). These criteria were tested for their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in diagnosis of severe malnutrition, defined as Subjective Global Assessment (SGA) C. RESULTS Hospitalization records for 120 critically ill patients were analyzed. 60 (50%), 17 (14.2%) and 43 (35.8%) patients were classified as SGA A, B, and C, respectively. The sensitivity in diagnosis of severe malnutrition was 79.1%, 58.1%, 65.1%, and 65.1%, and specificity was 94.8%, 74.0%, 94.8%, and 98.7% for NRS, NUTRIC, ESPEN, and ASPEN, respectively. NRS, ESPEN, and ASPEN had higher PPV (89.5%, 87.5%, and 87.5%, respectively) and NPV (89%, 83%, and 83.5%, respectively) than NUTRIC (PPV 55.6% and NPV 76%). NUTRIC showed the highest correlation with mortality, but none of the tools retained their correlation with mortality after adjustment for potential confounding factors. CONCLUSIONS NRS showed the highest sensitivity and high specificity, PPV, and NPV. NUTRIC had least effective overall performance in diagnosis of severe malnutrition in an ICU setting. A larger population may be required to explore the association between mortality and these nutritional assessment tools.
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Affiliation(s)
- Sornwichate Rattanachaiwong
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Benjamin Zribi
- Department of Anesthesia, Rabin Medical Center, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zribi B, Uziel O, Lahav M, Mesilati Stahy R, Singer P. Telomere Length Changes during Critical Illness: A Prospective, Observational Study. Genes (Basel) 2019; 10:genes10100761. [PMID: 31569793 PMCID: PMC6826589 DOI: 10.3390/genes10100761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: evaluation of telomere length change in acutely ill adult patients. Design: Blood samples were drawn on the first and seventh day of intensive care unit (ICU) stay to assess telomere length using a polymerase chain reaction (PCR)-based technique. Demographic data collected included age, weight, admission diagnosis, baseline laboratory values (pH, C- reactive protein (CRP), serum albumin level, white blood cell count (WBC) count, platelet count), and baseline SOFA and APACHE II scores. Additional data collected during the ICU stay included a repeated WBC count, the presence of positive blood cultures and outcome data, including death in the ICU or following discharge, whether ventilated or not at ICU discharge, and destination following discharge, i.e., medical ward or rehabilitation. Setting: General ICU in tertiary hospital. Patients: Forty patients admitted to the ICU within 72 h of hospital admission suffering from an acute illness were included in this prospective, observational study. Main results: Of the 40 patients studied, telomere shortening was noted in 21, telomere lengthening in 11, and no significant change in the other eight. The age of patients demonstrating telomere shortening was statistically significantly younger (45.4 vs. 61.5 years, p < 0.023) compared to those showing increased telomere length. In addition, a significant correlation was observed between the difference in telomere length and the corresponding difference in WBC count (telomere shortening was associated with a decreased WBC count and vice versa). A trend toward shortening was seen in patients with sepsis (p = 0.07). No significant correlations were found for any other demographic or outcome parameter and changes in telomere length. Conclusion: Changes in telomere length, both shortening and lengthening, were evident in the acute setting, but no associations between such changes with outcome were noted. Further studies in more homogeneous groups of patients appear to be warranted.
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Affiliation(s)
- Benjamin Zribi
- Department of Anesthesiology, Rabin Medical Center, Campus Beilinson, Petah Tikva 49100, Israel.
| | - Orit Uziel
- The Felsenstein Medical Research Center, Rabin Medical Center, Campus Beilinson, Petah Tikva and the Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100, Israel.
| | - Meir Lahav
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center and the Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100, Israel.
| | - Ronit Mesilati Stahy
- The Felsenstein Medical Research Center, Rabin Medical Center, Campus Beilinson, Petah Tikva 49100, Israel.
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Campus Beilinson and the Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100, Israel.
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Zribi B, Roy E, Pallandre A, Chebil S, Koubaa M, Mejri N, Magdinier Gomez H, Sola C, Korri-Youssoufi H, Haghiri-Gosnet AM. A microfluidic electrochemical biosensor based on multiwall carbon nanotube/ferrocene for genomic DNA detection of Mycobacterium tuberculosis in clinical isolates. Biomicrofluidics 2016; 10:014115. [PMID: 26865908 PMCID: PMC4744232 DOI: 10.1063/1.4940887] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/14/2016] [Indexed: 05/20/2023]
Abstract
Herein we present a microfluidic-multiplexed platform that integrates electrochemical sensors based on carbon nanotubes associated with ferrocene as redox marker (carbon nanotube (CNT)/ferrocene) for direct detection of pathogenic viral DNA from Hepatitis C and genomic DNA from Mycobacterium tuberculosis in clinical isolates. By operating the fluidic device under high flow (150 μl/min), the formation of a very thin depletion layer at the sensor surface (δS = 230 nm) enhances the capture rate up to one DNA strand per second. By comparison, this capture rate is only 0.02 molecule/s in a static regime without flow. This fluidic protocol allows thus enhancing the limit of detection of the electrochemical biosensor from picomolar in bulk solution to femtomolar with a large dynamic range from 0.1 fM to 1 pM. Kinetics analysis also demonstrates an enhancement of the rate constant of electron transfer (kS) of the electrochemical process from 1 s(-1) up to 6 s(-1) thanks to the geometry of the miniaturized fluidic electrochemical cell. This microfluidic device working under high flow allows selective direct detection of a Mycobacterium tuberculosis (H37Rv) rpoB allele from clinical isolate extracted DNA. We envision that a microfluidic approach under high flow associated with a multiwall CNT/ferrocene sensor could find useful applications as the point-of-care for multi-target diagnostics of biomarkers in real samples.
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Affiliation(s)
| | - E Roy
- Laboratoire de Photonique et de Nanostructures (LPN), CNRS, Université Paris-Saclay , route de Nozay, F-91460 Marcoussis, France
| | | | - S Chebil
- Laboratoire de Photonique et de Nanostructures (LPN), CNRS, Université Paris-Saclay , route de Nozay, F-91460 Marcoussis, France
| | - M Koubaa
- Laboratoire de Physique des Matériaux, LPM FSS, Faculté des Sciences de Sfax, Université de Sfax , Sfax, Tunisia
| | - N Mejri
- Université Paris-Saclay , UMR-CNRS 8182, Institue de Chimie Moléculaires et Matériaux d'Orsay (ICMMO), Equipe de Chimie Bioorganique et Bioinorganique (ECBB), Bâtiment 420, 91405, Orsay, France
| | - H Magdinier Gomez
- UMR-CNRS 9198, Institut de Biologie Intégrative de la Cellule (I2BC), Université Paris-Saclay , Bat 400, 91405 Orsay, France
| | - C Sola
- UMR-CNRS 9198, Institut de Biologie Intégrative de la Cellule (I2BC), Université Paris-Saclay , Bat 400, 91405 Orsay, France
| | - H Korri-Youssoufi
- Université Paris-Saclay , UMR-CNRS 8182, Institue de Chimie Moléculaires et Matériaux d'Orsay (ICMMO), Equipe de Chimie Bioorganique et Bioinorganique (ECBB), Bâtiment 420, 91405, Orsay, France
| | - A-M Haghiri-Gosnet
- Laboratoire de Photonique et de Nanostructures (LPN), CNRS, Université Paris-Saclay , route de Nozay, F-91460 Marcoussis, France
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