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Allgood SC, Su CC, Crooks AL, Meyer CT, Zhou B, Betterton MD, Barbachyn MR, Yu EW, Detweiler CS. Bacterial efflux pump modulators prevent bacterial growth in macrophages and under broth conditions that mimic the host environment. mBio 2023; 14:e0249223. [PMID: 37921493 PMCID: PMC10746280 DOI: 10.1128/mbio.02492-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023] Open
Abstract
New approaches for combating microbial infections are needed. One strategy for disrupting pathogenesis involves developing compounds that interfere with bacterial virulence. A critical molecular determinant of virulence for Gram-negative bacteria are efflux pumps of the resistance-nodulation-division family, which includes AcrAB-TolC. We previously identified small molecules that bind AcrB, inhibit AcrAB-TolC, and do not appear to damage membranes. These efflux pump modulators (EPMs) were discovered in an in-cell screening platform called SAFIRE (Screen for Anti-infectives using Fluorescence microscopy of IntracellulaR Enterobacteriaceae). SAFIRE identifies compounds that disrupt the growth of a Gram-negative human pathogen, Salmonella enterica serotype Typhimurium (S. Typhimurium), in macrophages. We used medicinal chemistry to iteratively design ~200 EPM35 analogs and test them for activity in SAFIRE, generating compounds with nanomolar potency. Analogs were demonstrated to bind AcrB in a substrate binding pocket by cryo-electron microscopy. Despite having amphipathic structures, the EPM analogs do not disrupt membrane voltage, as monitored by FtsZ localization to the cell septum. The EPM analogs had little effect on bacterial growth in standard Mueller Hinton Broth. However, under broth conditions that mimic the micro-environment of the macrophage phagosome, acrAB is required for growth, the EPM analogs are bacteriostatic, and the EPM analogs increase the potency of antibiotics. These data suggest that under macrophage-like conditions, the EPM analogs prevent the export of a toxic bacterial metabolite(s) through AcrAB-TolC. Thus, compounds that bind AcrB could disrupt infection by specifically interfering with the export of bacterial toxic metabolites, host defense factors, and/or antibiotics.IMPORTANCEBacterial efflux pumps are critical for resistance to antibiotics and for virulence. We previously identified small molecules that inhibit efflux pumps (efflux pump modulators, EPMs) and prevent pathogen replication in host cells. Here, we used medicinal chemistry to increase the activity of the EPMs against pathogens in cells into the nanomolar range. We show by cryo-electron microscopy that these EPMs bind an efflux pump subunit. In broth culture, the EPMs increase the potency (activity), but not the efficacy (maximum effect), of antibiotics. We also found that bacterial exposure to the EPMs appear to enable the accumulation of a toxic metabolite that would otherwise be exported by efflux pumps. Thus, inhibitors of bacterial efflux pumps could interfere with infection not only by potentiating antibiotics, but also by allowing toxic waste products to accumulate within bacteria, providing an explanation for why efflux pumps are needed for virulence in the absence of antibiotics.
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Affiliation(s)
- Samual C. Allgood
- Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Chih-Chia Su
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Cleveland Center for Membrane and Structural Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Amy L. Crooks
- Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Christian T. Meyer
- Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, USA
- Chemical and Biological Engineering, University of Colorado Boulder, Boulder, Colorado, USA
- Duet Biosystems, Nashville, Tennessee, USA
- Antimicrobial Research Consortium (ARC) Labs, Boulder, Colorado, USA
| | - Bojun Zhou
- Department of Physics, University of Colorado, Boulder, Colorado, USA
| | - Meredith D. Betterton
- Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Physics, University of Colorado, Boulder, Colorado, USA
- Center for Computational Biology, Flatiron Institute, New York, New York, USA
| | | | - Edward W. Yu
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Cleveland Center for Membrane and Structural Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Corrella S. Detweiler
- Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, USA
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Allgood SC, Su CC, Crooks AL, Meyer CT, Zhou B, Betterton MD, Barbachyn MR, Yu EW, Detweiler CS. Bacterial Efflux Pump Modulators Prevent Bacterial Growth in Macrophages and Under Broth Conditions that Mimic the Host Environment. bioRxiv 2023:2023.09.20.558466. [PMID: 37786697 PMCID: PMC10541609 DOI: 10.1101/2023.09.20.558466] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
New approaches for combatting microbial infections are needed. One strategy for disrupting pathogenesis involves developing compounds that interfere with bacterial virulence. A critical molecular determinant of virulence for Gram-negative bacteria are efflux pumps of the resistance-nodulation-division (RND) family, which includes AcrAB-TolC. We previously identified small molecules that bind AcrB, inhibit AcrAB-TolC, and do not appear to damage membranes. These efflux pump modulators (EPMs) were discovered in an in-cell screening platform called SAFIRE (Screen for Anti-infectives using Fluorescence microscopy of IntracellulaR Enterobacteriaceae). SAFIRE identifies compounds that disrupt the growth of a Gram-negative human pathogen, Salmonella enterica serotype Typhimurium (S. Typhimurium) in macrophages. We used medicinal chemistry to iteratively design ~200 EPM35 analogs and test them for activity in SAFIRE, generating compounds with nanomolar potency. Analogs were demonstrated to bind AcrB in a substrate binding pocket by cryo-electron microscopy (cryo-EM). Despite having amphipathic structures, the EPM analogs do not disrupt membrane voltage, as monitored by FtsZ localization to the cell septum. The EPM analogs had little effect on bacterial growth in standard Mueller Hinton Broth. However, under broth conditions that mimic the micro-environment of the macrophage phagosome, acrAB is required for growth, the EPM analogs are bacteriostatic, and increase the potency of antibiotics. These data suggest that under macrophage-like conditions the EPM analogs prevent the export of a toxic bacterial metabolite(s) through AcrAB-TolC. Thus, compounds that bind AcrB could disrupt infection by specifically interfering with the export of bacterial toxic metabolites, host defense factors, and/or antibiotics.
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Affiliation(s)
- Samual C Allgood
- Molecular, Cellular Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
| | - Chih-Chia Su
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Cleveland Center for Membrane and Structural Biology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Amy L Crooks
- Molecular, Cellular Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
| | - Christian T Meyer
- Molecular, Cellular Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
- Chemical and Biological Engineering, University of Colorado Boulder, Boulder, CO, USA
- Duet Biosystems, Nashville, TN, USA
- Antimicrobial Research Consortium (ARC) Labs, Boulder, CO, USA
| | - Bojun Zhou
- Department of Physics, University of Colorado, Boulder, CO, USA
| | - Meredith D Betterton
- Molecular, Cellular Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
- Department of Physics, University of Colorado, Boulder, CO, USA
- Center for Computational Biology, Flatiron Institute, New York, NY, USA
| | | | - Edward W Yu
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Cleveland Center for Membrane and Structural Biology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Corrella S Detweiler
- Molecular, Cellular Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
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Catapano JS, Labib MA, Frisoli FA, Cadigan MS, Baranoski JF, Cole TS, Zhou JJ, Nguyen CL, Whiting AC, Ducruet AF, Albuquerque FC, Lawton MT. An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial. J Neurosurg 2021; 135:1067-1071. [PMID: 33450736 DOI: 10.3171/2020.7.jns193431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management. METHODS The records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades. Outcomes at 1 year and 6 years post-aSAH were analyzed for each SAFIRE grade level, with a poor outcome defined as a modified Rankin Scale score > 2. Univariate analysis was performed for patients with a high SAFIRE grade (IV or V) for odds of poor outcome at the 1- and 6-year follow-ups. RESULTS A total of 405 patients with confirmed aSAH enrolled in the BRAT were analyzed; 357 patients had 1-year follow-up, and 333 patients had 6-year follow-up data available. Generally, as the SAFIRE grade increased, so did the proportion of patients with poor outcomes. At the 1-year follow-up, 18% (17/93) of grade I patients, 22% (20/92) of grade II patients, 32% (26/80) of grade III patients, 43% (38/88) of grade IV patients, and 75% (3/4) of grade V patients were found to have poor outcomes. At the 6-year follow-up, 29% (23/79) of grade I patients, 24% (21/89) of grade II patients, 38% (29/77) of grade III patients, 60% (50/84) of grade IV patients, and 100% (4/4) of grade V patients were found to have poor outcomes. Univariate analysis showed that a SAFIRE grade of IV or V was associated with a significantly increased risk of a poor outcome at both the 1-year (OR 2.5, 95% CI 1.5-4.2; p < 0.001) and 6-year (OR 3.7, 95% CI 2.2-6.2; p < 0.001) follow-ups. CONCLUSIONS High SAFIRE grades are associated with an increased risk of a poor recovery at late follow-up.
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Bathla G, Priya S, Samaniego E, Deo SK, Fain NH, Soni N, Ward C, Derdeyn CP. Cerebral computed tomographic angiography using third-generation reconstruction algorithm provides improved image quality with lower contrast and radiation dose. Neuroradiology 2020; 62:965-970. [PMID: 32277245 DOI: 10.1007/s00234-020-02406-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/16/2019] [Accepted: 03/13/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE We hypothesized that cerebral CT angiogram performed using third-generation reconstruction algorithm and lower contrast dose-low-kVp technique (LD-CTA) will provide better image quality when compared with regular contrast dose CTA at 120 kVp using a sinogram-affirmed iterative reconstruction algorithm (ND-CTA). METHODS Retrospective imaging review of 100 consecutive patients (50 each in LD- and ND-CTA groups). Two readers independently assessed the subjective image quality across multiple vascular segments on a Likert-like scale. Differences in contrast dose, CT dose index (CTDI), and dose length product (DLP) were compared using Mann-Whitney U test. Fisher's exact test was used to compare subjective image quality. Similarly, contrast- and signal-to-noise ratios (CNR and SNR) were compared in the mid-M1 MCA vessels bilaterally and the mid-basilar artery using Mann-Whitney U test. Interclass correlation coefficient (ICC) was calculated for the SNR/CNR values. RESULTS Both observers showed excellent correlation in subjective image quality (mean percentage agreement of 95.2% for group 1 versus 89.2% for group 2). LD-CTA group showed better SNR and CNR (p < 0.0001) for both MCA vessels and the mid-basilar artery. Interclass correlation coefficient showed moderate correlation (0.51-0.63) between readers. LD-CTA group also used lower contrast (49 cc versus 97 cc in ND-CTA) and had lower radiation exposure (DLP/CTDI for both groups 268.3/80.7 vs 519.5/36.08, both < 0.0001). CONCLUSION Next-generation reconstruction algorithm and low-kV scanning significantly improved image quality on cerebral CTA images despite lower contrast dose and, in addition, have lower radiation exposure.
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Affiliation(s)
- Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Sarv Priya
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Edgar Samaniego
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Simmi K Deo
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nicholas H Fain
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Neetu Soni
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Caitlin Ward
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Shin JB, Yoon DK, Pak S, Kwon YH, Suh TS. Comparative performance analysis for abdominal phantom ROI detectability according to CT reconstruction algorithm: ADMIRE. J Appl Clin Med Phys 2019; 21:136-143. [PMID: 31729832 PMCID: PMC6964754 DOI: 10.1002/acm2.12765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose We compared and analyzed the detectability performance pertaining to an abdominal phantom including a region of interest (ROI) according to a computed tomography (CT) reconstruction algorithm. Methods Three types of reconstruction algorithms (FBP, SAFIRE, and ADMIRE) were used to evaluate the detectability performance using the abdominal phantom (phantom size: 25 × 18 × 28 cm3). The vendor default settings for routine multi‐detector computed tomography abdominal scans were used. As the quantitative evaluation method, the contrast‐to‐noise ratio (CNR), difference in coefficient of variation (COV) with the normalization based on the FBP data, and the noise power spectrum (NPS) were measured. Results The characteristic of the ADMIRE‐3 reconstructed image was higher than those of the FBP and SAFIRE‐3 reconstructed images. The CNR values of the SAFIRE and ADMIRE images were much higher than the corresponding values of the FBP images. The difference in COV values for the ADMIRE images was ~1.2 times lower than the corresponding values of the SAFIRE images. Conclusion The comparative analysis of the abdominal phantom low‐contrast resolution differences for each CT exposure parameters showed that ADMIRE demonstrated better results than SAFIRE and FBP in terms of contrast, CNR, COV difference, and 1D NPS. This indicates that ADMIRE can provide a clearer observation even with the same number of contrast objects as compared to SAFIRE and FBP owing to its better contrast resolution in the central part of the contrast hole at low kV.
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Affiliation(s)
- Jun-Bong Shin
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Do-Kun Yoon
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, College of Medicine, Catholic University of Korea, Seoul, Korea
| | | | | | - Tae Suk Suh
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, College of Medicine, Catholic University of Korea, Seoul, Korea
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Wang L, Gong S, Yang J, Zhou J, Xiao J, Gu JH, Yang H, Zhu J, He B. CARE Dose 4D combined with sinogram-affirmed iterative reconstruction improved the image quality and reduced the radiation dose in low dose CT of the small intestine. J Appl Clin Med Phys 2018; 20:293-307. [PMID: 30508275 PMCID: PMC6333130 DOI: 10.1002/acm2.12502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 08/06/2018] [Accepted: 10/19/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Multislice computed tomography (MSCT) has been used for diagnosis of small intestinal diseases. However, the radiation dose is a big problem. This study was to investigate whether CARE Dose 4D combined with sinogram‐affirmed iterative reconstruction (SAFIRE) can provide better image quality at a lower dose for imaging small intestinal diseases compared to MSCT. Methods The noise reduction ability of SAFIRE was assessed by scanning the plain water mold using SOMATOM Definition Flash double‐source spiral CT. CT images at each stage of radiography for 239 patients were obtained. The patients were divided into groups A and B were based on different tube voltage and current or the image recombination methods. The images were restructured using with filtered back projection (FBP) and SAFIRE (S1–S5). The contrast noise ratio (CNR), CT Dose index (CTDI), subjective scoring, and objective scoring were compared to obtain the best image and reformation parameters at different stages of CT. Results Twenty‐six restructuring patterns of tube voltage and current were obtained by FBP and SAFIRE. The average radiation dose using CARE Dose 4D combined with SAFIRE (S4–S5) reduced approximately 74.85% compared to conditions where the tube voltage of 100 kV and tube current of 131 mAs for patients with MSCT small intestinal CT enterography at plain CT scan, arterial stage, small intestine, and portal venous phase. The objective and subjective scoring were all significantly different among groups A and B at each stage. Conclusions Combination of CARE Dose 4D and SAFIRE is shown to decrease the radiation dose while maintaining image quality.
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Affiliation(s)
- Lin Wang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu, China
| | - Shenchu Gong
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu, China
| | - Jushun Yang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu, China
| | - Jie Zhou
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu, China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health Nantong University, Nantong, Jiangsu, China
| | - Jin-Hua Gu
- Department of Pathophysiology, Nantong University Medical School, Nantong, Jiangsu, China
| | - Hong Yang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu, China
| | - Jianfeng Zhu
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu, China
| | - Bosheng He
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu, China.,Clinical Medicine Research Center, the Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Haubenreisser H, Fink C, Nance JW, Sedlmair M, Schmidt B, Schoenberg SO, Henzler T. Feasibility of slice width reduction for spiral cranial computed tomography using iterative image reconstruction. Eur J Radiol 2014; 83:964-969. [PMID: 24673978 DOI: 10.1016/j.ejrad.2014.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/27/2013] [Revised: 01/28/2014] [Accepted: 01/30/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To prospectively compare image quality of cranial computed tomography (CCT) examinations with varying slice widths using traditional filtered back projection (FBP) versus sinogram-affirmed iterative image reconstruction (SAFIRE). MATERIALS AND METHODS 29 consecutive patients (14 men, mean age: 72 ± 17 years) referred for a total of 40 CCT studies were prospectively included. Each CCT raw data set was reconstructed with FBP and SAFIRE at 5 slice widths (1-5mm; 1mm increments). Objective image quality was assessed in three predefined regions of the brain (white matter, thalamus, cerebellum) using identical regions of interest (ROIs). Subjective image quality was assessed by 2 experienced radiologists. Objective and subjective image quality parameters were statistically compared between FBP and SAFIRE reconstructions. RESULTS SAFIRE reconstructions resulted in mean noise reductions of 43.8% in the white matter, 45.6% in the thalamus and 42.0% in the cerebellum (p<0.01) compared to FBP on non contrast-enhanced 1mm slice width images. Corresponding mean noise reductions on 1mm contrast-enhanced studies were 45.7%, 47.3%, and 45.0% in the white matter, thalamus, and cerebellum, respectively (p<0.01). There was no significant difference in mean attenuation of any region or slice width between the two reconstruction methods (all p>0.05). Subjective image quality of IR images was mostly rated higher than that of the FBP images. CONCLUSION Compared to FBP, SAFIRE provides significant reductions in image noise while increasing subjective image in CCT, particularly when thinner slices are used. Therefore, SAFIRE may allow utilization of thinner slices in CCT, potentially reducing partial volume effects and improving diagnostic accuracy.
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Affiliation(s)
- Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - John W Nance
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | | | | | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
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