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Foro P, Narvaez A, Martinez A, Martinez M, Rodriguez De Dios N, Amorelli F, Liu F, Membrive I, Sanz J, Pera O, Algara M, Villalba G. A Phase II Trial of Intraoperative Radiotherapy after Surgical Resection of Brain Metastases: Feasibility and Efficacy NCT04847284. Int J Radiat Oncol Biol Phys 2023; 117:e104. [PMID: 37784633 DOI: 10.1016/j.ijrobp.2023.06.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Intraoperative radiation therapy (IORT) is an alternative to local radiation therapy for brain metastases, reducing total treatment time, and improving patient comfort, but the most effective dose is unknown. The objective of this study is to evaluate the efficacy and safety of IORT in patients with surgical excision of brain metastases at a dose of 20 Gy. MATERIALS/METHODS This trial is a single-institution, open-label, prospective, non-randomized study for intraoperative radiotherapy immediately after resection of brain metastases. Registered in January 2021, currently ongoing, planned to enroll 25 patients with IK ≥70, brain damage newly diagnosed by MRI, without dural contact and at least 1 cm to the optic nerve, chiasm and brainstem. In the baseline visit, the General Cognitive State will be carried out: Minimum Mental State Exams. Specific cognitive study: 1- Processing speed (SYmbol digit modalities test), 2- Executive function (TMT, back and forward digit span test, phonological and semantic verbal fluency test, Stroop color-word test), 3- Verbal memory (FCSRT). Quality of life will be monitored by completing the EORTC QL-C30 and BN20 questionnaires. Intraoperative radiation therapy will be performed with a 50 kV low energy X-ray portable linear accelerator using spherical applicators ranging from 1.5 to 4 cm kV to deliver 20 Gy to the surface. During IORT a maximum dose (DMax) of 8 Gy will be allowed to the optic nerve/chiasm and brainstem structures. MRI will be performed 72 hours after IORT. Neurocognitive Test and MRI after 6 weeks and every 3 months. The primary endpoint will be local progression free survival (PFS). Secondary endpoints will be overall survival, time to save cancer therapy, cognitive performance and quality of life, as well as IORT-related neurotoxicity complications will be evaluated according to the scale of the CTACAE version 4. The analysis of the median local progression free survival, overall survival will be analyzed using the Kaplan-Meier curve (long range test). All results will be considered statistically significant with a p value < 0.05. The statistical analysis will be carried out with statistical software. RESULTS The trial is open and ongoing to recruitment; we have included 7 patients. The 85.7% were male, mean age was 61.4 years range (43-74). The 57.1% were lung cancer metastases. For now, no tumor recurrence or neurocognitive complications have been observed and then once you have the results ready, we will publish them. CONCLUSION The limited current literature on the use of IORT in brain metastases appears to show efficacy and safety, but the most effective dose is unknown as well as whether it is as effective as other radiotherapy alternatives. Our study is ongoing and needs to be completed and evaluated with more follow-up in order to reach definitive conclusions.
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Affiliation(s)
- P Foro
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - A Narvaez
- Hospital del Mar, Neurosurgery Department, Barcelona, Spain
| | - A Martinez
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - M Martinez
- Hospital del Mar, Medical Oncology Department, Barcelona, Spain
| | | | - F Amorelli
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - F Liu
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - I Membrive
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - J Sanz
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - O Pera
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - M Algara
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - G Villalba
- Hospital del Mar, Neurosurgery Department, Barcelona, Spain
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Marciano S, Dirchwolf M, Torres MC, Allevato J, García Dans C, García B, Pollarsky F, Gaite L, Sirotinsky E, Rios B, Anselmo MN, Peche M, Hurtado E, Haddad L, Narvaez A, Mauro E, Martinez A, Bellizzi C, Ratusnu N, D'Amico C, Arora S, Gadano A. Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them. Rev Gastroenterol Mex (Engl Ed) 2021; 87:4-12. [PMID: 34690105 DOI: 10.1016/j.rgmxen.2021.09.002] [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] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. MATERIALS AND METHODS A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. RESULTS The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2 months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. CONCLUSIONS A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.
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Affiliation(s)
- S Marciano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M Dirchwolf
- Sección Hepatología, Hospital Privado de Rosario, Rosario, Argentina
| | - M C Torres
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Allevato
- Unidad de Diagnóstico y Tratamiento para Enfermedades Hepáticas de Neuquén, Neuquén, Argentina
| | - C García Dans
- Sección Hepatología, Hospital Zonal Bariloche Dr. Ramón Carrillo, Bariloche, Argentina
| | - B García
- Sección Hepatología, Centro de Estudios Digestivos de Mendoza, Mendoza, Argentina
| | - F Pollarsky
- Sección Hepatología, Hospital Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - L Gaite
- Sección Hepatología, Clínica de Nefrología, Santa Fe, Argentina
| | - E Sirotinsky
- Centro de Estudios Digestivos, Comodoro Rivadavia, Argentina
| | - B Rios
- Hepatología, Centro de Investigación, Neuquén, Argentina
| | - M N Anselmo
- Sección Gastroenterología y Hepatología, Hospital Zonal Esquel, Esquel, Argentina
| | - M Peche
- Hospital López Lima Gral Roca, Rio Negro, Argentina
| | - E Hurtado
- Hospital Municipal Coronel Suárez, Buenos Aires, Argentina
| | - L Haddad
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Narvaez
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - E Mauro
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Martinez
- Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - C Bellizzi
- Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - N Ratusnu
- Hospital Regional de Ushuaia, Ushuaia, Tierra del Fuego, Argentina
| | - C D'Amico
- Hepatología, CEMA - Centro de Especialidades Médicas Ambulatoria, Mar del Plata, Argentina
| | - S Arora
- Project ECHO, School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| | - A Gadano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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3
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Marciano S, Dirchwolf M, Torres MC, Allevato J, García Dans C, García B, Pollarsky F, Gaite L, Sirotinsky E, Rios B, Anselmo MN, Peche M, Hurtado E, Haddad L, Narvaez A, Mauro E, Martinez A, Bellizzi C, Ratusnu N, D Amico C, Arora S, Gadano A. Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them. Rev Gastroenterol Mex (Engl Ed) 2021; 87:S0375-0906(21)00015-X. [PMID: 33773856 DOI: 10.1016/j.rgmx.2020.08.006] [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] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. MATERIALS AND METHODS A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. RESULTS The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. CONCLUSIONS A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.
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Affiliation(s)
- S Marciano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M Dirchwolf
- Sección Hepatología, Hospital Privado de Rosario, Rosario, Argentina
| | - M C Torres
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Allevato
- Unidad de Diagnóstico y Tratamiento para Enfermedades Hepáticas de Neuquén, Neuquén, Argentina
| | - C García Dans
- Sección Hepatología, Hospital Zonal Bariloche Dr. Ramón Carrillo, Bariloche, Argentina
| | - B García
- Sección Hepatología, Centro de Estudios Digestivos de Mendoza, Mendoza, Argentina
| | - F Pollarsky
- Sección Hepatología, Hospital Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - L Gaite
- Sección Hepatología, Clínica de Nefrología, Santa Fe, Argentina
| | - E Sirotinsky
- Centro de Estudios Digestivos, Comodoro Rivadavia, Argentina
| | - B Rios
- Hepatología, Centro de Investigación, Neuquén, Argentina
| | - M N Anselmo
- Sección Gastroenterología y Hepatología, Hospital Zonal Esquel, Esquel, Argentina
| | - M Peche
- Hospital López Lima Gral Roca, Rio Negro, Argentina
| | - E Hurtado
- Hospital Municipal Coronel Suárez, Buenos Aires, Argentina
| | - L Haddad
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Narvaez
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - E Mauro
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Martinez
- Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - C Bellizzi
- Sección Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - N Ratusnu
- Hospital Regional de Ushuaia, Ushuaia, Tierra del Fuego, Argentina
| | - C D Amico
- Hepatología, CEMA - Centro de Especialidades Médicas Ambulatoria, Mar del Plata, Argentina
| | - S Arora
- Project ECHO, School of Medicine, University of New Mexico, Albuquerque, New Mexico, Estados Unidos de América
| | - A Gadano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Perez JE, Schmidt MA, Narvaez A, Welsh LK, Diaz R, Castro M, Ansari K, Cason RW, Bilezikian JA, Hope W, Guerron AD, Yoo J, Levinson H. Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction. Hernia 2020; 25:1-13. [PMID: 32959176 DOI: 10.1007/s10029-020-02304-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/27/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair. METHODS The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review. CONCLUSIONS There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair.
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Affiliation(s)
- J E Perez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M A Schmidt
- Department of Physical Therapy and Occupational Therapy, Duke University, Durham, NC, 27710, US
| | - A Narvaez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - L K Welsh
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - R Diaz
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M Castro
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - K Ansari
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - R W Cason
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - J A Bilezikian
- Department of General Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - W Hope
- General Surgery Specialists, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - A D Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - J Yoo
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - H Levinson
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US. .,Director of Innovation and Entrepreneurship, Associate Professor of Plastic and Reconstructive Surgery, Pathology, Dermatology and Surgical Sciences, Departments of Dermatology, Pathology, and Surgery, Duke University Medical Center, DUMC 3181, Durham, NC, 27710, US.
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Malavade S, Narvaez A, Mitra A, Ochoa T, Naik E, Sharma M, Galwankar S, Breglia M, Izurieta R. Cholera in ecuador: current relevance of past lessons learnt. J Glob Infect Dis 2011; 3:189-94. [PMID: 21731309 PMCID: PMC3125035 DOI: 10.4103/0974-777x.81699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 11/24/2022] Open
Abstract
This report analyses the trends in the cholera epidemic that hit Ecuador in 1991. The study is based on personal experiences and analysis of epidemiological databases from the Ministry of Public Health of Ecuador. The number of cases and initial attack rates in an immunologically naive population are described by province. An analysis of the Andean and coastal cholera patterns of transmission are described along with its associated risk factors. The logistical, environmental, and socio-cultural risk factors prevalent during the epidemic and the control measures implemented are also reviewed. Also, the role of the epidemic in the development of the public health and healthcare resources in Ecuador is discussed here. Current data indicate favorable conditions for another outbreak of cholera in Ecuador. In view of the existing risk factors, new strategies are proposed to prevent such an epidemic in the future.
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Affiliation(s)
- Ss Malavade
- Department of Global Health, University of South Florida, Florida, USA
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Cara J, Narvaez A, de la Varga V, Guerado E. Median nerve neuropathy from an old lunate dislocation. Acta Orthop Belg 1998; 64:100-3. [PMID: 9586259] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The case of an old volar dislocation of the lunate, associated with median nerve neuropathy, is described in a 37-year-old patient. The treatment took into account the age of the patient and the relative tolerance to the dislocation. We performed a simple excision of the lunate combined with a release of the transverse carpal ligament in order to free the median nerve, together with a tenosynovectomy of flexor digitorum profoundus. Two years after operation, wrist function was virtually complete and the patient was asymptomatic and had resumed his occupation.
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Affiliation(s)
- J Cara
- Department of Orthopaedics, Hospital Costa del Sol, Marbella, Spain
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Narvaez A, Dominguez E, Katakis I, Katz E, Ranjit K, Ben-Dov I, Willner I. Microperoxidase-11-mediated reduction of hemoproteins: electrocatalyzed reduction of cytochrome c, myoglobin and hemoglobin and electrocatalytic reduction of nitrate in the presence of cytochrome-dependent nitrate reductase. J Electroanal Chem (Lausanne) 1997. [DOI: 10.1016/s0022-0728(97)00242-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Valero MV, Amador R, Aponte JJ, Narvaez A, Galindo C, Silva Y, Rosas J, Guzman F, Patarroyo ME. Evaluation of SPf66 malaria vaccine during a 22-month follow-up field trial in the Pacific coast of Colombia. Vaccine 1996; 14:1466-70. [PMID: 8994323 DOI: 10.1016/s0264-410x(96)00070-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [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: 02/03/2023]
Abstract
A double-blind randomized placebo-controlled field trial with the SPf66 malaria vaccine was carried out in an endemic area consisting of 14 small villages with exclusive fluvial access, in a rain forest area along the Rosario River, Colombia. A total of 1257 subjects completed the full three dose vaccination schedule on days 0, 30 and 180 (643 vaccinated group/623 placebo group) and were followed-up by passive and active surveillance over a period of 22 months. One hundred and thirty-four Plasmodium falciparum malaria episodes were detected (53 in vaccinated group/81 in placebo group), yielding an attack rate of 5.47 cases/100 person years of follow-up (pyears) in the vaccine group and 8.44/100 pyears in the placebo group. The estimated vaccine protective efficacy was 35.2% (95% CI 8.4-54.2%, P = 0.01). This result supports earlier findings that the SPf66 malaria vaccine diminishes the risk of infection by P. falciparum in endemic areas of South America.
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Affiliation(s)
- M V Valero
- Instituto de Inmunologia, Hospital San Juan de Dios, Universidad Nacional de Colombia, Santafé de Bogotá, Colombia
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