Multidimensional Analysis of the Adult Human Heart in Health and Disease Using Hierarchical Phase-Contrast Tomography.


Journal

Radiology
ISSN: 1527-1315
Titre abrégé: Radiology
Pays: United States
ID NLM: 0401260

Informations de publication

Date de publication:
Jul 2024
Historique:
medline: 16 7 2024
pubmed: 16 7 2024
entrez: 16 7 2024
Statut: ppublish

Résumé

Background Current clinical imaging modalities such as CT and MRI provide resolution adequate to diagnose cardiovascular diseases but cannot depict detailed structural features in the heart across length scales. Hierarchical phase-contrast tomography (HiP-CT) uses fourth-generation synchrotron sources with improved x-ray brilliance and high energies to provide micron-resolution imaging of intact adult organs with unprecedented detail. Purpose To evaluate the capability of HiP-CT to depict the macro- to microanatomy of structurally normal and abnormal adult human hearts ex vivo. Materials and Methods Between February 2021 and September 2023, two adult human donor hearts were obtained, fixed in formalin, and prepared using a mixture of crushed agar in a 70% ethanol solution. One heart was from a 63-year-old White male without known cardiac disease, and the other was from an 87-year-old White female with a history of multiple known cardiovascular pathologies including ischemic heart disease, hypertension, and atrial fibrillation. Nondestructive ex vivo imaging of these hearts without exogenous contrast agent was performed using HiP-CT at the European Synchrotron Radiation Facility. Results HiP-CT demonstrated the capacity for high-spatial-resolution, multiscale cardiac imaging ex vivo, revealing histologic-level detail of the myocardium, valves, coronary arteries, and cardiac conduction system across length scales. Virtual sectioning of the cardiac conduction system provided information on fatty infiltration, vascular supply, and pathways between the cardiac nodes and adjacent structures. HiP-CT achieved resolutions ranging from gross (isotropic voxels of approximately 20 µm) to microscopic (approximately 6.4-µm voxel size) to cellular (approximately 2.3-µm voxel size) in scale. The potential for quantitative assessment of features in health and disease was demonstrated. Conclusion HiP-CT provided high-spatial-resolution, three-dimensional images of structurally normal and diseased ex vivo adult human hearts. Whole-heart image volumes were obtained with isotropic voxels of approximately 20 µm, and local regions of interest were obtained with resolution down to 2.3-6.4 µm without the need for sectioning, destructive techniques, or exogenous contrast agents. Published under a CC BY 4.0 license

Identifiants

pubmed: 39012246
doi: 10.1148/radiol.232731
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e232731

Auteurs

Joseph Brunet (J)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Andrew C Cook (AC)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Claire L Walsh (CL)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

James Cranley (J)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Paul Tafforeau (P)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Klaus Engel (K)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Owen Arthurs (O)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Camille Berruyer (C)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Emer Burke O'Leary (E)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Alexandre Bellier (A)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Ryo Torii (R)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Christopher Werlein (C)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Danny D Jonigk (DD)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Maximilian Ackermann (M)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Kathleen Dollman (K)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

Peter D Lee (PD)

From the Department of Mechanical Engineering, University College London, London, England (J.B., C.L.W., C.B., E.B.O.L., R.T., P.D.L.); European Synchrotron Radiation Facility, 71 Av des Martyrs, 38000 Grenoble, France (J.B., P.T., C.B., K.D.); UCL Institute of Cardiovascular Science, London, England (A.C.C.); Wellcome Sanger Institute, Hinxton, England (J.C.); Siemenst Healthineers, Erlangen, Germany (K.E.); Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England (O.A.); Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France (A.B.); Institute of Pathology, Hannover Medical School, Hannover, Germany (C.W.); Biomedical Research in Endstage and Obstructive Lung Disease Hannover, German Center for Lung Research (DZL), Hannover, Germany (D.D.J.); Institute of Pathology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany (D.D.J., M.A.); Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, Universität Witten/Herdecke, Wuppertal, Germany (M.A.); Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (M.A.); and Research Complex at Harwell, Didcot, England (P.D.L.).

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