Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement.
Identifieur interne : 001157 ( Main/Exploration ); précédent : 001156; suivant : 001158Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement.
Auteurs : Steven T. Woolson [États-Unis] ; Alex H S. Harris [États-Unis] ; David W. Wagner [États-Unis] ; Nicholas J. Giori [États-Unis]Source :
- The Journal of bone and joint surgery. American volume [ 1535-1386 ] ; 2014.
Descripteurs français
- KwdFr :
- Arthroplastie prothétique de genou (instrumentation), Arthroplastie prothétique de genou (méthodes), Fémur (chirurgie), Fémur (imagerie diagnostique), Humains (MeSH), Mâle (MeSH), Méthode en simple aveugle (MeSH), Soins postopératoires (MeSH), Tibia (chirurgie), Tibia (imagerie diagnostique), Tomodensitométrie (MeSH), Études prospectives (MeSH).
- MESH :
- chirurgie : Fémur, Tibia.
- imagerie diagnostique : Fémur, Tibia.
- méthodes : Arthroplastie prothétique de genou.
- instrumentation : Arthroplastie prothétique de genou, Humains, Mâle, Méthode en simple aveugle, Soins postopératoires, Tomodensitométrie, Études prospectives.
English descriptors
- KwdEn :
- Arthroplasty, Replacement, Knee (instrumentation), Arthroplasty, Replacement, Knee (methods), Femur (diagnostic imaging), Femur (surgery), Humans (MeSH), Male (MeSH), Postoperative Care (MeSH), Prospective Studies (MeSH), Single-Blind Method (MeSH), Tibia (diagnostic imaging), Tibia (surgery), Tomography, X-Ray Computed (MeSH).
- MESH :
- diagnostic imaging : Femur, Tibia.
- instrumentation : Arthroplasty, Replacement, Knee.
- methods : Arthroplasty, Replacement, Knee.
- surgery : Femur, Tibia.
- Humans, Male, Postoperative Care, Prospective Studies, Single-Blind Method, Tomography, X-Ray Computed.
Abstract
BACKGROUND
Patient-specific femoral and tibial cutting blocks produced with use of data from preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans have been employed recently to optimize component alignment in total knee arthroplasty. We report the results of a randomized controlled trial in which CT scans were used to compare postoperative component alignment between patients treated with custom instruments and those managed with traditional instruments.
METHODS
The in-hospital data and early clinical outcomes, including Knee Society scores, were determined in a randomized clinical trial of forty-seven patients who had undergone a total of forty-eight primary total knee arthroplasties with patient-specific instruments (twenty-two knees) or standard instruments (twenty-six knees). Orientation of the implants was compared by using three-dimensional CT data.
RESULTS
No significant differences were found between the study and control groups with respect to any clinical outcome after a minimum of six months of follow-up. The patient-specific tibial cutting block was abandoned in favor of a standard external alignment jig in seven of the twenty-two study knees because of possible malalignment. A detailed analysis of intent-to-treat and per-protocol groups of study and control knees did not show any significant improvement in component alignment, including femoral component rotation in the axial plane, in the patients treated with the custom instruments. The percentage of outliers--defined as less than -3° or more than 3° from the correct orientation of the tibial slope--was significantly higher in the group treated with use of patient-specific blocks than it was in the control group, in both the intent-to-treat (32% versus 8%, p = 0.032) and the per-protocol (47% versus 6%, p = 0.0008) analysis.
CONCLUSIONS
There were no significant improvements in clinical outcomes or knee component alignment in patients treated with patient-specific cutting blocks as compared with those treated with standard instruments. The group treated with patient-specific cutting blocks had a significantly higher prevalence of malalignment in terms of tibial component slope than the knees treated with standard instruments.
DOI: 10.2106/JBJS.L.01722
PubMed: 24599197
Affiliations:
Links toward previous steps (curation, corpus...)
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Woolson: swoolson@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Harris, Alex H S" sort="Harris, Alex H S" uniqKey="Harris A" first="Alex H S" last="Harris">Alex H S. Harris</name><affiliation wicri:level="2"><nlm:affiliation>VA Palo Alto Center for Health Care Evaluation, 795 Willow Road, Menlo Park, CA 94025.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>VA Palo Alto Center for Health Care Evaluation, 795 Willow Road, Menlo Park</wicri:cityArea></affiliation></author><author><name sortKey="Wagner, David W" sort="Wagner, David W" uniqKey="Wagner D" first="David W" last="Wagner">David W. Wagner</name><affiliation wicri:level="2"><nlm:affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Giori, Nicholas J" sort="Giori, Nicholas J" uniqKey="Giori N" first="Nicholas J" last="Giori">Nicholas J. Giori</name><affiliation wicri:level="2"><nlm:affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:24599197</idno><idno type="pmid">24599197</idno><idno type="doi">10.2106/JBJS.L.01722</idno><idno type="wicri:Area/Main/Corpus">001142</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001142</idno><idno type="wicri:Area/Main/Curation">001142</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">001142</idno><idno type="wicri:Area/Main/Exploration">001142</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement.</title><author><name sortKey="Woolson, Steven T" sort="Woolson, Steven T" uniqKey="Woolson S" first="Steven T" last="Woolson">Steven T. Woolson</name><affiliation wicri:level="2"><nlm:affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Harris, Alex H S" sort="Harris, Alex H S" uniqKey="Harris A" first="Alex H S" last="Harris">Alex H S. Harris</name><affiliation wicri:level="2"><nlm:affiliation>VA Palo Alto Center for Health Care Evaluation, 795 Willow Road, Menlo Park, CA 94025.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>VA Palo Alto Center for Health Care Evaluation, 795 Willow Road, Menlo Park</wicri:cityArea></affiliation></author><author><name sortKey="Wagner, David W" sort="Wagner, David W" uniqKey="Wagner D" first="David W" last="Wagner">David W. Wagner</name><affiliation wicri:level="2"><nlm:affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Giori, Nicholas J" sort="Giori, Nicholas J" uniqKey="Giori N" first="Nicholas J" last="Giori">Nicholas J. Giori</name><affiliation wicri:level="2"><nlm:affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto</wicri:cityArea></affiliation></author></analytic><series><title level="j">The Journal of bone and joint surgery. American volume</title><idno type="eISSN">1535-1386</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Arthroplasty, Replacement, Knee (instrumentation)</term><term>Arthroplasty, Replacement, Knee (methods)</term><term>Femur (diagnostic imaging)</term><term>Femur (surgery)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Postoperative Care (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Single-Blind Method (MeSH)</term><term>Tibia (diagnostic imaging)</term><term>Tibia (surgery)</term><term>Tomography, X-Ray Computed (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Arthroplastie prothétique de genou (instrumentation)</term><term>Arthroplastie prothétique de genou (méthodes)</term><term>Fémur (chirurgie)</term><term>Fémur (imagerie diagnostique)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Méthode en simple aveugle (MeSH)</term><term>Soins postopératoires (MeSH)</term><term>Tibia (chirurgie)</term><term>Tibia (imagerie diagnostique)</term><term>Tomodensitométrie (MeSH)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" qualifier="chirurgie" xml:lang="fr"><term>Fémur</term><term>Tibia</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Femur</term><term>Tibia</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Fémur</term><term>Tibia</term></keywords><keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Arthroplasty, Replacement, Knee</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Arthroplastie prothétique de genou</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Femur</term><term>Tibia</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Male</term><term>Postoperative Care</term><term>Prospective Studies</term><term>Single-Blind Method</term><term>Tomography, X-Ray Computed</term></keywords><keywords scheme="MESH" qualifier="instrumentation" xml:lang="fr"><term>Arthroplastie prothétique de genou</term><term>Humains</term><term>Mâle</term><term>Méthode en simple aveugle</term><term>Soins postopératoires</term><term>Tomodensitométrie</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Patient-specific femoral and tibial cutting blocks produced with use of data from preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans have been employed recently to optimize component alignment in total knee arthroplasty. We report the results of a randomized controlled trial in which CT scans were used to compare postoperative component alignment between patients treated with custom instruments and those managed with traditional instruments.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>The in-hospital data and early clinical outcomes, including Knee Society scores, were determined in a randomized clinical trial of forty-seven patients who had undergone a total of forty-eight primary total knee arthroplasties with patient-specific instruments (twenty-two knees) or standard instruments (twenty-six knees). Orientation of the implants was compared by using three-dimensional CT data.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>No significant differences were found between the study and control groups with respect to any clinical outcome after a minimum of six months of follow-up. The patient-specific tibial cutting block was abandoned in favor of a standard external alignment jig in seven of the twenty-two study knees because of possible malalignment. A detailed analysis of intent-to-treat and per-protocol groups of study and control knees did not show any significant improvement in component alignment, including femoral component rotation in the axial plane, in the patients treated with the custom instruments. The percentage of outliers--defined as less than -3° or more than 3° from the correct orientation of the tibial slope--was significantly higher in the group treated with use of patient-specific blocks than it was in the control group, in both the intent-to-treat (32% versus 8%, p = 0.032) and the per-protocol (47% versus 6%, p = 0.0008) analysis.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>There were no significant improvements in clinical outcomes or knee component alignment in patients treated with patient-specific cutting blocks as compared with those treated with standard instruments. The group treated with patient-specific cutting blocks had a significantly higher prevalence of malalignment in terms of tibial component slope than the knees treated with standard instruments.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24599197</PMID><DateCompleted><Year>2014</Year><Month>04</Month><Day>28</Day></DateCompleted><DateRevised><Year>2016</Year><Month>11</Month><Day>25</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1535-1386</ISSN><JournalIssue CitedMedium="Internet"><Volume>96</Volume><Issue>5</Issue><PubDate><Year>2014</Year><Month>Mar</Month><Day>05</Day></PubDate></JournalIssue><Title>The Journal of bone and joint surgery. American volume</Title><ISOAbbreviation>J Bone Joint Surg Am</ISOAbbreviation></Journal><ArticleTitle>Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement.</ArticleTitle><Pagination><MedlinePgn>366-72</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.2106/JBJS.L.01722</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Patient-specific femoral and tibial cutting blocks produced with use of data from preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans have been employed recently to optimize component alignment in total knee arthroplasty. We report the results of a randomized controlled trial in which CT scans were used to compare postoperative component alignment between patients treated with custom instruments and those managed with traditional instruments.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">The in-hospital data and early clinical outcomes, including Knee Society scores, were determined in a randomized clinical trial of forty-seven patients who had undergone a total of forty-eight primary total knee arthroplasties with patient-specific instruments (twenty-two knees) or standard instruments (twenty-six knees). Orientation of the implants was compared by using three-dimensional CT data.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">No significant differences were found between the study and control groups with respect to any clinical outcome after a minimum of six months of follow-up. The patient-specific tibial cutting block was abandoned in favor of a standard external alignment jig in seven of the twenty-two study knees because of possible malalignment. A detailed analysis of intent-to-treat and per-protocol groups of study and control knees did not show any significant improvement in component alignment, including femoral component rotation in the axial plane, in the patients treated with the custom instruments. The percentage of outliers--defined as less than -3° or more than 3° from the correct orientation of the tibial slope--was significantly higher in the group treated with use of patient-specific blocks than it was in the control group, in both the intent-to-treat (32% versus 8%, p = 0.032) and the per-protocol (47% versus 6%, p = 0.0008) analysis.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">There were no significant improvements in clinical outcomes or knee component alignment in patients treated with patient-specific cutting blocks as compared with those treated with standard instruments. The group treated with patient-specific cutting blocks had a significantly higher prevalence of malalignment in terms of tibial component slope than the knees treated with standard instruments.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Woolson</LastName><ForeName>Steven T</ForeName><Initials>ST</Initials><AffiliationInfo><Affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Harris</LastName><ForeName>Alex H S</ForeName><Initials>AH</Initials><AffiliationInfo><Affiliation>VA Palo Alto Center for Health Care Evaluation, 795 Willow Road, Menlo Park, CA 94025.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wagner</LastName><ForeName>David W</ForeName><Initials>DW</Initials><AffiliationInfo><Affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Giori</LastName><ForeName>Nicholas J</ForeName><Initials>NJ</Initials><AffiliationInfo><Affiliation>Surgery Section 112 (S.T.W. and N.J.G.) and Center for Tissue Regeneration, Repair and Restoration (D.W.W.), Palo Alto Veterans Administration Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304. E-mail address for S.T. Woolson: swoolson@stanford.edu.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Bone Joint Surg Am</MedlineTA><NlmUniqueID>0014030</NlmUniqueID><ISSNLinking>0021-9355</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D019645" MajorTopicYN="N">Arthroplasty, Replacement, Knee</DescriptorName><QualifierName UI="Q000295" MajorTopicYN="Y">instrumentation</QualifierName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005269" MajorTopicYN="N">Femur</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="Y">diagnostic imaging</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011182" MajorTopicYN="N">Postoperative Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016037" MajorTopicYN="N">Single-Blind Method</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013977" MajorTopicYN="N">Tibia</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="Y">diagnostic imaging</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014057" MajorTopicYN="Y">Tomography, X-Ray Computed</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2014</Year><Month>3</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2014</Year><Month>3</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2014</Year><Month>4</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">24599197</ArticleId><ArticleId IdType="pii">1832414</ArticleId><ArticleId IdType="doi">10.2106/JBJS.L.01722</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li></region></list><tree><country name="États-Unis"><region name="Californie"><name sortKey="Woolson, Steven T" sort="Woolson, Steven T" uniqKey="Woolson S" first="Steven T" last="Woolson">Steven T. Woolson</name></region><name sortKey="Giori, Nicholas J" sort="Giori, Nicholas J" uniqKey="Giori N" first="Nicholas J" last="Giori">Nicholas J. Giori</name><name sortKey="Harris, Alex H S" sort="Harris, Alex H S" uniqKey="Harris A" first="Alex H S" last="Harris">Alex H S. Harris</name><name sortKey="Wagner, David W" sort="Wagner, David W" uniqKey="Wagner D" first="David W" last="Wagner">David W. Wagner</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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