Clinical and genetic characteristics in a group of 45 patients with Turner syndrome (monocentric study)
Identifieur interne : 000360 ( Pmc/Checkpoint ); précédent : 000359; suivant : 000361Clinical and genetic characteristics in a group of 45 patients with Turner syndrome (monocentric study)
Auteurs : Simona Bucerzan [Roumanie] ; Diana Miclea [Roumanie] ; Radu Popp [Roumanie] ; Camelia Alkhzouz [Roumanie] ; Cecilia Lazea [Roumanie] ; Ioan Victor Pop [Roumanie] ; Paula Grigorescu-Sido [Roumanie]Source :
- Therapeutics and Clinical Risk Management [ 1176-6336 ] ; 2017.
Abstract
Recent years have seen a shift in perspective on Turner syndrome, as it is no longer considered a significant disability due to therapeutic advances. The delay of diagnosis and the underdiagnosis are common in Turner syndrome, especially because of the great phenotypic variability and lack of firm diagnostic criteria.
Our first aim was to assess the clinical and the cytogenetic characteristics and growth rate in growth hormone (GH)-treated patients as compared to those with spontaneous growth. The second aim was to analyze the Y chromosomal sequences.
We analyzed 45 patients diagnosed with Turner syndrome in Genetic Pathology Centre of Cluj Emergency Children’s Hospital. We carried out a study of the clinical features, the correlations between the karyotype and the phenotype, and we also made a research of Y chromosome sequences.
The average age at diagnosis was 8.9±5.4 years. A significant association was observed between the number of external phenotypical abnormalities and internal malformations (
The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be conducted.
Url:
DOI: 10.2147/TCRM.S126301
PubMed: 28496331
PubMed Central: 5422538
Affiliations:
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Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="af2-tcrm-13-613">Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author><author><name sortKey="Popp, Radu" sort="Popp, Radu" uniqKey="Popp R" first="Radu" last="Popp">Radu Popp</name><affiliation wicri:level="1"><nlm:aff id="af2-tcrm-13-613">Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country 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uniqKey="Grigorescu Sido P" first="Paula" last="Grigorescu-Sido">Paula Grigorescu-Sido</name><affiliation wicri:level="1"><nlm:aff id="af1-tcrm-13-613">Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28496331</idno><idno type="pmc">5422538</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422538</idno><idno type="RBID">PMC:5422538</idno><idno type="doi">10.2147/TCRM.S126301</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">004647</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004647</idno><idno 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Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author><author><name sortKey="Miclea, Diana" sort="Miclea, Diana" uniqKey="Miclea D" first="Diana" last="Miclea">Diana Miclea</name><affiliation wicri:level="1"><nlm:aff id="af1-tcrm-13-613">Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="af2-tcrm-13-613">Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author><author><name sortKey="Popp, Radu" sort="Popp, Radu" uniqKey="Popp R" first="Radu" last="Popp">Radu Popp</name><affiliation wicri:level="1"><nlm:aff id="af2-tcrm-13-613">Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author><author><name sortKey="Alkhzouz, Camelia" sort="Alkhzouz, Camelia" uniqKey="Alkhzouz C" first="Camelia" last="Alkhzouz">Camelia Alkhzouz</name><affiliation wicri:level="1"><nlm:aff id="af1-tcrm-13-613">Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author><author><name sortKey="Lazea, Cecilia" sort="Lazea, Cecilia" uniqKey="Lazea C" first="Cecilia" last="Lazea">Cecilia Lazea</name><affiliation wicri:level="1"><nlm:aff id="af1-tcrm-13-613">Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author><author><name sortKey="Pop, Ioan Victor" sort="Pop, Ioan Victor" uniqKey="Pop I" first="Ioan Victor" last="Pop">Ioan Victor Pop</name><affiliation wicri:level="1"><nlm:aff id="af2-tcrm-13-613">Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author><author><name sortKey="Grigorescu Sido, Paula" sort="Grigorescu Sido, Paula" uniqKey="Grigorescu Sido P" first="Paula" last="Grigorescu-Sido">Paula Grigorescu-Sido</name><affiliation wicri:level="1"><nlm:aff id="af1-tcrm-13-613">Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</nlm:aff><country xml:lang="fr">Roumanie</country><wicri:regionArea>Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca</wicri:regionArea><wicri:noRegion>Cluj-Napoca</wicri:noRegion></affiliation></author></analytic><series><title level="j">Therapeutics and Clinical Risk Management</title><idno type="ISSN">1176-6336</idno><idno type="eISSN">1178-203X</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Recent years have seen a shift in perspective on Turner syndrome, as it is no longer considered a significant disability due to therapeutic advances. The delay of diagnosis and the underdiagnosis are common in Turner syndrome, especially because of the great phenotypic variability and lack of firm diagnostic criteria.</p></sec><sec><title>Aim</title><p>Our first aim was to assess the clinical and the cytogenetic characteristics and growth rate in growth hormone (GH)-treated patients as compared to those with spontaneous growth. The second aim was to analyze the Y chromosomal sequences.</p></sec><sec><title>Materials and methods</title><p>We analyzed 45 patients diagnosed with Turner syndrome in Genetic Pathology Centre of Cluj Emergency Children’s Hospital. We carried out a study of the clinical features, the correlations between the karyotype and the phenotype, and we also made a research of Y chromosome sequences.</p></sec><sec><title>Results</title><p>The average age at diagnosis was 8.9±5.4 years. A significant association was observed between the number of external phenotypical abnormalities and internal malformations (<italic>r</italic>=0.45), particularly the cardiovascular ones (<italic>r</italic>=0.44). Patients treated with GH showed improvement in growth rate, with final stature significantly better than in untreated patients; benefits following treatment were greater if diagnosis was made before the age of 5 years. Thirteen percent of patients experienced spontaneous and complete puberty, whereas 30% experienced incomplete puberty. Patients with the 45,X genotype had a greater stature deficit and a higher incidence of cardiac malformations, compared with patients with 45,X/46,XX mosaic karyotype. Y chromosome sequences were found in only one patient, who subsequently underwent gonadectomy.</p></sec><sec><title>Conclusion</title><p>The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be conducted.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Davenport, Ml" uniqKey="Davenport M">ML Davenport</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cabrol, S" uniqKey="Cabrol S">S Cabrol</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nwosu, Ec" uniqKey="Nwosu E">EC Nwosu</name></author><author><name sortKey="Brockbank, A" uniqKey="Brockbank A">A Brockbank</name></author><author><name sortKey="Walkinshaw, Sa" uniqKey="Walkinshaw S">SA Walkinshaw</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hovatta, O" uniqKey="Hovatta O">O Hovatta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Massa, G" uniqKey="Massa G">G 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Ther Clin Risk Manag</journal-id><journal-id journal-id-type="iso-abbrev">Ther Clin Risk Manag</journal-id><journal-id journal-id-type="publisher-id">Therapeutics and Clinical Risk Management</journal-id><journal-title-group><journal-title>Therapeutics and Clinical Risk Management</journal-title></journal-title-group><issn pub-type="ppub">1176-6336</issn><issn pub-type="epub">1178-203X</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28496331</article-id><article-id pub-id-type="pmc">5422538</article-id><article-id pub-id-type="doi">10.2147/TCRM.S126301</article-id><article-id pub-id-type="publisher-id">tcrm-13-613</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Clinical and genetic characteristics in a group of 45 patients with Turner syndrome (monocentric study)</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bucerzan</surname><given-names>Simona</given-names></name><xref ref-type="aff" rid="af1-tcrm-13-613">1</xref></contrib><contrib contrib-type="author"><name><surname>Miclea</surname><given-names>Diana</given-names></name><xref ref-type="aff" rid="af1-tcrm-13-613">1</xref><xref ref-type="aff" rid="af2-tcrm-13-613">2</xref><xref ref-type="corresp" rid="c1-tcrm-13-613"></xref></contrib><contrib contrib-type="author"><name><surname>Popp</surname><given-names>Radu</given-names></name><xref ref-type="aff" rid="af2-tcrm-13-613">2</xref></contrib><contrib contrib-type="author"><name><surname>Alkhzouz</surname><given-names>Camelia</given-names></name><xref ref-type="aff" rid="af1-tcrm-13-613">1</xref></contrib><contrib contrib-type="author"><name><surname>Lazea</surname><given-names>Cecilia</given-names></name><xref ref-type="aff" rid="af1-tcrm-13-613">1</xref></contrib><contrib contrib-type="author"><name><surname>Pop</surname><given-names>Ioan Victor</given-names></name><xref ref-type="aff" rid="af2-tcrm-13-613">2</xref></contrib><contrib contrib-type="author"><name><surname>Grigorescu-Sido</surname><given-names>Paula</given-names></name><xref ref-type="aff" rid="af1-tcrm-13-613">1</xref></contrib></contrib-group><aff id="af1-tcrm-13-613"><label>1</label>Emergency Hospital for Children, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</aff><aff id="af2-tcrm-13-613"><label>2</label>Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania</aff><author-notes><corresp id="c1-tcrm-13-613">Correspondence: Diana Miclea, Emergency Hospital for Children, Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8, Victor Babes street, 400012, Cluj-Napoca, Romania, Email <email>bolca12diana@yahoo.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2017</year></pub-date><pub-date pub-type="epub"><day>04</day><month>5</month><year>2017</year></pub-date><volume>13</volume><fpage>613</fpage><lpage>622</lpage><permissions><copyright-statement>© 2017 Bucerzan et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement><copyright-year>2017</copyright-year><license><license-p>The full terms of this license are available at <ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link> and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Introduction</title><p>Recent years have seen a shift in perspective on Turner syndrome, as it is no longer considered a significant disability due to therapeutic advances. The delay of diagnosis and the underdiagnosis are common in Turner syndrome, especially because of the great phenotypic variability and lack of firm diagnostic criteria.</p></sec><sec><title>Aim</title><p>Our first aim was to assess the clinical and the cytogenetic characteristics and growth rate in growth hormone (GH)-treated patients as compared to those with spontaneous growth. The second aim was to analyze the Y chromosomal sequences.</p></sec><sec><title>Materials and methods</title><p>We analyzed 45 patients diagnosed with Turner syndrome in Genetic Pathology Centre of Cluj Emergency Children’s Hospital. We carried out a study of the clinical features, the correlations between the karyotype and the phenotype, and we also made a research of Y chromosome sequences.</p></sec><sec><title>Results</title><p>The average age at diagnosis was 8.9±5.4 years. A significant association was observed between the number of external phenotypical abnormalities and internal malformations (<italic>r</italic>=0.45), particularly the cardiovascular ones (<italic>r</italic>=0.44). Patients treated with GH showed improvement in growth rate, with final stature significantly better than in untreated patients; benefits following treatment were greater if diagnosis was made before the age of 5 years. Thirteen percent of patients experienced spontaneous and complete puberty, whereas 30% experienced incomplete puberty. Patients with the 45,X genotype had a greater stature deficit and a higher incidence of cardiac malformations, compared with patients with 45,X/46,XX mosaic karyotype. Y chromosome sequences were found in only one patient, who subsequently underwent gonadectomy.</p></sec><sec><title>Conclusion</title><p>The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be conducted.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>Turner syndrome</kwd><kwd>diagnosis</kwd><kwd>phenotype</kwd><kwd>karyotype</kwd><kwd>GH treatment</kwd><kwd>Y chromosome sequences</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-tcrm-13-613" position="float"><label>Figure 1</label><caption><p>Patients’ distribution according to their geographic area of origin in Romania.</p><p><bold>Abbreviations:</bold> AB, Alba; AG, Argeş; AR, Arad; B, Bucureşti; BC, Bacău; BH, Bihor; BN, Bistriţa-Năsăud; BR, Brăila; BT, Botoşani; BV, Braşov; BZ, Buzău; CJ, Cluj; CL, Călăraţi; CS, Caraş-Severin; CT, Constanşa; CV, Covasna; DB, Dâmboviţa; DJ, Dolj; GJ, Gorj; GL, Galaţi; GR, Giurgiu; HD, Hunedoara; HR, Harghita; IL, Ialomiţa; IS, Iaşi; MH, Mehedinţi; MM, Maramureş; MS, Mureş; NT, Neamţ; OT, Olt; PH, Prahova; SB, Sibiu; SJ, Sălaj; SM, Satu Mare; SV, Suceava; TL, Tulcea; TM, Timiş; TR, Teleorman; VL, Vâlcea; VN, Vrancea; VS, Vaslui.</p></caption><graphic xlink:href="tcrm-13-613Fig1"></graphic></fig><fig id="f2-tcrm-13-613" position="float"><label>Figure 2</label><caption><p>The main craniofacial dysmorphic signs observed in our patients.</p></caption><graphic xlink:href="tcrm-13-613Fig2"></graphic></fig><fig id="f3-tcrm-13-613" position="float"><label>Figure 3</label><caption><p>(<bold>A</bold>) Frequency of the main malformations (n=45); (<bold>B</bold>) skeletal abnormalities; (<bold>C</bold>) cardiovascular malformations; (<bold>D</bold>) renal malformations.</p></caption><graphic xlink:href="tcrm-13-613Fig3"></graphic></fig><fig id="f4-tcrm-13-613" position="float"><label>Figure 4</label><caption><p>The main clinical signs leading to diagnosis at different ages.</p></caption><graphic xlink:href="tcrm-13-613Fig4"></graphic></fig><fig id="f5-tcrm-13-613" position="float"><label>Figure 5</label><caption><p>Height at diagnosis (SD) in our study group.</p><p><bold>Abbreviation:</bold> SD, standard deviation.</p></caption><graphic xlink:href="tcrm-13-613Fig5"></graphic></fig><fig id="f6-tcrm-13-613" position="float"><label>Figure 6</label><caption><p>Classical phenotype of a patient (10 years old) with Turner syndrome.</p></caption><graphic xlink:href="tcrm-13-613Fig6"></graphic></fig><fig id="f7-tcrm-13-613" position="float"><label>Figure 7</label><caption><p>Stature growth in patients with Turner syndrome with/without GH treatment.</p><p><bold>Notes:</bold> (<bold>A</bold>) Stature (SD); (<bold>B</bold>) growth rate (cm/year) (*<italic>P</italic><0.05; **<italic>P</italic><0.001). Data in the figure are presented as mean ± standard deviation.</p><p><bold>Abbreviations:</bold> GH, growth hormone; SD, standard deviation; NS, not significant.</p></caption><graphic xlink:href="tcrm-13-613Fig7"></graphic></fig><fig id="f8-tcrm-13-613" position="float"><label>Figure 8</label><caption><p>Secondary sexual characteristics in patients with Turner syndrome, aged ≥12 years (n=30).</p></caption><graphic xlink:href="tcrm-13-613Fig8"></graphic></fig><table-wrap id="t1-tcrm-13-613" position="float"><label>Table 1</label><caption><p>Auxology in patients with Turner syndrome</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Somatic development</th><th valign="top" align="left" rowspan="1" colspan="1">n=45, mean ± standard deviation</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>At birth</bold></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Gestational age (weeks)</td><td valign="top" align="left" rowspan="1" colspan="1">38.52±1.64</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Newborn length (cm/SD)</td><td valign="top" align="left" rowspan="1" colspan="1">50.45±2.99/0.72±1.68</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Newborn weight (g/SD)</td><td valign="top" align="left" rowspan="1" colspan="1">2,923.9±466.7/−0.63±1.307</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>At diagnosis</bold></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Age at diagnosis (years)</td><td valign="top" align="left" rowspan="1" colspan="1">8.9±5.4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Height at diagnosis (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">−2.79±2.15</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Midparental height (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">−0.17±0.89</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Predictive height (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">−1.92±1.28</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Weight at diagnosis (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">2.27±2.34</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Roumanie</li></country></list><tree><country name="Roumanie"><noRegion><name sortKey="Bucerzan, Simona" sort="Bucerzan, Simona" uniqKey="Bucerzan S" first="Simona" last="Bucerzan">Simona Bucerzan</name></noRegion><name sortKey="Alkhzouz, Camelia" sort="Alkhzouz, Camelia" uniqKey="Alkhzouz C" first="Camelia" last="Alkhzouz">Camelia Alkhzouz</name><name sortKey="Grigorescu Sido, Paula" sort="Grigorescu Sido, Paula" uniqKey="Grigorescu Sido P" first="Paula" last="Grigorescu-Sido">Paula Grigorescu-Sido</name><name sortKey="Lazea, Cecilia" sort="Lazea, Cecilia" uniqKey="Lazea C" first="Cecilia" last="Lazea">Cecilia Lazea</name><name sortKey="Miclea, Diana" sort="Miclea, Diana" uniqKey="Miclea D" first="Diana" last="Miclea">Diana Miclea</name><name sortKey="Miclea, Diana" sort="Miclea, Diana" uniqKey="Miclea D" first="Diana" last="Miclea">Diana Miclea</name><name sortKey="Pop, Ioan Victor" sort="Pop, Ioan Victor" uniqKey="Pop I" first="Ioan Victor" last="Pop">Ioan Victor Pop</name><name sortKey="Popp, Radu" sort="Popp, Radu" uniqKey="Popp R" first="Radu" last="Popp">Radu Popp</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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