Amir Lerman

Sun Yat-Sen University, Shengcheng, Guangdong, China

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Publications (613)4730.94 Total impact

  • Circulation Cardiovascular Imaging 12/2015; 8(1). DOI:10.1161/CIRCIMAGING.114.002636 · 5.32 Impact Factor
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    ABSTRACT: Ghrelin is a growth hormone-releasing peptide, isolated from the stomach. Researches in progress documented that ghrelin participates in the stimulation of the hypothalamus-pituitary-adrenal axis at the hypothalamic level and in the regulation of energy balance. Growth hormone-independent functions have been ascribed to ghrelin. Among others, a large body of literature demonstrated the presence of specific receptors for ghrelin, distributed at the level of cardiomyocytes and endothelial cells. Therefore, a link between ghrelin and cardiovascular system has been hypothesized and, then, demonstrated in both experimental and clinical studies. Ghrelin has largely documented cardiac beneficial effects, including protection from ischemia/reperfusion injury, attenuation of left ventricular remodeling following myocardial infarction, and improvement of left ventricular function. Exercise level in patients with chronic heart failure had also been seen. Ghrelin exerts these effects through several mechanisms, including the inhibition of apoptosis. At the level of blood vessels, ghrelin exerts a significant impact on vascular function. In particular, acutely infused, ghrelin reverses endothelial dysfunction by increasing NO availability and restores the endothelin-1/nitric oxide imbalance in the peripheral microcirculation of patients with metabolic syndrome. Antioxidant/anti-inflammatory effects, and-or an ameliorated insulin sensitivity are proposed mechanisms whereby ghrelin exerts its vascular protective actions. At higher doses, ghrelin also decreases blood pressure, by mechanisms that involve the modulation of sympathetic nervous system. This finding highlights the ghrelin system as a promising candidate for cardiovascular drug discovery.
    Current pharmaceutical design 11/2015; · 3.45 Impact Factor
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    ABSTRACT: Background: Endothelial dysfunction plays a pivotal role in cardiovascular disease progression, and is associated with adverse events. The purpose of this systematic review and meta-analysis was to investigate the prognostic magnitude of noninvasive peripheral endothelial function tests, brachial artery flow-mediated dilation (FMD), and reactive hyperemia--peripheral arterial tonometry (RH-PAT) for future cardiovascular events. Methods and results: Databases of MEDLINE, EMBASE, and the Cochrane Library were systematically searched. Clinical studies reporting the predictive value of FMD or RH-PAT for cardiovascular events were identified. Two authors selected studies and extracted data independently. Pooled effects were calculated as risk ratio (RR) for continuous value of FMD and natural logarithm of RH-PAT index (Ln_RHI) using random-effects models. Thirty-five FMD studies of 17 280 participants and 6 RH-PAT studies of 1602 participants were included in the meta-analysis. Both endothelial function tests significantly predicted cardiovascular events (adjusted relative risk [95% CI]: 1% increase in FMD 0.88 [0.84-0.91], P<0.001, 0.1 increase in Ln_RHI 0.79 [0.71-0.87], P<0.001). There was significant heterogeneity in the magnitude of the association across studies. The magnitude of the prognostic value in cardiovascular disease subjects was comparable between these 2 methods; a 1 SD worsening in endothelial function was associated with doubled cardiovascular risk. Conclusions: Noninvasive peripheral endothelial function tests, FMD and RH-PAT, significantly predicted cardiovascular events, with similar prognostic magnitude. Further research is required to determine whether the prognostic values of these 2 methods are independent of each other and whether an endothelial function-guided strategy can provide benefit in improving cardiovascular outcomes.
    Journal of the American Heart Association 11/2015; 4(11):e002270-e002270. DOI:10.1161/JAHA.115.002270 · 4.31 Impact Factor
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    ABSTRACT: Background: Coronary microvascular dysfunction (CMD) is linked to adverse cardiovascular events. Definitive diagnosis of CMD requires invasive provocative testing during angiography. We developed and tested a novel computerized T wave analysis tool to identify electrocardiographic signatures of CMD. Methods: 1552 patients underwent an invasive assessment of coronary microvascular function. Patients with interpretable pre-procedural ECGs were divided into 2 age and sex matched groups (n=261 in each group, 75% female): normal microvascular function, CFR>2.5 (CFR+), and abnormal microvascular function, CFR≤2.5 (CFR-). ECGs were evaluated using a novel T wave program that quantified subtle changes in T wave morphology. Results: T wave repolarization parameters were significantly different between patients with normal and abnormal microvascular function. The top 3 features in males comprised of T wave area in V6 (CFR+: 10091.4mV(2) vs. CFR-: 8152.3mV(2), p<0.05); T1 Y-center of gravity in lead II (CFR+: 17.8mV vs. CFR-: 22.4, p<0.005) and T Peak-T End in lead II (CFR+: 97.6msec vs. CFR-: 91.1msec, p<0.05). These could identify the presence of an abnormal CFR with 74±0.2% accuracy. In females, the top 3 features were T wave right slope lead V6 (CFR+: -2489.1mV/msec vs. CFR-: -2352.3mV/msec, p<0.005); Amplitude in V6 (CFR+: 190.4mV vs. 172.7mV, p=0.05) and Y-center of gravity in lead V1 (CFR+: 33.3 vs. CFR-: 40.0, p=0.001). These features could identify the presence of an abnormal CFR with 67±0.3% accuracy. Conclusion: Our data demonstrates that a computer-based repolarization measurement tool may identify electrocardiographic signatures of CMD.
    International journal of cardiology 11/2015; 203. DOI:10.1016/j.ijcard.2015.10.228 · 4.04 Impact Factor
  • Megha Prasad · Lilach O. Lerman · Amir Lerman ·

    Journal of the American College of Cardiology 11/2015; 66(19):2126-2128. DOI:10.1016/j.jacc.2015.09.023 · 16.50 Impact Factor

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    ABSTRACT: Background: Decellularized heart valves are emerging as a potential alternative to current bioprostheses for valve replacement. Whereas techniques of decellularization have been thoroughly examined, terminal sterilization techniques have not received the same scrutiny. Methods: This study evaluated low-dose gamma irradiation as a sterilization method for decellularized heart valves. Incubation of valves and transmission electron microscopy evaluation after different doses of gamma irradiation were used to determine the optimal dose of gamma irradiation. Quantitative evaluation of mechanical properties was done by tensile mechanical testing of isolated cusps. Sterilized decellularized heart valves were tested in a sheep model (n = 3 [1 at 1,500 Gy and 2 at 3,000 Gy]) of pulmonary valve replacement. Results: Valves sterilized with gamma radiation between 1,000 Gy and 3,000 Gy were found to be optimal with in vitro testing. However, in vivo testing showed deteriorating valve function within 2 months. On explant, the valve with 1,500 Gy gamma irradiation showed signs of endocarditis with neutrophils on hematoxylin and eosin staining, and positive gram stain resembling streptococcus infection. The 3,000 Gy valves had no evidence of infection, but the hematoxylin and eosin staining showed evidence of wound remodeling with macrophages and fibroblasts. Tensile strength testing showed decreased strength (0 Gy: 2.53 ± 0.98 MPa, 1,500 Gy: 2.03 ± 1.23 MPa, and 3,000 Gy: 1.26 ± 0.90 MPa) with increasing levels of irradiation. Conclusions: Low-dose gamma irradiation does not maintain the mechanical integrity of valves, and the balance between sterilization and damage may not be able to be achieved with gamma irradiation. Other methods of terminal sterilization must be pursued and evaluated.
    The Annals of thoracic surgery 10/2015; DOI:10.1016/j.athoracsur.2015.07.080 · 3.85 Impact Factor

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    ABSTRACT: Purpose: Perirenal fat is associated with poor blood pressure control and chronic kidney disease, but the underlying mechanisms remain elusive. We tested the hypothesis that perirenal fat impairs renal arterial endothelial function in pigs with obesity-metabolic derangements (ObM). Material and methods: Fourteen domestic pigs were studied after 16 weeks of a high-fat/high-fructose diet (ObM) or standard chow (Lean). Renal blood flow (RBF), glomerular filtration rate (GFR), and visceral fat volumes were studied in-vivo with CT. Renal arterial endothelial function was also studied ex-vivo in the organ bath. Results: ObM pigs demonstrated increased body weight, blood pressure, cholesterol, and intra-abdominal fat compared to lean pigs, and perirenal fat volume was significantly larger. RBF and GFR were markedly elevated, while urinary protein level was preserved. Ex-vivo acetylcholine-induced endothelium-dependent vasodilation of renal artery rings was substantially impaired in ObM compared to Lean. Endothelial function was further blunted in both ObM and Lean arterial rings by incubation with perirenal fat harvested from ObM, but not from Lean pigs, and was restored by inhibition of tumor necrosis factor (TNF)-α. ObM perirenal fat also showed increased pro-inflammatory macrophage infiltration and TNF-α expression. Conclusions: ObM perirenal fat directly causes renal artery endothelial dysfunction, partly mediated by TNF-α.
    The Journal of urology 09/2015; DOI:10.1016/j.juro.2015.08.105 · 4.47 Impact Factor
  • Amir Lerman · Taek-Geun Kwon · Lilach O Lerman ·

    JACC. Cardiovascular imaging 09/2015; 8(9):1068-70. DOI:10.1016/j.jcmg.2015.05.008 · 7.19 Impact Factor
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    ABSTRACT: Epicardial adipose tissue (EAT) has been recognized as a sensitive marker of cardiometabolic risk. Recent evidence suggests efficacy of long-term statin therapy in reducing EAT in patients with coronary artery disease. Whether short-term statin therapy is associated with changes in the volume of EAT is currently unknown. A cohort of patients with atrial fibrillation who underwent pulmonary vein isolation were randomized to receive either 80 mg/day of atorvastatin (n = 38, 32 men, age 56 ± 11 years) or placebo (n = 41, 33 men, age 56 ± 10 years) for a 3-month period. EAT volume was assessed by cardiac computed tomography at baseline and at follow-up. Patients randomized to statin treatment exhibited a modest but significant decrease in median EAT volume (baseline vs follow-up: 92.3 cm(3) [62.0 to 133.3] vs 86.9 cm(3) [64.1 to 124.8], p <0.05), whereas median EAT remained unchanged in the placebo group (81.9 cm(3) [55.5 to 110.9] vs 81.3 cm(3) [57.1 to 110.5], p = NS). Changes in median systemic inflammatory markers and lipid profile were also seen with statin treatment: C-reactive protein (2.4 mg/L [0.7 to 3.7] vs 1.1 mg/L [0.5 to 2.7], p <0.05), total cholesterol (186 mg/dL [162.5 to 201] vs 123 mg/dL [99 to 162.5], p <0.001), and low-density lipoprotein cholesterol (116 mg/dL [96.5 to 132.5] vs 56 [40.5 to 81] mg/dL, p <0.001) diminished, whereas median body mass index did not change (27.8 kg/m(2) [25 to 30] versus 27.6 kg/m(2) [25.7 to 30.5], p = NS). No variations occurred in the placebo group. In conclusion, short-term intensive statin therapy significantly reduced the volume of EAT in patients with atrial fibrillation.
    The American journal of cardiology 09/2015; 116(9). DOI:10.1016/j.amjcard.2015.07.067 · 3.28 Impact Factor
  • Jaskanwal D Sara · Lilach O Lerman · Amir Lerman ·

    Journal of the American College of Cardiology 09/2015; 66(10):1116-8. DOI:10.1016/j.jacc.2015.07.030 · 16.50 Impact Factor
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    ABSTRACT: Objectives This study assessed the prevalence of coronary microvascular abnormalities in patients presenting with chest pain and nonobstructive coronary artery disease (CAD). Background Coronary microvascular abnormalities mediate ischemia and can lead to an increased risk of cardiovascular events. Methods Using an intracoronary Doppler guidewire, endothelial-dependent microvascular function was examined by evaluating changes in coronary blood flow in response to acetylcholine, whereas endothelial-independent microvascular function was examined by evaluating changes in coronary flow velocity reserve in response to intracoronary adenosine. Patients were divided into 4 groups depending on whether they had a normal (+) or abnormal (-) coronary blood flow (CBF) in response to acetylcholine (Ach) and a normal (+) or abnormal (-) coronary flow velocity reserve (CFR) in response to adenosine (Adn): CBFAch+, CFRAdn+ (n = 520); CBFAch-, CFRAdn+ (n = 478); CBFAch+, CFRAdn- (n = 173); and CBFAch-, CFRAdn- (n = 268). Results Two-thirds of all patients had some sort of microvascular dysfunction. Women were more prevalent in each group (56% to 82%). Diabetes was uncommon in all groups (7% to 12%), whereas hypertension and hyperlipidemia were relatively more prevalent in each group, although rates for most conventional cardiovascular risk factors did not differ significantly between groups. There were no significant differences in the findings of noninvasive functional testing between groups. In a multivariable analysis, age was the only variable that independently predicted abnormal microvascular function. Conclusions Patients with chest pain and nonobstructive CAD have a high prevalence of coronary microvascular abnormalities. These abnormalities correlate poorly with conventional cardiovascular risk factors and are dissociated from the findings of noninvasive functional testing.
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    ABSTRACT: Current risk models for predicting long-term mortality after percutaneous coronary intervention are restricted to all-cause mortality. We sought to develop novel risk models for the prediction of cardiac and noncardiac mortality after percutaneous coronary intervention. We retrospectively evaluated patients who underwent index percutaneous coronary intervention at Mayo Clinic from 2003 to 2008. Long-term deaths were ascertained through scheduled prospective surveillance. Cause of death was determined via telephone interviews, medical records, and autopsy reports. Fine and Gray extension of Cox proportional hazards models was used to model cause-specific cumulative incidence. Candidate variables and interactions were chosen a priori, without variable selection methods. Resulting models were mapped to an integer-based risk score. The study comprised 6636 patients followed up over a median of 62 months (25th, 75th percentiles: 45, 77 months). There were 1488 deaths, 518 (35%) cardiac, 938 (63%) noncardiac, and 32 (2%) unknown. The 5-year predicted cardiac mortality ranged from 0.6% to 97%, with a corrected c-statistic of 0.82. Risk factors for cardiac death included age, body mass index, ejection fraction, and history of congestive heart failure. The integer score for noncardiac death included age, medicine index, body mass index, current smoker, noncardiac Charlson index and cardiac Charlson index, and accommodated significant age-based interactions for smoking and the 2 Charlson indices. Predicted noncardiac mortality at 5 years ranged from 0.2% to 81%, with a corrected c-statistic of 0.77. We report novel risk models to predict cardiac and noncardiac long-term mortality after percutaneous coronary intervention. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Interventions 09/2015; 8(9). DOI:10.1161/CIRCINTERVENTIONS.114.002121 · 6.22 Impact Factor
  • Soumen Jana · Amir Lerman · Robert D Simari ·
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    ABSTRACT: The fibrosa layer of a cardiac aortic valve is composed mostly of a dense network of type I collagen fibers oriented in circumferential direction. This main layer bears the tensile load and responds to the high stress on a leaflet. The inner fibrosa layer is also the site of pathophysiologic changes that result in valvular dysfunction, including stenosis and regurgitation. In vitro studies of these changes are limited by the absence of a substrate that mimics the circumferentially oriented structure of the fibrosa layer. In heart valve tissue engineering, generation of this layer is challenging. This study aimed to develop an artificial fibrosa layer of a native aortic leaflet. A unique morphologically biomimicked, pliable but standalone substrate with circumferentially oriented nanofibers was fabricated by electrospinning on a novel collector designed for this study. The substrate had low-bulk tensile stiffness and ultimate strength; thus, cultured valvular interstitial cells (VICs) showed a fibroblast phenotype that is generally observed in healthy aortic leaflet. Furthermore, gene and protein expression and morphology of VICs in substrates were close to those in the fibrosa layer of a native aortic leaflet. This artificial fibrosa layer can be useful for in vitro studies of valvular dysfunctions.
    ACS Applied Materials & Interfaces 08/2015; 7(36). DOI:10.1021/acsami.5b04805 · 6.72 Impact Factor
  • Soumen Jana · Amir Lerman ·
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    ABSTRACT: Heart valve tissue engineering could be a possible solution for the limitations of mechanical and biological prostheses, which are commonly used for heart valve replacement. In tissue engineering, cells and their aggregates are seeded into a 3-dimensional platform, termed the scaffold, to make the engineered tissue construct. However, mimicking the mechanical and spatial heterogeneity of a heart valve structure in a fabricated scaffold with uniform cell distribution is daunting when approached conventionally. Bioprinting is an emerging technique that can produce biological products containing matrix and cells, together or separately with morphological, structural and mechanical diversity. This advance increases the possibility of fabricating the structure of a heart valve in vitro and using it as a functional tissue construct for implantation. This review describes the use of bioprinting technology in heart valve tissue engineering. Copyright © 2015. Published by Elsevier Inc.
    Biotechnology advances 08/2015; DOI:10.1016/j.biotechadv.2015.07.006 · 9.02 Impact Factor

  • Mayo Clinic Proceedings 08/2015; 90(8):1167-8. DOI:10.1016/j.mayocp.2015.05.013 · 6.26 Impact Factor
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    ABSTRACT: Coronary microvascular dysfunction (CMD) is associated with cardiovascular events in type 2 diabetes mellitus (T2DM). Optimal glycaemic control does not always preclude future events. We sought to assess the effect of the current target of HBA1c level on the coronary microcirculatory function and identify predictive factors for CMD in T2DM patients. We studied 100 patients with T2DM and 214 patients without T2DM. All of them with a history of chest pain, non-obstructive angiograms and a direct assessment of coronary blood flow increase in response to adenosine and acetylcholine coronary infusion, for evaluation of endothelial independent and dependent CMD. Patients with T2DM were categorized as having optimal (HbA1c < 7 %) vs. suboptimal (HbA1c ≥ 7 %) glycaemic control at the time of catheterization. Baseline characteristics and coronary endothelial function parameters differed significantly between T2DM patients and control group. The prevalence of endothelial independent CMD (29.8 vs. 39.6 %, p = 0.40) and dependent CMD (61.7 vs. 62.2 %, p = 1.00) were similar in patients with optimal vs. suboptimal glycaemic control. Age (OR 1.10; CI 95 % 1.04-1.18; p < 0.001) and female gender (OR 3.87; CI 95 % 1.45-11.4; p < 0.01) were significantly associated with endothelial independent CMD whereas glomerular filtrate (OR 0.97; CI 95 % 0.95-0.99; p < 0.05) was significantly associated with endothelial dependent CMD. The optimal glycaemic control was not associated with endothelial independent (OR 0.60, CI 95 % 0.23-1.46; p 0.26) or dependent CMD (OR 0.99, CI 95 % 0.43-2.24; p = 0.98). The current target of HBA1c level does not predict a better coronary microcirculatory function in T2DM patients. The appropriate strategy for prevention of CMD in T2DM patients remains to be addressed.
    Cardiovascular Diabetology 08/2015; 14(1):106. DOI:10.1186/s12933-015-0269-1 · 4.02 Impact Factor
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    ABSTRACT: Background: Hypothyroidism is associated with an increased risk of coronary artery disease, beyond that which can be explained by its association with conventional cardiovascular risk factors. Coronary endothelial dysfunction precedes atherosclerosis, has been linked to adverse cardiovascular events, and may account for some of the increased risk in patients with hypothyroidism. The aim of this study was to determine whether there is an association between epicardial and microvascular coronary endothelial dysfunction and hypothyroidism. Methods and results: In 1388 patients (mean age 50.5 [12.3] years, 34% male) presenting with stable chest pain to Mayo Clinic, Rochester, MN for diagnostic coronary angiography, and who were found to have nonobstructive coronary artery disease (<40% stenosis), we invasively assessed coronary artery endothelial-dependent microvascular and epicardial function by evaluating changes in coronary blood flow (% Δ CBF Ach) and diameter (% Δ CAD Ach), respectively, in response to intracoronary infusions of acetylcholine. Patients were divided into 2 groups: hypothyroidism, defined as a documented history of hypothyroidism or a thyroid-stimulating hormone (TSH) >10.0 mU/mL, n=188, and euthyroidism, defined as an absence of a history of hypothyroidism in the clinical record and/or 0.3<TSH≤10.0 mU/mL, n=1200. Subjects with a history of hypothyroidism had a significantly lower % Δ CBF Ach (48.26 [80.66] versus 64.58 [128.30]) compared to patients with euthyroidism, while the % Δ CAD Ach did not vary significantly between groups. After adjusting for covariates, females with hypothyroidism still had a significantly lower % Δ CBF Ach (estimated difference in % Δ CBF Ach [SE]: -16.79 [8.18]). Conclusions: Hypothyroidism in women is associated with microvascular endothelial dysfunction, even after adjusting for confounders, and may explain some of the increased risk of cardiovascular disease in these patients.
    Journal of the American Heart Association 07/2015; 4(8). DOI:10.1161/JAHA.115.002225 · 4.31 Impact Factor
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    ABSTRACT: Myocardial perfusion scintigraphy (MPS) is used widely to assess cardiovascular risk in patients with chest pain. The utility of carotid intima-media thickness (CIMT) and endothelial function as assessed by reactive hyperemia-peripheral arterial tonometry index (RHI) in risk stratifying patients with angina-like symptoms needs to be defined. We investigated whether the addition of CIMT and RHI to Framingham Cardiovascular Risk Score (FCVRS) and MPS improves comprehensive cardiovascular risk prediction in patients presenting with angina-like symptoms. We enrolled 343 consecutive patients with angina-like symptoms suspected of having stable angina. MPS, CIMT, and RHI were performed and patients were followed for cardiovascular events for a median of 5.3years (range 4.4-6.2). Patients were stratified by FCVRS and MPS. During the follow-up, 57 patients (16.6%) had cardiovascular events. Among patients without perfusion defect, low RHI was significantly associated with cardiovascular events in the intermediate and high FCVRS groups (hazard ratio (HR) [95% confidence interval (CI)] of RHI≤2.11 was 6.99 [1.34-128] in the intermediate FCVRS group and 6.08 [1.08-114] in the high FCVRS group). Furthermore, although MPS did not predict, only RHI predicted hard cardiovascular events (cardiovascular death, myocardial infarction, and stroke) independent from FCVRS, and adding RHI to FCVRS improved net reclassification index (20.9%, 95% CI 0.8-41.1, p=0.04). Especially, RHI was significantly associated with hard cardiovascular events in the high FCVRS group (HR [95% CI] of RHI≤1.93 was 5.66 [1.54-36.4], p=0.007). Peripheral endothelial function may improve discrimination in identifying at-risk patients for future cardiovascular events when added to FCVRS-MPS-based risk stratification. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 07/2015; 190(1). DOI:10.1016/j.ijcard.2015.04.124 · 4.04 Impact Factor

Publication Stats

25k Citations
4,730.94 Total Impact Points


  • 2013-2015
    • Sun Yat-Sen University
      • Department of Vascular Surgery
      Shengcheng, Guangdong, China
    • Konyang University Hospital
      Gaigeturi, Jeju-do, South Korea
  • 1999-2015
    • Mayo Foundation for Medical Education and Research
      • Division of Cardiovascular Diseases
      Рочестер, Michigan, United States
  • 1990-2015
    • Mayo Clinic - Rochester
      • • Department of Cardiovascular Diseases
      • • Department of Internal Medicine
      Рочестер, Minnesota, United States
  • 2012
    • University of California, Los Angeles
      Los Angeles, California, United States
  • 2010-2012
    • Rochester College
      Rochester, New York, United States
  • 2011
    • University of Florida
      Gainesville, Florida, United States
  • 2002-2009
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
    • University Hospital Essen
      Essen, North Rhine-Westphalia, Germany
  • 2008
    • Vanderbilt University
      Нашвилл, Michigan, United States
    • Duke University Medical Center
      Durham, North Carolina, United States
  • 2003
    • Technion - Israel Institute of Technology
      H̱efa, Haifa District, Israel
    • Second University of Naples
      Caserta, Campania, Italy
    • Aarhus University
      Aarhus, Central Jutland, Denmark
  • 2000
    • University of Pennsylvania
      • Department of Pediatrics
      Filadelfia, Pennsylvania, United States
  • 1998
    • University of Zurich
      Zürich, Zurich, Switzerland
    • University of Rome Tor Vergata
      Roma, Latium, Italy