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Farì G, Ranieri M, Marvulli R, Dell’Anna L, Fai A, Tognolo L, Bernetti A, Caforio L, Megna M, Losavio E. Is There a New Road to Spinal Cord Injury Rehabilitation? A Case Report about the Effects of Driving a Go-Kart on Muscle Spasticity. Diseases 2023; 11:107. [PMID: 37754303 PMCID: PMC10528365 DOI: 10.3390/diseases11030107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is a neurological disorder that causes a traumatic anatomical discontinuity of the spinal cord. SCI can lead to paraplegia, spastic, or motor impairments. Go-karting for people with SCI is an adapted sport that is becoming increasingly popular. The purpose of this case report is to shed light on the effects of driving a go-kart on a patient with SCI-related spasticity and to deepen understanding of the possible related role of whole-body vibration (WBV) and neuroendocrine reaction. METHODS The patient was a 50-year-old male with a spastic paraplegia due to traumatic SCI. He regularly practiced go-kart racing, reporting a transient reduction in spasticity. He was evaluated before (T0), immediately after (T1), 2 weeks after (T2), and 4 weeks after (T3) a go-kart driving session. On both sides, long adductor, femoral bicep, and medial and lateral gastrocnemius spasticity was assessed using the Modified Ashworth Scale (MAS), and tone and stiffness were assessed using MyotonPro. RESULTS It was observed that a go-kart driving session could reduce muscle spasticity, tone, and stiffness. CONCLUSIONS Go-kart driving can be a valid tool to obtain results similar to those of WBV and hormone production in the reduction of spasticity.
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Affiliation(s)
- Giacomo Farì
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Riccardo Marvulli
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Laura Dell’Anna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Annatonia Fai
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Lucrezia Tognolo
- Rehabilitation Unit, Department of Neuroscience, University of Padova, 35100 Padova, Italy;
| | - Andrea Bernetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Laura Caforio
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Ernesto Losavio
- Neurorehabilitation and Spinal Unit, Clinical and Scientific Institutes Maugeri IRCCS, 70124 Bari, Italy;
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Schaufler D, Manthou ME, Theotokis P, Rink-Notzon S, Angelov DN. Effects of Whole-Body Vibration and Manually Assisted Locomotor Therapy on Neurotrophin-3 Expression and Microglia/Macrophage Mobilization Following Thoracic Spinal Cord Injury in Rats. Curr Issues Mol Biol 2023; 45:3238-3254. [PMID: 37185735 PMCID: PMC10137282 DOI: 10.3390/cimb45040211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 04/02/2023] [Indexed: 05/17/2023] Open
Abstract
Microglial cells play an important role in neuroinflammation and secondary damages after spinal cord injury (SCI). Progressive microglia/macrophage inflammation along the entire spinal axis follows SCI, and various factors may determine the microglial activation profile. Neurotrophin-3 (NT-3) is known to control the survival of neurons, the function of synapses, and the release of neurotransmitters, while also stimulating axon plasticity and growth. We examined the effects of whole-body vibration (WBV) and forms of assisted locomotor therapy, such as passive flexion-extension (PFE) therapy, at the neuronal level after SCI, with a focus on changes in NT-3 expression and on microglia/macrophage reaction, as they play a major role in the reconstitution of CNS integrity after injury and they may critically account for the observed structural and functional benefits of physical therapy. More specifically, the WBV therapy resulted in the best overall functional recovery when initiated at day 14, while inducing a decrease in Iba1 and the highest increase in NT-3. Therefore, the WBV therapy at the 14th day appeared to be superior to the PFE therapy in terms of recovery. Functional deficits and subsequent rehabilitation depend heavily upon the inflammatory processes occurring caudally to the injury site; thus, we propose that increased expression of NT-3, especially in the dorsal horn, could potentially be the mediator of this favorable outcome.
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Affiliation(s)
- Diana Schaufler
- Department I of Internal Medicine, Lung Cancer Group Cologne, University Hospital Cologne, 50931 Cologne, Germany
- Anatomical Institute II, University of Cologne, 50931 Cologne, Germany
| | - Maria Eleni Manthou
- Anatomical Institute II, University of Cologne, 50931 Cologne, Germany
- Department of Histology and Embryology, Aristotle University Thessaloniki, 54124 Thessaloniki, Greece
| | - Paschalis Theotokis
- Department of Histology and Embryology, Aristotle University Thessaloniki, 54124 Thessaloniki, Greece
- Laboratory of Experimental Neurology and Neuroimmunology, Second Department of Neurology, AHEPA University Hospital, 54124 Thessaloniki, Greece
| | - Svenja Rink-Notzon
- Department of Prosthetic Dentistry, School of Dental and Oral Medicine, University of Cologne, 50931 Cologne, Germany
| | - Doychin N Angelov
- Anatomical Institute II, University of Cologne, 50931 Cologne, Germany
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Balbinot G, Li G, Wiest MJ, Pakosh M, Furlan JC, Kalsi-Ryan S, Zariffa J. Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review. J Neuroeng Rehabil 2021; 18:105. [PMID: 34187509 PMCID: PMC8244234 DOI: 10.1186/s12984-021-00888-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) disrupts spinal and supraspinal pathways, and this process is reflected in changes in surface electromyography (sEMG). sEMG is an informative complement to current clinical testing and can capture the residual motor command in great detail-including in muscles below the level of injury with seemingly absent motor activities. In this comprehensive review, we sought to describe how the sEMG properties are changed after SCI. We conducted a systematic literature search followed by a narrative review focusing on sEMG analysis techniques and signal properties post-SCI. We found that early reports were mostly focused on the qualitative analysis of sEMG patterns and evolved to semi-quantitative scores and a more detailed amplitude-based quantification. Nonetheless, recent studies are still constrained to an amplitude-based analysis of the sEMG, and there are opportunities to more broadly characterize the time- and frequency-domain properties of the signal as well as to take fuller advantage of high-density EMG techniques. We recommend the incorporation of a broader range of signal properties into the neurophysiological assessment post-SCI and the development of a greater understanding of the relation between these sEMG properties and underlying physiology. Enhanced sEMG analysis could contribute to a more complete description of the effects of SCI on upper and lower motor neuron function and their interactions, and also assist in understanding the mechanisms of change following neuromodulation or exercise therapy.
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Affiliation(s)
- Gustavo Balbinot
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
| | - Guijin Li
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Matheus Joner Wiest
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Julio Cesar Furlan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jose Zariffa
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
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Chow JW, Yablon SA, Stokic DS. Knee Muscle Stretch Reflex Responses After an Intrathecal Baclofen Bolus in Neurological Patients With Moderate-to-Severe Hypertonia. Neuromodulation 2020; 23:1018-1028. [PMID: 32023360 DOI: 10.1111/ner.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/13/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the prevalence, onset threshold, and response magnitude of stretch reflex response (SRR) in the knee extensors and flexors before and after an intrathecal baclofen (ITB) bolus injection in patients with moderate-to-severe hypertonia. MATERIALS AND METHODS SRRs were elicited by reciprocal passive knee extension/flexion movements at preset angular velocities of 5, 60, 120, 180, 240, and 300°/s using an isokinetic dynamometer and recorded with surface electromyographic (EMG) electrodes placed over the knee extensors and flexors in 53 neurologic patients before and at 2.5 and 5 hours after an ITB injection via lumbar puncture. Outcome measures included the number of patients with presence/absence of SRRs, the number of SRRs per session, SRR onset threshold angle and velocity, and response magnitudes (peak EMG and area under the EMG curve) for each muscle. Pre-post comparisons were completed using the Fisher's exact and Wilcoxon signed rank tests. RESULTS For both knee extensors and flexors, the proportion of patients with present SRRs (p < 0.0001) and the number of SRRs per session (p ≤ 0.027) decreased from pre- to post-ITB. The threshold velocity significantly increased post-injection in both muscles (p ≤ 0.001) without significant changes in the threshold angle. The response magnitudes significantly decreased in the knee extensors (p ≤ 0.016) but not the knee flexors after the injection. CONCLUSIONS The prevalence and threshold velocity of SRR emerged as the most robust and practical parameters for assessing hyperreflexia during ITB bolus trial that can complement clinical assessment of muscle hypertonia.
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Affiliation(s)
- John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Stuart A Yablon
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
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Manthou M, Abdulla DSY, Pavlov SP, Jansen R, Bendella H, Nohroudi K, Stein G, Meyer C, Ozsoy O, Ozsoy U, Behram Kandemir Y, Sarikcioglu L, Semler O, Schoenau E, Dunlop S, Angelov DN. Whole body vibration (WBV) following spinal cord injury (SCI) in rats: Timing of intervention. Restor Neurol Neurosci 2017; 35:185-216. [DOI: 10.3233/rnn-160691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marilena Manthou
- Department of Histology and Embryology, Aristotle University Thessaloniki, Greece
| | | | | | - Ramona Jansen
- Department of Anatomy I, University of Cologne, Germany
| | - Habib Bendella
- Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | | | - Gregor Stein
- Department of Orthopedics and Trauma Surgery, University of Cologne, Germany
| | - Carolin Meyer
- Department of Orthopedics and Trauma Surgery, University of Cologne, Germany
| | - Ozlem Ozsoy
- Department of Physiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Umut Ozsoy
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Levent Sarikcioglu
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | | | - Sarah Dunlop
- Experimental and Regenerative Neuroscience, School of Animal Biology, The University of Western Australia, WA, Australia
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Ji Q, He H, Zhang C, Lu C, Zheng Y, Luo XT, He C. Effects of whole-body vibration on neuromuscular performance in individuals with spinal cord injury: a systematic review. Clin Rehabil 2016; 31:1279-1291. [PMID: 27688299 DOI: 10.1177/0269215516671014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the effects of whole-body vibration on neuromuscular performance in people with spinal cord injury and evaluate the safe and effective vibration protocols. METHODS PubMed, EMBASE, CINAHL and PEDro were mainly searched for English literatures. Other data sources were ClinicalTrials.gov , Current Controlled Trials and reference lists of all relevant articles. The PEDro scale was used to evaluate the methodological quality, and the Oxford Centre for Evidence-based Medicine level of evidence was used to assess the level of evidence. Basic information and whole-body vibration protocols were extracted by two independent researchers. Any disagreements were resolved by the third researcher. RESULTS Of the eight included studies involving 94 individuals with spinal cord injury and 24 able-bodied participants, six of them reported beneficial effects of whole-body vibration on muscle activation and the other two on muscle spasticity. Based on the reviewed studies, an intermittent mode of whole-body vibration (frequency: 10-50 Hz; amplitude: 0.6-4 mm) is less likely to cause adverse events when applying to spinal cord injury subjects standing on platform (knees flexed at 10°-40°). CONCLUSIONS The strength of evidence is insufficient in supporting the benefits of whole-body vibration on neuromuscular performance in individuals with spinal cord injury. The intermittent vibration (frequency: 10-50 Hz; amplitude: 0.6-4 mm; knee flexion: 10°-40°) may be the possible effective range and have good compliance.
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Affiliation(s)
- Qiaodan Ji
- 1 Department of Rehabilitation Medicine, Sichuan University, Chengdu, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, People's Republic of China
| | - Hongchen He
- 1 Department of Rehabilitation Medicine, Sichuan University, Chengdu, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, People's Republic of China
| | - Chi Zhang
- 1 Department of Rehabilitation Medicine, Sichuan University, Chengdu, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, People's Republic of China
| | - Chunlan Lu
- 1 Department of Rehabilitation Medicine, Sichuan University, Chengdu, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, People's Republic of China
| | - Yu Zheng
- 1 Department of Rehabilitation Medicine, Sichuan University, Chengdu, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, People's Republic of China
| | - Xiao Tian Luo
- 1 Department of Rehabilitation Medicine, Sichuan University, Chengdu, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, People's Republic of China
| | - Chengqi He
- 1 Department of Rehabilitation Medicine, Sichuan University, Chengdu, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, People's Republic of China
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Serrao M, Ranavolo A, Andersen OK, Conte C, Don R, Cortese F, Mari S, Draicchio F, Padua L, Sandrini G, Pierelli F. Adaptive behaviour of the spinal cord in the transition from quiet stance to walking. BMC Neurosci 2012; 13:80. [PMID: 22800397 PMCID: PMC3445852 DOI: 10.1186/1471-2202-13-80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 07/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modulation of nociceptive withdrawal reflex (NWR) excitability was evaluated during gait initiation in 10 healthy subjects to investigate how load- and movement-related joint inputs activate lower spinal centres in the transition from quiet stance to walking. A motion analysis system integrated with a surface EMG device was used to acquire kinematic, kinetic and EMG variables. Starting from a quiet stance, subjects were asked to walk forward, at their natural speed. The sural nerve was stimulated and EMG responses were recorded from major hip, knee and ankle muscles. Gait initiation was divided into four subphases based on centre of pressure and centre of mass behaviours, while joint displacements were used to categorise joint motion as flexion or extension. The reflex parameters were measured and compared between subphases and in relation to the joint kinematics. RESULTS The NWR was found to be subphase-dependent. NWR excitability was increased in the hip and knee flexor muscles of the starting leg, just prior to the occurrence of any movement, and in the knee flexor muscles of the same leg as soon as it was unloaded. The NWR was hip joint kinematics-dependent in a crossed manner. The excitability of the reflex was enhanced in the extensor muscles of the standing leg during the hip flexion of the starting leg, and in the hip flexors of the standing leg during the hip extension of the starting leg. No notable reflex modulation was observed in the ankle muscles. CONCLUSIONS Our findings show that the NWR is modulated during the gait initiation phase. Leg unloading and hip joint motion are the main sources of the observed modulation and work in concert to prepare and assist the starting leg in the first step while supporting the contralateral leg, thereby possibly predisposing the lower limbs to the cyclical pattern of walking.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy.
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Field-Fote E, Ness LL, Ionno M. Vibration Elicits Involuntary, Step-Like Behavior in Individuals With Spinal Cord Injury. Neurorehabil Neural Repair 2012; 26:861-9. [DOI: 10.1177/1545968311433603] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Impaired walking is a debilitating consequence of spinal cord injury (SCI). This impairment arises, to some degree, from disruption of supraspinal pathways that activate the spinal locomotor central pattern generator (CPG). Evidence in nondisabled (ND) individuals suggests that vibration activates locomotor CPGs, eliciting involuntary step-like behavior. Objective. To compare vibration-elicited step-like behavior in individuals with chronic SCIs with the responses of ND individuals and to assess the influence of locomotor training on these responses. Methods. Participants included 7 individuals with motor-incomplete SCIs (MISCIs) and 6 with motor-complete SCIs (MCSCIs) who were untrained, 6 individuals with MISCIs who underwent locomotor training, and 8 ND individuals. Kinematic and EMG data were collected while vibration was applied to the quadriceps, hamstrings, or tensor fascia latae (TFL) muscles. Consistency and robustness of vibration-elicited responses was determined from hip and knee angle data. Results. Consistent and reliable step-like behaviors were elicited in individuals with MISCIs and MCSCIs, although responses were not as robust as those in ND individuals. Vibration to the TFL elicited the most robust responses. Consistency and robustness were not influenced by SCI severity or locomotor training but appeared to increase with repeated testing. Conclusion. These results confirm that vibration elicits step-like behaviors in individuals with SCIs, even those with no voluntary motor function in the legs. Further research is warranted to investigate the use of vibration as an approach to activating the spinal CPGs associated with stepping, perhaps as an adjunct to locomotor training for individuals with SCIs.
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Affiliation(s)
- Edelle Field-Fote
- University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Lanitia L. Ness
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michele Ionno
- University of Miami Miller School of Medicine, Miami, FL, USA
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