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Bock JM, Hanson BE, Asama TF, Feider AJ, Hanada S, Aldrich AW, Dyken ME, Casey DP. Acute inorganic nitrate supplementation and the hypoxic ventilatory response in patients with obstructive sleep apnea. J Appl Physiol (1985) 2021; 130:87-95. [PMID: 33211592 DOI: 10.1152/japplphysiol.00696.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Patients with obstructive sleep apnea (OSA) have increased cardiovascular disease risk largely attributable to hypertension. Heightened peripheral chemoreflex sensitivity (i.e., exaggerated responsiveness to hypoxia) facilitates hypertension in these patients. Nitric oxide blunts the peripheral chemoreflex, and patients with OSA have reduced nitric oxide bioavailability. We therefore investigated the dose-dependent effects of acute inorganic nitrate supplementation (beetroot juice), an exogenous nitric oxide source, on blood pressure and cardiopulmonary responses to hypoxia in patients with OSA using a randomized, double-blind, placebo-controlled crossover design. Fourteen patients with OSA (53 ± 10 yr, 29.2 ± 5.8 kg/m2, apnea-hypopnea index = 17.8 ± 8.1, 43%F) completed three visits. Resting brachial blood pressure and cardiopulmonary responses to inspiratory hypoxia were measured before, and 2 h after, acute inorganic nitrate supplementation [∼0.10 mmol (placebo), 4.03 mmol (low dose), and 8.06 mmol (high dose)]. Placebo increased neither plasma [nitrate] (30 ± 52 to 52 ± 23 μM, P = 0.26) nor [nitrite] (266 ± 153 to 277 ± 164 nM, P = 0.21); however, both increased following low (29 ± 17 to 175 ± 42 μM, 220 ± 137 to 514 ± 352 nM) and high doses (26 ± 11 to 292 ± 90 μM, 248 ± 155 to 738 ± 427 nM, respectively, P < 0.01 for all). Following placebo, systolic blood pressure increased (120 ± 9 to 128 ± 10 mmHg, P < 0.05), whereas no changes were observed following low (121 ± 11 to 123 ± 8 mmHg, P = 0.19) or high doses (124 ± 13 to 124 ± 9 mmHg, P = 0.96). The peak ventilatory response to hypoxia increased following placebo (3.1 ± 1.2 to 4.4 ± 2.6 L/min, P < 0.01) but not low (4.4 ± 2.4 to 5.4 ± 3.4 L/min, P = 0.11) or high doses (4.3 ± 2.3 to 4.8 ± 2.7 L/min, P = 0.42). Inorganic nitrate did not change the heart rate responses to hypoxia (beverage-by-time P = 0.64). Acute inorganic nitrate supplementation appears to blunt an early-morning rise in systolic blood pressure potentially through suppression of peripheral chemoreflex sensitivity in patients with OSA.NEW & NOTEWORTHY The present study is the first to examine the acute effects of inorganic nitrate supplementation on resting blood pressure and cardiopulmonary responses to hypoxia (e.g., peripheral chemoreflex sensitivity) in patients with obstructive sleep apnea (OSA). Our data indicate inorganic nitrate supplementation attenuates an early-morning rise in systolic blood pressure potentially attributable to blunted peripheral chemoreflex sensitivity. These data show proof-of-concept that inorganic nitrate supplementation could reduce the risk of cardiovascular disease in patients with OSA.
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Affiliation(s)
- Joshua M Bock
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Brady E Hanson
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Thomas F Asama
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Andrew J Feider
- Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Satoshi Hanada
- Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Aric W Aldrich
- Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Mark Eric Dyken
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Darren P Casey
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa.,Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa.,Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa
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Loiselle AR, Neustaeter A, de Kleine E, van Dijk P, Jansonius NM. Associations between tinnitus and glaucoma suggest a common mechanism: A clinical and population-based study. Hear Res 2019; 386:107862. [PMID: 31841861 DOI: 10.1016/j.heares.2019.107862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to determine if there is an association between tinnitus and glaucoma. We tested this by first completing a clinic-based cross-sectional questionnaire study in which we sent a series of tinnitus-related questions to glaucoma patients and healthy subjects, and then followed up with a large population-based cross-sectional study in which glaucoma and tinnitus were also assessed by questionnaire. For the clinical study, we received 209 responses from glaucoma patients and 109 responses from healthy subjects (primarily the spouses of the patients). For the population-based study, we evaluated 79,866 participants. Logistic regression models were used to test the relationship between glaucoma and tinnitus; the clinical study analysis was adjusted for age, gender, BMI, hypertension, and diabetes and the population-based study was adjusted for these same variables with the addition of socioeconomic status and subjective hearing loss. For the clinical study, glaucoma patients had an 85% increase in odds for tinnitus (adjusted OR 1.85, 95% CI 1.10 to 3.05). The effect did not depend on pretreatment intraocular pressure, and the associated symptoms were not pulsatile in nature. For the population-based study, glaucoma patients had a 19% increase in odds for tinnitus (adjusted OR 1.19, 95% CI 1.02 to 1.40). Overall, our results suggest that those with glaucoma are more likely to have tinnitus than those without glaucoma. These results provide hypotheses for a mechanism involved in both tinnitus and glaucoma. One possible mechanism could be vascular dysregulation due to impairment of nitric oxide production.
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Affiliation(s)
- Allison R Loiselle
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anna Neustaeter
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Emile de Kleine
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Sleep-Disordered Breathing and Diastolic Heart Disease. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sharma P, Dong Y, Somers VK, Peterson TE, Zhang Y, Wang S, Li G, Singh P. Intermittent hypoxia regulates vasoactive molecules and alters insulin-signaling in vascular endothelial cells. Sci Rep 2018; 8:14110. [PMID: 30237409 PMCID: PMC6148090 DOI: 10.1038/s41598-018-32490-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022] Open
Abstract
Vascular dysfunction and insulin resistance (IR) are associated with obstructive sleep apnea (OSA), which is characterized by frequent episodes of nocturnal intermittent hypoxia (IH). While it is recognized that the balance between vasoconstrictive (endothelin-1) and vasodilatory molecules (nitric oxide, NO) determine vascular profile, molecular mechanisms contributing to vascular dysfunction and IR in OSA are not completely understood. Caveolin-1 is a membrane protein which regulates endothelial nitric oxide synthase (eNOS) activity which is responsible for NO generation and cellular insulin-signaling. Hence, we examined the effects of IH on caveolin-1, eNOS, and endothelin-1 in human coronary artery endothelial cells in the context of IR. Chronic 3-day IH exposure up-regulated caveolin-1 and endothelin-1 expression while reducing NO. Also, IH altered insulin-mediated activation of AKT but not ERK resulting in increased endothelin-1 transcription. Similarly, caveolin-1 overexpression attenuated basal and insulin-stimulated NO synthesis along with impaired insulin-dependent activation of AKT and eNOS, with no effect on insulin-stimulated ERK1/2 phosphorylation and endothelin-1 transcription. Our data suggest that IH contributes to a vasoconstrictive profile and to pathway-selective vascular IR, whereby insulin potentiates ET-1 expression. Moreover, IH may partly mediate its effects on NO and insulin-signaling via upregulating caveolin-1 expression.
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Affiliation(s)
- Pragya Sharma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yu Dong
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA.,Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Timothy E Peterson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA.,Department of Neurosurgery Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yuebo Zhang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shihan Wang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Guangxi Li
- Department of Pulmonary and Critical Care Medicine, Rochester, MN, 55905, USA
| | - Prachi Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
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Nimeskern N. [The nose, an orthodontic-surgical marker]. Orthod Fr 2018; 89:307-322. [PMID: 30255845 DOI: 10.1051/orthodfr/2018020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Inthe quest for a universal marker to describe the physiological function of facialmechanics, the author has found nasal ventilation at rest to be a major factor to beborne in mind. MATERIALS AND METHODS Factors related to embryology, anatomyand respiratory physiology, along with analysis of the literature in the relevantareas, now enable us to view the nose in a different light. CONCLUSION The authorconcludes that nasal ventilation at rest constitutes a mandatory objective in theperformance of all types of therapy.
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Affiliation(s)
- Nicolas Nimeskern
- 1 rue Saint Sauveur, 68100 Mulhouse, France - FranceService de chirurgie maxillo-faciale, Hôpitaux Nord, 93 Grande rue de la croix rousse, 69004 Lyon, France
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Bonanno A, Riccobono L, Bonsignore MR, Lo Bue A, Salvaggio A, Insalaco G, Marrone O. Relaxin in Obstructive Sleep Apnea: Relationship with Blood Pressure and Inflammatory Mediators. Respiration 2016; 91:56-62. [PMID: 26731435 DOI: 10.1159/000443182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with nocturnal intermittent hypoxia, which may be responsible for increased circulating levels of vascular endothelial growth factor (VEGF) and inflammatory mediators, such as metalloproteinases (MMPs), and which contributes to the pathogenesis of systemic hypertension. Why some OSA patients remain normotensive is poorly understood. Relaxin-2, a pregnancy hormone, may sometimes circulate in men and could increase in hypoxic conditions. It exerts a vasodilatory activity and can modulate the release of molecules, such as MMPs and VEGF. OBJECTIVES The objective of this study was to explore if circulating relaxin-2 in male OSA subjects may be related to OSA severity, to circulating levels of MMPs, of their inhibitors (tissue inhibitors of metalloproteinases; TIMPs), and of VEGF, and if it may protect from hypertension. PATIENTS AND METHODS Fifty untreated male subjects with suspected OSA were recruited. After nocturnal polysomnography, a morning venous blood sample was withdrawn. Then, 24-hour ambulatory blood pressure (BP) monitoring was performed. RESULTS The respiratory disturbance index in the sample was 30.4 [interquartile range (IQR) 15.6-55.2]. Relaxin-2 was detectable in 20 subjects. These subjects did not differ in OSA severity or diurnal and nocturnal BP from subjects with undetectable relaxin-2, but they showed lower TIMP-1 (126.8 ± 29.1 vs. 156.9 ± 41.7 pg/ml, respectively; p = 0.007) and a marginally higher MMP-9/TIMP-1 molar ratio [0.58 (IQR 0.23-1.35) vs. 0.25 (IQR 0.15-0.56); p = 0.052]. CONCLUSIONS Relaxin-2 in male subjects was not related to OSA severity, but it was associated with lower TIMP-1. As it was often undetectable, even when BP values were normal, it is unlikely that it plays a role as a major factor protecting from hypertension in OSA.
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Affiliation(s)
- Anna Bonanno
- National Research Council, Institute of Biomedicine and Molecular Immunology x2018;A. Monroy', Palermo, Italy
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Manolis AJ, Kallistratos MS, Vlahakos DV, Mitrakou A, Poulimenos LE. Comorbidities Often Associated with Brain Damage in Hypertension: Diabetes, Coronary Artery Disease, Chronic Kidney Disease and Obstructive Sleep Apnoea. UPDATES IN HYPERTENSION AND CARDIOVASCULAR PROTECTION 2016. [DOI: 10.1007/978-3-319-32074-8_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bozkurt H, Neyal A, Geyik S, Taysi S, Anarat R, Bulut M, Neyal AM. Investigation of the Plasma Nitrite Levels and Oxidant-Antioxidant Status in Obstructive Sleep Apnea Syndrome. Noro Psikiyatr Ars 2015; 52:221-225. [PMID: 28360714 DOI: 10.5152/npa.2015.7607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/27/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders. In the present study, we assessed the nitrite level, which is an indirect indicator of nitric oxide (NO), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI), which may be associated with endotel dysfunction. We investigated the difference between the groups and the relationship among the severity of comorbid conditions. METHODS This study was conducted in 39 OSA patients confirmed by polysomnography and 40 healthy subjects (controls). The OSA group consisted of 10 women and 29 men and the control group consisted of 20 women and 20 men. Polysomnographic revealed mild OSA in two, moderate in 7 and severe in 30 cases. We measured plasma TAS, TOS and nitrite levels from venous blood. The OSI value was obtained by dividing the TOS and TAS values. Values were compared with the control group and between patient groups. RESULTS A high body mass index (BMI), cardiovasculer diseases (CVD) and the use of medication for co-morbid diseases were more prevalent in the OSA group (p=.001, p=.029 and p=.006, respectively). The median plasma TOS level and OSI in the obstructive sleep apnea syndrome (OUA) group were significantly higher than those in the control group (p=.001 and p=.001, respectively). The plasma median nitrite level and TAS did not show any significant difference between the OSA and the control groups. None of the parameters revealed a significant difference between severe and moderate OSA cases. CONCLUSION Our findings in the present study revealed that the oxidant-antioxidant balance shifted toward the oxidant side in OSA cases; however, the NO level did not change. These findings together may point out that some molecules other than NO may have a role in the pathophysiology of endothelial dysfunction and also in the disturbed oxidant-antioxidant balance in OSA.
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Affiliation(s)
- Hakan Bozkurt
- Department of Neurology, Gaziantep Private Medikal Park Hospital, Gaziantep, Turkey
| | - Abdurrahman Neyal
- Clinic of Neurology, Gaziantep Ersin Aslan State Hastanesi, Gaziantep, Turkey
| | - Sırma Geyik
- Department of Neurology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Seyithan Taysi
- Department of Biochemistry, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Rüksan Anarat
- Department of Biochemistry, Başkent University Faculty of Medicine, Adana, Turkey
| | - Mesut Bulut
- Clinic of Neurology, Samandağ State Hospital, Hatay, Turkey
| | - Ayşe Münife Neyal
- Department of Neurology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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Sadeghniiat-Haghighi K, Mohajeri-Tehrani MR, Khajeh-Mehrizi A, Fathi F, Saremi-Rasouli F, Ghajarzadeh M, Larijani B. Obstructive sleep apnea and excessive daytime sleepiness among patients with type 2 diabetes mellitus: a single-center study from Iran. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Launois S, Borel AL, Levy P, Pepin JL. Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials. Sleep Med Rev 2014; 21:23-38. [PMID: 25220580 DOI: 10.1016/j.smrv.2014.07.004] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 12/24/2022]
Abstract
Reducing cardiometabolic risk may represent an important target for effective obstructive sleep apnea (OSA) treatment. The impact of continuous positive airway pressure (CPAP), the first line therapy of OSA, on metabolic or inflammatory markers is still debated. A systematic literature search using several databases was performed. We provide a systematic analysis of randomized studies comparing therapeutic versus sham CPAP intervention and also include studies using a CPAP withdrawal design. We addressed the impact of CPAP on the following cardiometabolic biomarkers: 1) plasma and urine catecholamines and their metabolites that reflect sympathetic activity; 2) insulin resistance and lipid metabolism biomarkers; 3) oxidative stress, systemic and vascular inflammation biomarkers; 4) liver enzymes highlighting the association between OSA and nonalcoholic fatty liver disease (NAFLD); 5) coagulation biomarkers. The impact of CPAP on sympathetic activity is robust across studies and occurs rapidly. In contrast to sympathetic activity, the well-designed studies included in this review failed to demonstrate that CPAP alters metabolic or inflammatory markers in OSA. CPAP did not change glucose, lipids, insulin resistance levels or the ratio of patients with metabolic syndrome. In unselected OSA patients, it is not realistic to expect a clinically relevant decrease in cardiometabolic biomarkers with CPAP therapy.
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Affiliation(s)
- Ingrid Jullian-Desayes
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Marie Joyeux-Faure
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Renaud Tamisier
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Sandrine Launois
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Anne-Laure Borel
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Département d'Endocrinologie Diabétologie - Maladies de la Nutrition, Pôle Digidune, Grenoble, France
| | - Patrick Levy
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Jean-Louis Pepin
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France.
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Kumar P, Peers C. Foreword. Respir Physiol Neurobiol 2012; 184:115-6. [DOI: 10.1016/j.resp.2012.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
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