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Baroni A, Lamberti N, Gandolfi M, Rimondini M, Bertagnolo V, Grassilli S, Zerbinati L, Manfredini F, Straudi S. Traditional versus progressive robot-assisted gait training in people with multiple sclerosis and severe gait disability: study protocol for the PROGR-EX randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e002039. [PMID: 38779575 PMCID: PMC11110587 DOI: 10.1136/bmjsem-2024-002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Gait disorders are the most frequent symptoms associated to multiple sclerosis (MS). Robot-assisted gait training (RAGT) in people with MS (PwMS) has been proposed as a possible effective treatment option for severe motor disability without significant superiority when compared to intensive overground gait training (OGT). Furthermore, RAGT at high intensity may enhance fatigue and spasticity. This study aims to evaluate the effects of a low-intensity RAGT at progressively increasing intensity compared to conventional RAGT and OGT in PwMS and moderate to severe walking impairment. 24 PwMS will be recruited and assigned to one of the three treatment groups: low-intensity RAGT at progressively increasing intensity, conventional RAGT and OGT. All participants will receive 3-weekly treatment sessions of 3 hours each for 4 weeks. In the first 2 hours of treatment, all participants will receive a rehabilitation programme based on stretching exercises, muscle strengthening and educational interventions. During the last hour, subjects will undergo specific gait training according to the assignment group. Outcomes will be assessed before and after treatment and at 3-month follow-up. The primary outcome is walking speed. Secondary outcomes include mobility and balance, psychological measures, muscle oxygen consumption, electrical and haemodynamic brain activity, urinary biomarkers, usability, and acceptability of robotic devices for motor rehabilitation. The results of this study will provide a safe, affordable and non-operator-dependent, intervention for PwMS. Results in terms of functional, psychological, neurophysiological and biological outcomes will confirm our hypothesis. The study's trial registration number: NCT06381440.
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Affiliation(s)
- Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona University, Verona, Italy
| | - Michela Rimondini
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona University, Verona, Italy
| | - Valeria Bertagnolo
- Department of Translational Medicine, Ferrara University, Ferrara, Italy
| | - Silvia Grassilli
- Department of Environment and Prevention Sciences, Ferrara University, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
- Department of Neuroscience, Ferrara University Hospital, Ferrara, Italy
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Zhao F, Tomita M, Dutta A. Operational Modal Analysis of Near-Infrared Spectroscopy Measure of 2-Month Exercise Intervention Effects in Sedentary Older Adults with Diabetes and Cognitive Impairment. Brain Sci 2023; 13:1099. [PMID: 37509027 PMCID: PMC10377417 DOI: 10.3390/brainsci13071099] [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: 06/12/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The Global Burden of Disease Study (GBD 2019 Diseases and Injuries Collaborators) found that diabetes significantly increases the overall burden of disease, leading to a 24.4% increase in disability-adjusted life years. Persistently high glucose levels in diabetes can cause structural and functional changes in proteins throughout the body, and the accumulation of protein aggregates in the brain that can be associated with the progression of Alzheimer's Disease (AD). To address this burden in type 2 diabetes mellitus (T2DM), a combined aerobic and resistance exercise program was developed based on the recommendations of the American College of Sports Medicine. The prospectively registered clinical trials (NCT04626453, NCT04812288) involved two groups: an Intervention group of older sedentary adults with T2DM and a Control group of healthy older adults who could be either active or sedentary. The completion rate for the 2-month exercise program was high, with participants completing on an average of 89.14% of the exercise sessions. This indicated that the program was practical, feasible, and well tolerated, even during the COVID-19 pandemic. It was also safe, requiring minimal equipment and no supervision. Our paper presents portable near-infrared spectroscopy (NIRS) based measures that showed muscle oxygen saturation (SmO2), i.e., the balance between oxygen delivery and oxygen consumption in muscle, drop during bilateral heel rise task (BHR) and the 6 min walk task (6MWT) significantly (p < 0.05) changed at the post-intervention follow-up from the pre-intervention baseline in the T2DM Intervention group participants. Moreover, post-intervention changes from pre-intervention baseline for the prefrontal activation (both oxyhemoglobin and deoxyhemoglobin) showed statistically significant (p < 0.05, q < 0.05) effect at the right superior frontal gyrus, dorsolateral, during the Mini-Cog task. Here, operational modal analysis provided further insights into the 2-month exercise intervention effects on the very-low-frequency oscillations (<0.05 Hz) during the Mini-Cog task that improved post-intervention in the sedentary T2DM Intervention group from their pre-intervention baseline when compared to active healthy Control group. Then, the 6MWT distance significantly (p < 0.01) improved in the T2DM Intervention group at post-intervention follow-up from pre-intervention baseline that showed improved aerobic capacity and endurance. Our portable NIRS based measures have practical implications at the point of care for the therapists as they can monitor muscle and brain oxygenation changes during physical and cognitive tests to prescribe personalized physical exercise doses without triggering individual stress response, thereby, enhancing vascular health in T2DM.
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Affiliation(s)
- Fei Zhao
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Machiko Tomita
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Anirban Dutta
- School of Engineering, University of Lincoln, Lincoln LN67TS, UK
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Courter RJ, Alvarez E, Enoka RM, Ahmed AA. Metabolic costs of walking and arm reaching in persons with mild multiple sclerosis. J Neurophysiol 2023; 129:819-832. [PMID: 36883754 PMCID: PMC10085565 DOI: 10.1152/jn.00373.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
Movement slowness is a common and disruptive symptom of multiple sclerosis (MS). A potential cause is that individuals with MS slow down to conserve energy as a behavioral adjustment to heightened metabolic costs of movement. To investigate this prospect, we measured the metabolic costs of both walking and seated arm reaching at five speeds in persons with mild MS (pwMS; n = 13; 46.0 ± 7.7 yr) and sex- and age-matched controls (HCs; n = 13; 45.8 ± 7.8 yr). Notably, the cohort of pwMS was highly mobile and no individuals required a cane or aid when walking. We found that the net metabolic power of walking was approximately 20% higher for pwMS across all speeds (P = 0.0185). In contrast, we found no differences in the gross power of reaching between pwMS and HCs (P = 0.492). Collectively, our results suggest that abnormal slowness of movement in MS-particularly reaching-is not the consequence of heightened effort costs and that other sensorimotor mechanisms are playing a considerable role in slowing.NEW & NOTEWORTHY Individuals with multiple sclerosis (MS) often move more slowly than those without the disease. A possible cause is that movements in MS are more energetically expensive and slowing is an adaptation to conserve metabolic resources. Here, we find that while walking is more costly for persons with MS, arm-reaching movements are not. These results bring into question the driving force of movement slowness in MS and implicate other motor-related networks contributing to slowing.
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Affiliation(s)
- Robert J Courter
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, United States
- Department of Mechanical Engineering, University of Colorado, Colorado, Boulder, United States
| | - Enrique Alvarez
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, United States
| | - Alaa A Ahmed
- Department of Mechanical Engineering, University of Colorado, Colorado, Boulder, United States
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Straudi S, De Marco G, Martinuzzi C, Baroni A, Lamberti N, Brondi L, Da Roit M, Pizzongolo LDM, Basaglia N, Manfredini F. Combining a supervised and home-based task-oriented circuit training improves walking endurance in patients with multiple sclerosis. The MS_TOCT randomized-controlled trial. Mult Scler Relat Disord 2022; 60:103721. [DOI: 10.1016/j.msard.2022.103721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
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Comparison of Different Approaches Estimating Skeletal Muscle Oxygen Consumption Using Continuous-Wave Near-Infrared Spectroscopy at a Submaximal Contraction Level—A Comparative Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Continuous-wave near-infrared spectroscopy (CW-NIRS) is a method used to non-invasively estimate skeletal muscle oxygen consumption (mVO2). Three different signals are provided by CW-NIRS devices: (1) oxygenated hemoglobin (O2Hb); (2) deoxygenated hemoglobin (HHb); and (3) tissue saturation index (TSI). Typically, the signal’s slope is interpreted with respect to high or low mVO2 during a muscle action. What signal (or combination of signals) is used for slope interpretation differs according to what approach is used, and there are several published in literature. It is unclear if resulting mVO2 estimates can be used interchangeably. Hence, this work aimed to compare five commonly used approaches on the same set of CW-NIRS data regarding their agreement in estimated mVO2. A controlled, lab-based study setting was used for this experiment. Data are based on isometric dorsiflexion contractions of 15 subjects at 30% of voluntary maximum torque, at two different ankle angles. CW-NIRS was placed on the m. tibialis anterior and blood flow was occluded. The approaches for mVO2 estimation included calculations based on (1) TSI, (2) the difference between O2Hb and HHb (Hbdiff), (3) the mean of slopes from O2Hb and HHb (Hbmean), (4) the HHb signal, and (5) the O2Hb signal. Linear regression modelling was used to calculate respective slopes (r2 > 0.99). Repeated measures ANOVA identified significant differences between the approaches (p < 0.001, ω2 = 0.258). Post-hoc tests revealed that only TSI vs. Hbmean and Hbdiff vs. HHb gave comparable results (p > 0.271). In addition, Bland–Altman plots showed good accuracy (mean bias ~2%) but low precision (±20%) between the comparisons. Thus, the different approaches to estimate mVO2 cannot be used interchangeably. The results from different studies using different approaches should be compared with caution.
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DePauw EM, Rouhani M, Flanagan AM, Ng AV. Forearm muscle mitochondrial capacity and resting oxygen uptake: Relationship to symptomatic fatigue in persons with multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211028875. [PMID: 34262786 PMCID: PMC8246512 DOI: 10.1177/20552173211028875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Mitochondrial dysfunction has been implicated in the pathogenesis of multiple sclerosis (MS). Whether mitochondrial alterations are a function of ambulatory dysfunction or are of a non-ambulatory systemic nature is unclear. Objective To compare oxidative capacity, and rest muscle oxygen consumption (mVO2) in the upper limb of persons with multiple sclerosis (PwMS) to a control group (CON), whereby an upper limb would be comparatively independent of ambulation or deconditioning. Methods Near infra-red spectroscopy was used to measure oxidative capacity of the wrist flexors in PwMS (n = 16) and CON (n = 13). Oxidative capacity was indicated by the time constant (TC) of mVO2 recovery following brief wrist flexion contractions. Measurements included well-being, depression, symptomatic fatigue, disability, handgrip strength, cognition, and functional endurance. Analysis was by T-tests and Pearson correlations with p ≤ 0.05. Data are mean (SD). Results TC of mVO2 recovery was slower in PwMS (MS = 47(14) sec, CON = 36(11) sec; p = 0.03). No significant correlations were found between oxidative capacity and any other measures. Rest mVO2 was not different between groups, but correlated with symptomatic fatigue (r = 0.694, p = 0.003) and strength (0.585, p = 0.017) in PwMS. Conclusion Oxidative capacity was lower in the wrist flexors of PwMS, possibly indicating a systemic component of the disease. Within PwMS, rest mVO2 was associated with symptomatic fatigue.
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Affiliation(s)
- Elizabeth M DePauw
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Mitra Rouhani
- Exercise and Rehabilitation Science program, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Aidan M Flanagan
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Alexander V Ng
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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Zhang C, Modlesky CM, McCully KK. Measuring tibial hemodynamics and metabolism at rest and after exercise using near-infrared spectroscopy. Appl Physiol Nutr Metab 2021; 46:1354-1362. [PMID: 34019778 DOI: 10.1139/apnm-2021-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The bone vascular system is important, yet evaluation of bone hemodynamics is difficult and expensive. This study evaluated the utility and reliability of near-infrared spectroscopy (NIRS), a portable and relatively inexpensive device, in measuring tibial hemodynamics and metabolic rate. Eleven participants were tested twice using post-occlusive reactive hyperemia technique with the NIRS probes placed on the tibia and the medial gastrocnemius (MG) muscle. Measurements were made at rest and after 2 levels of plantarflexion exercise. The difference between oxygenated and deoxygenated hemoglobin signal could be reliably measured with small coefficients of variation (CV; range 5.7-9.8%) and high intraclass correlation coefficients (ICC; range 0.73-0.91). Deoxygenated hemoglobin rate of change, a potential marker for bone metabolism, also showed good reliability (CV range 7.5-9.8%, ICC range 0.90-0.93). The tibia was characterized with a much slower metabolic rate compared with MG (p < 0.001). While exercise significantly increased MG metabolic rate in a dose-dependent manner (all p < 0.05), no changes were observed for the tibia after exercise compared with rest (all p > 0.05). NIRS is a suitable tool for monitoring hemodynamics and metabolism in the tibia. However, the local muscle exercise protocol utilized in the current study did not influence bone hemodynamics or metabolic rate. Novelty: NIRS can be used to monitor tibial hemodynamics and metabolism with good reliability. Short-duration local muscle exercise increased metabolic rate in muscle but not in bone. High level of loading and exercise volume may be needed to elicit measurable metabolic changes in bone.
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Affiliation(s)
- Chuan Zhang
- School of Physical Education and Sport, Central China Normal University, Wuhan, Hubei, China
| | | | - Kevin K McCully
- Department of Kinesiology, University of Georgia, Athens, GA, USA
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Brain and Muscle: How Central Nervous System Disorders Can Modify the Skeletal Muscle. Diagnostics (Basel) 2020; 10:diagnostics10121047. [PMID: 33291835 PMCID: PMC7762031 DOI: 10.3390/diagnostics10121047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022] Open
Abstract
It is widely known that nervous and muscular systems work together and that they are strictly dependent in their structure and functions. Consequently, muscles undergo macro and microscopic changes with subsequent alterations after a central nervous system (CNS) disease. Despite this, only a few researchers have addressed the problem of skeletal muscle abnormalities following CNS diseases. The purpose of this review is to summarize the current knowledge on the potential mechanisms responsible for changes in skeletal muscle of patients suffering from some of the most common CSN disorders (Stroke, Multiple Sclerosis, Parkinson’s disease). With this purpose, we analyzed the studies published in the last decade. The published studies show an extreme heterogeneity of the assessment modality and examined population. Furthermore, it is evident that thanks to different evaluation methodologies, it is now possible to implement knowledge on muscle morphology, for a long time limited by the requirement of muscle biopsies. This could be the first step to amplify studies aimed to analyze muscle characteristics in CNS disease and developing rehabilitation protocols to prevent and treat the muscle, often neglected in CNS disease.
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Manfredini F, Straudi S, Lamberti N, Patergnani S, Tisato V, Secchiero P, Bernardi F, Ziliotto N, Marchetti G, Basaglia N, Bonora M, Pinton P. Rehabilitation Improves Mitochondrial Energetics in Progressive Multiple Sclerosis: The Significant Role of Robot-Assisted Gait Training and of the Personalized Intensity. Diagnostics (Basel) 2020; 10:diagnostics10100834. [PMID: 33080806 PMCID: PMC7602995 DOI: 10.3390/diagnostics10100834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022] Open
Abstract
Abnormal levels of pyruvate and lactate were reported in multiple sclerosis (MS). We studied the response of markers of mitochondrial function to rehabilitation in relation to type, intensity and endurance performance in severely disabled MS patients. Forty-six progressive MS patients were randomized to receive 12 walking sessions of robot-assisted gait training (RAGT, n = 23) or conventional overground therapy (CT, n = 23). Ten healthy subjects were also studied. Blood samples were collected to determine lactate, pyruvate, and glutathione levels and lactate/pyruvate ratio pre–post rehabilitation. In vivo muscle metabolism and endurance walking capacity were assessed by resting muscle oxygen consumption (rmVO2) using near-infrared spectroscopy and by six-minute walking distance (6MWD), respectively. The levels of mitochondrial biomarkers and rmVO2, altered at baseline with respect to healthy subjects, improved after rehabilitation in the whole population. In the two groups, an enhanced response was observed after RAGT compared to CT for lactate (p = 0.012), glutathione (<0.001), lactate/pyruvate ratio (p = 0.08) and rmVO2 (p = 0.07). Metabolic biomarkers and 6MWD improvements were exclusively correlated with a training speed markedly below individual gait speed. In severely disabled MS patients, rehabilitation rebalanced altered serum metabolic and muscle parameters, with RAGT being more effective than CT. A determinable slow training speed was associated with better metabolic and functional recovery. Trial Registration: ClinicalTrials.gov NCT02421731.
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (G.M.)
- Department of Neuroscience/Rehabilitation, Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Sofia Straudi
- Department of Neuroscience/Rehabilitation, Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Nicola Lamberti
- Department of Neuroscience and rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (G.M.)
- Correspondence: ; Tel.: +39-0532-236187
| | - Simone Patergnani
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (S.P.); (M.B.); (P.P.)
| | - Veronica Tisato
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (V.T.); (P.S.)
| | - Paola Secchiero
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (V.T.); (P.S.)
| | - Francesco Bernardi
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy;
| | - Nicole Ziliotto
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Giovanna Marchetti
- Department of Neuroscience and rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (G.M.)
| | - Nino Basaglia
- Department of Neuroscience/Rehabilitation, Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy; (S.S.); (N.B.)
| | - Massimo Bonora
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (S.P.); (M.B.); (P.P.)
| | - Paolo Pinton
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (S.P.); (M.B.); (P.P.)
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Zhang C, Hodges B, McCully KK. Reliability and reproducibility of a four arterial occlusions protocol for assessing muscle oxidative metabolism at rest and after exercise using near-infrared spectroscopy. Physiol Meas 2020; 41:065002. [PMID: 32392553 DOI: 10.1088/1361-6579/ab921c] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the reliability and reproducibility of using a four arterial occlusions protocol and near-infrared spectroscopy (NIRS) to measure resting and post-exercise muscle oxidative metabolism (mVO2). APPROACH mVO2 was measured on the forearm muscles on two different days (day1 and day2) within one week in 11 healthy young adults (24.2 ± 2.7 years; 5 males). mVO2 was measured using NIRS during four repeated arterial occlusions at rest, and 5 min after exercise consisting of 90 s of rapid concentric contractions (5 minEPOC). MAIN RESULTS Resting mVO2 with four measurements was 17.88 ± 3.04% min-1 on day 1 and 19.42 ± 3.03% min-1 on day 2 (p = 0.171) with a coefficient of variation (CV) of 10.1%. When using only the first measurement, the CV increased to 18.5% (p = 0.039). 5minEPOC was 212.4 ± 142.5% and 177.1 ± 125.8% higher than resting and was not different between days one and two (53.83 ± 21.17% min-1 and 52.22 ± 22.10% min-1, respectively, p= 0.199). The CV and intraclass correlation (ICC) for 5minEPOC between days one and two were, 6.5% and 0.98, respectively. Using only the first value for 5minEPOC resulted in slightly higher CV but similar ICC (7.6% and 0.98, respectively; both p > 0.05). SIGNIFICANCE Our results suggest that within a single testing session, one arterial occlusion can provide reproducible measurements for both resting and post-exercise mVO2 similar to that of a four arterial occlusions protocol. While a four arterial occlusion protocol provides similar reliability for post-exercise mVO2 with one arterial occlusion, it reduces the day-to-day variance for resting mVO2 and therefore should be employed for longitudinal studies.
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Affiliation(s)
- Chuan Zhang
- Department of Kinesiology, University of Georgia, Athens, GA, United States of America
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Buoite Stella A, Morelli ME, Giudici F, Sartori A, Manganotti P, di Prampero PE. Comfortable walking speed and energy cost of locomotion in patients with multiple sclerosis. Eur J Appl Physiol 2020; 120:551-566. [PMID: 31919582 DOI: 10.1007/s00421-019-04295-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022]
Abstract
Comfortable walking speed and energy cost of walking are physiological markers of metabolic activity during gait. People with multiple sclerosis are characterized by altered gait biomechanics and energetics, related to the degree of disability and spasticity, which lead to an increased energy cost of walking. Several studies concerning the energy cost of walking in multiple sclerosis have been published. Nevertheless, differences in protocols and characteristics of the sample have led to different outcomes. The aim of the present meta-analysis is to summarize results from studies with specific inclusion characteristics, and to present data about the comfortable walking speed and the energy cost of walking at that speed. Moreover, a detailed discussion of the potential mechanisms involved in the altered metabolic activity during exercise was included. A total of 19 studies were considered, 12 of which were also part of the quantitative analysis. Despite the strict selection process, high between-group heterogeneity was found for both outcomes. Nevertheless, the overall results suggest a pooled mean comfortable walking speed of 1.12 m/s (95% CI 1.05-1.18) and energy cost of 0.19 mLO2/kg/m (95% CI 0.17-0.21). These findings support the results of previous studies suggesting that energy cost of walking may be increased by 2-3 times compared to healthy controls (HC), and encourage the use of this marker in association with other parameters of the disease.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| | - Maria Elisa Morelli
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Fabiola Giudici
- Unit of Statistics, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Pietro Enrico di Prampero
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
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Jeffries O, Waldron M, Pattison JR, Patterson SD. Enhanced Local Skeletal Muscle Oxidative Capacity and Microvascular Blood Flow Following 7-Day Ischemic Preconditioning in Healthy Humans. Front Physiol 2018; 9:463. [PMID: 29867526 PMCID: PMC5954802 DOI: 10.3389/fphys.2018.00463] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/13/2018] [Indexed: 01/05/2023] Open
Abstract
Ischemic preconditioning (IPC), which involves intermittent periods of ischemia followed by reperfusion, is an effective clinical intervention that reduces the risk of myocardial injury and confers ischemic tolerance to skeletal muscle. Repeated bouts of IPC have been shown to stimulate long-term changes vascular function, however, it is unclear what metabolic adaptations may occur locally in the muscle. Therefore, we investigated 7 days of bilateral lower limb IPC (4 × 5 min) above limb occlusion pressure (220 mmHg; n = 10), or sham (20 mmHg; n = 10), on local muscle oxidative capacity and microvascular blood flow. Oxidative capacity was measured using near-infrared spectroscopy (NIRS) during repeated short duration arterial occlusions (300 mmHg). Microvascular blood flow was assessed during the recovery from submaximal isometric plantar flexion exercises at 40 and 60% of maximal voluntary contraction (MVC). Following the intervention period, beyond the late phase of protection (72 h), muscle oxidative recovery kinetics were speeded by 13% (rate constant pre 2.89 ± 0.47 min-1 vs. post 3.32 ± 0.69 min-1; P < 0.05) and resting muscle oxygen consumption (m O2) was reduced by 16.4% (pre 0.39 ± 0.16%.s-1 vs. post 0.33 ± 0.14%.s-1; P < 0.05). During exercise, changes in deoxygenated hemoglobin (HHb) from rest to steady state were reduced at 40 and 60% MVC (16 and 12%, respectively, P < 0.05) despite similar measures of total hemoglobin (tHb). At the cessation of exercise, the time constant for recovery in oxygenated hemoglobin (O2Hb) was accelerated at 40 and 60% MVC (by 33 and 43%, respectively) suggesting enhanced reoxygenation in the muscle. No changes were reported for systemic measures of resting heart rate or blood pressure. In conclusion, repeated bouts of IPC over 7 consecutive days increased skeletal muscle oxidative capacity and microvascular muscle blood flow. These findings are consistent with enhanced mitochondrial and vascular function following repeated IPC and may be of clinical or sporting interest to enhance or offset reductions in muscle oxidative capacity.
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Affiliation(s)
- Owen Jeffries
- School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom.,School of Biomedical Science, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark Waldron
- School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom.,School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - John R Pattison
- School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom
| | - Stephen D Patterson
- School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom
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13
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Willingham TB, McCully KK. In Vivo Assessment of Mitochondrial Dysfunction in Clinical Populations Using Near-Infrared Spectroscopy. Front Physiol 2017; 8:689. [PMID: 28959210 PMCID: PMC5603672 DOI: 10.3389/fphys.2017.00689] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/28/2017] [Indexed: 12/13/2022] Open
Abstract
The ability to sustain submaximal exercise is largely dependent on the oxidative capacity of mitochondria within skeletal muscle, and impairments in oxidative metabolism have been implicated in many neurologic and cardiovascular pathologies. Here we review studies which have demonstrated the utility of Near-infrared spectroscopy (NIRS) as a method of evaluating of skeletal muscle mitochondrial dysfunction in clinical human populations. NIRS has been previously used to noninvasively measure tissue oxygen saturation, but recent studies have demonstrated the utility of NIRS as a method of evaluating skeletal muscle oxidative capacity using post-exercise recovery kinetics of oxygen metabolism. In comparison to historical methods of measuring muscle metabolic dysfunction in vivo, NIRS provides a more versatile and economical method of evaluating mitochondrial oxidative capacity in humans. These advantages generate great potential for the clinical applicability of NIRS as a means of evaluating muscle dysfunction in clinical populations.
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Affiliation(s)
| | - Kevin K McCully
- Department of Kinesiology, University of GeorgiaAthens, GA, United States
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14
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Straudi S, Manfredini F, Lamberti N, Zamboni P, Bernardi F, Marchetti G, Pinton P, Bonora M, Secchiero P, Tisato V, Volpato S, Basaglia N. The effectiveness of Robot-Assisted Gait Training versus conventional therapy on mobility in severely disabled progressIve MultiplE sclerosis patients (RAGTIME): study protocol for a randomized controlled trial. Trials 2017; 18:88. [PMID: 28241776 PMCID: PMC5330064 DOI: 10.1186/s13063-017-1838-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background Gait and mobility impairments affect the quality of life (QoL) of patients with progressive multiple sclerosis (MS). Robot-assisted gait training (RAGT) is an effective rehabilitative treatment but evidence of its superiority compared to other options is lacking. Furthermore, the response to rehabilitation is multidimensional, person-specific and possibly involves functional reorganization processes. The aims of this study are: (1) to test the effectiveness on gait speed, mobility, balance, fatigue and QoL of RAGT compared to conventional therapy (CT) in progressive MS and (2) to explore changes of clinical and circulating biomarkers of neural plasticity. Methods This will be a parallel-group, randomized controlled trial design with the assessor blinded to the group allocation of participants. Ninety-eight (49 per arm) progressive MS patients (EDSS scale 6–7) will be randomly assigned to receive twelve 2-h training sessions over a 4-week period (three sessions/week) of either: (1) RAGT intervention on a robotic-driven gait orthosis (Lokomat, Hocoma, Switzerland). The training parameters (torque of the knee and hip drives, treadmill speed, body weight support) are set during the first session and progressively adjusted during training progression or (2) individual conventional physiotherapy focusing on over-ground walking training performed with the habitual walking device. The same assessors will perform outcome measurements at four time points: baseline (before the first intervention session); intermediate (after six training sessions); end of treatment (after the completion of 12 sessions); and follow-up (after 3 months from the end of the training program). The primary outcome is gait speed, assessed by the Timed 25-Foot Walk Test. We will also assess walking endurance, balance, depression, fatigue and QoL as well as instrumental laboratory markers (muscle metabolism, cerebral venous hemodynamics, cortical activation) and circulating laboratory markers (rare circulating cell populations pro and anti-inflammatory cytokines/chemokines, growth factors, neurotrophic factors, coagulation factors, other plasma proteins suggested by transcriptomic analysis and metabolic parameters). Discussion The RAGT training is expected to improve mobility compared to the active control intervention in progressive MS. Unique to this study is the analysis of various potential markers of plasticity in relation with clinical outcomes. Trial registration ClinicalTrials.gov, identifier: NCT02421731. Registered on 19 January 2015 (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1838-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Fabio Manfredini
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy. .,Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
| | - Nicola Lamberti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Unit of Translational Surgery and Vascular Diseases Center, Ferrara University Hospital, Ferrara, Italy
| | - Francesco Bernardi
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Giovanna Marchetti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Pinton
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Massimo Bonora
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Paola Secchiero
- Department of Morphology, Surgery and Experimental Medicine, Section of Anatomy and Histology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Veronica Tisato
- Department of Morphology, Surgery and Experimental Medicine, Section of Anatomy and Histology, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Center for Clinical Epidemiology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nino Basaglia
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
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15
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Harp MA, McCully KK, Moldavskiy M, Backus D. Skeletal muscle mitochondrial capacity in people with multiple sclerosis. Mult Scler J Exp Transl Clin 2016; 2:2055217316678020. [PMID: 28607744 PMCID: PMC5408569 DOI: 10.1177/2055217316678020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/26/2016] [Accepted: 10/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background People with multiple sclerosis (MS) have functional disability and may have reduced muscle mitochondrial capacity. Objective The objective of this paper is to measure muscle mitochondrial capacity of leg muscles using near-infrared spectroscopy (NIRS) and compare to functional status. Materials and methods People with MS (n = 16) and a control (CON) group (n = 9) were evaluated for 25-ft walk time. Mitochondrial capacity of both gastrocnemius muscles were measured with NIRS as the rate of recovery of oxygen consumption in after exercise. Results Mitochondrial capacity was lower in the MS group compared to the CON group (rate constants: 1.13 ± 0.29 vs. 1.68 ± 0.37 min−1, p < 0.05). There was a tendency for people with MS who used assistive devices to have lower mitochondrial capacity in the weaker leg (p = 0.07). Conclusion NIRS measurements of mitochondrial capacity suggest a 40% deficit in people with MS compared to CONs and this may contribute to walking disability.
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16
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Wens I, Eijnde BO, Hansen D. Muscular, cardiac, ventilatory and metabolic dysfunction in patients with multiple sclerosis: Implications for screening, clinical care and endurance and resistance exercise therapy, a scoping review. J Neurol Sci 2016; 367:107-21. [DOI: 10.1016/j.jns.2016.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 05/11/2016] [Accepted: 05/24/2016] [Indexed: 01/03/2023]
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17
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Jones S, Chiesa ST, Chaturvedi N, Hughes AD. Recent developments in near-infrared spectroscopy (NIRS) for the assessment of local skeletal muscle microvascular function and capacity to utilise oxygen. Artery Res 2016; 16:25-33. [PMID: 27942271 PMCID: PMC5134760 DOI: 10.1016/j.artres.2016.09.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose of review Continuous wave near infrared spectroscopy (CW NIRS) provides non-invasive technology to measure relative changes in oxy- and deoxy-haemoglobin in a dynamic environment. This allows determination of local skeletal muscle O2 saturation, muscle oxygen consumption (V˙O2) and blood flow. This article provides a brief overview of the use of CW NIRS to measure exercise-limiting factors in skeletal muscle. Recent findings NIRS parameters that measure O2 delivery and capacity to utilise O2 in the muscle have been developed based on response to physiological interventions and exercise. NIRS has good reproducibility and agreement with gold standard techniques and can be used in clinical populations where muscle oxidative capacity or oxygen delivery (or both) are impaired. CW NIRS has limitations including: the unknown contribution of myoglobin to the overall signals, the impact of adipose tissue thickness, skin perfusion during exercise, and variations in skin pigmentation. These, in the main, can be circumvented through appropriate study design or measurement of absolute tissue saturation. Summary CW NIRS can assess skeletal muscle O2 delivery and utilisation without the use of expensive or invasive procedures and is useable in large population-based samples, including older adults. An overview of CW NIRS to measure O2 utilisation and delivery is presented. CW NIRS is cheap, non-invasive, portable and useable in population-based samples. It is useful for understanding underlying mechanisms of deterioration in capacity.
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Affiliation(s)
- Siana Jones
- Corresponding author. UCL Institute of Cardiovascular Science, 10th Floor, 1-19 Torrington Place, London WC1E 7HB, UK. Fax: +44 207 594 1706.UCL Institute of Cardiovascular Science10th Floor, 1-19 Torrington PlaceLondonWC1E 7HEUK
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18
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Wang C, Zhang R, Zhang X, Wang H, Zhao K, Jin L, Zhang J, Wang X, Fang J. Noninvasive measurement of lower extremity muscle oxygen extraction fraction under cuff compression paradigm. J Magn Reson Imaging 2015; 43:1148-58. [PMID: 26527473 DOI: 10.1002/jmri.25074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/29/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To demonstrate the feasibility of using a susceptibility-based MRI technique with asymmetric spin-echo (ASE) sequence to assess the lower extremity muscle oxygen extraction fraction (OEF) alternations under cuff compression paradigm. METHODS Approved by the local institutional human study committee, nine healthy young volunteers participated in this study. All the ASE scans were conducted using a 3 Tesla clinical MRI scanner during resting state (pre), 1-3 min (post1) and 3-5 min (post2) after a pressure of 50 mmHg above individual systolic blood pressure imposed on the thigh. Moreover, near-infrared spectroscopy (NIRS) measurements were performed on the same day under the same cuff compression protocol to verify the accuracy of this susceptibility-based method. RESULTS In all volunteers, the mean MRI based OEF in gastrocnemius (GAS) muscle increased significantly from 0.28 ± 0.02 (pre) to 0.31 ± 0.03 (post1, P < 0.05) and 0.31 ± 0.03 (post2, P < 0.05). In addition, mean OEF in soleus (SOL) muscle went up from 0.31 ± 0.01 (pre) to 0.33 ± 0.03 (post1, P = 0.14) and 0.37 ± 0.04 (post2, P < 0.05). For comparison, NIRS measured 1-%HbO2 (percentage of deoxyhemoglobin concentration within total hemoglobin) in GAS rose significantly from 0.29 ± 0.03 (pre) to 0.31 ± 0.04 (post1, P < 0.05) and 0.31 ± 0.04 (post2, P < 0.05), which confirmed the accuracy of the MRI-based OEF. CONCLUSION This susceptibility-based OEF quantification technique together with cuff compression paradigm could provide a noninvasive, quantifiable and effective tool for measuring skeletal muscle oxygenation.
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Affiliation(s)
- Chengyan Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Rui Zhang
- College of Engineering, Peking University, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | | | - Kai Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | | | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
| | - Xiaoying Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jing Fang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
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