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Dawson ZE, Beaumont AJ, Carter SE. A Systematic Review of Physical Activity and Sedentary Behavior Patterns in an Osteoarthritic Population. J Phys Act Health 2024; 21:115-133. [PMID: 38086351 DOI: 10.1123/jpah.2023-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To explore physical activity (PA) and sedentary behaviors (SB) in individuals with lower limb (LL) Osteoarthritis (OA) and the influence of age, sex, and body mass index (BMI) on these behaviors. DESIGN Systematic review search: PubMed, Cochrane Library, ScienceDirect, and CINAHL databases were searched from inception until July 2023. Study criteria: Studies that reported quantifiable device-based or self-reported data for PA and SB variables in adults clinically diagnosed with LL OA were included. DATA SYNTHESIS A synthesis of PA and SB levels for those diagnosed with LL OA and the influence age, sex, and BMI have on these behaviors. RESULTS From the 1930 studies identified through the electronic search process, 48 met the inclusion criteria. PA guidelines were met by 33% of the sample population that measured moderate and moderate to vigorous PA. No studies reported 75 minutes per week or more of vigorous PA. Additionally, 58% of the population reporting SB were sedentary for 8 hours per day or more. Also, increasing age, BMI, and the female sex were identified as negative influences on PA levels. There were numerous methodological inconsistencies in how data were collected and reported, such as various activity monitor cut points for PA and SB bout duration. CONCLUSION Adults with LL OA may be at an increased risk of noncommunicable diseases due to low PA and high SB levels. It is important to consider age, sex, and BMI when investigating behavior patterns in those with LL OA.
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Affiliation(s)
- Zoe E Dawson
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Alexander J Beaumont
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Sophie E Carter
- School of Science, Technology and Health, York St John University, York, United Kingdom
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Tateuchi H, Yagi M, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Identifying Muscle Function-based Phenotypes Associated With Radiographic Progression of Secondary Hip Osteoarthritis. Arch Phys Med Rehabil 2023; 104:1892-1902. [PMID: 37230404 DOI: 10.1016/j.apmr.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purposes of our study were to (1) identify muscle function-based clinical phenotypes in patients with hip osteoarthritis (OA) and (2) determine the association between those phenotypes and radiographic progression of hip OA. DESIGN Prospective cohort study. SETTING Clinical biomechanics laboratory of a university. PARTICIPANTS Fifty women patients with mild-to-moderate secondary hip OA (N=50) were recruited from the orthopedic department of a single institution. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Two-step cluster analyses were performed to classify the patients, using hip flexion, extension, abduction, and external/internal rotation muscle strength (cluster analysis 1); relative hip muscle strength to total hip strength (ie, hip muscle strength balance; cluster analysis 2); and both hip muscle strength and muscle strength balance (cluster analysis 3) as variables. The association between the phenotype and hip OA progression over 12 months (indicated by joint space width [JSW] >0.5 mm) was investigated by logistic regression analyses. Hip joint morphology, hip pain, gait speed, physical activity, Harris hip score, and SF-36 scores were compared between the phenotypes. RESULTS Radiographic progression of hip OA was observed in 42% of the patients. The patients were classified into 2 phenotypes in each of the 3 cluster analyses. The solution in cluster analyses 1 and 3 was similar, and high-function and low-function phenotypes were identified; however, no association was found between the phenotypes and hip OA progression. The phenotype 2-1 (high-risk phenotype) extracted in cluster analysis 2, which had relative muscle weakness in hip flexion and internal rotation, was associated with subsequent hip OA progression, even after adjusting for age and minimum JSW at baseline (adjusted odds ratio [95% confidence interval], 3.60 [1.07-12.05]; P=.039). CONCLUSION As preliminary findings, the phenotype based on hip muscle strength balance, rather than hip muscle strength, may be associated with hip OA progression.
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Affiliation(s)
- Hiroshige Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruhiko Akiyama
- Department of Orthopedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Koji Goto
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka So
- Department of Orthopedic Surgery, Shiga General Hospital, Shiga, Japan
| | - Yutaka Kuroda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Koffman LJ, Crainiceanu CM, Roemmich RT, French MA. Identifying Unique Subgroups of Individuals With Stroke Using Heart Rate and Steps to Characterize Physical Activity. J Am Heart Assoc 2023; 12:e030577. [PMID: 37681556 PMCID: PMC10547293 DOI: 10.1161/jaha.123.030577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
Background Low physical activity (PA) is associated with poor health outcomes after stroke. Step counts are a common metric of PA; however, other physiologic signals (eg, heart rate) may help to identify subgroups of individuals poststroke at varying levels of risk of poor health outcomes. Here, we aimed to identify clinically relevant subgroups of individuals poststroke based on PA profiles that leverage multiple data sources, including step count and heart rate data, from wearable devices. Methods and Results Seventy individuals poststroke participated. Participants wore a Fitbit Inspire 2 for 1 year and completed clinical assessments. We defined a group-based steps-per-minute threshold and an individual heart rate threshold to categorize each minute of PA into 1 of 4 states: high steps/high heart rate, low steps/low heart rate, high steps/low heart rate, and low steps/high heart rate. We used the proportion of time spent in each state along with steps per day, sedentary time, mean steps among minutes with high steps and high heart rate, and resting heart rate in a k-means clustering algorithm to identify subgroups and compared Activity Measure for Post-Acute Care Mobility T Score, Stroke Impact Scale, and gait speed among subgroups. We identified 3 subgroups, Active (n=8), Sedentary (n=29), and Deconditioned (n=33), which differed significantly on all clustering variables except resting heart rate. We observed significant differences in Activity Measure for Post-Acute Care Mobility T scores between subgroups, with the Deconditioned subgroup exhibiting the lowest score. Conclusions Quantifying PA with heart rate and step count using readily available wearable devices can identify clinically meaningful subgroups of individuals poststroke.
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Affiliation(s)
- Lily J. Koffman
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Ryan T. Roemmich
- Department of Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreMD
- Center for Movement StudiesKennedy Krieger InstituteBaltimoreMD
| | - Margaret A. French
- Department of Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreMD
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Weber F, Müller C, Bahns C, Kopkow C, Färber F, Gellert P, Otte I, Vollmar HC, Brannath W, Diederich F, Kloep S, Rothgang H, Dieter V, Krauß I, Kloek C, Veenhof C, Collisi S, Repschläger U, Böbinger H, Grüneberg C, Thiel C, Peschke D. Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial. BMC Musculoskelet Disord 2023; 24:221. [PMID: 36959595 PMCID: PMC10034894 DOI: 10.1186/s12891-023-06255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
Introduction Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care. Methods This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation. Discussion After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs. Trial registration German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-023-06255-7.
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Affiliation(s)
- Franziska Weber
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carsten Müller
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Carolin Bahns
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- grid.8842.60000 0001 2188 0404Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Francesca Färber
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ina Otte
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Horst Christian Vollmar
- grid.5570.70000 0004 0490 981XInstitute of General Practice and Family Medicine, Ruhr University Bochum, Bochum, Germany
| | - Werner Brannath
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Freya Diederich
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Stephan Kloep
- grid.7704.40000 0001 2297 4381Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- grid.7704.40000 0001 2297 4381Department for Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Valerie Dieter
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Inga Krauß
- grid.411544.10000 0001 0196 8249Department of Sports Medicine, University Hospital, Medical Clinic, Interfaculty Research Institute for Sports and Physical Activity, Tuebingen, Germany
| | - Corelien Kloek
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Cindy Veenhof
- grid.5477.10000000120346234Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- grid.5477.10000000120346234Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Sandra Collisi
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Ute Repschläger
- grid.491717.dReferat Projektmanagement und Digitalisierung, Bundesverband selbstständiger Physiotherapeuten – IFK e. V., Bochum, Germany
| | - Hannes Böbinger
- grid.492243.a0000 0004 0483 0044Innovationsfonds & Produktportfolio, Techniker Krankenkasse, Hamburg, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Dirk Peschke
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Health Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
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Crijns TJ, Brinkman N, Ramtin S, Ring D, Doornberg J, Jutte P, Koenig K. Are There Distinct Statistical Groupings of Mental Health Factors and Pathophysiology Severity Among People with Hip and Knee Osteoarthritis Presenting for Specialty Care? Clin Orthop Relat Res 2022; 480:298-309. [PMID: 34817453 PMCID: PMC8747586 DOI: 10.1097/corr.0000000000002052] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is mounting evidence that objective measures of pathophysiology do not correlate well with symptom intensity. A growing line of inquiry identifies statistical combinations (so-called "phenotypes") of various levels of distress and unhelpful thoughts that are associated with distinct levels of symptom intensity and magnitude of incapability. As a next step, it would be helpful to understand how distress and unhelpful thoughts interact with objective measures of pathologic conditions such as the radiologic severity of osteoarthritis. The ability to identify phenotypes of these factors that are associated with distinct levels of illness could contribute to improved personalized musculoskeletal care in a comprehensive, patient-centered model. QUESTIONS/PURPOSES (1) When measures of mental health are paired with radiologic osteoarthritis severity, are there distinct phenotypes among adult patients with hip and knee osteoarthritis? (2) Is there a difference in the degree of capability and pain self-efficacy among the identified mental health and radiologic phenotypes? (3) When capability (Patient-reported Outcomes Measurement Information System Physical Function [PROMIS PF]) is paired with radiographic osteoarthritis severity, are there distinct phenotypes among patients with hip and knee osteoarthritis? (4) Is there a difference in mental health among patients with the identified capability and radiologic phenotypes? METHODS We performed a secondary analysis of data from a study of 119 patients who presented for musculoskeletal specialty care for hip or knee osteoarthritis. Sixty-seven percent (80 of 119) of patients were women, with a mean age of 62 ± 10 years. Seventy-six percent (91 of 119) of patients had knee osteoarthritis, and 59% (70 of 119) had an advanced radiographic grade of osteoarthritis (Kellgren-Lawrence grade 3 or higher). This dataset is well-suited for our current experiment because the initial study had broad enrollment criteria, making these data applicable to a diverse population and because patients had sufficient variability in radiographic severity of osteoarthritis. All new and returning patients were screened for eligibility. We do not record the percentage of eligible patients who do not participate in cross-sectional surveys, but the rate is typically high (more than 80%). One hundred forty-eight eligible patients started the questionnaires, and 20% (29 of 148) of patients did not complete at least 60% of the questionnaires and were excluded, leaving 119 patients available for analysis. We measured psychologic distress (Patient Health Questionnaire-2 [PHQ-2] and Generalized Anxiety Disorder-2 questionnaire [GAD-2]), unhelpful thoughts about pain (Pain Catastrophizing Scale-4 [PCS-4]), self-efficacy when in pain (Pain Self-Efficacy Questionnaire-2), and capability (PROMIS PF). One of two arthroplasty fellowship-trained surgeons assigned the Kellgren-Lawrence grade of osteoarthritis based on radiographs in the original study. We used a cluster analysis to generate two sets of phenotypes: (1) measures of mental health (PHQ-2, GAD-2, PCS-4) paired with the Kellgren-Lawrence grade and (2) capability (PROMIS PF) paired with the Kellgren-Lawrence grade. We used one-way ANOVA and Kruskal-Wallis H tests to assess differences in capability and self-efficacy and mental health, respectively. RESULTS When pairing measures of psychologic distress (PHQ-2 and GAD-2) and unhelpful thoughts (catastrophic thinking) with the grade of radiographic osteoarthritis, six distinct phenotypes arose. These groups differed in terms of capability and pain self-efficacy (for example, mild pathology/low distress versus average pathology/high distress [PROMIS PF, mean ± standard deviation]: 43 ± 6.3 versus 33 ± 4.8; p = 0.003). When pairing the degree of capability (PROMIS PF) with the Kellgren-Lawrence grade, four distinct phenotypes arose. Patients in three of these did not differ in terms of disease severity but had notable variation in the degree of limitations. Patients with these radiologic and capability phenotypes differed in terms of distress and unhelpful thoughts (for example, moderate pathology/low capability versus mild pathology/high capability [PHQ-2, median and interquartile range]: 3 [1 to 5] versus 0 [0 to 0]; p < 0.001). CONCLUSION Statistical groupings ("phenotypes") that include both measures of pathology and mental health are associated with differences in symptom intensity and magnitude of incapability and have the potential to help musculoskeletal specialists discern mental and social health priorities. Future investigations may test whether illness phenotype-specific comprehensive biopsychosocial treatment strategies are more effective than treatment of pathology alone. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Tom J. Crijns
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Job Doornberg
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Paul Jutte
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Karl Koenig
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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SILIŞTEANU SC, SILIŞTEANU AE, SZAKÁCS J. Influence of the physical activity in the elderly people diagnosed with knee osteoarthritis during the pandemic period caused by COVID-19. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Knee osteoarthritis is considered to be a chronic disease that affects the joints by causing pain, joint stiffness and decreased functional capacity. Regular physical activity can keep and increase functional capacity, it can reduce pain by improving movement behavior. The disruption of the sedentary behavior of the elderly patients with knee osteoarthritis can lead to improved physical function and general health. The purpose of this paper is to point out the role of physical activity in the elderly people diagnosed with knee osteoarthritis during the COVID-19 pandemic. Material and method. A total of 155 patients diagnosed (clinical and imaging) with knee ostoarthritis, who were treated on an outpatient basis, from May to September 2020, were studied. The parameters assessed in the study were pain, joint stiffness, the ability to carry out daily activities, anxiety and quality of life. Results and discussion.The studied group of patients was homogeneous in terms of the weight by age group and gender. Higher values were recorded in the study group in the evaluation of patients based on scales, the results being statistically significant, with value for p<0.05, which means that the hypothesis was validated. Conclusions. Patients of the study group recorded improvementin of functional capacity, joint stability and static and dynamic balance, which allowed a faster reintegration into the family and society.
Keywords: physical activity, pain, elderly people, knee osteoarthritis,
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Affiliation(s)
- Sînziana Călina SILIŞTEANU
- Railway Hospital Iasi - Specialty Ambulatory of Suceava 2 "Stefan cel Mare" University of Suceava FEFS-DSDU
| | | | - Juliánna SZAKÁCS
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of Medicine, Department of Biophysics
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