1
|
Inagaki S, Matsuura H, Sakurai K, Minati L, Yoshimura N. Decline in Sensory Integration in Old Age and Its Related Functional Brain Connectivity Correlates Observed during a Virtual Reality Task. Brain Sci 2024; 14:840. [PMID: 39199531 PMCID: PMC11352474 DOI: 10.3390/brainsci14080840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024] Open
Abstract
Sensory integration is an essential human function whose decline impacts quality of life, particularly in older adults. Herein, we propose an arm-reaching task based on a virtual reality head-mounted display system to assess sensory integration in daily life, and we examined whether reaching task performance was associated with resting-state functional connectivity (rsFC) between the brain regions involved in sensory integration. We hypothesized that declining sensory integration would affect performance during a reaching task with multiple cognitive loads. Using a task in which a young/middle-aged group showed only small individual differences, older adults showed large individual differences in the gap angle between the reaching hand and the target position, which was used to assess sensory integration function. Additionally, rsfMRI data were used to identify correlations between rsFC and performance in older adults, showing that performance was correlated with connectivity between the primary motor area and the left inferior temporal gyrus and temporo-occipital region. Connectivity between areas is related to visuomotor integration; thus, the results suggest the involvement of visuomotor integration in the decline of sensory integration function and the validity of the gap angle during this VR reaching task as an index of functional decline.
Collapse
Affiliation(s)
- Satoru Inagaki
- Human Centered Science and Biomedical Engineering, Department of Computer Science, School of Computing, Tokyo Institute of Technology, Tokyo 226-8501, Japan;
| | - Hirokazu Matsuura
- Information and Communications Engineering, Department of Information and Communications Engineering, School of Engineering, Tokyo Institute of Technology, Tokyo 226-8501, Japan; (H.M.); (K.S.)
| | - Kazuki Sakurai
- Information and Communications Engineering, Department of Information and Communications Engineering, School of Engineering, Tokyo Institute of Technology, Tokyo 226-8501, Japan; (H.M.); (K.S.)
| | - Ludovico Minati
- Institute of Innovative Research, Tokyo Institute of Technology, Tokyo 226-8501, Japan;
- Center for Mind/Brain Science, University of Trento, 38122 Trento, Italy
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610056, China
| | - Natsue Yoshimura
- School of Computing, Tokyo Institute of Technology, Tokyo 226-8501, Japan
| |
Collapse
|
2
|
Chen YC, Lo IP, Tsai YY, Zhao CG, Hwang IS. Dual-task improvement of older adults after treadmill walking combined with blood flow restriction of low occlusion pressure: the effect on the heart-brain axis. J Neuroeng Rehabil 2024; 21:116. [PMID: 38997727 PMCID: PMC11241870 DOI: 10.1186/s12984-024-01412-y] [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: 11/02/2023] [Accepted: 06/23/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVE This study explored the impact of one session of low-pressure leg blood flow restriction (BFR) during treadmill walking on dual-task performance in older adults using the neurovisceral integration model framework. METHODS Twenty-seven older adults participated in 20-min treadmill sessions, either with BFR (100 mmHg cuff pressure on both thighs) or without it (NBFR). Dual-task performance, measured through light-pod tapping while standing on foam, and heart rate variability during treadmill walking were compared. RESULTS Following BFR treadmill walking, the reaction time (p = 0.002) and sway area (p = 0.012) of the posture dual-task were significantly reduced. Participants exhibited a lower mean heart rate (p < 0.001) and higher heart rate variability (p = 0.038) during BFR treadmill walking. Notably, BFR also led to band-specific reductions in regional brain activities (theta, alpha, and beta bands, p < 0.05). The topology of the EEG network in the theta and alpha bands became more star-like in the post-test after BFR treadmill walking (p < 0.005). CONCLUSION BFR treadmill walking improves dual-task performance in older adults via vagally-mediated network integration with superior neural economy. This approach has the potential to prevent age-related falls by promoting cognitive reserves.
Collapse
Affiliation(s)
- Yi-Ching Chen
- Department of Physical Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung City, Taiwan
- Physical Therapy Room, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - I-Ping Lo
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City, 701, Taiwan
| | - Yi-Ying Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City, 701, Taiwan
| | - Chen-Guang Zhao
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City, 701, Taiwan
| | - Ing-Shiou Hwang
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City, 701, Taiwan.
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
| |
Collapse
|
3
|
de Rond V, D'Cruz N, Hulzinga F, McCrum C, Verschueren S, de Xivry JJO, Nieuwboer A. Neural correlates of weight-shift training in older adults: a randomized controlled study. Sci Rep 2023; 13:19609. [PMID: 37949995 PMCID: PMC10638445 DOI: 10.1038/s41598-023-46645-4] [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: 06/28/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
Mediolateral weight-shifting is an important aspect of postural control. As it is currently unknown whether a short training session of mediolateral weight-shifting in a virtual reality (VR) environment can improve weight-shifting, we investigated this question and also probed the impact of practice on brain activity. Forty healthy older adults were randomly allocated to a training (EXP, n = 20, age = 70.80 (65-77), 9 females) or a control group (CTR, n = 20, age = 71.65 (65-82), 10 females). The EXP performed a 25-min weight-shift training in a VR-game, whereas the CTR rested for the same period. Weight-shifting speed in both single- (ST) and dual-task (DT) conditions was determined before, directly after, and 24 h after intervention. Functional Near-Infrared Spectroscopy (fNIRS) assessed the oxygenated hemoglobin (HbO2) levels in five cortical regions of interest. Weight-shifting in both ST and DT conditions improved in EXP but not in CTR, and these gains were retained after 24 h. Effects transferred to wider limits of stability post-training in EXP versus CTR. HbO2 levels in the left supplementary motor area were significantly increased directly after training in EXP during ST (change < SEM), and in the left somatosensory cortex during DT (change > SEM). We interpret these changes in the motor coordination and sensorimotor integration areas of the cortex as possibly learning-related.
Collapse
Affiliation(s)
- Veerle de Rond
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nicholas D'Cruz
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Motor Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Femke Hulzinga
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christopher McCrum
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Sabine Verschueren
- Research Group for Musculoskeletal Rehabilitation, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- Motor Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
- Leuven Brain Institute (LBI), Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
- Leuven Brain Institute (LBI), Leuven, Belgium.
| |
Collapse
|
4
|
Wang D, Zhou J, Huang Y, Yu H. Identifying the changes in the cortical activity of various brain regions for different balance tasks: A review. NeuroRehabilitation 2023:NRE220285. [PMID: 37125575 DOI: 10.3233/nre-220285] [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: 05/02/2023]
Abstract
BACKGROUND Balance support is critical to a person's overall function and health. Previous neuroimaging studies have shown that cortical structures play an essential role in postural control. OBJECTIVE This review aims to identify differences in the pattern of neural activity induced by balance tasks with different balance control requirements. METHODS Seventy-four articles were selected from the field of balance training and were examined based on four brain function detection technologies. RESULTS In general, most studies focused on the activity changes of various cortical areas during training at different difficulty levels, but more and more attention has also begun to focus on the functional changes of other cortical and deep subcortical structures. Our analysis also revealed the neglect of certain task types. CONCLUSION Based on these results, we identify and discuss future research directions that may contribute to a clear understanding of neural functional plasticity under different tasks.
Collapse
Affiliation(s)
- Duojin Wang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Jiankang Zhou
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Yanping Huang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| |
Collapse
|
5
|
Trost W, Hars M, Fernandez N, Herrmann F, Chevalley T, Ferrari S, Gold G, Rizzoli R, Vuilleumier P, Trombetti A. Functional brain changes in sarcopenia: evidence for differential central neural mechanisms in dynapenic older women. Aging Clin Exp Res 2023; 35:1015-1025. [PMID: 37029271 PMCID: PMC10149465 DOI: 10.1007/s40520-023-02391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/10/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND The European Working Group on Sarcopenia in Older People (EWGSOP2) recently revised its definition and diagnostic criteria for sarcopenia, placing muscle strength at the forefront. The pathogenesis of dynapenia (or low muscle strength) is still not fully understood, but there is emerging evidence that central neural factors constitute critical determinants. METHODS Our cross-sectional study included 59 community-dwelling older women (mean age 73.1 ± 4.9 years). Participants underwent detailed skeletal muscle assessments for muscle strength defined by handgrip strength and chair rise time measurements using the recently published EWGSOP2 cut-off points. Functional magnetic resonance imaging (fMRI) was assessed during the performance of a cognitive dual-task paradigm, consisting of a baseline, two single-tasks (motor and arithmetic) and one dual-task (motor and arithmetic combined). RESULTS Forty-seven percent (28/59) of participants were classified as dynapenic. fMRI results revealed a differential recruitment of motor circuits in the brain during the dual-task condition in dynapenic as compared with non-dynapenic participants. In particular, while the brain activity during the single-tasks did not differ between the two groups, only during the dual-task non-dynapenic participants showed significant increased activation in dorsolateral prefrontal and premotor cortex, and in supplementary motor area as compared to dynapenic participants. CONCLUSION Our results point to a dysfunctional involvement of brain networks associated with motor control in dynapenia in a multi-tasking paradigm. A better knowledge of the link between dynapenia and brain functions could provide new impulses in the diagnosis and interventions for sarcopenia.
Collapse
Affiliation(s)
- Wiebke Trost
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva 14, Switzerland
- Laboratory for Behavioural Neurology and Imaging of Cognition, Campus Biotech, University of Geneva, Geneva, Switzerland
| | - Mélany Hars
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva 14, Switzerland
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Natalia Fernandez
- Laboratory for Behavioural Neurology and Imaging of Cognition, Campus Biotech, University of Geneva, Geneva, Switzerland
| | - François Herrmann
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Thierry Chevalley
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva 14, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva 14, Switzerland
| | - Gabriel Gold
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - René Rizzoli
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva 14, Switzerland
| | - Patrik Vuilleumier
- Laboratory for Behavioural Neurology and Imaging of Cognition, Campus Biotech, University of Geneva, Geneva, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva 14, Switzerland.
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
| |
Collapse
|
6
|
Riedmann U, Fink A, Weber B, Koschutnig K. Functional Connectivity as an Index of Brain Changes Following a Unicycle Intervention: A Graph-Theoretical Network Analysis. Brain Sci 2022; 12:brainsci12081092. [PMID: 36009155 PMCID: PMC9405869 DOI: 10.3390/brainsci12081092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/24/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Grey matter volume reductions in the right superior temporal gyrus (rSTG) were observed in young adults who learned to ride a unicycle. As these decreases were correlated with the acquired ability in unicycling, the authors interpreted the change as a brain tissue reorganization to increase postural control’s automated and efficient coordination. The current study aims to further corroborate this interpretation by looking at changes in the functional brain network in the very same sample of participants. For this reason, we applied graph theory, a mathematics field used to study network structure functionality. Four global and two local graph-theoretical parameters were calculated to measure whole brain and rSTG specific changes in functional network activity following the three-week-unicycle training. Findings revealed that the Local Efficiency of the rSTG was significantly elevated after the intervention indicating an increase in fault tolerance of the rSTG, possibly reflecting decentralisation of rSTG specific functions to neighbouring nodes. Thus, the increased Local Efficiency may indicate increased task efficiency by decentralising the processing of functions crucial for balance.
Collapse
|
7
|
Lehmann N, Kuhn YA, Keller M, Aye N, Herold F, Draganski B, Taube W, Taubert M. Brain Activation During Active Balancing and Its Behavioral Relevance in Younger and Older Adults: A Functional Near-Infrared Spectroscopy (fNIRS) Study. Front Aging Neurosci 2022; 14:828474. [PMID: 35418854 PMCID: PMC8997341 DOI: 10.3389/fnagi.2022.828474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/28/2022] [Indexed: 12/26/2022] Open
Abstract
Age-related deterioration of balance control is widely regarded as an important phenomenon influencing quality of life and longevity, such that a more comprehensive understanding of the neural mechanisms underlying this process is warranted. Specifically, previous studies have reported that older adults typically show higher neural activity during balancing as compared to younger counterparts, but the implications of this finding on balance performance remain largely unclear. Using functional near-infrared spectroscopy (fNIRS), differences in the cortical control of balance between healthy younger (n = 27) and older (n = 35) adults were explored. More specifically, the association between cortical functional activity and balance performance across and within age groups was investigated. To this end, we measured hemodynamic responses (i.e., changes in oxygenated and deoxygenated hemoglobin) while participants balanced on an unstable device. As criterion variables for brain-behavior-correlations, we also assessed postural sway while standing on a free-swinging platform and while balancing on wobble boards with different levels of difficulty. We found that older compared to younger participants had higher activity in prefrontal and lower activity in postcentral regions. Subsequent robust regression analyses revealed that lower prefrontal brain activity was related to improved balance performance across age groups, indicating that higher activity of the prefrontal cortex during balancing reflects neural inefficiency. We also present evidence supporting that age serves as a moderator in the relationship between brain activity and balance, i.e., cortical hemodynamics generally appears to be a more important predictor of balance performance in the older than in the younger. Strikingly, we found that age differences in balance performance are mediated by balancing-induced activation of the superior frontal gyrus, thus suggesting that differential activation of this region reflects a mechanism involved in the aging process of the neural control of balance. Our study suggests that differences in functional brain activity between age groups are not a mere by-product of aging, but instead of direct behavioral relevance for balance performance. Potential implications of these findings in terms of early detection of fall-prone individuals and intervention strategies targeting balance and healthy aging are discussed.
Collapse
Affiliation(s)
- Nico Lehmann
- Department of Sport Science, Institute III, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- *Correspondence: Nico Lehmann,
| | - Yves-Alain Kuhn
- Department of Neurosciences and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Martin Keller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Norman Aye
- Department of Sport Science, Institute III, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Bogdan Draganski
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Laboratory for Research in Neuroimaging, Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Wolfgang Taube
- Department of Neurosciences and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Marco Taubert
- Department of Sport Science, Institute III, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Science, Otto von Guericke University, Magdeburg, Germany
| |
Collapse
|
8
|
Orcioli-Silva D, Islam A, Baker MR, Gobbi LTB, Rochester L, Pantall A. Bi-Anodal Transcranial Direct Current Stimulation Combined With Treadmill Walking Decreases Motor Cortical Activity in Young and Older Adults. Front Aging Neurosci 2021; 13:739998. [PMID: 34924993 PMCID: PMC8681021 DOI: 10.3389/fnagi.2021.739998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Walking in the "real world" involves motor and cognitive processes. In relation to this, declines in both motor function and cognition contribute to age-related gait dysfunction. Transcranial direct current stimulation (tDCS) and treadmill walking (STW) have potential to improve gait, particularly during dual-task walking (DTW); walking whilst performing a cognitive task. Our aims were to analyze effects of combined anodal tDCS + STW intervention on cortical activity and gait during DTW. Methods: Twenty-three young adults (YA) and 21 older adults (OA) were randomly allocated to active or sham tDCS stimulation groups. Participants performed 5-min of mixed treadmill walking (alternating 30 s bouts of STW and DTW) before and after a 20-min intervention of active or sham tDCS + STW. Anodal electrodes were placed over the left prefrontal cortex (PFC) and the vertex (Cz) using 9 cm2 electrodes at 0.6 mA. Cortical activity of the PFC, primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) bilaterally were recorded using a functional near-infrared spectroscopy (fNIRS) system. Oxygenated hemoglobin (HbO2) levels were analyzed as indicators of cortical activity. An accelerometer measured gait parameters. We calculated the difference between DTW and STW for HbO2 and gait parameters. We applied linear mixed effects models which included age group (YA vs. OA), stimulation condition (sham vs. active), and time (pre- vs. post-intervention) as fixed effects. Treadmill belt speed was a covariate. Partial correlation tests were also performed. Results: A main effect of age group was observed. OA displayed higher activity bilaterally in the PFC and M1, unilaterally in the right PMC and higher gait variability than YA. M1 activity decreased in both YA and OA following active tDCS + STW. There was no overall effect of tDCS + STW on PFC activity or gait parameters. However, negative correlations were observed between changes in left PFC and stride length variability following active tDCS + STW intervention. Conclusion: Increased activity in multiple cortical areas during DTW in OA may act as a compensatory mechanism. Reduction in M1 activity following active tDCS + STW with no observed gait changes suggests improved neural efficiency.
Collapse
Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Aisha Islam
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annette Pantall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|