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Nevanperä S, Hu N, Walker S, Avela J, Piirainen JM. Modulation of H-reflex and V-wave responses during dynamic balance perturbations. Exp Brain Res 2023; 241:1599-1610. [PMID: 37142781 DOI: 10.1007/s00221-023-06625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
Motoneuron excitability is possible to measure using H-reflex and V-wave responses. However, it is not known how the motor control is organized, how the H-reflex and V-wave responses modulate and how repeatable these are during dynamic balance perturbations. To assess the repeatability, 16 participants (8 men, 8 women) went through two, identical measurement sessions with ~ 48 h intervals, where maximal isometric plantar flexion (IMVC) and dynamic balance perturbations in horizontal, anterior-posterior direction were performed. Soleus muscle (SOL) neural modulation during balance perturbations were measured at 40, 70, 100 and 130 ms after ankle movement by using both H-reflex and V-wave methods. V-wave, which depicts the magnitude of efferent motoneuronal output (Bergmann et al. in JAMA 8:e77705, 2013), was significantly enhanced as early as 70 ms after the ankle movement. Both the ratio of M-wave-normalized V-wave (0.022-0.076, p < 0.001) and H-reflex (0.386-0.523, p < 0.001) increased significantly at the latency of 70 ms compared to the latency of 40 ms and remained at these levels at latter latencies. In addition, M-wave normalized V-wave/H-reflex ratio increased from 0.056 to 0.179 (p < 0.001). The repeatability of V-wave demonstrated moderate-to-substantial repeatability (ICC = 0.774-0.912) whereas the H-reflex was more variable showing fair-to-substantial repeatability (ICC = 0.581-0.855). As a conclusion, V-wave was enhanced already at 70 ms after the perturbation, which may indicate that increased activation of motoneurons occurred due to changes in descending drive. Since this is a short time-period for voluntary activity, some other, potentially subcortical responses might be involved for V-wave increment rather than voluntary drive. Our results addressed the usability and repeatability of V-wave method during dynamic conditions, which can be utilized in future studies.
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Affiliation(s)
- Samuli Nevanperä
- Sports Technology Program, Faculty of Sport and Health Sciences, University of Jyväskylä, Kidekuja 2, 88610, Vuokatti, Finland.
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, PL35, 40700, Jyväskylä, Finland.
| | - Nijia Hu
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, PL35, 40700, Jyväskylä, Finland
| | - Simon Walker
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, PL35, 40700, Jyväskylä, Finland
| | - Janne Avela
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, PL35, 40700, Jyväskylä, Finland
| | - Jarmo M Piirainen
- Sports Technology Program, Faculty of Sport and Health Sciences, University of Jyväskylä, Kidekuja 2, 88610, Vuokatti, Finland
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, PL35, 40700, Jyväskylä, Finland
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Jin X, Zhang Z, Zhang L, Li L, Huang G. Using a new phase-locked visual feedback protocol to affirm simpler models for alpha dynamics. J Neurosci Methods 2022; 368:109473. [PMID: 34990698 DOI: 10.1016/j.jneumeth.2021.109473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/04/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
Abstract
Alpha band oscillations are the most prominent rhythmic oscillations in EEG, which are related to various types of mental diseases, such as attention deficit hyperactivity disorder, anxiety, and depression. However, the dynamics of alpha oscillations, especially how the endogenous alpha oscillations be entrained by exogenous stimulus, are still unclear. Recently, a newly-developed phase-locked visual feedback (PLVF) protocol has shown effectiveness in modulating alpha rhythm, which provides empirical evidence for the further investigation of the neural mechanism of alpha dynamics. In this work, extensive numerical simulations based on four well-studied models were used to investigate the questions that (1) What kind of dynamic model exhibits a modulation phenomenon of PLVF? (2) What is the dynamic mechanism of PLVF for alpha modulation? (3) Which factors affect the modulation effects in PLVF? The result indicates that the dynamics of endogenous alpha oscillations are close to a simpler dynamic structure, like fixed-point attractor or limit-cycle attractor, which shows a global consistent dynamic behavior at different phases of the alpha oscillation. The further analysis explains the dynamic mechanism of PLVF for amplitude and frequency modulation of the alpha rhythm, as well as the influence of parameter settings in the modulation. All these findings provide a deeper understanding of the endogenous alpha oscillations entrained by exogenous phased locked visual stimulus and lead in turn to the refinement of a control strategy for alpha modulation, which could potentially be used in developing new neural modulation methods for cognitive enhancement and mental diseases treatment.
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Affiliation(s)
- Xingyi Jin
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, Guangdong 518060, China
| | - Zhiguo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, Guangdong 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen 518060, China; Peng Cheng Laboratory, Shenzhen, Guangdong 518055, China
| | - Li Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, Guangdong 518060, China
| | - Linling Li
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, Guangdong 518060, China
| | - Gan Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, Guangdong 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, Guangdong 518060, China.
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O'Quinn MP, Dormer KJ, Huizar JF, Nguyen KT, Kaszala K, Sima A, Ellenbogen KA, Tan AY. Epicardial injection of nanoformulated calcium into cardiac ganglionic plexi suppresses autonomic nerve activity and postoperative atrial fibrillation. Heart Rhythm 2019; 16:597-605. [PMID: 30929671 PMCID: PMC6446939 DOI: 10.1016/j.hrthm.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Imbalanced activation of the cardiac autonomic nervous system triggers postoperative atrial fibrillation (POAF). Neuronal calcium overload induces apoptosis. We hypothesize that epicardial injection of timed-release nanoformulated CaCl2 (nCaCl2) into left atrial ganglionic plexi (GP) modulates autonomic function and suppresses POAF. OBJECTIVE The purpose of this study was to determine whether nCaCl2 GP therapy suppresses POAF. METHODS We used a novel canine model of POAF with implanted radiotelemetry to record nerve activity (NA) from the left stellate ganglion (SNA), left cardiac vagus nerve, and GP. At week 3, nCaCl2 (n = 7) or vehicle control (sham; n = 3) was injected into left pulmonary vein GP (LGP), followed by right pulmonary vein GP at week 4. Atrial effective refractory period (AERP) and atrial fibrillation vulnerability (AFV) were assessed in vivo. Resting and exercise NA and heart rate (HR) were assessed before and after LGP treatment. RESULTS AERP decreased (P < .0001) and AFV increased (P = .008) at week 3 vs baseline. However, nCaCl2-LGP treatment reversed these changes and restored them to baseline after 1 week (P = .04). Subsequent nCaCl2-right pulmonary vein GP treatment further reduced AFV (P = .03). In contrast, AFV increased (P = .001) and AERP remained decreased (P = .01) 1 week after sham-LGP treatment vs baseline. nCaCl2-LGP treatment reduced NA from GP (P < .02) and NA from the left cardiac vagus nerve (P < .05) and increased SNA (P < .02). Despite increased SNA, HR was decreased (P < .01) with loss of HR-SNA correlation (R = 0.62). After sham-LGP treatment, NA was unchanged and HR-SNA remained correlated (R = 0.95). Histology confirmed nCaCl2-GP colocalization, apoptosis, and loss of immunoreactivity in nCaCl2-treated somas. CONCLUSION Epicardial injection of nCaCl2 into left atrial GP induced neuroapoptosis and modulated autonomic function. This reversed a postoperative reduction in AERP and suppressed POAF.
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Affiliation(s)
- Michael P O'Quinn
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Kenneth J Dormer
- Liberty University College of Osteopathic Medicine, Lynchburg, Virginia
| | - Jose F Huizar
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | | | - Karoly Kaszala
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia
| | - Alex Y Tan
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VAMC, Richmond, Virginia; Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia.
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Romanov A, Pokushalov E, Ponomarev D, Bayramova S, Shabanov V, Losik D, Stenin I, Elesin D, Mikheenko I, Strelnikov A, Sergeevichev D, Kozlov B, Po SS, Steinberg JS. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study. Heart Rhythm 2018; 16:172-177. [PMID: 30414841 DOI: 10.1016/j.hrthm.2018.08.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Botulinum toxin (BTX) injections into epicardial fat pads in patients undergoing coronary artery bypass grafting (CABG) has resulted in suppression of atrial fibrillation (AF) during the early postoperative period through 1-year of follow-up in a pilot program. OBJECTIVE The purpose of this study was to report 3-year AF patterns by the use of implantable cardiac monitors (ICMs). METHODS Sixty patients with a history of paroxysmal AF and indications for CABG were randomized 1:1 to either BTX or placebo injections into 4 posterior epicardial fat pads. All patients received an ICM with regular follow-up for 3 years after surgery. The primary end point of the extended follow-up period was incidence of any atrial tachyarrhythmia after 30 days of procedure until 36 months on no antiarrhythmic drugs. The secondary end points included clinical events and AF burden. RESULTS At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3% in the BTX group vs 50% in the placebo group (hazard ratio 0.36; 95% confidence interval 0.14-0.88; P = .02). AF burden at 12, 24, and 36 months was significantly lower in the BTX group than in the placebo group: 0.22% vs 1.88% (P = .003), 1.6% vs 9.5% (P < .001), and 1.3% vs 6.9% (P = .007), respectively. In the BTX group, 2 patients (7%) were hospitalized during follow-up compared with 10 (33%) in the placebo group (P = .02). CONCLUSION Injection of BTX into epicardial fat pads in patients undergoing CABG resulted in a sustained and substantial reduction in atrial tachyarrhythmia incidence and burden during 3-year follow-up, accompanied by reduction in hospitalizations.
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Affiliation(s)
- Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Evgeny Pokushalov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Ponomarev
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Sevda Bayramova
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Vitaliy Shabanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Denis Losik
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Ilya Stenin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Dmitry Elesin
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Igor Mikheenko
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Artem Strelnikov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - David Sergeevichev
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation
| | - Boris Kozlov
- Institute of Cardiology, Siberian Division of Russian Academy of Medical Sciences, Tomsk, Russian Federation
| | - Sunny S Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jonathan S Steinberg
- Heart Research Follow-up Program, University of Rochester School of Medicine & Dentistry, Rochester, New York; SMG Arrhythmia Center, Summit Medical Group, Short Hills, New Jersey.
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Sato T, Okada Y. Enhancement of Gustatory Neural Responses by Parasympathetic Nerve in the Frog. Cell Mol Neurobiol 2018; 38:883-90. [PMID: 29103093 DOI: 10.1007/s10571-017-0562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
The autonomic nervous system affects the gustatory responses in animals. Frog glossopharyngeal nerve (GPN) contains the parasympathetic nerve. We checked the effects of electrical stimulation (ES) of the parasympathetic nerves on the gustatory neural responses. The gustatory neural impulses of the GPNs were recorded using bipolar AgCl wires under normal blood circulation and integrated with a time constant of 1 s. Electrical stimuli were applied to the proximal side of the GPN with a pair of AgCl wires. The parasympathetic nerves of the GPN were strongly stimulated for 10 s with 6 V at 30 Hz before taste stimulation. The integrated neural responses to 0.5 M NaCl, 2.5 mM CaCl2, water, and 1 M sucrose were enhanced to 130-140% of the controls. On the other hand, the responses for 1 mM Q-HCl and 0.3 mM acetic acid were not changed by the preceding applied ES. After hexamethonium (a blocker of nicotinic ACh receptor) was intravenously injected, ES of the parasympathetic nerve did not modulate the responses for all six taste stimuli. The mechanism for enhancement of the gustatory neural responses is discussed.
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Hawkins JL, Cornelison LE, Blankenship BA, Durham PL. Vagus nerve stimulation inhibits trigeminal nociception in a rodent model of episodic migraine. Pain Rep 2017; 2:e628. [PMID: 29392242 DOI: 10.1097/PR9.0000000000000628] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 12/30/2022] Open
Abstract
Introduction Although neck muscle tension is considered a risk factor for migraine, pungent odors can act as a trigger to initiate an attack in sensitized individuals. Although noninvasive vagus nerve stimulation (nVNS) is now an approved treatment for chronic migraine, how it functions to inhibit trigeminal nociception in an episodic migraine model is not known. Objectives The objectives of this study were to determine if nVNS could inhibit trigeminal nociception in a novel model of episodic migraine and investigate changes in the expression of proteins implicated in peripheral and central sensitization. Methods Sprague-Dawley male rats were injected with an inflammatory agent in the trapezius muscle before exposure to pungent volatile compounds, which was used to initiate trigeminal nociceptor activation. The vagus nerve was stimulated transdermally by a 1-ms pulse of 5 kHz sine waves, repeated at 25 Hz for 2 minutes. Nocifensive head withdrawal response to von Frey filaments was determined and immunoreactive protein levels in the spinal cord and trigeminal ganglion (TG) were investigated. Results Exposure to the pungent odor significantly increased the number of nocifensive withdrawals in response to mechanical stimulation of sensitized TG neurons mediated by neck muscle inflammation. Noninvasive vagus nerve stimulation inhibited nociception and repressed elevated levels of P-ERK in TG, Iba1 in microglia, and GFAP in astrocytes from sensitized animals exposed to the pungent odor. Conclusion Our findings demonstrate that nVNS inhibits mechanical nociception and represses expression of proteins associated with peripheral and central sensitization of trigeminal neurons in a novel rodent model of episodic migraine.
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Park YM, Cha MS, Kang WC, Shin MS, Kim YH, Choi IS, Shin EK. Torsades de Pointes associated with QT prolongation after catheter ablation of paroxysmal atrial fibrillation. Indian Pacing Electrophysiol J 2017; 17:146-149. [PMID: 29192591 PMCID: PMC5652273 DOI: 10.1016/j.ipej.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/26/2017] [Accepted: 07/11/2017] [Indexed: 01/09/2023] Open
Abstract
A 79-year-old woman who underwent catheter ablation for paroxysmal atrial fibrillation presented with Torsades de Pointes (TdP). Aggravation of prolonged QT interval which is most likely due to neural modulation by catheter ablation, played major role in the initiation of TdP. The patient was successfully treated with isoproterenol during acute stage and discharged after stabilization without implantation of permanent pacemaker or implantable cardioverter defibrillator.
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Affiliation(s)
- Yae Min Park
- Cardiology Division, Gachon University Gil Medical Center, Incheon, Republic of Korea.
| | - Mi Suk Cha
- Cardiology Division, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Woong Chol Kang
- Cardiology Division, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Mi-Seung Shin
- Cardiology Division, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Young-Hoon Kim
- Cardiology Division, Korea University Anam Hospital, Seoul, Republic of Korea
| | - In Suck Choi
- Cardiology Division, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Eak Kyun Shin
- Cardiology Division, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Smith S, Rossignol P, Willis S, Zannad F, Mentz R, Pocock S, Bisognano J, Nadim Y, Geller N, Ruble S, Linde C. Neural modulation for hypertension and heart failure. Int J Cardiol 2016; 214:320-30. [PMID: 27085120 DOI: 10.1016/j.ijcard.2016.03.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/19/2016] [Indexed: 01/08/2023]
Abstract
Hypertension (HTN) and heart failure (HF) have a significant global impact on health, and lead to increased morbidity and mortality. Despite recent advances in pharmacologic and device therapy for these conditions, there is a need for additional treatment modalities. Patients with sub-optimally treated HTN have increased risk for stroke, renal failure and heart failure. The outcome of HF patients remains poor despite modern pharmacological therapy and with established device therapies such as CRT and ICDs. Therefore, the potential role of neuromodulation via renal denervation, baro-reflex modulation and vagal stimulation for the treatment of resistant HTN and HF is being explored. In this manuscript, we review current evidence for neuromodulation in relation to established drug and device therapies and how these therapies may be synergistic in achieving therapy goals in patients with treatment resistant HTN and heart failure. We describe lessons learned from recent neuromodulation trials and outline strategies to improve the potential for success in future trials. This review is based on discussions between scientists, clinical trialists, and regulatory representatives at the 11th annual CardioVascular Clinical Trialist Forum in Washington, DC on December 5-7, 2014.
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Affiliation(s)
- S Smith
- The Ohio State University Wexner Medical Center, Department of Internal Medicine and Division of Cardiology, Columbus, OH, USA.
| | - P Rossignol
- Inserm, CIC 1433, Centre Hospitalier Universitaire, Universite´ de Lorraine, F-CRIN INI-CRCT, Nancy, France
| | - S Willis
- The Ohio State University Wexner Medical Center, Department of Internal Medicine and Division of Cardiology, Columbus, OH, USA
| | - F Zannad
- Inserm, CIC 1433, Centre Hospitalier Universitaire, Universite´ de Lorraine, F-CRIN INI-CRCT, Nancy, France
| | - R Mentz
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - S Pocock
- Medical Statistics Unit LSHTM, London, UK
| | - J Bisognano
- University of Rochester Medical Center, Department of Medicine, Cardiology, Rochester, NY, USA
| | - Y Nadim
- CVRx, Inc, Minneapolis, MN, USA
| | - N Geller
- Office of Biostatistics Research, Division of Cardiovascular Sciences, NHLBI, National Institutes of Health, Bethesda, MD, USA
| | - S Ruble
- Boston Scientific CRV, St. Paul, MN, USA
| | - C Linde
- Institution of Internal Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
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