May Sadik, Sally F. Barrington, Elin Trägårdh, Babak Saboury, Anne L. Nielsen, Annika L. Jakobsen, Jose L. L. Gongora, Jesus L. Urdaneta, Rajender Kumar, Lars Edenbrandt
Aim
To compare total metabolic tumour volume (tMTV), calculated using two artificial intelligence (AI)-based tools, with manual segmentation by specialists as the reference.
Methods
Forty-eight consecutive Hodgkin lymphoma (HL) patients staged with [18F] fluorodeoxyglucose positron emission tomography/computed tomography were included. The median age was 35 years (range: 7–75), 46% female. The tMTV was automatically measured using the AI-based tools positron emission tomography assisted reporting system (PARS) (from Siemens) and RECOMIA (recomia.org) without any manual adjustments. A group of eight nuclear medicine specialists manually segmented lesions for tMTV calculations; each patient was independently segmented by two specialists.
Results
The median of the manual tMTV was 146 cm3 (interquartile range [IQR]: 79–568 cm3) and the median difference between two tMTV values segmented by different specialists for the same patient was 26 cm3 (IQR: 10–86 cm3). In 22 of the 48 patients, the manual tMTV value was closer to the RECOMIA tMTV value than to the manual tMTV value segmented by the second specialist. In 11 of the remaining 26 patients, the difference between the RECOMIA tMTV and the manual tMTV was small (<26 cm3, which was the median difference between two manual tMTV values from the same patient). The corresponding numbers for PARS were 18 and 10 patients, respectively.
Conclusion
The results of this study indicate that RECOMIA and Siemens PARS AI tools could be used without any major manual adjustments in 69% (33/48) and 58% (28/48) of HL patients, respectively. This demonstrates the feasibility of using AI tools to support physicians measuring tMTV for assessment of prognosis in clinical practice.
{"title":"Metabolic tumour volume in Hodgkin lymphoma—A comparison between manual and AI-based analysis","authors":"May Sadik, Sally F. Barrington, Elin Trägårdh, Babak Saboury, Anne L. Nielsen, Annika L. Jakobsen, Jose L. L. Gongora, Jesus L. Urdaneta, Rajender Kumar, Lars Edenbrandt","doi":"10.1111/cpf.12868","DOIUrl":"10.1111/cpf.12868","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To compare total metabolic tumour volume (tMTV), calculated using two artificial intelligence (AI)-based tools, with manual segmentation by specialists as the reference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-eight consecutive Hodgkin lymphoma (HL) patients staged with [18F] fluorodeoxyglucose positron emission tomography/computed tomography were included. The median age was 35 years (range: 7–75), 46% female. The tMTV was automatically measured using the AI-based tools positron emission tomography assisted reporting system (PARS) (from Siemens) and RECOMIA (recomia.org) without any manual adjustments. A group of eight nuclear medicine specialists manually segmented lesions for tMTV calculations; each patient was independently segmented by two specialists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median of the manual tMTV was 146 cm<sup>3</sup> (interquartile range [IQR]: 79–568 cm<sup>3</sup>) and the median difference between two tMTV values segmented by different specialists for the same patient was 26 cm<sup>3</sup> (IQR: 10–86 cm<sup>3</sup>). In 22 of the 48 patients, the manual tMTV value was closer to the RECOMIA tMTV value than to the manual tMTV value segmented by the second specialist. In 11 of the remaining 26 patients, the difference between the RECOMIA tMTV and the manual tMTV was small (<26 cm<sup>3</sup>, which was the median difference between two manual tMTV values from the same patient). The corresponding numbers for PARS were 18 and 10 patients, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results of this study indicate that RECOMIA and Siemens PARS AI tools could be used without any major manual adjustments in 69% (33/48) and 58% (28/48) of HL patients, respectively. This demonstrates the feasibility of using AI tools to support physicians measuring tMTV for assessment of prognosis in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 3","pages":"220-227"},"PeriodicalIF":1.8,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erica Holmberg, Éva Tamás, Eva Nylander, Jan Engvall, Hans Granfeldt
Background
The prevalence of aortic valve stenosis (AS) is increasing due to an ageing population. Despite that right ventricular function has prognostic value for postoperative outcome, the right ventricle (RV) is not extensively studied and often not routinely assessed in AS. Our aim was to explore the relation between severe AS and RV function in a surgical aortic valve replacement (SAVR) cohort, comparing two imaging modalities for RV evaluation.
Methods
Patients with severe AS, underwent cardiovascular magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) before SAVR. RV dysfunction was defined as one or more of the following: tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV free wall strain (RVFWS) > −20% by TTE and RV ejection fraction (RVEF) <50% by CMR.
Results
Sixteen (33%) patients were found to have RV dysfunction. Patients with RV dysfunction showed significantly lower indexed aortic valve area, left ventricular (LV) ejection fraction as well as RV and LV stroke volumes compared to patients with maintained RV function. All patients with reduced RVEF also had changes in TAPSE or RVFWS and a larger number of patients had a reduced longitudinal RV function despite a normal RVEF.
Conclusion
In a SAVR cohort one-third of the patients had RV dysfunction, defined by RVEF, TAPSE or RVFW strain. Echocardiography detected subtle changes in RV function before RVEF was reduced. It is likely that the more pronounced the AS, the more frequent the occurrence of RV dysfunction.
背景:由于人口老龄化，主动脉瓣狭窄(AS)的患病率正在上升。尽管右心室功能对术后预后有预测价值，但在AS患者中，右心室(RV)并没有得到广泛的研究，通常也没有进行常规评估。我们的目的是探讨在外科主动脉瓣置换术(SAVR)队列中严重AS与RV功能之间的关系，比较两种成像方式对RV的评估。方法:重度AS患者在SAVR前行心血管磁共振成像(CMR)和经胸超声心动图(TTE)检查。右心室功能障碍定义为以下一项或多项:三尖瓣环面收缩漂移(TAPSE) < 17 mm, TTE检测右心室游离壁应变(RVFWS) > -20%， CMR检测右心室射血分数(RVEF) < 50%。结果:16例(33%)患者有右心室功能障碍。与左室功能维持的患者相比，右室功能障碍患者的主动脉瓣指数面积、左室射血分数以及左室和左室卒中容量明显降低。所有RVEF减少的患者也有TAPSE或RVFWS的变化，尽管RVEF正常，但大量患者的纵向RV功能降低。结论:在SAVR队列中，三分之一的患者有RVEF、TAPSE或RVFW菌株定义的RV功能障碍。超声心动图检测到RVEF减少前右室功能的细微变化。AS越明显，RV功能障碍的发生就越频繁。这篇文章受版权保护。版权所有。
{"title":"Right ventricular function in severe aortic stenosis assessed by echocardiography and MRI","authors":"Erica Holmberg, Éva Tamás, Eva Nylander, Jan Engvall, Hans Granfeldt","doi":"10.1111/cpf.12867","DOIUrl":"10.1111/cpf.12867","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prevalence of aortic valve stenosis (AS) is increasing due to an ageing population. Despite that right ventricular function has prognostic value for postoperative outcome, the right ventricle (RV) is not extensively studied and often not routinely assessed in AS. Our aim was to explore the relation between severe AS and RV function in a surgical aortic valve replacement (SAVR) cohort, comparing two imaging modalities for RV evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with severe AS, underwent cardiovascular magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) before SAVR. RV dysfunction was defined as one or more of the following: tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV free wall strain (RVFWS) > −20% by TTE and RV ejection fraction (RVEF) <50% by CMR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen (33%) patients were found to have RV dysfunction. Patients with RV dysfunction showed significantly lower indexed aortic valve area, left ventricular (LV) ejection fraction as well as RV and LV stroke volumes compared to patients with maintained RV function. All patients with reduced RVEF also had changes in TAPSE or RVFWS and a larger number of patients had a reduced longitudinal RV function despite a normal RVEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In a SAVR cohort one-third of the patients had RV dysfunction, defined by RVEF, TAPSE or RVFW strain. Echocardiography detected subtle changes in RV function before RVEF was reduced. It is likely that the more pronounced the AS, the more frequent the occurrence of RV dysfunction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 3","pages":"211-219"},"PeriodicalIF":1.8,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12867","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138175829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James Frith, Lisa Robinson, Jake Ryan Gibbon, John Allen
Introduction
Activation of muscles during standing is recommended to activate the skeletal muscle pump, increasing venous return and increasing blood pressure (BP) in people with orthostatic hypotension (OH).
Aim
The aim of this study is to determine if increasing the strength of the lower limb muscles can improve the effectiveness of the venous pump and postural BP in older people with OH.
Methods
Ten older people with OH underwent an 8-week lower limb strengthening intervention. Repeated measurements of orthostatic BP, calf venous ejection fraction (EF) and muscle strength took place before, during and after intervention.
Results
The intervention increased calf muscle strength by 21% (interquartile range: 18–28), p = 0.018, from a median baseline of 38 (34–45) kg. Participants had normal levels of venous EF 64% (51–75) at baseline, with little to no venous reflux. The median ejection volume at baseline was 44 (36–58) mL per calf. Despite increasing muscle strength, venous EF did not increase (percentage change −10% (−16 to 24), p = 0.8) and systolic BP drop did not improve (percentage change 0% (−17 to 16), p = 1.0). Similarly, visual analysis of individual case-series trends revealed increasing muscle strength with no clinically meaningful change in EF or orthostatic BP.
Conclusions
Muscle strengthening exercise does not increase the effectiveness of the skeletal muscle pump and is not an efficacious intervention for OH. As there is little to no venous pooling in the calf during standing in older people with OH, below knee compression is unlikely to be clinically effective.
{"title":"The effect of lower limb strengthening exercise on orthostatic blood pressure and the skeletal muscle pump in older people with orthostatic hypotension","authors":"James Frith, Lisa Robinson, Jake Ryan Gibbon, John Allen","doi":"10.1111/cpf.12866","DOIUrl":"10.1111/cpf.12866","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Activation of muscles during standing is recommended to activate the skeletal muscle pump, increasing venous return and increasing blood pressure (BP) in people with orthostatic hypotension (OH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this study is to determine if increasing the strength of the lower limb muscles can improve the effectiveness of the venous pump and postural BP in older people with OH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten older people with OH underwent an 8-week lower limb strengthening intervention. Repeated measurements of orthostatic BP, calf venous ejection fraction (EF) and muscle strength took place before, during and after intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intervention increased calf muscle strength by 21% (interquartile range: 18–28), <i>p</i> = 0.018, from a median baseline of 38 (34–45) kg. Participants had normal levels of venous EF 64% (51–75) at baseline, with little to no venous reflux. The median ejection volume at baseline was 44 (36–58) mL per calf. Despite increasing muscle strength, venous EF did not increase (percentage change −10% (−16 to 24), <i>p</i> = 0.8) and systolic BP drop did not improve (percentage change 0% (−17 to 16), <i>p</i> = 1.0). Similarly, visual analysis of individual case-series trends revealed increasing muscle strength with no clinically meaningful change in EF or orthostatic BP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Muscle strengthening exercise does not increase the effectiveness of the skeletal muscle pump and is not an efficacious intervention for OH. As there is little to no venous pooling in the calf during standing in older people with OH, below knee compression is unlikely to be clinically effective.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 3","pages":"205-210"},"PeriodicalIF":1.8,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136396671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assunta Trinchillo, Flavio Barchetti, Gabriella De Joanna, Marcello Esposito, Giovanni Piccirillo, Stefania Miniello
Background
Diabetic Striatopathy (DS) is a rare complication of a poor-controlled Diabetes Mellitus consisting of sudden onset of movement disorders. To date, there is still poor knowledge about the pathogenesis.
Case
We describe a 79 year old men affected by sudden onset hemichoreic movements whose cause was a non-ketotic hyperglycaemia diagnosed despite the normal blood glucose levels thanks to brain CT and magnetic resonance imaging. Then, we introduce a new magnetic resonance spectroscopy (MRS) finding never described until today which allowed us to produce a new pathogenetic theory of a phenomenon still without definitive explanations.
Literature Review
We performed a review of DS cases using the Medline database and we extracted main data regarding imaging findings.
Conclusions
Thanks to our MRS we show new imaging findings never described until today, with a new pathogenetic explanation, since all the causative hypotheses produced during the past years have never found evidence.
{"title":"A case of hemichorea associated with nonketotic hyperglycaemia: A new magnetic resonance spectroscopy (MRS) finding and possible future implications","authors":"Assunta Trinchillo, Flavio Barchetti, Gabriella De Joanna, Marcello Esposito, Giovanni Piccirillo, Stefania Miniello","doi":"10.1111/cpf.12865","DOIUrl":"10.1111/cpf.12865","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetic Striatopathy (DS) is a rare complication of a poor-controlled Diabetes Mellitus consisting of sudden onset of movement disorders. To date, there is still poor knowledge about the pathogenesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>We describe a 79 year old men affected by sudden onset hemichoreic movements whose cause was a non-ketotic hyperglycaemia diagnosed despite the normal blood glucose levels thanks to brain CT and magnetic resonance imaging. Then, we introduce a new magnetic resonance spectroscopy (MRS) finding never described until today which allowed us to produce a new pathogenetic theory of a phenomenon still without definitive explanations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Literature Review</h3>\u0000 \u0000 <p>We performed a review of DS cases using the Medline database and we extracted main data regarding imaging findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Thanks to our MRS we show new imaging findings never described until today, with a new pathogenetic explanation, since all the causative hypotheses produced during the past years have never found evidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 2","pages":"131-135"},"PeriodicalIF":1.8,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92153044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leon Csonka, Antti Tikkakoski, Anna P. Tikkakoski, Jussi Karjalainen, Lauri Lehtimäki
Decrease in forced expiratory volume in one second (FEV1) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV1.
We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6−16 years old. FEV1 and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and ϰ-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV1.
In the ROC analysis, areas under the curve were 0.851 (p < 0.001) and 0.921 (p < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV1, respectively. The agreement between changes in PEF and FEV1 varied from slight to substantial (ϰ values of 0.199–0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV1, respectively. Still, a fifth of the positive findings based on PEF were false.
Change in PEF is not a precise predictor of change in FEV1 in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.
{"title":"Relation of changes in PEF and FEV1 in exercise challenge in children","authors":"Leon Csonka, Antti Tikkakoski, Anna P. Tikkakoski, Jussi Karjalainen, Lauri Lehtimäki","doi":"10.1111/cpf.12864","DOIUrl":"10.1111/cpf.12864","url":null,"abstract":"<p>Decrease in forced expiratory volume in one second (FEV<sub>1</sub>) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV<sub>1</sub>.</p><p>We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6−16 years old. FEV<sub>1</sub> and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and <i>ϰ</i>-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV<sub>1</sub>.</p><p>In the ROC analysis, areas under the curve were 0.851 (<i>p</i> < 0.001) and 0.921 (<i>p</i> < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV<sub>1</sub>, respectively. The agreement between changes in PEF and FEV<sub>1</sub> varied from slight to substantial (<i>ϰ</i> values of 0.199–0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV<sub>1</sub>, respectively. Still, a fifth of the positive findings based on PEF were false.</p><p>Change in PEF is not a precise predictor of change in FEV<sub>1</sub> in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 2","pages":"179-185"},"PeriodicalIF":1.8,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71478950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mona Esbjörnsson, Barbara Norman, Moa Persson, Amarjit Saini, Jens Bülow, Eva Jansson
Background
Low-volume sprint exercise is likely to reduce body fat. Interleukin (IL-6) may mediate this by increasing adipose tissue (AT) lipolysis. Therefore, the exchange of AT IL-6 and glycerol, a marker of lipolysis, was examined in 10 healthy subjects performing three 30-s all-out sprints.
Methods
Blood samples were obtained from brachial artery (a) and a superficial subcutaneous vein (v) on the anterior abdominal wall up to 9 min after the last sprint and analysed for IL-6 and glycerol.
Results
Arterial IL-6 increased 2-fold from rest to last sprint. AT venous IL-6 increased 15-fold from 0.4 ± 0.4 at rest to 7.0 ± 4 pg × mL−1 (p < 0.0001) and AT v–a difference increased 45-fold from 0.12 ± 0.3 to 6.0 ± 5 pg x mL−1 (p < 0.0001) 9 min after last sprint. Arterial glycerol increased 2.5-fold from rest to 9 min postsprint 1 (p < 0.0001) and was maintained during the exercise period. AT venous and v–a difference of glycerol increased 2-fold from rest to 9 min postsprint 1 (p < 0.0001 and p = 0.01, respectively), decreased until 18 min postsprint 2 (p < 0.001 and p < 0.0001), and then increased again until 9 min after last sprint (both p < 0.01).
Conclusions
The concurrent increase in venous IL-6 and glycerol in AT after last sprint is consistent with an IL-6 induced lipolysis in AT. Glycerol data also indicated an initial increase in lipolysis after sprint 1 that was unrelated to IL-6. Increased IL-6 in adipose tissue may, therefore, complement other sprint exercise-induced lipolytic agents.
背景：小容量的短跑运动可能会减少身体脂肪。白细胞介素（IL-6）可能通过增加脂肪组织脂解来介导这种情况。因此，在进行三次30秒全力冲刺的10名健康受试者中，检测了脂肪组织（AT）IL-6和甘油（脂解的标志物）的交换。方法：在最后一次冲刺后9分钟内，从腹前壁的肱动脉（a）和皮下浅静脉（v）采集血样，并分析IL-6和甘油。结果：从休息到最后冲刺，动脉IL-6增加了2倍。AT静脉IL-6从静止时的0.4±0.4增加到7.0±4 pg x mL-1，增加了15倍（P＜0.0001），AT v-a差异从0.12±0.3增加到6.0±5 pg x mL-，增加了45倍（P＞0.0001）。从休息到冲刺1后9分钟，动脉甘油增加了2.5倍（P<0.0001），并在运动期间保持不变。从静止到冲刺1后9分钟，AT静脉和v-a甘油的差异增加了2倍（分别为P＜0.0001和P＝0.01），直到冲刺2后18分钟才降低（P＜0.001和P＜0.00001），结论：最后一次冲刺后脂肪组织中静脉IL-6和甘油的同时增加与IL-6诱导的脂肪组织脂解一致。甘油数据还表明，冲刺1后脂肪分解的最初增加与IL-6无关。因此，脂肪组织中IL-6的增加可能补充其他短跑运动诱导的脂肪分解剂。这篇文章受版权保护。保留所有权利。
{"title":"Enhanced interleukin-6 in human adipose tissue vein after sprint exercise: Results from a pilot study","authors":"Mona Esbjörnsson, Barbara Norman, Moa Persson, Amarjit Saini, Jens Bülow, Eva Jansson","doi":"10.1111/cpf.12863","DOIUrl":"10.1111/cpf.12863","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low-volume sprint exercise is likely to reduce body fat. Interleukin (IL-6) may mediate this by increasing adipose tissue (AT) lipolysis. Therefore, the exchange of AT IL-6 and glycerol, a marker of lipolysis, was examined in 10 healthy subjects performing three 30-s all-out sprints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Blood samples were obtained from brachial artery (a) and a superficial subcutaneous vein (v) on the anterior abdominal wall up to 9 min after the last sprint and analysed for IL-6 and glycerol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Arterial IL-6 increased 2-fold from rest to last sprint. AT venous IL-6 increased 15-fold from 0.4 ± 0.4 at rest to 7.0 ± 4 pg × mL<sup>−1</sup> (<i>p</i> < 0.0001) and AT v–a difference increased 45-fold from 0.12 ± 0.3 to 6.0 ± 5 pg x mL<sup>−1</sup> (<i>p</i> < 0.0001) 9 min after last sprint. Arterial glycerol increased 2.5-fold from rest to 9 min postsprint 1 (<i>p</i> < 0.0001) and was maintained during the exercise period. AT venous and v–a difference of glycerol increased 2-fold from rest to 9 min postsprint 1 (<i>p</i> < 0.0001 and <i>p</i> = 0.01, respectively), decreased until 18 min postsprint 2 (<i>p</i> < 0.001 and <i>p</i> < 0.0001), and then increased again until 9 min after last sprint (both <i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The concurrent increase in venous IL-6 and glycerol in AT after last sprint is consistent with an IL-6 induced lipolysis in AT. Glycerol data also indicated an initial increase in lipolysis after sprint 1 that was unrelated to IL-6. Increased IL-6 in adipose tissue may, therefore, complement other sprint exercise-induced lipolytic agents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 2","pages":"171-178"},"PeriodicalIF":1.8,"publicationDate":"2023-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71411000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shahnaz Akil, Anna E. Székely, Fredrik Hedeer, Berit Olsson, Henrik Engblom, Cecilia Hindorf
Background
The aim was to investigate to what extent the quantification of myocardial blood flow (MBF) from dynamic 13N-NH3 positron emission tomography (PET) images is affected by time frame schemes, time-of-flight (ToF), reconstruction algorithms, blood pool volume of interest (VOI) locations and compartment models in patients with suspected chronic coronary syndrome.
Methods
A standard MBF value was determined from 25 patients' rest/stress 13N-NH3 PET/CT images reconstructed with ordered subset expectation maximization (OSEM), 5 s time frame for the first frames without ToF, subsequently analyzed using a basal VOI and the deGrado compartment model. MBFs calculated using 2 or 10 s for the first frames, ToF, block-sequential regularized expectation maximization (BSREM), apical or large VOI, Hutchins or Krivokapich compartment models were compared to MBFstandard in Bland–Altman plots (bias ± SD).
Results
Good agreement in global rest/stress MBF (mL/min/g) was found when changing the time frame scheme or reconstruction algorithm (MBFstandard vs. MBF2s: −0.02 ± 0.06; MBF10s: 0.01 ± 0.07; MBFBSREM: 0.01 ± 0.07), while a lower level of agreement was found when altering the other factors (MBFstandard vs. MBFToF: −0.07 ± 0.10; MBFapical VOI: −0.27 ± 0.25; MBFlarge VOI: −0.11 ± 0.10; MBFHutchins: −0.08 ± 0.10; MBFKrivokapich: −0.47 ± 0.50).
Conclusions
Quantification of MBF from 13N-NH3 PET images is more affected by choice of compartment models, ToF and blood pool VOIs than by different time frame schemes and reconstruction algorithms.
{"title":"Influence of different time framings, reconstruction algorithms and post-processing methods on the quantification of myocardial blood flow from 13N-NH3 PET images","authors":"Shahnaz Akil, Anna E. Székely, Fredrik Hedeer, Berit Olsson, Henrik Engblom, Cecilia Hindorf","doi":"10.1111/cpf.12861","DOIUrl":"10.1111/cpf.12861","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The aim was to investigate to what extent the quantification of myocardial blood flow (MBF) from dynamic <sup>13</sup>N-NH<sub>3</sub> positron emission tomography (PET) images is affected by time frame schemes, time-of-flight (ToF), reconstruction algorithms, blood pool volume of interest (VOI) locations and compartment models in patients with suspected chronic coronary syndrome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A standard MBF value was determined from 25 patients' rest/stress <sup>13</sup>N-NH<sub>3</sub> PET/CT images reconstructed with ordered subset expectation maximization (OSEM), 5 s time frame for the first frames without ToF, subsequently analyzed using a basal VOI and the deGrado compartment model. MBFs calculated using 2 or 10 s for the first frames, ToF, block-sequential regularized expectation maximization (BSREM), apical or large VOI, Hutchins or Krivokapich compartment models were compared to MBF<sub>standard</sub> in Bland–Altman plots (bias ± SD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Good agreement in global rest/stress MBF (mL/min/g) was found when changing the time frame scheme or reconstruction algorithm (MBF<sub>standard</sub> vs. MBF<sub>2s</sub>: −0.02 ± 0.06; MBF<sub>10s</sub>: 0.01 ± 0.07; MBF<sub>BSREM</sub>: 0.01 ± 0.07), while a lower level of agreement was found when altering the other factors (MBF<sub>standard</sub> vs. MBF<sub>ToF</sub>: −0.07 ± 0.10; MBF<sub>apical VOI</sub>: −0.27 ± 0.25; MBF<sub>large VOI</sub>: −0.11 ± 0.10; MBF<sub>Hutchins</sub>: −0.08 ± 0.10; MBF<sub>Krivokapich</sub>: −0.47 ± 0.50).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Quantification of MBF from <sup>13</sup>N-NH<sub>3</sub> PET images is more affected by choice of compartment models, ToF and blood pool VOIs than by different time frame schemes and reconstruction algorithms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 2","pages":"154-163"},"PeriodicalIF":1.8,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50160970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marcin Machnia, Wafa Douzi, Hela Jdidi, Elzbieta Miller, Benoit Dugué
Objective
Common features in chronic inflammatory disease patients (CIDP) are inflammation, mental stress (MS), and autonomic nervous system imbalance. Whole-body cryotherapy (WBC) exposure and regular physical exercise are known to regulate these features. In this study, we assessed the impact of regular physical exercise and the use of WBC exposure in CIDP on the level of electrical skin resistance (SR) to evaluate the skin sympathetic nervous activity and and estimate MS levels.
Methods
SR was evaluated before and after a 10-day-period of daily physical exercise preceded or not by WBC (3 min at −110°C) in two groups of 134 CIDP (WBC vs. non-WBC groups).
Results
At baseline, the number of severe MS patients was similar in both groups. However, after the training period, the number of severe MS patients significantly decreased in the WBC group, only. An increase in SR (a decrease in stress level) was noted in the WBC group only, and such increase was higher in men than in women and in patients younger than 60 versus patients older than 60 years old.
Conclusion
The use of daily WBC combined with physical exercise induced physiological adaptations and lowered the sympathetic nervous activity that may reflect a reduced level of MS in CIDP. These adaptations seem to depend on gender and age.
{"title":"Impact of regular cold exposure on electrical skin resistance in patients with joint degenerative diseases","authors":"Marcin Machnia, Wafa Douzi, Hela Jdidi, Elzbieta Miller, Benoit Dugué","doi":"10.1111/cpf.12862","DOIUrl":"10.1111/cpf.12862","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Common features in chronic inflammatory disease patients (CIDP) are inflammation, mental stress (MS), and autonomic nervous system imbalance. Whole-body cryotherapy (WBC) exposure and regular physical exercise are known to regulate these features. In this study, we assessed the impact of regular physical exercise and the use of WBC exposure in CIDP on the level of electrical skin resistance (SR) to evaluate the skin sympathetic nervous activity and and estimate MS levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>SR was evaluated before and after a 10-day-period of daily physical exercise preceded or not by WBC <i>(3 min at −110°C)</i> in two groups of 134 CIDP <i>(WBC vs. non-WBC groups)</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, the number of severe MS patients was similar in both groups. However, after the training period, the number of severe MS patients significantly decreased in the WBC group, only. An increase in SR (a decrease in stress level) was noted in the WBC group only, and such increase was higher in men than in women and in patients younger than 60 versus patients older than 60 years old.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of daily WBC combined with physical exercise induced physiological adaptations and lowered the sympathetic nervous activity that may reflect a reduced level of MS in CIDP. These adaptations seem to depend on gender and age.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 2","pages":"164-170"},"PeriodicalIF":1.8,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49675118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven van Zanten, Richard Sutton, Viktor Hamrefors, Artur Fedorowski, Frederik J. de Lange
Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt-down time, a continuous beat-to-beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near-syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.
{"title":"Tilt table testing, methodology and practical insights for the clinic","authors":"Steven van Zanten, Richard Sutton, Viktor Hamrefors, Artur Fedorowski, Frederik J. de Lange","doi":"10.1111/cpf.12859","DOIUrl":"10.1111/cpf.12859","url":null,"abstract":"<p>Tilt table testing (TTT) has been used for decades to study short-term blood pressure (BP) and heart rate regulation during orthostatic challenges. TTT provokes vasovagal reflex in many syncope patients as a background of widespread use. Despite the availability of evidence-based practice syncope guidelines, proper application and interpretation of TTT in the day-to-day care of syncope patients remain challenging. In this review, we offer practical information on what is needed to perform TTT, how results should be interpreted including the Vasovagal Syncope International Study classification, why syncope induction on TTT is necessary in patients with unexplained syncope and on indications for TTT in syncope patient care. The minimum requirements to perform TTT are a tilt table with an appropriate tilt-down time, a continuous beat-to-beat BP monitor with at least three electrocardiogram leads and trained staff. We emphasize that TTT remains a valuable asset that adds to history building but cannot replace it, and highlight the importance of recognition when TTT is abnormal even without syncope. Acknowledgement by the patient/eyewitness of the reproducibility of the induced attack is mandatory in concluding a diagnosis. TTT may be indicated when the initial syncope evaluation does not yield a certain, highly likely, or possible diagnosis, but raises clinical suspicion of (1) reflex syncope, (2) orthostatic hypotension (OH), (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT in the patient with a certain, highly likely or possible diagnosis of reflex syncope, may be to educate patients on prodromes. In patients with reflex syncope with OH TTT can be therapeutic to recognize hypotensive symptoms causing near-syncope to perform physical countermanoeuvres for syncope prevention (biofeedback). Detection of hypotensive susceptibility requiring therapy is of special value.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 2","pages":"119-130"},"PeriodicalIF":1.8,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12859","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41232906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katarina Heimburg, Gisela Lilja, Erik Blennow Nordström, Hans Friberg, Lisa Gregersen Oestergaard, Anders M. Grejs, Thomas R. Keeble, Marco Mion, Niklas Nielsen, Christian Rylander, Magnus Segerström, Ida Katrine Thomsen, Susann Ullén, Johan Undén, Matthew P. Wise, Tobias Cronberg, Åsa B. Tornberg
Background
Low level of physical activity is a risk factor for new cardiac events in out-of-hospital cardiac arrest (OHCA) survivors. Physical activity can be assessed by self-reporting or objectively by accelerometery.
Aim
To investigate the agreement between self-reported and objectively assessed physical activity among OHCA survivors
Hypothesis
Self-reported levels of physical activity will show moderate agreement with objectively assessed levels of physical activity.
Method
Cross-sectional study including OHCA survivors in Sweden, Denmark, and the United Kingdom. Two questions about moderate and vigorous intensity physical activity during the last week were used as self-reports. Moderate and vigorous intensity physical activity were objectively assessed with accelerometers (ActiGraph GT3X-BT) worn upon the right hip for 7 consecutive days.
Results
Forty-nine of 106 OHCA survivors answered the two questions for self-reporting and had 7 valid days of accelerometer assessment. More physically active days were registered by self-report compared with accelerometery for both moderate intensity (median 5 [3:7] vs. 3 [0:5] days; p < 0.001) and vigorous intensity (1 [0:3] vs. 0 [0:0] days; p < 0.001). Correlations between self-reported and accelerometer assessed physical activity were sufficient (moderate intensity: rs = 0.336, p = 0.018; vigorous intensity: rs = 0.375, p = 0.008), and agreements were fair and none to slight (moderate intensity: k = 0.269, p = 0.001; vigorous intensity: k = 0.148, p = 0.015). The categorization of self-reported versus objectively assessed physical activity showed that 26% versus 65% had a low level of physical activity.
Conclusion
OHCA survivors reported more physically active days compared with the results of the accelerometer assessment and correlated sufficiently and agreed fairly and none to slightly.
{"title":"Agreement between self-reported and objectively assessed physical activity among out-of-hospital cardiac arrest survivors","authors":"Katarina Heimburg, Gisela Lilja, Erik Blennow Nordström, Hans Friberg, Lisa Gregersen Oestergaard, Anders M. Grejs, Thomas R. Keeble, Marco Mion, Niklas Nielsen, Christian Rylander, Magnus Segerström, Ida Katrine Thomsen, Susann Ullén, Johan Undén, Matthew P. Wise, Tobias Cronberg, Åsa B. Tornberg","doi":"10.1111/cpf.12860","DOIUrl":"10.1111/cpf.12860","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low level of physical activity is a risk factor for new cardiac events in out-of-hospital cardiac arrest (OHCA) survivors. Physical activity can be assessed by self-reporting or objectively by accelerometery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the agreement between self-reported and objectively assessed physical activity among OHCA survivors</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Self-reported levels of physical activity will show moderate agreement with objectively assessed levels of physical activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Cross-sectional study including OHCA survivors in Sweden, Denmark, and the United Kingdom. Two questions about moderate and vigorous intensity physical activity during the last week were used as self-reports. Moderate and vigorous intensity physical activity were objectively assessed with accelerometers (ActiGraph GT3X-BT) worn upon the right hip for 7 consecutive days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-nine of 106 OHCA survivors answered the two questions for self-reporting and had 7 valid days of accelerometer assessment. More physically active days were registered by self-report compared with accelerometery for both moderate intensity (median 5 [3:7] vs. 3 [0:5] days; <i>p</i> < 0.001) and vigorous intensity (1 [0:3] vs. 0 [0:0] days; <i>p</i> < 0.001). Correlations between self-reported and accelerometer assessed physical activity were sufficient (moderate intensity: <i>r</i><sub>s</sub> = 0.336, <i>p</i> = 0.018; vigorous intensity: <i>r</i><sub>s</sub> = 0.375, <i>p</i> = 0.008), and agreements were fair and none to slight (moderate intensity: <i>k</i> = 0.269, <i>p</i> = 0.001; vigorous intensity: <i>k</i> = 0.148, <i>p</i> = 0.015). The categorization of self-reported versus objectively assessed physical activity showed that 26% versus 65% had a low level of physical activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OHCA survivors reported more physically active days compared with the results of the accelerometer assessment and correlated sufficiently and agreed fairly and none to slightly.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"44 2","pages":"144-153"},"PeriodicalIF":1.8,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41193792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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