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Storlund RL, Rosen DAS, Haulena M, Sanatani S, Vander Zaag J, Trites AW. Ultrasound images of the ascending aorta of anesthetized northern fur seals and Steller sea lions confirm that the aortic bulb maintains continuous blood flow. JOURNAL OF EXPERIMENTAL ZOOLOGY. PART A, ECOLOGICAL AND INTEGRATIVE PHYSIOLOGY 2024; 341:458-469. [PMID: 38409932 DOI: 10.1002/jez.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
The increased size and enhanced compliance of the aortic bulb-the enlargement of the ascending aorta-are believed to maintain blood flow in pinnipeds during extended periods of diastole induced by diving bradycardia. The aortic bulb has been described ex vivo in several species of pinnipeds, but in vivo measurements are needed to investigate the relationship between structure and function. We obtained ultrasound images using electrocardiogram-gated transesophageal echocardiography during anesthesia and after atropine administration to assess the relationship between aortic bulb anatomy and cardiac function (heart rate, stroke volume, cardiac output) in northern fur seals (Callorhinus ursinus) and Steller sea lions (Eumetopias jubatus). We observed that the aortic bulb in northern fur seals and Steller sea lions expands during systole and recoils over the entire diastolic period indicating that blood flow is maintained throughout the entire cardiac cycle as expected. The stroke volumes we measured in the fur seals and sea lions fit the values predicted based on body size in mammals and did not change with increased heart rates, suggesting that greater stroke volumes are not needed for aortic bulb function. Overall, our results suggest that peripheral vasoconstriction during diving is sufficient to modulate the volume of blood in the aortic bulb to ensure that flow lasts over the entire diastolic period. These results indicate that the shift of blood into the aortic bulb of pinnipeds is a fundamental mechanism caused by vasoconstriction while diving, highlighting the importance of this unique anatomical adaptation.
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Affiliation(s)
- Rhea L Storlund
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A S Rosen
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Aquarium, Vancouver, British Columbia, Canada
| | | | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Vander Zaag
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Andrew W Trites
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
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Ng J, Ewe SH, Tan JL, Chao VTT, Ding ZP, Ling LH, Sin KYK, Chua TSJ, Sahlén A. Longitudinal analysis of thoracic aortic expansion in non-syndromic real-world patients. Heliyon 2023; 9:e15823. [PMID: 37305473 PMCID: PMC10256846 DOI: 10.1016/j.heliyon.2023.e15823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Remodeling of the thoracic aorta is commonly seen and viewed as a precursor to an aortic aneurysm. However, while aneurysms have been shown to expand at a rate of approximately 1 mm annually, the expansion of the pre-aneurysmal aorta is poorly characterized, especially in relation to age, gender, and aortic size per se. We identified patients that had undergone echocardiography at least twice at a large university medical center. Diagnosis codes, medications, and blood test results were obtained from hospital records. Syndromic patients were excluded (e.g., Marfan's syndrome, bicuspid aortic valve). Final population comprised n = 24,928 patients (median age 61.2 years (inter-quartile range (IQR): 50.6-71.5); 55.8% males) that had undergone a median of 3 echocardiograms (2-4; range 2-27) during a median of 4.0 years (IQR: 2.3-6.2). Hypertension was present in 39.6% of patients and diabetes in 20.7%, median LV ejection fraction was 56.0% (IQR: 41.0-62.0). Aortic size measurements were analyzed in mixed models while clustering on individual patients. Mean expansion was determined for sinus of Valsalva as 1.93 (95% confidence interval; CI95: 1.87-1.99) mm per decade, and for ascending aorta as 1.76 (CI95: 1.70-1.82) mm per decade. Faster expansion was found in males, with larger aortic size, and younger age (p for interaction <0.05 for all). In conclusion, expansion of the thoracic aorta, in real world, non-syndromic patients, is slow and averages <2 mm per decade. This will help to inform management of this large patient group.
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Affiliation(s)
- Josiah Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Ju Le Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Victor TT. Chao
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Lieng-Hsi Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kenny YK. Sin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Terrance SJ. Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Anders Sahlén
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Karolinska Institutet, Stockholm, Sweden
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Cardiovascular toxicities of androgen deprivation therapy in Asian men with localized prostate cancer after curative radiotherapy: a registry-based observational study. CARDIO-ONCOLOGY 2022; 8:4. [PMID: 35287756 PMCID: PMC8919574 DOI: 10.1186/s40959-022-00131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022]
Abstract
Background Androgen deprivation therapy (ADT) and radiotherapy (RT) are the mainstay treatment for localized prostate cancer and recurrence after surgery. Cardiovascular (CV) toxicity of ADT is increasingly recognized, and the risk relates to pre-existing risk factors and ADT modalities. Despite ethnic differences in the prevalence of CV risk factors and variations of CV mortality, data on ADT-related cardiotoxicities in the Asian population remain inconclusive. Our registry-based study investigated ADT-related major adverse cardiovascular events (MACE) after primary or salvage RT. Methods Our study combined two prospectively established registry databases from National Cancer Center Singapore and National Heart Center Singapore. The primary endpoint is time to first MACE after treatment. MACE is defined as myocardial infarction, stroke, unstable angina, or cardiovascular death. Two types of propensity score adjustments, including ADT propensity score as a covariate in the multivariable regression model and propensity score weighting, were applied to balance baseline features and CV risk factors between RT alone and RT + ADT groups. Results From 2000 to 2019, 1940 patients received either RT alone (n = 494) or RT + ADT (n = 1446) were included. After a median follow-up of 10 years (RT) and 7.2 years (RT+ ADT), the cumulative incidence of MACE at 1, 3 and 9 years was 1.2, 5 and 16.2% in RT group, and 1.1, 5.2 and 17.6% in RT + ADT group, respectively. There were no differences in the incidence of MACE between 2 groups (HR 1.01, 95% CI 0.78–1.30, p = 0.969). Pre-treatment CV risk factors were common (80%), and CV disease (15.9%) was the second leading cause of death after prostate cancer (21.1%). On univariate analysis, older age, Indians and Malays, pre-existing CV risk factors, and history of MACE were associated with higher MACE risk. After propensity score adjustments, there remained no significant differences in MACE risk between RT + ADT and RT group on multivariable analysis. Conclusions In our registry-based study, ADT is not associated with increased risk of major cardiovascular events among Southeast Asian men with prostate cancer after curative radiotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s40959-022-00131-4.
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Yu S, Guo X, Li G, Yang H, Zheng L, Sun Y. Gender discrepancy in the predictive effect of aortic root diameter on incidence of cardiovascular events among rural Northeast Chinese. BMJ Open 2022; 12:e039207. [PMID: 36691125 PMCID: PMC9454021 DOI: 10.1136/bmjopen-2020-039207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/28/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The possible predictive effect of echocardiographic aortic root diameter (ARD) on the incidence of cardiovascular events (CVEs) in a large, general population is limited. In addition, there is a lack of data about rural participants. We intend to figure out the possible relationship between ARD and the incidence of CVEs among the general population from rural China. DESIGN Population-based cohort study. SETTING Rural areas in Liaoning Province, Northeast China. PARTICIPANTS At baseline, 9810 participants (mean age 53±10, 49.1% male) were enrolled in the Northeast China Rural Cardiovascular Health Study between 2012 and 2017. MAIN OUTCOME MEASURES Cardiac ultrasonography, lifestyle, medical history, laboratory testing, blood pressure, weight and height. ARD measurement was conducted at the level of the sinuses of Valsalva. Furthermore, the ARD was indexed to height or body surface area. RESULTS During a median follow-up of 4.66 years, 550 non-fatal or fatal CVEs were recorded. Adjusting for blood pressure, age, total cholesterol, fasting blood glucose, estimated glomerular filtration rate, current smoking and drinking, previous cardiovascular diseases and antihypertensive treatment; ARD/height (HR per 1-unit increase=1.781, 95% CI: 1.160 to 2.736, p=0.008) was associated with an increased risk of CVEs in men only. The combination of left ventricular hypertrophy (LVH) and aortic dilation was an independent and powerful predictor for cardiovascular prognosis compared with aortic dilation alone in men but not in women. CONCLUSIONS Our study enrols a large sample of rural Chinese residents, and first confirms that ARD/height has a predictive effect on the incidence of CVEs among rural Chinese residents. The combination of LVH and aortic dilation is synergistic, which increases its predictive effect on CVEs in men only, suggesting that aortic dilatation predicts cardiovascular prognosis better than LVH does in men but not in women.
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Affiliation(s)
- Shasha Yu
- Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofan Guo
- The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guangxiao Li
- Clinical Epidemiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongmei Yang
- Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liqiang Zheng
- Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yingxian Sun
- The First Hospital of China Medical University, Shenyang, Liaoning, China
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Zhu F, Zhang Z, Lv C, Wang B, Wei F. A Rare Case Report of Endovascular Therapy for Basilar Artery Occlusion in a Young Adult with Marfan Syndrome. Vasc Endovascular Surg 2022; 56:335-339. [PMID: 35130085 DOI: 10.1177/15385744221078271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Basilar artery occlusion (BAO) is one of the most devastating types of ischaemic stroke and is identified by using computed tomography (CT) angiography. Marfan syndrome is an autosomal dominant disorder involving multisystem connective tissue, and the neurological complications are relatively rare. In this article, we report a case of a young Marfan syndrome patient complicated with BAO ischaemic stroke. The patient was an 18-year-old man with right hemiparesis, aphasia and impaired consciousness. CT angiography of the brain showed an occlusion distal to the basilar artery. Endovascular therapy including intravenous thrombolysis and mechanical thrombectomy (MT) was administered to this patient inside the therapeutic window. The patient had a favourable clinical outcome after endovascular therapy. Marfan syndrome may be a rare cause of ischaemic stroke with BAO. In addition, our report provides some evidence that can be used as a reference when planning therapeutic strategies for BAO patients with Marfan syndrome.
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Affiliation(s)
- FeiYan Zhu
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - ZhenZhong Zhang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Chenling Lv
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - BaiChen Wang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Fuquan Wei
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Loh J, Amanullah MR, See CK, Tang HC, Gunasegaran K, Hamid N, Lau J, Lee CY, Ewe SH, Ding ZP, Sahlén A. Predicting premature termination of exercise during Bruce protocol stress echocardiography. Echocardiography 2021; 38:1612-1617. [PMID: 34505312 DOI: 10.1111/echo.15186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/18/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS Clinical guidelines recommend that the exercise protocol of a stress echocardiogram is selected to induce volitional exhaustion after a target duration of at least 8 minutes. While the Bruce protocol is very commonly used for clinical stress tests, it is known to be "steep", and many patients therefore fail to reach 8 minutes. We studied predictors of failure and developed a method for identifying patients not suitable for Bruce protocol which was accurate and yet simple enough to be used as a point-of-care decision support tool. METHODS AND RESULTS We studied data out-patients undergoing Bruce protocol stress echocardiograms (n = 11 086) and analyzed predictors of inappropriate early termination (defined as test duration < 8 min as per current practice guidelines) using logistic regression. A prediction model was constructed as follows: .5 points were given for each of hypertension, diabetes, smoking, and E/e' > 7.9 in the resting echocardiogram; .1 point was added for each 1-unit increment in body mass index; 1 point was added for patient age by decade; 2.0 points were subtracted for male sex (p for all < 0.001). In tests on held-out validation data, the model was well calibrated (in plots of predicted vs actual risk) and discriminated failure versus non-failure well (C-statistic .86 for a score of 6.0 points; p < 0.001). CONCLUSION These data may help to standardize protocol selection in stress echocardiography, by identifying patients pre-hoc where Bruce protocol will be inappropriately steep.
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Affiliation(s)
- Julian Loh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | | | - Chai Keat See
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Hak Chiaw Tang
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | | | - Nadira Hamid
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Jeffrey Lau
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Chung Yin Lee
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - See Hooi Ewe
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Zee Pin Ding
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Anders Sahlén
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore.,Karolinska Institutet, Stockholm, Sweden
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Bikia V, Pagoulatou S, Trachet B, Soulis D, Protogerou AD, Papaioannou TG, Stergiopulos N. Noninvasive Cardiac Output and Central Systolic Pressure From Cuff-Pressure and Pulse Wave Velocity. IEEE J Biomed Health Inform 2019; 24:1968-1981. [PMID: 31796418 DOI: 10.1109/jbhi.2019.2956604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
GOAL We introduce a novel approach to estimate cardiac output (CO) and central systolic blood pressure (cSBP) from noninvasive measurements of peripheral cuff-pressure and carotid-to-femoral pulse wave velocity (cf-PWV). METHODS The adjustment of a previously validated one-dimensional arterial tree model is achieved via an optimization process. In the optimization loop, compliance and resistance of the generic arterial tree model as well as aortic flow are adjusted so that simulated brachial systolic and diastolic pressures and cf-PWV converge towards the measured brachial systolic and diastolic pressures and cf-PWV. The process is repeated until full convergence in terms of both brachial pressures and cf-PWV is reached. To assess the accuracy of the proposed framework, we implemented the algorithm on in vivo anonymized data from 20 subjects and compared the method-derived estimates of CO and cSBP to patient-specific measurements obtained with Mobil-O-Graph apparatus (central pressure) and two-dimensional transthoracic echocardiography (aortic blood flow). RESULTS Both CO and cSBP estimates were found to be in good agreement with the reference values achieving an RMSE of 0.36 L/min and 2.46 mmHg, respectively. Low biases were reported, namely -0.04 ± 0.36 L/min for CO predictions and -0.27 ± 2.51 mmHg for cSBP predictions. SIGNIFICANCE Our one-dimensional model can be successfully "tuned" to partially patient-specific standards by using noninvasive, easily obtained peripheral measurement data. The in vivo evaluation demonstrated that this method can potentially be used to obtain central aortic hemodynamic parameters in a noninvasive and accurate way.
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Seng MC, Shen X, Wang K, Chong DT, Fam JM, Hamid N, Amanullah MR, Yeo KK, Ewe SH, Chua TS, Ding ZP, Sahlén A. Allometric Relationships for Cardiac Size and Longitudinal Function in Healthy Chinese Adults - Normal Ranges and Clinical Correlates. Circ J 2018; 82:1836-1843. [PMID: 29695648 DOI: 10.1253/circj.cj-18-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac size measurements require indexing to body size. Allometric indexing has been investigated in Caucasian populations but a range of different values for the so-called allometric power exponent (b) have been proposed, with uncertainty as to whether allometry offers clinical utility above body surface area (BSA)-based indexing. We derived optimal values for b in normal echocardiograms and validated them externally in cardiac patients. METHODS AND RESULTS Values for b were derived in healthy adult Chinese males (n=1,541), with optimal b for left ventricular mass (LVM) of 1.66 (95% confidence interval 1.41-1.92). LV hypertrophy (LVH) defined as indexed LVM >75 g/m1.66 was associated with adverse outcomes in an external validation cohort (n=738) of patients with acute coronary syndrome (odds ratio for reinfarction: 2.4 (1.1-5.4)). In contrast, LVH defined by BSA-based indexing or allometry using exponent 2.7 exhibited no significant association with outcomes (P=NS for both). Cardiac longitudinal function also varied with body size: septal and RV free wall s', TAPSE and lateral e' all scaled allometrically (b=0.3-0.9). CONCLUSIONS An optimal b of 1.66 for LVM in healthy Chinese was found to validate well, with superior clinical utility both to that of BSA-based indexing and to b=2.7. The effect of allometric indexing of cardiac function requires further study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Anders Sahlén
- National Heart Centre Singapore.,Karolinska Institutet
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Liao Y, Dong Y, Cheng J. The Function of the Mitochondrial Calcium Uniporter in Neurodegenerative Disorders. Int J Mol Sci 2017; 18:ijms18020248. [PMID: 28208618 PMCID: PMC5343785 DOI: 10.3390/ijms18020248] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/16/2022] Open
Abstract
The mitochondrial calcium uniporter (MCU)-a calcium uniporter on the inner membrane of mitochondria-controls the mitochondrial calcium uptake in normal and abnormal situations. Mitochondrial calcium is essential for the production of adenosine triphosphate (ATP); however, excessive calcium will induce mitochondrial dysfunction. Calcium homeostasis disruption and mitochondrial dysfunction is observed in many neurodegenerative disorders. However, the role and regulatory mechanism of the MCU in the development of these diseases are obscure. In this review, we summarize the role of the MCU in controlling oxidative stress-elevated mitochondrial calcium and its function in neurodegenerative disorders. Inhibition of the MCU signaling pathway might be a new target for the treatment of neurodegenerative disorders.
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Affiliation(s)
- Yajin Liao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, No. 27 Taiping Road, Haidian District, Beijing 100039, China.
- The State Key Laboratory of Brain and Cognitive Sciences, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China.
| | - Yuan Dong
- Department of Biochemistry, Qingdao University Medical College, Qingdao 266071, China.
| | - Jinbo Cheng
- The State Key Laboratory of Brain and Cognitive Sciences, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China.
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