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Lewis CTA, Melhedegaard EG, Ognjanovic MM, Olsen MS, Laitila J, Seaborne RAE, Gronset M, Zhang C, Iwamoto H, Hessel AL, Kuehn MN, Merino C, Amigo N, Frobert O, Giroud S, Staples JF, Goropashnaya AV, Fedorov VB, Barnes B, Toien O, Drew K, Sprenger RJ, Ochala J. Remodeling of skeletal muscle myosin metabolic states in hibernating mammals. eLife 2024; 13:RP94616. [PMID: 38752835 PMCID: PMC11098559 DOI: 10.7554/elife.94616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Hibernation is a period of metabolic suppression utilized by many small and large mammal species to survive during winter periods. As the underlying cellular and molecular mechanisms remain incompletely understood, our study aimed to determine whether skeletal muscle myosin and its metabolic efficiency undergo alterations during hibernation to optimize energy utilization. We isolated muscle fibers from small hibernators, Ictidomys tridecemlineatus and Eliomys quercinus and larger hibernators, Ursus arctos and Ursus americanus. We then conducted loaded Mant-ATP chase experiments alongside X-ray diffraction to measure resting myosin dynamics and its ATP demand. In parallel, we performed multiple proteomics analyses. Our results showed a preservation of myosin structure in U. arctos and U. americanus during hibernation, whilst in I. tridecemlineatus and E. quercinus, changes in myosin metabolic states during torpor unexpectedly led to higher levels in energy expenditure of type II, fast-twitch muscle fibers at ambient lab temperatures (20 °C). Upon repeating loaded Mant-ATP chase experiments at 8 °C (near the body temperature of torpid animals), we found that myosin ATP consumption in type II muscle fibers was reduced by 77-107% during torpor compared to active periods. Additionally, we observed Myh2 hyper-phosphorylation during torpor in I. tridecemilineatus, which was predicted to stabilize the myosin molecule. This may act as a potential molecular mechanism mitigating myosin-associated increases in skeletal muscle energy expenditure during periods of torpor in response to cold exposure. Altogether, we demonstrate that resting myosin is altered in hibernating mammals, contributing to significant changes to the ATP consumption of skeletal muscle. Additionally, we observe that it is further altered in response to cold exposure and highlight myosin as a potentially contributor to skeletal muscle non-shivering thermogenesis.
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Affiliation(s)
| | | | - Marija M Ognjanovic
- Department of Biomedical Sciences, University of CopenhagenCopenhagenDenmark
| | - Mathilde S Olsen
- Department of Biomedical Sciences, University of CopenhagenCopenhagenDenmark
| | - Jenni Laitila
- Department of Biomedical Sciences, University of CopenhagenCopenhagenDenmark
| | - Robert AE Seaborne
- Department of Biomedical Sciences, University of CopenhagenCopenhagenDenmark
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King’s College LondonLondonUnited Kingdom
| | - Magnus Gronset
- Department of Cellular and Molecular Medicine, University of CopenhagenCopenhagenDenmark
| | - Changxin Zhang
- Department of Computational Medicine and Bioinformatics, University of MichiganAnn ArborUnited States
| | - Hiroyuki Iwamoto
- Spring-8, Japan Synchrotron Radiation Research InstituteHyogoJapan
| | - Anthony L Hessel
- Institute of Physiology II, University of MuensterMuensterGermany
- Accelerated Muscle Biotechnologies ConsultantsBostonUnited States
| | - Michel N Kuehn
- Institute of Physiology II, University of MuensterMuensterGermany
- Accelerated Muscle Biotechnologies ConsultantsBostonUnited States
| | | | | | - Ole Frobert
- Department of Clinical Medicine, Faculty of Health, Aarhus UniversityAarhusDenmark
- Faculty of Health, Department of Cardiology, Örebro UniversityÖrebroSweden
| | - Sylvain Giroud
- Energetics Lab, Department of Biology, Northern Michigan UniversityMarquetteUnited States
- Research Institute of Wildlife Ecology, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine ViennaViennaAustria
| | - James F Staples
- Department of Biology, University of Western OntarioLondonCanada
| | - Anna V Goropashnaya
- Center for Transformative Research in Metabolism, Institute of Arctic Biology, University of Alaska FairbanksFairbanksUnited States
| | - Vadim B Fedorov
- Center for Transformative Research in Metabolism, Institute of Arctic Biology, University of Alaska FairbanksFairbanksUnited States
| | - Brian Barnes
- Center for Transformative Research in Metabolism, Institute of Arctic Biology, University of Alaska FairbanksFairbanksUnited States
| | - Oivind Toien
- Center for Transformative Research in Metabolism, Institute of Arctic Biology, University of Alaska FairbanksFairbanksUnited States
| | - Kelly Drew
- Center for Transformative Research in Metabolism, Institute of Arctic Biology, University of Alaska FairbanksFairbanksUnited States
| | - Ryan J Sprenger
- Department of Zoology, University of British ColumbiaVancouverCanada
| | - Julien Ochala
- Department of Biomedical Sciences, University of CopenhagenCopenhagenDenmark
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Lewis CT, Tabrizian L, Nielsen J, Laitila J, Beck TN, Olsen MS, Ognjanovic MM, Aagaard P, Hokken R, Laugesen S, Ingersen A, Andersen JL, Soendenbroe C, Helge JW, Dela F, Larsen S, Sahl RE, Rømer T, Hansen MT, Frandsen J, Suetta C, Ochala J. Physical activity impacts resting skeletal muscle myosin conformation and lowers its ATP consumption. J Gen Physiol 2023; 155:e202213268. [PMID: 37227464 PMCID: PMC10225618 DOI: 10.1085/jgp.202213268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/07/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
It has recently been established that myosin, the molecular motor protein, is able to exist in two conformations in relaxed skeletal muscle. These conformations are known as the super-relaxed (SRX) and disordered-relaxed (DRX) states and are finely balanced to optimize ATP consumption and skeletal muscle metabolism. Indeed, SRX myosins are thought to have a 5- to 10-fold reduction in ATP turnover compared with DRX myosins. Here, we investigated whether chronic physical activity in humans would be associated with changes in the proportions of SRX and DRX skeletal myosins. For that, we isolated muscle fibers from young men of various physical activity levels (sedentary, moderately physically active, endurance-trained, and strength-trained athletes) and ran a loaded Mant-ATP chase protocol. We observed that in moderately physically active individuals, the amount of myosin molecules in the SRX state in type II muscle fibers was significantly greater than in age-matched sedentary individuals. In parallel, we did not find any difference in the proportions of SRX and DRX myosins in myofibers between highly endurance- and strength-trained athletes. We did however observe changes in their ATP turnover time. Altogether, these results indicate that physical activity level and training type can influence the resting skeletal muscle myosin dynamics. Our findings also emphasize that environmental stimuli such as exercise have the potential to rewire the molecular metabolism of human skeletal muscle through myosin.
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Affiliation(s)
- Christopher T.A. Lewis
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lee Tabrizian
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joachim Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jenni Laitila
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas N. Beck
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mathilde S. Olsen
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marija M. Ognjanovic
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rune Hokken
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Simon Laugesen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Arthur Ingersen
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper L. Andersen
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Casper Soendenbroe
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørn W. Helge
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Dela
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Steen Larsen
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Ronni E. Sahl
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tue Rømer
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel T. Hansen
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Frandsen
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julien Ochala
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Costache AD, Leon-Constantin MM, Roca M, Maștaleru A, Anghel RC, Zota IM, Drugescu A, Costache II, Chetran A, Moisă ȘM, Huzum B, Mitu O, Cumpăt C, Honceriu C, Mitu F. Cardiac Biomarkers in Sports Cardiology. J Cardiovasc Dev Dis 2022; 9:453. [PMID: 36547450 PMCID: PMC9781597 DOI: 10.3390/jcdd9120453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Sustained physical activity induces morphological and functional changes in the cardiovascular system. While mostly physiological, they can also become a trigger for major adverse cardiovascular events, the most severe of which are sudden cardiac arrest and sudden cardiac death. Therefore, any novel method which can help more accurately estimate the cardiovascular risk should be considered for further studying and future implementation in the standard protocols. The study of biomarkers is gaining more and more ground as they have already established their utility in diagnosing ischemic cardiac disease or in evaluating cardiac dysfunction in patients with heart failure. Nowadays, they are being implemented in the screening of apparently healthy individuals for the assessment of the cardiovascular risk. The aim of this paper is to gather published data regarding the measurements of cardiac biomarkers in athletes, i.e., troponins, myoglobin, CK-MB, NT-proBNP, and D-Dimers, and their potential use in the field of sports cardiology.
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Affiliation(s)
- Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Maria-Magdalena Leon-Constantin
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Mihai Roca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandra Maștaleru
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Răzvan-Constantin Anghel
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ioana-Mădălina Zota
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Andrei Drugescu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Irina-Iuliana Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiology, ”St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiology, ”St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Ștefana-Maria Moisă
- Department of Mother and Child Medicine-Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Pediatrics I, “St. Maria” Clinical Emergency Hospital, 700309 Iasi, Romania
| | - Bogdan Huzum
- Department of Morphofunctional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiology, ”St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Carmen Cumpăt
- Department of Management, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Cezar Honceriu
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” University, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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4
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Costache AD, Roca M, Honceriu C, Costache II, Leon-Constantin MM, Mitu O, Miftode RȘ, Maștaleru A, Iliescu-Halițchi D, Halițchi-Iliescu CO, Ion A, Duca ȘT, Popa DM, Abălasei B, Mocanu V, Mitu F. Cardiopulmonary Exercise Testing and Cardiac Biomarker Measurements in Young Football Players: A Pilot Study. J Clin Med 2022; 11:2772. [PMID: 35628899 PMCID: PMC9143869 DOI: 10.3390/jcm11102772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 02/06/2023] Open
Abstract
Constant and intense physical activity causes physiological adaptive changes in the human body, but it can also become a trigger for adverse events, such as sudden cardiac arrest or sudden cardiac death. Our main objective was to assess the use of combined cardiopulmonary exercise testing (CPET) and cardiac biomarker determinants in young professional athletes. We conducted a study which involved the full examination of 19 football players, all male, aged between 18 and 20 years old. They underwent standard clinical and paraclinical evaluation, a 12-lead electrocardiogram (ECG), and transthoracic echocardiography (TTE). Afterwards, a tailored CPET was performed and peripheral venous blood samples were taken before and 3 h after the test in order to determine five biomarker levels at rest and post-effort. The measured biomarkers were cardiac troponin I (cTnI), myoglobin (Myo), the MB isoenzyme of creatine-kinase (CK-MB), the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and D-dimers. While cTnI and NT-proBNP levels were undetectable both at rest and post-effort in all subjects, the variations in Myo, CK-MB and D-dimers showed significant correlations with CPET parameters. This highlights the potential use of combined CPET and biomarker determinants to evaluate professional athletes, and encourages further research on larger study groups.
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Affiliation(s)
- Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Mihai Roca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Cezar Honceriu
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” University, 700115 Iasi, Romania; (C.H.); (B.A.)
| | - Irina-Iuliana Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Maria-Magdalena Leon-Constantin
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Radu-Ștefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandra Maștaleru
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Dan Iliescu-Halițchi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, Arcadia Hospital, 700620 Iasi, Romania
| | - Codruța-Olimpiada Halițchi-Iliescu
- Department of Mother and Child Medicine-Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- Department of Pediatrics, Arcadia Hospital, 700620 Iasi, Romania
| | - Adriana Ion
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Ștefania-Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Delia-Melania Popa
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
| | - Beatrice Abălasei
- Faculty of Physical Education and Sports, “Alexandru Ioan Cuza” University, 700115 Iasi, Romania; (C.H.); (B.A.)
| | - Veronica Mocanu
- Department of Morphofunctional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Florin Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.-D.C.); (I.-I.C.); (M.-M.L.-C.); (O.M.); (R.-Ș.M.); (A.M.); (D.I.-H.); (A.I.); (Ș.-T.D.); (D.-M.P.); (F.M.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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