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Conclusion
opioid use disorder
In this study, zinc supplementation in patients with opioid use disorder subjected to MMT was investigated. Although the study results showed that zinc intake had the capability to positively influence relapse reduction and mental health in such people, more studies are needed before including this supplement in the tr...
PMC9817328
Acknowledgements
The authors hereby would like to extend their gratitude to all the participants and the staff of the addiction treatment clinic concerned, who cooperated to fulfill this study. They also appreciate the Vice-Chancellor’s Office for Research, affiliated with Isfahan University of Medical Sciences, Isfahan, Iran, for the ...
PMC9817328
Authors’ contributions
Both authors contributed to the study procedures, data collection, and analysis. The authors prepared the first draft and read and approved the final version.
PMC9817328
Funding
Not applicable.
PMC9817328
Availability of data and materials
The data used in this study will be made available from the corresponding author upon reasonable request.
PMC9817328
Declarations
PMC9817328
Ethics approval and consent to participate
A written informed consent form was obtained from all the participants once the research objectives and methodology were explained. The Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran, approved this study with the ethics code no. (IR.MUI.MED.REC. 1399.385). Moreover, the principles of the Decl...
PMC9817328
Consent for publication
Not applicable.
PMC9817328
Competing interests
The authors did not declare any conflict of interest.
PMC9817328
References
PMC9817328
Background
memory complaints
DV and AS contributed equally to this work.There is evidence that both omega-3 long-chain polyunsaturated fatty acids (PUFAs) (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) and cocoa flavanols can improve cognitive performance in both healthy individuals and in those with memory complaints. However, their...
PMC10447509
Objectives
memory complaints
To investigate the combined effect of EPA/DHA and cocoa flavanols (OM3FLAV) on cognitive performance and brain structures in older adults with memory complaints.
PMC10447509
Methods
cognitive impairment
A randomized placebo-controlled trial of DHA-rich fish oil (providing 1.1 g/d DHA and 0.4 g/d EPA) and a flavanol-rich dark chocolate (providing 500 mg/d flavan-3-ols) was conducted in 259 older adults with either subjective cognitive impairment or mild cognitive impairment. Participants underwent assessment at baselin...
PMC10447509
Results
TG, alertness
197 participants completed the study. The combined intervention had no significant effect on any cognitive outcomes, with the exception of reaction time variability (P = 0.007), alertness (P < 0.001), and executive function (P < 0.001), with a decline in function observed in the OM3FLAV group (118.6 [SD 25.3] at baseli...
PMC10447509
Conclusions
cognitive impairment
These results suggest that cosupplementation with ω-3 PUFAs and cocoa flavanols for 12 mo does not improve cognitive outcomes in those with cognitive impairment.This trial was registered at
PMC10447509
Keywords
PMC10447509
Abbreviations
Alzheimer’s diseaseblueberry powderbrain-derived neurotrophic factorbasal metabolic rateCognitive AgeingCDREFFLAVFOLPCMCIMoCAPCPPSCISwinburne University of TechnologyUniversity of East Anglia
PMC10447509
Introduction
dementia
SEPARATION
At a population level, interventions that delay the onset of dementia by 2 y are predicted to reduce the number of dementia patients by 20% [Investigations in model systems add validity to the prospective cohort evidence. Furthermore, they provide insights into the molecular and physiological mechanisms underlying long...
PMC10447509
Subjects and Methods
The study protocol and methods have been described in detail elsewhere [
PMC10447509
Ethics
The conduct, evaluation, and documentation of this study abide by Good Clinical Practice guidelines and the guiding principles of the Declaration of Helsinki. The study was approved by the Bellberry Human Research Ethics Committee (Study ID: 2015-03-227) and Swinburne University Human Research Ethics Committee (SHR Pro...
PMC10447509
Study design and participants
MCI
RECRUITMENT
The CANN trial was a 12-mo randomized placebo-controlled parallel study with 2 intervention arms. There were 2 recruitment sites, the UEA (Norwich, UK) and SUT (Melbourne, Australia), with MRI analyzed centrally at the University of Illinois (Urbana Champaign, Urbana, IL, United States). Participants were asked to atte...
PMC10447509
Intervention, assignment to group, and blinding
Participants were asked to consume 3 × 1 g oil capsules and 33 g of chocolate drops of either test or control products daily with the main meal of the day. The test capsules provided 1.1 g DHA and 0.4 g EPA per day in triglyceride form. The control capsules contained a blend of 80% palm oil and 20% corn oil to deliver ...
PMC10447509
Cognitive outcomes
Bracket
As described previously, cognition was assessed at each clinical visit using the CDR computerized assessment system (Bracket Cognition), the MoCA, the Delis–Kaplan Executive Function System, the Verbal Fluency Test (0 and 12 mo only), and the iPosition task. Paper-and pencil Bond-Lader Visual Analogue Scale of Mood and...
PMC10447509
MRI
APPENDIX
A subset of participants, representative of the full group, at both trial sites completed a neuroimaging session at baseline and 12 mo. Here, we report volumetric measures of brain structure in this neuroimaging subset derived from T1-weighted anatomical scans acquired at both sites. Further imaging modalities acquired...
PMC10447509
Biological sample collection and analysis
Participants provided an overnight fasted blood sample and a spot urine sample that was their first void of the day.For FLAV and methylxanthine analyses, the metabolites were purified from 50 μL human urine by 96-well plate solid phase extraction (Strata™-X Polymeric Reversed Phase, microelution 2 mg/well). The solid p...
PMC10447509
Dietary assessment
Cancer
CANCER
Assessment of diet at baseline and 12 mo was conducted using a 130-item The European Prospective Investigation into Cancer and Nutrition FFQ [
PMC10447509
Statistical analyses and sample size estimation
The sample size estimate has been detailed previously [All non-MRI analyses were conducted by ANCOVA using mixed models for repeated measures with SAS PROC MIXED. INTERVENTION was fitted as a fixed between-group factor (2 levels: intervention or control group). For non-MRI data, change from baseline was calculated for ...
PMC10447509
Results
PMC10447509
n-3 PUFA and FLAV response to intervention
PC 38:5
As anticipated, OM3FLAV intervention resulted in a significant increase in NEFA EPA and DHA and LPC EPA and DHA, along with PC 38:5, PC 38:6, and PC 40:6 fractions (Plasma n-3 PUFA, and urinary flavonoids at baseline and in response to interventionData are mean (SD); ANCOVA using mixed models for repeated measures, wit...
PMC10447509
Primary outcome measure
No significant impact of intervention on picture recognition performance was evident, with mean (SD) of 85.1 (1.3)% and 85.6 (1.4)% at baseline and 12 mo, respectively (Picture recognition new stimuli accuracy (%) at baseline and following 3 mo or 12 mo of a DHA-rich fish oil and cocoa flavanol mixture (OM3FLAV;
PMC10447509
Secondary cognitive outcome responses
SECONDARY
There was no significant effect of the intervention on any of the secondary composite or individual cognitive outcomes, with the exception of reaction time variability (Cognitive secondary endpoints and response to intervention as per protocol analysisData are mean (SD); ANCOVA using mixed models for repeated measures....
PMC10447509
Brain volumes
white matter volume
The baseline MRI data in the group as a whole (Structural MRI assessment of (A) hippocampal volume; (B) cortical volume; (C) cortical white matter volume; and (D) ventricular volume following 12-mo consumption of a DHA-rich fish oil and cocoa flavanol mixture (OM3FLAV;
PMC10447509
Plasma biochemistry
The intervention decreased plasma triglyceride levels by 22% in the OM3FLAV group by 3 mo, with no change in the control group (Plasma biochemistry at baseline and in response to interventionData are mean (SD); ANCOVA using mixed models for repeated measures, with change from baseline (ie, 3 mo-0 mo and 12 mo-0 mo) fit...
PMC10447509
Dietary data
Habitual intakes of oily fish (main dietary source of EPA and DHA), total flavonoids and flavan-3-ol were 0.724 portions per week, 842 mg/d and 193 mg/d respectively, with no baseline difference between groups (Nutrient intake (derived from the Food Frequency Questionnaire) at baseline and 12 moData are mean (SD); Inte...
PMC10447509
Discussion
memory deficits, MCI, dementia, atrophy, cognitive impairments, cognitive decline, OM3FLAV
SECONDARY, ATROPHY, INSULIN SENSITIVITY, CORTEX
The current study provides the first long-term data to suggest that supplementation with long-chain ω-3 fatty acids and FLAVs over 1 y does not improve cognitive function or brain volumes in individuals with subjective and objective cognitive impairments. The combined dietary intervention resulted in the expected sever...
PMC10447509
References
PMC10447509
Author contributions
The authors’ responsibilities were as follows –; AMM, AS, NJC, AC, DV: designed the research; DJW, MI, RG, RK: delivered the clinical trial; AS, NJC, HS: designed the cognitive assessment strategy; CK: designed and managed the flavonoid metabolite analysis of the urine samples; MK: undertook the lipidomic analysis unde...
PMC10447509
Conflict of interest
DJW has received research funding from Arla Foods, Bayer Healthcare, and Fonterra and consultancy/speaker honoraria from Neurobrands, Naturex, and Bayer Healthcare. AS has received research funding from: Abbott Nutrition, Arla Foods, Bayer, DuPont, Fonterra, GlaxoSmithKline, Nestlé, Nutricia-Danone, and Sanofi. He has ...
PMC10447509
Funding
The research was funded in part by
PMC10447509
Data availability
Data described in the manuscript, code book, and analytic code will be made available upon request pending application and approval.
PMC10447509
Supplementary data
The following is the Supplementary data to this article:
PMC10447509
Multimedia component1
PMC10447509
Acknowledgments
We acknowledge the large contribution by our colleague and friend Prof Keith Wesnes, who sadly died in 2020. Keith was largely responsible for the statistical analysis planning and execution of the CANN study. We thank our nursing and other support staff at our clinical research facilities at the University of East Ang...
PMC10447509
Background
Type 2 diabetes, impairments in cognitive function, T2DM
TYPE 2 DIABETES
Type 2 diabetes (T2DM) and poor glucose regulation in the immediate postprandial period are both associated with impairments in cognitive function. There is evidence that foods that generate a better postprandial glycemic response, such as low GI foods (which produce a lower glycemic peak, less variability, and a more ...
PMC10206291
Objectives
noninsulin-dependent T2DM
The primary aim of this research was to investigate whether a multimeal paradigm producing a low glycemic response was associated with cognitive benefits in patients with noninsulin-dependent T2DM relative to a multimeal paradigm producing a high glycemic response.
PMC10206291
Methods
noninsulin-dependent T2DM
Twenty-five adults with noninsulin-dependent T2DM (mean age: 57 y) consumed 2 multimeal profiles consisting of a breakfast, lunch, and afternoon snack on 2 separate test days following a randomized, counterbalanced, crossover design. The 2 conditions were a low GI profile (LGIP) and a high GI profile (HGIP).
PMC10206291
Results
satiety, cognitive and executive functions
Cognitive function, glycemic response, mood, and satiety were assessed over the day from 8:30 to 17:00. Overall, there were limited cognitive effects. However, there was evidence for cognitive benefits in the period before lunch, as demonstrated by better global cognitive and executive functions for the LGIP relative t...
PMC10206291
Conclusions
T2DM
This study shows that a multimeal paradigm producing a low glycemic response was associated with some benefits for cognitive function in patients with T2DM.
PMC10206291
Clinical Trail Registry reference
NCT03360604 (clinical
PMC10206291
Keywords
PMC10206291
Abbreviations
DIABETES
blood-brain barrierchoice reaction timedynamic cerebral autoregulationdependent variableglobal cognitive performancehigh GIhigh GI profilelow GIlow GI profilerapid visual information processingtype 2 diabetes
PMC10206291
Introduction
cognitive impairments, cognitive effect [Cognitive function, T2DM
SECONDARY, TYPE 2 DIABETES
Given that glucose is the main fuel for the brain, it is perhaps not surprising that conditions that are associated with abnormalities in glucose regulation, such as type 2 diabetes (T2DM), are associated with cognitive impairments [Interestingly, dietary intervention studies that have investigated the link between gly...
PMC10206291
Method
PMC10206291
Participants
T2DM
Twenty-five adults with a medical diagnosis of T2DM were recruited through a local advertisement at the University of Reading and the surrounding areas. These included 17 men and 8 women, with a mean age of 56.9 y (SD = 7.8), a mean BMI of 30.6 kg/m
PMC10206291
Design
sleepiness, meal carbohydrate
The study followed a counterbalanced, randomized, crossover design with 2 nutritional interventions that produced 2 different glycemic profiles (2 conditions); (1) a low GI profile (LGIP) and (2) a high GI glycemic profile (HGIP). Both conditions consisted of breakfast, lunch, and an afternoon snack (details below), an...
PMC10206291
Procedure
Diabetes
BLOOD, DIABETES
All exclusion criteria were checked with a self-report questionnaire which participants completed and returned by e-mail prior to a screening session. A 1-h screening session was arranged for the morning at the Hugh Sinclair Unit of Human Nutrition, University of Reading, when height and weight were measured with a Tan...
PMC10206291
Cognitive function
alertness
The cognitive task battery was administered with E-Prime 2.0 (Psychology Software Tool, Inc). There were 4 separate cognitive tasks: CRT, Rapid Visual Information Processing (RVIP), a merged CRT-RVIP task, and Letter Memory. The CRT task was a measure of general alertness and psychomotor speed. For each trial, a fixati...
PMC10206291
Glycemic response
Diabetes
DIABETES
Glucose concentrations were measured using a FreeStyle Libre continuous glucose monitoring system (Abbott Diabetes Care Inc). The sensor automatically measured interstitial glucose concentrations every minute and stored readings at 15-min intervals for 8 h. The data was wirelessly transmitted to the reader held by the ...
PMC10206291
Subjective mood and satiety
The Bond-Lader mood questionnaire [
PMC10206291
Analysis
Linear mixed models were used for all analyses. For glycemic response, the independent variables condition (LGIP and HGIP) and time (22-time points) were included as fixed factors, with the following covariates included as fixed factors; sex, age, BMI, baseline glucose, and baseline DV score. Baseline glucose was the f...
PMC10206291
Results
Background characteristics according to the randomization sequence for this crossover trial are shown in Baseline characteristics of participants by randomization sequence (either LGIP first and HGIP second or HGIP first and LGIP second) data are means and SELGIP, low GI profile; HGIP, high GI profile.
PMC10206291
Glycemic response
BLOOD
As shown in Blood glucose concentrations (mmol/L) for the low GI profile (LGIP) and the high GI meal profile (HGIP) for the test day following breakfast (
PMC10206291
Mood and satiety
sleepiness
As shown in Subjective ratings of hunger (A) and sleepiness (B) for the low GI profile (LGIP) and the high GI meal profile (HGIP) (
PMC10206291
Discussion
cognitive and executive functions, cognitive impairment, noninsulin-dependent T2DM, prediabetes, cognitive or mood effects of the meal profiles, sleepiness, cognitive and mood benefits, satiety, T2DM
EFFECTS LATE, PREDIABETES, OTHER METABOLIC DISORDERS
The aim of this study was to explore the cognitive effects of a multimeal paradigm that produced an LGI response over the course of the day relative to meals which produced an HGI response in patients with noninsulin-dependent T2DM. Overall, there were no cognitive effects for 7 of the 9 cognitive performance measures....
PMC10206291
Author contribution
The authors’ responsibilities were as follows–MG, DL, and JL: designed the research; MG and DL: wrote the manuscript; JL: edited the manuscript; MG: collected and analyzed the data; and all authors: read and approved the final manuscript.
PMC10206291
Conflict of intrest
The authors report no conflicts of interest.
PMC10206291
Data Availability
Data described in the manuscript will be made available upon request to the corresponding author
PMC10206291
Funding
The authors reported no funding was received for this study.
PMC10206291
References
PMC10206291
Background
hemorrhagic transformation, reperfusion injury, acute ischemic stroke, HT
Cerebrolysin could mitigate reperfusion injury and hemorrhagic transformation (HT) in animal models of acute ischemic stroke.
PMC10041692
Methods
Stroke, HT
SECONDARY, STROKE
This was a prospective, randomized, open-label, parallel-group with active control, multicenter pilot study. Cerebrolysin (30 mL/day over 14 days) was administered concurrently with alteplase (0.9 mg/kg) in 126 patients, whereas 215 control patients received alteplase alone. The primary outcomes were the rate of any an...
PMC10041692
Results
Cerebrolysin treatment resulted in a substantial decrease of the symptomatic HT rate with an odds ratio (OR) of 0.248 (95% CI: 0.072–0.851;
PMC10041692
Conclusions
neurological deficit, HT
Early add-on of Cerebrolysin to reperfusion therapy was safe and significantly decreased the rate of symptomatic HT as well as early neurological deficit. No effect on day 90 functional outcome was detected. Improvements in the imaging metrics support the neuroprotective and blood–brain barrier stabilizing activity of ...
PMC10041692
Trial registration
Name of Registry: ISRCTN.Trial Registration Number: Trial Registration Date: 16/02/2021.
PMC10041692
Keywords
PMC10041692
Introduction
neuroinflammation, stroke, AIS, HT, excitotoxicity, rtPA, acute ischemic stroke
STROKE, SECONDARY
Intravenous thrombolysis (IVT) within 4.5 h after acute ischemic stroke (AIS) substantially improves functional outcome [A plethora of experimental stroke models have demonstrated neuroprotective effects of Cerebrolysin and its ability to attenuate blood–brain barrier (BBB) permeability [In our current study, we looked...
PMC10041692
Methods
EMERGENCY
CEREHETIS was a prospective, randomized, open-label, active control, multicenter, parallel-group phase IIIb pilot study. The patients were enrolled across 8 centers in Russia – the Interregional Clinical Diagnostic Center (Kazan), Municipal Clinical Hospital #7 (Kazan), Kazan Federal University Hospital (Kazan), Perm T...
PMC10041692
Inclusion and exclusion criteria
arteriovenous malformation, bleeding, Gastrointestinal or genitourinary bleeding, Stroke, stroke, Seizure, intracranial aneurism, brain abscess, liver and kidney failure)• Known, neoplasm, HT, rtPA, head trauma, allergic reactions, trauma
BLEEDING, STROKE, ACUTE MYOCARDIAL INFARCTION, INTRACRANIAL HEMORRHAGE, STROKE, INFECTIVE ENDOCARDITIS, BRAIN TUMOR, ALLERGIC REACTION, BRAIN ABSCESS, ISCHEMIC STROKE, DISORDERS, SUBARACHNOID HEMORRHAGE, PERICARDITIS, NEOPLASM, ACUTE PANCREATITIS, BLOOD, DUODENAL ULCER, BLEEDING DIATHESIS
Main inclusion and exclusion criteria are outlined in Table Inclusion and exclusion criteria • Confirmed diagnosis of acute ischemic stroke• Age ≥ 18 years• Onset of stroke symptoms within 4.5 h before initiation of rtPA administration • Current or previous intracranial hemorrhage• Symptoms suggestive of subarachnoid h...
PMC10041692
Randomization and blinding
SECONDARY, RECRUITMENT
Each eligible patient was randomly assigned into either the Cerebrolysin or control group by simple randomization procedure. One randomization list for all centers was issued by generating Bernoulli variates with the probability parameter of 0.333. The Mersenne twister was used as an active generator and the starting p...
PMC10041692
Study treatment
stroke, death
STROKE
Both groups received a standard dose of 0.9 mg/kg rtPA (alteplase) administered intravenously within 4.5 h after symptom onset (maximal dosage 90 mg, 10% of the drug given in bolus and the rest in 60 min via intravenous infusion). In addition, measures of standard care for AIS patients were applied for both groups. Pat...
PMC10041692
Study procedures
stroke, Stroke
STROKE, STROKE
At the time of admission (day 0), the screening and baseline assessment was performed. Routine clinical, laboratory, and imaging data were collected. Follow-up visits were scheduled in 24 h (day 1, visit 1), on day 7 (visit 2), 14 (visit 3) and 90 (visit 4).The National Institutes of Health Stroke Scale (NIHSS) score w...
PMC10041692
Outcome measures
neurologic deterioration, death, liver and kidney function, HT
ADVERSE EVENTS
The study primary endpoints were any and symptomatic HT verified on a follow-up CT scan from day 0 to day 14. Symptomatic HT was defined according to the ECASS III trial: any apparently extravascular blood in the brain or within the cranium that was associated with clinical deterioration, as defined by an increase of 4...
PMC10041692
Advanced brain imaging procedures
infarct
INFARCT
On day 1 and 14, a routine brain MRI was acquired followed by an axial DTI scan. The MRI exam was performed on a GE Signa HDx 1.5 T scanner (GE Healthcare, USA). The DTI sequence parameters were as follows: spin-echo echo-planar imaging, repetition time = 6000 ms, echo time = 102.9 ms, field of view = 260 mm, b-value =...
PMC10041692
Statistical analysis
REGRESSION
Sample size calculation was performed by means of power analysis for matched case–control studies [The estimated number of subjects needed for the advanced brain imaging analysis, computed by power analysis for a two-sample means test [Once the desired sample size of 264 participants had been achieved, it became clear ...
PMC10041692
Results
stroke, hypertension, HT
INTRACRANIAL HEMORRHAGE, STROKE, ATRIAL FIBRILLATION, DIABETES MELLITUS, REGRESSION, HYPERTENSION
Of 1,117 assessed patients with AIS who were eligible for IVT, 341 subjects were recruited and constituted the ITT population. Twenty-three participants (6.7%) did not complete the study with the dropout rate being equal between the groups. Thus, 318 patients formed the dataset for PP analysis (Fig. CONSORT flow chartA...
PMC10041692
Primary endpoints
stroke, hypertension, HT
REGRESSION, STROKE, HYPERTENSION
In both arms, HT occurred mostly within 24 h after IVT. In the ITT population, Cerebrolysin set a favorable trend to lower any HT with a rate of 15.9% versus 23.3% in the control group and a corresponding OR of 0.543 (95% CI: 0.281–1.05; Study endpointsLikewise, Cerebrolysin treatment resulted in a substantial decrease...
PMC10041692
Secondary endpoints
agitation, HT
SIDE EFFECT
The percentage of patients with a favorable functional outcome was approximately the same in both groups. Early neurological recovery on day 14 was more noticeable in the Cerebrolysin group. However, the difference disappeared in patients with HT (Table Secondary endpoint. Modified Rankin Scale score on day 90. No seri...
PMC10041692
Advanced brain imaging
infarct
INFARCT
A total number of patients included in the advanced brain imaging analysis was 33 (Fig. Baseline characteristics (No differences in the DTI metrics and DWI infarct volume between the groups were observed on day 1 (Table DTI data, day 1However, patients treated with Cerebrolysin showed a significant improvement of their...
PMC10041692
Discussion
post-stroke, axonal and myelin damage, stroke, AIS, neurological deficit, HT, rtPA, intracranial hemorrhagic
DRUG-DRUG INTERACTION, STROKE, SECONDARY, EVENTS
The results of this randomized, open-label, multicenter pilot trial in stroke patients demonstrate beneficial effects of Cerebrolysin as an early add-on to IVT on the primary (the rate of symptomatic HT) and secondary (early neurological recovery) endpoints. Although we found a significant improvement in the DTI and PS...
PMC10041692
Conclusions
neurological deficit, HT
Early add-on of Cerebrolysin to reperfusion therapy was safe and significantly decreased the rate of symptomatic HT as well as early neurological deficit. However, no significant effect on day 90 functional outcome was detected. Improvements in the imaging metrics of the infarcted area support the neuroprotective and B...
PMC10041692
Acknowledgements
EMERGENCY
This study would not have been possible without the CEREHETIS investigators: Chauzov E.I., Nizhnekamsk District Hospital, Nizhnekamsk, Russia; Faskhutdinova A.T., Kazan Federal University Hospital, Kazan, Russia; Khastiev R.M., Arsk District Hospital, Arsk, Russia; Kulesh A.A., Perm Territorial Clinical Hospital, Perm,...
PMC10041692
Authors’ contributors
DRK: project design and execution, analysis, interpretation, manuscript review. MNK: project design and execution, manuscript preparation and review, data acquisition, analysis, interpretation. All authors have read and approved the manuscript.
PMC10041692
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
PMC10041692
Availability of data and materials
The datasets acquired and analyzed for this study are available from the corresponding author upon reasonable request.
PMC10041692
Declarations
PMC10041692
Ethics approval and consent to participate
This study was approved by the Local Ethics Committee of the Interregional Clinical Diagnostic Center, Kazan, Russia (Protocol #81 of 04/24/2018). However, there was a change in the list of the study centers after that approval, and the final version of the study protocol was issued on 04/30/2018. The amendment did not...
PMC10041692
Consent for publication
Not applicable.
PMC10041692
Competing interests
The authors declare that there is no conflict of interest.
PMC10041692
References
PMC10041692
2. Patients and Methods
PMC10055796