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Methods | OHCA, comatose | BLOOD, COMATOSE | In a double-blinded trial, we randomly assigned 60 comatose patients following OHCA to low (63 mmHg) or high (77 mmHg) mean arterial blood pressure (MAP). The trial was a sub-study in the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX). Global cerebral metabolism utilizing jugula... | PMC9951410 |
Results | SEPARATION | We found a clear separation in MAP between the groups (15 mmHg, | PMC9951410 | |
Conclusions | ROSC, comatose | COMATOSE | Among comatose patients resuscitated from OHCA, targeting a higher MAP 180 min after ROSC did not significantly improve cerebral energy metabolism within 96 h of post-resuscitation care. Patients with a poor clinical outcome exhibited significantly worse biochemical patterns, probably illustrating that insufficient tis... | PMC9951410 |
Supplementary Information | The online version contains supplementary material available at 10.1186/s13054-023-04376-y. | PMC9951410 | ||
Keywords | PMC9951410 | |||
Introduction | OHCA, cardiac arrest, comatose | CARDIAC ARREST, COMATOSE | Survival rates remain around 50% for comatose patients treated in the Intensive Care Unit (ICU) after out-of-hospital cardiac arrest (OHCA) [Adequate mean arterial blood pressure (MAP) is vital to maintain cerebral blood flow (CBF) at a level sufficient for preserving oxidative energy metabolism. Cerebral autoregulatio... | PMC9951410 |
Methods | PMC9951410 | |||
Trial design | S-20150173 HLP | BLOOD | The trial was a sub-study in the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX), see Supplementary Methods [According to national requirements and the principles of the Declaration of Helsinki, informed consent was obtained from next of kin and one independent medical doctor not... | PMC9951410 |
Patients | This sub-study included patients in a tertiary heart center, Odense University Hospital, Denmark. Inclusion and exclusion criteria have been published elsewhere [ | PMC9951410 | ||
Randomization and blinding | Patients were randomly assigned in a 1:1 ratio to low or high MAP using a web-based system involving dynamic permuted block sizes. The MAP intervention was double-blinded (see intervention). The physicians taking care of trial patients and assessing neurological prognosis were not blinded to bedside JBM and cerebral sa... | PMC9951410 | ||
Intervention | SEPARATION | The MAP intervention commenced at randomization and continued as long as the patients needed invasive blood pressure measurements. Patients were randomly monitored with a module (Phillips M1006B) offset to – 10% or a module offset to + 10%. Targeting a MAP of 70 mmHg during treatment in both groups caused a blinded com... | PMC9951410 | |
Post-resuscitation procedure | normocapnia | Targeted temperature management (TTM) commenced at ICU admission targeting 36.0 °C for 24 h, followed by rewarming at a rate of 0.5 °C/h. Sedation was mandated in both groups during the TTM period. Mechanical ventilation was adjusted to ensure normocapnia (PaCO | PMC9951410 | |
Neuromonitoring | neurological damage | JBM commenced after ICU admission and continued for 96 h or until arousal utilizing identical techniques as previously published (Additional file Bilateral, regional cerebral oxygen saturation (rSOThe biomarker of neurological damage, plasma neuron-specific enolase (NSE) level at 48 h, was measured by electrochemilumin... | PMC9951410 | |
JBM reference values and classification of ischemia | mitochondrial dysfunction, jugular venous blood, cerebral ischemia | MITOCHONDRIAL DYSFUNCTION, CEREBRAL ISCHEMIA | The definition of normal microdialysate values (lactate, pyruvate, glucose, glycerol, glutamate, LP ratio) in human jugular venous blood was based on JBM reference values obtained in anesthetized patients undergoing elective cardiac bypass surgery [Definitions of the biochemical patterns for cerebral ischemia and mitoc... | PMC9951410 |
Neurologic prognostication | status myoclonus, comatose | MULTIPLE ORGAN FAILURE, BRAIN DEATH, COMATOSE, REFRACTORY SHOCK | Active treatment continued until 72 h after TTM, except for patients with status myoclonus, brain death, or refractory shock with multiple organ failure. Patients who remained comatose despite cessation of sedation were evaluated by combining neurologic examination, EEG, somatosensory-evoked potential (SSEP), biomarker... | PMC9951410 |
Outcome | bleeding, arrhythmia, seizures, ischemia, OHCA, infection, mitochondrial dysfunction | BLEEDING, ARRHYTHMIA, ADVERSE EVENTS, ISCHEMIA, INFECTION, MITOCHONDRIAL DYSFUNCTION, COMPLICATIONS | The primary outcome was the difference between time-averaged means of microdialysis parameters and LP ratio (intervals of 12 h) between low vs high MAP group within 96 h of post-resuscitation care. Secondary outcomes of clinical interest were to compare (i) variables reflecting cerebral energy metabolism and patterns o... | PMC9951410 |
Statistical methods | cerebral desaturation, ischemia, hypotension, seizures | REGRESSION, ISCHEMIA | We estimated that a sample of 46 patients would provide 90% power to detect a relative LP ratio reduction of 35% in the high MAP group, compared with the low MAP group, using a patient-to-patient variation with standard deviation (SD) of 15 [The mean between-group difference in blood pressure during the intervention pe... | PMC9951410 |
Results | PMC9951410 | |||
Intervention | ROSC | SEPARATION | The median time from ROSC to randomization in the trial was 180 [120–210] min. There was a clear separation in MAP between the groups (mean difference: 15 mmHg ([CI], 13.1 to 17.3), p < 0.0001) (Fig. Mean arterial pressure during the intervention period. The MAP curves show the means, and the bars indicate ± 2 SD (95% ... | PMC9951410 |
Outcome | PMC9951410 | |||
Jugular bulb microdialysis | ROSC | The median time from ROSC to microdialysis monitoring was 260 min in the low and high MAP groups with monitoring durations of 65 [47–91] and 63 [45–89] hours, respectively (Additional file | PMC9951410 | |
Association between cerebral energy metabolism and MAP | No significant difference in microdialysis values between the two MAP groups was observed except for glycerol in the early post-resuscitation phase (12–36 h, Data are expressed as median (interquartile range). LP ratio: lactate/pyruvate ratio. Jugular bulb microdialysis variables in the study groups ( | PMC9951410 | ||
Association between cerebral energy metabolism and neurological outcome | Figure Median (IQR). Jugular bulb microdialysis parameters during the intervention period in patients discharged with unfavorable outcome (black line) (CPC 3–5, Non-survivors exhibited significantly increased levels of lactate, pyruvate, and glycerol (At 48 h, the median NSE ( | PMC9951410 | ||
Regional cerebral desaturation | During MAP intervention, no significant differences in rSOMedian (IQR). Regional cerebral oxygen saturation (rSO | PMC9951410 | ||
JBM variables in relation to critical episodes | EEG-verified | JBM levels in patients with EEG-verified epileptiform activity were not significantly different from other patients, except for significantly higher pyruvate levels during the first 48 h ( | PMC9951410 | |
Neurological outcome | ANOXIC BRAIN INJURY | At hospital discharge 22 of 30 patients (73%) in the low MAP group and 15/30 (50%) in the high MAP group had a poor functional outcome CPC 3–5. Within 90 days, 12 of 30 patients (40%) in the low MAP group and 8 of 30 patients (27%) in the high MAP group had died. Overall mortality during hospital stay was 33% due prima... | PMC9951410 | |
Adverse events | sepsis, arrhythmia, seizures, bleeding | ADVERSE EVENTS, SEPSIS, ARRHYTHMIA, BLEEDING | No significant differences were found in the percentages of patients with serious adverse events, including sepsis, arrhythmia, seizures and bleeding (Additional file | PMC9951410 |
Discussion | EEG-verified, OHCA, hypoperfusion, post-cardiac arrest, cardiac arrest, comatose, Secondary brain injury, reperfusion injury, mitochondrial dysfunction, cerebral ischemia | HYPOPERFUSION, BRAIN HYPOXIA, CARDIAC ARREST, COMATOSE, TRANSIENT CEREBRAL ISCHEMIA, SECONDARY, SEPARATION, MITOCHONDRIAL DYSFUNCTION, HYPERTENSION, CEREBRAL ISCHEMIA | This double-blinded randomized trial compared two blood pressure targets in comatose patients resuscitated from OHCA. Targeting a higher MAP (77 vs. 63 mmHg) did not significantly improve cerebral energy metabolism within 96 h of post-resuscitation care. No secondary outcomes, including cerebral oxygenation (rSOBedside... | PMC9951410 |
Limitations | death | SEPARATION, SECONDARY | Our study has several limitations. The assumption for the main study (BOX) 2 × 2 factorial design was that the effects of the MAP and Oxygen interventions were independent (no interaction) in relation to the primary outcome (death or CPC 3–4). However, central factors influencing cerebral metabolism are mainly, e.g., M... | PMC9951410 |
Conclusions | ROSC, comatose | COMATOSE | In comatose patients resuscitated from OHCA, targeting a higher MAP 180 min after ROSC did not significantly improve cerebral energy metabolism within 96 h of post-resuscitation care. Patients with a poor clinical outcome exhibited significantly worse biochemical patterns documenting that inadequate tissue oxygenation ... | PMC9951410 |
Acknowledgements | We thank the critical care healthcare professionals at the Department of Anesthesiology and Intensive Care, Odense University Hospital, who each and collectively made this study possible. | PMC9951410 | ||
Take-home message | ROSC, comatose | COMATOSE | Among comatose patients resuscitated from OHCA, targeting a higher MAP 180 min after ROSC did not significantly improve cerebral energy metabolism and oxygenation. Initial cerebral reperfusion in most patients is insufficient to restore cerebral energy metabolism, potentially influencing neurological outcomes. | PMC9951410 |
140-character tweet | ROSC, comatose | CARDIAC ARREST, COMATOSE | Targeting a higher MAP 180 min after ROSC did not significantly improve cerebral energy metabolism among comatose patients resuscitated from cardiac arrest. | PMC9951410 |
Author contributions | SIM, CH, JK, PT, CHN, THN and HS contributed to conceptualization. SIM, AF, CH, JK, PT, CHN, THN, AT, TK, and HS provided methodology. SIM and SM carried out formal analysis. SIM, SV, DM, and TT performed investigation. SIM and HS performed project administration. THN, AF, CH, JK, HS, and PT provided resources. AT and ... | PMC9951410 | ||
Funding | This study was sponsored by non-profit organizations, including the University of Southern Denmark, Region of Southern Denmark, and the Department of Anesthesiology and Intensive Care, Odense. Moreover, the study received independent grants from A.P. Moeller Foundation for the Advancement of Medical Science; Intensive ... | PMC9951410 | ||
Availability of data and materials | Deidentified data are available for sharing. The dataset analyzed in the present manuscript is available from the corresponding author on reasonable request. Any proposal will need approval from the ethics committee before sharing any patient data. A signed data transfer agreement will be required if a proposal is appr... | PMC9951410 | ||
Declarations | PMC9951410 | |||
Ethics approval and consent to participate | HLP, comatose | COMATOSE | The Danish Regional Committee on Health and Research Ethics approved the protocol (MICA-S-20150173 HLP, 01/01/2017). Danish legislation permits immediate inclusion of patients who are unable to provide consent in nonpharmaceutical trials and mandates that consent should be obtained at the first given opportunity after ... | PMC9951410 |
Consent to publish | Not applicable. | PMC9951410 | ||
Competing interest | None of the authors has any conflict of interest to declare. | PMC9951410 | ||
References | PMC9951410 | |||
Introduction | EOS | Pain-reducing effects of music listening are among the most widely studied and most replicable effects of music in clinical settings [The lack of research comparing pain-reducing effects between these two forms of music listening (i.e active vs. passive) is noteworthy because recent advances have proposed that active s... | PMC10381080 | |
Consort flow diagram on the study sample. | The experimental design is illustrated in | PMC10381080 | ||
Experimental design. | The experiment used a 2x2 design with the within-subject factors In accordance with the well-established pain-reducing effects of music listening in clinical settings [ | PMC10381080 | ||
Materials and methods | PMC10381080 | |||
Participants | A random sample of 59 participants, who were naïve with regard to the hypotheses, was included in the data analysis (age range 19 to 35 years, | PMC10381080 | ||
Stimuli | Music stimuli were presented with an average sound pressure of approximately 60 dB SPL over Beyerdynamic DT 770-PRO 250 Ohm headphones. 10 instrumental music experts were selected, each 30 seconds long (song characteristics are provided in | PMC10381080 | ||
Pressure algometry | Pain | Pain was applied by the experimenter during each trial using a Wagner Force One Pressure Algometer (Wagner Instruments, Greenwich, USA). The equipment head (used to apply the pressure) had a diameter of 12mm and a surface area of 113mm | PMC10381080 | |
Procedure | The investigation took place in a laboratory room at the department of biological and medical psychology of the University of Bergen. 40 experimental trials were delivered, 10 for each experimental trial type (Music Active, Music Passive, Silence Active, Silence Passive). The experimenter was blinded during the entire ... | PMC10381080 | ||
Experimental design & data analysis | Data analysis was computed using R (version 4.0.4) including the R Stats, R Base, and ggplot 2 (version 3.3.3) [ | PMC10381080 | ||
Within-subjects perceived pain per experimental condition. | pain | The violin plots show the distribution density of the perceived pain (rated on a scale ranging from 1 to 9) during music (red) or silence (blue) while performing either an active tapping task (darker colors) or a passive control task (lighter colors). The embedded box-and-whisker plots represent the 25th and the 75th p... | PMC10381080 | |
Emotional mechanisms underlying the pain-reducing effect of sensorimotor synchronization to music | To test our assumption that the mechanisms driving the pain-reducing effect of sensorimotor synchronization to music include emotion, we computed two additional LME analyses. For detailed information on the experimental design and data analysis for both analyses see | PMC10381080 | ||
Preference effect on the perceived pain for the music trials. | pain | Data are shown separately for the active tapping task and the passive control task. Perceived pain (rated on a scale ranging from 1 to 9) was reduced with increasing preference (rated on a scale ranging from 1 to 9 and mean-centered) and while performing the active tapping task (solid black line) compared to the passiv... | PMC10381080 | |
Within-subjects felt pleasantness per experimental condition. | The violin plots show the distribution density of the felt pleasantness (rated on a scale ranging from 1 to 9) during music (red) or silence (blue) while performing either an active tapping task (darker colors) or a passive control task (lighter colors). Note that pleasantness ratings were descriptively highest for tri... | PMC10381080 | ||
Discussion | pain | Our results show that participants felt less pain while actively tapping to music, compared with merely listening to music. This finding indicates that sensorimotor synchronization to music has analgesic effects. Compared to music listening without tapping, tapping to music elicited a moderate pain-reducing effect, and... | PMC10381080 | |
Limitations | pain | Our behavioral approach only provides an indirect measure of the activation of the EOS. This limitation warrants further discussion because the mixed-trial design of our study poses the question as to whether the level of endogenous opioids can vary every minute, forty times in a row, without contaminating the subseque... | PMC10381080 | |
Conclusion | EOS, pain | Results demonstrate that sensorimotor synchronization to music significantly impacts pain perception and can amplify the well-established pain-reducing effect of merely listening to music. Our results shed new light on the mechanisms underlying pain reduction with music, suggesting that such effects are driven by socia... | PMC10381080 | |
Supporting information | (DOCX)Click here for additional data file.(DOCX)Click here for additional data file.(DOCX)Click here for additional data file. | PMC10381080 | ||
CONSORT checklist. | (DOC)Click here for additional data file. | PMC10381080 | ||
Music excerpts played during the experiment. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Descriptive statistics of the applied pressure and duration of the applied pressure. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Inferential statistics of the LME analysis on single trial perceived pain. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Paired-Samples t-tests (one-tailed) on the perceived pain between all four experimental conditions. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Inferential statistics of the LME analysis on the single trial perceived pain for music trials. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Inferential statistics of the LME analysis on the single trial felt pleasantness. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Descriptive statistics of the felt arousal per experimental condition. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Supplementary methods for the pressure data. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Experimental instructions. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Supplementary methods: Experimental design and data analysis on emotional mechanisms underlying the pain-reducing effect of sensorimotor synchronization to music. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Data analysis & results on the pain-reducing effect of sensorimotor synchronization to music including the mean-centered EHI as a covariate to test for confounding effects of handedness. | (DOCX)Click here for additional data file. | PMC10381080 | ||
Data analysis & results on the pain-reducing effect of sensorimotor synchronization to music including gender as a covariate to test for confounding effects. | (DOCX)Click here for additional data file. | PMC10381080 | ||
1. Introduction | DOMS, skeletal muscle, inflammation, EIMD, muscle damage | INFLAMMATION, OXIDATIVE STRESS | Unaccustomed eccentric exercise results in muscle damage limiting physical performance for several days. This study investigated if Greenshell™ mussel (GSM) powder consumption expedited muscle recovery from eccentric exercise-induced muscle damage (EIMD). Methods: Twenty untrained adult men were recruited into a double... | PMC10221610 |
2. Materials and Methods | PMC10221610 | |||
2.1. Study Participants | A total of 22 healthy male volunteers between 21 and 45 years old who were not undergoing any form of exercise training and had similar fitness characteristics based on the Baecke habitual questionnaire [ | PMC10221610 | ||
2.2. Study Design | muscle damage, pain | CONTRACTIONS | This was a randomised, double-blind, placebo-controlled, cross-over intervention study. Eligible participants attended a familiarisation session at least one week prior to commencing the study. In this session, they were instructed on how to perform the bench-stepping exercise that they would be required to complete on... | PMC10221610 |
2.3. Dietary Intervention | The GSM and placebo interventions used in this study and the methods to characterise their composition have previously been described [ | PMC10221610 | ||
2.4. Exercise Protocol | The bench-stepping exercise protocol used in this study was modified from Newham et al. [ | PMC10221610 | ||
2.5. Muscle Function Assessment | CONTRACTION, CONTRACTIONS | Participants were seated on a Biodex isokinetic dynamometer at a position where the femoral epicondyle of the tested leg was aligned with the machine’s axis of rotation. The ankle strap of the machine was positioned 5 cm proximal to the test leg’s medial malleolus, and the ankle and thigh of the test leg were strapped ... | PMC10221610 | |
2.6. Subjective Pain Assessments | muscle soreness, affective pain, pain | CONTRACTIONS | Perceived muscle soreness during muscle function assessments was determined during the exercise trial and recovery (24, 48 and 72 h post exercise) days. Participants rated the severity of soreness of the exercising leg during the first maximal eccentric and isometric contractions on a 5-point Likert scale ranging from ... | PMC10221610 |
2.7. Blood Sampling | OXIDATIVE STRESS, LYSIS | Venous blood samples were collected into heparin and ethylenediaminetetraacetic acid (EDTA) vacutainer tubes and centrifuged at room temperature. The plasma layer and erythrocytes were collected, aliquoted and stored at −80 °C until measurement of creatine kinase (CK), cartilage oligomeric matrix protein (COMP), oxidat... | PMC10221610 | |
2.8. Creatine Kinase | Plasma CK collected pre and immediately post exercise and 24, 48 and 72 h post exercise was measured at a commercial laboratory (Canterbury Health Laboratories, Christchurch, New Zealand). The analysis of CK was quantified by spectrophotometry, which measured the rate of nicotinamide adenine dinucleotide (NADH) formati... | PMC10221610 | ||
2.9. Immune Measures | PMC10221610 | |||
2.9.1. Plasma Cytokine | TUMOUR NECROSIS | Plasma cytokine concentrations were analysed by bead array using Biolegend Legendplex™ 13-plex Human Essential Response panel (Cat. No. 740930, San Diego, CA, USA) according to the manufacturer’s instructions. The simultaneous quantitation of 13 cytokines (interleukin (IL)-4, IL-2, C-X-C motif chemokine ligand (CXCL)10... | PMC10221610 | |
2.9.2. Immune Cell Phenotyping | Isolated PBMC were first stained with Biolegend “zombie NIR” fixable viability dye (Cat. No. 423106; San Diego, CA, USA) according to the manufacturer’s instructions for 15 min at room temperature. Cells were washed in DPBS before being stained with fluorescently labelled cell surface markers at 4 °C for 15 min. The Bi... | PMC10221610 | ||
2.10. Statistical Analysis | Statistical analysis of data was conducted using analysis of variance (ANOVA), based on linear mixed effect models with fixed effects for trial arm, treatment and time × treatment interaction and random effects for participant, participant × trial arm and participant × time. Residuals were inspected to check that the a... | PMC10221610 | ||
3. Results | PMC10221610 | |||
3.1. Physical Characteristics of Participants | The variation in age, height and weight of participants recruited in this study is presented in Anthropometric measures of each volunteer were measured using manual scales, and habitual activity was determined using the Baecke Physical Activity Questionnaire. Vest weight worn by participants was equivalent to 15% of th... | PMC10221610 | ||
3.2. Muscle Function | Eccentric exercise from bench-stepping exercise induced a significant decline (time effect; For peak concentric torque, there was a significant reduction (time effect; | PMC10221610 | ||
3.3. Subjective Pain Assessments | DOMS, muscle soreness, Muscle damage, pain | CONTRACTIONS | Muscle damage from repeated eccentric contractions is typically accompanied by DOMS that persists for several days after exercise. The post-exercise sensory, affective, total and VAS-assessed pain of the eccentrically exercised leg at rest significantly increased (Total pain scores of the resting eccentrically exercise... | PMC10221610 |
3.4. Creatine Kinase | The bench-stepping exercise induced a significant change in plasma CK (time effect: | PMC10221610 | ||
3.5. Immune Measures | A significant time effect (No time, treatment or time × treatment interactions were measured for circulating total and sub populations of T cells, monocyte and neutrophils, indicating that exercise and GSM supplementation had no effect on the circulating populations of these immune cells post exercise ( | PMC10221610 | ||
4. Discussion | DOMS, Reduced muscle function, muscle soreness, EIMD, muscle damage, muscle [Muscle damage | INFILTRATION, CONTRACTIONS, INFLAMMATORY RESPONSE | The current study investigated the effectiveness of daily supplementation with GSM powder for four weeks to accelerate muscle recovery after EIMD in untrained males. Our findings show that GSM powder supplementation expedited muscle recovery following exercise-induced damage as determined by faster recovery of muscle f... | PMC10221610 |
5. Conclusions | DOMS, EIMD | The present study demonstrates that long-term supplementation with New Zealand GSM powder expedited the recovery of muscle function, reduced the severity of DOMS and facilitated the dissipation of DOMS and CK to baseline during recovery following EIMD to the quadriceps. These findings support the potential benefits of ... | PMC10221610 | |
Supplementary Materials | The following supporting information can be downloaded at: Click here for additional data file. | PMC10221610 | ||
Author Contributions | Conceptualization, D.L., M.B., M.R.M. and H.S.T.; methodology, D.L., M.B. and O.S.; validation, D.L., M.B. and O.S.; formal analysis, D.H.; investigation, D.L., N.N., G.S., O.S., N.B., A.K., T.B., K.B.-H. and A.C.; data curation, D.L., N.N., N.B. and D.H.; writing—original draft preparation, D.L.; writing—review and ed... | PMC10221610 | ||
Institutional Review Board Statement | The study was conducted in accordance with the Declaration of Helsinki, and approved by New Zealand’s Southern Health and Disability Ethics Committee (20/STH/75; 14 July 2020). | PMC10221610 | ||
Informed Consent Statement | Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from all subjects involved in the study to publish this paper. | PMC10221610 | ||
Data Availability Statement | The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical guidelines to protect the privacy of participants in this study. | PMC10221610 | ||
Conflicts of Interest | The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. | PMC10221610 | ||
References | Muscle soreness, Pain | Consolidated Standards of Reporting Trials (CONSORT) diagram illustrating the flow of participants through each stage of the randomised crossover trial.Muscle function assessments after bench-stepping exercise. Peak quadriceps isometric (Pain assessment of eccentrically exercised leg at rest after bench-stepping exerci... | PMC10221610 |
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