Cardiovascular evaluation with exercise testing using face mask during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic is associated with more than 127 million of infected people and 2.7 million deaths in the world. However, cardiovascular diseases are still a worldwide main health problem. Patients are afraid to go to the hospital because of the risk of being infected with SARS-COV2. In particular, exercise testing (ET) has been underused, due to the fear of the airborne aerosol generation. There are cardiology centers performing ET that ask patient to wear a mask, although its consequences are not yet well known and there is only preliminary information of its use in patients with heart disease. Purpose Our objective was to evaluate the ergometric behavior of patients that performed an ET wearing a mask during the COVID-19 pandemic (COVID-G) and compare them with patients in the pre-pandemic period. Methods A cohort of patients who underwent an ET from march to december 2020 was compared with patients that performed an ET between march and december 2019. Because of COVID-19 preventive restrictions, we used a larger and highly ventilated room to perform ET. The antisepsis protocol was performed (room and equipment) and healthcare crew always wore high efficiency masks and ocular protection. All patients studied in 2020, must had succeeded a biological triage, and wore a mask throughout the ET. Variables are presented as frequency (percentage), mean (standard deviation) or median (interquartile interval) according to variable-type and distribution. Chi-square test, Student's t test or the Wilcoxon rank test were used as appropriate. All p values less than 0.05 were considered stochastically significant. Results A total of 361 stress tests were studied, where 209 (58%) belonged to pre-pandemic group and 152 (42%) to COVID-G. Eighty-one percent were male, the mean age was 46±20 years and the most prevalent diagnosis was coronary heart disease (61%). There were no statistically diferences between groups according to demographic variables. No mayor adverse outcome occurred during ET. The most common reason of exercise suspension in COVID-G was dyspnea compared to pre-pandemic studies: 117 (77%) vs 8 (4%), OR= 6.3 (95% CI, 4.6 to 8.6, p<0.001). Heart rate behavior along ET did not show significant differences between groups. Nevertheless, blood pressure levels were significantly higher in COVID-G patients than those in pre-pandemic group. Exertional blood pressure index was higher in the COVID-G (1.31±0.24 vs 1.26±0.2, p<0.05) than the pre-pandemic group. On the other side, maximal exercise tolerance (METs) did not show significant differences between groups (p=ns). Conclusions Exercise testing can be safely performed in patients with cardiovascular disease while wearing masks. In the COVID period, a significantly lower number of ET was performed. In addition, ET performance with mask was associated with higher values of systolic blood pressure and an increased number of tests suspended due to dyspnea. FUNDunding Acknowledgement Type of funding sources: None. Blood pressure behavior Ergometric performance

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Blood Pressure Control and Exaggerated Blood Pressure Response in Nigerians with Essential Hypertension

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s15961 ◽

2014 ◽

Vol 8 ◽

pp. CMC.S15961

Author(s):

Olugbenga O. Abiodun ◽

Michael O. Balogun ◽

Rasaaq A. Adebayo ◽

Anthony O. Akintomide

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Essential Hypertension ◽

Exercise Testing ◽

Blood Pressure Response ◽

Pressure Control ◽

General Linear Model ◽

Pressure Response ◽

Chi Square ◽

Key Factor

Background Blood pressure (BP) control in hypertensives is important in preventing cardiovascular (CV) morbidity and mortality. This work was done to assess control of BP among Nigerian hypertensives at rest and during exercise. Materials and Methods A total of 85 male hypertensives were recruited consecutively and had clinical evaluation and treadmill (TM) exercise testing using the Bruce protocol. Independent t-test, chi-square, and Fisher's exact tests were used to compare patients with controlled and uncontrolled BP using SPSS version 16 software. Adjustment for confounders was by logistic regression and general linear model. Results Resting systolic BP (rSBP) (mmHg) and resting diastolic BP (rDBP) (mmHg) were significantly lower in the controlled group (115.0 ± 12.29, 133.1 ± 12.27, P = < 0.001 and 76.00 ± 6.55, 91.4 ± 8.00, P = < 0.001). The proportion of subjects with controlled BP was 37.7%. Adjusted peak SBP (PSBP) during exercise (mmHg) was significantly higher in the uncontrolled than in the controlled group (210.5 ± 27.31, 191.8 ± 20.77, P = 0.001). Adjusted exaggerated blood pressure response (EBPR) was found in 37 subjects (44%) in the uncontrolled group while seven subjects (0.1%) had EBPR in the controlled group ( P = 0.003). Conclusion This study shows that EBPR is significantly higher in subjects with uncontrolled BP compared with those with controlled BP. Therefore, good BP control may be the key factor in preventing EBPR in hypertensives.

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Korelasi Positif Perubahan Berat Badan Interdialisis dengan Perubahan Tekanan Darah Pasien Post Hemodialisa

Jurnal Ners dan Kebidanan Indonesia ◽

10.21927/jnki.2014.2(1).1-8 ◽

2016 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Purnomo Widiyanto ◽

Hamam Hadi ◽

Teguh Wibowo

Keyword(s):

Blood Pressure ◽

Body Weight ◽

Rank Test ◽

Dialysis Patients ◽

Exclusion Criteria ◽

Chi Square ◽

Positive Direction ◽

Blood Pressure Elevation ◽

History Of ◽

Fi Ltration

<p>Interdialysis body weight is used to determine ultra ﬁ ltration speed on hemodialisa patients. The overload ultra ﬁ ltration can inﬂ uence patients hemodynamic. According to Renal Registry Indonesia, it was 11 percent in 2012 dialysis patients experienced hypotension. This observational analytic study used cohort survey aims to analyse changing of interdialysis body weight and of blood pressure among dialysis patients in RSUD Saras Husada Purworejo. In this research, 40 respondents divided into two groups by purposive sampling based on inclusion and exclusion criteria. Data was analysed using Paired T-Test, Spearman Rank Test and Chi Square and was obtained characteristics subject sexes p= 0.736, p= 0.744 age, history of diabetes p=0.311 and p= 0.185 HT history means that there were no signiﬁ cant correlation with the increase interdialisis BB. (p>0.05). Correlation interdialisis BB with changing in BP, RR=2,750 x²= 3.84 and p= 0.050 (p= 0.050) was signiﬁ cantly in positive direction. Conclusion, there was correlation between interdialysis body weight changing with blood pressure elevation. 8% of those who exposed the rise interdialysis body weight was hypotension.</p>

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HUBUNGAN ANTARA PENGETAHUAN TENTANG HIPERTENSI DENGAN TINDAKAN MENGONTROL TEKANAN DARAH PADA WARGA DUKUH BANTULAN DESA JEMBUNGAN KECAMATAN BANYUDONO BOYOLALI

KOSALA : Jurnal Ilmu Kesehatan ◽

10.37831/jik.v1i2.50 ◽

2015 ◽

Vol 1 (2) ◽

Author(s):

Diyono Diyono ◽

Budi Kristanto ◽

Catur Budi Prasetyo

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Statistical Test ◽

Chi Square ◽

Cross Sectional ◽

The People ◽

The World ◽

The Subject ◽

The Relationship

Background. Hypertension is a leading cause of death in the world. Mostpatients who suffered from hypertension show lack of knowledge about how tocontrol their blood pressure. If the patient doesn’t control their blood pressure, itwill precipitate many complication such as CVA, coronary heart disease (CHD)and cronic kidney disease (CKD).Purpose. The purpose of this study was to determine the relationship betweenknowledge of hypertension and the people’s act to control their blood pressure.Subjects. The subject used in this study was the people of Dukuh Bantulan.The technique sampling was probability sampling and the total number ofresponden were 292 people.Methods. This study used a corelation design with cross sectional approach.Data were collected using a questionaire consist of 18 question duringApril – Mei 2013. Data processing used chi – square statistical test withsignifican level α = 0,03.Result. The result showed x2 count > x2 table (1,524 > 1,074). It can beconcluded that knowledge about hypertension has related to the people’s act tocontrol their blood pessure.Keywords : hypertension, blood pressure

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Role of pulse plethysmograph in the prediction of hypotension in caesarean section patient under spinal anesthesia

MedPulse International Journal of Anesthesology ◽

10.26611/10151936 ◽

2021 ◽

Vol 19 (3) ◽

pp. 77-80

Author(s):

Sheetal K Desai ◽

Keyword(s):

Blood Pressure ◽

Caesarean Section ◽

Spinal Anesthesia ◽

Characteristic Curve ◽

Elective Caesarean Section ◽

Rank Test ◽

Chi Square ◽

Significant Difference ◽

Chi Square Test

Background: Spinal anesthesia is a commonly employed technique for anesthesia for caesarean section and is associated with hypotension which may cause maternal morbidity. Prediction of hypotension before the procedure can reduce complications. The study aimed to evaluate the role of pulse plethysmograph in the prediction of hypotension in caesarean section patients under spinal anesthesia. Methods: The observational study was conducted on 50 patients who were undergoing emergency or elective caesarean section. Spinal anesthesia was performed by anaesthesiologist using a 25 or 26-gauge spinal needle with bupivacaine at L3-4 interspinous space. Pre and post-anesthesia observations such as the width of pulse plethysmograph, non-invasive blood pressure in another arm, and heart rate were recorded. Paired T-test, Wilcoxon sign rank test, and chi-square test was used to analyse data using R Studio V 1.2.5001 software. Results: Post spinal anesthesia minor fall in systolic blood pressure (SBP) was observed in 11 patients, moderate fall in 21 patients, severe fall in 8 patients and a massive fall in 10 patients. A significant difference was observed between mean pre- and post-spinal anesthesia SBP (P<0.001). Width of pulse plethysmograph (PPG) was maintained in 14 patients whereas, narrowed and significantly narrowed PPGs were observed in 29 and 7 patients, respectively. Significant association was observed between grades of SBP and width of PPG (P<0.05). Receiver operating characteristic curve showed the width of PGG was good for prediction of hypotension in patient (AUC=0.828). Conclusion: Width of PPG can be used to predict SA induced maternal hypotension.

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Analisis Faktor Determinan yang berhubungan dengan Kepatuhan Rekomendasi Modifikasi Gaya Hidup Pasien Hipertensi

Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) ◽

10.26699/jnk.v7i2.art.p256-263 ◽

2020 ◽

Vol 7 (2) ◽

pp. 256-263

Author(s):

Abdul Qodir

Keyword(s):

Blood Pressure ◽

Lifestyle Modification ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

Lifestyle Modifications ◽

Chi Square ◽

Cross Sectional ◽

Hypertensive Patients ◽

Consecutive Sampling ◽

Knowledge Practice

Penatalaksanaan farmakologis dan non farmakologis dipercaya dapat mengontrol tekanan darah dan mencegah komplikasi, tetapi banyak pasien hipertensi tekanan darahnya tidak terkontrol. Hal tersebut dikarenakan kepatuhan yang buruk dalam melaksanakan rekomendasi gaya hidup. Penelitian ini bertujuan untuk menganalisis determinan faktor yang berhungan dengan kepatuhan melaksanakan rekomendasi modifikasi gaya hidup. Penelitian ini menggunakan metode cross-sectional di pukesmas dinoyo Kota Malang tahun 2019. Teknik pengambilan sampel menggunakan Consecutive Sampling. Kuesioner yang digunakan meliputi : karakteristik demografi, pengetahuan dan rekomendasi mofifikasi gaya hidup pasien hipertensi. Hubungan antara rekomendasi modifikasi gaya hidup dengan variabel independen dianalisis menggunakan uji chi square dan analisis regresi logistik. 140 pasien hipertensi berpartisipasi dalam penelitian ini (60 laki-laki, 80 wanita). Prevalensi kepatuhan adalah 28,6 %. Tingkat pengetahuan berhubungan signifikan dengan kepatuhan melaksanakan rekomendasi gaya hidup (p=0,00). Jenis kelamin, usia, dan tingkat pendidikan tidak mempunyai hubungan signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup (p= 0,06; p=0,21; p=0,87). Pengetahuan mempunyai hubungan yang signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup. Management of pharmacological and non-pharmacological is believed to control blood pressure and prevent complications, but many hypertensive patients have uncontrolled blood pressure. This is due to poor adherence to recommended lifestyle modifications. This study was aimed to determine the factors associated with adherence to recommended lifestyle modifications of hypertensive patients. A cross-sectional study was conducted in Pukesmas Dinoyo Malang in 2019. Consecutive Sampling was used to select study subjects. The questionnaire included information about demographic characteristics, knowledge, practice of lifestyle-modification measures. Associations between adherence to lifestyle modification and independent variables were analyzed using chi square and multivariate logistic regression analysis. 140 hypertensive patients participated in the study (60 men, 80 women). The prevalence of adherence was 28.6%. The level of knowledge was significant associated with adherence to recommended lifestyle modifications (p = 0.00). Genders , age, and educational level were no significant associated with to recommended lifestyle modifications (p= 0.06; p=0.21; p=0.87). Knowledge was significant associated with adherence to recommended lifestyle modifications of hypertensive patients.

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Hubungan Kadar Kolesterol Total Dan Hipertensi Dengan Kejadian Penyakit Jantung Koroner DI RSUD dr. Soedarso Pontianak

Jurnal Laboratorium Khatulistiwa ◽

10.30602/jlk.v1i2.144 ◽

2018 ◽

Vol 1 (2) ◽

pp. 99

Author(s):

Laila Kamila ◽

Maulidiyah Salim

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Total Cholesterol ◽

Blood Vessels ◽

Public Hospital ◽

Sampling Technique ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Purposive Sampling

Abstract: Coronary heart is a disease that offense to blood vessels and heart attack due to constriction of blood vessels. A high level of cholesterol in blood or exceeds the normal limit can form sediment in wall of blodd vessels which cause blood vessels constriction or blockage. This research object to determine whether there is a correlation between cholesterol level total and hypertension with coronary heart disease in patients who hospitalized in Regional Public Hospital of dr. Soedarso Pontianak. This study was used cross sectional design, purposive sampling technique, it gained 50 people as samples. The measurement of blood pressure was done in heart poly and cholesterol total level in clinic laboratory of Regional Public Hospital of dr. Soedarso by using enzymatic CHOD-PAP method. It can be obtained that 10 people had hypertension and 40 people did not.the average of total cholesterol was 224 mg/dl. Maximum value of total cholesterol was 224 mg/dl and 152 mg/dl as minimum value. Data has been analyzed by using statistical test, Chi-Square, to determine the correlation of total cholesterol wit coronary heart disease, obtained p value=0,024 (less than α=0,05). Correlation of hypertension and coronary heart disease gained p value=0,923 (more than α=0,05), it can be concluded that total cholesterol correlated with coronary heart disease, and there was not a correlation between hypertension and coronary heart disease.Abstrak: Jantung koroner adalah penyakit yang menyerang pembuluh darah dan serangan jantung, karena penyempitan pada pembuluh darah. Kadar kolesterol yang tinggi dalam darah melebihi normal dapat membentuk endapan pada dinding pembuluh darah sehingga menyebabkan penyempitan dan tersumbatnya pembuluh darah. Penelitian ini bertujuan untuk mengetahui hubungan kadar kolesterol total dan hipertensi dengan penyakit jantung koroner pada pasien di RSUD dr. Soedarso Pontianak. Disain penelitian ini menggunakan cross sectional, teknik pengambilan sampel yaitu purposive sampling, didapat jumlah sampel 50 orang. Pengukuran Tensi Darah dilakukan di poli Jantung dan pemeriksaan kadar kolesterol total di laboratorium klinik RSUD dr. Soedarso Pontianak dengan metode enzimatik CHOD-PAP. Hasil penelitian didapatkan 10 orang mengalami hipertensi dan 40 orang non hipertensi. Rata-rata kadar kolesterol total 224 mg/ dl. Nilai maksimum kadar kolesterol total yaitu 224 mg/dl dan nilai minimum yaitu 152 mg/dl. Analisa data dengan uji statistik Chi-square untuk mengetahui hubungan kolesterol total dengan penyakit jantung koroner didapatkan nilai p = 0,024 (lebih kecil dari α 0,05). Uji hubungan hipertensi dengan penyakit jantung koroner didapat nilai p = 0,923 (lebih besar dari α 0,05), dapat disimpulkan terdapat hubungan kadar kolesterol total dengan penyakit jantung koroner dan tidak ada hubungan hipertensi dengan penyakit jantung koroner.

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Effects of an Antihypertensive Combination in Japanese Hypertensive Outpatients Based on the Long-Acting Calcium Channel Blocker Benidipine on Vascular and Renal Events: A Sub-Analysis of the COPE Trial

Current Hypertension Reviews ◽

10.2174/1573402116666200129130151 ◽

2020 ◽

Vol 16 ◽

Author(s):

Seiji Umemoto ◽

Toshio Ogihara ◽

Masunori Matsuzaki ◽

Hiromi Rakugi ◽

Kazuyuki Shimada ◽

...

Keyword(s):

Blood Pressure ◽

Calcium Channel ◽

Calcium Channel Blocker ◽

Channel Blocker ◽

Rank Test ◽

Vascular Events ◽

Treatment Groups ◽

Β Blocker ◽

The Difference ◽

Long Acting

Background: In the trial known as COPE (Combination Therapy of Hypertension to Prevent Cardiovascular Events) three benidipine (a calcium channel blocker; CCB) regimens were compared. Hypertensive Japanese outpatients aged 40–85 years (n=3,293) who did not achieve the target blood pressure of <140/90 mmHg with benidipine 4 mg/day were treated with the diuretic thiazide (n=1,094) or a β-blocker (n=1,089) or an additional angiotensin receptor blocker (ARB; n=1,110). A significantly higher incidence of hard cardiovascular composite endpoints and of fatal or non-fatal strokes was observed in the benidipine-β-blocker group compared to the benidipine-thiazide group. Objective and Methods: We further evaluated the treatment effects of the three benidipine-based regimens on vascular and renal events in a sub-analysis of the COPE patients. Results: A total of 10 vascular events (0.8 per 1,000 person-years) including one aortic dissection (0.1 per 1,000 person-years) and nine cases of peripheral artery disease (0.8 per 1,000 person-years) were documented, as was a total of seven renal events (0.6 per 1,000 person-years). No significant differences in vascular and renal events were revealed among the three treatment groups: vascular events p=0.92 renal events p=0.16 log-rank test. Conclusions: Blood pressure-lowering therapy with benidipine combined with an ARB, β-blocker, or thiazide was similarly effective in the prevention of vascular and renal events in hypertensive outpatients, although there is no enough these events to compare the difference in the three treatment groups.

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Association between Objectively Measured Physical Activity and Arterial Stiffness in Children with Congenital Heart Disease

Journal of Clinical Medicine ◽

10.3390/jcm10153266 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3266

Author(s):

Laura Willinger ◽

Leon Brudy ◽

Renate Oberhoffer-Fritz ◽

Peter Ewert ◽

Jan Müller

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Heart Rate ◽

Congenital Heart Disease ◽

Heart Disease ◽

Arterial Stiffness ◽

Systolic Blood Pressure ◽

Congenital Heart ◽

Z Score ◽

Objectively Measured

Background: The association between physical activity (PA) and arterial stiffness is particularly important in children with congenital heart disease (CHD) who are at risk for arterial stiffening. The aim of this study was to examine the association between objectively measured PA and arterial stiffness in children and adolescents with CHD. Methods: In 387 children and adolescents with various CHD (12.2 ± 3.3 years; 162 girls) moderate-to-vigorous PA (MVPA) was assessed with the “Garmin vivofit jr.” for 7 consecutive days. Arterial stiffness parameters including pulse wave velocity (PWV) and central systolic blood pressure (cSBP) were non-invasively assessed by oscillometric measurement via Mobil-O-Graph®. Results: MVPA was not associated with PWV (ß = −0.025, p = 0.446) and cSBP (ß = −0.020, p = 0.552) in children with CHD after adjusting for age, sex, BMI z-score, peripheral systolic blood pressure, heart rate and hypertensive agents. Children with CHD were remarkably active with 80% of the study population reaching the WHO recommendation of average 60 min of MVPA per day. Arterial stiffness did not differ between low-active and high-active CHD group after adjusting for age, sex, BMI z-score, peripheral systolic blood pressure, heart rate and hypertensive agents (PWV: F = 0.530, p = 0.467; cSBP: F = 0.843, p = 0.359). Conclusion: In this active cohort, no association between PA and arterial stiffness was found. Longer exposure to the respective risk factors of physical inactivity might be necessary to determine an impact of PA on the vascular system.

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Short-Term Effect of Orthodontic Treatment with Clear Aligners on Pain and sEMG Activity of Masticatory Muscles

Medicina ◽

10.3390/medicina57020178 ◽

2021 ◽

Vol 57 (2) ◽

pp. 178

Author(s):

Alessandro Nota ◽

Silvia Caruso ◽

Shideh Ehsani ◽

Gianmaria Fabrizio Ferrazzano ◽

Roberto Gatto ◽

...

Keyword(s):

Surface Electromyography ◽

Orthodontic Treatment ◽

Masticatory Muscles ◽

Rank Test ◽

Nominal Data ◽

Chi Square ◽

Initial Reduction ◽

Signed Rank Test ◽

Chi Square Test ◽

Semg Activity

Background and objectives: The aim of this study is to evaluate mandibular elevator muscles activity and pain on palpation in the early stages of orthodontic treatment with clear aligners using surface electromyography (sEMG). Materials and methods: Surface electromyography (sEMG) activity and pain level on muscle palpation of masseter and anterior temporalis muscles were recorded in a sample of 16 adult subjects (aged 18–32 years; mean 22.5 +/− 3.5 SD) undergoing orthodontic treatment with clear aligners before the treatment (T0), after 1 month of treatment (two clear aligners) (T1), and after 3 months of treatment (T2) (six clear aligners). A chi-square test for nominal data, a Friedman test, and a Wilcoxon-signed rank test as post hoc analysis were applied. Results: No statistically significant differences in muscular pain were observed. At T1, the sEMG activity of masseter muscles at mandibular rest position showed a statistically significant reduction, but after 3 months (T2), the data appeared similar to T0 (p = 0.03 and p = 0.02). Conclusions: During the treatment with clear aligners, subjects could experience an initial reduction in the masseter basal activity after 1 month of treatment. This effect tends to decrease to baseline levels after 3 months of therapy.

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Biomarker potential of lncRNA GNAS-AS1 in osteosarcoma prognosis and effect on cellular function

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02611-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhanhu Mi ◽

Yanyun Dong ◽

Zhibiao Wang ◽

Peng Ye

Keyword(s):

Cell Proliferation ◽

Cell Function ◽

Cox Regression ◽

Bone Cancer ◽

Prognostic Indicator ◽

Migration And Invasion ◽

Rank Test ◽

Chi Square ◽

Invasion And Migration ◽

Novel Therapeutic Strategies

Abstract Background Osteosarcoma (OS) is a type of bone cancer that occurs in children and adolescents at a rate of 5%. The purpose of this study is to explore the lncRNA GNAS-AS1 expression profile, prognosis significance in OS, and biological effect on OS cell function. Methods One hundred eight pairs of tissues were collected, and OS cell lines were purchased. lncRNA GNAS-AS1 expression in these tissues and cells were analyzed by qRT-PCR. Clinical data were analyzed using chi-square tests, Kaplan-Meier curves (log-rank test), and Cox regression. CCK-8 and transwell assay were conducted to analyze the effect of lncRNA GNAS-AS1 on cell proliferation, invasion, and migration. The downstream miRNA was presumed. Results The expression of lncRNA GNAS-AS1 was significantly increased in OS cells and tissues, and related to Enneking staging and distant metastasis. Patients with high lncRNA GNAS-AS1 expression represented shorter overall survival and was an independent prognostic predictor of OS. LncRNA GNAS-AS1 knockdown inhibited cell proliferation, migration, and invasion by regulated miR-490-3p partly at least. Conclusions LncRNA GNAS-AS1 can be used as a prognostic indicator and its inhibition suppress the development of OS, suggesting its value as novel therapeutic strategies in OS.

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