<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03829709</url>
  </required_header>
  <id_info>
    <org_study_id>2,629,073</org_study_id>
    <nct_id>NCT03829709</nct_id>
  </id_info>
  <brief_title>Electromiography Study in the Respiratory Muscle Training in Human Lymphotropic Virus Type 1</brief_title>
  <official_title>Electromiography Study in the Respiratory Muscle Training in Human Lymphotropic Virus Type 1</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Universidade Metodista de Piracicaba</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Universidade Metodista de Piracicaba</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The main objective of the research will be to analyze, through surface electromyography, the&#xD;
      impact of inspiratory muscle training before a supervised home training protocol in patients&#xD;
      with human T-cell lymphotropic virus type 1 (HTLV-1). For this, a clinical, longitudinal,&#xD;
      prospective, quantitative and single center trial will be carried out, aiming at home&#xD;
      inspiratory muscle training lasting 5 weeks, 3 times a week, 30 minutes daily through the IMT&#xD;
      Threshold, with 14 volunteers enrolled in the Laboratory of Studies in Functional&#xD;
      Rehabilitation (LAERF) of the Federal University of Pará (UFPA). They will be classified as&#xD;
      the manifestation of Tropical Spastic Paraparesis / Myelopathy (PET / MAH) for GP (PET / MAH&#xD;
      probable) and GD (PET / MAH definitive) groups, obeying inclusion criteria. For&#xD;
      characterization of expiratory flow rates and flows, as well as respiratory muscle strength,&#xD;
      they will be submitted to spirometry and manovacuometry, pre, per, and post treatment,&#xD;
      respectively. For the analysis of the electromyographic activity, the diaphragm, parasternal&#xD;
      and sternocleidomastoid muscles will be counted in the follow-up during the analysis of&#xD;
      inspiratory muscle strength, as well as once a week during the conduction of the inspiratory&#xD;
      muscle training protocol. The collected data will be stored in a Microsoft Office Excel® 2010&#xD;
      worksheet and then submitted to statistical analysis using the Bioestat 5.0® program,&#xD;
      adopting a standard error of 5%. The theoretical support of the research will have a&#xD;
      bibliographical survey of scientific articles collected during the design of the project, and&#xD;
      the accomplishment of the research. It is expected to map, through the surface&#xD;
      electromyographic study, the impact of respiratory muscle training at a distance on the&#xD;
      inspiratory muscle strength of patients with HTLV-I virus with probable or definitive PET /&#xD;
      MAH.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Human T-lymphotropic viruses, HTLV (Human Lymphotrophic Virus T), are retroviruses, which&#xD;
      stand out as type 1 (HTLV-1) and type 2 (HTLV-2), the former being the etiologic agent of&#xD;
      serious organ diseases such as leukemia adult T-cell lymphoma (ATLL), a neurological&#xD;
      disorder, Tropical Spastic Paraparesis / HTLV-I-associated myelopathy (PET / HAM) and other&#xD;
      non-malignant ophthalmologic, dermatological, rheumatic and osteomyelitis non-malignant&#xD;
      disorders. For HTLV-2 it has not yet separated with some disease.&#xD;
&#xD;
      The highest prevalence of virus is found in countries of the Caribbean, South America,&#xD;
      Melanesia Islands, West Africa and Japan. Brazil is an endemic country for infection and&#xD;
      prevalence varies from state to state, being highest in Bahia, Pernambuco and Pará. The form&#xD;
      of sexual transmission, hematologic for blood transfusions or accompanied by contaminated&#xD;
      needles, mother-to-child verticalization, the passage of the lymphocyte infected by breast&#xD;
      milk and also in the perinatal period.&#xD;
&#xD;
      The mechanism of the disease comes from the infection of several types of cells, such as T&#xD;
      and B lymphocytes, monocytes and fibroblasts. However, its tropism is by TCD4 + cells. The&#xD;
      form of contamination is cell-cell, thus being transferred from infected material to&#xD;
      uninfected cells, modifying the immune system, as well as cell cells.&#xD;
&#xD;
      The main characteristic of HTLV infection is that in most cases the virus persists&#xD;
      asymptomatic and undetectable by the immune system per year or until death in about 98% of&#xD;
      the patients, while the hosts are able to transmit the virus. There are still no basic&#xD;
      surveys on how severe forms of symptoms of graves occur in those infected.&#xD;
&#xD;
      In this context, when the individual becomes symptomatic, he is affected by chronic infection&#xD;
      that may be associated with disabling diseases that compromise quality of life, such as the&#xD;
      neurological disease PET-MAH. The onset is insidious with frequent changes in gait and&#xD;
      urinary symptoms, mainly affecting the lower limbs such as spasticity, hyperreflexia,&#xD;
      sensory-motor dysfunctions such as neuropathic or nociceptive pain, paresis, paralysis and&#xD;
      paresthesia, urinary bladder disorders, muscle weakness and low back pain. The early&#xD;
      diagnosis of motor complications in the face of the onset of neurological disease also&#xD;
      contributes to the prevention of the installation of motor sensory sequelae if the&#xD;
      physiotherapeutic treatment is established early. According to this reference, one of the&#xD;
      aspects of preventive care refers to the functional autonomy correlated with physical&#xD;
      conditioning in order to increase the strength and / or endurance of the skeletal muscles.&#xD;
&#xD;
      In this way, the possibility of morphological and functional changes in the respiratory&#xD;
      system is also highlighted. With preventive therapeutic possibilities, the respiratory muscle&#xD;
      training (TMR) appears to this indicator with reference to the maximum inspiratory and&#xD;
      expiratory pressures (PiMáx and PeMáx). This procedure directly reflects on the patient's&#xD;
      functionality, having as guideline the conduction of training protocols. The protocol should&#xD;
      be conducted at least three days weekly frequently twice daily.&#xD;
&#xD;
      One tool to evaluate muscular behavior during TMR is surface electromyography (EMGs), which&#xD;
      consists of a non-invasive detection of the muscular electrical activity by which it is&#xD;
      presented graphically. It is constituted by the transcription of the sum of the electrical&#xD;
      activity of all the active muscle fibers, through the positioning of electrodes on the skin.&#xD;
      Thus, in order to verify the muscular activity of the respiratory dynamics related to&#xD;
      inspiration, the main groups are the diaphragm, parasternal intercostal, sternocleidomastoid,&#xD;
      abdominal rectus.&#xD;
&#xD;
      Therefore, the training requires time, availability and greater displacement of the patient&#xD;
      to the outpatient treatment units, thus causing difficulties in adherence to the proposed&#xD;
      therapy. To that end, it has been proposed ways that facilitate such conduction, such as home&#xD;
      treatments, which, in most cases, the patient is supervised by the physiotherapist at least&#xD;
      once a week presently followed by distance monitoring.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">January 30, 2019</start_date>
  <completion_date type="Actual">July 23, 2020</completion_date>
  <primary_completion_date type="Actual">July 23, 2020</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>N/A</allocation>
    <intervention_model>Single Group Assignment</intervention_model>
    <intervention_model_description>Rehabilitation</intervention_model_description>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Inspiratory and expiratory muscle force</measure>
    <time_frame>Five weeks</time_frame>
    <description>The evaluation of respiratory muscle strength will be performed by measuring the maximal inspiratory pressure (PiMáx) and expiratory (PeMAx) measurements with manovacuometer (+ - 300cmH2O). In order to perform the measurement of PiMáx and PeMáx, referring to inspiratory and expiratory muscle strength respectively. The values can range from 0 to 300 cmH2O, being 0 no strength and 300 maximum respiratory muscle strength.</description>
  </primary_outcome>
  <number_of_arms>1</number_of_arms>
  <enrollment type="Actual">20</enrollment>
  <condition>HTLV-I Infections</condition>
  <arm_group>
    <arm_group_label>Intervention Group</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>The inspiratory muscle training (IMT) will be performed in the morning shift for 30 minutes, 3 times a week for 5 weeks. The first training session each week will be held at the LAERF under the direct supervision of the investigator and the other two home-based training sessions under the supervisor's distance supervision. They will receive the Threshold® IMT linear loading device, and guidelines for handling, posture and asepsis. The initial training load for each participant will be adjusted to 25% of PiMáx. Participants will be trained and instructed to do the exercise program on their own at home. Once a week, during the return to the laboratory the researcher will determine the new values for load (1st week 25%, 2nd week 35%, 3rd week 40%, 4th week 45%, 5th week 50%).</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Rehabilitation</intervention_name>
    <description>The first training session each week will be held at the LAERF under the direct supervision of the investigator and the other two home-based training sessions under the supervisor's distance supervision. They will receive the Threshold® IMT linear loading device, and guidelines for handling, posture and asepsis. The initial training load for each participant will be adjusted to 25% of PiMáx. Participants will be trained and instructed to do the exercise program on their own at home. Once a week, during the return to the laboratory the researcher will determine the new values for load (1st week 25%, 2nd week 35%, 3rd week 40%, 4th week 45%, 5th week 50%).</description>
    <arm_group_label>Intervention Group</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  volunteers of both sexes&#xD;
&#xD;
          -  HTLV-1 positive serology with definitive or probable PET / MAH&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  pulmonary diseases&#xD;
&#xD;
          -  serious comorbidities such as heart disease and uncontrolled arterial hypertension&#xD;
&#xD;
          -  cognitive alterations that impede the conduction of the protocol&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>80 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>João S Oliveira, phd</last_name>
    <role>Study Chair</role>
    <affiliation>Universidade Metodista de Piracicaba</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Universidade da Amazônia</name>
      <address>
        <city>Belém</city>
        <state>Pará</state>
        <zip>66060902</zip>
        <country>Brazil</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Brazil</country>
  </location_countries>
  <results_reference>
    <citation>Magno Falcao LF, Falcao ASC, Medeiros Sousa RC, Vieira WB, de Oliveira RTM, Normando VMF, Dias GADS, Santos MCS, Rocha RSB, Yoshikawa GT, Koyama RVL, Fujihara S, Correa VAC, Fuzii HT, Quaresma JAS. CT Chest and pulmonary functional changes in patients with HTLV-associated myelopathy in the Eastern Brazilian Amazon. PLoS One. 2017 Nov 2;12(11):e0186055. doi: 10.1371/journal.pone.0186055. eCollection 2017. Erratum In: PLoS One. 2017 Dec 27;12 (12 ):e0190436.</citation>
    <PMID>29095831</PMID>
  </results_reference>
  <results_reference>
    <citation>Levy J, Prigent H, Bensmail D. Respiratory rehabilitation in multiple sclerosis: A narrative review of rehabilitation techniques. Ann Phys Rehabil Med. 2018 Jan;61(1):38-45. doi: 10.1016/j.rehab.2017.06.002. Epub 2017 Nov 8.</citation>
    <PMID>29128525</PMID>
  </results_reference>
  <results_reference>
    <citation>Nakamura T. HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP): the role of HTLV-I-infected Th1 cells in the pathogenesis, and therapeutic strategy. Folia Neuropathol. 2009;47(2):182-94.</citation>
    <PMID>19618340</PMID>
  </results_reference>
  <results_reference>
    <citation>Nikoletou D, Man WD, Mustfa N, Moore J, Rafferty G, Grant RL, Johnson L, Moxham J. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disabil Rehabil. 2016;38(3):250-9. doi: 10.3109/09638288.2015.1036171. Epub 2015 Apr 17.</citation>
    <PMID>25885668</PMID>
  </results_reference>
  <results_reference>
    <citation>Sa KN, Macedo MC, Andrade RP, Mendes SD, Martins JV, Baptista AF. Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives. J Multidiscip Healthc. 2015 Feb 23;8:117-25. doi: 10.2147/JMDH.S71978. eCollection 2015.</citation>
    <PMID>25759588</PMID>
  </results_reference>
  <verification_date>August 2020</verification_date>
  <study_first_submitted>January 30, 2019</study_first_submitted>
  <study_first_submitted_qc>January 31, 2019</study_first_submitted_qc>
  <study_first_posted type="Actual">February 4, 2019</study_first_posted>
  <last_update_submitted>August 11, 2020</last_update_submitted>
  <last_update_submitted_qc>August 11, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">August 13, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Universidade Metodista de Piracicaba</investigator_affiliation>
    <investigator_full_name>Rodrigo Santiago Barbosa Rocha, Phd</investigator_full_name>
    <investigator_title>Director of Human Movement Department</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>HTLV-I Infections</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03829709
org study id: 2,629,073
nct id: NCT03829709
lead sponsor: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
The main objective of the research will be to analyze, through surface electromyography, the
      impact of inspiratory muscle training before a supervised home training protocol in patients
      with human T-cell lymphotropic virus type 1 (HTLV-1). For this, a clinical, longitudinal,
      prospective, quantitative and single center trial will be carried out, aiming at home
      inspiratory muscle training lasting 5 weeks, 3 times a week, 30 minutes daily through the IMT
      Threshold, with 14 volunteers enrolled in the Laboratory of Studies in Functional
      Rehabilitation (LAERF) of the Federal University of Pará (UFPA). They will be classified as
      the manifestation of Tropical Spastic Paraparesis / Myelopathy (PET / MAH) for GP (PET / MAH
      probable) and GD (PET / MAH definitive) groups, obeying inclusion criteria. For
      characterization of expiratory flow rates and flows, as well as respiratory muscle strength,
      they will be submitted to spirometry and manovacuometry, pre, per, and post treatment,
      respectively. For the analysis of the electromyographic activity, the diaphragm, parasternal
      and sternocleidomastoid muscles will be counted in the follow-up during the analysis of
      inspiratory muscle strength, as well as once a week during the conduction of the inspiratory
      muscle training protocol. The collected data will be stored in a Microsoft Office Excel® 2010
      worksheet and then submitted to statistical analysis using the Bioestat 5.0® program,
      adopting a standard error of 5%. The theoretical support of the research will have a
      bibliographical survey of scientific articles collected during the design of the project, and
      the accomplishment of the research. It is expected to map, through the surface
      electromyographic study, the impact of respiratory muscle training at a distance on the
      inspiratory muscle strength of patients with HTLV-I virus with probable or definitive PET /
      MAH.
Human T-lymphotropic viruses, HTLV (Human Lymphotrophic Virus T), are retroviruses, which
      stand out as type 1 (HTLV-1) and type 2 (HTLV-2), the former being the etiologic agent of
      serious organ diseases such as leukemia adult T-cell lymphoma (ATLL), a neurological
      disorder, Tropical Spastic Paraparesis / HTLV-I-associated myelopathy (PET / HAM) and other
      non-malignant ophthalmologic, dermatological, rheumatic and osteomyelitis non-malignant
      disorders. For HTLV-2 it has not yet separated with some disease.

      The highest prevalence of virus is found in countries of the Caribbean, South America,
      Melanesia Islands, West Africa and Japan. Brazil is an endemic country for infection and
      prevalence varies from state to state, being highest in Bahia, Pernambuco and Pará. The form
      of sexual transmission, hematologic for blood transfusions or accompanied by contaminated
      needles, mother-to-child verticalization, the passage of the lymphocyte infected by breast
      milk and also in the perinatal period.

      The mechanism of the disease comes from the infection of several types of cells, such as T
      and B lymphocytes, monocytes and fibroblasts. However, its tropism is by TCD4 + cells. The
      form of contamination is cell-cell, thus being transferred from infected material to
      uninfected cells, modifying the immune system, as well as cell cells.

      The main characteristic of HTLV infection is that in most cases the virus persists
      asymptomatic and undetectable by the immune system per year or until death in about 98% of
      the patients, while the hosts are able to transmit the virus. There are still no basic
      surveys on how severe forms of symptoms of graves occur in those infected.

      In this context, when the individual becomes symptomatic, he is affected by chronic infection
      that may be associated with disabling diseases that compromise quality of life, such as the
      neurological disease PET-MAH. The onset is insidious with frequent changes in gait and
      urinary symptoms, mainly affecting the lower limbs such as spasticity, hyperreflexia,
      sensory-motor dysfunctions such as neuropathic or nociceptive pain, paresis, paralysis and
      paresthesia, urinary bladder disorders, muscle weakness and low back pain. The early
      diagnosis of motor complications in the face of the onset of neurological disease also
      contributes to the prevention of the installation of motor sensory sequelae if the
      physiotherapeutic treatment is established early. According to this reference, one of the
      aspects of preventive care refers to the functional autonomy correlated with physical
      conditioning in order to increase the strength and / or endurance of the skeletal muscles.

      In this way, the possibility of morphological and functional changes in the respiratory
      system is also highlighted. With preventive therapeutic possibilities, the respiratory muscle
      training (TMR) appears to this indicator with reference to the maximum inspiratory and
      expiratory pressures (PiMáx and PeMáx). This procedure directly reflects on the patient's
      functionality, having as guideline the conduction of training protocols. The protocol should
      be conducted at least three days weekly frequently twice daily.

      One tool to evaluate muscular behavior during TMR is surface electromyography (EMGs), which
      consists of a non-invasive detection of the muscular electrical activity by which it is
      presented graphically. It is constituted by the transcription of the sum of the electrical
      activity of all the active muscle fibers, through the positioning of electrodes on the skin.
      Thus, in order to verify the muscular activity of the respiratory dynamics related to
      inspiration, the main groups are the diaphragm, parasternal intercostal, sternocleidomastoid,
      abdominal rectus.

      Therefore, the training requires time, availability and greater displacement of the patient
      to the outpatient treatment units, thus causing difficulties in adherence to the proposed
      therapy. To that end, it has been proposed ways that facilitate such conduction, such as home
      treatments, which, in most cases, the patient is supervised by the physiotherapist at least
      once a week presently followed by distance monitoring.
allocation: N/A
intervention model: Single Group Assignment
intervention model description: Rehabilitation
primary purpose: Treatment
masking: None (Open Label)
measure: Inspiratory and expiratory muscle force
time frame: Five weeks
description: The evaluation of respiratory muscle strength will be performed by measuring the maximal inspiratory pressure (PiMáx) and expiratory (PeMAx) measurements with manovacuometer (+ - 300cmH2O). In order to perform the measurement of PiMáx and PeMáx, referring to inspiratory and expiratory muscle strength respectively. The values can range from 0 to 300 cmH2O, being 0 no strength and 300 maximum respiratory muscle strength.
arm group label: Intervention Group
arm group type: Experimental
description: The inspiratory muscle training (IMT) will be performed in the morning shift for 30 minutes, 3 times a week for 5 weeks. The first training session each week will be held at the LAERF under the direct supervision of the investigator and the other two home-based training sessions under the supervisor's distance supervision. They will receive the Threshold® IMT linear loading device, and guidelines for handling, posture and asepsis. The initial training load for each participant will be adjusted to 25% of PiMáx. Participants will be trained and instructed to do the exercise program on their own at home. Once a week, during the return to the laboratory the researcher will determine the new values for load (1st week 25%, 2nd week 35%, 3rd week 40%, 4th week 45%, 5th week 50%).
intervention type: Other
intervention name: Rehabilitation
description: The first training session each week will be held at the LAERF under the direct supervision of the investigator and the other two home-based training sessions under the supervisor's distance supervision. They will receive the Threshold® IMT linear loading device, and guidelines for handling, posture and asepsis. The initial training load for each participant will be adjusted to 25% of PiMáx. Participants will be trained and instructed to do the exercise program on their own at home. Once a week, during the return to the laboratory the researcher will determine the new values for load (1st week 25%, 2nd week 35%, 3rd week 40%, 4th week 45%, 5th week 50%).
arm group label: Intervention Group
criteria: 
gender: All
minimum age: 18 Years
maximum age: 80 Years
healthy volunteers: No
last name: João S Oliveira, phd
role: Study Chair
affiliation: Universidade Metodista de Piracicaba
facility: 
country: Brazil
citation: Magno Falcao LF, Falcao ASC, Medeiros Sousa RC, Vieira WB, de Oliveira RTM, Normando VMF, Dias GADS, Santos MCS, Rocha RSB, Yoshikawa GT, Koyama RVL, Fujihara S, Correa VAC, Fuzii HT, Quaresma JAS. CT Chest and pulmonary functional changes in patients with HTLV-associated myelopathy in the Eastern Brazilian Amazon. PLoS One. 2017 Nov 2;12(11):e0186055. doi: 10.1371/journal.pone.0186055. eCollection 2017. Erratum In: PLoS One. 2017 Dec 27;12 (12 ):e0190436.
PMID: 29095831
citation: Levy J, Prigent H, Bensmail D. Respiratory rehabilitation in multiple sclerosis: A narrative review of rehabilitation techniques. Ann Phys Rehabil Med. 2018 Jan;61(1):38-45. doi: 10.1016/j.rehab.2017.06.002. Epub 2017 Nov 8.
PMID: 29128525
citation: Nakamura T. HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP): the role of HTLV-I-infected Th1 cells in the pathogenesis, and therapeutic strategy. Folia Neuropathol. 2009;47(2):182-94.
PMID: 19618340
citation: Nikoletou D, Man WD, Mustfa N, Moore J, Rafferty G, Grant RL, Johnson L, Moxham J. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disabil Rehabil. 2016;38(3):250-9. doi: 10.3109/09638288.2015.1036171. Epub 2015 Apr 17.
PMID: 25885668
citation: Sa KN, Macedo MC, Andrade RP, Mendes SD, Martins JV, Baptista AF. Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives. J Multidiscip Healthc. 2015 Feb 23;8:117-25. doi: 10.2147/JMDH.S71978. eCollection 2015.
PMID: 25759588
responsible party type: Principal Investigator
investigator affiliation: Universidade Metodista de Piracicaba
investigator full name: Rodrigo Santiago Barbosa Rocha, Phd
investigator title: Director of Human Movement Department
mesh term: HTLV-I Infections
sharing ipd: No