International Journal of Clinical and Experimental Physiology 2019-04-11T06:14:39+00:00 IJCEP Editorial Office Open Journal Systems <p><strong>Aim and Scope</strong></p> <p>The aim of International Journal of Clinical and Experimental Physiology (IJCEP) is to publish quality research papers in Physiology that have clinical application in medicine or the papers with experimental evidences having future perspective of application in medicine. As Physiology is the mother-subject of all branches of medicine, the ‘Clinical Physiology’ component will include in addition to the research data in ‘Clinical Physiology’, the research papers from all branches of clinical medicine such as diabetes, hypertension, heart disease, endocrine disorders, neurological dysfunctions, pulmonary diseases, gastrointestinal disorders etc., explaining the pathophysiological basis of the diseases and the physiological basis of management and prevention of the diseases. The ‘Experimental Physiology’ component will include reports on all experimental physiology research and the experimental models of diseases that facilitate understanding the pathophysiologic processes and management of diseases. However, the works in ‘Applied Physiology’ or the works in ‘Basic Research in Physiology’ intending to have application in clinical physiology and medicine will be considered for publication in IJCEP. Also, ‘Preventive Physiology’ such as role of nutrition, relaxation therapy, yoga, exercises etc. in health promotion will be published in this journal.</p> <p><strong>Subjects Covered</strong></p> <p>Physiology (Basic, Experimental, Applied and Clinical), Clinical Medicine, Endocrinology, Neurophysiology, Cardiovascular Physiology and Medicine, Gastrointestinal Physiology and Medicine, Pulmonary Physiology and Medicine, Clinical Biochemistry, Exercise Physiology, Nutrition, Sports Physiology and Medicine, Aviation Physiology and Medicine, Behavioural Physiology and Medicine, Reproductive Physiology and Medicine, Ophthalmic Physiology and Medicine, Physiology and Medicine related to ear, nose and throat, Orthopedic Physiology and Medicine, Pathophysiology of Lifestyle and Stress Disorders, Clinical Pharmacology, Physiology of Metabolism and Metabolic disorders and Physiology of Yoga.</p> Cardiovascular Risks in Indian Population Could be Linked to Lean Metabolic Syndrome 2019-04-09T11:24:12+00:00 Gopal Krushna Pal <p style="text-align: justify;">There are multiple risk factors for developing Cardiovascular Disease (CVD). However, some risk factors that commonly cluster together such as obesity, dyslipidemia, hypertension and hyperglycemia have been termed as the <em>Metabolic Syndrome</em> (MS). Recently the National Cholesterol Education Program’s Adult Treatment Panel III report (ATP III) defined the criteria for metabolic syndrome.<sup>[1]</sup> The selected criteria differ from those of other organizations and therefore, the National Heart, Lung and Blood Institute, in collaboration with the American Heart Association, convened a conference to examine scientific issues related to definition of the metabolic syndrome. ATP III identified six components of the metabolic syndrome that relate to CVD: abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance ± glucose intolerance, proinflammatory and prothrombotic states.[<sup>1]</sup> Though the pathogenesis of the metabolic syndrome is still unclear, two potential etiological categories have been more emphasized: obesity with associated disorders of adipose tissue and disorders due to insulin resistance.&nbsp;<strong>Read more. . .&nbsp;</strong></p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Physiological Effects of Angiotensin III 2019-04-11T05:58:57+00:00 Debela Tolessa Adugna Chala Kelil Haji Gizaw Mamo Gizaw Eshetu <p style="text-align: justify;">The Renin Angiotensin System (RAS) is a peptide hormone system that has many physiological effects. In addition to this it plays an important role in the pathophysiology of money diseases, such as hypertension, Congestive Heart Failure (CHF), Myocardial Infarction (MI) and diabetic nephropathy. The main biologically active peptides of RAS are Angiotensinogen (AGT), Angiotensin II (Ang II), Angiotensin III (Ang III), Angiotensin IV (Ang IV) and Angiotensin [Ang-(1–7)]. Even though, Ang II is still considered the major peptide of the RAS, there is growing evidence that peptide fragments of Ang II like Ang III also have various and important physiologic roles. Moreover, most of the available studies have focused on Ang II as the likely key peptide from the RAS that directly and indirectly regulates physiological functions. However, findings from recent studies suggest that Ang III may produce physiologically relevant effects that are similar to those produced by Ang II. Ang III is heptapeptide and has about 40% of the vasopressin activity of Ang II, but 100% of the aldosterone-stimulating activity. It has been suggested that Ang III is the natural aldosterone-stimulating peptide. However, this appears not to be the case and instead Ang III is simply a breakdown product with some biologic activity. Therefore, this research review focuses on Ang III and physiological effects that it produces in the body. This review is also expected to focus on the recent knowledge of Ang III and physiologic effects in various parts of human body.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Effect of Acute Administration of Ethanol Extract of Wild Fig (Ficus thonningii) on Spatial Memory and Learning in CD-1 Mice 2019-04-11T06:00:19+00:00 Aduema Wadioni Akunneh-Wariso Chris <p style="text-align: justify;"><strong>Background and Aim:</strong> Since there is an increasing demand by people for means of enhancing the neuro-cognitive functions of the brain and the side effects of many neuro-cognitive drugs which have left many persons with irreversible neurological damage. This situation has lead to our investigation of the neuro-cognitive properties (learning and memory) of the plant, <em>Ficus thioningii</em> (wild fig). <strong>Methods:</strong> 30 Adult Swiss mice weighing between 16 -21g, were divided into 3 groups, 10 mice per group. Before the neurobehavioral parameters were assessed, the LD<sub>50</sub>, acute toxicological screenings of the plant were determined. Group A being the control, received rat feed with normal saline, group B being the low dose were administered with Ficus thoninngii extract at a dose of 10mg/kg and group C being the high dose were administered with <em>Ficus thoninngii</em> extract at a dose of 20mg/kg, this administration lasted for 14 days. All animals were allowed clean drinking water. <strong>Results:</strong> The data’s were analyzed and the results showed that on days 1, 2 and 3 of acquisition training mice from low dose and high dose learned equally when compared to the control. In the reversal training, memory was improved in the low dose and high dose treated mice when compared to control at (<em>p</em>&lt;0.05, <em>p</em>&lt;0.01 and <em>p</em>&lt;0.001). During the probe trial, the swim duration in the South-East quadrant was significantly higher for high dose and low dose compared to control (<em>p</em>&lt;0.01 and at <em>p</em>&lt;0.001). However, during the visible platform task, the swim latencies for the low dose and high dose group were also significantly lower compared to control (<em>p</em>&lt;0.001). <strong>Conclusion:</strong> The results suggest that consumption of <em>Ficus thoninngii</em> extracts enhances learning and memory in mice, thus <em>Ficus thoninngii</em> containing diet may be beneficial in the improvement of learning and memory.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Effect of Four-week Honey-treatment on Blood Glucose and Lipid Profile in an Experimental Model of Diabetic Neuropathy 2019-04-11T06:02:12+00:00 Allampalli Sirisha Girwar Singh Gaur Pravati Pal Zachariah Bobby Bharathi Balakumar Gopal Krushna Pal <p style="text-align: justify;"><strong>Background and Aim:</strong> Honey is a natural substance with various medicinal properties which include antibacterial, antihypertensive, hepatoprotective, hypoglycemic and antioxidant effects. However, the role of honey in the management of neuropathic morbidities in diabetic neuropathy has not been studied. Especially, the effect of honey on fasting blood glucose and lipid profile in diabetic neuropathy has not been assessed. Therefore, in the present study we have assessed the effect of honey treatment on blood glucose and lipid profile in animal diabetic neuropathy model. <strong>Methods:</strong> Twenty-four healthy male Wistar albino rats of 10-12 weeks age, weighing 200±30 g were obtained from JIPMER central animal house. After one week of habituation, rats were divided into three groups randomly. After developing diabetic neuropathy, Fasting Blood Glucose (FBG) and lipid profile, Aspartate Transaminase (AST) and Alanine transaminase (ALT) were measured in blood sample in the rats before and after honey treatment. <strong>Results:</strong> Significant increase in FBG, AST, ALT and lipid profile except HDL cholesterol was seen in diabetic neuropathy when compared with normal healthy rats. There was a significant reduction in all these parameters except HDL-cholesterol after four-week honey treatment in comparison with diabetic neuropathy rats without treatment. <strong>Conclusion:</strong> Honey, given at a dose of 0.5 gm/kg BW for four weeks is effective in reducing blood glucose, atherogenic index and lipid profile and improving liver functions in albino rats.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Comparative Analysis of Depth of Meditation Between Long-Term and Short Term Meditators using Electroencephalography 2019-04-11T06:03:34+00:00 Dipti Magan Raj Kumar Yadav Kishore Kumar Deepak <p style="text-align: justify;"><strong>Background and Aim:</strong> The present study was designed to evaluate the brain electrical activity among Long-term meditators (LTMs) and Short-term meditators (STMs) using Electroencephalography (EEG). <strong>Methods:</strong> This prospective study involved 40 mins of EEG recordings, carried out twice i.e. at Day 0 (Baseline) and at Day 10 (During meditation) in thirty-four (34) participants. Twelve (12) apparently healthy male, right-handed, practicing preksha meditation (Since &gt;5 years, at least 5 days a week) were recruited as long-term meditators; Twelve (12) subjects who attended the 10-days short-term yoga-based lifestyle intervention program were recruited as short-term meditators; Ten (10) male healthy controls, who did not participate in any dietary/yoga intervention were recruited among the staff members. The EEG waves were analyzed at Day 0 and at Day 10 using Wilcoxon Signed Rank test and Repeated measured ANOVA respectively. One-way ANOVA was used for the baseline EEG waves activity comparison among LTMs <em>vs.</em> STMs <em>vs.</em> Controls. The response to photic stimulation was also assessed during meditation. <strong>Results:</strong> Significant different patterns of alpha and theta waves (<em>p</em>&lt;0.05) activity was observed for LTM <em>vs.</em> STM during meditation <em>vs.</em> baseline. Also, significant different baseline EEG waves (<em>p</em>&lt;0.05) were observed among LTM <em>vs</em>. STM <em>vs.</em> Controls. <strong>Conclusion:</strong> Findings may be useful in defining the basic EEG features to differentiate meditators based on the duration of practice of meditation and depth of meditation.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Comparative Assessment of Problem Based and Web- based Learning in Neurophysiology 2019-04-11T06:04:56+00:00 Varghese Anne Celine C <p style="text-align: justify;"><strong>Background and Aim:</strong> Neurophysiology concepts are difficult to understand in the first hearing and to apply in clinical situations too. To fill this gap, the teaching- learning methods have to be modified. This study introduces two learning methods in this scenario and comparatively assesses them. The objective of the study was to compare the problem- based and web - based learning methods in Neurophysiology. And To find the effects of problem- based and web - based learning methods. <strong>Methods:</strong> The quasi-experimental study was carried out on I MBBS students of MOSC Medical College, Kolenchery, who were divided randomly into two groups: Problem-based Learning group (PBL) and Web-based Learning (WBL) group. Pre and Post- test were administered to the two groups and individual feedback was collected online. <strong>Results:</strong> The pre and post test marks in the 2 groups did not show any significant difference by Wilcoxon Signed Rank Test (<em>p</em>=0.636 for the PBL group and <em>p</em>=0.051 for the WBL group). Inter-group Post-test score comparison by Mann-Whitney U test gave a non-significant result (<em>p</em>-value=0.056). <strong>Conclusion:</strong> This indicates that there is no significant intra- or inter- group improvement in the scores obtained. Feedback responses collected from both groups showed proportionately higher number of students wanting more topics to be taken in a similar manner.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Practice of Alternate-nostril Breathing (Anuloma-Viloma Pranayama) Attenuates the Development of Hypertension and Cardiometabolic Dysfunctions During Pregnancy in Women Having Risk Factors for Pregnancy-Induced Hypertension 2019-04-11T06:06:34+00:00 Gopal Krushna Pal Syed Habeebullah Pravati Pal Manivannan Subha Kuppusamy Saranya Nivedita Nanda <p style="text-align: justify;"><strong>Background and Objective:</strong> The early prediction and prevention of Pregnancy-induced Hypertension (PIH), a common morbid disorder of pregnancy is unsatisfactory. Therefore, in the present study we have investigated the role of alternate-nostril breathing (anulomaviloma pranayama) on cardiometabolic risks and prevention of PIH in women having risks of PIIH. <strong>Methods:</strong> A total of 148 subjects consisting of study group (n=76): pregnant women having risk factors for PIH and practiced pranayama; and control group (n=72): pregnant women with risk factors for PIH, but did not practice pranayama were recruited from obstetric out-patient department. Spectral analysis of Heart Rate Variability (HRV), autonomic Function Tests (AFTs), lipid profile, markers of insulin resistance, inflammation and oxidative stress were assessed in both groups in all the three trimesters. <strong>Results:</strong> It was observed that LF-HF ratio, the most sensitive indicator of sympathovagal imbalance was significantly reduced (<em>P</em>&lt;0.001) and was linked to reduction in cardiometabolic risks and prediction of hypertension status in study group subjects following pranayama practice from their 1<sup>st</sup> trimester compared to control group subjects who did not practice pranayama. <strong>Conclusion:</strong> Practice of anuloma-viloma pranayama from 1<sup>st</sup> trimester improves sympathovagal balance, reduces cardiometabolic risks and prevents the development of PIH in later part of pregnancy in women having risk factors for PIH.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Study of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Hypertensives and Normotensives 2019-04-11T06:07:56+00:00 Hardikkumar Amrutbhai Mistry Dharitri Mansukhbhai Parmar <p style="text-align: justify;"><strong>Background and Aim:</strong> Long-term hypertension proceed to development of atherothrombotic disease and it’s a major healthcare problem worldwide. Platelets and neutrophils play an important role in Cardiovascular (CV) events and development of atherothrombotic disease. Recently, Neutrophil/lymphocyte Ratio (NLR) and Platelet/lymphocyte Ratio (PLR), which can be easily calculated from the differential blood count, have been proposed as novel systemic inflammation-based markers predictive of thrombotic events. The aim of the present study was to explore the association between NLR and PLR with hypertension and as an indicator of cardiovascular risk. <strong>Methods:</strong> It’s a cross sectional study. 50 Hypertensive patients aged 40 – 60 years, males and females with the history of Previously diagnosed hypertension &gt;1 year duration or taking anti-hypertensive medications with blood pressure Systolic BP &gt; 140 mm Hg, Diastolic BP &gt; 90 mmHg were taken as study group. 50 normotensives aged 40 – 60, males and females with Systolic BP &lt; 140 mmHg, Diastolic BP &lt; 90 mmHg were taken as control group, who were matching socio-economically with study group. A detailed history and physiological parameters were taken. Blood pressure was measured via auscultatory method using sphygmomanometer. Under aseptic precautions, 3 ml of venous blood samples were collected and analysed. <strong>Results:</strong> Neutrophil to Lymphocyte Ratio (NLR) was significantly higher (<em>p</em>&lt;0.01) in study group. Platelet to Lymphocyte Ratio (PLR) was also higher in study group but statistically not significant (<em>p</em>&gt;0.05). <strong>Conclusion:</strong> Hypertensives with higher NLR have greater risk for athero-thrombotic and atherosclerotic events.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Swimming Helps Elderly Population to Improve Mental Speed and Attention 2019-04-11T06:09:06+00:00 Sakharayapatna Vasegowda <p style="text-align: justify;"><strong>Background and Aim:</strong> Swimming is an ideal physical activity for the elderly population because of its low impact on joints and minimal risk of injury. Previous studies have proven that swimming has beneficial effect on skeletal and cardiovascular health. But studies to assess effects of swimming on cognitive health of elderly are lacking. <strong>Methods:</strong> This study was undertaken to assess and compare the level of cognition among elderly swimmers and non swimmers. 50 elderly subjects who regularly swim and 50 elderly non swimmers were recruited. Digit symbol substitution test and Digit vigilance test were done to assess the mental speed and attention of the subjects. <strong>Results:</strong> Results were statistically analyzed using students t test to compare between the groups. Swimmers took less time to complete both Digit symbol substitution test and Digit vigilance test than non swimmers. <strong>Conclusion:</strong> Elderly swimmers had better mental speed and attention compared to non swimmers.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Assessment of Plasma Iron, Feritin, Blood Platelets and Hemoglobin Concentration in Rabbits Given Amoxicillin Overdose Supplemented with Raw Cucumber Juice 2019-04-11T06:10:26+00:00 Mathew Folaranmi Olaniyan Martins Afolabi Oladega <p style="text-align: justify;"><strong>Background and Aim:</strong> Raw Cucumber (<em>Cucumis sativus</em>) fruit juice contains substances of health promoting bioactivities. Plasma iron is stored in the liver and blood cells. Platelets are blood cells involved in blood clotting for homeostasis while haemoglobin (found on red blood cells) concentration is an index of anaemia and polycythemia. This work was therefore designed to assess plasma iron, feritin, blood platelets and hemoglobin concentration in rabbits given amoxicillin overdose supplemented with raw cucumber fruit Juice. <strong>Methods:</strong> Fifteen rabbits of the same sex weighing 0.9 – 1.4Kg divided into 3 groups of 5 rabbits each were used for the study. Group A- 5 control rabbits; Group B –5 rabbits given 30.0mg/kgBW subcutaneous injection of amoxicillin every 24 hrs for 7 days which was followed by 30ml raw cucumber fruit juice supplementation for 14 days; Group C–5 rabbits given 30.0mg/ kgBW subcutaneous injection of amoxicillin every 24 hrs and raw cucumber fruit juice supplementation for 14 days simultaneously. Plasma iron, ferritin and hemoglobin concentration were determined in the rabbits biochemically by spectrophotometry and immunoturbidometry while platelets were enumerated by haemocytometry. <strong>Results:</strong> There was a significant increase in plasma ferritin and iron with a significant decrease in haemoglobin concentration and blood platelets when the rabbits were given 30.0mg/kgBW subcutaneous injection of amoxicillin every 24 hrs for 7 days compared with the results obtained from the control rabbits, their basal samples and when they were supplemented with30ml raw cucumber fruit juice for 14 days with <em>p</em>&lt;0.05. There was a significant decrease in plasma ferritin and iron with a significant increase in haemoglobin concentration and blood platelets when they were supplemented with3 0ml raw cucumber fruit juice for 14 days compared with the results obtained when they were given 30.0mg/kgBW subcutaneous injection of amoxicillin every 24 hrs for 7 days with <em>p</em>&lt;0.05. <strong>Conclusion :</strong> There was a significant increase in plasma ferritin and iron with a significant decrease in haemoglobin concentration and blood platelets upon administration of amoxicillin overdose which was reversed when the supplement of raw cucumber fruit juice was given. Cucumber fruit juice possibly has a protective effect on blood cells and liver as there was no significant haematological alteration when amoxicillin overdose and raw cucumber fruit juice were co-administered.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Treatment of Spontaneous Pneumothorax by using the Video Assisted Thoracoscopic Surgery and Mini Invasive Thoracoscopic Surgery 2019-04-11T06:11:42+00:00 Kwang-Hak Ju Hyon-Jong Kim Song-Ho Kim Yong-Jin Liu <p style="text-align: justify;"><strong>Background and Aim:</strong> The temporizing treatment for spontaneous pneumothorax had been established methodically, but thoracoscopic surgical methods has been not yet. The objective of the study is to show the treatment effect of intra- and post-operation by using rational thoracoscopic surgery for the patients with spontaneous pneumothorax. <strong>Methods:</strong> We had performed Video Assisted Thoracoscopic Surgery (VATS) and Mini Invasive Thoracoscopic Surgery (MITS) for 322 patients with spontaneous pneumothorax and established rational surgery approach between January 2011 and December 2017. And then we evaluated the outcome of surgery compared to common thoracotomy.<strong> Results:</strong> Compared to common thoracotomy, VATS was an operation with large economic efficacy because of light operation associated injury, fast recovery and the ability to decrease temporary disability rate. And also it saved different drugs and provided Quality of life (QOL) because of low operative cicatrix. <strong>Conclusion:</strong> VATS not only gave light operative burden to patients but also decreased surgeons’ mental and physical fatigue. In the MITS automatic suture tool with expensive cost and limited indications was not used and the range of indications were wide and operating time was shortened because of procedure under direct visual field associated with thoracoscopy.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Study of the Six Minute Walk Test in Healthy Adults of 17 to 50 Years 2019-04-09T10:45:47+00:00 Moghi Chaudhari Hemant Kumar Mehta Chinmay Shah <p style="text-align: justify;"><strong>Background and Aim:</strong> Six minute walk test tells about the functional exercise capacity. Six minute walk test can be used in both normal as well as diseased individuals The aim of the present study was to find out effect of six minute walk test in healthy adults of 17-50 years. Methods: The present study is observational and cross section study.240 healthy participants who volunteered to participate were between age of 17-50 years, free from Injury and with no History of hospitalization or chronic disease influencing their exercise capacity were recruited. Anthropometric variables (age, weight, height and Body Mass Index (BMI), were recorded before and after the test along with SpO<sub>2</sub>), Heart Rate (HR), Blood Pressure (BP) as well as Borg’s Scale. <strong>Results:</strong> The statistical analysis of the data clearly shows that all the parameters like SpO<sub>2</sub>, Systolic BP, Diastolic BP and heart rate, significantly increased after the 6 min walk test. The mean values of all the parameters like SpO<sub>2</sub>, systolic BP, diastolic BP and heart rate after the 6 min walk test were calculated and compared with the mean values of same parameters before the 6 min walk test was performed. The difference in 6 min walk test among different variable like visceral fat, subcutaneous fat, skeletal muscle mass, total body fat as well as BMI were statistically significant except Waist Hip Ratio (WHR). Physiological responses of parameters like SpO<sub>2</sub>, Systolic BP, Diastolic BP and Heart rate before and after 6 minute walk test were statistically significant. (<em>P</em>˂0.05). <strong>Conclusion:</strong> Six minute walk test is beneficial to determine cardiac efficiency and early detection of cardiac diseases.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## Using Google Forms for Medical Survey: A Technical Note 2019-04-09T06:06:25+00:00 Himel Mondal Shaikat Mondal Tania Ghosal Sarika Mondal <p style="text-align: justify;">Survey is an effective way of collecting data from a large sample within a short time. Due to increased use of digital medium, online survey is gaining popularity among researchers. It enables the surveyor to collect data from any corner of the world. Though the response rate is lower than physical survey, online survey has several advantages. Hence, we felt the necessity of sharing the basics of creating an online survey with budding researchers. Google form is an online survey platform which provides the service of creating survey forms, receiving responses and analysis of data free of cost. We used this platform to describe an example of conversion of a physical questionnaire to an online form. Hope this miniature technical guide help the readers to know the basic skills to create a form online for their future studies.</p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement## News and Views 2019-04-11T06:14:39+00:00 Lalitha V <p style="text-align: justify;">Fat cells in the body have their own biological clocks and they exhibit circadian rhythms affecting various metabolic functions. Circadian rhythms are approximately 24 hour changes governed by the body’s internal clock. Imbalance between the human clock and the environment is believed to be one of the major contributor of obesity. Jonathan et al conducted several experiments on human fat cells and analyzed the circadian rhythm of the fat cells and their gene expressions were studied.[1] Researchers have identified 727 genes in the fat tissue that express their own circadian rhythm. A clear separation in gene rhythms was identified with approximately a third peaking in the morning and two thirds in the evening. Morning-peaking transcripts were associated with regulation of gene expression and nucleic acid biology while the evening –peaking transcripts were associated with redox activity and acid metabolism. These rhythms clearly show that genes within fat cells naturally complete their functions at different times during the day which could impact on their metabolic processes. Hence, fat cells don’t just store the excess energy but they are active metabolic tissues, full of their own rhythms.<sup>[1]</sup></p> 2019-03-06T00:00:00+00:00 ##submission.copyrightStatement##