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Modelling and Control of Non-invasive Vagus Nerve Stimulation for Autoimmune Diseases (1A) (VaNeSA)

Primary Purpose

Systemic Lupus Erythematosus, Autoimmune Disorder, Vagus Nerve Autonomic Disorder

Status
Recruiting
Phase
Not Applicable
Locations
Spain
Study Type
Interventional
Intervention
Parasym 1Hz
Parasym 30Hz
Sham Intervention
Sponsored by
Hospital Clinic of Barcelona
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional screening trial for Systemic Lupus Erythematosus focused on measuring Parasympathetic Nervous System, Vagus Nerve Stimulation

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Systemic lupus erythematosus (SLE) (defined by the American College of Rheumatology- or SLICC criteria) Musculoskeletal pain ≥ 4 on a non-anchored VAS 10 cm scale BILAG C on Musculoskeletal Domain of the BILAG 2004 If on corticosteroids, the dose must be stable and ≤ 10mg/day (prednisone or equivalent) for at least 28 days before baseline, If on background immunosuppressive treatment the dose must be stable for at least 28 days before baseline Able and willing to give written informed consent and comply with the requirements of the study protocol. Exclusion Criteria: Treatment with rituximab within one year of baseline as it is related to lymphocyte depletion that could alter the result of the biomarker study (subjects with previous treatment with rituximab can enter study only with documentation of B cell repletion). Treatment with cyclophosphamide within 2 months of baseline as it is related to lymphocyte depletion that could alter the result of the biomarker study. Expectation to increase steroids and/or immunosuppressive treatment. Anti-phospholipid syndrome. Fibromyalgia (fibromyalgia will be defined as a score > 13 on the Fibromyalgia Symptom Scale), chronic fatigue syndrome. Treatment with an anti-cholinergic or sympathicomimetic medication, including over the counter medications. Implantable electronic devices such as pacemakers, defibrillators, hearing aids, cochlear implants or deep brain stimulators. Joint replacement within 60 days prior to study enrolment or planned within the course of the study. Any planned surgical procedure requiring general anaesthesia within the course of the study. Intra-articular cortisone injections within 28 days of the start of study. Chronic inflammatory disorders apart from SLE affecting the joints. Investigational drug and/or treatment during the 28 days or seven half-lives of the investigational drug prior to the start of study drug dosing (Day 0), whichever is the greater length of time. Active infection including hepatitis B, hepatitis C or HIV at baseline due to high prevalence of neuropathy. Any condition which, in the opinion of the investigator, would jeopardize the subject's safety following exposure to a study intervention. Pregnancy or lactation. Haemoglobin below 9.0 gm/dL (by the most recent CBC) as anaemia is related to no- neurogenic orthostatic hypotension and increases cardiovascular symptoms in COMPASS 31 scale Comorbid disease that may require administration of corticosteroid use. Inability to comply with study and follow-up procedures. Known cardiac arrhythmia, severe cardiac disease or neurodegenerative disease. Known or confirmed at baseline screening peripheral or autonomic nervous system involvement, including LES-related, toxic polyneuropathies, metabolic neuropathies (including diabetes), etc. Previous experience with vagus nerve stimulation devices

Sites / Locations

  • Hospital ClinicRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Sham Comparator

Experimental

Experimental

Arm Label

Sham

30 hertz (Hz) Stimulation

1Hz Stimulation

Arm Description

Control group to be subjected to sham stimulation.

Group of patients treated via 30Hz transcutaneous electrical nerve stimulation

Group of patients treated via 1Hz transcutaneous electrical nerve stimulation

Outcomes

Primary Outcome Measures

Number of patients with Systemic Lupus Erythematosus with clinical and analytic change after non-invasive vagus nerve stimulation (nVNS) at different waveform parameters
We will develop an nVNS platform with an integrated nVNS decision support system, including nVNS and physiological wearable sensors, that will optimize nVNS waveform parameters to maximize the therapeutic effect while minimizing unwanted side effects. Therapeutic effect and side effects will be measured by clinical, neurophysiological and analytic tests as described in "secondary outcome measures".

Secondary Outcome Measures

Blood count
Complete blood count
Erythrocyte sedimentation rate
Marker of inflammatory conditions, mm/h
C-reactive protein
Markers of inflammatory conditions, mg/dl
Anti-dsDNA
Serological marker of activity in Systemic lupus erythematosus (SLE) ui/ml
C3, C4
Serological markers of activity in Systemic lupus erythematosus (SLE) g/l
Tumoral necrosis factor (TNF), Interleukin (IL) -6, IL-10 and Il1B
Levels of pro-inflammatory cytokines, pg/ml
High mobility group box 1 protein (HMGB1)
Levels of pro-inflammatory cytokines, ui
Alpha interferon (IFNα)
Ratios of IFNα protein, ui
EuroQol-5D (EQ-5D-5L),
EQ-5D-5L questionaries. Minimum 1, maximum 3, higher scores mean a worse outcome.
Lupus Patient-Reported Outcome (LupusPRO)
Lupus PRO questionaries. Minimum 0, maximum 5, higher scores mean a worse outcome.
Lupus Quality of Life (LupusQoL)
Lupus QoL questionaries. Minimum 1, maximum 7, higher scores mean a worse outcome.
Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)
FACIT-F scale. Minimum 0, maximum 4, higher scores mean a worse outcome.
Fatigue Severity Scale (FSS)
FSS. Minimum 1, maximum 7, higher scores mean a worse outcome.
Composite Autonomic Symptom Score (Compass-31)
Self-scoring Compass 31 autonomic assessment. Minimum 0, maximum 100, higher scores mean a worse outcome.
28-joint count
28-joint count will be used to assess articular involvement.
Physician's Global Assessment (PGA)
PGA as non-specific activity scale. Minimum 0, maximum 3, higher scores mean a worse outcome.
Patients' Global Assessment (PtGA)
PtGA as non-specific activity scale. Minimum 0, maximum 100, higher scores mean a worse outcome.
Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI)
CLASI will be used to evaluate skin involvement.Minimum 0, maximum 100, higher scores mean a worse outcome.
Numeric scale ranges (NRS)
11-point NRS scale for pain. Minimum 0, maximum 10, higher scores mean a worse outcome.
Visual Analog Scale (VAS)
VSA for pain. Minimum 0, maximum 10, higher scores mean a worse outcome.
High-frequency power, low-frequency power
Continuous electrocardiogram will be recorded at rest for 5 minutes for heart rate variability (HRV) analysis (high-frequency power HF, low-frequency power LF), m2
LF to HF power ratio
Continuous electrocardiogram will be recorded at rest for 5 minutes for heart rate variability (HRV) analysis ( LF to HF power ratio)
Cardiovagal evaluation. (Composite autonomic scoring scale)
Continuous electrocardiogram heart rate changes during deep breathing and postural changes (beats per minute).Composite autonomic scoring scale minimun 0, maximum 3, higher scores mean a worse outcome.
Vasalva ratio
Continuous electrocardiogram heart rate changes during Valsalva manoeuvre (ratio).
Sympathetic evaluation (Composite autonomic scoring scale)
Beat-to-beat blood pressure changes to isometric exercise, Valsalva manoeuvre and postural changes, (mmHg). Composite autonomic scoring scale minimun 0, maximum 4, higher scores mean a worse outcome.
Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K)
Disease-specific activity scale. Minimum 0, maximum 105, higher scores mean a worse outcome.
BILAG-2004
Disease-specific activity scale. Minimum 0, maximum 32, higher scores mean a worse outcome.

Full Information

First Posted
October 4, 2022
Last Updated
January 19, 2023
Sponsor
Hospital Clinic of Barcelona
Collaborators
Universitat de Girona, Hospital Mutua de Terrassa, Imperial College London, Johns Hopkins University
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1. Study Identification

Unique Protocol Identification Number
NCT05704153
Brief Title
Modelling and Control of Non-invasive Vagus Nerve Stimulation for Autoimmune Diseases (1A)
Acronym
VaNeSA
Official Title
Modelling and Control of Non-invasive Vagus Nerve Stimulation for Autoimmune Diseases (1A)
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 30, 2022 (Actual)
Primary Completion Date
October 2023 (Anticipated)
Study Completion Date
October 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hospital Clinic of Barcelona
Collaborators
Universitat de Girona, Hospital Mutua de Terrassa, Imperial College London, Johns Hopkins University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The overall goal of this clinical trial is to evaluate the causality relationship between the non vagus nerve stimulation waveform parameters and the therapeutic effect. Thus, unlocking a pathway to optimize parameters that maximize the benefits of therapy and minimize unwanted side effects. The experimental design includes the analysis of physiological signals, clinical biomarkers of disease, and clinical outcomes to determine the most effective measures for the monitoring, optimization, and personalization of non vagus nerve stimulation in systemic lupus erythematosus disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Systemic Lupus Erythematosus, Autoimmune Disorder, Vagus Nerve Autonomic Disorder
Keywords
Parasympathetic Nervous System, Vagus Nerve Stimulation

7. Study Design

Primary Purpose
Screening
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
VaNeSA is a multicentre, national, randomized, double-blind, parallel-group, placebo-controlled, outpatient study.
Masking
Participant
Allocation
Randomized
Enrollment
18 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Sham
Arm Type
Sham Comparator
Arm Description
Control group to be subjected to sham stimulation.
Arm Title
30 hertz (Hz) Stimulation
Arm Type
Experimental
Arm Description
Group of patients treated via 30Hz transcutaneous electrical nerve stimulation
Arm Title
1Hz Stimulation
Arm Type
Experimental
Arm Description
Group of patients treated via 1Hz transcutaneous electrical nerve stimulation
Intervention Type
Device
Intervention Name(s)
Parasym 1Hz
Intervention Description
Transcutaneous auricular vagus nerve stimulation of 1Hz
Intervention Type
Device
Intervention Name(s)
Parasym 30Hz
Intervention Description
Transcutaneous Auricular Vagus Nerve Stimulation of 30Hz
Intervention Type
Device
Intervention Name(s)
Sham Intervention
Intervention Description
Sham stimulation
Primary Outcome Measure Information:
Title
Number of patients with Systemic Lupus Erythematosus with clinical and analytic change after non-invasive vagus nerve stimulation (nVNS) at different waveform parameters
Description
We will develop an nVNS platform with an integrated nVNS decision support system, including nVNS and physiological wearable sensors, that will optimize nVNS waveform parameters to maximize the therapeutic effect while minimizing unwanted side effects. Therapeutic effect and side effects will be measured by clinical, neurophysiological and analytic tests as described in "secondary outcome measures".
Time Frame
Visit 1(baseline, exploratory study, up to 30days prior to first nVNS)
Secondary Outcome Measure Information:
Title
Blood count
Description
Complete blood count
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Erythrocyte sedimentation rate
Description
Marker of inflammatory conditions, mm/h
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
C-reactive protein
Description
Markers of inflammatory conditions, mg/dl
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Anti-dsDNA
Description
Serological marker of activity in Systemic lupus erythematosus (SLE) ui/ml
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
C3, C4
Description
Serological markers of activity in Systemic lupus erythematosus (SLE) g/l
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Tumoral necrosis factor (TNF), Interleukin (IL) -6, IL-10 and Il1B
Description
Levels of pro-inflammatory cytokines, pg/ml
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
High mobility group box 1 protein (HMGB1)
Description
Levels of pro-inflammatory cytokines, ui
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Alpha interferon (IFNα)
Description
Ratios of IFNα protein, ui
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
EuroQol-5D (EQ-5D-5L),
Description
EQ-5D-5L questionaries. Minimum 1, maximum 3, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels and 1 month after nVNS.
Title
Lupus Patient-Reported Outcome (LupusPRO)
Description
Lupus PRO questionaries. Minimum 0, maximum 5, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Lupus Quality of Life (LupusQoL)
Description
Lupus QoL questionaries. Minimum 1, maximum 7, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)
Description
FACIT-F scale. Minimum 0, maximum 4, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Fatigue Severity Scale (FSS)
Description
FSS. Minimum 1, maximum 7, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Composite Autonomic Symptom Score (Compass-31)
Description
Self-scoring Compass 31 autonomic assessment. Minimum 0, maximum 100, higher scores mean a worse outcome.
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
28-joint count
Description
28-joint count will be used to assess articular involvement.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Physician's Global Assessment (PGA)
Description
PGA as non-specific activity scale. Minimum 0, maximum 3, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Patients' Global Assessment (PtGA)
Description
PtGA as non-specific activity scale. Minimum 0, maximum 100, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI)
Description
CLASI will be used to evaluate skin involvement.Minimum 0, maximum 100, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Numeric scale ranges (NRS)
Description
11-point NRS scale for pain. Minimum 0, maximum 10, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Visual Analog Scale (VAS)
Description
VSA for pain. Minimum 0, maximum 10, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
High-frequency power, low-frequency power
Description
Continuous electrocardiogram will be recorded at rest for 5 minutes for heart rate variability (HRV) analysis (high-frequency power HF, low-frequency power LF), m2
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
LF to HF power ratio
Description
Continuous electrocardiogram will be recorded at rest for 5 minutes for heart rate variability (HRV) analysis ( LF to HF power ratio)
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Cardiovagal evaluation. (Composite autonomic scoring scale)
Description
Continuous electrocardiogram heart rate changes during deep breathing and postural changes (beats per minute).Composite autonomic scoring scale minimun 0, maximum 3, higher scores mean a worse outcome.
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Vasalva ratio
Description
Continuous electrocardiogram heart rate changes during Valsalva manoeuvre (ratio).
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Sympathetic evaluation (Composite autonomic scoring scale)
Description
Beat-to-beat blood pressure changes to isometric exercise, Valsalva manoeuvre and postural changes, (mmHg). Composite autonomic scoring scale minimun 0, maximum 4, higher scores mean a worse outcome.
Time Frame
Baseline, after five days of stimulation and 1 month after stimulation. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K)
Description
Disease-specific activity scale. Minimum 0, maximum 105, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels
Title
BILAG-2004
Description
Disease-specific activity scale. Minimum 0, maximum 32, higher scores mean a worse outcome.
Time Frame
Baseline, days 1-2-3-4-5 of nVNS, after five days of nVNS, after 2 weeks of nVNS, after3 weeks of nVSN. Additionally, 2 and 3months after stimulation if the biomarkers and scales of activity do not return to baseline levels

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Systemic lupus erythematosus (SLE) (defined by the American College of Rheumatology- or SLICC criteria) Musculoskeletal pain ≥ 4 on a non-anchored VAS 10 cm scale BILAG C on Musculoskeletal Domain of the BILAG 2004 If on corticosteroids, the dose must be stable and ≤ 10mg/day (prednisone or equivalent) for at least 28 days before baseline, If on background immunosuppressive treatment the dose must be stable for at least 28 days before baseline Able and willing to give written informed consent and comply with the requirements of the study protocol. Exclusion Criteria: Treatment with rituximab within one year of baseline as it is related to lymphocyte depletion that could alter the result of the biomarker study (subjects with previous treatment with rituximab can enter study only with documentation of B cell repletion). Treatment with cyclophosphamide within 2 months of baseline as it is related to lymphocyte depletion that could alter the result of the biomarker study. Expectation to increase steroids and/or immunosuppressive treatment. Anti-phospholipid syndrome. Fibromyalgia (fibromyalgia will be defined as a score > 13 on the Fibromyalgia Symptom Scale), chronic fatigue syndrome. Treatment with an anti-cholinergic or sympathicomimetic medication, including over the counter medications. Implantable electronic devices such as pacemakers, defibrillators, hearing aids, cochlear implants or deep brain stimulators. Joint replacement within 60 days prior to study enrolment or planned within the course of the study. Any planned surgical procedure requiring general anaesthesia within the course of the study. Intra-articular cortisone injections within 28 days of the start of study. Chronic inflammatory disorders apart from SLE affecting the joints. Investigational drug and/or treatment during the 28 days or seven half-lives of the investigational drug prior to the start of study drug dosing (Day 0), whichever is the greater length of time. Active infection including hepatitis B, hepatitis C or HIV at baseline due to high prevalence of neuropathy. Any condition which, in the opinion of the investigator, would jeopardize the subject's safety following exposure to a study intervention. Pregnancy or lactation. Haemoglobin below 9.0 gm/dL (by the most recent CBC) as anaemia is related to no- neurogenic orthostatic hypotension and increases cardiovascular symptoms in COMPASS 31 scale Comorbid disease that may require administration of corticosteroid use. Inability to comply with study and follow-up procedures. Known cardiac arrhythmia, severe cardiac disease or neurodegenerative disease. Known or confirmed at baseline screening peripheral or autonomic nervous system involvement, including LES-related, toxic polyneuropathies, metabolic neuropathies (including diabetes), etc. Previous experience with vagus nerve stimulation devices
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Judith Navarro, MD
Phone
0034
Email
JNAVARR1@clinic.cat
Facility Information:
Facility Name
Hospital Clinic
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Judith Navarro, MD
Phone
93 227 54 00

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
https://micelab.udg.edu/projects/
Description
Framework of the general project lead by Iván Contreras : VaNeSA

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Modelling and Control of Non-invasive Vagus Nerve Stimulation for Autoimmune Diseases (1A)

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