1
|
Mineroff J, Maghfour J, Ozog DM, Lim HW, Kohli I, Jagdeo J. Photobiomodulation CME part II: Clinical applications in dermatology. J Am Acad Dermatol 2024:S0190-9622(24)00187-7. [PMID: 38307144 DOI: 10.1016/j.jaad.2023.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 02/04/2024]
Abstract
Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types.
Collapse
Affiliation(s)
- Jessica Mineroff
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York
| | - Jalal Maghfour
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan
| | - David M Ozog
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Henry W Lim
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Indermeet Kohli
- The Henry W. Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York.
| |
Collapse
|
2
|
Baracho VDS, Silva NCD, Peixoto MFD, Sampaio KH, Cordeiro CAF, Lucas TC. LED phototherapy in tissue repair of chronic wounds in people with diabetes: a systematic review. Rev Gaucha Enferm 2023; 44:e20220274. [PMID: 37585961 DOI: 10.1590/1983-1447.2023.20220274.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/20/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To identify scientific evidence of LED photobiomodulation in the treatment and tissue repair of chronic wounds in people with Diabetes Mellitus, types I and II. METHOD Systematic review conducted from September/2021 to April/2022 in PubMed, LILACS, SCIELO, COHRANE, EMBASE and Web of Science. Randomized and observational clinical trials using LED in wound healing in diabetics, published between 2015 and 2022 were included. Data were descriptively analyzed with title/abstract screening, full text articles reading and definitive selection after meeting the predefined inclusion and exclusion criteria. RESULTS Fromthe total of 840 references, eight articles were selected, that evaluated the effectiveness of LED phototherapy in wounds of diabetic patients. CONCLUSION LED light proved to be beneficial in tissue repair, with increased production in collagen and fibroblasts, angiogenesis, reduction of inflammation and, consequently, a decrease in lesion size.
Collapse
Affiliation(s)
- Valéria da Silva Baracho
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde. Diamantina, Minas Gerais, Brasil
| | - Natália Cristina da Silva
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde. Diamantina, Minas Gerais, Brasil
| | - Marco Fabrício Dias Peixoto
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Educação Física. Diamantina, Minas Gerais, Brasil
| | - Kinulpe Honorato Sampaio
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Medicina. Diamantina, Minas Gerais, Brasil
| | - Cláudia Aparecida Fernandes Cordeiro
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde. Diamantina, Minas Gerais, Brasil
| | - Thabata Coaglio Lucas
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Enfermagem. Diamantina, Minas Gerais , Brasil
| |
Collapse
|
3
|
Austin E, Geisler AN, Nguyen J, Kohli I, Hamzavi I, Lim HW, Jagdeo J. Visible light. Part I: Properties and cutaneous effects of visible light. J Am Acad Dermatol 2021; 84:1219-1231. [PMID: 33640508 DOI: 10.1016/j.jaad.2021.02.048] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022]
Abstract
Approximately 50% of the sunlight reaching the Earth's surface is visible light (400-700 nm). Other sources of visible light include lasers, light-emitting diodes, and flash lamps. Photons from visible light are absorbed by photoreceptive chromophores (e.g., melanin, heme, and opsins), altering skin function by activating and imparting energy to chromophores. Additionally, visible light can penetrate the full thickness of the skin and induce pigmentation and erythema. Clinically, lasers and light devices are used to treat skin conditions by utilizing specific wavelengths and treatment parameters. Red and blue light from light-emitting diodes and intense pulsed light have been studied as antimicrobial and anti-inflammatory treatments for acne. Pulsed dye lasers are used to treat vascular lesions in adults and infants. Further research is necessary to determine the functional significance of visible light on skin health without confounding the influence of ultraviolet and infrared wavelengths.
Collapse
Affiliation(s)
- Evan Austin
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York
| | | | - Julie Nguyen
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York
| | - Indermeet Kohli
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Iltefat Hamzavi
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Henry W Lim
- Department of Dermatology, Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan
| | - Jared Jagdeo
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, VA New York Harbor Healthcare System, Brooklyn Campus, Brooklyn, New York.
| |
Collapse
|
4
|
Bavaresco T, Pires AUB, Moraes VM, Osmarin VM, Silveira DT, Lucena ADF. Low-level laser therapy for treatment of venous ulcers evaluated with the Nursing Outcome Classification: study protocol for a randomized controlled trial. Trials 2018; 19:372. [PMID: 30001202 PMCID: PMC6044085 DOI: 10.1186/s13063-018-2729-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/07/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Different methods are available for the treatment of venous ulcers. Most current approaches focus on a combination of topical and compressive therapy. Adjuvant low-level laser therapy may be helpful in lesions with a protracted healing course, but evidence for its use is still limited. This paper describes the protocol of a randomized controlled trial designed to compare the effect of adjuvant low-level laser therapy versus conventional venous ulcer tissue repair, evaluated by a nurse using clinical indicators from the Nursing Outcomes Classification (NOC). METHODS/DESIGN For this prospective randomized controlled trial, 40 adult patients of both sexes with active venous ulcers will be recruited. Subjects will be selected by the sealed-envelope method without any annotation or external identification that might refer to the type of study group. At the time of unblinding, a label with the description of the group to which the patient belongs (that is, control or intervention) will be found inside the envelope. Conventional treatment (topical medication and compressive therapy) will be offered to both groups. Additionally, the intervention group will receive adjuvant low-level laser therapy. All patients will be followed weekly until ulcer healing or for a maximum of 16 weeks. Evaluation of tissue repair will be based on 14 clinical indicators drawn from NOC for wound healing (secondary intention) and tissue integrity (skin and mucous membranes). The primary endpoint will be decreased wound size and scar formation. This laser therapy is expected to enhance the quality, speed, and effectiveness of the treatment of venous ulcers, a chronic condition. This should reduce associated costs to the health service and allow patients to resume their daily activities sooner. DISCUSSION This randomized clinical trial will use a validated method to investigate the effect of a novel intervention for the treatment of venous ulcers. TRIAL REGISTRATION ClinicalTrials.gov, NCT03229330 . Registered on July 2017.
Collapse
Affiliation(s)
- Taline Bavaresco
- Nursing School at Universidade Federal do Rio Grande do Sul, São Manoel, 963, Rio Branco, Porto Alegre, 90620-110, Brazil. .,, Caxias do Sul, Brazil.
| | - Ananda Ughini Bertoldo Pires
- Nursing School at Universidade Federal do Rio Grande do Sul, São Manoel, 963, Rio Branco, Porto Alegre, 90620-110, Brazil
| | - Vítor Monteiro Moraes
- Nursing School at Universidade Federal do Rio Grande do Sul, São Manoel, 963, Rio Branco, Porto Alegre, 90620-110, Brazil
| | - Viviane Maria Osmarin
- Nursing School at Universidade Federal do Rio Grande do Sul, São Manoel, 963, Rio Branco, Porto Alegre, 90620-110, Brazil
| | - Denise Tolfo Silveira
- Nursing School at Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, São Manoel, 963, Rio Branco, Porto Alegre, 90620-110, Brazil
| | - Amália de Fátima Lucena
- Nursing School at Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, São Manoel, 963, Rio Branco, Porto Alegre, 90620-110, Brazil.,Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Santa Cecilia, Porto Alegre, RS, 90035-903, Brazil
| |
Collapse
|
5
|
Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev 2018; 6:CD012583. [PMID: 29906322 PMCID: PMC6513558 DOI: 10.1002/14651858.cd012583.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Venous leg ulcers are open skin wounds on the lower leg which can be slow to heal, and are both painful and costly. The point prevalence of open venous leg ulcers in the UK is about 3 cases per 10,000 people, and many people experience recurrent episodes of prolonged ulceration. First-line treatment for venous leg ulcers is compression therapy, but a wide range of dressings and topical treatments are also used. This diversity of treatments makes evidence-based decision-making challenging, and a clear and current overview of all the evidence is required. This review is a network meta-analysis (NMA) which assesses the probability of complete ulcer healing associated with alternative dressings and topical agents. OBJECTIVES To assess the effects of (1) dressings and (2) topical agents for healing venous leg ulcers in any care setting and to rank treatments in order of effectiveness, with assessment of uncertainty and evidence quality. SEARCH METHODS In March 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also scanned reference lists of relevant included studies as well as reviews, meta-analyses, guidelines and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We updated this search in March 2018; as a result several studies are awaiting classification. SELECTION CRITERIA We included published or unpublished randomised controlled trials (RCTs) that enrolled adults with venous leg ulcers and compared the effects of at least one of the following interventions with any other intervention in the treatment of venous leg ulcers: any dressing, or any topical agent applied directly to an open venous leg ulcer and left in situ. We excluded from this review dressings attached to external devices such as negative pressure wound therapies, skin grafts, growth factors and other biological agents, larval therapy and treatments such as laser, heat or ultrasound. Studies were required to report complete wound healing to be eligible. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We conducted this NMA using frequentist meta-regression methods for the efficacy outcome; the probability of complete healing. We assumed that treatment effects were similar within dressings classes (e.g. hydrocolloid, foam). We present estimates of effect with their 95% confidence intervals (CIs) for individual treatments focusing on comparisons with widely used dressing classes, and we report ranking probabilities for each intervention (probability of being the best, second best, etc treatment). We assessed the certainty (quality) of the body of evidence using GRADE for each network comparison and for the network as whole. MAIN RESULTS We included 78 RCTs (7014 participants) in this review. Of these, 59 studies (5156 participants, 25 different interventions) were included in the NMA; resulting in 40 direct contrasts which informed 300 mixed-treatment contrasts.The evidence for the network as a whole was of low certainty. This judgement was based on the sparsity of the network leading to imprecision and the general high risk of bias in the included studies. Sensitivity analyses also demonstrated instability in key aspects of the network and results are reported for the extended sensitivity analysis. Evidence for individual contrasts was mainly judged to be low or very low certainty.The uncertainty was perpetuated when the results were considered by ranking the treatments in terms of the probability that they were the most effective for ulcer healing, with many treatments having similar, low, probabilities of being the best treatment. The two most highly-ranked treatments both had more than 50% probability of being the best (sucralfate and silver dressings). However, the data for sucralfate was from one small study, which means that this finding should be interpreted with caution. When exploring the data for silver and sucralfate compared with widely-used dressing classes, there was some evidence that silver dressings may increase the probability of venous leg ulcer healing, compared with nonadherent dressings: RR 2.43, 95% CI 1.58 to 3.74 (moderate-certainty evidence in the context of a low-certainty network). For all other combinations of these five interventions it was unclear whether the intervention increased the probability of healing; in each case this was low- or very low-certainty evidence as a consequence of one or more of imprecision, risk of bias and inconsistency. AUTHORS' CONCLUSIONS More research is needed to determine whether particular dressings or topical agents improve the probability of healing of venous leg ulcers. However, the NMA is uninformative regarding which interventions might best be included in a large trial, largely because of the low certainty of the whole network and of individual comparisons.The results of this NMA focus exclusively on complete healing; whilst this is of key importance to people living with venous leg ulcers, clinicians may wish to take into account other patient-important outcomes and factors such as patient preference and cost.
Collapse
Affiliation(s)
- Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Amber D Rithalia
- Independent Researcher7 Victoria Terrace, KirkstallLeedsUKLS5 3HX
| | - Nikki Stubbs
- St Mary's HospitalLeeds Community Healthcare NHS Trust3 Greenhill RoadLeedsUKLS12 3QE
| | - Marta O Soares
- University of YorkCentre for Health EconomicsAlcuin 'A' BlockHeslingtonYorkUKYO10 5DD
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | | |
Collapse
|
6
|
Jagdeo J, Austin E, Mamalis A, Wong C, Ho D, Siegel DM. Light-emitting diodes in dermatology: A systematic review of randomized controlled trials. Lasers Surg Med 2018; 50:613-628. [PMID: 29356026 PMCID: PMC6099480 DOI: 10.1002/lsm.22791] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE In dermatology, patient and physician adoption of light-emitting diode (LED) medical technology continues to grow as research indicates that LEDs may be used to treat skin conditions. The goal of this systematic review is to critically analyze published randomized controlled trials (RCTs) and provide evidence-based recommendations on the therapeutic uses of LEDs in dermatology based on published efficacy and safety data. METHODS A systematic review of the published literature on the use of LED treatments for skin conditions was performed on September 13th 2017. RESULTS Thirty-one original RCTs were suitable for review. CONCLUSIONS LEDs represent an emerging modality to alter skin biology and change the paradigm of managing skin conditions. Acne vulgaris, herpes simplex and zoster, and acute wound healing received grade of recommendation B. Other skin conditions received grade of recommendation C or D. Limitations of some studies include small patient sample sizes (n < 20), absent blinding, no sham placebo, and varied treatment parameters. Due to few incidences of adverse events, affordability, and encouraging clinical results, we recommend that physicians use LEDs in clinical practice and researchers continue to explore the use of LEDs to treat skin conditions. Lasers Surg. Med. 9999:1-16, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jared Jagdeo
- Department of DermatologyUniversity of California at DavisSacramentoCalifornia
- Dermatology ServiceSacramento VA Medical CenterMatherCalifornia
- Department of DermatologyDownstate Medical CenterState University of New YorkBrooklynNew York
| | - Evan Austin
- Department of DermatologyUniversity of California at DavisSacramentoCalifornia
- Dermatology ServiceSacramento VA Medical CenterMatherCalifornia
| | - Andrew Mamalis
- Department of DermatologyDownstate Medical CenterState University of New YorkBrooklynNew York
| | | | - Derek Ho
- Department of DermatologyUniversity of California at DavisSacramentoCalifornia
- Dermatology ServiceSacramento VA Medical CenterMatherCalifornia
| | - Daniel M. Siegel
- Department of DermatologyDownstate Medical CenterState University of New YorkBrooklynNew York
| |
Collapse
|
7
|
Vitse J, Bekara F, Byun S, Herlin C, Teot L. A Double-Blind, Placebo-Controlled Randomized Evaluation of the Effect of Low-Level Laser Therapy on Venous Leg Ulcers. INT J LOW EXTR WOUND 2017; 16:29-35. [DOI: 10.1177/1534734617690948] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to determine the effect of low-level laser therapy (LLLT) on chronic venous leg ulcers (VLUs). A double-blinded prospective randomized controlled trial was conducted to compare incidence of complete wound closure, ulcer size and pain reduction in patients randomized to 24 treatments of placebo or LLLT (635 nm) over 12 weeks. Patients presented with a 6-week history of VLUs ranging in size from 5 to 20 cm2. Venous origin was confirmed by Doppler ultrasound and an ankle brachial index of 0.8 or greater. Of 24 patients, 23% of the test group (n = 13) and 18% of placebo group (n = 11) achieved complete wound closure. At 12 weeks, patients in test and placebo groups had a mean surface area reduction of 6.26 cm2 ( P < .0001) and 6.72 cm2 ( P < .005), respectively, and a mean pain score decrease of 43.54 points ( P < .0001) and 25.73 points ( P = .002) respectively. Differences between groups was not statistically significant for wound closure ( P = 1.0) or ulcer size ( P = .80). Mean ulcer pain was significantly reduced from initiation of treatment compared with 4 weeks’ follow-up after 12 weeks with LLLT ( P < .01). Within the limitations of the study, LLLT may not have early effects as an adjunctive therapy to wound healing of VLUs, but LLLT may have delayed effects on VLU healing and associated pain, which requires further study.
Collapse
Affiliation(s)
- Julian Vitse
- Montpellier University Hospital, Montpellier, France
| | - Farid Bekara
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Byun
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Luc Teot
- Montpellier University Hospital, Montpellier, France
| |
Collapse
|
8
|
Light-emitting diodes at 940 nm attenuate colitis-induced inflammatory process in mice. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2016; 162:367-373. [DOI: 10.1016/j.jphotobiol.2016.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 12/31/2022]
|
9
|
França CM, Anders JJ, Lanzafame RJ. Photobiomodulation in Wound Healing: What Are We Not Considering? Photomed Laser Surg 2016; 34:51-2. [DOI: 10.1089/pho.2015.4073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Cristiane Miranda França
- Post Graduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, Sao Paulo, Sao Paulo, Brazil
| | - Juanita J. Anders
- Department of Anatomy, Physiology, and Genetics, Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | |
Collapse
|