1
|
Immune Cells in Cutaneous Wound Healing: A Review of Functional Data from Animal Models. Int J Mol Sci 2022; 23:ijms23052444. [PMID: 35269586 PMCID: PMC8910456 DOI: 10.3390/ijms23052444] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
The healing of skin wounds involves the activation and recruitment of various immune cell types, many of which are believed to contribute significantly to different aspects of the repair process. Roles for immune cells have been described in practically all stages of wound healing, including hemostasis, inflammation, proliferation and scar formation/remodeling. Over the last decade, tools to deplete immune cell populations in animal models have become more advanced, leading to a surge in the number of studies examining the function of specific immune cell types in skin repair. In this review, we will summarize what is known about distinct immune cell types in cutaneous wound healing, with an emphasis on data from animal studies in which specific cell types have been targeted.
Collapse
|
2
|
Massara M, Pucci G, Stilo G, Alberti A, Surace R, Foti G, Volpe P. The role of the cord blood platelet gel in the management of a diabetic foot with tendon exposure. Regen Med 2021; 16:1051-1056. [PMID: 34558982 DOI: 10.2217/rme-2021-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diabetic foot infection is frequent in diabetic patients and is due to neuropathy, trauma or peripheral arterial disease. The presence of an abscess requires urgent drainage and specific antibiotic therapy. Patients with critical limb ischemia need revascularization and, subsequently the intervention of a plastic surgeon is often required in cases of exposure of tendons and ligaments. During the COVID-19 pandemic, a patient was refered to our department with an abscess on the dorsum of the left foot. After urgent drainage with tendon exposure, he started specific antibiotic therapy and underwent tibial vessels angioplasty. After infection healing cord blood platelet gel was applied, accelerating the healing process, with injection of its liquid part into the exposed tendons, thus retaining the vital functions of the tendons.
Collapse
Affiliation(s)
- Mafalda Massara
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
| | - Giulia Pucci
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89214, Italy
| | - Giuseppe Stilo
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
| | - Antonino Alberti
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
| | - Rosangela Surace
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89214, Italy
| | - Giovanni Foti
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89214, Italy
| | - Pietro Volpe
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, 89124, Italy
| |
Collapse
|
3
|
Volpe P, Pucci G, Stilo G, Alberti A, Foti G, Surace R, Massara M. Use of cord blood platelet gel to enhance healing of deep surgical site dehiscences after peripheral bypass. Regen Med 2020; 15:1951-1956. [PMID: 33118483 DOI: 10.2217/rme-2020-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Surgical site dehiscence after lower limb revascularization through bypass represents a serious postoperative complication, especially in diabetic and obese patients, with subsequent risk of early graft failure, infection, sepsis, hemorrhage, major amputation and sometimes death. To prevent bypass exposure and subsequent complications, physicians recur to reoperation, antibiotic therapy, advanced dressing and vacuum-assisted closure therapy. To improve the process of wound healing, cord blood platelet gel can be used to fill deep and large wounds. Growth factors released from platelets in the cord blood platelet gel stimulate the process of healing and allow patients to be followed up in Outpatient Surgery, thus reducing hospital stay and costs, while providing excellent results.
Collapse
Affiliation(s)
- Pietro Volpe
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Giulia Pucci
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Giuseppe Stilo
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Antonino Alberti
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Giovanni Foti
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Rosangela Surace
- Calabria Cord Blood Bank, Service of Immunohaematology & Transfusion Medicine, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| | - Mafalda Massara
- Unit of Vascular & Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", 89124 Reggio Calabria, Italy
| |
Collapse
|
4
|
Grande R, Fiori G, Russo G, Fioramonti P, Campagnol M, di Marzo L. A multistage combined approach to promote diabetic wound healing in COVID-19 era. Int Wound J 2020; 17:1863-1870. [PMID: 32820598 PMCID: PMC7461201 DOI: 10.1111/iwj.13476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022] Open
Abstract
When diabetes mellitus is not properly controlled with drugs and a healthy lifestyle, it exposes patients with advanced peripheral arterial disease or critical limb ischaemia (CLI) to the most serious complications, in particular lower limb ulcers. Surgical or endovascular treatments represent the first line of intervention; in addition, the adequate management of ulcers can guarantee not only a faster wound healing but also the improvement of the patient's prognosis. To speed up this process, negative pressure wound therapy (NPWT), platelet-rich plasma (PRP), and other advanced moist wound dressing have been proposed. During Coronavirus disease 2019 (COVID-19) pandemic, many patients with CLI and diabetes mellitus had difficult access to advanced treatments with a significant reduction in life expectancy. We report the cases of patients with non-healing ulcers and CLI treated with an empiric multistage approach after successful endovascular revascularisation; the postoperative course was eventful in all patients, and foot ulcers are currently in an advanced state of healing. The association between adequate revascularisation, systemic anti-inflammatory, and antibiotic therapy with the multistage advanced medications ensures healing of ulcers, limb salvage, and improvement of patient prognosis.
Collapse
Affiliation(s)
- Raffaele Grande
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Giulia Fiori
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Giulia Russo
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Paolo Fioramonti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Monica Campagnol
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Luca di Marzo
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
5
|
Histopathologic Evaluation of the Effects of Intraurethral Platelet Rich Plasma in Urethral Trauma Experimentally Induced in Rat Model. Urology 2020; 141:187.e9-187.e14. [PMID: 32302623 DOI: 10.1016/j.urology.2020.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/08/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the efficacy of platelet rich plasma applied early initialization after urethral trauma for preventing inflammation and spongiofibrosis. MATERIALS AND METHODS Twenty-three rats were randomized and divided into 3 groups, with 10 rats in 2 groups. Only sham group had 3 rats. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6- and 12-o'clock. For 15 days, group I was given platelet rich plasma (PRP) once a day without urethral injury (sham group), group II (n = 10) was not given any medical treatment only urethral injury group (UI-PRP), group III (n = 10) was given PRP once a day intraurethrally as instillation using a 22 ga catheter sheath with urethral injury (UI+PRP). On day 15, the penises of the rats were degloved to perform penectomy. RESULTS A significant difference was detected in all parameters when the sham, UI-PRP, UI+PRP groups were compared (respectively, P = .001, / <.001, / .008 / .007) and a significant difference was observed among mucosal inflammation, fibrosis, and edema parameters when UI-PRP and UI+PRP groups were compared. (Respectively; P <.001, / <.001 / .006). CONCLUSION In this study, it was shown that intraurethral PRP applied after urethral trauma significantly decreased mucosal inflammation, spongiofibrosis, and edema. Depending on the results we acquired in this study, we think that PRP may be a promising option in urethral stricture treatment.
Collapse
|
6
|
Orrapin S, Rekasem K. Role of Topical Biological Therapies and Dressings in Healing Ischemic Wounds. INT J LOW EXTR WOUND 2018. [DOI: 10.1177/1534734618815360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ischemic wounds are the most severe expression of critical limb ischemia (CLI), and they have been defined clinically as an end stage of peripheral arterial disease. Urgent revascularization is a fundamental part for limb salvage in patients with CLI. However, the risk of revascularization should be weighed against the likelihood of success given a patient’s life-threatening comorbidities. Once the condition of arterial insufficiency is revascularized, wound care is an important aspect to promote the wound healing process and infection control. MOIST concept for wound care is a modern systematic treatment for enhanced wound healing process. Currently, advanced biological therapies are emerging in ischemic wound therapies to restore the wound healing process and involve active biological agents to support the wound healing process. We studied and summarized the different types of available topical biological therapies and their mechanisms on the healing process including platelet-derived growth factor, epidermal growth factor, fibroblast growth factor, and vascular endothelial growth factor, platelet-rich plasma, and honey for local wound care of patient with CLI. Our review suggests that topical platelet-derived growth factor, epidermal growth factor, platelet-rich plasma, and honey are available as well as considered in the ischemic wound healing process enhancement through the MOIST concept. In conclusion, biologic wound dressing or topical agent therapy may improve the wound healing process, increase limb salvage, is inexpensive, and provides potential safety with nontoxic low-risk therapy in patients with an ischemic wound. Thus, local wound care by biological dressing should be added in adjuvant treatment for ischemic wound patients. However, further randomized studies are needed to support efficacy and long-term outcomes of these biological dressing in patients with ischemic wound.
Collapse
Affiliation(s)
- Saritphat Orrapin
- Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
| | | |
Collapse
|
7
|
Olivieri B, Yates TE, Vianna S, Adenikinju O, Beasley RE, Houseworth J. On the Cutting Edge: Wound Care for the Endovascular Specialist. Semin Intervent Radiol 2018; 35:406-426. [PMID: 30728657 PMCID: PMC6363558 DOI: 10.1055/s-0038-1676342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Clinical outcomes in patients with critical limb ischemia (CLI) depend not only on endovascular restoration of macrovascular blood flow but also on aggressive periprocedural wound care. Education about this area of CLI therapy is essential not only to maximize the benefits of endovascular therapy but also to facilitate participation in the multidisciplinary care crucial to attaining limb salvage. In this article, we review the advances in wound care products and therapies that have granted the wound care specialist the ability to heal previously nonhealing wounds. We provide a primer on the basic science behind wound healing and the pathogenesis of ischemic wounds, familiarize the reader with methods of tissue viability assessment, and provide an overview of wound debridement techniques, dressings, hyperbaric therapy, and tissue offloading devices. Lastly, we explore emerging technology on the horizons of wound care.
Collapse
Affiliation(s)
- Brandon Olivieri
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | - Timothy E. Yates
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | - Sofia Vianna
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | | | - Robert E. Beasley
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | - Jon Houseworth
- School of Podiatric Medicine, Barry University, Miami, Florida
| |
Collapse
|
8
|
Xue M, Zhao R, Lin H, Jackson C. Delivery systems of current biologicals for the treatment of chronic cutaneous wounds and severe burns. Adv Drug Deliv Rev 2018; 129:219-241. [PMID: 29567398 DOI: 10.1016/j.addr.2018.03.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
While wound therapy remains a clinical challenge in current medical practice, much effort has focused on developing biological therapeutic approaches. This paper presents a comprehensive review of delivery systems for current biologicals for the treatment of chronic wounds and severe burns. The biologicals discussed here include proteins such as growth factors and gene modifying molecules, which may be delivered to wounds free, encapsulated, or released from living systems (cells, skin grafts or skin equivalents) or biomaterials. Advances in biomaterial science and technologies have enabled the synthesis of delivery systems such as scaffolds, hydrogels and nanoparticles, designed to not only allow spatially and temporally controlled release of biologicals, but to also emulate the natural extracellular matrix microenvironment. These technologies represent an attractive field for regenerative wound therapy, by offering more personalised and effective treatments.
Collapse
|
9
|
Volpe P, Marcuccio D, Stilo G, Alberti A, Foti G, Volpe A, Princi D, Surace R, Pucci G, Massara M. Efficacy of cord blood platelet gel application for enhancing diabetic foot ulcer healing after lower limb revascularization. Semin Vasc Surg 2017; 30:106-112. [PMID: 29793677 DOI: 10.1053/j.semvascsurg.2017.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The efficacy of umbilical cord blood platelet gel (CBPG) application on healing foot ulcers was analyzed in 10 diabetic patients treated for critical lower limb ischemia by surgical or endovascular arterial revascularization. During a 9-month period, 20 diabetic patients affected by critical lower limb ischemia with tissue loss were enrolled in this nonblinded, consecutive series, randomized clinical trial. After clinical evaluation, patients underwent endovascular or surgical revascularization of the affected limb, followed by minor amputations or surgical debridement of ischemic lesions. Patients were then randomly divided into two groups: 10 patients in Group A treated with standard wound care and 10 patients in Group B treated with topic application of CBPG. The CBPG protocol consisted of platelet gel application twice a week for 4 weeks and then once a week for an additional 4 weeks. Healing was assessed by direct ulcer dimension tracing onto clear plastic sheet and subsequent computerized planimetry. The mean pretreatment and post-treatment ulcer areas at 30 days for Group A were 15.1 cm2 and 8.1 cm2, respectively, and for Group B were 15.7 cm2 and 3.25 cm2, respectively; resulting in a mean ulcer area reduction of 46% for Group A and 79% for Group B patients (P < .01). These observations suggest CBPG application can promote more rapid wound healing than standard care, and indicate the need for a randomized, multicenter trial to confirm clinical efficacy.
Collapse
Affiliation(s)
- Pietro Volpe
- Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Daniela Marcuccio
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Giuseppe Stilo
- Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Antonino Alberti
- Unit of Vascular Surgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Giovanni Foti
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | - Domenica Princi
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Rosangela Surace
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Giulia Pucci
- Calabria Cord Blood Bank, Service of Immunohaematology and Transfusion Medicine, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Mafalda Massara
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via Leonida 49, Taranto, Italy.
| |
Collapse
|
10
|
Abstract
Apical revascularization (AR) and platelet-rich plasma have been used to restore dental pulp vitality in infected immature permanent teeth. Two regenerative therapies are cell transplantation and cell homing. This article updates and benchmarks these therapies with cell homing. A case report concluded that AR increased root length; however, quantitative and statistical assessments disproved this. Regenerative endodontic therapies require prospective clinical trials demonstrating safety and efficacy. These therapies are intrinsically susceptible to procedural and patient variations. Cell homing uses novel molecules that drive therapeutic efficacy, and may be less sensitive to procedural and patient variations.
Collapse
Affiliation(s)
- Ling He
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA; Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China
| | - Juan Zhong
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA
| | - Qimei Gong
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA; Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China
| | - Bin Cheng
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 631, New York, NY 10032, USA.
| | - Sahng G Kim
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, College of Dental Medicine, Columbia University, 630 West 168 Street - PH7Stem #128, New York, NY 10032, USA.
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China.
| | - Jeremy J Mao
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China; Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street - PH7E, New York, NY 10032, USA.
| |
Collapse
|
11
|
|
12
|
Akgül A, Cirak M, Birinci T. Applications of Platelet-Rich Plasma in Lymphedema. Lymphat Res Biol 2016; 14:206-209. [PMID: 27599222 DOI: 10.1089/lrb.2015.0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Platelet-rich plasma (PRP) is an autologous concentrated preparation of human platelets contained in a small volume of plasma that is characterized by hemostatic and tissue-repairing effects. Being enriched by various kinds of growth factors, and their tissue-repairing effects have made them the focus of attention for use in tissue regeneration. PRP has been safely used and documented in many different fields, including orthopedics, sports injuries, dental and periodontal surgery, and cosmetic, plastic, cardiovascular, general, and maxillofacial surgery. The current evidence obtained from in vitro and animal studies pointed out that PRP may potentially be used to regenerate injured lymphatic vessels to treat or prevent lymphedema. Therefore, we have reviewed existing literature on the clinical uses of PRP in lymphedema and inquired whether there is enough evidence to support the use of PRP in clinical practice as a treatment option. In contrast to in vitro and animal models, there is no clinical trial regarding the use of PRP in lymphedema treatment. Only two animal studies matched to our research yielded positive and promising results in terms of the potential role of PRP in future for lymphedema therapies. In the light of these findings, it is clear that this is an important issue that should be studied in greater depth to clarify the efficacy of PRP in the management of lymphedema.
Collapse
Affiliation(s)
- Ahmet Akgül
- 1 Department of Gerontology, Faculty of Health Sciences, Istanbul University , Istanbul, Turkey .,2 Department of Cardiovascular Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital , Istanbul, Turkey
| | - Musa Cirak
- 3 Department of Neurosurgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital , Istanbul, Turkey
| | - Tansu Birinci
- 4 Department of Physiotherapy and Rehabilitation, Istanbul University , Istanbul, Turkey
| |
Collapse
|