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Berisha-Muharremi V, Tahirbegolli B, Phypers R, Hanna R. Efficacy of Combined Photobiomodulation Therapy with Supplements versus Supplements alone in Restoring Thyroid Gland Homeostasis in Hashimoto Thyroiditis: A Clinical Feasibility Parallel Trial with 6-Months Follow-Up. J Pers Med 2023; 13:1274. [PMID: 37623524 PMCID: PMC10455109 DOI: 10.3390/jpm13081274] [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: 08/03/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Hashimoto thyroiditis (HT) is a thyroid-specific autoimmune disorder, triggering hypothyroidism in a population with an adequate dietary intake. Despite the current conventional treatment focuses on the permanent replacement of levothyroxine (LT4) deficiency, it appears that thyroid autoimmunity remains the cause of persistent symptoms in patients with HT, even when they achieve to be euthyroid from a biochemical standpoint. Photobiomodulation (PBM) showed to be an effective therapy in the management of autoimmune diseases, but with limited evidence. Hence, our study was conducted to appraise the efficacy of PBM therapy with supplements in restoring thyroid gland homeostasis in patients with HT compared with supplements alone. Seventy-four female subjects aged between 20 and 50 years old were recruited and divided equally into two groups: PBM and supplements group (group 1); and supplements alone group (group 2). The PBM dosimetry and treatment protocols were as follows: wavelength, 820 nm; power output, 200 mW; continuous emission mode; irradiating time, 20 s per point; fluence, 32 J/cm2 per point; treatment frequency, twice a week (excluding weekends); and treatment duration, three consecutive weeks. Whereas, the supplements protocol for both groups was the same, as follows: subjects with a serum level of vitamin D3 <40 ng/dL, who received replacement according to their serum levels, and all the subjects had a daily intake of 100 µg of oral selenium. The biochemical (FT3, FT4, antiTPO and antiTG) and anthropometric measurements were evaluated. Our findings showed significant improvement in group 1 parameters (PBM+ supplements) compared with group 2 (supplements only) in terms of weight loss and reduction in the following parameters: BMI, hip and waist circumference, waist/hip ratio, TSH, antiTPO, antiTG and treatment dose of LT4 (p < 0.05). Our results, for the first time, demonstrated an efficacy of PBM delivered at a lower fluence with supplements in restoring thyroid function, anthropometric parameters and lifestyle factors in patients with HT. Hence, extensive studies with a longer follow-up period are warranted.
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Affiliation(s)
- Venera Berisha-Muharremi
- Faculty of Medicine, University of Prishtina, Bulevardi i Dëshmorëve nn, 10000 Prishtina, Kosovo;
- Poliklinika Endomedica, Muharrem Fejza Str. Nr. 84, 10000 Prishtina, Kosovo
| | - Bernard Tahirbegolli
- Department of Management of Health Institution and Services, Heimerer College, 10000 Prishtina, Kosovo;
- National Sports Medicine Centre, Lagjia e Spitalit nn, 10000 Prishtina, Kosovo
| | - Ruth Phypers
- Laser Medicine Centre, 10 Harley Street, London W1G 9PF, UK;
| | - Reem Hanna
- Department of Oral Surgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV, 16132 Genoa, Italy
- Department of Restorative Dental Sciences, UCL-Eastman Dental Institute, Faculty of Medical Sciences, Rockefeller, University College London, London WC1E 6DE, UK
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Hossein-Khannazer N, Kazem Arki M, Keramatinia L, Rezaei-Tavirani M. Low-Level Laser Therapy in the Treatment of Autoimmune Thyroiditis. J Lasers Med Sci 2022; 13:e34. [PMID: 36743139 PMCID: PMC9841386 DOI: 10.34172/jlms.2022.34] [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: 01/11/2022] [Accepted: 07/18/2022] [Indexed: 01/27/2023]
Abstract
Introduction: Autoimmune thyroiditis (AIT) is an autoimmune disorder that is characterized by thyroid gland dysfunction. Low-level laser therapy (LLLT), as a safe and non-invasive intervention, has gained much attention in many clinical applications including pain relief, regenerative medicine, and autoimmune. Methods: In this review, we discuss the effect of LLLT on cellular responses and its application in the treatment of AIT. Such keywords as "low-level laser therapy", "photobiomodulation" and "autoimmune thyroiditis" were used to find studies related to laser therapy in AIT in Google Scholar, PubMed and Medline databases. Results: LLLT reduced thyroid gland inflammation and inhibited immune cell trafficking. LLLT modulated inflammatory responses and improved thyroid gland regeneration. Conclusion: Investigations indicated that besides current treatment strategies, LLLT could be a promising therapeutic approach for the treatment of AIT.
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Affiliation(s)
- Nikoo Hossein-Khannazer
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to Nikoo Hossein-Khannazer, Mostafa Rezaei-Tavirani,
| | - Mandana Kazem Arki
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - liasghar Keramatinia
- Department of Social Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to Nikoo Hossein-Khannazer, Mostafa Rezaei-Tavirani,
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Abstract
Low-level laser therapy (LLLT) has become an important part of the therapeutic process in various diseases. However, despite the broad use of LLLT in everyday clinical practice, the full impact of LLLT on cell life processes has not been fully understood. This paper presents the current state of knowledge concerning the mechanisms of action of LLLT on cells. A better understanding of the molecular processes occurring within the cell after laser irradiation may result in introducing numerous novel clinical applications of LLLT and potentially increases the safety profile of this therapy.
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Kardalas E, Sakkas E, Ruchala M, Macut D, Mastorakos G. The role of transforming growth factor beta in thyroid autoimmunity: current knowledge and future perspectives. Rev Endocr Metab Disord 2022; 23:431-447. [PMID: 34529221 DOI: 10.1007/s11154-021-09685-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
The complex mechanisms, which are related to the pathophysiology and the development of autoimmune thyroid diseases, involve transforming growth factor beta (TGF-β) and its interplay with the immune system. The aim of this review is to examine the role of TGF-β regarding thyroid autoimmunity and explore the potent role of this molecule either as a diagnostic or prognostic marker or a therapeutic target regarding autoimmune thyroid diseases. TGF-β is clearly a master regulator of the immune response, exerting either inhibitory or facilitatory effects on cells of the immune system. Thus, this molecule is involved in the pathogenesis and development of autoimmune thyroid diseases. Recent research has revealed the involvement of TGF-β in the pathophysiology of autoimmune thyroid diseases. The role of TGF-β in the development of autoimmune thyroid diseases varies, depending on its concentrations, the type of the activated TGF-β signalling pathway, the genetic predisposition of the patient and the pathophysiologic stage of the disease. TGF-β could emerge as a useful diagnostic or prognostic marker for the evolution of thyroid autoimmunity. Promising perspectives for the effective therapeutic use of TGF-β regarding thyroid autoimmunity exist. The main treatment approaches incorporate either enhancement of the immunosuppressive role of TGF-β or inhibition of its facilitatory role in the autoimmune thyroid diseases. Further research towards deeper understanding of TGF-β physiology and clinical application of its possible therapeutic role regarding thyroid autoimmunity is needed.
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Affiliation(s)
- Efstratios Kardalas
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, 'Aretaieion' Hospital, Medical School, National and Kapodistrian University of Athens, Vassilissis Sofias Str. 76, Athens, 11528, Greece
| | - Evangelos Sakkas
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, 'Aretaieion' Hospital, Medical School, National and Kapodistrian University of Athens, Vassilissis Sofias Str. 76, Athens, 11528, Greece
- Obstetrics and Gynecology Private Practice, Michalakopoulou Str. 169, Athens, 11527, Greece
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego 49, Poznan, 60-355, Poland
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Univercity Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića Street 8, Belgrade, 11000, Serbia
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, 'Aretaieion' Hospital, Medical School, National and Kapodistrian University of Athens, Vassilissis Sofias Str. 76, Athens, 11528, Greece.
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Treatment with Light-Emitting Diodes of Wavelength 863 nm Delays DMBA/TPA-Induced Skin Tumor Formation and Decreases Proinflammatory Cytokine Levels in ICR Mice. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4400276. [PMID: 35252445 PMCID: PMC8890868 DOI: 10.1155/2022/4400276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/27/2022] [Indexed: 12/02/2022]
Abstract
The popularity of light/energy devices for cosmetic purposes (e.g., skin care) is increasing. However, the effects and underlying mechanisms remain poorly understood. Commencing in the 1960s, various studies have evaluated the beneficial effects of a light source on cells and tissues. The techniques evaluated include low-level light (laser) therapy and photobiomodulation (PBM). Most studies on PBM used red light sources, but, recently, many studies have employed near-infrared light sources including those of wavelength 800 nm. Here, we used a light-emitting diode (LED) array with a wavelength of 863 nm to treat DMBA/TPA-induced mouse skin tumors; treatment with the array delayed tumor development and reduced the levels of systemic inflammatory cytokines. These results suggest that light therapy could be beneficial. However, the effects were small. Further studies on different skin tumors using an optimized LED setup are required. Combination therapies (conventional methods and an LED array) may be useful.
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Aguida B, Pooam M, Ahmad M, Jourdan N. Infrared light therapy relieves TLR-4 dependent hyper-inflammation of the type induced by COVID-19. Commun Integr Biol 2021; 14:200-211. [PMID: 34552685 PMCID: PMC8451450 DOI: 10.1080/19420889.2021.1965718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The leading cause of mortality from COVID-19 infection is respiratory distress due to an exaggerated host immune response, resulting in hyper-inflammation and ensuing cytokine storms in the lungs. Current drug-based therapies are of limited efficacy, costly, and have potential negative side effects. By contrast, photobiomodulation therapy, which involves periodic brief exposure to red or infrared light, is a noninvasive, safe, and affordable method that is currently being used to treat a wide range of diseases with underlying inflammatory conditions. Here, we show that exposure to two 10-min, high-intensity periods per day of infrared light causes a marked reduction in the TLR-4 dependent inflammatory response pathway, which has been implicated in the onset of cytokine storms in COVID-19 patients. Infrared light exposure resulted in a significant decline in NFkB and AP1 activity as measured by the reporter gene assay; decreased expression of inflammatory marker genes IL-6, IL-8, TNF-alpha, INF-alpha, and INF-beta as determined by qPCR gene expression assay; and an 80% decline in secreted cytokine IL6 as measured by ELISA assay in cultured human cells. All of these changes occurred after only 48 hours of treatment. We suggest that an underlying cellular mechanism involving modulation of ROS may downregulate the host immune response after Infrared Light exposure, leading to decrease in inflammation. We further discuss technical considerations involving light sources and exposure conditions to put these observations into potential clinical use to treat COVID-19 induced mortality.
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Affiliation(s)
| | - Marootpong Pooam
- Department of Biology, Faculty of Science, Naresuan University, Phitsanulok, Thailand
| | - Margaret Ahmad
- Cnrs, Ibps, Sorbonne Université, Paris, France.,Department of Biology, Xavier University, Cincinnati, Ohio, USA
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Kardalas E, Maraka S, Papagianni M, Paltoglou G, Siristatidis C, Mastorakos G. TGF-β Physiology as a Novel Therapeutic Target Regarding Autoimmune Thyroid Diseases: Where Do We Stand and What to Expect. ACTA ACUST UNITED AC 2021; 57:medicina57060621. [PMID: 34198624 PMCID: PMC8232149 DOI: 10.3390/medicina57060621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
Transforming growth factor beta (TGF-β), as a master regulator of immune response, is deeply implicated in the complex pathophysiology and development of autoimmune thyroid diseases. Based on the close interplay between thyroid autoimmunity and TGF-β, scientific interest was shifted to the understanding of the possible role of this molecule regarding the diagnosis, prognosis, and therapy of these diseases. The main aim of this review is to present research data about possible treatment options based on the role of TGF-β in thyroid autoimmunity. Suggested TGF-β-mediated therapeutic strategies regarding autoimmune thyroid diseases include either the enhancement of its immunosuppressive role or inhibition of its facilitatory role in thyroid autoimmunity. For example, the application of hr-TGF-β can be used to bolster the inhibitory role of TGF-β regarding the development of thyroid diseases, whereas anti-TGF-β antibodies and similar molecules could impede its immune-promoting effects by blocking different levels of TGF-β biosynthesis and activation pathways. In conclusion, TGF-β could evolve to a promising, novel therapeutic tool for thyroid autoimmunity.
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Affiliation(s)
- Efstratios Kardalas
- Endocrine Unit, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias Str. 76, 11528 Athens, Greece; (E.K.); (G.P.)
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72501, USA;
| | - Maria Papagianni
- Unit of Endocrinology, Diabetes and Metabolism, 3rd Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital of Thessaloniki, Konstantinoupoleos Str. 49, 54642 Thessaloniki, Greece;
| | - George Paltoglou
- Endocrine Unit, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias Str. 76, 11528 Athens, Greece; (E.K.); (G.P.)
| | - Charalampos Siristatidis
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias Str. 76, 11528 Athens, Greece;
| | - George Mastorakos
- Endocrine Unit, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias Str. 76, 11528 Athens, Greece; (E.K.); (G.P.)
- Correspondence:
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Pooam M, Aguida B, Drahy S, Jourdan N, Ahmad M. Therapeutic application of light and electromagnetic fields to reduce hyper-inflammation triggered by COVID-19. Commun Integr Biol 2021; 14:66-77. [PMID: 33995820 PMCID: PMC8096326 DOI: 10.1080/19420889.2021.1911413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022] Open
Abstract
COVID-19 - related morbidity is associated with exaggerated inflammation and cytokine production in the lungs, leading to acute respiratory failure. The cellular mechanisms underlying these so-called 'cytokine storms' are regulated through the Toll-like receptor 4 (TLR4) signaling pathway and by ROS (Reactive Oxygen Species). Both light (Photobiomodulation) and magnetic fields (e.g., Pulsed Electro Magnetic Field) stimulation are noninvasive therapies known to confer anti-inflammatory effects and regulate ROS signaling pathways. Here we show that daily exposure to two 10-minute intervals of moderate intensity infra-red light significantly lowered the inflammatory response induced via the TLR4 receptor signaling pathway in human cell cultures. Anti-inflammatory effects were likewise achieved by electromagnetic field exposure of cells to daily 10-minute intervals of either Pulsed Electromagnetic Fields (PEMF), or to Low-Level static magnetic fields. Because current illumination and electromagnetic field therapies have no known side effects, and are already approved for some medical uses, we have here developed protocols for verification in clinical trials of COVID-19 infection. These treatments are affordable, simple to implement, and may help to resolve the acute respiratory distress of COVID-19 patients both in the home and in the hospital.
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Affiliation(s)
- Marootpong Pooam
- Photobiology Research Group, Sorbonne Université - CNRS, Paris, France
- Department of Biology, Faculty of Science, Naresuan University, Phitsanulok, Thailand
| | - Blanche Aguida
- Photobiology Research Group, Sorbonne Université - CNRS, Paris, France
| | - Soria Drahy
- Photobiology Research Group, Sorbonne Université - CNRS, Paris, France
| | - Nathalie Jourdan
- Photobiology Research Group, Sorbonne Université - CNRS, Paris, France
| | - Margaret Ahmad
- Photobiology Research Group, Sorbonne Université - CNRS, Paris, France
- Xavier University, Cincinnati, Ohio, U.S.A
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Höfling DB, Chavantes MC, Buchpiguel CA, Cerri GG, Marui S, Carneiro PC, Chammas MC. Safety and Efficacy of Low-Level Laser Therapy in Autoimmune Thyroiditis: Long-Term Follow-Up Study. Int J Endocrinol 2018; 2018:8387530. [PMID: 30532779 PMCID: PMC6247385 DOI: 10.1155/2018/8387530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 06/24/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION A randomized clinical trial (RCT) was performed to evaluate the efficacy of low-level laser therapy (LLLT) for hypothyroidism induced by chronic autoimmune thyroiditis (CAT). OBJECTIVE The objective was to assess the safety and actions of LLLT 6 years after completion of the RCT. MATERIALS AND METHODS Forty-three participants were invited to participate in this study 6 years after completion of the RCT. Twenty-five were subjected to LLLT (group L), and 18 were subjected to placebo (group P). Primary outcome measure: frequency of thyroid nodules, which were subjected to fine-needle aspiration biopsy. Secondary outcome measures: dose of levothyroxine required to treat hypothyroidism, thyroid peroxidase antibodies (anti-TPO), and anti-thyroglobulin antibodies (anti-Tg). RESULTS In group L, a nodule was observed in three patients, who all had a Bethesda II classification. In group P, a nodule was also observed in three patients, with two classified as Bethesda II and one as Bethesda III. The levothyroxine dose required by group L was significantly lower than that required by group P (P = 0.002). The anti-TPO and anti-Tg levels did not differ between the groups. CONCLUSION LLLT, by the methods described, has been shown to be safe for the treatment of hypothyroidism resulting from CAT. This trial is registered with ClinicalTrials.gov Identifier: NCT02240563.
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Affiliation(s)
- Danilo Bianchini Höfling
- Ultrasound Unit, Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
| | | | - Carlos Alberto Buchpiguel
- Radiology Institute (InRad); Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
| | - Giovanni Guido Cerri
- Radiology Institute (InRad); Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
| | - Suemi Marui
- Thyroid Unit, Department of Endocrinology and Metabolism, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, Brazil
| | - Paulo Campos Carneiro
- Department of Pathology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, Brazil
| | - Maria Cristina Chammas
- Ultrasound Unit, Department of Radiology, University of Sao Paulo Medical School, Hospital das Clínicas, 05403-000 São Paulo, SP, Brazil
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Abstract
Photobiomodulation (PBM) also known as low-level level laser therapy is the use of red and near-infrared light to stimulate healing, relieve pain, and reduce inflammation. The primary chromophores have been identified as cytochrome c oxidase in mitochondria, and calcium ion channels (possibly mediated by light absorption by opsins). Secondary effects of photon absorption include increases in ATP, a brief burst of reactive oxygen species, an increase in nitric oxide, and modulation of calcium levels. Tertiary effects include activation of a wide range of transcription factors leading to improved cell survival, increased proliferation and migration, and new protein synthesis. There is a pronounced biphasic dose response whereby low levels of light have stimulating effects, while high levels of light have inhibitory effects. It has been found that PBM can produce ROS in normal cells, but when used in oxidatively stressed cells or in animal models of disease, ROS levels are lowered. PBM is able to up-regulate anti-oxidant defenses and reduce oxidative stress. It was shown that PBM can activate NF-kB in normal quiescent cells, however in activated inflammatory cells, inflammatory markers were decreased. One of the most reproducible effects of PBM is an overall reduction in inflammation, which is particularly important for disorders of the joints, traumatic injuries, lung disorders, and in the brain. PBM has been shown to reduce markers of M1 phenotype in activated macrophages. Many reports have shown reductions in reactive nitrogen species and prostaglandins in various animal models. PBM can reduce inflammation in the brain, abdominal fat, wounds, lungs, spinal cord.
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Affiliation(s)
- Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, BAR414, 40 Blossom Street, Boston, MA 02114, USA
- Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
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Sonis ST, Hashemi S, Epstein JB, Nair RG, Raber-Durlacher JE. Could the biological robustness of low level laser therapy (Photobiomodulation) impact its use in the management of mucositis in head and neck cancer patients. Oral Oncol 2016; 54:7-14. [DOI: 10.1016/j.oraloncology.2016.01.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
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