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Carver C, Rashid Z, Shuker S. Microneedling versus microcoring: A review of percutaneous collagen induction for the face and neck. J Cosmet Dermatol 2024; 23:1541-1550. [PMID: 38196306 DOI: 10.1111/jocd.16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/06/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Microneedling (MN) and microcoring (MCT) are both methods used for percutaneous collagen induction. This minimally invasive technique involves creating controlled damage in cutaneous tissue to induce neocollagenesis and neoelastogenesis. MN utilizes solid microneedles and is commonly combined with radiofrequency (RF) to add thermal energy, while MCT involves hollow microneedles capable of removing excess tissue without inducing scar formation. AIMS The purpose of this review was to summarize recent literature for MN and MCT, with the goal of assisting clinical decision making regarding the use of these technologies. METHODS PubMed search was conducted for relevant articles published within the last 10 years. Scoping literature review was then performed with pertinent findings reported. RESULTS Existing literature investigating MCT is sparse. Limited data on in vivo, human effects of this technology exist. Two out of 14 studies in this review pertained to MCT. CONCLUSION Additional high-powered clinical studies are needed to guide future cosmetic treatments with MN and MCT.
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Affiliation(s)
- C Carver
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Z Rashid
- La Peau Dermatology, Mesa, Arizona, USA
| | - S Shuker
- La Peau Dermatology, Mesa, Arizona, USA
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Jia Y, Qiu L, Zhang H, Li Z, Zhao P, Zhang Y, Zhang B. Efficacy and Safety of Type III Collagen Lyophilized Fibers Using Mid-to-Deep Dermal Facial Injections for the Correction of Dynamic Facial Wrinkles. Aesthetic Plast Surg 2024:10.1007/s00266-023-03838-6. [PMID: 38302714 DOI: 10.1007/s00266-023-03838-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study aimed to evaluate the therapeutic efficacy and safety of injecting Type III collagen lyophilized fibers into the mid-to-deep layers of the facial dermis to ameliorate dynamic facial wrinkles. METHODS In this retrospective analysis, clinical data were collected from patients exhibiting dynamic facial wrinkles (encompassing frown lines, forehead lines, and crow's feet) with a wrinkle severity rating scale (WSRS) score of 3 or higher. In the control group, 75 participants received collagen implant injections into the mid-to-deep facial dermal layers, whereas 76 participants in the experimental group received injections of Type III collagen lyophilized fibers in similar layers. The study analyzed and compared clinical efficacy, WSRS score alterations, patient satisfaction, and safety profiles between the groups over the 30-day and 90-day treatment periods. RESULTS At the 30-day mark, the therapeutic efficacy was not significantly different between the two groups (P > 0.05). However, at 90 days, the treatment efficacy in the experimental group surpassed that in the control group, showing a statistically significant difference (P < 0.05). After 30 days of treatment, the WSRS score improvement in the experimental group was significantly superior to that in the control group (P < 0.05). Conversely, at the 90-day mark, the results revealed no significant variation in WSRS score improvements between the two groups (P > 0.05). Regarding treatment satisfaction among researchers and participants post-30 and 90-day treatment in both groups, no statistically significant differences were observed (P > 0.05). Similarly, the incidence of adverse reactions between the groups was not statistically significant (P > 0.05). CONCLUSIONS Injections of lyophilized type III collagen fibers into the mid-to-deep layers of the facial dermis have a definitive therapeutic effect on dynamic facial wrinkles. This treatment not only substantially diminishes wrinkle severity but also has a commendable safety profile. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yao Jia
- Plastic Surgery, The First Hospital of Shanxi Medical University, 85 Jiefang South Road, Yingze District, Taiyuan, 030001, Shanxi Province, China
| | - Lixia Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Hui Zhang
- Plastic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Zhi Li
- Department of Burn and Plastic Surgery, Shanxi Bethune Hospital, Taiyuan, 030032, China
| | - Peng Zhao
- Dermatology Department of Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Yue Zhang
- Plastic Surgery, The First Hospital of Shanxi Medical University, 85 Jiefang South Road, Yingze District, Taiyuan, 030001, Shanxi Province, China
| | - Baolin Zhang
- Plastic Surgery, The First Hospital of Shanxi Medical University, 85 Jiefang South Road, Yingze District, Taiyuan, 030001, Shanxi Province, China.
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Voller L, Rahman Z. Translational Biochemistry of the Skin. Facial Plast Surg Clin North Am 2023; 31:443-452. [PMID: 37806678 DOI: 10.1016/j.fsc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Understanding translational biochemistry of the skin is an essential component in mastering non-invasive aesthetic treatments. Collagen is the most abundant protein in the animal kingdom and plays a significant role in maintaining structural function in biologically healthy human skin. Collagen degradation and synthesis occurs throughout human life. Upregulation of collagen synthesis remains the mainstay of non-invasive aesthetic skin treatments. Elastin is a smaller yet significant component in the skin's ability to maintain biologically healthy stretch and recoil. Multi-Omics represents a relatively nascent field in the optimization and development of therapies aimed at the aesthetic improvement of the skin.
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Affiliation(s)
- Lindsey Voller
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion B, 4th Floor, MC 5338, Redwood City, CA 94603, USA
| | - Zakia Rahman
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion B, 4th Floor, MC 5338, Redwood City, CA 94603, USA.
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Vingan NR, Wamsley CE, Panton JA, Mangalagiri D, Turer D, Akgul Y, Barillas J, Culver A, Kenkel JM. Investigating the Efficacy of Modified Lipoaspirate Grafting to Improve the Appearance of Atrophic Acne Scars: A Pilot Study. Aesthet Surg J 2023; 43:NP613-NP630. [PMID: 37051925 DOI: 10.1093/asj/sjad102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. Although lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis. OBJECTIVES This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars. METHODS Patients underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3 and 6 months posttreatment. Scars were assessed with standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed with patient and clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation. RESULTS Ten patients between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. Clinician GAIS and patient GAIS scores showed clinical improvement at both 3- and 6-month follow-up compared with baseline (P < .05). Blinded clinician GAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (P < .0001). The attenuation coefficient increased at 6-month follow-up, suggesting collagen remodeling and reorganization over the study period. Patients experienced anticipated posttreatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported. CONCLUSIONS Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring. LEVEL OF EVIDENCE: 4
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Li X, Gao J, Zheng H, Zou C, Yu Z, Wu Z, Zhang J. Study of platelet-rich plasma application for skin and plastic surgery in recent 20 years: A bibliometric analysis. J Cosmet Dermatol 2023; 22:1852-1862. [PMID: 36762408 DOI: 10.1111/jocd.15653] [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: 08/22/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND In recent years, platelet-rich plasma (PRP) has been used in plastic surgery, dermatology, and other treatment procedures worldwide. Since the number of scientific writings has been significantly increasing, it is challenging to generate a manual compilation and systematic review of PRP's therapeutic applications in dermatology and plastic surgeries. This study aimed to make a bibliometric analysis of the literature in the field and evaluate research hotspots and frontiers in this field in the past 20 years. METHODS Using the Academic Search Premier and ScienceDirect defined search terms, we searched the Web of Science Core Collection (WoSCC) and Scopus databases. All data were analyzed using CiteSpace 5.8.R3 and VOSviewer, including countries, institutions, authors, keywords, cited authors, cited journals, cited references, discovered research hotspots, and frontiers. RESULTS A total of 1931 studies were retrieved. The number of publications on PRP application in dermatology and plastic surgeries showed a yearly increase. The United States was the most significant contributor to this field, while Italy's contribution was noteworthy. The journal with the highest number of relevant articles in dermatology and plastic surgery included the Journal of Cosmetic Dermatology. However, the Wound Repair and Regeneration and International Journal of Molecular Sciences were the leading journals that should be paid attention to in the future. Author Anitua E from the Tor Vergata University of Rome published the most publications in this field. In the keyword co-occurrence analysis, all keywords were divided into six clusters, and the most common one in recent years was "PRP for facial beauty." Facial rejuvenation, scar, and alopecia were the main hotspots and research trends in this field. CONCLUSIONS Based on the current global trends, the use of PRP in cosmetics and skin care is receiving increasing attention from researchers and clinicians. Recently, an increasing number of articles on PRP's application in skin tissue repair have been published in the United States and Italy. The number of studies on hair loss, facial rejuvenation, and scar management is increasing, suggesting that these subjects may become research hotspots for PRP in dermatology and cosmetic surgeries in recent years.
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Affiliation(s)
- Xianhui Li
- The Eighth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junqing Gao
- Affiliated Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Haishan Zheng
- The Eighth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chengyou Zou
- The Eighth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhuoan Yu
- The Eighth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zouping Wu
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiasheng Zhang
- Affiliated Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
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Alqam M, Wamsley CE, Hitchcock TM, Jones BC, Akgul Y, Kenkel JM. Efficacy and tolerability of a microneedling device for treating wrinkles on the face. J Cosmet Dermatol 2023; 22:206-213. [PMID: 35403786 PMCID: PMC10084046 DOI: 10.1111/jocd.14985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES A microneedling pen has been cleared by the US Food and Drug Administration, indicated for improving the appearance of adult facial acne scars. The objective of this study was to assess the device's effectiveness for treating wrinkles of the face area. MATERIALS AND METHODS Healthy adults seeking to improve the appearance of face wrinkles were enrolled (N = 35), receiving four monthly microneedling procedures by a trained aesthetician who treated the face skin per manufacturer instructions. Wrinkle assessments were performed by two trained blinded raters by comparing baseline images of each subject with images obtained at 90 days post-procedure. Subsequently, the two raters were unblinded for the Clinician's Global Aesthetic Improvement Scale (CGAIS) assessment. Subjects completed the Subject's Global Aesthetic Improvement Scale (SGAIS) and a Satisfaction Questionnaire at 30 and 90 days post-treatment. RESULTS The study was completed by 32 subjects with a mean (SD) age of 56.3 (5.0) years. Wrinkle assessments demonstrated significant improvement in the face areas (p < 0.001). The SGAIS scores showed significant improvements after 30 and 90 days post-treatment (for each, p < 0.001). The CGAIS scores also showed significant improvements at 90 days post-treatment (p < 0.001). Most subjects reported some level of improvement in their appearance at 30 days (73.3%) and 90 days (68.8%) post-treatment. The satisfaction questionnaire showed high levels of improvement in wrinkles (93.8%), satisfaction with the treatment procedure (87.5%) and would recommend microneedling to friends and family members (80.6%) on the face and neck. CONCLUSION Microneedling is a viable, minimally invasive option for treating wrinkles of the face. CLINICALTRIALS gov Identifier: NCT03803059.
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Affiliation(s)
- Mona Alqam
- Medical Affairs & Clinical Development, Crown Laboratories, Dallas, Texas, USA
| | - Christine E Wamsley
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Brian C Jones
- Medical Affairs & Clinical Development, Crown Laboratories, Dallas, Texas, USA
| | - Yucel Akgul
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey M Kenkel
- Clinical Center for Cosmetic Laser Treatment and Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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Cheng H, Zhang R, Zhuo F. Synergistic effect of microneedle-delivered extracellular matrix compound and radiofrequency on rejuvenation of periorbital wrinkles. Front Med (Lausanne) 2022; 9:900784. [PMID: 35935789 PMCID: PMC9355126 DOI: 10.3389/fmed.2022.900784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background A combination of minimally invasive modalities can induce collagen regeneration more quickly and promote the penetration of topical agents, thus promoting skin rejuvenation. In this study, we aimed to investigate the synergistic efficacy of extracellular matrix compound (ECM-C) via microneedle (MN) and radiofrequency (RF) on periorbital wrinkles. Method A total of 25 participants with periorbital wrinkles were selected for this study. The left and right side of the periorbital area was randomly given ECM-C via MN or ECM-C via MN combined with RF. MN combined with ECM-C treatment was given 5 times at 2 weeks intervals, whereas RF treatment was given 3 times at 4-week intervals. The following items were assessed: wrinkles by VISIA® system; biophysical parameters such as skin hydration, transepidermal water loss (TEWL), erythema index, and melanin index by CK multiple probe adapter; and skin elasticity and skin thickness by DermaLab Combo® photographs were taken at the baseline and 2 weeks after the last treatment. Subjective assessments, such as Crow's Feet Grading Scale (CFGS) and Global Aesthetic International Scale (GAIS), were also recorded. Result A total of 25 participants with an average age of 43 years participated in this trial. Periorbital wrinkles on both sides decreased after the treatment, and the side treated with ECM via MN and RF showed better improvement than the other side with ECM-C via MN alone. Skin hydration increased after the treatment on both sides. TEWL, skin erythema, and skin melanin indexes were not changed. Skin elasticity and skin thickness increased more on the side of ECM-C via MN and RF than on the other side of ECM-C via MN alone. The evaluation scores for CFGS improved on either side; however, no difference was found for CFGS and GAIS between intergroup comparisons after the treatment. Conclusion The objective assessment of wrinkles, elasticity, and thickness of periorbital skin improved more on the side with ECM-C treatment via MN combined with RF than on the other side of ECM-C treatment via MN only. However, no statistically significant difference was found between the subjective CFGS and GAIS evaluation of the two sides.
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8
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Alqam M, Wamsley CE, Hitchcock T, Jones BC, Akgul Y, Kenkel JM. Efficacy and Tolerability of a Microneedling Device for Treating Wrinkles on the Neck. Aesthet Surg J 2022; 42:1154-1160. [PMID: 35397167 PMCID: PMC9472661 DOI: 10.1093/asj/sjac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background A microneedling pen has been cleared by the US FDA and is indicated for improving the appearance of facial acne scars in adults. Objectives The aim of this study was to assess the effectiveness of this microneedling pen for treating wrinkles. This paper focuses on the results on the neck, an area of recent importance with video meetings placing physical stress on the neck area, leading to wrinkles. Methods Healthy adult men and women were enrolled (N = 35). Subjects received 4 monthly microneedling procedures at depths of up to 2.5 mm. Wrinkle assessments were performed by 2 trained blinded raters by comparing images of each subject at baseline and at 90 days postprocedure. The 2 raters were unblinded for the Clinician’s Global Aesthetic Improvement Scale assessment. Subjects completed the Subject’s Global Aesthetic Improvement Scale and a questionnaire regarding satisfaction with the treated areas of the face and neck at 30 and 90 days posttreatment. Results The study was completed by 32 subjects. Wrinkle assessments demonstrated significant improvement in the neck areas (P < 0.001). Both Global Aesthetic Improvement Scales showed significant improvements at 90 days posttreatment (P < 0.001). Most subjects reported some level of improvement in their appearance at 30 days (73.3%) and 90 days (68.8%) posttreatment. The satisfaction questionnaire showed high levels of improvement in wrinkles (93.8%), satisfaction with the results (87.5%), and would recommend microneedling to friends and family members (80.6%). Conclusions Microneedling is a viable, minimally invasive option for treating wrin kles of the neck. Level of Evidence: 4
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Affiliation(s)
| | - Christine E Wamsley
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Yucel Akgul
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey M Kenkel
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Kislevitz M, Lu KB, Wamsley CE, Parsa S, Hoopman JE, Kenkel JM, Akgul Y. Bipolar Fractional Radiofrequency Treatment of Suprapatellar Skin Assessment Using Noninvasive Devices and Microbiopsy. Aesthet Surg J 2021; 41:NP1997-NP2008. [PMID: 33942050 DOI: 10.1093/asj/sjab210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Noninvasive treatments for skin tightening are gaining popularity. However, no studies have assessed bipolar fractional radiofrequency treatment on suprapatellar skin. OBJECTIVES The purpose of this study was to evaluate the efficacy of bipolar fractional radiofrequency treatment on suprapatellar skin. METHODS Twenty patients received 1 bilateral suprapatellar bipolar fractional radiofrequency treatment. They returned 7 days, 3 weeks, 3 months, and 6 months posttreatment. Noninvasive measurements were obtained at each visit, including high-resolution ultrasonography, optical coherence tomography, transepidermal water loss and skin elasticity. Microbiopsies were collected in the treatment area for histologic and gene expression analyses. Three clinicians completed photographic evaluations comparing texture and laxity at baseline vs 6 months posttreatment. RESULTS Fifteen subjects completed all 6 visits. Both transepidermal water loss and dermal-epidermal junction roughness were increased at 3 weeks and 3 months posttreatment. Both attenuation coefficient and stiffness were increased significantly at 3 and 6 months posttreatment. Blood flow 0.5 mm below the surface and expression of epidermal hyaluronic acid and inflammatory genes IL-1b and IL-6 were significantly higher at 7 days posttreatment compared with pretreatment and 3 months posttreatment. There were no statistically significant changes in collagen- or elastin-related genes and proteins at 7 days or 3 months posttreatment. An improvement in texture and laxity was observed at 6 months posttreatment in 17.7% and 24.4% of photographs, respectively. CONCLUSIONS Radiofrequency treatment by microneedling of suprapatellar skin shows limited effects in decreasing skin laxity and improving skin appearance. At a molecular level, the treatment resulted in lower elastin and hyaluronic acid levels and increased dermal-epidermal junction roughness based on histology and optical coherence tomography imaging. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mikaela Kislevitz
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Karen B Lu
- Department of Plastic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Christine E Wamsley
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shyon Parsa
- UT Southwestern Medical School, Dallas, TX, USA
| | - John E Hoopman
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey M Kenkel
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yucel Akgul
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Majidian M, Moy RL. Commentary on: A Single-Center Trial to Evaluate the Efficacy and Tolerability of Four Microneedling Treatments on Fine Lines and Wrinkles of Facial and Neck Skin in Subjects With Fitzpatrick Skin Types I-IV: An Objective Assessment Using Non-Invasive Devices and 0.33-mm Microbiopsies. Aesthet Surg J 2021; 41:NP1619-NP1620. [PMID: 33714993 DOI: 10.1093/asj/sjab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mandy Majidian
- Tulane University School of Medicine, New Orleans, LA, USA
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