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Rosenthal A, Kolli H, Israilevich R, Moy R. Lasers for the prevention and treatment of hypertrophic scars: a review of the literature. J COSMET LASER THER 2020; 22:115-125. [PMID: 32576064 DOI: 10.1080/14764172.2020.1783451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the increasing knowledge about wound healing mechanisms and the advancements made in laser technology, hypertrophic scars remain difficult to manage. This review intends to discuss the laser devices studied in the prevention and treatment of HS, arising from trauma, surgery, and burns, detail their mechanisms of action, and emphasize those devices with the most promising effects. Most of the suggested mechanisms and explanations for the use of lasers in treating hypertrophic scars are based on selective photothermolysis, in which the light energy emitted from a laser is absorbed by its intended target, thereby disrupting existing collagen and altering the cycle of neocollagenesis. Through our literature review, we have determined that combination therapies, utilizing more than one laser target demonstrate enhanced clinical efficacy. Further, early use of laser devices has been shown to enhance the cosmetic result of sutured wounds and may play a role in preventing the development of hypertrophic scars.
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Affiliation(s)
- Amanda Rosenthal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine , Miami, FL, USA.,Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Hiren Kolli
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Rachel Israilevich
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
| | - Ronald Moy
- Research Department, Moy-Fincher-Chipps Facial Plastics & Dermatology , Beverly Hills, CA, USA
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2
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Abstract
Keloids are pathological scars that grow over time and extend beyond the initial site of injury after impaired wound healing. These scars frequently recur and rarely regress. They are aesthetically disfiguring, can cause pain, itching, discomfort as well as psychological stress, often affecting quality of life. Many treatment modalities, including surgical and non-surgical, have been explored and have been reported to be beneficial; however, none have been absolutely satisfactory or optimal for the treatment of all keloid subtypes to date. This poses a major challenge to clinicians. Often, a combinational therapeutic approach appears to offer the best results with higher patient satisfaction compared to monotherapy. The aetiopathogenesis of keloids is not fully elucidated; however, with recent advances in molecular biology and genetics, insight is being gained on the complex process of scar formation and hence new therapeutic and management options for keloids. In this paper, we explore the literature and summarise the general concepts surrounding keloid development and review both current (corticosteroids, surgical excision, silicone-based products, pressure therapy, radiotherapy, cryotherapy, laser therapy, imiquimod and 5-fluorouracil) and emerging (stem cell therapy, mitomycin C, verapamil, interferons, bleomycin, botulinum toxin type A and angiotensin-converting enzyme inhibitors) treatments. Increased knowledge and understanding in this area may potentially lead to the discovery and development of novel therapeutic options that are more efficacious for all keloid types. LAY SUMMARY Keloids are problematic scars that are difficult to treat and manage. The aetiopathogenesis of keloids is not clear; however, recent advances in molecular biology and genetics are beginning to shed light on the underlying mechanisms implicated in keloid scar formation which will hopefully lead to the development of treatment options for all keloid types. This review summarises current and emerging therapies.
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Affiliation(s)
- Nkemcho Ojeh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Uma Gaur
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados, West Indies
| | - Andrew LeRoy Forde
- Pine Medical Centre, 3rd Avenue Belleville, St. Michael, Barbados, West Indies
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Forbat E, Al-Niaimi F. Nonvascular uses of pulsed dye laser in clinical dermatology. J Cosmet Dermatol 2019; 18:1186-1201. [PMID: 31002479 DOI: 10.1111/jocd.12924] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 01/24/2023]
Abstract
Lasers are fast becoming the vogue of dermatology ranging from ablative, nonablative, fractional photothermolysis to vascular lasers. There are a range of vascular lasers including potassium titanyl phosphate (KTP 532 nm), pulsed dye laser (PDL -595 nm), diode (810 nm), and Nd:YAG (1064 nm). PDL is a laser that emits yellow light using Rhodamine dye as it is lasing medium. Typical vascular lesions which are treated by PDL include port wine stain, hemangioma, telangiectasia, spider angioma, and rosacea. This article focuses on the use of PDL beyond primary vascular conditions. We review the evidence, or lack thereof, of the use of PDL in acne vulgaris, scars, striae, warts, molluscum, psoriasis, rejuvenation, basal cell carcinoma (BCC), and miscellaneous dermatological sequelae.
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Affiliation(s)
| | - Firas Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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Fu X, Dong J, Wang S, Yan M, Yao M. Advances in the treatment of traumatic scars with laser, intense pulsed light, radiofrequency, and ultrasound. BURNS & TRAUMA 2019; 7:1. [PMID: 30723753 PMCID: PMC6350396 DOI: 10.1186/s41038-018-0141-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 12/25/2018] [Indexed: 12/21/2022]
Abstract
Traumatic scarring is one of the most common complications after soft tissue injury caused by burns and trauma, which affects tens of millions of people worldwide every year. Traumatic scars diminish the quality of life due to disfigurement, symptoms of pain and itch, and restricted motion. The pathogenesis and pathophysiology of traumatic scar remain elusive. The management for traumatic scars is comprised of surgical and non-surgical interventions such as pressure therapy, silicone, corticosteroid, and radiotherapy, which are chosen by clinicians based on the physical examinations of scars. Recently, great progress in treating traumatic scars has been achieved by the development of novel technologies including laser, intense pulsed light (IPL), radiofrequency, and ultrasound. The aim of this review article was to summarize the advances of these technologies for traumatic scars intervention.
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Affiliation(s)
- Xiujun Fu
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Jiying Dong
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Shen Wang
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Min Yan
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Min Yao
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
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Ibrahim SM, Saudi WM, Abozeid MF, Elsaie ML. Early fractional carbon dioxide laser intervention for postsurgical scars in skin of color. Clin Cosmet Investig Dermatol 2019; 12:29-34. [PMID: 30655685 PMCID: PMC6324605 DOI: 10.2147/ccid.s177622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Fractional CO2 laser is one of the most effective treatment options used to resurface scars. Objective To evaluate the efficacy and safety of early treatment of postsurgical scar by fractional ablative CO2 laser. Methods A total of 27 Egyptian patients with recent postoperative scars were enrolled in this study. Three sessions of fractional CO2 laser with a 1-month interval were started 4 weeks after surgery. Vancouver Scar Scale (VSS) was used as an assessment tool at 1 and 3 months after the final treatment. Patients reported their satisfaction using a subjective 4-point scale. Results Results demonstrated a statistically significant overall average improvement of the VSS (5.33±1.33) before compared with (2.55±1.06) 3 months after the last laser treatment (P≤0.001). Among the individual parameters in the VSS, the most significant improvements were found in pigmentation, height, and pliability. Patient's subjective satisfaction scores showed a significant greater degree of satisfaction after laser treatment. Conclusion Fractional ablative CO2 laser is an effective and safe treatment modality for surgical scars in the early postsurgical period.
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Affiliation(s)
- Shady M Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | - Wael M Saudi
- Department of Dermatology, Misr University for Science & Technology, 6th of October City, Egypt
| | | | - Mohamed L Elsaie
- Department of Dermatology, National Research Centre, Cairo, Egypt,
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Forbat E, Ali FR, Al-Niaimi F. Treatment of keloid scars using light-, laser- and energy-based devices: a contemporary review of the literature. Lasers Med Sci 2017; 32:2145-2154. [PMID: 29047002 DOI: 10.1007/s10103-017-2332-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 09/19/2017] [Indexed: 01/28/2023]
Abstract
Keloid scars are common and have a predilection for young, ethnic skin often with a family history. Keloids can be painful and pruritic and cause significant emotional distress when particularly visible or prominent. In this article, we review the evidence underlying the use of laser- and energy-based devices for treatment of keloid scars, either as monotherapy or in conjunction with other therapies such as corticosteroids, surgery and silicone gel in the treatment of keloid scars.
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Affiliation(s)
- E Forbat
- Chelsea and Westminster Hospital, 369 Fulham Rd, London, SW10 9NH, UK
| | - F R Ali
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology,, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - F Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology,, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
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Nonconventional Use of Flash-Lamp Pulsed-Dye Laser in Dermatology. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7981640. [PMID: 27631010 PMCID: PMC5007316 DOI: 10.1155/2016/7981640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/28/2016] [Indexed: 12/04/2022]
Abstract
Flash-lamp pulsed-dye laser (FPDL) is a nonablative technology, typically used in vascular malformation therapy due to its specificity for hemoglobin. FPDL treatments were performed in a large group of patients with persistent and/or recalcitrant different dermatological lesions with cutaneous microvessel involvement. In particular, 149 patients (73 males and 76 females) were treated. They were affected by the following dermatological disorders: angiokeratoma circumscriptum, genital and extragenital viral warts, striae rubrae, basal cell carcinoma, Kaposi's sarcoma, angiolymphoid hyperplasia, and Jessner-Kanof disease. They all underwent various laser sessions. 89 patients (59.7%) achieved excellent clearance, 32 patients (21.4%) achieved good-moderate clearance, 19 patients (12.7%) obtained slight clearance, and 9 subjects (6.1%) had low or no removal of their lesion. In all cases, FPDL was found to be a safe and effective treatment for the abovementioned dermatological lesions in which skin microvessels play a role in pathogenesis or development. Further and single-indication studies, however, are required to assess a standardized and reproducible method for applying this technology to “off-label” indications.
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Abstract
This article presents an overview of the literature regarding treatments for keloid disease, hypertrophic scars, and striae distensae in dark pigmented skin. Striae, keloid, and hypertrophic scarring present a challenging problem for both the clinician and patient. No single therapy is advocated for hypertrophic scars, keloid scars, or striae distensae. New therapies have shown promise in the treatment of hypertrophic and keloid scars, and in patients with dark pigmented skin. This article provides guidance on the assessment and determination of patients' suitability for certain treatment options, as well as advice on the follow-up of patients affected with problematic scarring and striae.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7DN, UK; Plastic and Reconstructive Surgery Research, Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University Hospital of South Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7DN, UK; Plastic and Reconstructive Surgery Research, Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, University Hospital of South Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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Tredget EE, Levi B, Donelan MB. Biology and principles of scar management and burn reconstruction. Surg Clin North Am 2014; 94:793-815. [PMID: 25085089 DOI: 10.1016/j.suc.2014.05.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hypertrophic scarring is extremely common and is the source of most morbidity related to burns. The biology of hypertrophic healing is complex and poorly understood. Multiple host and injury factors contribute, but protracted healing of partial thickness injury is a common theme. Hypertrophic scarring and heterotopic ossification may share some basic causes involving marrow-derived cells. Several traditional clinical interventions exist to modify hypertrophic scar. All have limited efficacy. Laser interventions for scar modification show promise, but as yet do not provide a definitive solution. Their efficacy is only seen when used as part of a multimodality scar management program.
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Affiliation(s)
| | - Benjamin Levi
- Shriners Hospital for Children and Massachusetts General Hospital, Boston, MA, USA
| | - Matthias B Donelan
- Shriners Hospital for Children and Massachusetts General Hospital, Boston, MA, USA
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Brewin M, Lister T. Prevention or treatment of hypertrophic burn scarring: A review of when and how to treat with the Pulsed Dye Laser. Burns 2014; 40:797-804. [DOI: 10.1016/j.burns.2013.12.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/25/2013] [Accepted: 12/17/2013] [Indexed: 11/29/2022]
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Ohshiro T, Ohshiro T, Sasaki K. Laser scar management technique. Laser Ther 2013; 22:255-60. [PMID: 24511202 DOI: 10.5978/islsm.13-or-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/06/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. METHODS Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. RESULTS AND CONCLUSIONS Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual.
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Affiliation(s)
- Takafumi Ohshiro
- Department of Plastic and Reconstructive Surgery, Ohshiro Clinic, Tokyo
| | - Toshio Ohshiro
- Department of Plastic and Reconstructive Surgery, Ohshiro Clinic, Tokyo
| | - Katsumi Sasaki
- Department of Plastic and Reconstructive Surgery, Ohshiro Clinic, Tokyo
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Eke U, Diaz C, Abdullah A. Keloid scars in type VI skin successfully treated with combined surgery and pulsed dye laser therapy. Br J Dermatol 2012; 168:1360-2. [PMID: 23252810 DOI: 10.1111/bjd.12159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pulsed dye laser treatment with different onset times for new surgical scars: a single-blind randomized controlled trial. Lasers Med Sci 2012; 27:1095-8. [DOI: 10.1007/s10103-011-1044-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 12/12/2011] [Indexed: 11/27/2022]
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15
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Vrijman C, van Drooge A, Limpens J, Bos J, van der Veen J, Spuls P, Wolkerstorfer A. Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review. Br J Dermatol 2011; 165:934-42. [DOI: 10.1111/j.1365-2133.2011.10492.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Laser Treatment for Improvement and Minimization of Facial Scars. Facial Plast Surg Clin North Am 2011; 19:527-42. [DOI: 10.1016/j.fsc.2011.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fabbrocini G, Annunziata MC, D'Arco V, De Vita V, Lodi G, Mauriello MC, Pastore F, Monfrecola G. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract 2010; 2010:893080. [PMID: 20981308 PMCID: PMC2958495 DOI: 10.1155/2010/893080] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 09/07/2010] [Accepted: 09/28/2010] [Indexed: 11/30/2022] Open
Abstract
Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%-14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.
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Affiliation(s)
- Gabriella Fabbrocini
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - M. C. Annunziata
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - V. D'Arco
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - V. De Vita
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - G. Lodi
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - M. C. Mauriello
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - F. Pastore
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
| | - G. Monfrecola
- Division of Clinical Dermatology, Department of Systematic Pathology, University of Naples Federico II, Via Sergio Pansini 5, 80133 Napoli, Italy
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Abstract
Today, laser therapy is standard treatment for a wide variety of dermatologic complaints. From skin rejuvenation to the management of complex vascular malformations, laser treatment has proved to be an effective, innovative solution to once-challenging dilemmas. However, laser application in those with darker complexions remains a topic of great concern. Although contemporary devices may use longer-wavelength lasers and cooling devices to isolate target tissues within patients with high levels of epidermal melanin, significant risk remains. Today's laser surgeon must have a thorough understanding of patient concerns, lesion character and response to treatment, as well as the unique needs of those with darker skin. In this article, we discuss critical issues in patient assessment, proper evaluation of common skin complaints, and laser therapy use for a variety of lesions in the ethnic population.
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Affiliation(s)
- Patrick D Cole
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Pulsed dye laser in burn scars: Current concepts and future directions. Burns 2010; 36:443-9. [DOI: 10.1016/j.burns.2009.08.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/14/2009] [Indexed: 01/22/2023]
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20
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Bloemen MC, van der Veer WM, Ulrich MM, van Zuijlen PP, Niessen FB, Middelkoop E. Prevention and curative management of hypertrophic scar formation. Burns 2009; 35:463-75. [DOI: 10.1016/j.burns.2008.07.016] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 07/08/2008] [Indexed: 12/26/2022]
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Galeckas KJ. Update on Lasers and Light Devices for the Treatment of Vascular Lesions. ACTA ACUST UNITED AC 2008; 27:276-84. [DOI: 10.1016/j.sder.2008.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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