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Wang Y, Sun Z, Cai L, Zhang F. Comparative efficacy and safety of six photoelectric therapies for the atrophic acne scars: A network meta-analysis. Indian J Dermatol Venereol Leprol 2023; 89:353-362. [PMID: 37067138 DOI: 10.25259/ijdvl_572_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/01/2022] [Indexed: 02/05/2023]
Abstract
Objectives
This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG).
Methods
A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists’ evaluation(DE), the patients’ overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH).
Results
Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2.
Conclusion
FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present.
Registration
PROSPERO CRD42021242160
(available from https://www.crd.york.ac.uk/prospero).
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Affiliation(s)
| | | | - Lingling Cai
- Department of Dermatology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Fengchuan Zhang
- Department of Dermatology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
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2
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Sabry HH, Hegazy MS, Ahmed E, Salem RM. Q-Switched 1064-nm Nd: YAG laser versus fractional carbon dioxide laser for post acne scarring: A split-face comparative study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:465-470. [PMID: 35020221 DOI: 10.1111/phpp.12773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/05/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Many treatment modalities are available for post acne scarring. However, the response to the treatment is extremely variable among patients. AIM The aim of this study was to compare the efficacy and safety of Q-switched Nd: YAG (1064 nm) and fractional CO2 (10,600 nm) lasers in the treatment of atrophic post acne scars. METHODS This study included 20 patients with atrophic facial post acne scars graded according to Sharquie's score. All subjects received four sessions of laser treatment with a 4-week interval between the sessions. The study was designed as a double-blinded, comparative, split-face study applying Q-switched 1064-nm Nd:YAG laser to the right side of the face and fractional CO2 laser to the left side. RESULTS Q-switched 1064-nm Nd: YAG laser achieved significantly higher improvement percentage when compared to fractional CO2 lasers (33.33% versus 17.37% Sharquie's score reduction, respectively). There was a significant negative correlation between the percentages of improvement and the patients' age on both sides and a significant positive correlation with the baseline Sharquie scores on both sides. CONCLUSION Q-Switched 1064-nm Nd: YAG laser could be a promising safe option for the management of atrophic post acne scars.
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Affiliation(s)
- Hanan Hassan Sabry
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohammed Saad Hegazy
- Department of Dermatology, Venereology and Andrology, Armed Forces College of Medicine, Cairo, Egypt
| | - Eman Ahmed
- Dermatology, Kobbry El Kobba Hospital, Cairo, Egypt
| | - Rehab Mohammed Salem
- Department of Dermatology and Andrology, Faculty of Medicine, Benha University, Benha, Egypt
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3
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Clinical evaluation of efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Neodymium:YAG laser in the treatment of inflammatory acne vulgaris in adolescent and post-adolescent patients: a prospective randomized split-face comparative study. Lasers Med Sci 2022; 37:2471-2478. [PMID: 35084634 PMCID: PMC9232433 DOI: 10.1007/s10103-022-03510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/17/2022] [Indexed: 11/05/2022]
Abstract
Large numbers of local and systemic therapies are available for acne treatment. Common oral or topical retinoids, antibiotics, or keratolytics are used but sometimes are inconvenient, and side effects caused by these conventional therapies prompted a search for effective and safe treatments. This study aimed to evaluate the efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Nd:YAG laser in the treatment of moderate inflammatory acne vulgaris in both adolescents and post-adolescent patients. This split-face comparative study was carried out on thirty patients who suffered from moderate inflammatory and non-inflammatory acne vulgaris. The patients were classified into two groups: group I: adolescent (≤ 25 years) and group II: post-adolescent (< 25 years). Each group received four sessions of intralesional PRP injection on one side of the face and a long-pulsed Nd:YAG (1064 nm) laser on the other side with 2 weeks interval. Evaluation was done by blinded dermatologists using photographs and lesions counting and by patient satisfaction. Side effects were also noted. Both groups (adolescents and post-adolescent) showed a high statistically significant improvement of inflammatory as well as non-inflammatory lesions either in PRP or Nd:YAG laser–treated side with no significant difference between the two sides. The intralesional PRP injection and 1064 nm long-pulsed Nd:YAG laser are safe and effective methods for controlling inflammatory as well as non-inflammatory acne vulgaris in both adolescents and post-adolescent patients.
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4
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Salameh F, Shumaker PR, Goodman GJ, Spring LK, Seago M, Alam M, Al-Niaimi F, Cassuto D, Chan HH, Dierickx C, Donelan M, Gauglitz GG, Haedersdal M, Krakowski AC, Manuskiatti W, Norbury WB, Ogawa R, Ozog DM, Paasch U, Victor Ross E, Clementoni MT, Waibel J, Bayat A, Goo BL, Artzi O. Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations. Lasers Surg Med 2021; 54:10-26. [PMID: 34719045 DOI: 10.1002/lsm.23484] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. STUDY DESIGN/MATERIALS AND METHODS An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. RESULTS The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. CONCLUSION Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.
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Affiliation(s)
- Fares Salameh
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Peter R Shumaker
- VA San Diego Healthcare System and University of California, San Diego, California, USA
| | - Greg J Goodman
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Leah K Spring
- Micrographic Surgery and Surgical Oncology, SkinCare Physicians, Chestnut Hill, Massachusetts, USA
| | - Meghan Seago
- VA San Diego Healthcare System and University of California, San Diego, California, USA.,Micrographic Surgery and Surgical Oncology, Scripps Clinic, La Jolla, California, USA
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Henry Hl Chan
- Private Practice and Department of Medicine (Dermatology), University of Hong Kong, People's Republic of China
| | | | - Matthias Donelan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig Maximillian University, Munich, Germany
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | | | - William B Norbury
- Department of Surgery, University of Texas Medical Branch, Shriners Hospital for Children-Galveston, Galveston, Texas, USA
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Uwe Paasch
- Department of Dermatology, Venereology, and Allergy, University of Leipzig, Leipzig, Germany
| | | | | | - Jill Waibel
- Miami Dermatology and Laser Institute, Miami, Florida, USA
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, England, UK.,MRC-SA Wound Healing Unit, Hair & Skin Research Laboratory, Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Boncheol Leo Goo
- Naeum Dermatology and Aesthetic Clinic/Skin Rehabilitation Center, Seoul, Korea
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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5
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Akerman L, Solomon-Cohen E, Rozenblat M, Hodak E, Lapidoth M, Levi A. 1064-nm Q-switched fractional Nd:YAG laser is safe and effective for the treatment of post-surgical facial scars. Lasers Med Sci 2020; 36:871-874. [PMID: 32845427 DOI: 10.1007/s10103-020-03134-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
Post-surgical facial scars are often associated with unaesthetic outcome. Treatment of these scars using various lasers could be beneficial; however, the use of the Q-switched fractional (QSF) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has yet to be evaluated for this indication. Our objective was to determine the safety and efficacy of a QSF-Nd:YAG laser for the treatment of post-surgical facial scars. Eleven (5 male, 6 female) patients who underwent facial surgery with significant scarring were treated using the QSF-Nd:YAG laser. Scars were exposed to 600-1200 mJ/stacked pulses (12-24 mJ per pixel), emitted at a rate of 10 Hz for up to 2 passes per treatment session, receiving overall 3-6 treatments. Patient follow-up was 3 months. Scars' photographs were blindly assessed by two dermatologists, who graded them on a scale of scar severity from 1 to 5 (1 = least severe, 5 = most severe) before and after treatment. A blinded before/after recognition of these photographs was also performed. Patient satisfaction was assessed 3 months post-treatment and graded on a scale of 1-5 (1 = not satisfied, 5 = very satisfied). Pain perception and adverse effects were also evaluated. Patients demonstrated a decrease in scar severity score by a mean of 1.57 points (p = 0.0005). A blinded before/after recognition was correct in 86.5% of the cases. Pain and adverse effects were mild and transient. Patient satisfaction was high (4.2). QSF-Nd:YAG laser is a safe and effective modality for the treatment of post-surgical facial scars.
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Affiliation(s)
- Lehavit Akerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Solomon-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel.
| | - Mati Rozenblat
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Emmilia Hodak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel
| | - Moshe Lapidoth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel
| | - Assi Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel
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Rathod D, Foroughi A, Mekokishvili L, Wollina U, Lotti T, Rajan A, Goldust M. A cross-sectional, multi-center study on treatment of facial acne scars with low-energy double-pass 1450-nm diode laser. Dermatol Ther 2020; 33:e13326. [PMID: 32208551 DOI: 10.1111/dth.13326] [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] [Received: 01/15/2020] [Revised: 03/15/2020] [Accepted: 03/18/2020] [Indexed: 01/30/2023]
Abstract
Acne scars are the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo-sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low-energy double-pass 1450-nm diode laser on acne scars. This study was conducted on 48 patients with acne scars, treated at 4-week interval with low-energy double-pass 1450-nm diode laser. Patients were evaluated clinically and with photographs, at day 0, first month and third month post the final treatment and during follow-up visit. Five treatment sessions were completed by all patients. Approximately, 79.2% of patients showed around 30% improvement. At the end of third month follow-up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post-inflammatory hyperpigmentation and transient hyperpigmentation was observed in one case, which vanished within 2 months. Our study showed that 1450-nm diode laser treatment was efficient and well endured in facial acne scars when used with double-pass at low-energy.
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Affiliation(s)
- Dipali Rathod
- Consultant Dermatologist, Mumbai, Maharashtra, India
| | | | - Lali Mekokishvili
- Department of Dermatology, Caucasus International University, Faculty of Medicine, Tbilisi, Georgia
| | - Uwe Wollina
- Department of Dermatology and Allergology, StädtischesKlinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | - Aswath Rajan
- Department of Dermatology, Venereology and Leprology, Goa Medical College, Bambolim, Goa, India
| | - Mohamad Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Affiliation(s)
- Neil S. Sadick
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Andrea Cardona
- Residente de tercer año, Universidad del Rosario, Bogota, Columbia
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8
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Ezra N, Arshanapalli A, Bednarek R, Akaishi S, Somani AK. The microsecond 1064 nm Nd:YAG laser as an adjunct to improving surgical scars following Mohs micrographic surgery. J COSMET LASER THER 2016; 18:225-9. [PMID: 27077529 DOI: 10.3109/14764172.2016.1157356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Scarring following skin surgery is an unavoidable certainty. Scars resulting from Mohs Micrographic Surgery (MMS) can cause both cosmetic and functional problems. Various lasers have been used to treat scars, but the role of the microsecond pulsed 1064 nanometer neodymium-doped yttrium aluminum garnet (1064 nm Nd:YAG) in treating surgical scars is not well-defined. OBJECTIVE We aim to examine the clinical application of the 1064 nm Nd:YAG laser in improving surgical scars. METHODS Ten patients who were unhappy with cosmetic or functional outcomes of their surgical scars following MMS were treated with 1-3 sessions of the 1064 nm Nd:YAG laser to improve their scars. Therapy completion was determined by patient satisfaction with the appearance of their scars and/or resolution of any contractures that formed following surgery. RESULTS All ten patients were pleased with the improved appearance of their scars. Four patients saw complete resolution of an ectropion or eclabium that formed secondary to scar contractures from MMS. The side effects of laser treatments were limited to 1-2 hours of erythema, and there were no incidences of adverse effects or recurrence of contractures. CONCLUSION Our clinical experience with the 1064 nm Nd:YAG laser provides promising data on improving appearance of and functionality from post-surgical scars.
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Affiliation(s)
- Navid Ezra
- a Department of Dermatology , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Ashish Arshanapalli
- a Department of Dermatology , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Robert Bednarek
- a Department of Dermatology , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Satoshi Akaishi
- b Department of Plastic , Reconstructive and Aesthetic Surgery , Nippon Medical School, Tokyo , Japan
| | - Ally-Khan Somani
- a Department of Dermatology , Indiana University School of Medicine , Indianapolis , IN , USA
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Cohen BE, Brauer JA, Geronemus RG. Acne scarring: A review of available therapeutic lasers. Lasers Surg Med 2015; 48:95-115. [PMID: 26414762 DOI: 10.1002/lsm.22410] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The utilization of lasers in dermatology has greatly expanded in recent decades. Acne scarring is a common indication in which lasers play an important therapeutic role. STUDY DESIGN/MATERIALS AND METHODS Available lasers include traditional ablative lasers, such as carbon dioxide and erbium lasers, traditional non-ablative lasers, such as neodymium, diode, alexandrite, pulsed dye lasers and intense pulse light, as well as both ablative, and non-ablative fractional laser systems. CONCLUSION We sought to provide a framework for understanding the various types of lasers available to treat acne scars and review the primary literature pertaining to the efficacy, safety, and advantages of each laser discussed.
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Affiliation(s)
- Brandon E Cohen
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 240 East 38th Street, New York, NY 10016
| | - Jeremy A Brauer
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 240 East 38th Street, New York, NY 10016
- Laser & Skin Surgery Center of New York, 317 E 34th St, New York, NY 10016
| | - Roy G Geronemus
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, 240 East 38th Street, New York, NY 10016
- Laser & Skin Surgery Center of New York, 317 E 34th St, New York, NY 10016
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10
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Xiong C, He R, Pi L, Li J, Yao C, Jiang J, Zheng X. Adsorption of Neodymium(III) on Acrylic Resin (110 Resin) from Aqueous Solutions. SEP SCI TECHNOL 2014. [DOI: 10.1080/01496395.2014.955204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Legres LG, Chamot C, Varna M, Janin A. The Laser Technology: New Trends in Biology and Medicine. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jmp.2014.55037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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