TY - JOUR AU - Wu, Shan AU - Jiang, Zhixuan AU - Dong, Jiying AU - Yao, Min TI - Evaluation of thermodynamic bioeffects of long-pulsed 1064 nm laser in the photothermal lipolysis JF - LASERS IN SURGERY AND MEDICINE J2 - LASER SURG MED VL - 56 PY - 2024 IS - 1 SP - 90 EP - 99 PG - 10 SN - 0196-8092 DO - 10.1002/lsm.23742 UR - https://m2.mtmt.hu/api/publication/34639019 ID - 34639019 LA - English DB - MTMT ER - TY - JOUR AU - Kruglova, L.S. AU - Surkichin, S.I. AU - Avin, M. TI - Laser technologies for genitourinary syndrome of menopause JF - Plastic Surgery and Aesthetic Medicine J2 - Plast. Surg. Aesthet. Med. VL - 2023 PY - 2023 IS - 2 SP - 81 EP - 86 PG - 6 SN - 2686-7346 DO - 10.17116/plast.hirurgia202302181 UR - https://m2.mtmt.hu/api/publication/34224198 ID - 34224198 N1 - Export Date: 28 October 2023 Correspondence Address: Surkichin, S.I.; Central State Medical Academy of Administrative Directorate of the President of the Russian FederationRussian Federation; email: surkichinsi24@mail.ru AB - Genitourinary syndrome of menopause (GSM) is a complex of atrophic symptoms following reduced level of estrogens in vulvovaginal and ure-thral zones. Approximately 50% of menopausal women have signs and symptoms of GSM. The most common symptoms are vaginal dry-ness (100%), dyspareunia (78%), burning (57%), itching (57%) and dysuria (32%). All these symptoms can affect sexual function and quality of life. We analyzed literature data on GSM therapy with the following laser technologies: CO2 laser, erbium laser (Er:YAG) and neodymium laser (Nd:YAG). Clinical cases and management of patients with GSM are considered in detail. We assessed the effectiveness and safety of laser techniques. © 2023, Media Sphera Publishing Group. All rights reserved. LA - Russian DB - MTMT ER - TY - JOUR AU - Wu, S. AU - Wang, C. AU - Yao, M. AU - Han, D. AU - Li, Q. TI - Photothermal lipolysis accelerates ECM production via macrophage-derived ALOX15-mediated p38 MAPK activation in fibroblasts JF - JOURNAL OF BIOPHOTONICS J2 - J BIOPHOTONICS VL - 16 PY - 2023 IS - 4 SN - 1864-063X DO - 10.1002/jbio.202200321 UR - https://m2.mtmt.hu/api/publication/33600345 ID - 33600345 AB - Skin and subcutaneous tissue tightening is usually treated by noninvasive photothermal treatment for medical esthetics purpose, while the underlying mechanism remains to be elucidated. Here, we hypothesized that adipocyte injury, as a stimulator, may regulate extracellular matrix (ECM) production by increasing ALOX15 in macrophages, which could lead to fibroblast activation. In this study, we show that lipolysis was induced by laser heating (45°C for 15 min) in patients and rats, and adipocyte thermal injury stimulates the ECM production in fibroblasts by ALOX15 that was increased in cocultured macrophages. These phenomena were evidenced by the ALOX15 knockdown. In addition, ALOX15 metabolite 12(S)-HETE activated p38 MAPK signaling pathway that mediated the production of ECM in fibroblast. In summary, the results of this study demonstrate that the mechanisms of adipose photothermal injury-induced skin and/or subcutaneous tissue tightening may have clinical relevance for noninvasive or minimally invasive photothermal therapeutics. © 2022 Wiley-VCH GmbH. LA - English DB - MTMT ER - TY - JOUR AU - Xin, Hui AU - Yu, Fangbo AU - Deng, Chenggang AU - Chen, Ming AU - Li, Dong AU - Chen, Bin TI - Parametric investigation of multi-pulsed cryogen spray cooling for skin protection during hyperthermal laser lipolysis through in vitro experiment and numerical simulation JF - INTERNATIONAL JOURNAL OF THERMAL SCIENCES J2 - INT J THERM SCI VL - 190 PY - 2023 PG - 8 SN - 1290-0729 DO - 10.1016/j.ijthermalsci.2023.108294 UR - https://m2.mtmt.hu/api/publication/33938242 ID - 33938242 N1 - State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Shaanxi, Xi'an, 710049, China School of Mechanical Engineering, Ningxia University, Ningxia, Yinchuan, 750021, China Export Date: 28 October 2023 CODEN: RGTHA Correspondence Address: Chen, B.; State Key Laboratory of Multiphase Flow in Power Engineering, Shaanxi, China; email: chenbin@mail.xjtu.edu.cn Funding details: National Natural Science Foundation of China, NSFC, 52036007 Funding details: Fundamental Research Funds for the Central Universities Funding text 1: This research was funded by the National Natural Science Foundation of China (grant number 52036007) and the Fundamental Research Funds for the Central Universities. AB - Nowadays laser lipolysis has been a widely accepted modality to remove fat. Transcutaneous hyperthermal laser lipolysis has attracted researchers' interest because of its non-invasive nature and high efficiency. However, the possible thermal damage of skin tissue owing to the competitive absorption of laser energy between water and adipose tissue limits its application, which necessitates the development of efficient skin cooling technology. An in vitro laser experiment of streaky pork under 1210 nm laser irradiation with different power (E) and irradiation (t) proved that the epidermis temperature will exceed the safety threshold of 47 degrees C when E = 6W and t >= 5s, or E >= 9W and t >= 3s. To protect skin from thermal injury, the multi-pulsed cryogen spraying cooling (MP-CSC) by using R134a was introduced and numerical simulation was conducted to optimize cooling and laser parameters by simplifying the skin tissue to a multi-layered model. The simulation results suggest that hyperthermal laser lipolysis with a power of 6W similar to 9W and an irradiation duration of 7s can be realized for an area as large as 3 x 7.2 mm(2), by coupling MP-CSC with a pulse duration of 10 ms, a pulse delay of 2000 ms and a pulse number of 5. In this sense, the MP-CSC has great potential to prompt transcutaneous hyperthermal laser lipolysis. LA - English DB - MTMT ER - TY - JOUR AU - Badawi, Ashraf AU - Sobeih, Tarek AU - Jasmina, Vesel TI - Periocular rejuvenation using a unique non-ablative long-pulse 2940 nm Er:YAG laser JF - LASERS IN MEDICAL SCIENCE J2 - LASER MED SCI VL - 37 PY - 2022 SP - 1111 EP - 1118 PG - 8 SN - 0268-8921 DO - 10.1007/s10103-021-03362-6 UR - https://m2.mtmt.hu/api/publication/32381540 ID - 32381540 N1 - Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt Dermatology and Allergology Department, Faculty of Medicine, Szeged University, Szeged, Hungary Oakville, Canada Information Sciences Division, Nathan Kline Institute, Orangeburg, NY, United States LA&HA - Laser and Health Academy, Ljubljana, Slovenia Export Date: 17 April 2022 CODEN: LMSCE Correspondence Address: Badawi, A.; Medical Laser Applications, Egypt; email: ashrafbadawi@hotmail.com AB - The periocular region is challenging for cosmetic laser surgeons. Surgery and laser resurfacing have traditionally been used to correct periorbital lines and wrinkles. Although effective, the associated downtime with these methods has made many people reluctant to decide for such treatments. More recently, the non-ablative long-pulse 2940 nm Er:YAG laser is being used to improve the structure and function and hence the appearance of skin in the periorbital region. The objective of this study is to evaluate the safety and efficacy of long-pulse 2940 nm Er:YAG laser for non-ablative treatment of periorbital static wrinkles and skin laxity. This is a prospective analysis of 30 patients treated for periorbital rejuvenation using three sessions of non-ablative long-pulse Er:YAG laser over a 3-month period. All patients were assessed according to Fitzpatrick's classification of periorbital wrinkles to class I, II, or III and were treated with 2940 nm Er:YAG laser using a fluence of 3.75 J/cm(2), a repetition rate of 1.7-2 Hz, and with the SMOOTH (TM) pulse mode (250 ms). The treatment sessions were performed on each patient, 4 weeks apart. Patient improvement was assessed before each laser session as well as at 12 months after the final treatment. Blind photographic evaluations were performed by three independent physicians using unlabeled before and after photos arranged in non-chronological order. Reviewers were asked to determine the before and after photos. Patients were asked to answer a questionnaire measuring satisfaction 4 weeks after each session, and to report any adverse reactions. There was statistically and clinically significant improvement in the Fitzpatrick classification of the periorbital wrinkles. Blinded evaluators correctly identified the before and after photos in all cases. All patients reported mild edema and erythema, which persisted for 1 to 2 days, and superficial peeling of the skin for 4 to 6 days after each laser treatment. No long-term adverse effects were reported. The non-ablative long-pulse 2940 nm Er:YAG laser seems to be a safe and effective treatment for periocular rejuvenation with minimal and tolerable adverse reaction. The improvement attained from the laser sessions was persisting after 1 year denoting the long-term efficacy of the procedure. LA - English DB - MTMT ER - TY - JOUR AU - Fiala, Thomas AU - Lavin, Philip TI - Safety of a 1064-nm robotic laser system for noninvasive lipolysis of the flanks JF - LASERS IN SURGERY AND MEDICINE J2 - LASER SURG MED VL - 54 PY - 2022 IS - 5 SP - 672 EP - 681 PG - 10 SN - 0196-8092 DO - 10.1002/lsm.23532 UR - https://m2.mtmt.hu/api/publication/32784746 ID - 32784746 N1 - Export Date: 17 April 2022 CODEN: LSMED Correspondence Address: Fiala, T.; Department of Surgery, United States; email: drfiala@drfiala.com LA - English DB - MTMT ER - TY - JOUR AU - Gambacciani, M. AU - Fidecicchi, T. TI - Short-term effects of an erbium/neodymium laser combination in superficial dyspareunia: a pilot study JF - CLIMACTERIC J2 - CLIMACTERIC VL - 25 PY - 2022 IS - 2 SP - 208 EP - 211 PG - 4 SN - 1369-7137 DO - 10.1080/13697137.2021.2014809 UR - https://m2.mtmt.hu/api/publication/32784747 ID - 32784747 N1 - Export Date: 17 April 2022 CODEN: CLIMF Correspondence Address: Gambacciani, M.; Menopause and Osteoporosis Unit, 152/f, Italy; email: margamba54@gmail.com LA - English DB - MTMT ER - TY - JOUR AU - Kim, Sojung TI - A Pilot Study to Assess the Efficacy and Safety of an Intelligent Approach to Noninvasive Body Core Strengthening with a Novel Functional Magnetic Muscle Stimulation (FMS) System JF - Medical Lasers J2 - Medical Lasers VL - 11 PY - 2022 IS - 1 SP - 21 EP - 30 PG - 10 SN - 2287-8300 DO - 10.25289/ML.2022.11.1.21 UR - https://m2.mtmt.hu/api/publication/32784762 ID - 32784762 LA - English DB - MTMT ER - TY - JOUR AU - Wang, Y. AU - Song, Y. TI - Efficacy of Combined Treatment with Intense Pulsed Light and Erbium Fractional Laser in Striae Gravidarum JF - CLINICAL COSMETIC AND INVESTIGATIONAL DERMATOLOGY J2 - CLIN COSMET INV DERM VL - 15 PY - 2022 SP - 2817 EP - 2824 PG - 8 SN - 1178-7015 DO - 10.2147/CCID.S387970 UR - https://m2.mtmt.hu/api/publication/33600346 ID - 33600346 N1 - Export Date: 28 January 2023 Correspondence Address: Song, Y.; Department of Plastic Surgery, No. 18, Daoshan Road, Gulou District, Fujian, China; email: Yongsong1985@163.com AB - Purpose: Laser and intense pulsed light (IPL) treatments are preferred over invasive procedures due to less pain. This study looked at the efficacy and safety of IPL and Erbium fractional laser for patients with striae gravidarum (SG). Patients and Methods: All 60 patients with SG were successfully enrolled in the study. IPL treatment was followed by Erbium fractional laser (wavelength 2940 nm) treatment at 4-week intervals for a total of three treatments. SG elasticity was assessed with a SEM575 custom instrument and patients were scored for SG span with an Antera 3D multifunctional skin imaging analyzer. A 3D skin impact system was used to assess patients’ epidermal thickness. A visual analog scale (VAS) was used to assess patients’ pain scores during the treatment period. Improvement in stretch marks was assessed with the Global Aesthetic Improvement Scale (GAIS). The occurrence of adverse events was recorded at a follow-up of 3 months. Patient satisfaction with the outcome of the treatment was also recorded. Results: Area of stretch marks decreased from 7.89 ± 0.49 cm2 pre-treatment to 4.94 ± 1.16 cm2 post-treatment (P < 0.001). The grayness values and atrophy of stretch marks were reduced after treatment. Furthermore, skin elasticity and thickness at the lesions of patients increased significantly after the treatment (P < 0.001), while the width of the stretch marks significantly decreased (P < 0.001). The VAS score was 5.45 ± 1.31, the incidence of adverse events was 25%, and patient satisfaction with the efficacy was 96.67%. Conclusion: IPL combined with Erbium fractional laser improves the area and atrophy of SG, lightens the color, and increases the elasticity and thickness of the skin, with high treatment safety and remarkable clinical results. © 2022 Russian Academy of Sciences. All rights reserved. LA - English DB - MTMT ER - TY - JOUR AU - Xin, Hui AU - Deng, Chenggang AU - Zhou, Hongmei AU - Sang, Xuehao AU - Chen, Bin TI - Histopathological evaluation of the R134a multipulsed spray cooling assisted 1210 nm laser lipolysis by the murine model in vivo JF - LASERS IN SURGERY AND MEDICINE J2 - LASER SURG MED VL - 54 PY - 2022 IS - 10 SP - 1298 EP - 1308 PG - 11 SN - 0196-8092 DO - 10.1002/lsm.23607 UR - https://m2.mtmt.hu/api/publication/33426013 ID - 33426013 N1 - State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Shaanxi, Xi'an, China Department of Dermatology, 2nd Affiliated Hospital, Medical School, Laser Treatment Center, Xi'an Jiaotong University, Shaanxi, Xi'an, China Cited By :1 Export Date: 28 January 2023 CODEN: LSMED Correspondence Address: Chen, B.; State Key Laboratory of Multiphase Flow in Power Engineering, Shaanxi, China; email: chenbin@mail.xjtu.edu.cn Chemicals/CAS: eosin, 17372-87-1, 51395-88-1, 548-26-5; hematoxylin, 517-28-2 Tradenames: BrightLase Ultra-100; BX51, Olympus Manufacturers: Olympus Funding details: National Natural Science Foundation of China, NSFC, 52036007 Funding details: Fundamental Research Funds for the Central Universities Funding text 1: This research was funded by the National Natural Science Foundation of China, grant number 52036007 and the Fundamental Research Funds for the Central Universities. AB - Background and Objective Owing to the greater absorption affinity for lipo-rich tissue than water, the 1210 nm laser is a promising candidate for transcutaneous lipolysis in the near-infrared band. However, fat reduction is limited because laser therapy may yield thermal injury of normal tissue. A new protocol to incorporate multipulsed cryogen spray cooling is beneficial to improve the lipolysis effect, and the parameters of laser and cooling can be optimized via skin histopathological analysis. Materials and Methods A murine in vivo model of inguinal tissue of SD rats was established to test the effectivity of transcutaneous lipolysis protocol by R134a multipulsed spray cooling assisted 1210 nm laser irradiation. Tissue response of lipolysis with/without cooling 10 days post the treatment was evaluated by histopathological analysis of skin samples stained with hematoxylin-eosin (HE), through which safe and effective parameters for lipolysis were determined. Results From histopathological analysis of the inguinal tissue of SD rats irradiated by the 1210 nm laser alone, the optimal durations are respectively 7 and 3 s (seconds) for low-dosage (6 W) and high-dosage (9 W) therapy, with pronounced lipolysis effect and minimum injury of skin tissue. The multipulsed spray cooling by R134a with a pulse duration of 10 ms (milliseconds), a pulse delay of 2000 ms, and a pulse number of 5 can be introduced to assist the 1210 nm laser therapy with a power of 9 W and a duration of 7 s to achieve desirable fat liquefaction while keeping the complete structure of skin tissue as well as esthetic-related beneficial effects of hair removal and skin rejuvenation. Conclusion Excellent lipolysis effect can be achieved via R134a multipulsed spray cooling assisted high-dosage 1210 nm laser irradiation with reasonably matched laser and cooling parameters. The protocol is as follows: Start MP-CSC for one cycle, and then fire the laser with specific power and duration, while keeping MP-CSC accordingly. This new protocol may promote the safe and effective clinical implement of transcutaneous laser lipolysis in body contouring. LA - English DB - MTMT ER - TY - JOUR AU - Kozma, Bence AU - Pákozdy, Krisztina Lili AU - Lampé, Rudolf AU - Berényi, Ervin László AU - Takács, Péter TI - Ultrahang-elasztográfia alkalmazásának lehetőségei a szülészet-nőgyógyászatban = Application of ultrasound elastography in obstetrics and gynecology JF - ORVOSI HETILAP J2 - ORV HETIL VL - 162 PY - 2021 IS - 18 SP - 690 EP - 695 PG - 6 SN - 0030-6002 DO - 10.1556/650.2021.32094 UR - https://m2.mtmt.hu/api/publication/32033210 ID - 32033210 LA - Hungarian DB - MTMT ER - TY - JOUR AU - Scala, J. AU - Tirant, M. AU - Van, Thuong N. AU - Lotti, T. TI - Low-Level Laser Therapy in fat reduction: what evidence do we have? JF - Journal of Applied Cosmetology J2 - Journal of Applied Cosmetology VL - 39 PY - 2021 IS - 1 SP - 47 EP - 54 PG - 8 SN - 0392-8543 UR - https://m2.mtmt.hu/api/publication/32501823 ID - 32501823 N1 - Export Date: 20 November 2021 CODEN: JACOE Correspondence Address: Scala, J.; Institute of Dermatologic and Regenerative Sciences, Via Alfonso la Marmora 29, Italy; email: jacscala@yahoo.it AB - Low level laser therapy (LLLT) dates to early '70 to induce hair and wound regeneration then to reduce inflammation, edema and chronic pain and in present times is widely used for cosmetic fat reduction but despite the presence of many LLLT devices on the market the exact biochemical mechanism to explain its therapeutic effects is yet to be fully understood. Published data from treatments used to achieve fat layer reduction were pooled and reviewed to assess efficacy, safety and patient satisfaction and proposed models of LLLT biological action are discussed. © 2021 International Ediemme. All rights reserved. LA - English DB - MTMT ER - TY - JOUR AU - Wu, S. AU - Pei, Q. AU - Ni, W. AU - Fu, X. AU - Zhang, W. AU - Song, C. AU - Peng, Y. AU - Guo, Q. AU - Dong, J. AU - Yao, M. TI - HSPA1A Protects Cells from Thermal Stress by Impeding ESCRT-0–Mediated Autophagic Flux in Epidermal Thermoresistance JF - JOURNAL OF INVESTIGATIVE DERMATOLOGY J2 - J INVEST DERMATOL VL - 141 PY - 2021 IS - 1 SP - 48 EP - 58.e3 SN - 0022-202X DO - 10.1016/j.jid.2020.05.105 UR - https://m2.mtmt.hu/api/publication/31631353 ID - 31631353 N1 - Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Institute of Traumatic Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China Export Date: 15 October 2020 CODEN: JIDEA Correspondence Address: Yao, M.; Department of Burns and Plastic Surgery, School of Clinical Medicine, 639 Zhizaoju Road, China; email: my058@vip.sina.com Funding details: National Natural Science Foundation of China, NSFC, 81772118 Funding text 1: This work was supported by the National Natural Science Foundation of China (No. 81772118 ). We are grateful to Jianxiu Yu, Yanmin Guo, and Jianfeng He for their technical support. AB - Thermoresistance is a physiological phenomenon relevant to noninvasive laser treatments for skin esthetics and tumor removal, although the underlying mechanism remains elusive. We hypothesized that HSPA1A may regulate autophagy by reducing ESCRT-0 and/or STAM2 levels, which could lead to thermal protection from cell death. In this study, we showed that thermoresistance was induced in mouse epidermal tissue and HaCaT cells by heating at 45 °C for 10 minutes. Moreover, HSPA1A levels were increased in thermoresistant mouse epidermis and HaCaT cells. HSPA1A was highly involved in protecting cells from thermal cytotoxicity, as evidenced by the knockdown or overexpression assays of the HSPA1A gene. In addition, ESCRT-0 and STAM2 levels were dramatically decreased in thermoresistant cells, which was mediated by HSPA1A binding to STAM2, particularly through HSPA1A amino acids 395‒509. Furthermore, the loss of ESCRT-0 and/or STAM2 in response to HSPA1A–STAM2 binding regulated autophagy by impeding autophagosome‒lysosome fusion and abolishing autophagic flux in cellular thermoresistance, significantly reducing thermal cytotoxicity and promoting cell survival. To our knowledge, it is previously unreported that HSPA1A–ESCRT-0 and/or STAM2 modulates heat-induced resistance by inhibiting autophagic flux. In summary, the results of this study demonstrate that the mechanisms of thermoresistance may have clinical relevance for noninvasive or minimally invasive thermal therapeutics. © 2020 The Authors LA - English DB - MTMT ER - TY - JOUR AU - Marreira, M. AU - Rocha, Mota L. AU - Silva, D.F.T. AU - Pavani, C. TI - Study protocol for the use of photobiomodulation with red or infrared LED on waist circumference reduction: A randomised, double-blind clinical trial JF - BMJ OPEN J2 - BMJ OPEN VL - 10 PY - 2020 IS - 8 SN - 2044-6055 DO - 10.1136/bmjopen-2019-036684 UR - https://m2.mtmt.hu/api/publication/31631352 ID - 31631352 N1 - Export Date: 15 October 2020 Correspondence Address: Pavani, C.; Biophotonics Applied to Health Sciences, Universidade Nove de JulhoBrazil; email: chrispavani@gmail.com Chemicals/CAS: alanine aminotransferase, 9000-86-6, 9014-30-6; aspartate aminotransferase, 9000-97-9; cholesterol, 57-88-5 Manufacturers: FLIR, United States AB - Introduction The search for non-invasive procedures to reduce localised adiposity in aesthetics clinics has recently been increasing. In this context, procedures, such as cryolipolysis, ultracavitation, photobiomodulation (PBM) and other techniques have been proposed. Some studies have shown that PBM can be used in body contouring. However, there is no standardisation of the protocol. More than that, as in other techniques for reducing adipose tissue, the availability of triacylglycerol may affect the lipid profile in the blood, bringing consequences to the general health of an individual. This work will aim to compare the light wavelengths when using PBM as a technique for reducing the abdominal waist circumference, while also evaluating the efficacy of the method. Changes in the lipid profile in the blood, with a long-term follow-up, will also be appraised. Methods and analysis This will be a controlled, randomised, double-blind, single-centred clinical trial. 174 patients will be recruited at the Nove de Julho University, Brazil, and then divided into three groups: Group A - RED PBM; Group B - INFRARED PBM; Group C - PLACEBO (Sham) treatment. The treatments will consist of eight sessions, two times a week, for 4 weeks. At each session, the participants will receive 30 minutes PBM (using a radiant exposure of 127 J/cm 2), with an abdominal strap containing 4 LED clusters, with 72 devices each, following the indication of randomisation. All of the groups will receive 30 min of Aussie Current, at 4 kHz, modulated at 10 Hz, 40-60 mA. The main outcome of this study will be waist circumference reduction. The secondary variables will be anthropometric data, lipid profile, liver function and adipose tissue thickness, changes in the local microcirculation, and the quality of life and self-esteem. The analyses will be performed at four stages of the research, D0, end of the eighth session (D30), 15 days after the last session (FU15), 90 days after the last session (FU90) and 180 days after the last session (FU180). Ethics and dissemination The Ethics Committee of the Nove de Julho University, Brazil, approved the modified version of this project under No. 3414146 on 26 June 2019. This study is not yet recruiting. The results obtained will be published in a peer-reviewed journal in the related field. Trial registration number Brazilian Registry of Clinical Trials - ReBec (RBR-9bwxcx). © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. LA - English DB - MTMT ER -