1
|
Klop C, Schreurs R, De Jong GA, Klinkenberg ET, Vespasiano V, Rood NL, Niehe VG, Soerdjbalie-Maikoe V, Van Goethem A, De Bakker BS, Maal TJ, Nolte JW, Becking AG. An open-source, three-dimensional growth model of the mandible. Comput Biol Med 2024; 175:108455. [PMID: 38663350 DOI: 10.1016/j.compbiomed.2024.108455] [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: 11/10/2023] [Revised: 02/28/2024] [Accepted: 04/07/2024] [Indexed: 05/15/2024]
Abstract
The available reference data for the mandible and mandibular growth consists primarily of two-dimensional linear or angular measurements. The aim of this study was to create the first open-source, three-dimensional statistical shape model of the mandible that spans the complete growth period. Computed tomography scans of 678 mandibles from children and young adults between 0 and 22 years old were included in the model. The mandibles were segmented using a semi-automatic or automatic (artificial intelligence-based) segmentation method. Point correspondence among the samples was achieved by rigid registration, followed by non-rigid registration of a symmetrical template onto each sample. The registration process was validated with adequate results. Principal component analysis was used to gain insight in the variation within the dataset and to investigate age-related changes and sexual dimorphism. The presented growth model is accessible globally and free-of-charge for scientists, physicians and forensic investigators for any kind of purpose deemed suitable. The versatility of the model opens up new possibilities in the fields of oral and maxillofacial surgery, forensic sciences or biological anthropology. In clinical settings, the model may aid diagnostic decision-making, treatment planning and treatment evaluation.
Collapse
Affiliation(s)
- Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery 3D Lab, Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Guido A De Jong
- Department of Oral and Maxillofacial Surgery 3D Lab, Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Edwin Tm Klinkenberg
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Valeria Vespasiano
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Naomi L Rood
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Valerie G Niehe
- Department of Radiology, Groene Hart Ziekenhuis, Bleulandweg 10, 2803 HH, Gouda, the Netherlands
| | - Vidija Soerdjbalie-Maikoe
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium; Netherlands Forensic Institute, Department of Forensic Medical Research, Laan van Ypenburg 6, 2497 GB, The Hague, the Netherlands
| | - Alexia Van Goethem
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Bernadette S De Bakker
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Thomas Jj Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery 3D Lab, Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Jitske W Nolte
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Alfred G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Zhao Z, Bao J, Shen G, Cai M, Yu H. Integrating Virtual Surgical Planning and 3D-Printed Tools with Iliac Bone Grafts for Orbital and Zygomatic Reconstruction in Hemifacial Microsomia Patients. J Clin Med 2023; 12:7538. [PMID: 38137607 PMCID: PMC10743899 DOI: 10.3390/jcm12247538] [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: 10/17/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Hemifacial Microsomia (HFM) is the second most common congenital craniofacial malformation syndrome, and the complexity of HFM makes its treatment challenging. The present study aimed to introduce a new approach of utilization of virtual surgical planning (VSP) and 3D-printed surgical adjuncts for maxillofacial reconstruction. Five HFM patients were included in this study. All participants were provided with a full VSP, including the design of osteotomy lines, the design and fabrication of 3D-printed cutting guides, fixation plates, and titanium mesh for implantation. With the assistance of 3D-printed cutting guides and fixation plates, the orbital deformities were corrected, and a 3D-printed titanium mesh combined with iliac cancellous bone graft was applied to reconstruct the zygomatic arch. The surgical accuracy, effectiveness, and bone absorption rate were evaluated. All patients completed the entirely digital treatment process without experiencing severe complications. The surgical adjuncts were effective in aligning the movement of the bone segments with the surgical plan, resulting in mean 3D deviations (1.0681 ± 0.15 mm) and maximum 3D deviations (3.1127 ± 0.44 mm). The image fusion results showed that the patients' postoperative position of the maxilla, zygoma, and orbital rim was consistent with the virtual surgical plan, with only a slight increase in the area of bone grafting. The postoperative measurements showed significant improvement in the asymmetry indices of Er (AI of Er: from 17.91 ± 3.732 to 5.427 ± 1.389 mm, p = 0.0001) and FZ (AI of FZ: from 7.581 ± 1.435 to 4.070 ± 1.028 mm, p = 0.0009) points. In addition, the observed bone resorption rate at the 6-month follow-up across the five patients was 45.24% ± 3.13%. In conclusion, the application of VSP and 3D-printed surgical adjuncts demonstrates significant value in enhancing the precision and effectiveness of surgical treatments for HFM. A 3D-printed titanium mesh combined with iliac cancellous bone graft can be considered an ideal alternative for the reconstruction of the zygomatic arch.
Collapse
Affiliation(s)
| | | | | | - Ming Cai
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China; (Z.Z.); (J.B.); (G.S.)
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China; (Z.Z.); (J.B.); (G.S.)
| |
Collapse
|
3
|
Pei J, Liao X, Ge L, Liu J, Jiang X. Anterior cerebral falx plane in MR images to estimate the craniofacial midline. Sci Rep 2023; 13:16489. [PMID: 37779134 PMCID: PMC10543626 DOI: 10.1038/s41598-023-42807-6] [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: 04/07/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
Multiple methods have been proposed for evaluating the symmetry of facial contour by utilizing the median sagittal plane of the skull as a reference and measuring the maxillofacial region. To replace the manual mark point analysis method, we used the anterior cerebral falx plane in MRI images as an indicator of the craniofacial midline. The MRI examination data of 30 individuals were analyzed with a MeVisLab workstation. Two independent examiners performed 15 anthropometric measurements (4 angular, 11 linear) and compared the MRI-based anterior cerebral falx plane with the manual mark point analysis of the craniofacial midline estimation. All measurements were repeated after 3 weeks. Statistical analyses included the repeatability and reproducibility of the 2 methods based on intra-observer and inter-observer correlation coefficients (ICCs), respectively. Precision was estimated by intergroup comparison of the coefficient of variation. The anterior falx plane derived from the MRI data resulted in an intra-observer ICC of 0.869 ± 0.065 (range 0.733-0.936) and inter-observer ICC of 0.876 ± 0.0417 (0.798-0.932) for all measurements, showing significant correlations with the ICC values obtained by the mark point method (p < 0.05). The coefficient of variation showed that the precisions of the 2 methods were statistically comparable. We conclude that, for MRI-based craniofacial midline estimation, measurements made using the anterior cerebral falx plane are as precise, repeatable, and reproducible as those using the manual mark point analysis method. It has a high potential for application in radiation-free 3-dimensional craniofacial analysis.
Collapse
Affiliation(s)
- Jun Pei
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Xu Liao
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Lingling Ge
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Jianwei Liu
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China
| | - Xiling Jiang
- Affiliated Hospital of Chifeng University, Yuanlin Road 98, Chi Feng, 150400, Neimenggu, China.
| |
Collapse
|
4
|
Correlation between head shape and volumetric changes following spring-assisted posterior vault expansion. J Craniomaxillofac Surg 2021; 50:343-352. [DOI: 10.1016/j.jcms.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
|
5
|
Hierl T, Doerfler HM, Huempfner-Hierl H, Kruber D. Evaluation of the Midface by Statistical Shape Modeling. J Oral Maxillofac Surg 2020; 79:202.e1-202.e6. [PMID: 32971060 DOI: 10.1016/j.joms.2020.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this investigation was to generate a statistical shape model (SSM) of the midface and evaluate symmetry, gender aspects, and bone thickness. METHODS About 102 computed tomography scans were analyzed to create the SSM. This included segmentation, landmark attribution, and Procrustes and principal component analysis. Afterward, symmetry and gender differences were visualized by registration and color coding. Bone thickness was calculated by measuring the distance between outer and inner surfaces. RESULTS Symmetry was high in all models. The male model showed a more prominent forehead, nasal bones, and larger bizygomatic width. Bone thickness resembled the concept of vertical and horizontal maxillary pillars and buttresses. CONCLUSIONS SSM can be used to analyze midface morphology and help in virtual surgery planning. Calculation of bone thickness could also be a useful tool in surgical planning and biomechanics.
Collapse
Affiliation(s)
- Thomas Hierl
- Head of Department, Department of Oral & Maxillofacial Plastic Surgery, Helios Vogtland-Klinikum Plauen, Plauen, Germany.
| | - Hans-Martin Doerfler
- Engineer, Faculty of Mechanical and Energy Engineering, University of Applied Sciences (HTWK), Leipzig, Germany
| | - Heike Huempfner-Hierl
- Head, Department of Oral & Maxillofacial Plastic Surgery, Helios Vogtland-Klinikum Plauen, Plauen, Germany
| | - Daniel Kruber
- Computer Scientist, Faculty of Mechanical and Energy Engineering, University of Applied Sciences (HTWK), Leipzig, Germany
| |
Collapse
|
6
|
Ortún-Terrazas J, Fagan MJ, Cegoñino J, Illipronti-Filho E, Pérez Del Palomar A. Towards an early 3D-diagnosis of craniofacial asymmetry by computing the accurate midplane: A PCA-based method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 191:105397. [PMID: 32092615 DOI: 10.1016/j.cmpb.2020.105397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/11/2020] [Accepted: 02/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Craniofacial asymmetry is a common growth disorder often caused by unilateral chewing. Although an early orthodontic treatment would avoid surgical procedures later in life, the uncertainty of defining the accurate sagittal midplane potentially leads to misdiagnosis and therefore inaccurate orthodontic treatment plans. This novel study aims to 3D-diagnose craniofacial complex malformations in children with unilateral crossbite (UXB) considering a midplane which compensates the asymmetric morphology. METHODS The sagittal midplane of 20 children, fifteen of whom exhibited UXB, was computed by a PCA-based method which compensates the asymmetry mirroring the 3D models obtained from cone-beam computed tomography data. Once determined, one side of the data was mirrored using the computed midplane to visualize the malformations on the hard and soft tissues by 3D-computing the distances between both halves. Additionally, 31 skull's landmarks were manually placed in each model to study the principal variation modes and the significant differences in the group of subjects with and without UXB through PCA and Mann-Whitney U test analyses respectively. RESULTS Morphological 3D-analysis showed pronounced deformities and aesthetic implications for patients with severe asymmetry (jaw deviation > 0.8 mm) in whole craniofacial system, while initial signs of asymmetry were found indistinctly in the mandible or maxilla. We detected significant (p < 0.05) malformations for example in mandibular ramus length (0.0086), maxillary palate width (0.0481) and condylar head width (0.0408). Craniofacial malformations increased the landmarks' variability in the group of patients with UXB over the control group requiring 8 variation modes more to define 99% of the sample' variability. CONCLUSIONS Our findings demonstrated the viability of early diagnosis of craniofacial asymmetry through computing the accurate sagittal midplane which compensates the individual's asymmetrical morphology. Furthermore, this study provides important computational insights into the determination of craniofacial deformities which are caused by UXB, following some empirical findings of previous clinical studies. Hence, this computational approach can be useful for the development of new software in craniofacial surgery or for its use in biomedical research and clinical practice.
Collapse
Affiliation(s)
- Javier Ortún-Terrazas
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.
| | - Michael J Fagan
- Medical and Biological Engineering, School of Engineering and Computer Science, University of Hull, Hull, United Kingdom
| | - Jose Cegoñino
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Edson Illipronti-Filho
- School of Dentistry, Department of Orthodontics and Pediatric Dentistry, University of São Paulo, São Paulo, Brazil
| | - Amaya Pérez Del Palomar
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
7
|
Knoops PGM, Papaioannou A, Borghi A, Breakey RWF, Wilson AT, Jeelani O, Zafeiriou S, Steinbacher D, Padwa BL, Dunaway DJ, Schievano S. A machine learning framework for automated diagnosis and computer-assisted planning in plastic and reconstructive surgery. Sci Rep 2019; 9:13597. [PMID: 31537815 PMCID: PMC6753131 DOI: 10.1038/s41598-019-49506-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/19/2019] [Indexed: 12/15/2022] Open
Abstract
Current computational tools for planning and simulation in plastic and reconstructive surgery lack sufficient precision and are time-consuming, thus resulting in limited adoption. Although computer-assisted surgical planning systems help to improve clinical outcomes, shorten operation time and reduce cost, they are often too complex and require extensive manual input, which ultimately limits their use in doctor-patient communication and clinical decision making. Here, we present the first large-scale clinical 3D morphable model, a machine-learning-based framework involving supervised learning for diagnostics, risk stratification, and treatment simulation. The model, trained and validated with 4,261 faces of healthy volunteers and orthognathic (jaw) surgery patients, diagnoses patients with 95.5% sensitivity and 95.2% specificity, and simulates surgical outcomes with a mean accuracy of 1.1 ± 0.3 mm. We demonstrate how this model could fully-automatically aid diagnosis and provide patient-specific treatment plans from a 3D scan alone, to help efficient clinical decision making and improve clinical understanding of face shape as a marker for primary and secondary surgery.
Collapse
Affiliation(s)
- Paul G M Knoops
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Plastic and Oral Surgery, Boston Children's Hospital & Harvard School of Dental Medicine, Boston, MA, USA
| | - Athanasios Papaioannou
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Computing, Imperial College London, London, UK
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Richard W F Breakey
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Alexander T Wilson
- Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Derek Steinbacher
- Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Bonnie L Padwa
- Department of Plastic and Oral Surgery, Boston Children's Hospital & Harvard School of Dental Medicine, Boston, MA, USA
| | - David J Dunaway
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, London, UK.
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK.
| |
Collapse
|
8
|
Badiali G, Marcelli E, Bortolani B, Marchetti C, Cercenelli L. An average three-dimensional virtual human skull for a template-assisted maxillofacial surgery. Int J Artif Organs 2019; 42:566-574. [PMID: 31117867 DOI: 10.1177/0391398819849075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Although many advances have been made in three-dimensional virtual planning in maxillofacial surgery, facial harmony is still difficult to achieve and is heavily dependent on the surgeon's experience. The aim of the study is to present a method to build up an average three-dimensional virtual human skull to be used as a reference template for bone repositioning and reconstruction during maxillofacial surgical interventions. METHODS A total of 20 patients (10 females and 10 males) were selected for the optimal outcome after orthognathic surgery. Postoperative cone-beam computed tomography scans were collected and processed in order to obtain three-dimensional digital models of each skull. For male and female subgroups, the three-dimensional skull models were registered and an average three-dimensional virtual skull model was computed. Deviation color maps were calculated to show differences between each postoperative skull model in the population and the obtained average three-dimensional skull. A clinical use case of genioplasty treatment assisted by the provided average three-dimensional skull template was presented. RESULTS The overall mean deviation from the average three-dimensional skull model was 1.3 ± 0.6 and 1.6 ± 0.5 mm in male and female subgroups, respectively. For both groups, the greatest deviations were at the area of the mandible, while almost no deviation was found at the zygomatic and orbital areas. In the presented use case, the female average three-dimensional skull model was effectively used for guiding surgical planning. CONCLUSION The presented method of obtaining an average three-dimensional virtual human skull may offer the interesting perspective of performing an innovative template-assisted maxillofacial surgery.
Collapse
Affiliation(s)
- Giovanni Badiali
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Barbara Bortolani
- Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Marchetti
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences and S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|