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Kumar N, Parsa AD, Rahman E. A Core Curriculum for Postgraduate Program in Non-Surgical Aesthetics: A Cross-sectional Delphi Study. AESTHETIC SURGERY JOURNAL OPEN FORUM 2022; 4:ojac023. [PMID: 35662906 PMCID: PMC9154017 DOI: 10.1093/asjof/ojac023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The desire for portraying a young and beautiful face and body is driving people to seek aesthetic treatment and accelerating the exponential growth of nonsurgical aesthetic (NSA) procedures. Unfortunately, despite impressive advances, NSA is yet to have a formal clinical education program. Objectives This study aimed to identify the content and structure of an evidence-based postgraduate curriculum in NSA. Methods The Delphi questionnaire was developed after a comprehensive literature review and a focus group discussion. The questionnaire was emailed to 40 experts and 20 trainee physicians worldwide through the online survey platform and was asked to assign a rating on a 4-point Likert scale. A “1” represents a strong disagreement about integrating a topic in the NSA curriculum, and a “4” indicates a firm agreement. A pre-fixed percentage agreement of 80% and Cronbach’s α = 0.90 was established to represent a consensus for the current study. Results The response rate for the Delphi study was 90.0%, 88.8%, and 90% in the first, second, and third rounds, respectively. The experts and trainee physicians agreed with all the proposed topics (≥80%) and considered them critical for the proposed NSA curriculum. The mean score for each was ≥ 3, and Cronbach’s α value for the Delphi was 0.94, confirming internal consistency and reliability. Conclusions The consensus demonstrates significant advances toward developing an evidence-based curriculum for a postgraduate program in NSA, which is essential to support the growing demand for trained aesthetic physicians.
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Affiliation(s)
- Narendra Kumar
- Division of Biosciences, Department of Cell and Developmental Biology, University College London, London, WC1E6BT, United Kingdom
| | - Ali Davod Parsa
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, United Kingdom
| | - Eqram Rahman
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, United Kingdom
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Insights into the Anti-Aging Prevention and Diagnostic Medicine and Healthcare. Diagnostics (Basel) 2022; 12:diagnostics12040819. [PMID: 35453867 PMCID: PMC9028886 DOI: 10.3390/diagnostics12040819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/04/2022] Open
Abstract
Aging is an irreversible and natural phenomenon that occurs as a person ages. Anti-aging medicine applies advanced science and medical technology to early detection, prevention, treatment, and reversal of age-related dysfunctions, disorders, and diseases. Therefore, anti-aging diagnostic medicine and healthcare are important factors in helping the elderly population lead healthy and active lives. However, it is challenging to diagnose various aging and related diseases accurately through various forms of anti-aging diagnostic medicine and health management. It may not be treated appropriately, so many older people are making various efforts to prevent aging themselves in advance. Therefore, anti-aging medicine and health care have been developed in various forms, from health checkups to alternative medicine and biophysical technology beyond simple clinical medicine, and are being applied to demand the needs of the elderly. This review intends to explore and characterize various applications related to anti-aging medicine and healthcare in the elderly. In addition, economic, medical, and ethical considerations arising from the relationship between the increase in the elderly population and the continuous development of anti-aging medicine can be considered.
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Cook M, Richey A, Brafman DA, Frow EK. Weighing up the evidence used by direct-to-consumer stem cell businesses. Stem Cell Reports 2021; 16:2852-2860. [PMID: 34767748 PMCID: PMC8693621 DOI: 10.1016/j.stemcr.2021.10.007] [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: 05/06/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/04/2022] Open
Abstract
Hundreds of businesses across the United States offer direct-to-consumer stem-cell-based interventions that have not been approved by the Food and Drug Administration. Here, we characterize the types of evidence used on the websites of 59 stem cell businesses in the Southwest United States to market their services. We identify over a dozen forms of evidence, noting that businesses are less likely to rely on “gold-standard” scientific evidence, like randomized clinical trials, and instead draw substantially on forms of evidence that we identify as being “ambiguous.” Ambiguous evidence has some scientific or medical basis, but its interpretation is highly context-dependent. These findings highlight the interpretive responsibility placed on prospective patients. We identify actions for regulators and professional societies to assist with evaluating evidence, but caution that focusing on the (in)validity of particular evidence types is unlikely to eliminate demand for stem-cell-based treatments in this complex marketplace. We characterize the evidence used by 59 stem cell businesses in the Southwest United States We identify that clinics rely on scientifically and medically “ambiguous” evidence Ambiguous evidence places interpretive responsibility on prospective patients We offer suggestions to help prospective patients navigate this complex landscape
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Affiliation(s)
- Margaret Cook
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Alexandra Richey
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - David A Brafman
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Emma K Frow
- School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA; School for the Future of Innovation in Society, Arizona State University, Tempe, AZ 85287, USA.
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Wang JV, Schoenberg E, Zaya R, Rohrer T, Zachary CB, Saedi N. The rise of stem cells in skin rejuvenation: A new frontier. Clin Dermatol 2020; 38:494-496. [PMID: 32972609 DOI: 10.1016/j.clindermatol.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Stem cells have recently garnered increased attention, especially pertaining to their use in cutaneous rejuvenation. Their popularity has continued to grow with patients and consumers alike, which has followed the substantial marketing bolstering them. Although limited, studies have begun to demonstrate promise in the field of esthetics. We review the prominent studies in the literature to shed more light on the use of stem cells for cosmetic practitioners.
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Affiliation(s)
- Jordan V Wang
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Elizabeth Schoenberg
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Romsin Zaya
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas Rohrer
- SkinCare Physicians, Chestnut Hill, Massachusetts, USA
| | | | - Nazanin Saedi
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Erikainen S, Couturier A, Chan S. Marketing Experimental Stem Cell Therapies in the UK: Biomedical Lifestyle Products and the Promise of Regenerative Medicine in the Digital Era. SCIENCE AS CULTURE 2019; 29:219-244. [PMID: 33716572 PMCID: PMC7905833 DOI: 10.1080/09505431.2019.1656183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Stem cell research has attracted much public and biomedical anticipation centred on the possibility of using stem cells to treat various diseases and conditions, but the number of evidence-based therapies is currently limited. Numerous commercial direct-to-consumer (DTC) businesses are nonetheless marketing experimental stem cell therapies online for myriad medical conditions and aesthetic ailments, which has attracted critique due to safety and efficacy concerns. Existing research has largely focused on the problem of unproven therapies and regulatory pathways for addressing it. The proliferation of these experimental products must also be examined, however, in the broader socio-technological context of consumer culture and changing practices of knowledge-making in the digital era. DTC stem cell therapies have emerged as a new biomedical 'lifestyle' product that blurs the boundaries between 'science,' 'medicine,' and 'consumer culture.' In using, conceptualising and marketing stem cells, commercial businesses build on and commercially co-opt alternative epistemic and ontological frames that challenge scientific medicine. They advance promissory narratives about their potential that tap on cultural aspirations around the future of medicine and health. This is key, not only for understanding how and why these therapies have proliferated but also in conceptualising what the 'problem' around them actually is.
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Affiliation(s)
- Sonja Erikainen
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Anna Couturier
- EuroStemCell, Scottish Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Sarah Chan
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Wang JV, Schoenberg E, Rohrer T, Zachary CB, Saedi N. Stem cells in aesthetic dermatology: bioethical and professional obligations. Arch Dermatol Res 2019; 311:833-835. [DOI: 10.1007/s00403-019-01955-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/07/2019] [Accepted: 07/13/2019] [Indexed: 12/22/2022]
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Making Sense of Stem Cells and Fat Grafting in Plastic Surgery: The Hype, Evidence, and Evolving U.S. Food and Drug Administration Regulations. Plast Reconstr Surg 2019; 143:417e-424e. [PMID: 30688913 DOI: 10.1097/prs.0000000000005207] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Autologous fat grafting and adipose-derived stem cells are two distinct entities with two different risk profiles, and should be regulated as such. Autologous fat grafting prepared with the additional step of stromal vascular fraction isolation is considered a form of "stem cell therapy" given the high concentration of stem cells found in stromal vascular fraction. Much ambiguity existed in the distinction between autologous fat grafting and stromal vascular fraction initially, in terms of both their biological properties and how they should be regulated. The market has capitalized on this in the past decade to sell unproven "stem cell" therapies to unknowing consumers while exploiting the regulatory liberties of traditional fat grafting. This led to a Draft Guidance from the U.S. Food and Drug Administration in 2014 proposing stricter regulations on fat grafting in general, which in turn elicited a response from plastic surgeons, who have safely used autologous fat grafting in the clinical setting for over a century. After a series of discussions, the U.S. Food and Drug Administration released its Final Guidance in November of 2017, which established clear distinctions between autologous fat grafting and stromal vascular fraction and their separate regulations. By educating ourselves on the U.S. Food and Drug Administration's final stance on fat grafting and stem cell therapy, we can learn how to navigate the regulatory waters for the two entities and implement their clinical use in a responsible and informed manner.
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Johnson ML, Johnson L, Mahabir RC, Bernard R. Perspectives on the FDA Draft Guidances for Use of Adipose Tissue. Aesthet Surg J 2017; 37:622-625. [PMID: 28333305 PMCID: PMC5434492 DOI: 10.1093/asj/sjx049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Martin L Johnson
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
- Founding Editor of Aesthetic Surgery Journal
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Raman C Mahabir
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Robert Bernard
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
- Founding Editor of Aesthetic Surgery Journal
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Kashihara H, Nakayama T, Hatta T, Takahashi N, Fujita M. Evaluating the Quality of Website Information of Private-Practice Clinics Offering Cell Therapies in Japan. Interact J Med Res 2016; 5:e15. [PMID: 27222494 PMCID: PMC4897299 DOI: 10.2196/ijmr.5479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 11/16/2022] Open
Abstract
Background Although the safety and effectiveness of stem cell therapies are yet to be proven, recent studies show that such therapies are being advertised with some questionable marketing techniques to effect positive portrayal of the therapies on the webpages of private-practice clinics to sell their therapies worldwide. In such context, those clinics communicate directly with consumers (patients and their family members) via the clinics’ websites. Meanwhile, the Health Science Council at the Ministry of Health, Labour, and Welfare (MHLW) in Japan has pointed out noncompliance of some local clinics with the provisions concerning medical advertising in the Medical Care Act in the past. However, locally little is known about the current status of those clinics including the quality of their webpage information disseminated. Objective To evaluate the quality of website information of private-practice clinics offering cell therapies in Japan. Methods Twenty-four websites with 77 treatments from the Google search were identified for evaluation. The following three exploratory analyses were performed: first in order to ascertain web-based portrayal of private-practice clinics offering cell therapies, a descriptive analysis was conducted using a coding frame; second we evaluated the quality of the target website information from the viewpoint of the level of consideration taken for patients and their family members, using 10 quality criteria (“the Minimum Standard”) from the e-Health Code of Ethics 2.0; third we counted and coded expressions that matched set categories for “name-dropping” and “personalized medicine” in the information posted on these websites. Results Analysis on the treatments (N=77) revealed 126 indications (multiple response): the top three indications were “cancer,” “skin-rejuvenation/antiaging/anti–skin aging,” and “breast augmentation/buttock augmentation.” As for the portrayal of treatment risks and benefits, 78% (60/77) of treatments were mentioned with “benefits,” whereas 77% (59/77) of treatments were mentioned with “risks.” As for the source(s) cited for the discussions of treatment risks and benefits, no treatment quoted an expert’s opinion for the risks, whereas 7% (6/77) treatments quoted external sources for the benefits. As for the results with e-Health Code of Ethics 2.0, not a single clinic fulfilled all the 10 criteria; 63% (15/24) of the clinics was found exercising “name-dropping,” and 21% (5/24) of the clinics mentioned expressions related to “personalized medicine” on their websites. Conclusions Our website content analyses confirmed the following: (1) the clinics mentioned the risks or benefits of the treatments with hardly any scientific citations, (2) the way the website information was disseminated was inappropriate for patients and their families, and (3) many websites seemed to be using marketing techniques in order to draw patients’ interests or attentions. It is important that more similar studies are undertaken globally to enable an orchestrated regulatory approach toward private-practice clinics.
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Affiliation(s)
- Hidenori Kashihara
- Center for iPS Cell Research and Application (CiRA), Kyôto University, Kyôto, Japan.
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Aunan JR, Watson MM, Hagland HR, Søreide K. Molecular and biological hallmarks of ageing. Br J Surg 2016; 103:e29-46. [PMID: 26771470 DOI: 10.1002/bjs.10053] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ageing is the inevitable time-dependent decline in physiological organ function that eventually leads to death. Age is a major risk factor for many of the most common medical conditions, such as cardiovascular disease, cancer, diabetes and Alzheimer's disease. This study reviews currently known hallmarks of ageing and their clinical implications. METHODS A literature search of PubMed/MEDLINE was conducted covering the last decade. RESULTS Average life expectancy has increased dramatically over the past century and is estimated to increase even further. Maximum longevity, however, appears unchanged, suggesting a universal limitation to the human organism. Understanding the underlying molecular processes of ageing and health decline may suggest interventions that, if used at an early age, can prevent, delay, alleviate or even reverse age-related diseases. Hallmarks of ageing can be grouped into three main categories. The primary hallmarks cause damage to cellular functions: genomic instability, telomere attrition, epigenetic alterations and loss of proteostasis. These are followed by antagonistic responses to such damage: deregulated nutrient sensing, altered mitochondrial function and cellular senescence. Finally, integrative hallmarks are possible culprits of the clinical phenotype (stem cell exhaustion and altered intercellular communication), which ultimately contribute to the clinical effects of ageing as seen in physiological loss of reserve, organ decline and reduced function. CONCLUSION The sum of these molecular hallmarks produces the clinical picture of the elderly surgical patient: frailty, sarcopenia, anaemia, poor nutrition and a blunted immune response system. Improved understanding of the ageing processes may give rise to new biomarkers of risk or prognosis, novel treatment targets and translational approaches across disciplines that may improve outcomes.
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Affiliation(s)
- J R Aunan
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - M M Watson
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - H R Hagland
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Centre for Organelle Research (CORE), Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - K Søreide
- Gastrointestinal Translational Research Unit, Molecular Laboratory, Stavanger University Hospital, Stavanger, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Du L, Rachul C, Guo Z, Caulfield T. Gordie Howe's "Miraculous Treatment": Case Study of Twitter Users' Reactions to a Sport Celebrity's Stem Cell Treatment. JMIR Public Health Surveill 2016; 2:e8. [PMID: 27227162 PMCID: PMC4869214 DOI: 10.2196/publichealth.5264] [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] [Received: 10/22/2015] [Revised: 12/20/2015] [Accepted: 01/04/2016] [Indexed: 01/24/2023] Open
Abstract
Background Former Detroit Red Wing Gordie Howe received stem cell (SC) treatment in Mexico in December 2014 for a stroke he suffered in October 2014. The news about his positive response to the SC treatment prompted discussion on social networks like Twitter. Objective This study aims to provide information about discussions that took place on Twitter regarding Howe’s SC treatment and SC treatment in general. In particular, this study examines whether tweets portrayed a positive or negative attitude towards Howe’s SC treatment, whether or not tweets mention that the treatment is unproven, and whether the tweets mention risks associated with the SC treatment. Methods This is an infodemiology study, harnessing big data published on the Internet for public health research and analysis of public engagement. A corpus of 2783 tweets about Howe’s SC treatment was compiled using a program that collected English-language tweets from December 19, 2014 at 00:00 to February 7, 2015 at 00:00. A content analysis of the corpus was conducted using a coding framework developed through a two-stage process. Results 78.87% (2195/2783) of tweets mentioned improvements to Howe’s health. Only one tweet explicitly mentioned that Howe’s SC treatment was unproven, and 3 tweets warned that direct-to-consumer SC treatments lacked scientific evidence. In addition, 10.31% (287/2783) of tweets mentioned challenges with SC treatment that have been raised by scientists and researchers, and 3.70% (103/2783) of tweets either defined Howe as a “stem cell tourist” or claimed that his treatment was part of “stem cell tourism”. In general, 71.79% (1998/2783) of tweets portrayed a positive attitude towards Howe’s SC treatment. Conclusions Our study found the responses to Howe’s treatment on Twitter to be overwhelmingly positive. There was far less attention paid to the lack of scientific evidence regarding the efficacy of the treatment. Unbalanced and uncritical discussion on Twitter regarding SC treatments is another example of inaccurate representations of SC treatments that may create unrealistic expectations that will facilitate the market for unproven stem cell therapies.
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Affiliation(s)
- Li Du
- Health Law Institute Faculty of Law University of Alberta Edmonton, AB Canada
| | - Christen Rachul
- School of Linguistics and Language Studies Carleton University Ottawa, ON Canada
| | - Zhaochen Guo
- Department of Computing Science University of Alberta Edmonton, AB Canada
| | - Timothy Caulfield
- Health Law Institute, Law Centre, University of Alberta Edmonton, AB Canada
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Mosahebi A. Commentary on: The Fountain of Stem Cell-Based Youth? Online Portrayals of Anti-Aging Stem Cell Technologies. Aesthet Surg J 2015; 35:737-8. [PMID: 26229129 DOI: 10.1093/asj/sjv014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Afshin Mosahebi
- Dr Mosahebi is a Consultant Plastic Surgeon, Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
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Gordie Howe’s Stem Cell ‘Miracle’: A Qualitative Analysis of News Coverage and Readers’ Comments in Newspapers and Sports Websites. Stem Cell Rev Rep 2015; 11:667-75. [DOI: 10.1007/s12015-015-9606-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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