Performance and recovery go hand in hand when training or doing physical activities, regardless if you’re an athlete or not. In fact, athletes and their trainers utilize light therapy to improve their performance and muscle health and optimize recovery. To expound further, this article will tackle optimizing performance in fitness, improving the recovery process, and breaking down the significance of light therapy.
Optimizing performance means paying attention to the body and how it functions, to live and train the body, and to find the best way to support its functions. Performance is not based on how hard or heavy are the weights you lift or the number of kilometers you’ve run; it is how effective your performance is and how you match it with your lifestyle (with the way you eat, drink and sleep).
On the other hand, recovery is about the effectiveness of the body’s healing process and the conscious effort of being in your best shape by enhancing your workout. It is also about utilizing the body’s tools and functions to effectively finish the jobs required daily.
Performance and recovery are correlated to one another. In exercising or training, if you want to improve fitness, workouts should be consistent. To get stronger, faster, and bigger, certain efforts must be made to increase performance levels. The recovery process is essential in health. It contributes to the workout; it is the downtime between training sessions or a break due to an injury or a period of healing from any exhaustion experienced.
Breaks like cool-downs, rest, and ample time of sleep give your body time to recuperate. They also allow healing for the muscles and tissues affected, strained, or damaged from workouts or training.
Performance is better when recovery time from soreness or inflammation is maximized. It also helps prevent burnout, fatigue, and possible injuries. If recovery is not made right, your physical performance may not reach its optimal state. Some athletes and trainers even make a recovery a priority over training itself. They believe that when an athlete recovers better than their competition, they will train harder in the long run.
Even if you are not an athlete, you should know how to let your body rest, heal, and recover properly from any form of injury or physical activity. Everyone has their own activity levels to maintain. It may not be sports-related, but everyone demands effort from their bodies on a day-to-day basis.
Regardless if you are an athlete, your body has limits. And if you push too hard, the body can break down and perform worse, especially if you didn’t observe any recovery time. Overtraining and pushing the body beyond its limits can affect performance in the short term or long term. Chances of injury are higher when you don’t allow yourself to recover, and it may also affect hormonal levels and the function of the immune system. The body needs time to process inflammation or any injury.
Inflammation happens when the body responses to danger or strain. It often takes place during a strenuous workout. When exercising, inflammation may indicate muscular damage. And when a muscle is “damaged,” it means that the tissue is growing and undergoes repair to get stronger.
Experiencing inflammation is a normal part of the growth and repair of muscle tissues. However, if you won’t set aside time for recovery, your inflammation may worsen over time and lead to greater health consequences.
Here are some ways that can help you improve your body’s recovery process:
The body speaks when it sends signals to the brain. Sometimes, we dismiss these signals because of training goals. This may eventually lead to fatigue and injury. When you experience pain or when your muscles are sore, it is important to give your body time to recuperate. You must also be aware of your heart rate, especially at rest, as it may be saying something about the state of your health.
Besides giving your body time to recuperate, deep sleep also allows the body to digest and process fat and recover from inflammation or damaged muscle tissues. It is harder for the body to recover from pain, strain, fatigue, and injury when you’re sleeping less than 7–8 hours per night. If you’re struggling with getting enough sleep, try doing meditation or speak with a doctor so he/she can advise you about developing a sleeping routine.
Getting the right amount of whole foods, good carbohydrates, protein, and good fat can also boost your performance and recovery. Lowering your intake of processed foods, alcohol, and sugary drinks can also help decrease inflammation.
The performance and recovery of our bodies depend entirely on our cells. When our cells are creating and using energy efficiently, our bodies recover faster. ATP (adenosine triphosphate) energy is released to give us power in what we do. The process of creating ATP energy works best when our body and cells are well-balanced, reaching a state called homeostasis.
High-quality devices are now available in the market to help athletes and trainers enhance the body’s natural healing and recovery process through light therapy.
Light therapy is a non-invasive treatment that uses LED lights to deliver red and near-infrared light to the skin and cells. It promotes efficient cellular ATP energy production and helps restore the balance of cells and tissues. Light therapy can be done before or after a workout. Some even do it both times — before and after a workout, depending on their goals.
Pre-conditioning with light therapy before working out can also help strengthen muscle performance. It can limit muscle damage and strain, lessening the chances of inflammation or soreness. When used after a workout, it promotes the speedy recovery of muscles and accelerates its adaptability to exercise. It also helps the body process acute inflammation after physical activity.
Muscles are composed of millions of cells that need to release ATP energy to fulfill the body's jobs, balancing exercise and stress. Light therapy helps improve cellular ATP energy, glycogen synthesis, oxidative stress reduction, and protection against muscle damage from exercising. Light therapy also helps improve blood circulation and oxygen availability, which allows better healing and recovery. It helps with the overall improvement of physical performance and faster recovery times. It also helps limit fatigue from exercising and strength training.
As discussed, light therapy promotes faster healing and recovery and soothes cells under stress when doing strenuous workouts, incurring injuries, and experiencing inflammation. When you set aside time for recovery, you give your body and cells what they need to function, thus improving your overall performance.
At Kaiyan Medical, we offer high-quality light therapy devices to help you achieve and maintain your fitness and performance goals. If you have questions about our products and the brands we offer, please don’t hesitate to contact us. We will respond to you as soon as possible.
When it comes to pain, we could hardly avert it! Especially the muscle pain. Given that the human body has over 600 muscles, it is tough to avoid muscle pain. Evidently, one out of three Americans is affected by muscle pain annually.
Not only this, Musculoskeletal pain affects around 116 million Americans, which results in poor productivity, missed work or school, fatigue, and lost interest in work.
But doesn’t we treatments for this chronic pain? Of course, we do have several options. Currently, therapies available consist of non-steroidal anti-inflammatory drugs, steroid injections, pain medications, and surgery. Each of these has its own specific risk profiles.
What we need now is an effective solution that is less time-consuming, low risk, safe and non-invasive, and yet cost-effective. All these features are available in treatment; we call Low Laser Light Therapy (LLLT). Light therapy has been in the medical field over the past forty years. Light therapy has been demonstrated to lessen inflammation and edema, promote healing in a range of musculoskeletal pathologies. LLLT is being accepted around the globe. This is an advanced, cost-effective, non-invasive therapy for pain that could elevate the quality of life while reducing your financial strains. The causes of muscular pain are numerous. Hence, LLLT helps people from all fields like sports, fitness, medical, and even old age.
In this process, light with a wavelength in the red to the near-infrared region of the spectrum (660nm–905nm) is employed on the skin surface. The reason for using these wavelengths is that they have the ability to penetrate the skin and soft/hard tissues. From various conducted clinical trials, this treatment is proven to have a good effect on pain, inflammation, and repairing of the tissues. The therapy goes from 30 to 120 seconds or more a week, depending upon the pain's severity.
Based on the tissue condition, the therapy can go on for weeks or months. LLLT has resulted in relief and reduction of inflammation, pain relief, and accelerated tissue regeneration.
But how does the light actually work?
Do you know that many acute orthopedic conditions such as strains, sprains, muscular back pain, frozen shoulder, neck and back pain, etc., are amenable to Low Laser Light Therapy (LLLT)?
The Infra-Red light relieves pain in a different section of the body and increases relaxation sensation while also comforting the muscles. LLLT has been shown to enhance the multiplication of cells like fibroblasts, keratinocytes, endothelial cells, and lymphocytes. Fibroblasts and keratinocytes are two major cell types that respond to the inflammatory phase in the repair/regeneration process.
LLLT can enhance neovascularization, promote angiogenesis, and increase collagen synthesis to succor in the healing of acute and chronic wounds. The LED light sessions have shown the ability to heal skin, nerves, tendons, cartilage, and bones. Low-intensity LLLT stimulates mitochondria and also enhances the mitochondrial membrane potential.
The peripheral nerve endings of nociceptors (also known as the pain receptors), consisting of the thinly myelinated and unmyelinated, slow-conducting C fibers, lie within the epidermis. This complex network converts harmful stimuli into action potentials. Moreover, these nerve endings lie on the surface or superficial in nature, making the LLLT wavelength penetration work easy.
Hence, with the rise of chronic pain in different countries, it is imperative to validate cost-effective and safe techniques for managing painful conditions, allowing people to live active and productive lives. Light therapy is constantly evolving in relieving muscular pain. It improves the muscle's endurance, reduces muscle soreness, joint pain, and inflammation.
It’s time to let go of the pain!!
Experience the difference with light therapy from Kaiyan Medical.
https://pubmed.ncbi.nlm.nih.gov/12605431/
https://pubmed.ncbi.nlm.nih.gov/27472858/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743666/
Which is the vitamin that is not normally found in any vegetarian food? Vitamin D.
Scientists have defined vitamins as organic (carbon-containing) chemicals that must be obtained from dietary sources because they are not produced by our bodies. Vitamins play a crucial role in our body’s metabolism, but only tiny amounts are needed to fill that role.
The discovery of Vitamin D was the culmination of a long search for a way to cure rickets in the 1920s, a painful childhood bone disease. Within a decade, the fortification of foods with vitamin D was on the way, and rickets became rare in the United States. However, research results suggest that vitamin D may have a role in other aspects of human health.
Vitamin Dit’s absent from all-natural foods except for fish and egg yolks, and even when it’s obtained from foods, it must be transformed by the body before it can do any good. That’s why the energy of the Sun is so important.
The sun’s energy turns a chemical in your skin into vitamin D3, which is carried to your liver and then your kidneys to transform it into active vitamin D.
Humans, day by day, spend less time outdoors. Most people work indoors now, and many of our leisure pursuits occur in an indoor setting as well. What’s more, when we are outside, many people avoid the sun as much as possible. The result is the body not absorbing enough UVB rays to create the amount of vitamin D it requires. Often, symptoms of vitamin D deficiency are quite mild. When noticed, they mainly consist of:
Though you may not notice any symptoms, that doesn’t mean that vitamin D deficiency doesn’t present serious health risks. These include:
Less chance of having a baby
Without sunlight, there will be more melatonin in a woman’s body. This is a hormone that suppresses fertility, thereby reducing her chances of conceiving a baby. Moreover, women who get less sunlight reach their menopause earlier than those who are exposed to the Sun. Men can also suffer from a lack of sunlight; it directly influences testosterone levels.
Raw nerves
It’s believed that if children don’t get enough sunlight, they’ll be more at risk of developing multiple sclerosis, a disease of the central nervous system when they become adults.
All those aches and pains
Without sunlight, be prepared to get more pains all over your body. Sunlight helps to warm the body’s muscles and reduce the pain caused by inflammatory conditions such as arthritis.
No sunny emotions
Without sunlight, we would be forever stuck with the seasonal affective disorder (SAD), commonly known as the winter blues. It’s a form of depression that is specifically caused by a lack of sunlight. Artificial light cannot fully replace natural sunlight.
Recent evidence suggests that vitamin D may help prevent many disorders, such as diabetes, multiple sclerosis, rheumatoid arthritis, chronic obstructive pulmonary disease, asthma, bronchitis, premenstrual syndrome, increased blood pressure, strokes and heart attacks, and even cancer. Low serum vitamin D levels are also associated with being overweight, abdominal obesity, metabolic syndrome, stroke, and diabetes. In addition, having lower blood vitamin D levels for a long period is associated with increased heart attacks and all-cause mortality.
In Kaiyan medical, we believe in the benefits of light. We believe in healing without chemicals. With our lights, we want you to have the best version of yourself. More at kaiyanmedical.com
Color Light therapy is based on the idea of restoring balance by applying color to the body. Its history is rooted as far back as the Mayan culture.
In India, Ayurveda, an ancient form of medicine practiced for thousands of years, is based on the idea that every individual contains five elements of the universe that are present in specific proportions unique to each individual, including their personality type and constitution. When these elements are out of balance, Ayurveda works with the energies inherent in the colors of the spectrum to restore this balance.
In ancient Egypt the art of healing with color was founded in the Hermetic tradition, the Ancient Egyptians and Greeks used colored minerals, stones, crystals, salves, and dyes as remedies, and painted treatment sanctuaries in various shades of color.
In China, traditional Chinese medicine incorporates color to be associated with each organ and elemental system. This healing method looks at the idea that every individual is a balance. The first color wheel was invented by Sir Isaac Newton. He split white sunlight into red, orange, yellow, green, cyan, and blue. He then joined the two ends of the color spectrum together to show the natural progression of colors.
Light Therapy has been valued throughout history as a remarkable source of healing. Today, the therapeutic applications of light and color are being investigated in major hospitals and research centers worldwide. Results indicate that full-spectrum, ultraviolet, colored, and laser light can have therapeutic value for a range of conditions from chronic pain and depression to immune disorders.
Light Therapy has been reported, as part of a healthy lifestyle, to temporarily reduce swelling, relieve pain, decrease inflammation, accelerate open wound healing and greatly reduce overall recovery after medical/surgical procedures. Patients have demonstrated an increased range of motion, decreased muscle tension and spasm, and improved circulation.
Rejuvenating LED light therapy can be used for temporary pain management such as joint and back pain, sore or torn muscles, sprains, arthritis, post-surgical scars, burns, wounds, and more. When used with infrared technology, light therapy (phototherapy) is one of the most effective and non-invasive ways to improve overall wellness.
Light therapy is also used to temporarily relieve Seasonal Affective Disorder (SAD). SAD affects individuals when the lack of sunlight results in seasonal depression. Phototherapy helps with SAD by resetting the internal biological clock (Circadian rhythms), helping individuals sleep better, and regulate their mood. Even companies, such as GE and Philips, have created phototherapeutic products to improve and regulate mood.
Light therapy is also a growing treatment for anti-aging. Many individuals have seen a temporary reduction in the appearance of fine lines, wrinkles, crow’s feet, and age spots.
Light therapy is “effective at improving the appearance of the face, neck, and chest by reducing the signs of aging, wrinkles and age spots”, says Web M.D. Combined with infrared therapy, LED phototherapy can be a great way to revitalize skin.
Color is light split into different wavelengths vibrating at different speeds and at different frequencies. Objects that ABSORB all wavelengths and DO NOT reflect are black in nature. Objects that REFLECT all wavelengths and DO reflect are white in nature. Between black and white lies COLOR. Colors are wavelengths of energy that, to us, appear as color because of the potential and capabilities of the object to either absorb or reflect the energy.
In the early 1990s, RLT was used by scientists to help grow plants in space. The scientists found that the intense light from red light-emitting diodes (LEDs) helped promote the growth and photosynthesis of plant cells.
The red light was then studied for its potential application in medicine, more specifically to find out if RLT could increase energy inside human cells. The researchers hoped that RLT could be an effective way to treat the muscle atrophy, slow wound healing, and bone density issues caused by weightlessness during space travel.
You may have heard of red light therapy (RLT) by its other names, which include:
Red is called “The Great Healer”. So far is the most popular light therapy. To wind down before bed, use red light. “The color signals that it’s night, which may encourage the body to produce melatonin,” says Michael Breus, Ph.D., an advisory board member for SleepScore Labs.
Red light can also improve your workout. Just one to five minutes of exposure to red and infrared light right before exercise boosted strength and prevented soreness, says Ernesto Leal-Junior, Ph.D., the head of the Laboratory of Phototherapy in Sports and Exercise at Nove de Julho University in Brazil. “Certain wavelengths of red and infrared light-660 to 905 nanometers-reach skeletal muscle tissue, stimulating the mitochondria to produce more ATP, a substance that cells use as fuel,” he says.
Green is the universal healing color. Originally, the color of love. Green is midway in the color spectrum; therefore, it contains both a physical nature and a spiritual nature, in equal balance and in equal harmony.
Gazing at green light can reduce chronic pain (caused by fibromyalgia or migraines, for example) by up to 60 percent, according to a study in the journal Pain, and animal studies have shown that the beneficial effects can last up to nine days. “Looking at green light seems to lead to an increase in the body’s production of enkephalins, pain-killing opioid-like chemicals. And it reduces inflammation, which plays a role in many chronic pain conditions,” says researcher Mohab Ibrahim, M.D., Ph.D.
More studies are needed before doctors can make recommendations on how and how often to use green light to treat migraines and other pain, and Dr. Ibrahim says you should see a physician before trying to treat yourself at home. But at this point research indicates that exposing yourself to an hour or two every night-either by using a green light bulb in a lamp or by wearing glasses fitted with tinted optical filters-may decrease migraines and other types of chronic pain
Helps to treat and prevent hyper-pigmentation by inhibiting the production of excess melanin which then prevents it from traveling to the surface. It will help break up the melanin clusters that are already on the surface.
Yellow helps awaken mental inspiration arousing a higher mentality. Thus, it is an excellent color for nervous or nerve-related conditions or ailments; fueling the solar plexus. Yellow has a very enriching effect upon the intellect. Yellow can be used for conditions of the stomach, liver, and intestines. It can help the pores of the skin by repairing scarred tissue. These rays have an alkalizing effect which strengthens the nerves. Awakening, inspiring, and vitally stimulating the higher mind promoting self-control. Typical diseases treated by yellow are constipation, gas, liver troubles, diabetes, eczema, and nervous exhaustion. Providing clarity of thought, increasing awareness, stimulating interest, and curiosity yellow energy is related to the ability to perceive or understand.
The yellow is used for treating redness, flushing, irritation, and Rosacea. It may also reduce the appearance of the tiny blood vessels on the nose and face.
Blue light therapy technology is an additional option for the treatment of acne. Research has shown in-office and at-home systems produce positive results.
“Blue light therapy effectively helps alleviate this common skin condition affecting 50 million Americans and 94 percent of all females, according to Judith Hellman, MD, a board-certified dermatologist, in practice in New York City. Dr. Hellman, who practices medical dermatology and specializes in dermatological surgery, laser surgery, and anti-aging skin treatments, explains how the blue light treatment system works for acne, its uses, and her clinical experience with the technology.
It is used as a gentle acne treatment to control oil production in the skin as well as reduce inflammation. It also promotes the synthesis of protein and collagen.
Orange Light
Orange has a freeing action upon the mind, relieving repression. Because orange is a blend of red and yellow, it combines physical energy with mental wisdom, inducing a transformation between lower physical reaction and higher mental response. Thus, it is often referred to as “The Wisdom Ray.” Orange is warm, cheering, and non-constricting.
Through orange, we are able to heal the physical body (red) and, at the same time, induce within the mind (yellow) greater understanding. Orange helps assimilate new ideas. Orange is the best emotional stimulant, helping to remove inhibitions paving independent social behavior. Bring joy to your workday and strengthen your appetite for life. Orange aids in repairing inflammation of the kidneys, gallstones, menstrual cramps, epilepsy, wet cough, and all sinus conditions.
Purple Light
Violet is the last color we can see before light passes on to ultra-violet. Violet purifies our thoughts and feelings giving us inspiration in all undertakings. The violet energy connects us to our spiritual self bringing guidance, wisdom, and inner strength and enhances artistic talent and creativity. Leonardo da Vinci proclaimed that you can increase the power of meditation ten-fold by meditating under the gentle rays of Violet, as found in church windows.
Light therapy uses colors for their proposed wellness abilities in treating emotional and physical disturbances. Light therapy is based on the premise that different colors evoke different responses in people. For example, some colors are considered to be stimulating, whereas others may be soothing. Color therapy has been suggested for many uses, based on tradition or on scientific theories. Consult with a health care provider before using color therapy for any use.
Infrared Light
Infrared light penetrates to the inner layers of the skin at about 2 to 7 centimeters deep. Hence, it reaches the muscles, nerves, and even the bones. Many studies have shown that a frequency of infrared light, with wavelengths from 700 to 1,000 nanometers, is best used for healing inflammatory conditions.
The use of electricity for healing purposes began in 2,750 BC when people used electric eels to give electric shocks. Electricity and magnetism were used in people with just little success. However, in 1975, transcutaneous electrical stimulation (TENS) was developed to treat chronic pain. It was not until recently that infrared therapy was developed to improve wound healing, reduce the pain caused by arthritis, boost endorphin levels, and bioactivate neuromodulators.
Infrared therapy technology allows people to harness the benefits of the sun, without being exposed to harmful ultraviolet rays. Also, infrared therapy is safe and effective, without adverse side effects. As a matter of fact, infrared light is safe and is used even for infants in neonatal intensive care.
Infrared light is absorbed by the photoreceptors in cells. Once absorbed, the light energy kickstarts a series of metabolic events, triggering several natural processes of the body on a cellular level.
Kaiyan Medical
In Kaiyan, we are in love with light therapy. We believe in the natural balance in our bodies. We develop devices such as the Aduro mask which will provide you with the full range of color light therapies.
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Wouldn’t it be great if we could each reduce a couple of inches off our waist without having to diet or exercise for so long? Losing weight and fat is one of the most common health goals, both for medical and cosmetic reasons. For years, millions of people have tried different pills, injections, “natural” herbs, and many products that are supposed to help us reduce weight. Unfortunately, these usually don’t work
Many people trying to lose weight just want to look better in the mirror, or at the beach. A wide variety of therapies to target fat and improve appearance are called “body contouring” or “body sculpting”, some surgical, others noninvasive. But many of them don’t work, or produce troublesome side effects. Green light therapy is completely natural & noninvasive and has proven to be an effective option for changing the way your body looks.
In the clinical trial NCT03647748 a double-blind, placebo-controlled randomized evaluation of the effect of Cellulize, a green light low-level laser system for aesthetic use for the non-invasive reduction in fat layer for body contouring and reduction of cellulite.
The Cellulize is a non-invasive green light system with a power output of 105mW/cm2, consisting of 150 light-emitting diodes (LEDs) that emit visible light at a nominal wavelength of 532nm ± 3nm (visible green light spectrum) and a spectral bandwidth of 10nm. Cellulize® is indicated for uses non-invasive dermatological aesthetic treatment for the reduction of circumference of hips, waist, and thighs. The Massager component is indicated for the temporary reduction in the appearance of cellulite.
Cumulative circumferences of waist, hip, left and right thighs for each patient was calculated before and after treatment. Three main points were concluded as a result of the study:
1. Cellulize causes immediate inch loss in subjects after a regimen of six treatments of 32 minutes (8 minutes on each of four positions) compared to individuals subjected to a placebo device for equivalent treatment. In a typical regimen, patients lost an average cumulative of 2.67 inches of circumference compared to the placebo average of 0.5 inches. This meets the anticipated primary outcome measure “Average Change in Inches of Total Circumference Measurements for the effect of Cellulize, a LED 532nm green light low-level laser system for aesthetic use for the non-invasive reduction in fat layer for body contouring from baseline measurements, and after treatment. ”
Figure 1, below, shows the graphical summary of inch loss for patients in the Cellulize active group and the Placebo control group respectively. Table 1 gives the mean values for both groups as well as the standard deviation for the “after” measurements, as well as 7-day and 14-day follow-ups relative to the “before” measurements for each patient:
2. While the durability of effect is also impacted by extrinsic factors after treatments such as diet, it was demonstrated that subjects were more likely to show continued inch loss upon following up with each subject at 7 days and again at 14 days. In general, patients undergoing active Cellulize 532nm green light continued losing some inch with an average continued loss of an additional 1.20 inches for a total average inch loss of 3.87 inches where average placebo measurements after 14 days yielded a net gain (not a loss) of 0.875 inches. This implies that the green light treatment meets the expected primary outcome of demonstrated durability of effect after a short -term follows up of 2 weeks.
3 Finally, the effect of Cellulize LED 532nm green light without any other intervention was measured for its effect on cellulite as part of the study. The Nurnberger-Muller Scale (NMS), a four-stage scale used as an industry standard to classify stage or degree of cellulite and to determine the change in stage or degree of cellulite following treatment intervention, was used to ensure consistent evaluation standards. Results from the active device as well as placebo both showed that cellulite, in general, did not decrease on the back of thigh/buttocks for subjects after a single treatment of 532nm green light. This result failed to meet the anticipated primary outcome measure of decreasing the appearance of cellulite as a measure of the Nurnberger-Muller Scale (NMS) from baseline to completion of treatment for the thigh/buttock area.
The FDA product classification code, OLI, has a guidance document which is the special control for this product, Guidance for Industry and FDA Staff — Class II Special Controls Guidance Document: Low-Level Laser System for Aesthetic Use. According to the guidance document, FDA believes that special controls, when combined with the general controls, will be sufficient to provide reasonable assurance of the safety and effectiveness of the low-level laser system for aesthetic use. Cellulize complies with all of the standards outlined in the special controls consensus standards.
To learn more about OLI products, you can visit https://fda.report/Product-Code/OLI
Here in Kaiyan Medical, we are pioneers and innovators with light therapy. We keep developing technologies with green light and trying to reach more markets.
Effects of Green Light Therapy on Body Contouring and Cellulite
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da Silveira Campos RM, Dâmaso AR, et al. The effects of exercise training associated with low-level laser therapy on biomarkers of adipose tissue transdifferentiation in obese women. Lasers in Medical Science. 2018 Aug;33(6):1245–1254.
