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We propose a series of defined steps for removal of these confounding issues, to ultimately aid in the development of more robust clinical biomarkers.
Finally, an overview of the state of research regarding the clinical use of different matrices and the common challenges faced in using dECM are provided, with possible solutions to help translate naturally derived dECM matrices into more robust clinical use.
Mechanistic and proof-of-concept studies are still required to clarify the underlying mechanisms involved, while properly designed clinical trials are warranted to translate preclinical or early-phase clinical data into more robust clinical evidence.
This is in contrast to the significant increase in proliferation and 600% increase in neurogenesis seen after ECT [16], and parallels the more robust clinical efficacy of ECT in treating depression compared to pharmacological agents such as fluoxetine [40].
More robust clinical trials are needed to corroborate these findings.
Based on this pilot trial, further large-scale study is needed for more robust clinical outcomes.
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To engineer larger, more robust, and clinical relevant constructs, a great number of viable chondrocytic cells are needed.
However, more robust surrogate clinical endpoints include LV ejection fraction (measured by echocardiography, myocardial nuclear scanning or cardiac MRI and MII size (measured by myocardial nuclear scanning or cardiac MRI).
Moreover, we have chosen FLIM over simple fluorescence imaging because the fluorescence lifetime measurement is less sensitive to intensity artifacts, photo-bleaching, light scattering and excitation intensity, which makes it more robust for clinical applications [ 13].
A more robust pre-clinical wear simulation framework is required in order to simulate wider and higher ranges of activities, observed in different patient populations such as younger more active patients.
Prospective clinical studies too may offer more robust data on clinical symptoms and signs associated with differentiating H5N1 from other diseases as well as determining those likely to fare least well clinically and thus benefit most from influenza specific clinical interventions.
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