1
|
Young KM, Degner DA. Surgical description and outcome of ultrasound-guided minimally invasive parathyroidectomy in 50 dogs with primary hyperparathyroidism. Vet Surg 2023; 52:18-25. [PMID: 36221891 DOI: 10.1111/vsu.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/23/2022] [Accepted: 09/04/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe the surgical technique and clinical outcome of minimally invasive parathyroidectomy for primary hyperparathyroidism (PHPT) in the dog. ANIMALS Fifty client-owned dogs with PHPT that underwent minimally invasive parathyroidectomy. STUDY DESIGN Retrospective cohort study. METHODS An ultrasound-guided mini lateral approach was made via a plane established between the sternocephalicus muscle and sternohyoideus muscles to expose the thyroid gland and enlarged parathyroid gland. Abnormal parathyroid glands were removed en bloc via partial thyroidectomy. The technique for bilateral disease was similar, the skin incision was made on midline and moved laterally to develop the above-mentioned plane of dissection. Age, sex, breed, bodyweight, ultrasound findings, histopathological diagnosis, surgical time, preoperative clinical signs, and clinical outcome were extracted from the records for descriptive statistics. RESULTS A total of 62 glands were surgically removed, including 17 hyperplastic glands (17/62, 27.4%), 34 adenomas (34/62, 54.8%), and two carcinomas (2/62, 3.2%). Hypercalcemia resolved shortly after surgery in 44 dogs (44/45, 97.8%). One dog had recurrent hypercalcemia (1/45, 2.2%), one dog had persistent hypercalcemia (1/45, 2.2%), two dogs had permanent hypocalcemia requiring life-long calcitriol supplementation (2/45, 4.4%), and one dog died from clinical hypocalcemia (1/45, 2.2%). CONCLUSION Minimally invasive parathyroidectomy was associated with a low morbidity and led to favorable outcomes in 44/45 dogs in this series. CLINICAL SIGNIFICANCE The results of this study supports the use of minimally invasive parathyroidectomy to treat PHPT in dogs.
Collapse
|
2
|
Analytical and Clinical Validation of a New Immunoenzymatic Method for the Measurement of Canine Parathyroid Hormone. Animals (Basel) 2020; 10:ani10122411. [PMID: 33348538 PMCID: PMC7766972 DOI: 10.3390/ani10122411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Simple Summary In dogs affected with chronic kidney disease (CKD), mineral disorders, including renal hyperparathyroidism (RHPT), are frequent. Secondary RHPT is the increase in serum parathyroid hormone (PTH), that can have a significant impact in the disease progression. Despite its clinical utility, the measurement of serum PTH is not routinely executed due to limited availability of validated methods. The aims of this study were: the analytical validation of a new method for PTH measurement in dogs and analysis of the preliminary association of the obtained results with the renal status. Twenty-seven samples obtained from dogs that were healthy or affected with CKD were analysed. PTH was measured using a commercially available human assay. The precision and accuracy of this method were assessed and the PTH stability at different temperatures was evaluated. Clinical validation was performed by comparing PTH values with clinicopathological parameters often altered during CKD, such as creatinine and phosphorus, and with the disease severity. The method showed an optimal precision and accuracy; the stability was compatible with the standard sample processing times. PTH was positively associated with creatinine and phosphorus. The investigated method was successfully validated in dogs, allowing its use for clinical purposes. Abstract Renal hyperparathyroidism (RHPT) is one of the main complications in dogs affected with Chronic Kidney Disease (CKD). The measurement of serum parathyroid hormone (PTH) could be of clinical utility for the disease’s treatment and follow-up; however, PTH is not routinely determined due to limited available methods, often not fully validated in dogs. The aims of this study were the analytical validation of an immunoenzymatic method for the measurement of PTH in canine serum and the analysis of preliminary association of the obtained results with renal function. Twenty-six samples obtained from dogs healthy or affected with CKD were analysed. PTH was measured using a two-site immunoenzymometric human assay (ST AIA-PACK® Intact PTH, Tosoh Bioscience). The analytical validation protocol evaluated the assay precision and accuracy. Also, the PTH’s storage stability at 20 °C, 4 °C and −20 °C was assessed. Clinical validation was performed by comparing PTH values with creatinine, phosphorus and International Renal Interest Society (IRIS) stage. The method showed optimal precision and accuracy, whereas stability was adequate up to 4 h at 20 °C, 24 h at 4 °C and 6 months at −20 °C. PTH was positively associated with creatinine, phosphorus and IRIS stage. The investigated method was thus successfully validated in dogs, allowing its use for clinical purpose.
Collapse
|
3
|
Primary Hyperparathyroidism in a Quarter Horse Mare Associated With a Chief Cell Adenoma. J Equine Vet Sci 2020; 95:103302. [PMID: 33276927 DOI: 10.1016/j.jevs.2020.103302] [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: 09/10/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 11/27/2022]
Abstract
Primary hyperparathyroidism is rare in large animal species, and little is known regarding its pathophysiology, endocrine and electrolyte derangements, diagnosis, medical management, and prognosis. This report describes the clinicopathologic diagnosis of a parathyroid (PT) gland chief cell adenoma in a 12-year-old Quarter Horse mare, including PT hormone (PTH) and electrolyte disarrangements associated with the neoplasia, the surgical removal of the adenoma, and medical management of the case. This report also describes for the first time the use PTH immunohistochemistry to confirm the nature of this neoplasia in a horse.
Collapse
|
4
|
Secrest S, Grimes J. Ultrasonographic size of the canine parathyroid gland may not correlate with histopathology. Vet Radiol Ultrasound 2019; 60:729-733. [PMID: 31353771 DOI: 10.1111/vru.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/18/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022] Open
Abstract
Accurate ultrasonographic differentiation of normal versus abnormal parathyroid glands is important for clinical workup and presurgical screening in dogs with hypercalcemia. In previous published studies, size has been the only ultrasonographic criterion correlated with histologic diagnoses of abnormal parathyroid glands. In this retrospective, cross-sectional study, the medical records of dogs with ultrasonographic examinations of the parathyroid glands and histologic diagnoses of parathyroid gland hyperplasia, adenoma, and adenocarcinoma were evaluated. Ultrasonographic characteristics were recorded for each gland and compared among histologic diagnosis groups. A total of 49 dogs and 59 parathyroid glands were sampled and assigned to the following groups for analyses: adenoma (n = 24), hyperplastic (n = 20), and adenocarcinoma (n = 15). There were no associations with dog age, sex, weight, breed; or gland laterality, location, ultrasonographic shape, or echogenicity among histologic diagnosis groups (P > .05). Parathyroid gland adenocarcinomas were found to be less likely to have a homogeneous echotexture on ultrasonographic evaluation, with hyperplastic glands being smaller (P = .022) and adenocarcinomas being larger (P = .042). While 3 mm was the optimum cutoff for differentiating hyperplastic and neoplastic parathyroid glands in this sample of dogs, values varied widely within groups and there were overlapping values between groups. Therefore, authors caution against using ultrasonographic size as a sole criterion for differentiating hyperplasia from neoplasia and normal versus abnormal parathyroid glands.
Collapse
Affiliation(s)
- Scott Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, University of Georgia College of Veterinary Medicine, Athens, Georgia
| | - Janet Grimes
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, Georgia
| |
Collapse
|
5
|
Riehl V, Hartmann A, Rohrberg A, Neiger R. Percutaneous ultrasound-guided ethanol ablation for treatment of primary hyperparathyroidism in a cat. JFMS Open Rep 2019; 5:2055116919860276. [PMID: 31308957 PMCID: PMC6607573 DOI: 10.1177/2055116919860276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary A 9-year-old male neutered European Shorthair cat was presented owing to vomiting and mild weight loss. Clinical examination was normal, but biochemistry results showed increased concentrations of total calcium (4.05 mmol/l; reference interval [RI] 2.20-2.90 mmol/l) and ionised calcium (iCa) (2.19 mmol/l; RI 1.12-1.40 mmol/l), as well as hypophosphataemia (2.5 mg/dl; RI 3.1-7.5 mg/dl). Parathyroid hormone (PTH) concentration (>1000 pg/ml) was markedly increased, while parathyroid hormone-related protein concentration (<0.8 pmol/l) was normal. Neck ultrasound showed a large left parathyroid mass (13 × 7 × 6 mm). Under general anaesthesia and with ultrasonographic guidance, a fine-needle aspiration of the mass followed by chemical ablation with 2 ml 96% ethanol was performed. The cat was re-evaluated and iCa concentration measured 24 h, 72 h, 5 days, 4 weeks and 4 months post-ablation. Normocalcaemia was reached within 24 h, remained stable throughout the whole evaluation period and the concentration of PTH normalised 4 months later. Vomiting stopped promptly after chemical ablation and a slight change in voice, as well as a mild prolapse of the nictitating membrane, were the only side effects after the treatment but resolved some weeks later. Relevance and novel information To our knowledge, this is the first report of successful chemical ablation of a parathyroid mass in a cat with primary hyperparathyroidism. Chemical ablation might therefore be a possible alternative to parathyroidectomy in cats.
Collapse
Affiliation(s)
| | | | | | - Reto Neiger
- Veterinary Clinic Hofheim, Hofheim am Taunus, Germany
| |
Collapse
|
6
|
Gorenberg EB, Johnson AL, Magdesian KG, Bertin FR, Costa LRR, Theelen MJP, Durward-Akhurst SA, Cruz Villagrán C, Carslake H, Frank N, Tomlinson JE. Diagnosis and treatment of confirmed and suspected primary hyperparathyroidism in equids: 17 cases (1999-2016). Equine Vet J 2019; 52:83-90. [PMID: 30980730 DOI: 10.1111/evj.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is uncommon in equids. OBJECTIVES To describe the diagnostic findings and efficacy of treatment in equids with primary hyperparathyroidism. STUDY DESIGN Retrospective case series describing 16 horses and one mule. METHODS Cases were identified by retrospective review of records at Cornell University and via an ACVIM listserv query. Inclusion criteria were an equid with hypercalcemia, normal renal function and high parathyroid hormone (PTH) or histopathological diagnosis of a parathyroid adenoma. Equids with normal PTH and PTH-related protein (PTHrP) in the face of hypercalcemia were included as suspect cases. RESULTS The most common presenting complaints were weight loss (12/17) and hypercalcemia (10/17). PTH was above reference range in 12/17 cases. Suspected parathyroid tumours were localised in 12/14 equids imaged using ultrasonography alone (2/3), technetium 99m Tc sestamibi scintigraphy alone (1/1) or both modalities (9/10). Three horses did not have imaging performed. Surgical exploration successfully excised tumours in six of 10 cases. Five were located at the thoracic inlet, and surgery resulted in complete cure. One tumour was excised from the thyroid lobe, and the horse remained hypercalcemic. Four other cases explored surgically, four treated medically and three that were not treated also remained hypercalcemic. MAIN LIMITATIONS The small study size prohibited statistical analysis. CONCLUSIONS Parathyroid adenomas in equids can be successfully localised with ultrasonography and scintigraphy. Surgical excision appears more likely to be successful for single gland disease at the thoracic inlet.
Collapse
Affiliation(s)
- E B Gorenberg
- Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - A L Johnson
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - K G Magdesian
- University of California Davis Veterinary Medical Teaching Hospital, Davis, California, USA
| | - F-R Bertin
- The University of Queensland School of Veterinary Science, Gatton, Queensland, Australia
| | - L R R Costa
- University of California Davis Veterinary Medical Teaching Hospital, Davis, California, USA
| | - M J P Theelen
- Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands
| | - S A Durward-Akhurst
- Department of Veterinary Population Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - C Cruz Villagrán
- The University of Adelaide, Roseworthy, South Australia, Australia
| | - H Carslake
- School of Veterinary Science, University of Liverpool, Philip Leverhulme Equine Hospital, Cheshire, UK
| | - N Frank
- Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - J E Tomlinson
- Baker Institute for Animal Health, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| |
Collapse
|
7
|
Mooney CT, Shiel RE, Fawcett K, Matthews E, Gunn E. A comparison of canine whole and intact parathyroid hormone concentrations as measured by different assays. J Small Anim Pract 2019; 60:507-513. [PMID: 31017670 DOI: 10.1111/jsap.13006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 01/07/2019] [Accepted: 02/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To compare an intact immunoradiometric parathyroid hormone assay with (1) a non-isotopic technique; and, (2) a whole parathyroid hormone immunoradiometric assay. MATERIALS AND METHODS Intact parathyroid hormone concentrations were measured using immunoradiometric (Scantibodies) and chemiluminescent (Immulite 2000) assays. Whole parathyroid hormone concentration was measured using an immunoradiometric assay (Scantibodies). RESULTS A total of 48 and 47 samples, respectively, were used to compare immunoradiometric and chemiluminescent intact parathyroid concentrations and intact and whole parathyroid hormone concentrations by immunoradiometric assays. Using chemiluminescence, 39 (81.3%) samples had intact parathyroid hormone concentrations at or below the reported limit of detection of the assay (0.3 pmol/L). Intact [6.3 (2.0 to 95.5) pmol/L] and whole [3.3 (0.8 to 125.2) pmol/L] immunoradiometric parathyroid hormone concentrations exhibited excellent correlation. CLINICAL SIGNIFICANCE Not all parathyroid hormone assays perform similarly. The chemiluminescent assay in this study cannot be recommended for use in dogs. The immunoradiometric intact parathyroid hormone assay proved to be a more reliable method. Given the correlation between intact and whole parathyroid hormone concentrations, it remains unclear which one is superior for routine clinical decision-making.
Collapse
Affiliation(s)
- C T Mooney
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, D04 W6F6, Ireland
| | - R E Shiel
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, D04 W6F6, Ireland
| | - K Fawcett
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, D04 W6F6, Ireland
| | - E Matthews
- National Institute for Bioprocessing Research and Training, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - E Gunn
- Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, D04 W6F6, Ireland
| |
Collapse
|
8
|
Singh A, Giuffrida MA, Thomson CB, Baum J, Kramek B, Liptak JM, Hyndman P, Ringwood B, Smeak D, Ham K, Berg J, Thieman-Mankin K, Blois SL, Boston SE. Perioperative characteristics, histological diagnosis, and outcome in cats undergoing surgical treatment of primary hyperparathyroidism. Vet Surg 2019; 48:367-374. [PMID: 30666680 DOI: 10.1111/vsu.13165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/08/2018] [Accepted: 12/24/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To report perioperative characteristics, complications, histopathologic diagnosis and outcome in cats undergoing surgical treatment for primary hyperparathyroidism (PHPT). STUDY DESIGN Multi-institutional, retrospective case series. ANIMALS Thirty-two client-owned cats. METHODS Medical records of cats treated with surgical removal of 1 or more parathyroid gland(s) with confirmed histopathologic evaluation were reviewed. Cats were divided into preoperative ionized calcium (iCa) groups corresponding to the 33rd, 67th, and 100th percentiles of the preoperative iCa results of the study population. Follow-up consisted of phone conversation with owners or primary veterinarian. RESULTS Ionized calcium was above reference range in all cats (median 1.8 mmol/L [interquartile range, 1.5-1.9]). Abnormal tissue was excised after cervical exploration in all cats. The most common histopathologic diagnoses were parathyroid adenoma in 20 of 32 (62.5%) cats and parathyroid carcinoma in 7 of 32 (21.9%) cats. At discharge, 6 of 32 (18.8%) cats had hypercalcemia, 5 of 32 (15.6%) had hypocalcemia, and 21 of 32 (65.6%) were normocalcemic. Preoperative iCa did not correlate with postoperative iCa. The median follow-up time was 332 days (range, 7-3156). Overall median survival time was 1109 days (95% CI, 856-1332). Survival time was not associated with preoperative iCa group, hypocalcemia at discharge, hypercalcemia at discharge, or diagnosis of carcinoma. CONCLUSION In this cohort of cats, parathyroid adenoma was the most common cause of PHPT, and surgical treatment resulted in very good median survival time. Preoperative iCa was not predictive of postoperative hypocalcemia. CLINICAL SIGNIFICANCE Surgical parathyroidectomy for treatment of PHPT in cats provides a favorable prognosis.
Collapse
Affiliation(s)
- Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Christopher B Thomson
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota
| | - Jared Baum
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Betty Kramek
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota
| | - Julius M Liptak
- Department of Surgery, VCA Canada-Alta Vista Animal Hospital, Ottawa, Ontario, Canada
| | - Philip Hyndman
- Department of Surgery, Veterinary Emergency Clinic, Toronto, Ontario, Canada
| | - Brendon Ringwood
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota
| | - Daniel Smeak
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Kathleen Ham
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | - John Berg
- Department of Clinical Sciences, Tufts University, North Grafton, Massachusetts
| | - Kelley Thieman-Mankin
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Sarah E Boston
- VCA Canada-404 Veterinary Emergency and Referral, Newmarket, Ontario, Canada
| |
Collapse
|
9
|
Vessieres F, Gomez Selgas A, Rasotto R, Raffan E. Primary hyperparathyroidism associated with hyperplasia of multiple parathyroid glands in a dog. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2015-000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Aida Gomez Selgas
- Department of Small Animal Internal MedicineAnimal Health TrustNewmarketUK
| | | | - Eleanor Raffan
- University of Cambridge Metabolic Research LaboratoriesCambridgeUK
| |
Collapse
|
10
|
Adrenocorticotrophic hormone causes an increase in cortisol, but not parathyroid hormone, in dogs. Res Vet Sci 2014; 98:13-5. [PMID: 25544698 DOI: 10.1016/j.rvsc.2014.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 11/23/2014] [Accepted: 11/26/2014] [Indexed: 11/23/2022]
Abstract
Dogs with spontaneous disorders of glucocorticoid production often have marked disturbances in calcium homeostasis. For example, hypercalcaemia is frequently observed in dogs with hypoadrenocorticism and secondary hyperparathyroidism is a common feature of canine hyperadrenocorticism. The mechanism(s) by which glucocorticoids modulate calcium homeostasis in dogs remains ill-defined. The hypothesis of this study is that a marked increase in serum cortisol concentrations would lead to an immediate negative calcium balance state which would drive a compensatory increase in parathyroid hormone (PTH) concentrations. This hypothesis was investigated by measuring serum cortisol and plasma PTH concentration in 19 dogs before and after administration of adrenocorticotrophic (ACTH) hormone. Post ACTH administration, there was a significant increase in serum cortisol, but not PTH, concentrations. The results of this study do not support the hypothesis that an increase in endogenous glucocorticoids influences calcium balance sufficiently to cause an immediate, compensatory increase in parathyroid hormone concentration.
Collapse
|
11
|
Tomlinson JE, Johnson AL, Ross MW, Engiles JB, Levine DG, Wisner WA, Sweeney RW. Successful detection and removal of a functional parathyroid adenoma in a pony using technetium Tc 99m sestamibi scintigraphy. J Vet Intern Med 2014; 28:687-92. [PMID: 24417704 PMCID: PMC4858011 DOI: 10.1111/jvim.12285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/20/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- J E Tomlinson
- New Bolton Center, University of Pennsylvania, Kennett Square, PA
| | | | | | | | | | | | | |
Collapse
|
12
|
Jackson AE. In this issue - June 2012. Aust Vet J 2012. [DOI: 10.1111/j.1751-0813.2012.00946.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|