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Salih A, Giannikaki S, Escanilla N, Ioannides-Hoey CSFK, Best M. Etiologies of nontraumatic feline uveitis in the UK: A retrospective observational study of 72 cats. Open Vet J 2023; 13:1195-1204. [PMID: 37842107 PMCID: PMC10576583 DOI: 10.5455/ovj.2023.v13.i9.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Background Uveitis is a common ophthalmic diagnosis in cats, that can lead to discomfort and loss of vision. Identification of nonidiopathic cases facilitates treatment and could reduce morbidity associated with this condition. Aim To evaluate etiologies of nontraumatic uveitis in the UK, to compare diagnostic features between idiopathic cases and those with an established underlying etiology, and to investigate the association of clinical signs and abnormal diagnostic findings with a confirmed etiology. Methods Records of cats diagnosed with uveitis at a UK referral center between August 2009 and April 2018 were retrospectively reviewed, excluding traumatic (and reflex) cases. Cases were categorized based on whether an underlying etiology had been established in cases with confirmed etiology, idiopathic, and inconclusive cases. All cases had a minimum of 12-month follow-up unless an underlying etiology had been established. Population characteristics, clinical signs, diagnostic investigation features, and results were reported. Results 72 cases of uveitis were included, of which male cats and domestic breeds were overrepresented. An underlying etiology was determined in 23.6% of cases: 9.7% had infectious diseases, 5.6% had systemic neoplasia, 4.2% had primary ocular neoplasia, and 4.2% had metabolic disease. Idiopathic uveitis comprised 37.5% of cases, and the remaining 38.9% were inconclusive, of which 35.7% died or were euthanased within the follow-up period. Among the study population, no significant age difference was found between cats with idiopathic disease or confirmed etiology. The unilateral disease was reported in 56.9% of cases and was not different across the idiopathic cases and confirmed etiology groups. The most common ophthalmic clinical sign was an aqueous flare, followed by keratic precipitates and hypotony. Iris color change (p = 0.015) and the presence of an intraocular mass (p = 0.025) were associated with an underlying etiology. Conclusion Idiopathic uveitis was found to be the most common diagnosis in this study population. However, a similar proportion of cases had possible underlying etiologies as a high proportion manifested systemic disease within the follow-up time. An underlying etiology could be established only in a quarter of cases. Further studies are required to standardize the investigations required when assessing cats with uveitis to minimize patient morbidity.
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Thayer V, Gogolski S, Felten S, Hartmann K, Kennedy M, Olah GA. 2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines. J Feline Med Surg 2022; 24:905-933. [PMID: 36002137 PMCID: PMC10812230 DOI: 10.1177/1098612x221118761] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CLINICAL IMPORTANCE Feline infectious peritonitis (FIP) is one of the most important infectious diseases and causes of death in cats; young cats less than 2 years of age are especially vulnerable. FIP is caused by a feline coronavirus (FCoV). It has been estimated that around 0.3% to 1.4% of feline deaths at veterinary institutions are caused by FIP. SCOPE This document has been developed by a Task Force of experts in feline clinical medicine as the 2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines to provide veterinarians with essential information to aid their ability to recognize cats presenting with FIP. TESTING AND INTERPRETATION Nearly every small animal veterinary practitioner will see cases. FIP can be challenging to diagnose owing to the lack of pathognomonic clinical signs or laboratory changes, especially when no effusion is present. A good understanding of each diagnostic test's sensitivity, specificity, predictive value, likelihood ratio and diagnostic accuracy is important when building a case for FIP. Before proceeding with any diagnostic test or commercial laboratory profile, the clinician should be able to answer the questions of 'why this test?' and 'what do the results mean?' Ultimately, the approach to diagnosing FIP must be tailored to the specific presentation of the individual cat. RELEVANCE Given that the disease is fatal when untreated, the ability to obtain a correct diagnosis is critical. The clinician must consider the individual patient's history, signalment and comprehensive physical examination findings when selecting diagnostic tests and sample types in order to build the index of suspicion 'brick by brick'. Research has demonstrated efficacy of new antivirals in FIP treatment, but these products are not legally available in many countries at this time. The Task Force encourages veterinarians to review the literature and stay informed on clinical trials and new drug approvals.
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Mitchell JL, MacDougall L, Dobromylskyj MJ, Smith K, Stavinohova R, Gunn-Moore DA, Hope JC, Scurrell E. Ocular mycobacterial lesions in cats. Vet Pathol 2022; 59:792-805. [PMID: 35587045 PMCID: PMC9358306 DOI: 10.1177/03009858221098431] [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] [Indexed: 11/16/2022]
Abstract
Ocular mycobacterial infections are an under-recognized cause of morbidity in the
domestic cat. This study aimed to explore the distribution, histopathological
appearance, and severity of feline ocular mycobacterial lesions, and to
characterize the immune cell population with immunohistochemistry. Routine
histological staining with hematoxylin and eosin, and Masson’s trichrome, was
performed to identify ocular lesions and assign an inflammation score based on
the number of cells present. Acid-fast bacilli were detected with Ziehl-Neelsen,
and immunohistochemistry for ionized calcium-binding adaptor protein-1 (Iba1),
calprotectin, cluster of differentiation 3 (CD3), and Pax5 was undertaken on
formalin-fixed paraffin-embedded tissue samples from 24 cases of ocular
mycobacteriosis. Posterior or panuveitis with concurrent retinitis was
identified in 20/24 cases (83%), with retinal detachment in 16/20 (80%) of these
cases. Choroidal lesions had the highest median inflammation score.
Ziehl-Neelsen-positive organisms were detected in 20/24 cases (83%), with the
highest prevalence of acid-fast bacilli detected in choroidal lesions (16/20,
80%). Lesions were typically granulomatous to pyogranulomatous, characterized by
abundant numbers of Iba1-positive macrophages, followed by calprotectin-positive
granulocytes and monocytes, fewer T cells, and rarer B cells. However, where
iritis was identified, inflammation was typically lymphoplasmacytic (11/16
cases, 69%). Where diagnostic testing was performed, tuberculosis (ie, infection
with Mycobacterium bovis, Mycobacterium
microti, or a nonspeciated Mycobacterium
tuberculosis-complex pathogen) was diagnosed in 20/22 cats (91%),
with Mycobacterium lepraemurium infection identified in the
other 2/22 cats (9%). These results suggest the choroid is the primary site of
lesion development in most cases of feline ocular mycobacteriosis, and
inflammatory changes are associated with the presence of mycobacteria localized
to ocular tissues.
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Affiliation(s)
| | | | | | - Ken Smith
- Royal Veterinary College, Hatfield, UK
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Jeanes EC, Wegg ML, Mitchell JA, Priestnall SL, Fleming L, Dawson C. Comparison of the prevalence of Domestic Cat Hepadnavirus in a population of cats with uveitis and in a healthy blood donor cat population in the United Kingdom. Vet Ophthalmol 2021; 25:165-172. [PMID: 34806802 DOI: 10.1111/vop.12956] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Domestic Cat Hepadnavirus (DCH) is a novel virus recently identified in the domestic cat. Currently, little is known regarding its clinical significance. The hepadnaviridae family includes the Hepatitis B Virus (HBV). Co-infection of HBV and Hepatitis C in humans increases the risk of uveitis. We aimed to determine whether DCH is present in the United Kingdom (UK) and whether DCH warrants investigation as a potential cause of uveitis in cats. PROCEDURES Clinical records from the Royal Veterinary College (RVC) and the Animal Health Trust (AHT) were reviewed for feline cases diagnosed with endogenous uveitis. A healthy control group was identified from cats presented to the RVC as blood donors. DNA was extracted from stored blood samples using commercially available kits. Polymerase chain reaction assays were performed to confirm the presence of feline DNA and to detect the presence of DCH DNA using previously described protocols. RESULTS Blood samples were available from 65 cats with endogenous uveitis and 43 healthy control cats. Two blood samples from cats with endogenous uveitis tested positive for the presence of DCH DNA. DCH DNA was not detected in the control group. There was no statistically significant difference between the prevalence of DCH between the groups. CONCLUSIONS Domestic Cat Hepadnavirus is present in the UK. This study failed to demonstrate a conclusive link between DCH and uveitis in cats, although further studies to investigate an association with other feline diseases are warranted.
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Affiliation(s)
- Emily C Jeanes
- Queen Mother Hospital for Animals, Royal Veterinary College, North Mymms, Hertfordshire, UK
| | - Michaela L Wegg
- Animal Health Trust. Centre for Small Animal Studies, Newmarket, Suffolk, UK
| | | | | | - Lorraine Fleming
- Animal Health Trust. Centre for Small Animal Studies, Newmarket, Suffolk, UK
| | - Charlotte Dawson
- Queen Mother Hospital for Animals, Royal Veterinary College, North Mymms, Hertfordshire, UK
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Wegg ML, Jeanes EC, Pollard D, Fleming L, Dawson C. A multicenter retrospective study into endogenous causes of uveitis in cats in the United Kingdom: Ninety two cases. Vet Ophthalmol 2021; 24:591-598. [PMID: 34037308 DOI: 10.1111/vop.12898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate the most common causes of endogenous feline uveitis in a UK referral population and to investigate associations based on signalment. METHODS Retrospective multicenter cross-sectional study from 2010 to 2019 including cats presented to the Animal Health Trust and the Royal Veterinary College with clinical signs consistent with uveitis. Cats were included in analyzes if they had a full physical examination including an ophthalmic examination, complete blood count, serum biochemistry, and infectious disease testing for at least two diseases unless the diagnosis was found on clinical examination (eg, neoplasia). RESULTS A total of 92 cats were included in the study. The majority of cats presenting with uveitis were male (66.3%). The most common causes of endogenous uveitis were idiopathic uveitis (42/92 45.7%), feline infectious peritonitis (FIP) 15/92 16.3%), and lymphoma (10/92 10.9%). Fisher's exact test showed differences in breed across diagnosis groups (p = .002) with purebred cats being overrepresented in the lymphoma and FIP groups. Kruskal-Wallis test showed differences in median age across diagnosis groups (p < .001) with cats in the FIP group having the youngest age (median 1.4 years, interquartile range (IQR) 0.4-1.8 years) and cats in the neoplasia (primary or paraneoplastic) group having the oldest age (median 12.8 IQR 10.8-13.8). Idiopathic uveitis was unilateral in 56.1% of cases, and infectious causes were unilateral in 47.8% of cases. CONCLUSIONS The most common cause of endogenous uveitis in a population of cats in the UK was idiopathic uveitis, followed by FIP and lymphoma.
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Sharpe EK, Meekins JM, Roush JK, Rankin AJ, KuKanich B. Effect of oral administration of robenacoxib on inhibition of paracentesis-induced blood-aqueous barrier breakdown in healthy cats. Am J Vet Res 2018; 79:443-449. [PMID: 29583043 DOI: 10.2460/ajvr.79.4.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of oral administration of robenacoxib on inhibition of anterior chamber paracentesis (ACP)-induced breakdown of the blood-aqueous barrier (BAB) and assess whether robenacoxib can cross an intact BAB in healthy cats. ANIMALS 12 healthy adult domestic shorthair cats. PROCEDURES Cats received robenacoxib (6-mg tablet in a treat, PO; n = 6) or a control treatment (treat without any drug, PO; 6) once daily for 3 days, beginning 1 day before ACP. One eye of each cat served as an untreated control, whereas the other underwent ACP, during which a 30-gauge needle was used to aspirate 100 μL of aqueous humor for determination of robenacoxib concentration. Both eyes of each cat underwent anterior chamber fluorophotometry at 0 (immediately before), 6, 24, and 48 hours after ACP. Fluorescein concentration and percentage fluorescein increase were used to assess extent of ACP-induced BAB breakdown and compared between cats that did and did not receive robenacoxib. RESULTS Extent of BAB breakdown induced by ACP did not differ significantly between cats that did and did not receive robenacoxib. Low concentrations of robenacoxib were detected in the aqueous humor (mean, 5.32 ng/mL; range, 0.9 to 16 ng/mL) for 5 of the 6 cats that received the drug. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that oral administration of robenacoxib did not significantly decrease extent of BAB breakdown in healthy cats. Detection of low robenacoxib concentrations in the aqueous humor for most treated cats indicated that the drug can cross an intact BAB.
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Sim ZH, Pinard CL, Plattner BL, Bienzle D. Cyclooxygenase-2 expression in the eyes of cats with and without uveitis. Am J Vet Res 2017; 79:90-97. [PMID: 29287164 DOI: 10.2460/ajvr.79.1.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the distribution and intensity of cyclooxygenase (COX)-2 expression in the eyes of cats with and without uveitis and to determine whether COX-2 expression is correlated with severity of inflammation. SAMPLES Archived ocular tissue specimens from 51 cats with and 10 cats without ocular disease. PROCEDURES Specimens from only 1 eye were evaluated for each cat. Specimens were stained with H&E stain or immunohistochemical stain for detection of COX-2 and reviewed. For each eye, the type, severity, and distribution of inflammation and the distribution and intensity of COX-2 expression were determined for the uvea and other ocular tissues. Correlation between COX-2 expression and inflammation severity was also assessed. RESULTS COX-2 was not expressed in any nondiseased eye. Of the 51 diseased eyes, 20 had histologic evidence of lymphocytic-plasmacytic uveitis, 13 had neutrophilic uveitis, 11 had diffuse iris melanoma with uveitis, and 7 had diffuse iris melanoma without uveitis. Of the 44 eyes with uveitis, COX-2 was detected in the uvea of 16, including 11 eyes with lymphocytic-plasmacytic uveitis, 4 with neutrophilic uveitis, and 1 with diffuse iris melanoma-induced uveitis. Inflammation was severe, moderate, or mild in 10, 5, and 1 of those eyes, respectively. Cyclooxygenase-2 was detected in the cornea of 21 eyes with uveitis and 1 eye with diffuse iris melanoma without uveitis. Uveitis severity was positively correlated with COX-2 expression in both the uvea and cornea. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that COX-2 is an inflammatory mediator in feline uveitis but not diffuse iris melanoma.
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Aranda ML, Fleitas MFG, Dieguez H, Iaquinandi A, Sande PH, Dorfman D, Rosenstein RE. Melatonin as a Therapeutic Resource for Inflammatory Visual Diseases. Curr Neuropharmacol 2017; 15:951-962. [PMID: 28088912 PMCID: PMC5652015 DOI: 10.2174/1570159x15666170113122120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/15/2016] [Accepted: 01/06/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Uveitis and optic neuritis are prevalent ocular inflammatory diseases, and highly damaging ocular conditions. Both diseases are currently treated with corticosteroids, but they do not have adequate efficacy and are often associated with severe side effects. Thus, uveitis and optic neuritis remain a challenging field to ophthalmologists and a significant public health concern. OBJECTIVE This review summarizes findings showing the benefits of a treatment with melatonin in experimental models of these inflammatory ocular diseases. RESULTS Oxidative and nitrosative damage, tumor necrosis factor, and prostaglandin production have been involved in the pathogeny of uveitis and optic neuritis. Melatonin is an efficient antioxidant and antinitridergic, and has the ability to reduce prostaglandin and tumor necrosis factor levels both in the retina and optic nerve. Moreover, melatonin not only prevents functional and structural consequences of experimental uveitis and optic neuritis, but it is also capable of suppressing the actively ongoing ocular inflammatory response. CONCLUSIONS Since melatonin protects ocular tissues against inflammation, it could be a potentially useful anti-inflammatory therapy in ophthalmology.
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Affiliation(s)
- Marcos L. Aranda
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - María Florencia González Fleitas
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Hernán Dieguez
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Agustina Iaquinandi
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | - Pablo H. Sande
- Laboratory of Retinal Neurochemistry and Experimental Ophthalmology, Department of Human Biochemistry, School of Medicine/CEFyBO, University of Buenos Aires/CONICET, Buenos Aires, Argentina
| | | | - Ruth E. Rosenstein
- Address correspondence to this author at the Department of Human Biochemistry, School of Medicine, CEFyBO, University of Buenos Aires, CONICET, Paraguay 2155, 5th Floor, (1121), Buenos Aires, Argentina;, Tel: 54-11-45083672 (ext 37); Fax: 54-11-45083672 (ext 317);, E-mail:
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Jinks MR, English RV, Gilger BC. Causes of endogenous uveitis in cats presented to referral clinics in North Carolina. Vet Ophthalmol 2015; 19 Suppl 1:30-7. [PMID: 26559384 PMCID: PMC7169280 DOI: 10.1111/vop.12324] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the causes of endogenous uveitis in cats presenting to referral ophthalmology clinics in North Carolina. PROCEDURE Medical records of cats diagnosed with endogenous uveitis at North Carolina State University's College of Veterinary Medicine (NCSU-CVM) or Animal Eye Care Associates of Cary, NC between 2003 and 2015 were reviewed. Inclusion criteria were cats that had complete diagnostic workups, including clinical, clinicopathological, serological, and histopathological data, as well as imaging modalities. Serology was consistently completed for feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), feline coronavirus (FCoV), Toxoplasma gondii, and Bartonella spp. RESULTS One hundred and twenty cats met the inclusion criteria. Seroprevalence of FeLV (2.7%), FIV (7.3%), FCoV (34.7%), T. gondii (23.7%), and Bartonella spp. (43.2%) was observed, with a combined seroprevalence of 59.2%. Nineteen cats (15.8%) were diagnosed with feline infectious peritonitis (FIP) based on clinical, hematological, serological, histopathological, and necropsy findings. The average age of all cases was 7.62 years, while the average age of cats diagnosed with FIP was 1.82 years. Neoplasia was diagnosed in six cats (5.0%). No underlying etiology was found in 49 cats (40.8%). CONCLUSIONS Both idiopathic and neoplastic causes of uveitis were less prevalent than previously reported in studies, while seropositivity was higher than previously reported for the study area. This may be due to improved diagnostic capabilities or that cats with infectious disease were more likely to be referred. Because of the high prevalence of FIP, young cats with uveitis should be evaluated for hyperglobulinemia and FCoV serology should be performed as minimal diagnostics.
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Affiliation(s)
- Maggie R Jinks
- College of Veterinary Medicine, NCSU-CVM, Clinical Sciences, Raleigh, NC, USA
| | | | - Brian C Gilger
- College of Veterinary Medicine, NCSU-CVM, Clinical Sciences, Raleigh, NC, USA
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Hsu KK, Pinard CL, Johnson RJ, Allen DG, KuKanich BK, Nykamp SG. Systemic absorption and adverse ocular and systemic effects after topical ophthalmic administration of 0.1% diclofenac to healthy cats. Am J Vet Res 2015; 76:253-65. [PMID: 25710762 DOI: 10.2460/ajvr.76.3.253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To quantify plasma concentrations and determine adverse ocular, renal, or hepatic effects associated with repeated topical ophthalmic application of 0.1% diclofenac to healthy cats. ANIMALS 8 healthy sexually intact male cats. PROCEDURES A randomized, placebo-controlled crossover study was conducted. A topical formulation of 0.1% diclofenac was administered 4 times/d for 7 days to 4 cats, and artificial tear (control) solution was administered to the other 4 cats. After a 12-day washout period, cats received the other treatment. Ophthalmic examinations were performed daily. Plasma samples were obtained on days 1 and 7 for pharmacokinetic analysis. A CBC, serum biochemical analysis, urinalysis, determination of urine protein-to-creatinine ratio, and determination of glomerular filtration rate were performed before the start of the study and after each 7-day treatment period. RESULTS Mild conjunctival hyperemia was the only adverse ocular effect detected. Maximal drug concentration and area under the curve were significantly higher on day 7 than on day 1. Diclofenac-treated cats had a significantly lower glomerular filtration rate than did control-treated cats after the second but not after the first treatment period, presumably associated with iatrogenic hypovolemia. CONCLUSIONS AND CLINICAL RELEVANCE Topical ophthalmic administration of 0.1% diclofenac was well tolerated in healthy cats, with only mild signs of ocular irritation. Detectable systemic concentrations of diclofenac were achieved with accumulation over 7 days. Systemic absorption of diclofenac may be associated with reduced glomerular filtration rate, particularly in volume-contracted animals. Topical ophthalmic 0.1% diclofenac should be used with caution in volume-contracted or systemically ill cats.
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Affiliation(s)
- Kimberly K Hsu
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada
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Benz P, Maaß G, Csokai J, Fuchs-Baumgartinger A, Schwendenwein I, Tichy A, Nell B. Detection of Encephalitozoon cuniculi in the feline cataractous lens. Vet Ophthalmol 2011; 14 Suppl 1:37-47. [DOI: 10.1111/j.1463-5224.2011.00873.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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