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Marco-Martorell M, Duffy N, Martinez M, Maddox T, Robson K. Agreement of Pain Assessment Using the Short Form of the Canine Glasgow Composite Measure Pain Scale between Veterinary Students, Veterinary Nurses, Veterinary Surgeons, and ECVAA-Diplomates. Animals (Basel) 2024; 14:2310. [PMID: 39199844 PMCID: PMC11350858 DOI: 10.3390/ani14162310] [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: 06/10/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Abstract
Several pain scoring systems have been validated to measure pain in dogs. However, pain may not be adequately assessed since these tools are associated with high-level inter-observer variation. The aim of this study is to evaluate the agreement of pain assessment using the CMPS-SF between veterinary students, veterinary nurses, veterinary surgeons, and European College of Veterinary Anaesthesia and Analgesia (ECVAA) diplomates. Forty-five client-owned dogs presented to a teaching hospital were enrolled in this prospective, observational study. All dogs were pain-scored in vivo, while a video of the assessment was recorded and subsequently evaluated by twenty assessors, with five per group. Mean scores between groups were compared, and agreement within groups and agreement of the average scores between groups were assessed by calculating the intraclass correlation coefficient (ICC). The intervention point at which dogs were deemed to require additional analgesia was also evaluated. Overall agreement of pain assessment was poor (ICC = 0.494). Nurses had the best inter-observer agreement (ICC = 0.656), followed by ECVAA diplomates (ICC = 0.540), veterinary surgeons (ICC = 0.478), and veterinary students (ICC = 0.432). The best inter-group agreement was between veterinary surgeons and nurses (ICC = 0.951) and between ECVAA diplomates and nurses (ICC = 0.951). Students were more likely to determine that additional analgesia was required compared to other groups. Pain assessment is key for animal welfare, and training in this area should be reinforced to improve consistency.
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Affiliation(s)
- Mireia Marco-Martorell
- Leahurst Campus, University of Liverpool, Chester High Road, Neston CH64 7TE, UK; (T.M.); (K.R.)
| | - Natalie Duffy
- Northwest Veterinary Specialists, Linnaeus Veterinary Limited, Ashville Point, Beechwood, Sutton Weaver, Runcorn WA7 3FW, UK;
| | - Miguel Martinez
- Chester Gates Veterinary Specialists (CVS), Chester CH1 6LT, UK;
| | - Thomas Maddox
- Leahurst Campus, University of Liverpool, Chester High Road, Neston CH64 7TE, UK; (T.M.); (K.R.)
| | - Katherine Robson
- Leahurst Campus, University of Liverpool, Chester High Road, Neston CH64 7TE, UK; (T.M.); (K.R.)
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Molle C, Villamonte-Chevalier A, Carabalona J, Klajer A, Letesson J, Ragetly G, Védrine B, Blondiau J, Gauthier O. Pilot Clinical Trial to Evaluate In Situ Calcium Phosphate Cement Injection for Conservative Surgical Management of Appendicular Osteosarcoma in Dogs. Animals (Basel) 2024; 14:1460. [PMID: 38791676 PMCID: PMC11117317 DOI: 10.3390/ani14101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Cementoplasty is a minimally invasive procedure that consists of injecting a bone substitute into the tumor lesion to provide bone reinforcement and alleviate pain. This study aimed to demonstrate the feasibility, safety, and efficacy of cementoplasty with a calcium phosphate cement in osteosarcoma to reduce pain and preserve limb function. Throughout the 6-month study, dogs received no adjuvant therapy, and dogs' evaluations included a clinical examination, monitoring of postoperative complications, radiographic follow-up, and assessment of limb function and pain scores. Out of 12 dogs enrolled, 10 were withdrawn before study completion due to deterioration in their general condition. Nine (9) dogs were followed until D28, six until D56, and two until D183. Compared to D0, more than 50% of the dogs showed improvement in both veterinarian and owner scores at their final visit. Throughout the study, 10 major and 4 minor complications were reported, all unrelated to the procedure. This open non-controlled study provides first evidence of the feasibility, safety, and efficacy of cementoplasty procedure using a calcium phosphate bone cement to relieve pain and preserve limb function in dogs suffering from appendicular osteosarcoma.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Olivier Gauthier
- Département de Chirurgie des Animaux de Compagnies, Centre Hospitalier Universitaire Vétérinaire ONIRIS, 44307 Nantes, France;
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3
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A composite scale to recognize abdominal pain and its variation over time in response to analgesia in rabbits. Vet Anaesth Analg 2022; 49:323-328. [DOI: 10.1016/j.vaa.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 01/30/2023]
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Flesner BK, Torres BT, Hutcheson KD, Rindt H, Zalcman AR, Maitz CA. A Pilot Study of Cancer-Induced Bone Pain Using Validated Owner Questionnaires, Serum N-Telopeptide Concentration, Kinetic Analysis, and PET/CT. Front Vet Sci 2022; 8:637195. [PMID: 34977203 PMCID: PMC8716557 DOI: 10.3389/fvets.2021.637195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Cancer-induced bone pain, despite its frequency and severity, is a poorly understood phenomenon in people and animals. Despite excitement regarding translational osteosarcoma studies, there is a lack of attention toward examining cancer pain in dogs. In this pilot study, we used a multimodal pain assessment methodology to evaluate pain relief after therapeutic intervention in dogs with primary bone cancer. We hypothesized that intervention would cause objective evidence of pain relief. Evaluations of 8 dogs with primary bone cancer included 18F-FDG PET/CT scans, kinetic analysis, validated owner questionnaires (Canine Brief Pain Inventory, canine BPI), and serum N-telopeptide (NTx) concentration. Dogs were routinely staged and had 18F-FDG PET/CT scans prior to treatment with day 0, 7, 14, and 28 canine BPI, serum NTx, orthopedic exam, and kinetic analysis. Dogs treated with zoledronate and radiation underwent day 28 18F-FDG PET scans. All clinical trial work was approved by the University of Missouri IACUC. Four dogs underwent amputation (AMP) for their appendicular bone tumors; four received neoadjuvant zoledronate and hypofractionated radiation therapy (ZOL+RT). Canine BPI revealed significant improvements in pain severity and pain interference scores compared to baseline for all dogs. Positive changes in peak vertical force (+16.7%) and vertical impulse (+29.1%) were noted at day 28 in ZOL+RT dogs. Dogs receiving ZOL+RT had a significant (at least 30%) reduction in serum NTx from baseline compared to amputated dogs (p = 0.029). SUVmax (p = 0.11) and intensity (p = 0.013) values from PET scans decreased while tumor uniformity (p = 0.017) significantly increased in ZOL+RT-treated tumors; gross tumor volume did not change (p = 0.78). Owner questionnaires, kinetic analysis, and 18F-FDG PET/CT scans showed improved pain relief in dogs receiving ZOL+RT. Serum NTx levels likely do not directly measure pain, but rather the degree of systemic osteoclastic activity. Larger, prospective studies are warranted to identify the ideal objective indicator of pain relief; however, use of multiple assessors is presumably best. With improved assessment of pain severity and relief in dogs with cancer, we can better evaluate the efficacy of our interventions. This could directly benefit people with cancer pain, potentially decreasing the amount of subtherapeutic novel drugs entering human clinical trials.
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Affiliation(s)
- Brian K Flesner
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Bryan T Torres
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Kyle D Hutcheson
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Hansjörg Rindt
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Amy R Zalcman
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
| | - Charles A Maitz
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States
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Leung J, Beths T, Carter JE, Munn R, Whittem T, Bauquier SH. Intravenous Acetaminophen Does Not Provide Adequate Postoperative Analgesia in Dogs Following Ovariohysterectomy. Animals (Basel) 2021; 11:ani11123609. [PMID: 34944384 PMCID: PMC8697971 DOI: 10.3390/ani11123609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 01/16/2023] Open
Abstract
Simple Summary Acetaminophen is the most commonly used pain relief (analgesic) agent in humans worldwide and its use is becoming more frequent in dogs. However, limited evidence supports this use. This study aimed to investigate the analgesic effect of acetaminophen when administered as an intravenous injection post-operatively in female dogs. A total of 34 dogs were randomly divided into two groups and either administered acetaminophen or saline intravenously immediately after desexing. The dogs had their pain levels evaluated at 10, 20, 40, 60, 120, and 180 min after awakening from general anesthesia and the pain levels between groups were compared. Concurrently, the dogs had blood collected at 2, 5, 10, 40, and 80 min following injection of the acetaminophen. The blood was analyzed to quantify the levels of acetaminophen in the body. This study found that acetaminophen was no better than saline in providing analgesia in dogs following surgery. This study suggests that acetaminophen used alone may not be an appropriate post-operative analgesic agent for desexing procedures. Abstract (1) Objective: To investigate the analgesic effects of intravenous acetaminophen after intravenous administration in dogs presenting for ovariohysterectomy. (2) Methods: 14 ASA I client-owned female entire dogs. In this randomized, blinded, clinical study, dogs were given meperidine and acepromazine intramuscularly before induction of anesthesia with intravenous propofol. Anesthesia was maintained with isoflurane in oxygen. Intravenous acetaminophen 20 mg/kg or 0.9% NaCl was administered postoperatively. Pain assessments were conducted using the Glasgow Pain Scale short form before premedication and at 10, 20, 60, 120, and 180 min post-extubation or until rescue analgesia was given. The pain scores, times, and incidences of rescue analgesia between the groups was compared. Blood was collected before and 2, 5, 10, 20, 40, and 80 min after acetaminophen administration. Acetaminophen plasma concentration was quantified by liquid chromatography-mass spectrometry. The acetaminophen plasma concentration at the time of each pain score evaluation was subsequently calculated. (3) Results: There was no significant difference in pain scores at 10 min, highest pain scores, or time of rescue analgesia between groups. In each group, 3 dogs (43%) received rescue analgesia within 20 min. (4) Conclusions: Following ovariohysterectomy in dogs, there was no detectable analgesic effect of a 20 mg/kg dosage of intravenous acetaminophen administered at the end of surgery.
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Affiliation(s)
- Jessica Leung
- Translational Research and Clinical Trials (TRACTs), U-Vet, Melbourne Veterinary School, The University of Melbourne, Melbourne 3030, Australia; (J.L.); (J.E.C.); (S.H.B.)
| | - Thierry Beths
- Translational Research and Clinical Trials (TRACTs), U-Vet, Melbourne Veterinary School, The University of Melbourne, Melbourne 3030, Australia; (J.L.); (J.E.C.); (S.H.B.)
- Correspondence:
| | - Jennifer E. Carter
- Translational Research and Clinical Trials (TRACTs), U-Vet, Melbourne Veterinary School, The University of Melbourne, Melbourne 3030, Australia; (J.L.); (J.E.C.); (S.H.B.)
| | - Richard Munn
- Cognosco, Anexa Vet Services, Morrinsville 3110, New Zealand;
| | - Ted Whittem
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia;
| | - Sebastien H. Bauquier
- Translational Research and Clinical Trials (TRACTs), U-Vet, Melbourne Veterinary School, The University of Melbourne, Melbourne 3030, Australia; (J.L.); (J.E.C.); (S.H.B.)
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Testa B, Reid J, Scott ME, Murison PJ, Bell AM. The Short Form of the Glasgow Composite Measure Pain Scale in Post-operative Analgesia Studies in Dogs: A Scoping Review. Front Vet Sci 2021; 8:751949. [PMID: 34660773 PMCID: PMC8515184 DOI: 10.3389/fvets.2021.751949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
The measurement and treatment of acute pain in animals is essential from a welfare perspective. Valid pain-related outcome measures are also crucial for ensuring reliable and translatable findings in veterinary clinical trials. The short form of the Glasgow Composite Measure Pain Scale (CMPS-SF) is a multi-item behavioral pain assessment tool, developed and validated using a psychometric approach, to measure acute pain in the dog. Here we conduct a scoping review to identify prospective research studies that have used the CMPS-SF. We aim to describe the contexts in which it has been used, verify the correct use of the scale, and examine whether these studies are well-designed and adequately powered. We identify 114 eligible studies, indicating widespread use of the scale. We also document a limited number of modifications to the scale and intervention level, which would alter its validity. A variety of methods, with no consensus, were used to analyse data derived from the scale. However, we also find many deficiencies in reporting of experimental design in terms of the observers used, the underlying hypothesis of the research, the statement of primary outcome, and the use of a priori sample size calculations. These deficiencies may predispose to both type I and type II statistical errors in the small animal pain literature. We recommend more robust use of the scale and derived data to ensure success of future studies using the tool ensuring reliable and translatable outcomes.
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Affiliation(s)
- Barbara Testa
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jacqueline Reid
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom.,NewMetrica Research, Glasgow, United Kingdom
| | - Marian E Scott
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Pamela J Murison
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Andrew M Bell
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
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Efficacy of tramadol for postoperative pain management in dogs: systematic review and meta-analysis. Vet Anaesth Analg 2021; 48:283-296. [DOI: 10.1016/j.vaa.2021.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022]
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della Rocca G, Gamba D. Chronic Pain in Dogs and Cats: Is There Place for Dietary Intervention with Micro-Palmitoylethanolamide? Animals (Basel) 2021; 11:952. [PMID: 33805489 PMCID: PMC8065429 DOI: 10.3390/ani11040952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
The management of chronic pain is an integral challenge of small animal veterinary practitioners. Multiple pharmacological agents are usually employed to treat maladaptive pain including opiates, non-steroidal anti-inflammatory drugs, anticonvulsants, antidepressants, and others. In order to limit adverse effects and tolerance development, they are often combined with non-pharmacologic measures such as acupuncture and dietary interventions. Accumulating evidence suggests that non-neuronal cells such as mast cells and microglia play active roles in the pathogenesis of maladaptive pain. Accordingly, these cells are currently viewed as potential new targets for managing chronic pain. Palmitoylethanolamide is an endocannabinoid-like compound found in several food sources and considered a body's own analgesic. The receptor-dependent control of non-neuronal cells mediates the pain-relieving effect of palmitoylethanolamide. Accumulating evidence shows the anti-hyperalgesic effect of supplemented palmitoylethanolamide, especially in the micronized and co-micronized formulations (i.e., micro-palmitoylethanolamide), which allow for higher bioavailability. In the present paper, the role of non-neuronal cells in pain signaling is discussed and a large number of studies on the effect of palmitoylethanolamide in inflammatory and neuropathic chronic pain are reviewed. Overall, available evidence suggests that there is place for micro-palmitoylethanolamide in the dietary management of chronic pain in dogs and cats.
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Affiliation(s)
- Giorgia della Rocca
- Department of Veterinary Medicine, Centro di Ricerca sul Dolore Animale (CeRiDA), Università degli Studi di Perugia, 06123 Perugia, Italy
| | - Davide Gamba
- Operational Unit of Anesthesia, Centro Veterinario Gregorio VII, 00165 Roma, Italy;
- Freelance, DG Vet Pain Therapy, 24124 Bergamo, Italy
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KuKanich B, KuKanich K, Rankin DC, Upchurch DA, Comroe A, Crauer B, Berke K, Klocke EE, Gonzalez SE, Mason D, Jensen G, Orchard R, Fitzgerald AH, Cho P, Komp M. Perioperative analgesia associated with oral administration of a novel methadone-fluconazole-naltrexone formulation in dogs undergoing routine ovariohysterectomy. Am J Vet Res 2020; 81:699-707. [PMID: 33112167 DOI: 10.2460/ajvr.81.9.699] [Citation(s) in RCA: 1] [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 determine perioperative analgesia associated with oral administration of a novel methadone-fluconazole-naltrexone formulation in dogs undergoing routine ovariohysterectomy. ANIMALS 43 healthy female dogs. PROCEDURES Dogs were randomly assigned to receive the methadone-fluconazole-naltrexone formulation at 1 of 2 dosages (0.5 mg/kg, 2.5 mg/kg, and 0.125 mg/kg, respectively, or 1.0 mg/kg, 5.0 mg/kg, and 0.25 mg/kg, respectively, PO, q 12 h, starting the evening before surgery; n = 15 each) or methadone alone (0.5 mg/kg, SC, q 4 h starting the morning of surgery; 13). Dogs were sedated with acepromazine, and anesthesia was induced with propofol and maintained with isoflurane. A standard ovariohysterectomy was performed by experienced surgeons. Sedation and pain severity (determined with the Glasgow Composite Pain Scale-short form [GCPS-SF]) were scored for 48 hours after surgery. Rescue analgesia was to be provided if the GCPS-SF score was > 6. Dogs also received carprofen starting the day after surgery. RESULTS None of the dogs required rescue analgesia. The highest recorded GCPS-SF score was 4. A significant difference in GCPS-SF score among groups was identified at 6:30 am the day after surgery, but not at any other time. The most common adverse effect was perioperative vomiting, which occurred in 11 of the 43 dogs. CONCLUSIONS AND CLINICAL RELEVANCE Oral administration of a methadone-fluconazole-naltrexone formulation at either of 2 dosages every 12 hours (3 total doses) was as effective as SC administration of methadone alone every 4 hours (4 total doses) in dogs undergoing routine ovariohysterectomy. Incorporation of naltrexone in the novel formulation may provide a deterrent to human opioid abuse or misuse.
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Tomacheuski RM, Taffarel MO, Cardoso GS, Derussi AAP, Ferrante M, Volpato R, Luna SPL. Postoperative Analgesic Effects of Laserpuncture and Meloxicam in Bitches Submitted to Ovariohysterectomy. Vet Sci 2020; 7:vetsci7030094. [PMID: 32708066 PMCID: PMC7559566 DOI: 10.3390/vetsci7030094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background: This prospective, randomised and blind study investigated the efficacy of laserpuncture for postoperative pain management in dogs. Method: Sixteen bitches were sedated with acepromazine and randomly treated before ovariohysterectomy with meloxicam 0.2 mg·kg−1 intramuscular or laserpuncture (wavelength 904 mm, frequency 124 Hz, potency 10 Joules, 100 s in each acupoint). Anaesthesia was performed with propofol, isoflurane/O2, and fentanyl. The Glasgow Composite Measure Pain Scale (GCMPS) and Dynamic Interactive Visual Analog Scale (DIVAS) were used to evaluate postoperative pain before and for 24 h after surgery. Morphine was administrated as rescue analgesia when pain scores were ≥3.33 (GCMPS). Differences between treatments, time points, and amount of rescue analgesia between groups were investigated by the Mann–Whitney test and the area under the curve (AUC) for GCMPS, Friedman, and Chi-squared tests, respectively (p < 0.05). Results: Dogs treated with laserpuncture presented lower GCMPS AUC for 24 h and lower GCMPS scores at 2 and 4 h postoperatively (p = 0.04). Three dogs treated with meloxicam required postoperatively rescue analgesia against none treated with laserpuncture. Conclusions: In this preliminary study, laserpuncture mitigated postoperative pain in dogs following ovariohysterectomy, and the technique is a promising adjunct to perioperative pain management in dogs undergoing soft tissue surgery.
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Affiliation(s)
- Rubia M. Tomacheuski
- Department of Anesthesiology, Medical School, São Paulo State University (Unesp), Botucatu 18618687, Brazil;
| | - Marilda O. Taffarel
- Department of Veterinary Medicine, Maringá State University (UEM), Umuarama 87502970, Brazil;
| | - Guilherme S. Cardoso
- Department of Veterinary Clinics, Londrina State University (UEL), Londrina 86057970, Brazil;
| | - Ana A. P. Derussi
- Department of Animal Reproduction, José do Rosário Vellano University (UNIFENAS), Alfenas 37131587, Brazil;
| | - Marcos Ferrante
- Department of Veterinary Medicine, Federal University of Lavras (UFLA), Lavras 37200900, Brazil;
| | - Rodrigo Volpato
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu 18618000, Brazil;
| | - Stelio P. L. Luna
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu 18618000, Brazil;
- Correspondence: ; Tel.: +55-14-996275212
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