1
|
Kaufman HW, Wang C, Wang Y, Han H, Chaudhuri S, Usvyat L, Hahn Contino C, Kossmann R, Kraus MA. Machine Learning Case Study: Patterns of Kidney Function Decline and Their Association With Clinical Outcomes Within 90 Days After the Initiation of Renal Dialysis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:33-39. [PMID: 36723279 DOI: 10.1053/j.akdh.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Abstract
A case study explores patterns of kidney function decline using unsupervised learning methods first and then associating patterns with clinical outcomes using supervised learning methods. Predicting short-term risk of hospitalization and death prior to renal dialysis initiation may help target high-risk patients for more aggressive management. This study combined clinical data from patients presenting for renal dialysis at Fresenius Medical Care with laboratory data from Quest Diagnostics to identify disease trajectory patterns associated with the 90-day risk of hospitalization and death after beginning renal dialysis. Patients were clustered into 4 groups with varying rates of estimated glomerular filtration rate (eGFR) decline during the 2-year period prior to dialysis. Overall rates of hospitalization and death were 24.9% (582/2341) and 4.6% (108/2341), respectively. Groups with the steepest declines had the highest rates of hospitalization and death within 90 days of dialysis initiation. The rate of eGFR decline is a valuable and readily available tool to stratify short-term (90 days) risk of hospitalization and death after the initiation of renal dialysis. More intense approaches are needed that apply models that identify high risks to potentially avert or reduce short-term hospitalization and death of patients with a severe and rapidly progressive chronic kidney disease.
Collapse
Affiliation(s)
| | - Catherine Wang
- Statistics and Data Science, Dietrich College of Humanities and Social Sciences, Carnegie Mellon University, Pittsburgh, PA
| | - Yuedong Wang
- Department of Statistics and Applied Probability, College of Letters and Science, University of California - Santa Barbara, Santa Barbara, CA
| | - Hao Han
- Fresenius Medical Care, Waltham, MA
| | | | | | | | | | | |
Collapse
|
2
|
Wyld MLR, Mata NLDL, Viecelli A, Swaminathan R, O'Sullivan KM, O'Lone E, Rowlandson M, Francis A, Wyburn K, Webster AC. Sex-Based Differences in Risk Factors and Complications of Chronic Kidney Disease. Semin Nephrol 2022; 42:153-169. [PMID: 35718363 DOI: 10.1016/j.semnephrol.2022.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Globally, females are ∼30% more likely to have pre-dialysis chronic kidney disease (CKD) than males for reasons that are not fully understood. CKD is associated with numerous adverse health outcomes which makes understanding and working to eradicating sex based disparities in CKD prevalence essential. This review maps both what is known, and what is unknown, about the way sex and gender impacts (1) the epidemiology and risk factors for CKD including age, diabetes, hypertension, obesity, smoking, and cerebrovascular disease, and (2) the complications from CKD including kidney disease progression, cardiovascular disease, CKD mineral and bone disorders, anaemia, quality-of-life, cancer and mortality. This mapping can be used to guide future research.
Collapse
Affiliation(s)
- Melanie L R Wyld
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia.
| | - Nicole L De La Mata
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ramyasuda Swaminathan
- Department of Nephrology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Kim M O'Sullivan
- Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Emma O'Lone
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Matthew Rowlandson
- Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia
| | - Anna Francis
- Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kate Wyburn
- Department of Renal Medicine,Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Renal and Transplant Medicine, Westmead Hospital, Sydney, Australia
| |
Collapse
|
3
|
Ting SW, Fan PC, Lin YS, Lin MS, Lee CC, Kuo G, Chang CH. Uremic pruritus and long-term morbidities in the dialysis population. PLoS One 2020; 15:e0241088. [PMID: 33104746 PMCID: PMC7588085 DOI: 10.1371/journal.pone.0241088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Uremic pruritus (UP) is a multifactorial problem that contributes to low quality of life in dialysis patients. The long-term influences of UP on dialysis patients are still poorly understood. This study aims to elucidate the contribution of UP to long-term outcomes. Materials and method We used the Taiwan National Health Insurance Research Database to conduct this study. Patients on chronic dialysis were included and divided into UP and non-UP groups according to the long-term prescription of antihistamine in the absence of other indications. The outcomes include infection-related hospitalization, catheter-related infection, major adverse cardiac and cerebrovascular events (MACCE) and parathyroidectomy. Results After propensity score matching, 14,760 patients with UP and 29,520 patients without UP were eligible for analysis. After a mean follow-up of 5 years, we found that infection-related hospitalization, MACCE, catheter-related infection, heart failure and parathyroidectomy were all slightly higher in the UP than non-UP group (hazard ratio: 1.18 [1.16–1.21], 1.05 [1.01–1.09], 1.16 [1.12–1.21], 1.08 [1.01–1.16] and 1.10 [1.01–1.20], respectively). Subgroup analysis revealed that the increased risk of adverse events by UP was generally more apparent in younger patients and patients who underwent peritoneal dialysis. Conclusion UP may be significantly associated with an increased risk of long-term morbidities.
Collapse
Affiliation(s)
- Sze-Wen Ting
- Department of Dermatology, New Taipei City Tu-Cheng Municipal Hospital, New Taipei City (Built and Operated by Chang Gung Medical Foundation), Taoyuan, Taiwan
| | - Pei-Chun Fan
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ming-Shyan Lin
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Puzi City, Taiwan
| | - Cheng-Chia Lee
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail: ,
| |
Collapse
|
4
|
Shardlow A, McIntyre NJ, Fluck RJ, McIntyre CW, Taal MW. Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3. BMJ Open 2017; 7:e016528. [PMID: 28838895 PMCID: PMC5629682 DOI: 10.1136/bmjopen-2017-016528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Vitamin D deficiency, elevated fibroblast growth factor 23 (FGF23) and elevated parathyroid hormone (PTH) have each been associated with increased mortality in people with chronic kidney disease (CKD). Previous studies have focused on the effects of FGF23 in relatively advanced CKD. This study aims to assess whether FGF23 is similarly a risk factor in people with early CKD, and how this risk compares to that associated with vitamin D deficiency or elevated PTH. DESIGN Prospective cohort study. SETTING Thirty-two primary care practices. PARTICIPANTS One thousand six hundred and sixty-four people who met Kidney Disease: Improving Global Outcomes (KDIGO) definitions for CKD stage 3 (two measurements of estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73 m2 at least 90 days apart) prior to study recruitment. OUTCOME MEASURES All-cause mortality over the period of study follow-up and progression of CKD defined as a 25% fall in eGFR and a drop in GFR category, or an increase in albuminuria category. RESULTS Two hundred and eighty-nine participants died during the follow-up period. Vitamin D deficiency (HR 1.62, 95% CI 1.01 to 2.58) and elevated PTH (HR 1.42, 95% CI 1.09 to 1.84) were independently associated with all-cause mortality. FGF23 was associated with all-cause mortality in univariable but not multivariable analysis. Fully adjusted multivariable models of CKD progression showed no association with FGF23, vitamin D status or PTH. CONCLUSIONS In this cohort of predominantly older people with CKD stage 3 and low risk of progression, vitamin D deficiency and elevated PTH were independent risk factors for all-cause mortality but elevated FGF23 was not. While FGF23 may have a role as a risk marker in high-risk populations managed in secondary care, our data suggest that it may not be as important in CKD stage 3, managed in primary care. TRIAL REGISTRATION NUMBER National Institute for Health Research Clinical Research Portfolio Study Number 6632.
Collapse
Affiliation(s)
- Adam Shardlow
- Renal Medicine, Royal Derby Hospital, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, Centre for Kidney Research and Innovation, School of Medicine, The University of Nottingham, Royal Derby Hospital, Derby, UK
| | | | | | - Christopher W McIntyre
- Division of Nephrology, Schulich School of Medicine and Dentistry University of Western Ontario, London, Ontario, Canada
| | - Maarten W Taal
- Renal Medicine, Royal Derby Hospital, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, Centre for Kidney Research and Innovation, School of Medicine, The University of Nottingham, Royal Derby Hospital, Derby, UK
| |
Collapse
|
5
|
Shen H, Xu Y, Lu J, Ma C, Zhou Y, Li Q, Chen X, Zhu A, Shen G. Small dense low-density lipoprotein cholesterol was associated with future cardiovascular events in chronic kidney disease patients. BMC Nephrol 2016; 17:143. [PMID: 27716087 PMCID: PMC5053337 DOI: 10.1186/s12882-016-0358-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/28/2016] [Indexed: 01/01/2023] Open
Abstract
Background Cardiovascular disease (CVD) is often comorbid with chronic kidney disease (CKD). Small low-density lipoprotein cholesterol (sdLDL-C) has also been found to increase risk for CVD. The goal of the present study was to determine the nature of the relationship between sdLDL-C concentration and CVD in patients with CKD. Methods One-hundred and forty-five subjects (113 men and 32 women) with CKD (Stage 3 and Stage 4) participated this retrospective study. The concentration of sdLDL-C was measured in samples from 145 CKD patients between 2010 and 2012 during a four-year follow-up period. Results A total of eight fatal cardiovascular events (CVs) and 46 nonfatal CVs were registered in the four-year follow-up period. Multivariate Cox regression analysis showed that sdLDL-C [1.278, 95 % (1.019–1.598)] and sdLDL-C/LDL-C [2.456, 95 % (1.421–15.784)], at final observation, were independent risks of CVs. A Kaplan-Meier survival analysis showed that patients with sdLDL-C >38 mg/dl (logrank: 4.375, P = 0.037), and sdLDL-C/LDL-C ratio >0.3 levels (logrank: 11.94, P = 0.018) were at increased risk for CVs. Conclusion The results of this study indicated that for patients suffering CKD, a significant relationship exists between an elevated sdLDL-C concentration and the risk of cardiovascular disease.
Collapse
Affiliation(s)
- Hao Shen
- Department of Clinical Laboratory Medicine, First People's Hospital of Wujiang District, Nantong University, Suzhou, China.
| | - Yan Xu
- Department of Nephrology, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| | - Jingfen Lu
- Department of Clinical Laboratory Medicine, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| | - Chunfang Ma
- Department of Clinical Laboratory Medicine, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| | - Yadong Zhou
- Department of Clinical Laboratory Medicine, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| | - Qiong Li
- Department of Clinical Laboratory Medicine, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| | - Xu Chen
- Department of Clinical Laboratory Medicine, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| | - Ao Zhu
- Department of Geriatrics, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| | - Guorong Shen
- Department of Clinical Laboratory Medicine, First People's Hospital of Wujiang District, Nantong University, Suzhou, China
| |
Collapse
|
6
|
Hamano T. [Kidney diseases and metabolic disorders--Basics and applications required for general physicians. Topics: VII. Abnormality in phosphate metabolism]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2015; 104:953-959. [PMID: 26591345 DOI: 10.2169/naika.104.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
7
|
Sonmez A, Yilmaz MI, Saglam M, Unal HU, Gok M, Cetinkaya H, Karaman M, Haymana C, Eyileten T, Oguz Y, Vural A, Rizzo M, Toth PP. The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease. Lipids Health Dis 2015; 14:29. [PMID: 25885289 PMCID: PMC4407467 DOI: 10.1186/s12944-015-0031-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/01/2015] [Indexed: 01/22/2023] Open
Abstract
Background Cardiovascular disease (CVD) risk is substantially increased in subjects with chronic kidney disease (CKD). The Triglycerides (TG) to High-Density Lipoprotein Cholesterol (HDL-C) ratio is an indirect measure of insulin resistance and an independent predictor of cardiovascular risk. No study to date has been performed to evaluate whether the TG/HDL-C ratio predicts CVD risk in patients with CKD. Methods A total of 197 patients (age 53 ± 12 years) with CKD Stages 1 to 5, were enrolled in this longitudinal, observational, retrospective study. TG/HDL-C ratio, HOMA-IR indexes, serum asymmetric dimethyl arginine (ADMA), high sensitivity C-reactive protein (CRP), parathyroid hormone (PTH), calcium, phosphorous, estimated glomerular filtration rate (eGFR), and albumin levels were measured. Flow mediated vasodilatation (FMD) of the brachial artery was assessed by using high-resolution ultrasonography. Results A total of 11 cardiovascular (CV) deaths and 43 nonfatal CV events were registered in a mean follow-up period of 30 (range 9 to 35) months. Subjects with TG/HDL-C ratios above the median values (>3.29) had significantly higher plasma ADMA, PTH, and phosphorous levels (p = 0.04, p = 0.02, p = 0.01 respectively) and lower eGFR and FMD values (p = 0.03, p < 0.001 respectively). The TG/HDL-C ratio was an independent determinant of FMD (β = −0.25 p = 0.02) along with TG, HDL-C, hsCRP, serum albumin, phosphate levels, systolic blood pressure, PTH, eGFR and the presence of diabetes mellitus. The TG/HDL-C ratio was also a significant independent determinant of cardiovascular outcomes [HR: 1.36 (1.11-1.67) (p = 0.003)] along with plasma ADMA levels [HR: 1.31 (1.13-1.52) (p < 0.001)] and a history of diabetes mellitus [HR: 4.82 (2.80-8.37) (p < 0.001)]. Conclusion This study demonstrates that the elevated TG/HDL-C ratio predicts poor CVD outcome in subjects with CKD. Being a simple, inexpensive, and reproducible marker of CVD risk, the TG/HDL-C ratio may emerge as a novel and reliable indicator among the many well-established markers of CVD risk in CKD. Systematic review registration Clinical trial registration number and date: NCT02113462 / 10-04-2014.
Collapse
Affiliation(s)
- Alper Sonmez
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Mahmut Ilker Yilmaz
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Mutlu Saglam
- Department of Radiology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Hilmi Umut Unal
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Mahmut Gok
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Hakki Cetinkaya
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Murat Karaman
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Cem Haymana
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Tayfun Eyileten
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Yusuf Oguz
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Abdulgaffar Vural
- Department of Nephrology, Gulhane School of Medicine, 06018, Etlik, Ankara, Turkey.
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
| | - Peter P Toth
- University of Illinois School of Medicine, Peoria, Il, USA.
| |
Collapse
|
8
|
Ferraresi M, Pia A, Guzzo G, Vigotti FN, Mongilardi E, Nazha M, Aroasio E, Gonella C, Avagnina P, Piccoli GB. Calcium-phosphate and parathyroid intradialytic profiles: A potential aid for tailoring the dialysate calcium content of patients on different hemodialysis schedules. Hemodial Int 2015; 19:572-82. [PMID: 25819092 DOI: 10.1111/hdi.12296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Severe hyperparathyroidism is a challenge on hemodialysis. The definition of dialysate calcium (Ca) is a pending issue with renewed importance in cases of individualized dialysis schedules and of portable home dialysis machines with low-flow dialysate. Direct measurement of calcium mass transfer is complex and is imprecisely reflected by differences in start-to-end of dialysis Ca levels. The study was performed in a dialysis unit dedicated to home hemodialysis and to critical patients with wide use of daily and tailored schedules. The Ca-phosphate (P)-parathyroid hormone (PTH) profile includes creatinine, urea, total and ionized Ca, albumin, sodium, potassium, P, PTH levels at start, mid, and end of dialysis. "Severe" secondary hyperparathyroidism was defined as PTH > 300 pg/mL for ≥3 months. Four schedules were tested: conventional dialysis (polysulfone dialyzer 1.8-2.1 m(2) ), with dialysate Ca 1.5 or 1.75 mmol/L, NxStage (Ca 1.5 mmol/L), and NxStage plus intradialytic Ca infusion. Dosages of vitamin D, calcium, phosphate binders, and Ca mimetic agents were adjusted monthly. Eighty Ca-P-PTH profiles were collected in 12 patients. Serum phosphate was efficiently reduced by all techniques. No differences in start-to-end PTH and Ca levels on dialysis were observed in patients with PTH levels < 300 pg/mL. Conversely, Ca levels in "severe" secondary hyperparathyroid patients significantly increased and PTH decreased during dialysis on all schedules except on Nxstage (P < 0.05). Our data support the need for tailored dialysate Ca content, even on "low-flow" daily home dialysis, in "severe" secondary hyperparathyroid patients in order to increase the therapeutic potentials of the new dialysis techniques.
Collapse
Affiliation(s)
- Martina Ferraresi
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Anna Pia
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Gabriella Guzzo
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Federica Neve Vigotti
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Elena Mongilardi
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Marta Nazha
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Emiliano Aroasio
- Laboratory, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Cinzia Gonella
- Laboratory, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| | - Paolo Avagnina
- Dietetics and Clinical Nutrition, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino, Turin, Italy
| | - Giorgina Barbara Piccoli
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Torino
| |
Collapse
|
9
|
Whaley-Connell AT, Kurella Tamura M, Jurkovitz CT, Kosiborod M, McCullough PA. Advances in CKD detection and determination of prognosis: executive summary of the National Kidney Foundation-Kidney Early Evaluation Program (KEEP) 2012 annual data report. Am J Kidney Dis 2013; 61:S1-3. [PMID: 23507265 DOI: 10.1053/j.ajkd.2013.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 11/11/2022]
|