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ABSTRACT: Dysregulation of immune responses within joints plays an important role in development of inflammatory arthritis. We determined expression of a panel of immune response and matrix turnover genes in synovial fluid collected from a group of dogs with stifle oligoarthritis and associated degenerative cranial cruciate ligament (CCL) rupture (n=27). We also studied synovial fluid gene expression in dogs affected with other forms of degenerative arthritis (n=9) and in the stifle joint of healthy dogs with intact CCL (n=14). After collection, synovial cells were pelleted and RNA was isolated. Relative expression of cathepsin K, cathepsin S, tartrate-resistant acid phosphatase (TRAP), matrix metalloproteinase-9 (MMP-9), invariant chain (li), toll-like receptor-2 (TLR-2), and TLR-9 was determined using real-time quantitative RT-PCR. Data were normalized to peripheral blood mononuclear cells (PBMC) as an internal control. Relative expression of cathepsin K, MMP-9, TRAP, and li was increased in the stifle synovial fluid of dogs with oligoarthritis, when compared with the stifles of healthy dogs (P<0.05). In contrast, relative expression of all of the genes-of-interest in synovial fluid from joints affected with other forms of arthritis was not significantly different from the stifles of healthy dogs. TRAP expression was also significantly increased in the stifle joints of dogs with oligoarthritis, when compared to joint expression of TRAP in dogs with other forms of degenerative arthritis (P<0.05). In the dogs with stifle oligoarthritis, expression of both matrix turnover and immune response genes was increased in stifle synovial fluid, when compared with the internal PBMC control, whereas in healthy dogs and dogs with other forms of arthritis, only expression of matrix turnover genes was increased in synovial fluid, when compared with the internal PBMC control (P<0.05). Taken together, these findings suggest that antigen-specific immune responses within the stifle joint may be involved in the pathogenesis of persistent synovitis and associated joint degradation in dogs with oligoarthritis and degenerative CCL rupture.
Veterinary Immunology and Immunopathology 11/2007; 119(3-4):214-21. · 2.08 Impact Factor
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Journal of Orthopaedic Research 12/2005; 19(5):990 - 990. · 2.81 Impact Factor
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ABSTRACT: To compare the effects of caudal pole hemi-meniscectomy (CPHM) and complete medial meniscectomy (MM), specifically with respect to development of secondary osteoarthritis, in the stifle joints of clinically normal dogs.
14 large-breed dogs.
Unilateral CPHM (7 dogs) or MM (7) was performed, and the left stifle joints served as untreated control joints. Gait was assessed in all dogs before surgery and at 4, 8, 12, and 16 weeks postoperatively. After euthanasia, joints were evaluated grossly; Mankin cartilage scores, subchondral bone density assessment, and articular cartilage proteoglycan extraction and western blot analyses of 3B3(-) and 7D4 epitopes were performed.
Weight distribution on control limbs exceeded that of treated limbs at 4 and 16 weeks after surgery in the CPHM group and at 4 and 8 weeks after surgery in the MM group; weight distribution was not significantly different between the 2 groups. After 16 weeks, incomplete meniscal regeneration and cartilage fibrillation on the medial aspect of the tibial plateau and medial femoral condyle were detected in treated joints in both groups. Mankin cartilage scores, subchondral bone density, and immunoexpression of 3B3(-) or 7D4 in articular cartilage in CPHM- or MM-treated joints were similar; 7D4 epitope concentration in synovial fluid was significantly greater in the MM-treated joints than in CPHM-treated joints.
Overall severity of secondary osteoarthritis induced by CPHM and MM was similar. Investigation of 7D4 epitope concentration in synovial fluid suggested that CPHM was associated with less disruption of chondrocyte metabolism.
American Journal of Veterinary Research 09/2004; 65(8):1053-60. · 1.27 Impact Factor
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ABSTRACT: This study compared the effect of augmentation of allograft host bone junctions with recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS), autogenous cancellous bone graft (CBG), and a collagen sponge alone in a canine intercalary femoral defect model repaired with a frozen allograft. Outcome assessment included serial radiographs, dual energy X-ray absorptiometry scans, and gait analyses, and mechanical testing and histology of post-mortem specimens. The distal junction healed more quickly and completely with rhBMP-2 than ACS alone based on qualitative radiography and histologic evaluations. The primary tissue in the unhealed gaps in the ACS group was fibrous connective tissue. The proximal allograft host bone junction had complete bone union in the three treatment groups. There was significantly greater new bone callus formation at both junctions with rhBMP-2 than with CBG or ACS alone that resulted in increased bone density around the allograft host bone junctions. All dogs shifted their weight from the treated leg to the contralateral pelvic limb immediately after surgery. Weight bearing forces were redistributed equally between the pelvic limbs at 12 weeks after surgery with rhBMP-2, at 16 weeks after surgery with CBG, and at 24 weeks after surgery with ACS alone. Bending and compressive stiffnesses of the whole treated femora were equal to the contralateral control femora in all treatment groups, whereas torsional rigidities of the whole treated femora for the CBG and ACS groups were significantly less than the control. Both the proximal and distal junctions the treated with rhBMP-2 had torsional stiffnesses and strengths equal to intact control bones. Ultimate failure torques of the proximal junctions of the CBG group and of both junctions of the ACS group were significantly less than the BMP-treated bones. Augmentation of the allograft host bone junctions with rhBMP-2 on an ACS gave results for all parameters measured that equaled or exceeded autogenous graft in this canine intercalary femoral defect model.
Journal of Orthopaedic Research 04/2001; 19(2):308-17. · 2.81 Impact Factor
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ABSTRACT: The purpose of this study was to determine the effect of recombinant human bone morphogenetic protein type 2 (rhBMP-2) on the histomorphometry of femoral allograft-host bone union and allograft remodeling. A 6 cm mid-diaphyseal femoral defect was created and filled with an allograft stabilized with an interlocking nail in 21 dogs. Dogs were randomly divided into three equal groups and the allograft-host bone junctions and the mid-diaphyses of the allografts were treated with either an absorbable collagen sponge (ACS) loaded with rhBMP-2 (BMP group), an autogenous cancellous bone graft (CBG group), or ACS loaded with buffer solution (ACS group). All dogs received daily tetracycline until sacrifice at 24 weeks to label new bone formation. Histomorphometric analyses on sections of proximal and distal allograft-host bone junctions and the mid-diaphyseal portion of allografts were performed using fluorescent and regular light microscopy. Analyses of the host bone and junctions between allograft and host bone revealed significantly greater new bone formation and larger osteon radii in the BMP group compared to CBG and ACS groups and contralateral intact bone. Porosity in CBG and ACS groups was significantly higher than in the BMP group, which had similar values to intact bone. In transverse sections of allografts, the largest pore diameters were present in the CBG group. Based on all parameters measured, significantly higher bone turnover occurred in the outer cortical area of the allograft in all groups as compared to the inner cortical and mid-cortical areas. New bone formation and osteon radius/osteon width in allografts were similar for all three groups. Higher porosity and larger pore diameters in the CBG and ACS groups suggested higher bone resorption versus formation in these groups compared to the BMP group. The results of this study reveal more balanced allograft bone resorption and bone formation in the BMP group, with greater resorptive activity in the CBG and ACS groups. However, neither rhBMP-2 nor autogenous bone graft increased allograft incorporation when compared to the negative control (ACS group).
Journal of Orthopaedic Research 04/2001; 19(2):318-27. · 2.81 Impact Factor
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ABSTRACT: The purpose of this study was to determine the effect of recombinant human bone morphogenetic protein type 2 (rhBMP-2) on the histomorphometry of femoral allograft-host bone union and allograft remodeling. A 6 cm mid-diaphyseal femoral defect was created and filled with an allograft stabilized with an interlocking nail in 21 dogs. Dogs were randomly divided into three equal groups and the allograft-host bone junctions and the mid-diaphyses of the allografts were treated with either an absorbable collagen sponge (ACS) loaded with rhBMP-2 (BMP group), an autogenous cancellous bone graft (CBG group), or ACS loaded with buffer solution (ACS group). All dogs received daily tetracycline until sacrifice at 24 weeks to label new bone formation. Histomorphometric analyses on sections of proximal and distal allograft-host bone junctions and the mid-diaphyseal portion of allografts were performed using fluorescent and regular light microscopy. Analyses of the host bone and junctions between allograft and host bone revealed significantly greater new bone formation and larger osteon radii in the BMP group compared to CBG and ACS groups and contralateral intact bone. Porosity in CBG and ACS groups was significantly higher than in the BMP group, which had similar values to intact bone. In transverse sections of allografts, the largest pore diameters were present in the CBG group. Based on all parameters measured, significantly higher bone turnover occurred in the outer cortical area of the allograft in all groups as compared to the inner cortical and mid-cortical areas. New bone formation and osteon radius/osteon width in allografts were similar for all three groups. Higher porosity and larger pore diameters in the CBG and ACS groups suggested higher bone resorption versus formation in these groups compared to the BMP group. The results of this study reveal more balanced allograft bone resorption and bone formation in the BMP group, with greater resorptive activity in the CBG and ACS groups. However, neither rhBMP-2 nor autogenous bone graft increased allograft incorporation when compared to the negative control (ACS group). © 2001 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Journal of Orthopaedic Research 02/2001; 19(2):318 - 327. · 2.81 Impact Factor
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ABSTRACT: To describe cancellous architecture of the proximal portion of the femur in dogs with osteoarthritis.
30 dogs with coxofemoral osteoarthritis.
All dogs had femoral head and neck excision or total hip arthroplasty. Histomorphometry software was used to analyze computer images of 100-microm-thick coronal and transverse plane sections of the head and neck of the femur. Histologic preparations of coronal and transverse sections of articular cartilage were graded.
Bone volume/total volume, trabecular thickness, trabecular number, and bone surface/total volume were significantly higher in the femoral head than femoral neck. Trabecular alignment (anisotropy) and separation were significantly higher in the femoral neck than femoral head. Anisotropy was significantly increased in the medial portion of the femoral head in the coronal plane and in the cranial portion of the femoral neck in the transverse plane, compared with healthy dogs. The medial half of femoral head cartilage that overlies the proximomedial cancellous bone region had significantly more degraded cartilage than the lateral half. Histologic grades for cranial and caudal halves of femoral head articular cartilage were similar.
Most findings were similar to those in healthy dogs. Greater trabecular alignment in the proximomedial region of the femoral head and craniolateral region of the femoral neck in dogs with osteoarthritis suggests an altered transfer of load through the coxofemoral joint. Greater cartilage degradation on the medial half of the femoral head supports an association between increased trabecular alignment and cartilage degradation.
American Journal of Veterinary Research 11/2000; 61(10):1267-72. · 1.27 Impact Factor
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ABSTRACT: To describe the cancellous bone architecture of the head and neck of the femur in healthy dogs by use of automated histomorphometry techniques in conjunction with histologic grading of articular cartilage.
30 mature male dogs with healthy coxo-femoral joints
Dogs were 1.5 to 4 years old and weighed 27 to 37 kg. Computer images of fine-detail radiographs of 100-microm-thick coronal and transverse plane sections of the head and neck of the femur (14 dogs) were analyzed by use of histomorphometry software. Statistical comparisons among histomorphometric indices of 4 regions were performed. Histologic preparations of coronal and transverse plane sections of femoral head articular cartilage (16 dogs) were graded. Median grades for lateral, medial, cranial, and caudal halves of the femoral head articular cartilage were determined.
Bone volume/total volume, trabecular thickness and number, and bone surface/total volume were significantly higher in the femoral head than in the femoral neck. Anisotropy (trabecular alignment) and trabecular separation were significantly higher in the femoral neck than in the femoral head. Anisotropy was significantly higher in the caudal half of the femoral neck than in the cranial half. Cartilage had histologic grades indicating health without significant differences among lateral, medial, cranial, and caudal halves of femoral head cartilage.
A predictable cancellous architecture in the head and neck of the femur is associated with healthy cartilage.
American Journal of Veterinary Research 04/2000; 61(3):268-74. · 1.27 Impact Factor
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ABSTRACT: This study used radiography, gait analysis, gluteal muscle mass, mechanical testing, and qualitative histology to compare three methods of gluteal muscle attachment to an allograft/endoprosthetic composite of the proximal 25% of the femur in an in vivo canine model. The three methods of gluteal muscle attachment were identical to those used clinically in human patients for hip revision and proximal femoral limb salvage: the host gluteal tendon sutured to the allograft tendon (tendon group), the host greater trochanter with intact gluteal tendons secured to the allograft with a cable-grip system (grip group), and periosteally vascularized proximal femoral bone onlay with intact tendons wrapped around the allograft (wrap group). On the basis of radiographs taken every 2 months, the tendon group had more graft fractures than did the grip or wrap group. Radiographic union of the graft-host bone junction occurred more rapidly and there was less graft resorption in the wrap group than in the other two groups. In all dogs, peak vertical ground-reaction forces in the treated limb decreased immediately after surgery and then slowly increased over the length of the study. The dogs in the wrap group regained normal weight-bearing on the treated limb more quickly than did those in the other groups. The constructs in the tendon group were weaker and less stiff immediately after surgery than were those in the other groups or in intact controls. Histologic analysis confirmed that the wrap technique resulted in complete union of the host bone-allograft junction more often than did the other techniques. The wrap method had the best functional outcome after 9 months when an allograft/endoprosthetic composite was used during total hip arthroplasty in this canine model.
Journal of Orthopaedic Research 02/2000; 18(1):56-63. · 2.81 Impact Factor
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ABSTRACT: The number of orthopaedic injuries sustained by racing greyhounds from five greyhound tracks in the state of Wisconsin, USA, was obtained over a two-year period. Calculated injury rates were analysed to predict the probability that a given competitor would have an injury based on track design, temperature, bodyweight, grade of race, race distance, race number, injury location on track and type of trauma. One track had a significantly higher injury rate than the others, and this track was constructed with a decreased initial straightaway, a decreased turning radius in the second turn and an increased turn bank. Increased injury rates were also seen with successively higher grades of race, suggesting a possible correlation with speed. Race distance had a significant effect on racing greyhound injury rates as well. Races measuring 3/16 mile and 7/16 mile resulted in a higher incidence of injury as compared with races with lengths of 5/16 mile and 3/8 mile. Injuries were most likely to occur at the first turn of a race. Temperature, bodyweight, race number and type of trauma had no significant effect on injury rate. Speed, race distance and track design were significant factors that were found to influence the injury rate of the racing greyhound and should be areas to focus on for the prevention of injury.
Journal of Small Animal Practice 10/1999; 40(9):428-32. · 1.00 Impact Factor
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ABSTRACT: To determine whether medullary reaming alone, or followed by cemented hemiarthroplasty, influenced porosity, vascularity, and new bone formation in the proximal portion of the femur in dogs.
12 adult mixed-breed dogs.
Unilateral femoral head and neck excisions were performed, followed by femoral medullary reaming in 6 dogs and femoral medullary reaming and cemented hemiarthroplasty in 6 dogs; the contralateral femur was used as a control. All dogs were euthanatized 28 days after surgery, and femurs were harvested. Vascularity, porosity, and new bone formation were quantified for all femurs of dogs from both groups at 3 proximal-to-distal levels, 3 regions (periosteal, midcortical, and endosteal), and 4 quadrants (cranial, caudal, medial, and lateral) of the femur.
Medullary reamed and cemented hemiarthroplasty femurs had significant increases in vascularity and porosity at all levels and in new bone formation at levels 2 and 3. Porosity was increased significantly in the periosteal region of the cemented hemiarthroplasty (9.7+/-0.7%), compared with control (2.3+/-0.2%) and medullary reamed (8.4+/-0.7%) femurs. Porosity was increased in the caudal and medial quadrants in the medullary reamed and cemented hemiarthroplasty femurs; vascularity results were similar.
Increased porosity, vascularity, and new bone formation in reamed and cemented hemiarthroplasty-treated femurs supports the theory that surgical trauma associated with medullary reaming is an important factor in early cortical bone loss after hip arthroplasty.
Femoral remodeling associated with reaming and broaching is appreciable but may be only a temporary response, whereas other factors may be responsible for chronic cortical bone loss.
American Journal of Veterinary Research 09/1999; 60(8):922-8. · 1.27 Impact Factor
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ABSTRACT: A case of synovial osteochondromatosis (SOC) in a young deerhound's shoulder is reviewed. The age of onset and initially unaffected articular surfaces suggested primary SOC. Histological criteria for primary versus secondary osteochondromatosis are contradictory and unclear. Initial loose body removal and partial synovectomy resulted in several months of improvement but loose bodies returned. Severe degenerative changes were found one year after the initial exploratory surgery. Arthrodesis resulted in a functional, non-painful joint.
Journal of Small Animal Practice 09/1998; 39(8):397-400. · 1.00 Impact Factor
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ABSTRACT: In a canine model, the fixation stability of a prosthesis and proximal bone graft composite were measured relative to the distal femur. One group had the prosthesis graft composite cemented into the distal femur. The second group had the prosthesis graft composite press fit into the distal femur for biologic ingrowth. Displacements of the proximal femoral grafts relative to the host bone in each group were measured after ex vivo (acute with graft) implantation and 4 months after implantation. A third group with no osteotomy (acute intact) simulated perfect graft to host bone union. Relative displacements representing 6 degrees freedom (translation and rotation) were calculated from the displacement values measured by 9 eddy current transducers. Measurements of displacement were used to test the hypothesis that distal press fit fixation equals distal cement fixation at 4 months after implantation. In all cases the measured translations and rotations of the graft to implant construct were small and of a magnitude that should encourage bone ingrowth (< 0.05 mm and < 0.1 degree, respectively). The stability of the press fit group at 4 months was not significantly different from the cemented group in axial and transverse displacement during axial and transverse loading, respectively. There was no difference in stabilities at 4 months between distal press fit and cemented fixation in hip replacements requiring a proximal femoral graft.
Clinical Orthopaedics and Related Research 08/1997; · 2.53 Impact Factor
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ABSTRACT: Two dogs with supraspinatus calcifying tendinopathy were lame in their forelimbs and were treated by the surgical excision of the calcified lesion. The lameness in both dogs improved after surgery without additional medical treatment, as evidenced by force-plate analysis of their gait.
The Veterinary record 09/1996; 139(6):137-9. · 1.25 Impact Factor
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ABSTRACT: Neurological improvement after decompressive surgery, without routine therapeutic or prophylactic disc fenestration, was evaluated retrospectively in a consecutive series of 93 dachshunds with thoracolumbar disc extrusion. In 24 per cent of procedures, deep pain sensation was not elicited in at least one hind paw before surgery. Median neurological status one to seven days after surgery, at the time of discharge, was significantly improved after hemilaminectomy compared with dorsal laminectomy (P < 0.05). After hemilaminectomy, deep pain sensation was not elicited in one or both hind paws of 8 per cent of dogs in which pain sensation was elicited before surgery, compared with 21 per cent after dorsal laminectomy (P > 0.05). Improvement in neurological grade at follow-up examination two to 12 weeks after hemilaminectomy was not significantly different compared with dorsal laminectomy (P > 0.05). Of dogs which were unable to walk before surgery, 83 per cent regained the ability to walk after hemilaminectomy, compared with 74 per cent after dorsal laminectomy (P > 0.05). In both groups, 50 per cent of dogs in which deep pain sensation was abnormal before surgery eventually regained the ability to walk after surgery (P = 1). One to two years after the first operation, a second laminectomy was performed in only 5 per cent of dogs because of extrusion of a different intervertebral disc which had not been fenestrated.
Journal of Small Animal Practice 08/1995; 36(8):360-7. · 1.00 Impact Factor
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ABSTRACT: The effects of a collared femoral endoprosthesis in uncemented total hip arthroplasty were evaluated in 12 dogs. This experimental study compared the biomechanic and histologic responses between collared and collarless femoral prostheses 4 months after implantation. Implant stability (micromotion) and cortical surface strain were evaluated immediately and 4 months after implantation in a simulated postoperative condition, whereas bone ingrowth, cortical porosity, and cortical remodeling were assessed after 4 months only. There were no significant differences in implant stability or cortical surface strains when the collared and collarless groups were compared acutely or after 4 months (P > .05). There were also no significant differences in percent fill, bony ingrowth, or cortical geometry after 4 months (P > .05). There was a significant increase in cortical porosity measured from the proximal femur after 4 months for both the collared (P = .0002) and collarless groups (P = .009) and when both groups were compared (collarless, 8.2% and collared, 5.8%; P = .03). The results suggest that a collar may be beneficial in decreasing the cortical remodeling that occurs in the proximal femoral cortex after implantation of an uncemented total hip arthroplasty.
The Journal of Arthroplasty 03/1995; 10(1):63-73. · 2.38 Impact Factor
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ABSTRACT: If a plating technique is used, fractures of the radius and ulna are usually stabilised by the application of a plate to the radius, or by the placement of plates on both the radius and ulna. This report describes the treatment of comminuted fractures of the proximal radius and ulna in a young dog by the application of a single plate to the caudal surface of the ulna. Satisfactory healing of both fractures occurred by five weeks after surgery. This approach avoided the difficult surgical approach to the proximal radius, and simplified the management of a dog with multiple fractures in one limb.
The Veterinary record 07/1994; 134(23):599-601. · 1.25 Impact Factor
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ABSTRACT: Effects of canine hip replacement (with a porous-coated femoral component) on the material properties of surrounding cortical bone were evaluated. The hypotheses were: (1) after four months of implantation, mechanical properties of the cortex would change, and (2) a collared implant would be associated with smaller changes than a collarless design. Unilateral total hip arthroplasty was performed in 15 mixed-breed dogs. Nine received a collared and six received a collarless femoral component. Four months after implantation, longitudinal ultrasonic wave propagation velocities and bone mineral densities (from dual energy X-ray absorptiometry) were measured in harvested femora and used to calculate the axial elastic constitutive coefficients for the cortex surrounding the implants. Results showed no difference in bone elasticity or bone density between collared and collarless designs. Significant velocity decreases from control values (p < 0.0001) were noted in all implanted femora at four months. Bone mineral densities also displayed decreased values after four months of implantation (p < 0.0145). Elastic coefficients were consistently less after four months of implantation when compared to control values (p < 0.0001). This alteration in material properties would affect load transfer into the implanted femur via the increased disparity between implant and bone stiffnesses regardless of the component design. Significant differences in the elastic coefficients between implanted and control femora support hypothesis 1. However, no group differences were found between collared and collarless implantations; thus, the study does not support hypothesis 2.
Journal of Biomechanics 02/1994; 27(2):137-44. · 2.43 Impact Factor
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ABSTRACT: A canine hip replacement model was used to compare fixation stability in cemented and cementless femoral components. Parameters of comparison were the load-induced positional changes of each prosthesis relative to its proximal femoral cortex, hereafter called relative displacements. Identical femoral components, with the proximal third of their stem porous-coated, were implanted in the right femurs of 10 large, mixed-breed dogs. Five were tightly fit to allow porous ingrowth, and five were cemented into the medullary canal. Four months after implantation, all femurs were harvested. A prosthesis was implanted in the left (normal) femur of each dog ex vivo with fixation identical to the contralateral limb to simulate acute postoperative fixation. Eddy current transducers measured relative displacements under application of static loads, serially applied in the axial, mediolateral, and craniocaudal directions. Thereafter, the femurs were transversely sectioned and morphologically analyzed to correlate bony apposition at the implant surface with relative displacements. We observed no difference in relative displacements between acute and 4-month-cemented groups (e.g., 0.0059 +/- 0.0021 vs. 0.0060 +/- 0.0048 mm, respectively, for 100-N axial loading measured at midstem). With cementless implantation, relative displacements of the acute group were significantly larger (p = 0.007) than those of the 4-month group (e.g., 0.236 +/- 0.257 vs. 0.097 +/- 0.129 mm, respectively, for 100-N axial loading measured at midstem). Cementless components implanted for 4 months were not significantly different than cemented components, but a trend suggested that they were still not as stable as cemented components, particularly for craniocaudal loads. Relative displacements of the 4-month, porous ingrowth group were approximately proportional to the percentage of bony apposition raised to the -1.44 power (r = 0.94).
Journal of Orthopaedic Research 04/1992; 10(2):300-9. · 2.81 Impact Factor
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ABSTRACT: A flexed dorsoplantar radiographic view of the talocrural joint was a useful additional view to diagnose abnormalities of the lateral trochlear ridge of the talus of 2 dogs. This view outlined the subchondral bone of both trochlear ridges of the talus and the apposing cochlea tibiae of the distal portion of the tibia. The tarsus was flexed at the level of the talocrural joint, and an x-ray beam was centered on the joint. With this additional view, fractures of the lateral trochlear ridge were readily diagnosed. This view would help to demonstrate osteochondral lesions of the lateral trochlear ridge.
Journal of the American Veterinary Medical Association 10/1991; 199(5):598-600. · 1.79 Impact Factor
