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2.
Clinically healthy reptiles may shed Salmonella and therefore act as a potential zoonotic threat. Most people in Northern European countries are rarely exposed to reptiles, but many zoos have education departments where children have direct contact with this group of animals. The objectives of this study were to determine the prevalence and serotype distribution of Salmonella among reptiles in the Education Department (n = 55) at Copenhagen Zoo and compare it to the Zoo’s main reptile collection (n = 145) to evaluate the zoonotic risk. Salmonella was isolated from cloacal swabs by selective enrichment, and a single isolate from each positive sample was further identified by biochemical tests and serotyped. The overall prevalence was 35% (69/200) with significant difference between the Education Department (64%, 35/55) and the main reptile collection (23%, 34/145). A total of 28 serotypes were detected. Ten serotypes were isolated from more than one specimen and four from more than one species. Salmonella enterica subsp. enterica serovar Eastbourne was the predominant serotype (32%, 22/69) and was also the serotype isolated from most reptile species (n = 7). Transmission of serotypes from one department to another was very limited indicated by the serotype distribution. Despite the relative high prevalence observed among the reptiles in the Zoo’s Education Department compared to the reptiles in the Zoo’s main reptile collection, no Salmonella cases have been linked to the Zoo, and Salmonella ser. Eastbourne is very rarely isolated from humans in Denmark. Simple hygienic procedures such as hand washing which is consistently carried out following handling of reptiles at the Education Department may reduce the risk and therefore contribute to this low prevalence.  相似文献   

3.
Background: In reptile medicine, plasma chemistry analysis is widely used for the evaluation of an individual's health status. The standard method for the determination of plasma albumin concentration is protein electrophoresis combined with the determination of total protein concentration, but the bromcresol green (BCG) dye‐binding method is also used. The reliability of the BCG method for the measurement of albumin concentration in reptiles is unknown. Objective: The aim of this study was to compare the plasma albumin values of turtles obtained by protein electrophoresis and the BCG method. Methods: Between March 2008 and September 2008, heparinized plasma samples from 16 clinically healthy and 10 diseased turtles of different species were collected. Plasma albumin concentrations were measured by protein electrophoresis and by the BCG method. The results of the 2 methods were compared using Passing–Bablok regression and Bland–Altman plots. Results: Albumin concentration measured by BCG was weakly correlated with the corresponding protein electrophoretic values in all turtles (rs=.610, P<.001) and in healthy turtles evaluated separately (rs=.700, P=.003), whereas in diseased turtles no such correlation was found (rs=.374, P=.287). The albumin concentration measured with the 2 different methods differed significantly in all turtles (P=.009; Wilcoxon's test) and in healthy turtles (P=.005) but not in diseased animals (P=.241). In the Bland–Altman plot a systematic error was found between the 2 methods in diseased turtles. Conclusion: Measurement of albumin by the BCG dye‐binding method may lead to inaccurate results for plasma albumin concentration, especially in ill turtles. Therefore, for health assessment in turtles, albumin should be measured by protein electrophoresis.  相似文献   

4.
Reptile‐associated salmonellosis (RAS) occurs when Salmonella is transmitted from a reptile to a human. This study describes the epidemiology of RAS in Minnesota during 1996–2011. All Minnesotans with confirmed Salmonella infections are reported to the Minnesota Department of Health (MDH). Case patients are interviewed about illness characteristics and risk factors, including foods eaten, drinking and recreational water exposures, contact with ill people, and animal contact. Willing RAS case patients can submit stool from the reptile for culture. Serotype and pulsed‐field gel electrophoresis (PFGE) subtype of Salmonella isolates from reptiles and case patients are compared. Of 8389 sporadic (not associated with an outbreak) non‐typhoidal salmonellosis case patients in Minnesotans during 1996–2011, 290 (3.5%) reported reptile exposure. The median age of case patients with reptile exposure was 11 years, 31% were under the age of 5 years and 67% were under the age of 20 years; 50% were female. The median illness duration was 8 days; 23% required hospitalization. The most commonly reported reptile exposures were lizard (47%), snake (20%), turtle (19%) and a combination of reptile types (14%). Eighty‐four per cent of isolates from case patients who reported reptile exposure were Salmonella enterica subspecies I. The three most common serotypes were Typhimurium (15%), Enteritidis (7%) and subspecies IV serotypes (7%). Of 60 reptiles testing positive for Salmonella, 36 (60%) yielded the same Salmonella serotype as the human isolate. Twenty‐six of 27 reptile isolates that were subtyped by PFGE were indistinguishable from the human isolate. Of these, 88% were subspecies I; the most common serotypes were Enteritidis (12%), Typhimurium (8%), and Bareilly (8%). RAS accounts for approximately 3.5% of salmonellosis cases in Minnesota, primarily affecting children. The majority of isolates from case patients and reptiles belonged to Salmonella subspecies I, suggesting that reptiles are a source of human infection with serotypes not traditionally considered to be reptile‐associated.  相似文献   

5.
Background: The Gila monster (Heloderma suspectum), one of several venomous lizard species in the world, is found within the United States and Mexico and is recognized as an iconic symbol of the American Southwest. Thus, Gila monsters are of growing interest in the captive reptile trade and within zoological and educational institutions. Objectives: The aims of this study were to determine results for CBCs, describe cytochemical reactions in WBCs, and obtain plasma biochemical and protein electrophoresis results from wild‐caught and captive‐bred H. suspectum. Methods: Ventral tail vein blood samples were obtained from 16 captive (14 wild‐caught and 2 captive‐bred) Gila monsters. CBCs, RBC morphometric analysis, plasma biochemical analysis, and protein electrophoresis were performed. Leukocytes were stained for peroxidase, Sudan black B (SBB), chloroacetate esterase, napthyl butyrate esterase, and leukocyte alkaline phosphatase, and blood smears were examined for the presence of hemoparasites. Results: The median (range) PCV was 37% (22–50%) and WBC count was 4.6 × 103/μL (3.3–6.4 × 103/μL) with approximately 50% heterophils and fewer lymphocytes, basophils, azurophils, and monocytes in decreasing order. Cytochemical reactions were unique among reptiles with strong staining for peroxidase and SBB in monocytes/azurophils. Biochemical results were similar to those of earlier reports with slight increases in uric acid and urea concentrations. Plasma electrophoretic results indicated that albumin was approximately equal to the combined globulin fractions. Conclusions: Results of blood analysis in healthy wild‐caught and captive‐bred H. suspectum may be useful for monitoring health status in this species.  相似文献   

6.
The standard of today's reptile practice calls on clinicians to use an ever-increasing array of diagnostic tools to gather information and obtain a definitive diagnosis. Few, if any, pathognomonic signs exist for reptile diseases, and for most clinical syndromes there is a lack of information regarding pathophysiology for one to define standard therapeutic protocols based solely on clinical signs without objective diagnostic information. For example, in the relatively distant past, clinicians treating reptile patients would routinely administer parenteral calcium to green iguanas (Iguana iguana) with the primary presenting clinical sign of muscle tremors. Today, veterinarians who treat reptiles recognize that the risk of soft tissue mineralization and permanent damage to arteries, renal tubules, and other tissues usually outweighs the potential short-term benefit of calcium therapy. Before calcium therapy is initiated, it is best to know the patient's ionized calcium concentration to reduce the risk of potential adverse therapeutic side effects. A problem-oriented diagnostic approach directed toward minimizing risk and maximizing therapeutic benefit is now the standard of reptile practice.  相似文献   

7.

Background

Exotic reptiles have become increasingly common domestic pets worldwide and are well known to be carriers of different parasites including some with zoonotic potential. The need of accurate diagnosis of gastrointestinal endoparasite infections in domestic reptiles is therefore essential, not only for the well-being of captive reptiles but also for the owners. Here, two different approaches for the detection of parasite stages in reptile faeces were compared: a combination of native and iodine stained direct smears together with a flotation technique (CNF) versus the standard SAF-method.

Results

A total of 59 different reptile faeces (20 lizards, 22 snakes, 17 tortoises) were coprologically analyzed by the two methods for the presence of endoparasites. Analyzed reptile faecal samples contained a broad spectrum of parasites (total occurence 93.2%, n = 55) including different species of nematodes (55.9%, n = 33), trematodes (15.3%, n = 9), pentastomids (3.4%, n = 2) and protozoans (47.5%, n = 28). Associations between the performances of both methods to detect selected single parasite stages or groups of such were evaluated by Fisher''s exact test and marginal homogeneity was tested by the McNemar test. In 88.1% of all examined samples (n = 52, 95% confidence interval [CI] = 77.1 - 95.1%) the two diagnostic methods rendered differing results, and the McNemar test for paired observations showed highly significant differences of the detection frequency (P < 0.0001).

Conclusion

The combination of direct smears/flotation proved superior in the detection of flagellates trophozoites, coccidian oocysts and nematode eggs, especially those of oxyurids. SAF-technique was superior in detecting larval stages and trematode eggs, but this advantage failed to be statistically significant (P = 0.13). Therefore, CNF is the recommended method for routine faecal examination of captive reptiles while the SAF-technique is advisable as additional measure particularly for wild caught animals and individuals which are to be introduced into captive collections.  相似文献   

8.
ObjectivesTo describe characteristics of echocardiography and cranial coelomic radiography in a cohort of iguanas.AnimalsTwenty apparently healthy adult green iguanas (Iguana iguana) from a reptile sanctuary.MethodsPhysical examination, radiography, two-dimensional and color Doppler echocardiography were performed to assess cardiac structures and function, and any related normal or abnormal findings were recorded.ResultsEchocardiographic examination was possible without sedation and allowed visualization of the great vessels, atria, and ventricle. Some structures could not be evaluated in a minority of the iguanas due to individual differences in bony conformation and imaging quality. Suspected abnormal echocardiographic findings in 3 iguanas included pericardial effusion (n = 1) and enlarged caudal vena cava and/or sinus venosus (n = 2). Objective measurements were repeatable as assessed by within-subject coefficient of variation, and reliable as assessed by intra-observer intraclass correlation coefficient. Left atrial and ventricular measurements were significantly correlated with body weight. Valve regurgitation was common, with atrioventricular valve regurgitation present in 53% (9/17) and aortic or pulmonic valve regurgitation in 71% (12/17) of otherwise normal iguanas. A heart murmur was not appreciated during examination of any of the iguanas. Heart size cannot be measured radiographically due to superimposition and silhouetting of other coelomic structures. Echocardiographic or radiographic findings consistent with mineralization of the great vessels were present in 76% of iguanas (13/17).ConclusionsEchocardiography in iguanas is well tolerated without sedation and allowed both subjective evaluation and structural measurements. Valve regurgitation and great vessel mineralization were commonly observed in this cohort of apparently healthy adult iguanas.  相似文献   

9.
Background: In routine canine medicine, anticoagulated blood is often the only sample sent to laboratories for diagnostic purposes. This hampers the interpretation of protein electrophoretic tracings because plasma contains fibrinogen, which migrates in the β–γ region. In human medicine, fibrinogen can be precipitated from plasma using ethanol. Objectives: The purpose of this study was to assess ethanol precipitation as a method for removing fibrinogen from canine plasma so as to facilitate the interpretation of electorphoresis results. Methods: Blood samples collected from 40 dogs were divided into plain tubes and tubes containing EDTA (n=20) or lithium–heparin (n=20). An aliquot of plasma from each sample was incubated with ethanol at a final concentration of 100 mL/L. Cellulose acetate electrophoresis was then performed on serum, plasma, and plasma treated with ethanol. To verify the efficiency of ethanol treatment, fibrinogen was added to 5 canine serum samples at final concentrations of 2.5, 5.0, and 10.0 g/L, and electrophoresis was performed before and after ethanol treatment. Results: Visual analysis of electrophoretograms from ethanol‐treated samples confirmed the disappearance of the fibrinogen peak from the β2‐globulin region. Treatment with ethanol caused a significant decrease in the percentage of β2‐globulins and a significant increase in the percentage of α2‐globulins. Absolute values of most electrophoretic fractions were significantly decreased in ethanol‐treated plasma compared with serum. Conclusions: Ethanol treatment successfully removed fibrinogen from canine plasma and normalized electrophoretic profiles, but probably also precipitated proteins other than fibrinogen. Ethanol treatment is recommended to facilitate visual identification of abnormal monoclonal peaks, but not for determining absolute protein concentrations in electrophoretic fractions.  相似文献   

10.
BACKGROUND: Serum protein analysis in both humans and experimental animal species has so far been carried out by labor-intensive techniques, such as agarose gel electrophoresis (AGE). OBJECTIVE: The objective of this study was to evaluate capillary electrophoresis (CE) as an alternative technique to AGE for the analysis of serum proteins from healthy animals. METHODS: Blood samples were collected into tubes without anticoagulant from 6 fasted healthy male mice, rats, dogs, marmosets, and humans. Serum proteins were separated by CE using a technique standardized for the analysis of human proteins, and the results (efficiency, resolution, and precision) were compared with those obtained through AGE. RESULTS: Compared with AGE, CE resulted in narrower peaks and more peaks. The efficiency of protein separation by CE was significantly higher for all species, and resolution (R) was significantly higher in samples from dogs. Using rat serum, intraday reproducibility was lower for all protein fractions, and interday reproducibility was lower for most peaks, compared with AGE. CONCLUSIONS: We conclude that CE is a viable alternative to AGE for the determination of protein electrophoresis in a routine veterinary clinical pathology laboratory. The minimal sample requirement (2 microL), complete automation, and quantitative results make CE an especially valuable technique for protein analysis in experimental animal models.  相似文献   

11.
While most human Salmonella infections result from exposure to contaminated foods, an estimated 11% of all Salmonella infections are attributed to animal exposures, including both direct animal handling and indirect exposures such as cleaning cages and handling contaminated pet food. This report describes the epidemiologic, environmental and laboratory investigations conducted in the United States as part of the response to an international outbreak of tetracycline‐resistant Salmonella enterica serotype I 4,[5],12:i:‐ infections with over 500 illnesses occurring from 2008 to 2010. This investigation found that illness due to the outbreak strain was significantly associated with exposure to pet reptiles and frozen feeder rodents used as food for pet reptiles. Salmonella isolates indistinguishable from the outbreak strain were isolated from a frozen feeder mice‐fed reptile owned by a case patient, as well as from frozen feeder mice and environmental samples collected from a rodent producing facility (Company A). An international voluntary recall of all Company A produced frozen feeder animals sold between May 2009 and July 2010 occurred. Only 13% of cases in our investigation were aware of the association between Salmonella infection and mice or rats. Consumers, the pet industry, healthcare providers and veterinarians need to be aware of the potential health risk posed by feeder rodents, whether live or frozen. Frozen feeder rodent producers, suppliers and distributors should follow the animal food labelling requirements as described in 21 CFR §501.5, and all packages of frozen feeder rodents should include safe handling instructions. Persons should wash their hands thoroughly with soap and water after handling live or frozen feeder rodents, as well as reptiles or anything in the area where the animals live. Continued opportunities exist for public health officials, the pet industry, veterinarians and consumers to work together to prevent salmonellosis associated with pet food, pets and other animals.  相似文献   

12.
Background: Genetic background can influence the expected values of hematologic and serum biochemical analytes in domestic animal species. Objective: The purpose of this study was to determine if there are breed‐related differences in serum biochemical variables in healthy purebred dogs of 4 breeds and to develop appropriate reference intervals. Methods: Alaskan Malamutes (n=59), Siberian Huskies (n=78), Golden Retrievers (n=90), and English Setters (n=77) were included in the study. The dogs had a median age of 42 months (range 10–112 months) and each breed included a mix of intact and neutered dogs of both sexes. Serum biochemical profiles (Olympus AU400e) were performed along with physical examinations, CBCs, and urinalyses to ensure dogs were clinically healthy. Differences in the values of biochemical analytes were assessed nonparametrically and reference intervals for all breeds combined were calculated as the central 95% percentile. Results: Significant differences were observed between breeds for all serum biochemical analytes except alkaline phosphatase, glucose, and chloride. The analyte ranges had a large degree of overlap between the different breeds. Conclusions: Although many statistically significant breed‐related differences in serum biochemical values were observed, the differences were small and unlikely to have clinical relevance or impact medical decision making.  相似文献   

13.
Pseudomonas aeruginosa represents an opportunistic pathogen for animals and humans that is often associated with high disease morbidity and, at times, mortality. Captive reptiles have been shown to be reservoirs of P. aeruginosa strains that can be sources of exposure to humans that come in contact with these animals. In this study, the prevalence of P. aeruginosa among subclinical captive reptile species and the antimicrobial sensitivity of bacterial isolates were investigated. Sixty-five oral swabs were collected from captive reptiles belonging to 15 different species in which no overt signs of disease were evident. From this group of animals, 46 (70.8%) isolates were identified as P. aeruginosa. All of the P. aeruginosa strains were shown to have a wide range of antibiotic resistance. At present, there is a paucity of data regarding the prevalence of P. aeruginosa in various reptile species; therefore, continued scientific investigations are indicated to determine the significance of P. aeruginosa infection as it relates to captive reptile species.  相似文献   

14.
Manatees (Trichechus manatus latirostris) are afflicted with inflammatory and infectious disease secondary to human interaction, such as boat strike and entanglement, as well as "cold stress syndrome" and pneumonia. White-blood-cell count and fever, primary indicators of systemic inflammation in most species, are insensitive in diagnosing inflammatory disease in manatees. Acute phase-response proteins, such as haptoglobin and serum amyloid A, have proven to be sensitive measures of inflammation/infection in domestic large animal species. This study assessed diagnosis of generalized inflammatory disease by different methods including total white-blood-cell count, albumin: globulin ratio, gel electrophoresis analysis, C-reactive protein, alpha, acid glycoprotein, haptoglobin, fibrinogen, and serum amyloid A. Samples were collected from 71 apparently healthy and 27 diseased animals during diagnostic medical examination. Serum amyloid A, measured by ELISA, followed by albumin:globulin ratio, measured by plasma gel electrophoresis, were most sensitive in diagnosing inflammatory disease, with diagnostic sensitivity and specificity of approximately 90%. The reference interval for serum amyloid A is <10-50 microg/ml with an equivocal interval of 51-70 microg/ml. The reference interval for albumin:globulin ratio by plasma gel electrophoresis is 0.7-1.1. Albumin: globulin ratio, calculated using biochemical techniques, was not accurate due to overestimation of albumin by bromcresol green dye-binding methodology. Albumin:globulin ratio, measured by serum gel electrophoresis, has a low sensitivity of 15% due to the lack of fibrinogen in the sample. Haptoglobin, measured by hemoglobin titration, had a reference interval of 0.4-2.4 mg/ml, a diagnostic sensitivity of 60%, and a diagnostic specificity of 93%. The haptoglobin assay is significantly affected by hemolysis. Fibrinogen, measured by heat precipitation, has a reference interval of 100-400 mg/dl, a diagnostic sensitivity of 40%, and a diagnostic specificity of 95%.  相似文献   

15.
Gammopathies associated with plasma cell neoplasms in a 15-year-old female spayed domestic shorthaired cat and a 9-year-old female spayed Rottweiler dog were evaluated by serum protein electrophoresis. In the cat, the plasma cell neoplasm was found in the liver and spleen, and an evaluable sample of bone marrow was not obtained. Some of the plasma cells had the morphologic appearance of flame cells. The paraprotein was confirmed as IgG based on agar gel immunodiffusion precipitation and both immunocytochemical and immunohistochemical staining. The dog had multiple myeloma with production of IgG and IgA paraproteins. In both cases, serum proteins were evaluated by 2 methods of protein electrophoresis: cellulose acetate electrophoresis (CAE) and capillary zone electrophoresis (CZE). In the cat and the dog, CAE showed a single large oligoclonal-like peak, which occurred in the γ-region in the cat and the β-γ-region in the dog, whereas CZE showed a biclonal gammopathy with 2 very close narrow spikes in the γ- and β-γ-regions in the cat and dog, respectively. In selected cases, CZE may be more effective than routine CAE in distinguishing oligoclonal from monoclonal or biclonal paraproteinemia.  相似文献   

16.
The green iguana, Iguana iguana, is used as a model in reptile anesthesia research because of its size, availability, and the body of knowledge characterizing its physiology. Arterial blood gas values in nonanesthetized green iguanas have not been determined because of the technical difficulty involved. Vascular access port (VAP) placement to facilitate blood sampling has been described in other species, but not lacertilians. This abstract describes the technique for placement of VAPs and the values for arterial blood gas parameters in seven 1 kg adult green iguanas. Using sterile technique, a 1.5 cm incision was made on the lateral side of the neck. Blunt dissection ventral to the external jugular vein revealed the internal and external carotid arteries near their bifurcation. The catheter was inserted into the internal carotid artery and then guided to the common carotid artery. The other end of the catheter was tunneled below the skin to a subcutaneous location, caudal‐dorsal to the iSPSilateral scapula. The skin was closed and the port was flushed twice a week with heparinized saline. Post‐operatively, the VAPs were well tolerated by the iguanas. Difficulties included port disconnection (n = 1), inability to aspirate blood after a few weeks (n = 2), and infection (n = 1). The iguanas were breathing room air prior to and during blood collection. From the five functional VAPs, the blood pH, PCO2, PO2, HCO‐3, and BE (measured at 37 °C) were 7.45 ± 0.06; 37.5 ± 7.0 mm Hg, 99.0 ±16.6 mm Hg, 25.4 ± 2.5 mmol L–1, and 1.5 ±2.4 mmol L–1 respectively (mean ± SD). VAPs can be successfully used to facilitate collection of arterial blood gas samples in green iguanas. These values are similar to those reported for most mammalian species. This technique should facilitate research in anesthesiology and respiratory physiology of iguanas and other lacertilians.  相似文献   

17.
Problem-oriented reptile medicine is an explicit, definable process focused on the identification and resolution of a patient's problems. This approach includes gathering case information, clearly defining the problems, making plans to address each problem, and following up with the case over time. Case information and published literature serve as evidence to support clinical decisions and pathophysiological rationale. This article describes the problem-solving process used to diagnose and treat a green iguana (Iguana iguana) that presents with ovostasis.  相似文献   

18.
Anemia is a relatively common blood disorder but a seemingly underreported and investigated condition in reptiles. Better characterization of anemia in the sick reptile could help determine which available diagnostic tools could be best utilized to determine the cause of low red blood cell counts in these animals. There are, however, a number of limitations that exist when trying to interpret hematologic data for the large number of reptilian species presented to the exotic animal practitioner, including interspecific and intraspecific variation in hematological reference values, limited availability to specific reagents, and a lack of scientific-based studies that focus on anemic conditions in reptiles. Therefore, better documentation and consistency in the scientific-based studies of reptile anemia and rapid dissemination of this information are considered necessary to increase our knowledge in this area of reptile medicine. Collaborative research efforts between practitioners, owners, reptile collection curators, pathologists, immunologists, microbiologists, toxicologists, and laboratory scientists are urgently needed to augment our understanding of anemia and other hematological disorders in reptiles.  相似文献   

19.
To testify the relevance of Jacobsson's equation for estimating bovine glomerular filtration rate (GFR), we prepared an integrated formula based on its equation using clinically healthy dairy (n = 99) and beef (n = 63) cows, and cows with reduced renal function (n = 15). The isotonic, nonionic, contrast medium iodixanol was utilized as a test tracer. The GFR values estimated from the integrated formula were well consistent with those from the standard multisample method in each cow strain, and the Holstein equation prepared by a single blood sample in Holstein dairy cows. The basal reference GFR value in healthy dairy cows was significantly higher than that in healthy beef cows, presumably due to a breed difference or physiological state difference. It is concluded that the validity for the application of Jacobsson's equation to estimate bovine GFR is proven and it can be used in bovine practices.  相似文献   

20.
Background: Guinea pigs (Cavia porcellus) are often presented as patients in veterinary practice. Nevertheless, only limited information is available about endocrine diseases or thyroxine reference values for the species. Objective: The aim of this study was to determine serum thyroxine concentrations in a well‐defined population of clinically healthy pet guinea pigs. Methods: Between October 2007 and July 2008, serum samples were collected from 40 clinically healthy guinea pigs of different sexes, ages, and breeds that were presented to our clinic for a general health check or for castration. Pregnant females were excluded from the study. Thyroxine concentration was measured using a chemiluminescence test (Immulite 2000 Canine Total T4). Results: Thyroxine concentrations ranged from 14.2 to 66.9 nmol/L (1.1–5.2 μg/dL) with a median value of 27.0 nmol/L (2.1 μg/dL). Females (n=16) had significantly (P=.039; Mann–Whitney U‐test) lower thyroxine values than castrated males (n=8), whereas no differences were found between females and intact males (n=16) or between intact and castrated males. No significant correlation was found between thyroxine concentration and age. Conclusion: This is the first report of serum thyroxine reference values for a well‐defined population of healthy pet guinea pigs as measured by a chemiluminescence assay. The results were higher than those previously reported for this species and emphasize the importance of using appropriate reference intervals for the diagnosis of hyperthyroidism.  相似文献   

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