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1.
OBJECTIVE: To compare the findings of light microscopic evaluation of routine unstained wet-mounted preparations and air-dried, modified Wright-stained preparations of urine sediment with results of quantitative aerobic bacteriologic culture of urine. DESIGN: Masked prospective study. SAMPLE POPULATION: 459 urine samples collected by cystocentesis from 441 dogs. PROCEDURE: Urinalyses and quantitative bacteriologic cultures of urine were performed. Unstained wet-mounted preparations and air-dried, modified Wright-stained urine sediment preparations were examined by light microscopy for the presence of bacteria. RESULTS: Compared with results of quantitative bacteriologic culture, routine unstained preparations and modified Wright-stained preparations had sensitivities of 82.4% and 93.2%, specificities of 76.4% and 99.0%, positive predictive values of 40.1% and 94.5%, negative predictive values of 95.8% and 98.7%, and test efficiencies of 77.3% and 98.0%, respectively. Compared with 74 samples that yielded growth on bacteriologic culture, the routine unstained method had concordance and misclassification rates of 39.2% and 60.8%, respectively, whereas the Wright-stained method had concordance and misclassification rates of 78.4% and 21.6%, respectively. Significant associations between each of occult blood in urine, pyuria, female sex, and lower urine specific gravity with bacteriuria detected by Wright-stained sediment examination and quantitative bacteriologic culture of urine were identified. CONCLUSIONS AND CLINICAL RELEVANCE: Examination of modified Wright-stained preparations of urine sediment appeared to be a rapid, cost effective method that significantly improved the sensitivity, specificity, positive predictive value, and test efficiency of light microscopic detection of bacteriuria, compared with that of the routine unstained method.  相似文献   

2.
Background: Urinary sediment examination and quantitative urinary culture results are frequently discordant. Objectives: The aims of this study were to compare accuracy of light microscopic examination of wet‐mounted unstained (wet‐unstained) and air‐dried modified Wright‐stained (dry‐stained) sedimented preparations of urine with results of quantitative aerobic bacterial culture for detection and characterization of bacteriuria in cats. In addition, the presence of pyuria detected by urinalysis and potential risk factors were assessed. Methods: A blinded prospective study was conducted on 472 urinary samples collected from 410 cats by cystocentesis. The age and sex of each cat were recorded. Complete urinalyses were performed and included quantification of WBCs. Quantity and morphology of bacteria in each specimen were determined by light microscopic examination of wet‐unstained (performed by certified medical technologists) and dry‐stained (performed by a veterinary clinical pathologist) sedimented preparations of urine and compared with results of quantitative bacterial cultures. Results: Of 472 urinary specimens, 29 were positive for bacteriuria by culture and considered true positives and 443 were considered true negatives. Compared with these results, examination of wet‐unstained and dry‐stained urines had sensitivities of 75.9% and 82.8%, specificities of 56.7% and 98.7%, and test efficiencies of 57.8% and 97.7%, respectively. Positive likelihood ratios were 1.8 and 63.7 and negative likelihood ratios were 0.42 and 0.17 for wet‐unstained and dry‐stained examinations, respectively. Compared with 29 culture‐positive samples, the wet‐unstained method had morphologic concordance and misclassification rates of 37.9% and 62.1%, respectively, whereas the dry‐stained method had morphologic concordance and misclassification rates of 65.5% and 34.5%, respectively. Only 34% of samples with bacteriuria had pyuria. Frequency of bacteriuria was not significantly different based on age and sex of the cats, but there was a tendency for increased frequency in female cats and in cats >10 years old. Conclusions: Staining dried urinary sediment with a modified Wright‐stain significantly improved sensitivity, specificity, and test efficiency of microscopic detection and classification of bacteriuria compared with the wet‐unstained method. Pyuria should not be a criterion for determining the presence or absence of bacteriuria.  相似文献   

3.
This study assessed the standard urinalysis technique and sediment stain techniques as predictors of bacterial culture results for canine and feline urine. Canine (n = 111) and feline (n = 79) urine samples were evaluated using unstained wet-mount and air-dried Gram and Wright-Giemsa stained sediment; results were compared to aerobic bacterial culture. Eleven canine and 7 feline urine samples were culture positive. Unstained wet-mount and stained sediment had sensitivities of 89% and 83% and specificities of 91% and 99%, respectively. The specificity of using either stain was higher (P < 0.01) than wet-mount examination for detecting bacteriuria. There were significant differences among 3 technologists in detecting true positives (P < 0.01). Association of sediment and culture results used 112 canine and 81 feline samples. There was a negative association (P < 0.01) between lipid detection and wet-mount identification of bacteria.  相似文献   

4.
Commercial macroscopic test-strips (dipsticks) that indirectly detect urine leukocytes by quantifying leukocyte esterase (LE) activity have been advocated as a simple, rapid, and inexpensive alternative to microscopic examination for detection of significant pyuria in urine specimens. The purpose of this study was to evaluate the diagnostic performance of a commercial LE test-strip for detection of feline pyuria. Two hundred and thirteen consecutive urine specimens were collected from 188 different feline patients and analyzed for LE activity with a LE test-strip (Multistix 2 Reagent Strips:Ames Division, Bayer Corp., Elkhart, IN). Results of the LE test-strip were compared with those of standard urine biochemical and microscopic sediment evaluations. Compared with urine sediment leukocyte counts, the LE test-strip had a sensitivity of 77%, a specificity of 34%, positive and negative predictive values of 14 and 91 % respectively, and an overall test efficiency of 39%. Multivariable logistic regression analysis did not reveal significant associations between pyuria (>5 WBC/hpf) and a positive LE test- strip reaction; however, hematuria, lipiduria, increasing age, and decreasing urine specific gravity were associated with a significantly increased risk for positive LE test-strip reactions. We conclude that the LE test-strip evaluated in this study is highly nonspecific for detection of significant pyuria in feline urine specimens and should not replace routine microscopic urine sediment examination in this species.  相似文献   

5.
Background – Few studies have investigated the frequency of urinary tract infection (UTI) in dogs receiving long‐term ciclosporin therapy. Hypothesis/Objectives – The goal of the study was to investigate the frequency of UTI in dogs receiving ciclosporin with or without glucocorticoids. A secondary goal was to determine whether bacteriuria, pyuria and urine specific gravity were good predictors of UTI, and if ciclosporin dose, concurrent ketoconazole therapy, sex or duration of therapy affected the frequency of UTI. Animals – Eighty‐seven dogs with various inflammatory skin disorders and 59 control dogs with inflammatory skin conditions that had not received glucocorticoids or ciclosporin for 6 months were enrolled. Methods – This study was retrospective. The first urine culture from dogs receiving ciclosporin was compared with control dogs using Fisher’s exact test. A logistic mixed model was used to test for association between a positive bacterial culture and duration of treatment, dose of ciclosporin, concurrent ketoconazole therapy and sex. The sensitivities and specificities for bacteriuria, pyuria and urine specific gravity were determined. Results – Twenty‐six of 87 (30%) ciclosporin‐treated dogs had at least one positive culture. Compared with 3% positive control samples, 15% were positive in treated dogs (P = 0.027). The sensitivity and specificity were, respectively, 64.1 and 98.1% for bacteriuria, 74.4 and 70.9% for pyuria, and 56.4 and 65.3% for urine specific gravity. All other analysed parameters were not significantly different. Conclusions and clinical importance – The results suggest that routine urine cultures and assessment of bacteriuria by cystocentesis should be part of the monitoring for dogs on long‐term ciclosporin with and without glucocorticoids.  相似文献   

6.
Knowledge of the occurrence of bacteriuria in adult, healthy cats is scarce in the scientific literature. A study was designed to investigate the occurrence of bacteriuria in healthy cats without current or previous signs of lower urinary tract disease. The study included 108 cats, 53 males (49.5%) and 55 females (50.5%). The cats ranged in age between 7 months and 18 years, with a mean age of 4.4 years and a median age of 4.0 years. Urine was obtained by cystocentesis from all the cats, and was submitted for bacteriological analyses. Urine and urine sediment was cultured on separate blood agar plates for quantification and species identification by standard procedures. Detection of ≥10(3)colony forming units (cfu) per ml urine was defined as significant bacteriuria. Significant bacteriuria exceeding 10(5) cfu/ml was detected in one sample with a combination of Enterococcus species and Staphylococcus species. There was no bacterial growth in the urine samples from 107 cats (99.1%). Results from our study indicate that the prevalence of bacteriuria in clinically healthy, adult cats is low. Also, that contamination of samples is rare when urine is collected by cystocentesis.  相似文献   

7.
A commercially available leukocyte esterase assay was evaluated for application in analyzing canine urine for the detection of pyuria. In 229 urine samples, the leukocyte esterase activity was compared with leukocyte concentrations, as assessed by microscopic sediment analysis and chamber cell counts. The leukocyte esterase assay was specific (93.2%) for canine pyuria, but was poorly sensitive (46.0%) and did not appear to be applicable to analysis of canine urine samples.  相似文献   

8.
Background: Urinary tract infections (UTIs) may be subclinical or difficult to detect in dilute urine as sediment abnormalities may not be observed. In our laboratory, bacterial culture is automatically performed (reflex culture) on samples with urine specific gravity (USG)≤1.013 to increase the likelihood of detecting infection. The value of routine culture of dilute urine, however, has not been fully assessed. Objective: The purpose of this retrospective study was to evaluate the frequency of positive bacterial cultures and analyze the diagnostic utility and cost‐effectiveness of culture compared with routine sediment examination for detecting UTI in dilute urine specimens from dogs. Methods: Urinalysis and concurrent aerobic bacterial culture results were obtained from the electronic medical record system at the University of California–Davis Veterinary Medical Teaching Hospital for samples with USG≤1.013 analyzed from July 1998 through January 2005. Urine collection method, presence of leukocytes and bacteria, bacterial culture results, and clinical diagnosis were recorded. Cost‐effectiveness of reflex culture, based on low USG as the sole criterion, was evaluated. Results: Of 1264 urine specimens, 106 (8.4%) had positive bacterial cultures. Using culture as the gold standard, sediment evaluation had a diagnostic sensitivity of 58.5% and specificity of 98.3% (diagnostic accuracy 94.9%). An additional cost of $60 per patient was incurred, leading to average annual costs of $11,668 for reflex bacterial cultures of all samples with low USG, regardless of collection method. Within our study population, 10 urine samples needed to be cultured for each true positive result. Conclusions: The sensitivity of urine sediment evaluation is low for UTI in dilute urine samples; however, reflex bacterial culture does not appear to be cost‐effective in dogs with USG≤1.013 in the absence of active urine sediment or high clinical suspicion for UTI.  相似文献   

9.
Objective : To identify the optimal method of submission of canine and feline urine for bacterial culture. Methods : Cystocentesis samples from 250 animals (200 dogs, 50 cats) suspected of having urinary tract infections were collected. The reference aliquot, without preservative, was processed on site within 2 hours. Two further aliquots (one without preservative, one with boric acid) were stored at room temperature for up to 7 hours and then posted by guaranteed next day delivery to a commercial laboratory for analysis. Results : Forty‐seven of the samples were positive on culture in the reference test. There was no significant difference between reference test results and those of samples posted without preservative (P=0·39), but samples posted in boric acid were significantly less likely to give a positive result (P=0·01). Samples posted without preservative had a sensitivity of 82% and a specificity of 98%; for boric acid, sensitivity was 73% and specificity 99%. Clinical Significance : Postal urine samples should be submitted to the laboratory in a plain sterile tube.  相似文献   

10.
Feline lower urinary tract disease (FLUTD) is considered to be one of the most common diagnoses in feline patients. Several authors have concluded that feline idiopathic cystitis is the most common cause of FLUTD, whereas infectious cystitis is diagnosed in only 2% of the cases. In the period from January 2003 to February 2005, 134 cats that presented with signs of lower urinary tract disorders were included in a study at the Norwegian School of Veterinary Science. Ninety-seven percent were first opinion cases. All the cats went through a physical examination, and blood samples were collected for haematology and clinical chemistry. The urine analysis included urine stix, specific gravity, microscopic examination of the sediment and microbiological culturing. The urine samples were collected as voided mid-stream urine samples, by catheter or by cystocentesis and the method used was registered. Of the 134 cats included in the study, 37% were diagnosed as having obstructive and 63% as having non-obstructive FLUTD. In total 44 cats (33%) were diagnosed with bacteriuria, exceeding 10(3) colony forming units per millilitre (cfu/ml) and 33 (25%) of these cats had bacterial growth exceeding 10(4) cfu/ml, either alone or in combination with crystals and/or uroliths. Six cats (18%) with bacterial growth exceeding 10(4) cfu/ml were older than 8 years. No significant difference was found between the sampling methods performed with regard to bacteriuria. This study indicates that bacteriuria may have been underdiagnosed in Norwegian cats with clinical signs of FLUTD. It also confirms the importance of microbiological culturing in first opinion cases with FLUTD and that a skilled operator can get representative samples regardless the choice of method.  相似文献   

11.
The goal of this study was to evaluate the sensitivity and specificity of two cowside tests for subclinical ketosis in dairy cows. The tests utilize milk and urine samples, respectively. One hundred and eighty-five cows, one to sixty days postpartum, were sampled for milk, urine, and blood. Subclinical ketosis was defined with serum beta-hydroxybutyrate measurements. The sensitivity and the specificity of both tests at different beta-hydroxybutyrate levels were estimated. When subclinical ketosis was defined at beta-hydroxybutyrate levels of 1.4 mmol/L and higher, the milk test had sensitivity of 90% and specificity of 96%. The urine test lacked specificity (values < 67%), but sensitivity was 100% at beta-hydroxybutyrate levels of 1.4 mmol/L upward. Both the milk and urine test can be used to monitor subclinical ketosis in a herd. Milk testing is preferred, because of the easy obtainability of milk combined with the overall better test characteristics.  相似文献   

12.
Background — Commercial testing for microalbuminuria in human urine is often performed with point-of-care semiquantitative test strips followed by quantitative testing when indicated. An ELISA that quantifies canine urine albumin concentration has been developed, but semiquantitative test strips for use in the dog are not available.
Objective — The purpose of this study was to prospectively determine the concordance of canine urine albumin concentrations measured by a commercial human test strip and by ELISA.
Methods — Urine samples were obtained from 67 dogs evaluated for a variety of clinical conditions. Dipstick urinalyses were performed on all samples; clinician discretion determined method of urine collection and performance of urine sediment examination and/or urine culture. Urine albumin concentration was determined using test strips (Clinitek Microalbumin, Bayer Corporation, Elkhart, Ind, USA), and results were compared with those obtained by ELISA.
Results — The Clinitek strips correctly determined albumin concentration in 42 of 67 (63%) urine samples tested. Concordance was lowest (48%) for dogs with microalbuminuria (10–300 μg/mL by ELISA). Clinitek strip sensitivity and specificity for correct identification of microalbuminuria were 48% and 75%, respectively. Concordance was lower in dogs with urinary tract infection or hematuria and in samples collected by catheterization. Sensitivity and specificity for correct identification of microalbuminuria after exclusion of dogs with urinary tract infection or hematuria were 59% and 83%, respectively.
Conclusion — These results suggest that the Clinitek strips lack sufficient concordance with results obtained by ELISA to be reliable screening tests for microalbuminuria in the dog. A reliable semiquantitative point-of-care test for canine urine albumin concentrations below those detected by standard urine dipsticks is still needed.  相似文献   

13.
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14.
Background: For differential leukocyte counts, automated blood smear evaluation systems have been too slow or inaccurate to replace or supplement the manual differential count. The CellaVision DM96Vision (DM96V), a new instrument, is an automated image analysis system that is rapid and accurate enough to be used for enumerating human leukocytes and may be useful for analysis of canine blood. Objectives: The aims of this study were to evaluate the performance of the DM96V in differential counting of canine leukocytes, to compare its performance with that of other methods, and to analyze interoperator variability. Methods: Four methods of determining the leukocyte differential count of 108 canine blood samples were compared based on agreement, precision, and errors as well as relative performance. Differential counts were obtained using the DM96V, the manual method, and automated methods performed by the Advia 2120 and Sysmex XT‐2000iV. Results: All leukocyte types were detected by the DM96V and the manual method, and all 4 methods had similar mean and median results in most cases. The automated methods were more precise than either the DM96V or manual method when comparing identification of a single type of leukocyte, especially neutrophils and lymphocytes. However, precision of the automated methods was only fair for monocytes, and the Advia and Sysmex failed to identify basophils. The Advia reported fewer monocytes and eosinophils than did the other methods. Significantly fewer lymphocytes were identified by the manual method than by the Sysmex, Advia, and DM96V. The DM96V occasionally presented duplicate images of the same neutrophils. Conclusions: The CellaVision DM96V is a satisfactory system for facilitating canine differential leukocyte counting. The DM96V differential count was more similar to the manual count than to automated counts, which were more precise but had errors and omissions in detecting some types of leukocytes.  相似文献   

15.
Early detection of cancers, although essential for treatment effectiveness, can be difficult to achieve, and some tests introduce additional health risks. New, non-invasive detection methods with greater sensitivity and specificity are needed. Several authors have published research suggesting that dogs may be able to detect lung, breast, prostate, ovarian, and melanoma cancers by smelling skin lesions, urine, exhaled breath, and surgically extracted tumors. We conducted a systematic search using the PubMed and EMBASE databases to identify all known published data on canine scent detection of cancers. Of 531 potentially relevant publications, 11 full text articles were examined, and 5 were selected for inclusion in the review. Two studies involved dogs detecting breast cancer (sensitivity 88% using exhaled breath and 22% using urine; specificity was 98% and 20%, respectively), 1 involved bladder cancer (41% of urine samples detected), 1 involved melanoma (75–85.7% of in situ tumors detected), 1 involved lung cancer (sensitivity 99% and specificity 99% using exhaled breath), 1 involved ovarian cancer (sensitivity 100% and specificity 97.5% using thawed frozen tumor samples), and 1 involved prostate cancer (18% of urine samples detected). One study on ovarian cancer is in progress. Early successes with canine scent detection suggest chemical analysis of exhaled breath may be a valid method for cancer detection. Tests using exhaled breath showed better sensitivity and specificity than with urine. Future research should target other tumor types, and seek to identify what exhaled compounds may signal a cancer diagnosis.  相似文献   

16.
The analytic precision of an automated blood analyzer, the Technicon H*1(R), was evaluated utilizing blood samples collected from 20 piglets at 1 and 14 days of age. The effect of storing the blood samples at 4 degrees C for 24 and 48 hours also was determined. Blood samples were analyzed twice on the first day and once on each of the subsequent tow days. Within-sample coefficient of variation was approximately 1% for hemoglobin concentration, erythrocyte count, hematocrit, mean cell volume, erythrocyte distribution width and hemoglobin distribution width (HDW); and approximately 5% for total leukocyte (WBC), neutrophils and lymphocyte counts. Mean HDW and automated differential WBC counts changed during storage to a degree that could be of clinical importance. Manual determination of differential WBC counts were compared with those obtained from the automated analyzer. Results correlated well for neutrophils (r=0.92 in 1-day-old and r=0.93 in 14-day-old piglets, P<0.001) and lymphocytes (r=0.85 in 1-day-old and r=0.93 in 14-day-old piglets, P<0.001). Other WBC values were too low to compare reasonably.  相似文献   

17.
A multichannel, semiautomated, blood cell counting system (Coulter Counter Model S550) was modified for use in veterinary hematology by increasing both the erythrocyte and leukocyte aperture currents to 225 V and 195 V, respectively, followed by calibration with human blood. It was evaluated by use of 350 samples from dogs, cats, horses, and cows. Values for leukocyte count, erythrocyte count, mean corpuscular volume, and hematocrit generated by the S550 were compared with values generated by an automated multichannel counter with histogram capability and other reference procedures when appropriate. Mean differences for values between S550 and reference values were less than calibration tolerance limits for the instrument. Correlation coefficients were excellent for all values of each species. To assess behavior of leukocytes of the different species with respect to the counting threshold, leukocyte size distribution histograms were generated for all samples analyzed on the S550. Means for mean leukocyte volumes in diluent and lysing reagents were 55.5, 56.6, 67.4, and 72.8 fl for dogs, cats, horses, and cows, respectively. Canine leukocyte counts, because of small leukocyte size, were an average of 14% less for 5 samples analyzed on the unmodified instrument, compared with analysis after increasing the leukocyte aperture current. Leukocyte threshold failures attributable to interfering particles, resulting in falsely high counts, were recognized in 14%, 10%, 8% and 0% of feline, bovine, canine, and equine samples, respectively. The magnitude of error in these samples averaged 5% for cows and dogs, but was considered not important. However, leukocyte counts of feline samples in this group averaged 44% falsely high.  相似文献   

18.
OBJECTIVE: To compare sensitivity and specificity of cytologic examination and 3 chromogen tests for detection of occult blood in cockatiel (Nymphicus hollandicus) excrement. ANIMALS: 20 adult cockatiels. PROCEDURES: Pooled blood from birds was divided into whole blood and lysate aliquots. Excrement was mixed with each aliquot in vitro to yield 6 hemoglobin (Hb) concentrations (range, 0.375 to 12.0 mg of Hb/g of excrement). For the in vivo portion of the study, birds were serially gavaged with each aliquot separately at 5 doses of Hb (range, 2.5 to 40 mg/kg). Three chromogen tests and cytologic examination were used to test excrement samples for occult blood. Sensitivity, specificity, and observer agreement were calculated. RESULTS: In vitro specificity ranged from 85%to 100% for the 3 chromogen tests and was 100% for cytologic examination. Sensitivity was 0% to 35% for cytologic examination and 100% for the 3 chromogen tests on samples containing >or= 1.5 mg of Hb/g of excrement. In vivo specificity was 100%, 90%, 65%, and 45% for cytologic examination and the 3 chromogen tests, respectively. Sensitivity was 0% to 5% for cytologic examination and >or= 75% for all 3 chromogen tests after birds received doses of Hb >or= 20 mg/kg. Observer agreement was lowest for cytologic examination. CONCLUSIONS AND CLINICAL RELEVANCE: Chromogen tests were more useful than cytologic examination for detection of occult blood in cockatiel excrement. The best combination of sensitivity, specificity, and observer agreement was obtained by use of a chromogen test.  相似文献   

19.
BackgroundUrinalysis (UA) is often used to screen for bacterial cystitis, regardless of sediment results, and followed up by quantitative urine culture (UC) for definitive diagnosis.ObjectivesDetermine prevalence of positive UCs in dogs with inactive urine sediments on routine UA.AnimalsA total of 1049 urine samples with inactive urine sediments and UCs collected from dogs presented to a veterinary specialty hospital between January 2018 and February 2020.MethodsRetrospective study of dogs with an inactive urine sediment on routine UA and follow‐up UCs. Signalment, UA findings, proteinuria, and UC results were recorded. Associations among these findings were assessed using multivariate logistic regression carried out using a backward stepwise method.ResultsOverall prevalence of positive UC was 3.4% (95% confidence interval [CI], 2.4‐4.8). Escherichia coli was the most commonly isolated bacteria. Only naturally voided samples were associated with increased prevalence of positive culture when compared to collection by cystocentesis or a non‐specified method. No statistically significant association with culture positivity was found for urine protein‐to‐creatinine ratio, urine specific gravity, urine pH, breed, age, or sex.Conclusions and Clinical ImportanceBased on the low prevalence (3.4%) of positive culture in urine samples from dogs with inactive sediment on routine UA and the relatively high cost of UC and sensitivity, cost‐benefit analysis including clinical suspicion of lower urinary tract disease should inform testing decisions, rather than routinely performing cultures on urine samples without active sediments.  相似文献   

20.
Use of inflammatory cell activities in bovine milk to diagnose mastitis   总被引：1，自引：0，他引：1  
The activity of leukocytes, determined by chemiluminescence (CL) emission, was compared with the somatic cell count (SCC) in 4,883 quarter-milk samples from 132 dairy cows. The presence of bacteria was determined by bacteriologic culture of samples in which SCC and CL were high. Chemiluminescence was measured with an automated illuminometer system at 37 C after separating the leukocytes from milk by allowing them to adhere to cotton-wool swabs. Chemiluminescence emission was induced by opsonized zymosan and enhanced by luminol. After luminol and zymosan were added to the measuring vials containing the swabs, CL emission increased rapidly, reaching its maximum usually at about 15 minutes of reaction time, and decreasing slowly thereafter. In general, good correlation was found between CL and SCC (r = 0.876; P less than or equal to 0.001; n = 4,883). Even milk samples with low SCC gave reliably measurable CL signals. Minor pathogens in the milk caused about a sevenfold increase in both SCC and CL, whereas major pathogens caused 14- and 25-fold increases in SCC and CL, respectively. The diagnostic situation that requires both sensitivity and specificity to be at least 90% was attained only by the CL assay for major pathogens. These results suggest that the measurement of milk leukocyte activity by CL assay applies well to the diagnosis of mastitis, and has the potential to become a large-scale laboratory test, as well as a simple cowside test.  相似文献   

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