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Topic:Clinical Study

Clinical studies in equine research involve the systematic investigation of health and disease in horses through structured scientific methods. These studies aim to evaluate the safety and efficacy of treatments, understand disease mechanisms, and improve veterinary care practices. Clinical studies can include randomized controlled trials, observational studies, and case-control studies. They may focus on various aspects such as pharmacokinetics, therapeutic interventions, and diagnostic techniques. This page compiles peer-reviewed research studies and scholarly articles that explore the design, implementation, and findings of clinical studies in equine medicine, providing insights into their impact on horse health and veterinary practices.
Modified abaxial sesamoid nerve block provides enhanced proximal diffusion compared to basisesamoid block and lower proximal diffusion than traditional low plantar nerve block in equine hind limbs: ex vivo and in vivo study.
Journal of the American Veterinary Medical Association    August 29, 2023   1-6 doi: 10.2460/javma.23.04.0212
Estrada RJ, Alvarado GJ, Vargas A, Vargas J, Vargas D, Chacón R, Razquin P, Vindas R.To determine the proximal diffusion distance of radiopaque contrast medium and mepivacaine/methylene blue solution and incidence of inadvertent intrasynovial and intravascular injections of modified sesamoid nerve block (MASB) when compared with traditional plantar nerve analgesia techniques of the equine distal hind limb. Methods: Ex vivo model: 18 hind limbs; and in vivo model: 5 horses in a crossover study. Methods: In the ex vivo model, a mepivacaine/methylene blue solution was used to compare the diffusion distance between MASB, basisesamoid block (BSB), and traditional low plantar block ...
Regulatory T lymphocytes and selected cytokines in horses with mild to severe equine asthma and different inflammatory cytology profiles.
Research in veterinary science    August 25, 2023   Volume 163 104998 doi: 10.1016/j.rvsc.2023.104998
Hamouzová P, Drábková Z, Stehlíková Š, Řeháková K, Čížek P, Dobešová O, Jahn P, Doubek J.This study determined Tregs and inflammatory cytokines in BALF and peripheral blood (PB) of adult horses with mild and severe asthma and different BALF cytological inflammation profiles. Horses of diverse breeds with asthma (age range: 2-20 years, n = 24) were divided into groups according to the number of points obtained in a standardized clinical scoring system (mild-moderate equine asthma - MEA, severe equine asthma - SEA) and according to the inflammation type based on cytological finding. Plasma levels of IFN-γ, IL-4, IL-10, IL-17 and MMP-9 in the BALF were determined by ELISA. Tregs ...
Partial Genome Characterization of Novel Parapoxvirus in Horse, Finland.
Emerging infectious diseases    August 23, 2023   Volume 29, Issue 9 1941-1944 doi: 10.3201/eid2909.230049
Virtanen J, Hautaniemi M, Dutra L, Plyusnin I, Hautala K, Smura T, Vapalahti O, Sironen T, Kant R, Kinnunen PM.We report a sequencing protocol and 121-kb poxvirus sequence from a clinical sample from a horse in Finland with dermatitis. Based on phylogenetic analyses, the virus is a novel parapoxvirus associated with a recent epidemic; previous data suggest zoonotic potential. Increased awareness of this virus and specific diagnostic protocols are needed.
Use of Stem Cells for the Treatment of Musculoskeletal Injuries in Horses.
The Veterinary clinics of North America. Equine practice    August 23, 2023   S0749-0739(23)00051-2 doi: 10.1016/j.cveq.2023.07.003
Watts AE.Mesenchymal stem cells (MSCs) are used as a regenerative therapy in horses for musculoskeletal injury since the late 1990s and in some regions are standard of care for certain injuries. Yet, there is no Food and Drug Administration-approved MSC therapeutic in the United States for horses. In humans, lack of regulatory approval in the United States has been caused by failure of late-phase clinical trials to demonstrate consistent efficacy, perhaps because of nonuniformity of MSC preparation and application techniques. This article discusses clinical evidence for musculoskeletal applications of ...
Factors associated with insulin responses to oral sugars in a mixed-breed cohort of ponies.
Equine veterinary journal    August 22, 2023   Volume 56, Issue 2 253-263 doi: 10.1111/evj.13983
Knowles EJ, Harris PA, Elliott J, Chang YM, Menzies-Gow NJ.Serum insulin concentration at 60 min (InsulinT60) during an oral sugar test (OST) indicates future laminitis risk and insulin dysregulation (ID). Associations between InsulinT60 and physical and owner-reported variables may help clinicians select individuals for ID testing. Associations between InsulinT60 and other metabolic markers may help elucidate ID pathophysiology. Objective: To describe associations between (A) season, physically-apparent and owner-reported factors and binary InsulinT60 interpretation (initial models) and (B) variables included in the initial models, other metabolic ...
History, Rest and Exercise Score (HRE-S) for assessment of disease severity in horses with trigeminal-mediated headshaking.
Equine veterinary journal    August 22, 2023   doi: 10.1111/evj.13986
Kloock T, Pickles KJ, Roberts V, Uhlendorf F, Twele L, Wilkens HL, Stehle E, Feige K, Niebuhr T.In horses with trigeminal-mediated headshaking (TMHS), clinical signs are likely to be expression of neuropathic facial pain. Currently, subjective assessment of disease severity is used as measure of compromise of animal's welfare. Objective: To develop and validate a precise scoring system for TMHS: History, Rest and Exercise Score (HRE-S). The HRE-S consists of three subscores: history score (H-S), resting score (R-S) and exercise score (E-S). Methods: Retrospective observational study. Methods: Seven masked observers with different experience used HRE-S to score 40 video recordings taken d...
Findings consistent with equine proximal suspensory desmitis can be reliably detected using computed tomography and differ between affected horses and controls. Müller EMT, Vanderperren K, Merle R, Rheinfeld S, Leelamankong P, Lischer CJ, Ehrle A.The objective of this retrospective, observational, controlled study was to evaluate bone and soft tissue window CT images of the proximoplantar metatarsus III region in twenty horses with pain localized to the proximal suspensory ligament (PSL) and 20 horses with findings nonrelated to tarsal pain. All horses underwent CT and radiographic examination. Images were reviewed by three independent observers who graded the severity and localization of findings. Bone-related categories as well as soft tissue-related categories were evaluated. For the comparison of imaging findings in horses with and...
Use of Biologics and Stem Cells in the Treatment of Other Inflammatory Diseases in the Horse.
The Veterinary clinics of North America. Equine practice    August 20, 2023   S0749-0739(23)00052-4 doi: 10.1016/j.cveq.2023.07.004
Barrett JG, MacDonald ES.Mesenchymal stem cells (MSCs) are powerful immunomodulatory cells that act via multiple mechanisms to coordinate, inhibit, and control the cells of the immune system. MSCs act as rescuers for various damaged or degenerated cells of the body via (1) cytokines, growth factors, and signaling molecules; (2) extracellular vesicle (exosome) signaling; and (3) direct donation of mitochondria. Several studies evaluating the efficacy of MSCs have used MSCs grown using xenogeneic media, which may reduce or eliminate efficacy. Although more research is needed to optimize the anti-inflammatory potential o...
Rotation of liquid-preserved artificial insemination doses on roller benches affects sperm quality during storage in stallions.
Reproduction in domestic animals = Zuchthygiene    August 19, 2023   Volume 58, Issue 10 1413-1419 doi: 10.1111/rda.14456
Dierberger H, Pieper L, Jung M, Schulze M.Appropriate stallion semen handling is of great importance in equine artificial insemination (AI) industry. Optimal treatment of AI doses is aiming for best sperm preservation by excluding strong environmental influences and adding media that favour sperm survival. One method widely used in stallion sperm handling is the rotation of liquid-preserved semen samples on roller benches during storage. As previous studies in boars give rise to the fact that rotation should not be considered beneficial for spermatozoa anymore, the present study investigated the influence of continuous rotation of dil...
Use of Doppler ultrasonography for selection of recipients in embryo transfer programs in horses.
Theriogenology    August 18, 2023   Volume 211 142-150 doi: 10.1016/j.theriogenology.2023.08.012
Morelli KG, Lourenço GG, Marangon VR, Feltrin IR, Imura Oshiro TS, Rodrigues da Silva IV, Pugliesi G.We aimed to evaluate the impact of corpus luteum (CL) and uterine characteristics accessed by B-mode and Color-Doppler ultrasonography in recipient mares at the time of embryo transfer (ET) on pregnancy outcomes. Recipient mares (n = 110), between days 3-9 after spontaneous ovulation, received a fresh embryo. Immediately before ET, the reproductive system was assessed by transrectal palpation for the following parameters: uterine tone (0-3), CL echogenicity (0-6), CL type (homogeneous, trabecular or anechoic center), luteal area (cm2), uterine echogenicity (0-3), uterine edema (0-3), luteal ...
Segmental analysis and long-term monitoring of vadadustat in equine hair for the purpose of doping control.
Journal of analytical toxicology    August 18, 2023   bkad057 doi: 10.1093/jat/bkad057
Ishii H, Shibuya M, Kusano K, Sone Y, Kamiya T, Wakuno A, Ito H, Miyata K, Yamada M, Leung GN.Vadadustat is a newly launched hypoxia-inducible factor stabilizer with anti-anemia and erythropoietic effects; however, its use in horses is expressly forbidden in both racing and equestrian competitions. Following our previous report on the pharmacokinetic study of vadadustat in horse plasma and urine, a long-term longitudinal analysis of vadadustat in horse hair after nasoesophageal administration (3 g/day for 3 days) to three thoroughbred mares is described in this study. Our main objective is to further extend the detection period of vadadustat for the purpose of doping control. Three...
Antibiotic usage in 14 equine practices over a 10-year period (2012-2021).
Equine veterinary journal    August 16, 2023   doi: 10.1111/evj.13988
Tallon RE, Whitt B, Bladon BM.Monitoring antibiotic usage is an important part of tackling antimicrobial resistance. The use of computerised records for monitoring has been previously described in the equine sector but there is currently no consensus on metrics used to report usage. Objective: To document antibiotic use in equine practices in the United Kingdom over a 10-year period using commercially available practice management software. Methods: Retrospective survey. Methods: A custom antibiotic usage report was created using Eclipse® practice management software. Participating practices were given instructions on how...
Bronchoalveolar Lavage Cytology in Severe Equine Asthma: Cytocentrifugated versus Sediment Smear Preparations.
Veterinary sciences    August 16, 2023   Volume 10, Issue 8 527 doi: 10.3390/vetsci10080527
Morini M, Gobbo F, Rinnovati R, Romagnoli N, Peli A, Massarenti C, Spadari A, Pietra M.Equine asthma is a common respiratory disease that may affect horses of any age. The diagnosis of severe equine asthma (SEA) (historically referred as recurrent airway obstruction or RAO) is based mainly on the history of the animal and clinical signs, which are further supported by the cytological examination of the bronchoalveolar lavage (BAL). This can also be helpful in monitoring the inflammation of the lower airways in response to environmental management and medication. The cytocentrifugated preparation is usually considered the method of choice for BAL cytological interpretation. The a...
Flow cytometric detection and identification of different leukocyte subpopulations in stallion semen.
Reproduction in domestic animals = Zuchthygiene    August 16, 2023   doi: 10.1111/rda.14451
Köhne M, Kirch F, Tönissen A, Martinsson G, Rabe U, Sieme H, Schuberth HJ.To improve accuracy in evaluating stallion ejaculates, an antibody-based, flow cytometric assay for the detection and identification of leukocyte subpopulations (CD4-, CD8-, CD21-, CD172a-positive cells) in stallion semen (n = 12) was established. For establishment of the assay, native semen was supplemented with blood leukocytes (control: 20% leukocytes, 80% sperm cells) and analysed by flow cytometry. Adding antioxidants (ascorbic acid and butylated hydroxytoluol) to semen immediately after collection inhibited rapid death of lymphoid cells in sperm leukocyte mixtures. In control set-ups...
Antimicrobial Activity of Plasma Rich in Platelets (PRP) on the Ocular Microbiota of Healthy Horses from Minas Gerais: In Vitro Study.
Veterinary medicine international    August 16, 2023   Volume 2023 2407768 doi: 10.1155/2023/2407768
Torres LEC, Florez CO, Oliveira JG, Vieira GD, Ribeiro IS, Keller KM, Leme FOP, Fantini P, Maranhão RPA.In equine ophthalmology, ulcerative keratitis is among the most common conditions and, in general, arises as a consequence of some trauma suffered. Secondarily, subsequent contamination by pathogenic or resident bacteria of the horse's ocular microbiota may have undesirable consequences. Under physiological conditions, the normal microbiota coexists with the immune status of the host, serving as a barrier, ensuring the health of the ocular surface, and inhibiting the proliferation of pathogens. However, in the imbalance of immune barriers, the normal microbiota can become pathogenic and lead t...
Evaluation of the agreement between lingual and thoracic limb noninvasive blood pressure with invasive blood pressure measurements in anaesthetized horses.
Veterinary anaesthesia and analgesia    August 16, 2023   Volume 51, Issue 1 1-9 doi: 10.1016/j.vaa.2023.08.007
Parra Martínez C, Rico Pérez B, Kaartinen J.To evaluate the agreement between noninvasive arterial blood pressure (NIBP) measured from the tongue and thoracic limb with invasive blood pressure (IBP), and to compare NIBP measured from the tongue and thoracic limb in anaesthetized horses. Methods: Prospective clinical study. Methods: A group of eight client-owned healthy horses anaesthetized for scheduled procedures, American Society of Anesthesiologists classification I-II, weighing (mean ± standard deviation) 498 ± 91 kg and aged 7.8 ± 6.75 years. Methods: Animals were premedicated with intravenous (IV) romifidine (0.04-0.08 mg kg-1)...
Effect of Lavage Solution Type on Bronchoalveolar Lavage Fluid Cytology in Clinically Healthy Horses.
Animals : an open access journal from MDPI    August 15, 2023   Volume 13, Issue 16 2637 doi: 10.3390/ani13162637
Westermann CM, de Bie AG, Olave C, de Grauw JC, Teske E, Couetil LL.Equine bronchoalveolar lavage (BAL) is usually performed with 250-500 mL of isotonic saline at pH 5.5. The acidic pH of saline may cause an increase in airway neutrophil count 48 h after BAL. Other isotonic solutions such as Ringer's solution, phosphate-buffered saline (PBS) or Plasma-Lyte 148 have a neutral pH of 7.4 and might be a better choice for BAL by not provoking inflammation and the influx of neutrophils into airways. BAL was performed in four healthy horses in four different lung lobes using four different solutions in a randomized crossover design. In each lobe, BAL was performed tw...
Effects of insulin-like growth factor-1 on the proliferation and apoptosis of stallion testicular cells under normal and heat stress culture conditions.
Animal reproduction science    August 15, 2023   Volume 256 107319 doi: 10.1016/j.anireprosci.2023.107319
Shakeel M, Yoon M.This study investigated the effect of heat stress on stallion testicular cells (TCs) and the effect of insulin-like growth factor (IGF)-1 on TC viability, proliferation, and apoptosis, including different stages of germ cells. TCs were divided into control or treatment groups with 0.01, 0.1, 1, 10, and 100 ng/mL of recombinant human IGF-1 (rhIGF-1) for 24 h at 34 °C and 37 °C. The population and viability were measured before and after treatment. The effects of rhIGF-1 on TC viability, proliferation, and apoptosis were determined using RT-qPCR. Proliferating cell nuclear antigen (PCNA) a...
Retained efficacy of ivermectin against cyathostomins in Swedish horse establishments practicing selective anthelmintic treatment.
Veterinary parasitology    August 14, 2023   Volume 322 110007 doi: 10.1016/j.vetpar.2023.110007
Alm YH, Osterman-Lind E, Martin F, Lindfors R, Roepstorff N, Hedenström U, Fredriksson I, Halvarsson P, Tydén E.Cyathostominae are ubiquitous to grazing horses and regarded the most prevalent internal parasite in the horse. Unfortunately, decades of indiscriminate use of anthelmintic drugs have resulted in the development of resistance in cyathostomins to all currently available drug groups, the most recent being a documented lack of efficacy to the macrocyclic lactones (ML). In vivo determination of anthelmintic resistance in horses most often utilises the faecal egg count reduction test (FECRT). Further, a shortened egg reappearance period (ERP) can indicate a change in response to the applied treatme...
Regenerative Strategies in Treatment of Peripheral Nerve Injuries in Different Animal Models.
Tissue engineering and regenerative medicine    August 12, 2023   Volume 20, Issue 6 839-877 doi: 10.1007/s13770-023-00559-4
Khaled MM, Ibrahium AM, Abdelgalil AI, El-Saied MA, El-Bably SH.Peripheral nerve damage mainly resulted from traumatic or infectious causes; the main signs of a damaged nerve are the loss of sensory and/or motor functions. The injured nerve has limited regenerative capacity and is recovered by the body itself, the recovery process depends on the severity of damage to the nerve, nowadays the use of stem cells is one of the new and advanced methods for treatment of these problems. Following our review, data are collected from different databases "Google scholar, Springer, Elsevier, Egyptian Knowledge Bank, and PubMed" using different keywords such as Periphe...
Identification of allergens in Artocarpus heterophyllus, Moringa oleifera, Trianthema portulacastrum and Syzygium samarangense.
Clinical and molecular allergy : CMA    August 11, 2023   Volume 21, Issue 1 6 doi: 10.1186/s12948-023-00187-2
Iddagoda J, Gunasekara P, Handunnetti S, Jeewandara C, Karunatilake C, Malavige GN, de Silva R, Dasanayake D.It is clinically important to identify allergens in Artocarpus heterophyllus (jackfruit), Moringa oleifera (moringa), Trianthema portulacastrum (horse purslane) and Syzygium samarangense (rose apple). This study included 7 patients who developed anaphylaxis to jackfruit (1), moringa (2), horse purslane (3) and rose apple (1). We sought to determine allergens in the edible ripening stages of jackfruit (tender, mature, and ripened jackfruit) and seeds, edible parts of moringa (seeds, seedpod, flesh inside seedpod, and leaves), horse purslane leaves and ripened rose apple fruit. The persistence o...
Development of a fixed list of descriptors for the qualitative behavioral assessment of thoroughbred horses in the racing environment.
Frontiers in veterinary science    August 10, 2023   Volume 10 1189846 doi: 10.3389/fvets.2023.1189846
Jaramillo FM, Oliveira TM, Silva PEA, Trindade PHE, Baccarin RYA.Horse racing is a major sport practiced worldwide. The environment to which horses are exposed during race meetings can influence their behavior. However, to the best of our knowledge, a method for assessing a horse's response to its surroundings during the pre- and post-race periods has not yet been reported. This study aimed to create a standard list of descriptors for use in a qualitative behavioral assessment (QBA) focused on assessing the emotional expressivity of horses before and after racing events. Unassigned: Seventy pre- or post-race 30-second videos of horses were randomly selected...
Electrocardiographic Reference Values in Clinically Healthy Lusitano Horses.
Veterinary sciences    August 10, 2023   Volume 10, Issue 8 doi: 10.3390/vetsci10080518
Triguinho A, Fontes-Sousa AP, Pimenta J, Cotovio M.The Lusitano horse is gaining popularity in the equestrian world, and as a result, the significance of applied sports medicine for this breed is growing. As cardiology plays a crucial role in this field, numerous studies have been conducted to establish electrocardiographic reference values in various breeds to ensure a more accurate evaluation. However, studies regarding healthy Lusitano horses are lacking. So, this study aimed to establish electrocardiographic reference values for Lusitano horses, utilizing a sample of 82 clinically healthy animals. The evaluation involved lead II and base-a...
Gastroscopic characterisation and prevalence of gastric ulcer syndrome in working mules in Colombia.
Equine veterinary journal    August 9, 2023   Volume 56, Issue 3 449-455 doi: 10.1111/evj.13985
Calixto-Vega LC, Martínez-Aranzales JR.The existing literature does not contain information about the prevalence of gastric ulcers in mules, and on the potential associations between the presence of ulcers and work load, work type, diet, sex, age and body condition score (BCS). Objective: To estimate the prevalence and factors associated with mule gastric ulcer syndrome (MGUS) and evaluate its distribution in both mule squamous gastric disease (MSGD) and mule glandular gastric disease (MGGD) mucosa in a population of mules in Colombia. Methods: Observational, cross-sectional. Methods: A total of 97 clinically healthy mules of diffe...
Computed tomographic features and surgical treatment of equine mandibular aneurysmal bone cysts with β-tricalcium phosphate in a multicenter case series.
Journal of the American Veterinary Medical Association    August 9, 2023   1-9 doi: 10.2460/javma.23.03.0137
Spoormakers TJ, Heim C, Vermunt L, Fürst A, Rovel T.To describe clinical and imaging features and surgical treatment of equine mandibular aneurysmal bone cysts (ABCs) with β-tricalcium phosphate (TCP). Methods: 3 horses (cases 1, 2, and 3) and 1 pony (case 4) with histologically confirmed ABC. Methods: All cases had mandibular swelling with intact adjacent skin. Cases 1 to 3 had a body condition score of 3/5 and case 4 had 2/5 and showed quidding during mastication and, at oral examination, large interdental spaces and loose elements adjacent to the swelling. Radiography or CT was performed in all cases. In cases 1, 3, and 4, an expansile sept...
An application of the density standard and scaled-pixel-counting protocol to assess the radiodensity of equine incisor teeth affected by resorption and hypercementosis: preliminary advancement in dental radiography.
BMC veterinary research    August 9, 2023   Volume 19, Issue 1 116 doi: 10.1186/s12917-023-03675-4
Górski K, Borowska M, Turek B, Pawlikowski M, Jankowski K, Bereznowski A, Polkowska I, Domino M.Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome is a dental disease where the radiographic signs may be quantified using radiographic texture features. This study aimed to implement the scaled-pixel-counting protocol to quantify and compare the image structure of teeth and the density standard in order to improve the identification of the radiographic signs of tooth resorption and hypercementosis using the EOTRH syndrome model. Results: A detailed examination of the oral cavity was performed in 80 horses and maxillary incisor teeth were evaluated radiographically, in...
A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension.
Equine veterinary journal    August 9, 2023   Volume 56, Issue 3 514-521 doi: 10.1111/evj.13987
Comino F, Pollock PJ, Fulton I, Hewitt-Dedman C, Handel I, Gorvy DA.To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. Objective: To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. Methods: Retrospective case series. Methods: All wounds that were managed with the Tensi...
18F-sodium fluoride positron emission tomography provides pertinent additional information to computed tomography for assessment and management of tarsal pain in horses.
Journal of the American Veterinary Medical Association    August 9, 2023   1-8 doi: 10.2460/javma.23.03.0164
Espinosa-Mur P, Spriet M, Manso-Diaz G, Arndt S, Perez-Nogues M, Roman JL, Garcia-Mata R, Katzman SA, Galuppo LD.To assess the value of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) for imaging the tarsus and proximal metatarsus and compare it with CT and lameness evaluation. Methods: 25 horses with lameness localized to the tarsal and proximal metatarsal regions that underwent 18F-NaF PET/CT between 2016 and 2021. Methods: 18F-NaF PET and CT images were retrospectively independently evaluated by 3 observers. Standardized uptake values (SUV) were used to characterize 18F-NaF uptake. Correlation between PET and CT findings with subjective and objective maximum (Max-D) and minimum pelvic...
Pharmacokinetic modelling of orally administered cannabidiol and implications for medication control in horses.
Frontiers in veterinary science    August 9, 2023   Volume 10 1234551 doi: 10.3389/fvets.2023.1234551
Eichler F, Poźniak B, Machnik M, Schenk I, Wingender A, Baudisch N, Thevis M, Bäumer W, Lischer C, Ehrle A.Cannabidiol (CBD) products gain increasing popularity amongst animal owners and veterinarians as an alternative remedy for treatment of stress, inflammation or pain in horses. Whilst the use of cannabinoids is banned in equine sports, there is limited information available concerning CBD detection times in blood or urine. The aim of this study was to determine the pharmacokinetic properties of CBD following oral administration in the horse to assist doping control laboratories with interpreting CBD analytical results. Part 1: dose escalation study: Single oral administration of three escalatin...
Further comments on: Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians’ experience.
Equine veterinary journal    August 8, 2023   Volume 55, Issue 5 927 doi: 10.1111/evj.13970
Gray P.No abstract available