Gary S. Fanton, MD

All Publications

• Deep-learning-assisted diagnosis for knee magnetic resonance imaging: Development and retrospective validation of MRNet. PLoS medicine Bien, N., Rajpurkar, P., Ball, R. L., Irvin, J., Park, A., Jones, E., Bereket, M., Patel, B. N., Yeom, K. W., Shpanskaya, K., Halabi, S., Zucker, E., Fanton, G., Amanatullah, D. F., Beaulieu, C. F., Riley, G. M., Stewart, R. J., Blankenberg, F. G., Larson, D. B., Jones, R. H., Langlotz, C. P., Ng, A. Y., Lungren, M. P. 2018; 15 (11): e1002699

  Abstract

  BACKGROUND: Magnetic resonance imaging (MRI) of the knee is the preferred method for diagnosing knee injuries. However, interpretation of knee MRI is time-intensive and subject to diagnostic error and variability. An automated system for interpreting knee MRI could prioritize high-risk patients and assist clinicians in making diagnoses. Deep learning methods, in being able to automatically learn layers of features, are well suited for modeling the complex relationships between medical images and their interpretations. In this study we developed a deep learning model for detecting general abnormalities and specific diagnoses (anterior cruciate ligament [ACL] tears and meniscal tears) on knee MRI exams. We then measured the effect of providing the model's predictions to clinical experts during interpretation.METHODS AND FINDINGS: Our dataset consisted of 1,370 knee MRI exams performed at Stanford University Medical Center between January 1, 2001, and December 31, 2012 (mean age 38.0 years; 569 [41.5%] female patients). The majority vote of 3 musculoskeletal radiologists established reference standard labels on an internal validation set of 120 exams. We developed MRNet, a convolutional neural network for classifying MRI series and combined predictions from 3 series per exam using logistic regression. In detecting abnormalities, ACL tears, and meniscal tears, this model achieved area under the receiver operating characteristic curve (AUC) values of 0.937 (95% CI 0.895, 0.980), 0.965 (95% CI 0.938, 0.993), and 0.847 (95% CI 0.780, 0.914), respectively, on the internal validation set. We also obtained a public dataset of 917 exams with sagittal T1-weighted series and labels for ACL injury from Clinical Hospital Centre Rijeka, Croatia. On the external validation set of 183 exams, the MRNet trained on Stanford sagittal T2-weighted series achieved an AUC of 0.824 (95% CI 0.757, 0.892) in the detection of ACL injuries with no additional training, while an MRNet trained on the rest of the external data achieved an AUC of 0.911 (95% CI 0.864, 0.958). We additionally measured the specificity, sensitivity, and accuracy of 9 clinical experts (7 board-certified general radiologists and 2 orthopedic surgeons) on the internal validation set both with and without model assistance. Using a 2-sided Pearson's chi-squared test with adjustment for multiple comparisons, we found no significant differences between the performance of the model and that of unassisted general radiologists in detecting abnormalities. General radiologists achieved significantly higher sensitivity in detecting ACL tears (p-value = 0.002; q-value = 0.019) and significantly higher specificity in detecting meniscal tears (p-value = 0.003; q-value = 0.019). Using a 1-tailed t test on the change in performance metrics, we found that providing model predictions significantly increased clinical experts' specificity in identifying ACL tears (p-value < 0.001; q-value = 0.006). The primary limitations of our study include lack of surgical ground truth and the small size of the panel of clinical experts.CONCLUSIONS: Our deep learning model can rapidly generate accurate clinical pathology classifications of knee MRI exams from both internal and external datasets. Moreover, our results support the assertion that deep learning models can improve the performance of clinical experts during medical imaging interpretation. Further research is needed to validate the model prospectively and to determine its utility in the clinical setting.

  View details for PubMedID 30481176

• Viscoelastic Properties of Common Suture Material Used for Rotator Cuff Repair and Arthroscopic Procedures ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Hurwit, D., Fanton, G., Tella, M., Behn, A., Hunt, K. J. 2014; 30 (11): 1406-1412

  Abstract

  The purpose of this study was to evaluate the viscoelastic properties of 5 suture materials, commonly used in arthroscopic rotator cuff repairs, when subjected to physiological loads.We evaluated 5 commercially available No. 2 sutures undergoing both creep and cyclic testing in both dry air and phosphate-buffered saline solution (PBS) maintained at 37°C. The selected sutures were MagnumWire (ArthroCare, Austin, TX), Ethibond (Ethicon, Somerville, NJ), FiberWire (Arthrex, Naples, FL), Orthocord (DePuy, Warsaw, IN), and Force Fiber (Tornier, Bloomington, MN).Regarding creep testing, in the PBS test environment, FiberWire showed the greatest stiffness (71.1 ± 2.1 N/mm), the smallest initial extension at the 60-N load (1.10 ± 0.04 mm), and the smallest amount of creep (0.57 ± 0.01 mm). Orthocord showed the smallest amount of relaxed elongation in PBS (0.73 ± 0.11 mm). Regarding cyclic testing, in the PBS testing environment, Ethibond exhibited the smallest dynamic creep (0.28 ± 0.02 mm), FiberWire displayed the smallest peak-to-peak displacement (0.17 ± 0.00 mm), and Orthocord showed the smallest amount of relaxed elongation after cyclic loading (0.63 ± 0.11 mm).FiberWire consistently displayed more extreme viscoelastic properties--greater stiffness and less extensibility--than the other suture types studied. Orthocord showed the smallest amount of relaxed elongation in both testing environments. Differences in testing environment affect the behavior of each suture type. Testing in physiologically approximating conditions such as PBS maintained at 37°C is warranted.Although many other factors affect the success of rotator cuff repairs, the viscoelastic properties of sutures may be a useful predictor of suture performance.

  View details for DOI 10.1016/j.arthro.2014.05.030

  View details for Web of Science ID 000344481200008

• Novel drug product to improve joint motion and function and reduce pain after arthroscopic anterior cruciate ligament reconstruction ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Fanton, G. S., Dillingham, M. F., Wall, M. S., Gillenwater, G. E., Khan, A. M., Carver, T. J., Perkins, J. G., Demopulos, G. A. 2008; 24 (6): 625-636

  Abstract

  OMS103HP, an investigational drug product containing ketoprofen, amitriptyline, and oxymetazoline, is added to arthroscopic irrigation solution. OMS103HP was evaluated in patients undergoing arthroscopic anterior cruciate ligament reconstruction to assess the drug's safety and ability to improve postoperative knee function and motion, reduce postoperative pain, and allow earlier return to work.This was a prospective, double-blind, vehicle-controlled, parallel-group, randomized study. Allograft anterior cruciate ligament reconstruction patients in both treatment and vehicle control groups were monitored for safety and efficacy (e.g., measurements of knee function and motion, pain, and return to work) over a 30-day postoperative period. The efficacy endpoints of primary interest were assessed by use of both responder and time-to-event analyses.There were statistically significant differences (P < or = .05) between the OMS103HP and vehicle control groups in the endpoints of knee function (knee function composite and straight-leg raise component of knee function composite), range of motion (median number of days to maximum passive flexion of 90 degrees or greater without pain and time to discontinuation of continuous passive motion), quadriceps and hamstring muscle strength, successful pain management, and return to work. The overall incidences of adverse events and abnormal clinical laboratory values for both OMS103HP- and vehicle-treated subjects were similar, and none was attributed to OMS103HP.The clinical benefits of OMS103HP in this study were reduced postoperative pain; improved postoperative knee motion, quadriceps and hamstring muscle strength, and knee function; and earlier return to work as measured by surgeons, nurses, and physical therapists across repeated clinic visits and rehabilitation sessions and recorded by patients in daily diaries. The drug was well tolerated.

  View details for DOI 10.1016/j.arthro.2008.02.003

  View details for PubMedID 18514105

• Acute compartment syndrome of the thigh in a football athlete - A case report and the role of the vacuum-assisted wound closure dressing JOURNAL OF ORTHOPAEDIC TRAUMA Lee, A. T., Fanton, G. S., McAdams, T. R. 2005; 19 (10): 748-750

  Abstract

  We present a case of compartment syndrome of the thigh due to blunt injury in a Division I American football player managed with fasciotomy and vacuum-assisted wound closure. This case report discusses the vacuum-assisted wound closure dressing as an alternative to more traditional closure techniques such as suture retention devices and split-thickness skin grafting. We feel that any surgeon involved in performing fasciotomies should be familiar with this increasingly used closure device and its potential complications.

  View details for PubMedID 16314725

• Postoperative epidural injection of saline can shorten postanesthesia care unit time for knee arthroscopy patients Feminist Theory and Music 4 Conference Brock-Utne, J. G., Macario, A., Dillingham, M. F., Fanton, G. S. W B SAUNDERS CO-ELSEVIER INC. 1998: 247–51

  Abstract

  The goal of this prospective, double-blind study was to ascertain if the postanesthesia care unit (PACU) stay of outpatients receiving epidural anesthesia for knee arthroscopy is decreased by injection of epidural saline at the end of the case.Twenty healthy patients undergoing knee arthroscopy received lumbar epidural anesthesia with 2% lidocaine. At the end of surgery, in a double-blind design, group 1 patients (intervention group) received 20 mL 0.9% saline injected into the epidural catheter. Patients in group 2 (control group) had 1 mL 0.9% saline injected into the epidural catheter. In the PACU, the epidural catheter was removed, and motor block was assessed at 15-minute intervals according to the Bromage scale. Standard discharge criteria for our ambulatory surgery center were followed.Patients who received 20 mL epidural 0.9% saline remained in phase I (intensive nursing) 83 +/- 8 minutes compared with control patients who stayed 110 +/- 8 minutes (P < .01). Nonmedical issues related to the unavailability of the patients transportation or waiting for medications to be issued from the pharmacy delayed discharge from phase II (non-nursing) in 70% of group 1 patients and 60% of group 2 patients. Time to actual hospital dismissal for group I was 119 +/- 14 minutes, compared with 159 +/- 13 minutes (P < .05) for group 2.Patients receiving epidural anesthesia for knee arthroscopy had a shorter PACU stay if they received an injection of saline into the epidural space at the end of surgery.

  View details for PubMedID 9613534

• Patellar tendon graft harvesting using horizontal incisions for anterior cruciate ligament reconstruction ARTHROSCOPY Mishra, A. K., Fanton, G. S., Dillingham, M. F., Carver, T. J. 1995; 11 (6): 749-752

  Abstract

  Autograft endoscopic anterior cruciate ligament (ACL) reconstruction traditionally has been performed via standard arthroscopy portals and a single longitudinal anterior incision. This vertical incision is used for harvesting the central third of the patellar tendon with patellar and tibial bone blocks. From 1992 to 1995, more than 400 cases have been done with a new technique of graft procurement. This new method employs two transverse incisions that are more cosmetic and are less likely to become a source of pain or flexion limitation.

  View details for Web of Science ID A1995TK29000020

  View details for PubMedID 8679042

• Viscoelastic properties of common suture material used for rotator cuff repair and arthroscopic procedures. Arthroscopy Hurwit, D., Fanton, G., Tella, M., Behn, A., Hunt, K. J. 2014; 30 (11): 1406-1412

  Abstract

  The purpose of this study was to evaluate the viscoelastic properties of 5 suture materials, commonly used in arthroscopic rotator cuff repairs, when subjected to physiological loads.We evaluated 5 commercially available No. 2 sutures undergoing both creep and cyclic testing in both dry air and phosphate-buffered saline solution (PBS) maintained at 37°C. The selected sutures were MagnumWire (ArthroCare, Austin, TX), Ethibond (Ethicon, Somerville, NJ), FiberWire (Arthrex, Naples, FL), Orthocord (DePuy, Warsaw, IN), and Force Fiber (Tornier, Bloomington, MN).Regarding creep testing, in the PBS test environment, FiberWire showed the greatest stiffness (71.1 ± 2.1 N/mm), the smallest initial extension at the 60-N load (1.10 ± 0.04 mm), and the smallest amount of creep (0.57 ± 0.01 mm). Orthocord showed the smallest amount of relaxed elongation in PBS (0.73 ± 0.11 mm). Regarding cyclic testing, in the PBS testing environment, Ethibond exhibited the smallest dynamic creep (0.28 ± 0.02 mm), FiberWire displayed the smallest peak-to-peak displacement (0.17 ± 0.00 mm), and Orthocord showed the smallest amount of relaxed elongation after cyclic loading (0.63 ± 0.11 mm).FiberWire consistently displayed more extreme viscoelastic properties--greater stiffness and less extensibility--than the other suture types studied. Orthocord showed the smallest amount of relaxed elongation in both testing environments. Differences in testing environment affect the behavior of each suture type. Testing in physiologically approximating conditions such as PBS maintained at 37°C is warranted.Although many other factors affect the success of rotator cuff repairs, the viscoelastic properties of sutures may be a useful predictor of suture performance.

  View details for DOI 10.1016/j.arthro.2014.05.030

  View details for PubMedID 25108903

• Arthroscopic visualization and assisted excision of osteoid osteoma at the knee AMERICAN JOURNAL OF SPORTS MEDICINE Abnousi, F., Saliman, J. D., Fanton, G. S. 2008; 36 (2): 375-378

  View details for DOI 10.1177/0363546507307865

  View details for Web of Science ID 000252663900021

  View details for PubMedID 17878430

• Anterior cruciate ligament reconstruction using cryopreserved allografts CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Indelli, P. F., Dillingham, M. F., Fanton, G. S., Schurman, D. J. 2004: 268-275

  Abstract

  Primary ACL reconstruction historically has been done using autograft tissues whereas allografts have been limited to revision cases and patients who are older or with lower physical demands because some animal studies suggested a slower biologic incorporation rate. The purpose of the current study was to evaluate the effectiveness of the cryopreserved Achilles tendon allograft in primary ACL reconstruction in a consecutive series of athletes. Fifty consecutive patients with a strenuous or moderate preinjury activity level, as defined by the International Knee Documentation Committee (IKDC), had ACL reconstruction using cryopreserved Achilles tendon allografts secured with bioabsorbable interference screws. Five patients were professional athletes. The average age of the patients was 36 years (range, 17-50 years). A 3- to 5-year followup study was done in all of the patients using the IKDC form. Tunnel widening was measured in the lateral radiographs at the widest level. The overall outcome was normal or nearly normal in 94% of the patients. No failures were reported in this series. Forty-six patients (92%) returned to their same preinjury sport activity level. The average KT-1000 side-to-side difference was 2.3 mm. Average tibial tunnel widening was 2.7 mm (range, 0-6 mm); no significant correlation was observed between increased tunnel size and a fair or poor clinical outcome. This experience shows that favorable results can be obtained with cryopreserved Achilles tendon allografts in athletes in whom avoiding donor site morbidity may be an issue in terms of a prompt return to sport.

  View details for DOI 10.1097/01.blo.0000118443.99753.c5

  View details for Web of Science ID 000220580200038

  View details for PubMedID 15057108

• Septic arthritis in postoperative anterior cruciate ligament reconstruction CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Indelli, P. F., Dillingham, M., Fanton, G., Schurman, D. J. 2002: 182-188

  Abstract

  A review of postoperative infected anterior cruciate ligament reconstructions was done on 3500 consecutive arthroscopic procedures. The purpose was to assess incidence, diagnosis, treatment, and outcome factors. Six postoperative intraarticular infections were detected. Average followup was 3 years (range, 2-8 years). The rate of infection was 0.14%. Five men and one woman with a median age of 32.5 years (range, 20-51 years) comprised the study group. The average interval from the onset of symptoms to the initial arthroscopic intervention was 7.5 days (range, 2-20 days). Staphylococcus aureus was present in three knees, Staphylococcus epidermidis in two, and Streptococcus nonhemolytic in one. All patients had initial arthroscopic debridement and lavage followed by 6 weeks of intravenous antibiotics. Two grafts were removed: one patient had delayed ligament reconstruction and the other had total knee arthroplasty. The remaining patients had full range of motion. In the group with the best result, two patients had Staphylococcus epidermidis and one had Staphylococcus aureus, which was treated 2 days after clinical symptoms began. The other two patients infected with Staphylococcus aureus had unsatisfactory results. Anterior cruciate ligament infection is rare, but diagnosable. When treated early with appropriate antibiotic therapy and arthroscopic debridement, four of six grafts were retained. If the infection does not respond rapidly to early therapy, then graft removal is an option.

  View details for PubMedID 11964649

• Two-year outcome of arthroscopic bankart repair and electrothermal-assisted capsulorrhaphy for recurrent traumatic anterior shoulder instability 19th Annual Meeting of the Arthroscopy-Association-of-North-America Mishra, D. K., Fanton, G. S. W B SAUNDERS CO-ELSEVIER INC. 2001: 844–49

  Abstract

  Arthroscopic treatment of chronic anterior shoulder instability in active athletes is reportedly less successful than open techniques. We performed arthroscopic stabilization for confirmed capsulolabral avulsions and followed-up patients prospectively for a minimum of 24 months. Type of Study: Prospective nonrandomized study.We studied 42 patients (mean age, 26 years) with recurrent traumatic anterior dislocations. They reported an average of 9 dislocations preoperatively. An average of 69 months elapsed from initial dislocation to surgery. The shoulders underwent arthroscopic capsulolabral repair with either a suture anchor and horizontal mattress suture, or an absorbable tack. Each shoulder also was treated with a monopolar radiofrequency probe for thermal shrinkage of the middle, anteroinferior, and posteroinferior glenohumeral ligaments. Patients were evaluated prospectively for pain, motion, stability, and function using the modified Rowe score.At a mean of 28 months postoperatively, 38 patients had returned to their preinjury sports. Three patients (7%) had a traumatic redislocation. Using the modified Rowe score, statistically significant improvements were noted for pain, stability, and function. There was no significant change in motion. The overall modified Rowe score improved from 38 points preoperatively to 89 points at final evaluation (P <.001).These results indicate that arthroscopic treatment of patients with recurrent traumatic anterior instability yields results comparable to open procedures, including athletes involved in high-level contact and collision sports. We believe that addressing capsular laxity surgically is critical, particularly when dealing with chronic instability. This procedure allows the surgeon to reliably correct the labral detachment and the capsular redundancy while preserving motion and minimizing morbidity.

  View details for Web of Science ID 000171444500008

  View details for PubMedID 11600982

• Monopolar electrothermal arthroscopy for treatment of shoulder instability in the athlete OPERATIVE TECHNIQUES IN SPORTS MEDICINE Fanton, G. S. 2000; 8 (3): 242-249

  View details for DOI 10.1053/otsm.2000.18002

  View details for Web of Science ID 000089989900009

• Arthroscopic monopolar radiofrequency thermal stabilization for chronic lateral ankle instability: a preliminary report on 10 cases. journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons Oloff, L. M., Bocko, A. P., Fanton, G. 2000; 39 (3): 144-153

  Abstract

  This study represents a preliminary review of 10 patients having undergone arthroscopic monopolar thermal stabilization for ankle instability from October 1996 to June 1998. All patients in this study expressed mild to moderate chronic ankle instability complaints and were dissatisfied with their attempts at conservative care. Subjective clinical results were evaluated in all patients having undergone this procedure utilizing a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. In addition, eight of these patients underwent pre- and postoperative stress radiographs. The average age of the patient population in this study was 34.5 +/- 9.26 years. The preoperative AOFAS scores averaged 58.3 +/- 8.96 and the postoperative were 88.1 +/- 11.09 points. Patients returned to full activities on the average of 3 months. Postoperative ankle varus stress test reduced on the average of 2.8 degrees +/- 2.77 degrees, while the anterior drawer measurements reduced 4.8 +/- 1.83 mm. The reduction in anterior drawer test amounted to an approximate 60% decrease in talar excursion postoperatively. All patients who underwent this procedure achieved ankle stability and commented that they would undergo the procedure again.

  View details for PubMedID 10862385

• Bilateral stress fractures of the anterior part of the tibial cortex - A case report JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Brukner, P., Fanton, G., Bergman, A. G., Beaulieu, C., Matheson, G. O. 2000; 82A (2): 213-218

  View details for Web of Science ID 000085208600007

• Arthroscopy of the calcaneocuboid and talonavicular joints. journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons OLOFF, L., Schulhofer, S. D., Fanton, G., Dillingham, M. 1996; 35 (2): 101-108

  Abstract

  The authors describe the anatomy, portal placement, technique, indications, and preliminary results of seven cases of calcaneocuboid or talonavicular joint pathology that underwent elective investigational diagnostic or therapeutic arthroscopy with a follow up of 3-14 months. All patients had failed available conservative therapy. Results of treatment were five excellent and two good cases. Two patients required arthrotomy. There were no complications associated with portal placement, arthroscopic technique, or instrumentation. Arthroscopy of the calcaneocuboid and talonavicular joints has proven to be a relatively safe and valuable diagnostic and therapeutic tool. It is hoped that advances in small joint arthroscopy application will encourage further technological evolution in arthroscopic instrumentation and establish a foundation for further arthroscopic exploration of the small joints of the foot.

  View details for PubMedID 8722876

• Shoulder arthroscopy using the holmium:YAG laser system: State of the art 1994 ORTHOPADE Fanton, G. S. 1996; 25 (1): 79-83

  Abstract

  The Ho:YAG laser has been found to be a safe and efficacious adjunct to many arthroscopic shoulder procedures. The curved, thin handpieces are easily manipulated around the surfaces of the joint. Postoperative inflammation is minimized, and a versatile instrument that can cut, coagulate, ablate, and cauterize has obvious benefit where optimal visualization is required. The potential for chondral contouring and bone resection is currently being studied, and the use of laser-induced thermal contraction of soft tissue collagen may add some exciting possibilities to the treatment of joint instabilities.

  View details for Web of Science ID A1996TZ37900013

  View details for PubMedID 8622850

• LATERAL RETINACULAR RELEASE - THE HOLMIUM-YAG LASER VERSUS ELECTROCAUTERY CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Shapiro, G. S., Fanton, G. S., Dillingham, M. F., PERKASH, R. 1995: 42-47

  Abstract

  A retrospective study was conducted in which several parameters of postoperative recovery were compared between 2 groups of patients: 25 patients who had lateral retinacular release surgery in which the holmium:yttrium-aluminum-garnet (Ho:YAG) laser was used, and a control group of 17 patients who had the same surgery in which electrocautery was used. Postoperative recovery times of patients treated with the Ho:YAG laser were significantly decreased as compared with the recovery rates of patients in the control group. Morbidity also was reduced in the group for whom the laser was used. The results of this study indicate that the 2.1-micron-wave-length, pulsed Ho:YAG laser can be used safely and effectively to perform lateral retinacular release surgery.

  View details for Web of Science ID A1995QB44700009

  View details for PubMedID 7641457

• HOLMIUM - YAG LASER EFFECTS ON ARTICULAR-CARTILAGE METABOLISM IN-VITRO Conference on Laser Surgery: Advanced Characterization, Therapeutics, and Systems IV Smith, R. L., Montgomery, L., Fanton, G., Dillingham, M., Schurman, D. J. SPIE - INT SOC OPTICAL ENGINEERING. 1994: 149–153

  View details for Web of Science ID A1994BB54S00021

• Reconstruction for recurrent dislocation of the proximal tibiofibular joint. A new technique. Orthopaedic review Shapiro, G. S., Fanton, G. S., Dillingham, M. F. 1993; 22 (11): 1229-1232

  Abstract

  Recurrent dislocation of the proximal tibiofibular joint is a rare injury. It has been reported in parachutists and water-skiers. A technique for reconstructing the joint by using an iliotibial band fascial graft is described. This technique is recommended for recurrent dislocations of a nonarthritic proximal tibiofibular joint.

  View details for PubMedID 8127606

• INTRAARTICULAR HEMANGIOMA OF THE KNEE ARTHROSCOPY Shapiro, G. S., Fanton, G. S. 1993; 9 (4): 464-466

  Abstract

  Intraarticular hemangioma is a rare cause of knee pain and effusion. The presentation of unexplained recurrent hemearthrosis associated with no or minimal trauma, skin manifestations of hemangioma, and radiographic and magnetic resonance imaging study results should alert the clinician of this unusual entity. Successful arthroscopic ablation is reported with the use of the holmium:yttrium-aluminum-garnet (YAG) laser.

  View details for Web of Science ID A1993LQ79000016

  View details for PubMedID 8216580