髌股关节疼痛综合征研究热点与内容的可视化分析

背景：髌股关节疼痛综合征是运动损伤领域常见疾病,国内外对其研究逐年递增,但目前中国尚无针对髌股关节疼痛综合征的可视化分析。目的：客观分析近13年国内外髌股关节疼痛综合征的文献信息,总结该领域近期研究方向并梳理国内外知识结构。方法：通过Web of Science和中国知网数据库中收集近13年髌股关节疼痛综合征的相关文献,运用Citespace软件进行相关指标的可视化分析,最终呈现该领域研究热点及发展趋势。结果与结论：①最终Web of Science数据库中共纳入1 679篇文献,其中发文最多的作者是来自澳大利亚拉筹伯大学的De Oliveira Silva D和澳大利亚墨尔本大学的Crossley KM;热点关键词是Hip(髋关节)、Biomechanics(生物力学)、Prevention(预后)、Prevalence(患病率)、Consensus statement(共识声明)、Gender differences(性别差异)、Electromyographic activity(肌电活动)、Risk factor(风险因素)和Osteoarthritis(骨关节炎)等。②中国知网数据库中共纳入分析214篇文献,其中发文量最多的作者是来自广州医科大学附属第二医院康复科的缪萍;热点关键词是关节镜、生物力学、力量训练、股外侧肌、表面肌电、髌股关节炎和关节置换等。③此领域的国际研究结果显示,髌股关节疼痛综合征患者运动过程中可呈现膝关节外旋增加、髋内收增加、髋内旋减少的生物力学特点;强化髋外展外旋肌能有效改善患者的疼痛并促进功能恢复;目前国际上治疗该疾病最合适的方法是个性化定制的多模式干预方案,包括臀肌和股四头肌强化、强调教育方法和活动调整。④此领域的主要中国研究结果显示,采用关节镜下手术可改善髌股关节疼痛综合征患者的疼痛症状,而髌股关节置换对此类患者早期单纯严重髌股关节炎有一定疗效;此病的康复训练方法主要以髋关节力量训练为主,辅以核心肌群、下肢离心力量和神经肌肉控制训练;与国外疗法相比,具有中国特色的针灸和中医敷药等治疗方法的也取得了一定成果。https://orcid.org/0000-0001-5311-4704 (许杰) ;https://orcid.org/0000-0002-3366-0385(罗小兵) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

不同年龄段人群行走足底压力特征分析

目的获取不同年龄段人群正常行走时足底压力的动力学参数,为设计制作不同年龄段鞋垫和运动鞋提供理论依据,最大程度减小足部发生损伤的风险。方法使用Footscan测力平板对4个年龄段120名受试者(20～30、30～40、40～50、50～60岁男女各15名)足底压力峰值、压强峰值进行测试。结果足底压力峰值随着年龄增长不断变化,大部分呈上升趋势,只有在第1趾骨区域随着年龄的增长压力峰值逐渐减小,第1趾骨区域女性足底压力峰值在逐渐减小;大部分受试者第2、4拓骨头受力明显高于第1、5跖骨; 50～60岁年龄段男性第2跖骨压力峰值也明显大于20～50岁年龄段人群(P0. 05)。随着年龄增长,仅仅第1趾骨压力峰值逐渐减小,其余区域均呈现增长现象;压强峰值有显著变化,尤其以第2、3跖骨变化最大,呈上升趋势(P0. 05)。结论人体足底各分区的压力、压强随着年龄增长并非一成不变,找出每个年龄段人群足底压力特点,制定相应的运动鞋,才能更好发挥运动鞋的功能。     

扁平足患者足底压力与足底感觉特征

目的 探究不同足型人群足底压力与足底感觉之间的关系,为扁平足患者损伤评价以及运动恢复提供理论参考。方法 通过三维足型扫描仪,对招募的受试者进行初步筛查;根据足弓指数进行组别划分,正常足组16人,扁平足组16人。使用Footscan高频足底压力测试系统和Semmes-Weinstein Monofilaments单丝测试分别进行组别间的足底压力和足底感觉测试。对测试结果进行统计描述和相关性分析。结果 扁平足组左右足弓与左右足跟内侧区域的足底压力冲量相较于正常足组存在显著增加的趋势(P<0.05);扁平足组第1跖骨以及足弓位置的足底感觉阈值相较于正常足组更低(P<0.05);扁平足组左脚(P=0.012,R=0.500)和右脚(P=0.021,R=0.341)足弓位置的足底感觉与足底压力之间存在显著的正相关。结论 扁平足人群足弓降低和过度外翻的结构特点,导致其足弓和足跟内侧位置的足底压力冲量增大,足底感觉敏感性阈值降低;同时,足底感觉与足底压力之间存在相关性,足弓足底压力冲量负荷越大,足底感觉阈值越低。     

单、双肩书包负重行走儿童的足底压力测量

背景：在儿童时期,不同形式、质量的书包负重可能会引起步态变形。目的：检测儿童书包负重行走时的动态足底压力分布。 方法：采用比利时Footscan USB2平板式足底压测试系统对24名健康学龄儿童进行动态足底压力测试。受试者分别以自然状态、单肩背书包、双肩背书包步行经过Footscan测力平板,观察步态、支撑期时相、压强及足轴角。 结果与结论：与自然行走时比较,双肩负重行走时,受试者整足着地阶段百分比增高,左、右足的足轴角增大,足部足跟、第2跖骨、第1跖骨处的压强值增大(P < 0.05);单肩负重行走时,步态上表现出双足支撑期各阶段的不平衡,负重侧足跟、第2跖骨、第3跖骨处的压强值急剧增大,同时负重侧足轴角显著大于自然及双肩负重行走时(P < 0.05)。说明书包负重增加了儿童行走的不稳定性,单肩负重儿童双足支撑期时相及压力均表现出不平衡的特征。     

老年肌肉减少症患者的足底压力变化

文题释义：肌肉减少症：随着增龄和老年化过程,老年人的肌量逐渐减少,肌肉力量与肌肉强度也出现相应的下降,称为肌肉减少症。足底压力：人体足底压力分布反映有关足的结构、功能及整个身体姿势控制等情况。背景：肌肉减少症是老年化社会进程中不可避免的疾病,肌肉力量的下降、关节灵活性的降低、足部的结构和功能发生改变会不同程度地引起老年人步态特征的改变。因此通过对比老年肌肉减少症患者与未患肌肉减少症的老年人足底压力测试数据,有助于为临床预测老年肌肉减少症患者的跌倒风险提供精准评价指标。目的：探讨老年肌肉减少症患者的足底压力变化,为临床预测老年肌肉减少症患者的跌倒发生风险提供精准评价指标。方法：应用Footscan2.0足底压力检测系统采集老年肌肉减少症患者和未患肌肉减少症的老年人对照组足底压力数据,对比分析受试者步长、步速、触地时长、足底分区压力、足底压力中心移动轨迹。试验经中国科学技术大学附属第一医院伦理委员会批准。结果与结论：肌肉减少症组步长、步速较对照组均降低;肌肉减少症组触地时长较对照组延长;肌肉减少症组左足第二至第五脚趾区、第三跖骨区、足中部区、第四跖骨区、第五跖骨区足底压力变化与对照组相较差异有显著性意义;肌肉减少症组右足第二至第五脚趾区、第三跖骨区、第四跖骨区、第五跖骨区足底压力变化与对照组相比较差异有显著性意义;肌肉减少症组足底压力中心轨迹总长度、左右足椭圆短轴长度、左右足椭圆长轴长度变化与对照组差异有显著性意义。提示老年肌肉减少症患者步行能力、平衡控制能力较对照组减低,步态对称性较未患对照组变差。ORCID: 0000-0003-2320-8026(何媛媛);0000-0002-3764-2192(丁呈彪)中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

日常运动时足底压力实时检测方法研究

目的 基于进行足底压力日常运动负荷监测的需求,研究一种通过少量传感器对日常运动时总足底压力进行实时检测的有效方法。方法 通过Pedar-X足底压力测试系统采集10名受试者完成5种典型日常运动（原地跳跃、行走、慢跑、上楼和下楼）时的足底压力数据。随后,使用逐步线性回归对PedarX 的99个传感器的压强数据进行分析,根据偏F检验的显著性,由高到低逐个引入关键位置的压强值,直到再引入1个后,各位置的压强值间出现严重多重共线性,以此分别得到5个在5种运动中基于少量测试点数据实时计算总足底压力的模型。然后,以Pedar-X系统测量得到的另外4名受试者完成5种单项运动和由5种运动组合的连续运动时的足底压力数据为实测值,对5个回归模型进行验证和比较。结果 无论是单项还是连续日常运动,采用5种运动回归模型估测的自身运动时的总足底压力均与Pedar-X系统的实测值相近,采用行走运动回归模型估测的各种运动时的总足底压力也均与PedarX系统的实测值相近,而且两种估测方法的结果之间也无显著差异。结论 利用5个分别置于拇趾、第2跖骨、第3跖骨、足跟内侧、足跟外侧的压力传感器和行走运动的足底压力回归模型就可对日常运动下的总足底压力进行有效检测。     

平地自然行走护士的步态特征和足底压力分布◆

背景：繁忙的工作和快速行走的严格要求势必造成护士足部压力增高,甚至引起足部疾病。目的：分析护士平地自然行走下的步态特征和足底压力分布。方法：采用比利时RSscan INTERNATIONAL公司生产的足底压力分布测试系统对73名护士进行动态足底压力测试。结果与结论：护士步态分析中足底压强、冲量、支撑时间数据分析一致：在自然步态下,护士足部最大压强部位在第2、3跖骨区;足部最大冲量部位在前足;支撑期时间所占比例最大的是前足离地阶段;加上护士步速较快,足底压力相应增高,前足压力也随其增大。提示护士前足压力较高,易疲劳而发生运动损伤。因此,护士要科学的选择护士鞋或鞋垫,调整足底压力分布和足底冲量,加强对前足、特别是前足第2~3跖骨区的保护,尽可能避免足部疲劳和损伤的发生。     

老年糖尿病患者的足底压力及步态特征

BACKGROUND: Plantar pressure is one of the major risk factors for diabetic footulcers.     

基于足底压力对人体平衡能力的定量评估研究进展

目的 探索足底压力对人体平衡能力的定量评估研究,寻求行之有效、简单易行、可靠性高的描述人体平衡能力的参数指标。方法 基于疾病平衡障碍患者的康复与评估、不同生理状态、不同体育运动,对平衡能力的定量评估研究进行综述。结果 梳理得出基于足底压力对人体平衡能力的定量评估研究中参数指标的不同情形,总结并提出了两组参数指标,一是动力学参数指标,二是运动学参数指标,用以定量评估平衡能力。结论 基于足底压力的定量评估参数指标在大多数情况下能对人体平衡能力的评价提供依据,从而通过锻炼、治疗等手段进一步改善人体平衡能力,减少人体跌倒损伤风险,并有望为足底压力平衡量化分析和相关医疗器械研制提供一定帮助。     

肥胖男性少年足底动态压力变化参数

背景：青少年肥胖常引发扁平足、足、膝内外翻等症状。 目的：了解13~15岁肥胖男生足底压力参数的分布特点,认识对青少年身体平衡能力等方面所产生的影响。 方法：随机选择长春市东北师范大学附属中学13~15岁的健康在校男生60人,根据体质量指数标准分为18.5~24.9 kg/m²的对照组,25~30 kg/m²的超重组和大于30 kg/m²的肥胖组,各20人。借助比利时footscan足底压力测试系统,分析各组自然行走时足底动态压力分布变化特征。 结果与结论：不同体质量男生的足底垂直力-时间曲线的足跟着地时的冲击峰和足完全放平时出现的谷值出现在步态周期的百分比随体质量的增加而加长;超重组和肥胖组足弓部位的触地时间明显大于对照组,同时足弓和足跟的接触面积百分比增大,而前足的百分比值减小;超重组和肥胖组的足底总峰值压强明显大于对照组,足底总压强与体质量呈正相关,足底的接触面积和体质量之间存在着明显的正相关;除了足跟和第1趾骨外,超重组和肥胖组其他各部位及总的压强变化率均大于对照组。说明超重于肥胖可使男生足底压力发生变化。     

髌股关节痛业余跑者性别特异的下肢生物力学特征

目的 研究髌股关节痛(patellofemoralpain,PFP)业余跑者性别特异的下肢生物力学特征.方法 选取15名男性和10名女性PFP业余跑者作为实验组,并匹配25名无损伤业余跑者作为对照组.采集所有受试者跑步时的下肢运动学、动力学和表面肌电数据.采用双因素方差分析确定组别与性别对跑步时下肢生物力学特征的影响....     

Atrial septal defect: a diagnostic approach

A simple objective screening method for diagnosis of the atrial septal defect (ASD) is needed. Acoustic signals were collected from 61 children with ASD and 60 with a physiological murmur. The second heart sound (S2) and the spectrum of systolic murmur were analysed. A statistical model was designed using stepwise logistic regression analysis. Significant variables distinguishing pathological form normal findings were the interval between the first heart sound and the beginning of systolic murmur or the respiratory variation of S2, and the frequency of the murmur at its maximum intensity. The area under the ROC curve was 0.922; indicating very good fit of the model and the confidence interval was 0.872–0.971. The sensitivity of the model was 91% and the specificity 73%. The analysis of acoustic findings from the heart is a valuable tool in diagnosing ASD. The next step will be automating this process.     

Receiver-operating characteristic (ROC) curves: a fundamental tool for improving the clinical usefulness of in vitro IgE tests

In order to establish the most efficient thresholds for serum allergen-specific IgE measured by the Pharmacia CAP System, a "second-generation" in vitro method, we evaluated results from 89 subjects with suspected inhalant allergies, using receiver-operating characteristic (ROC) curve analysis. Sera samples were analyzed by the Pharmacia CAP System for specific IgE, the choice of allergens to be tested being based upon the symptoms and clinical history of each patient. Results were analyzed by ROC analysis for the five most representative allergens, cat dander (et), Dermatophagoides pteronyssinus (d₁) Lolium perenne (g₅), wall pellitory (W₁₉), and wormwood (w₅). The areas under the ROC curves were found to be satisfactory, ranging from 0.931 (e₁) to 0.974 (g₅) when we excluded w₅, which had a significantly smaller area (0.81). To establish the most efficient threshold for each allergen, we calculated the clinical sensitivity, specificity, efficiency, and negative and positive predictive values. The thresholds giving a higher diagnostic efficiency were as follows: 0.40 kUa/1 for dj, 0.55 kUa/1 for g₅, 0.50 for e₁, 0.65 kUa/1 for w₁₉, and 1.00 kUa/1 for w₅. It is concluded that quantitative reporting of specific IgE measurement has numerous advantages, but the choice of the positive threshold seems to be a prerequisite for obtaining the optimal clinical efficiency. It is also suggested that a specific threshold should be adopted for each allergen.     

Generalized Joint Laxity Associated With Increased Medial Foot Loading in Female Athletes

Context:

The relationship between generalized joint laxity and plantar pressure distribution of the foot and the potential implications for lower extremity injury have not been studied.

Objective:

To determine the relationship between generalized joint laxity and dynamic plantar pressure distribution. We hypothesized that individuals with greater generalized joint laxity, or hypermobility, would have greater dynamic medial midfoot pressure and loading during walking than nonhypermobile individuals.

Design:

Case control.

Setting:

Institutional biomechanics laboratory.

Patients or Other Participants:

Participants included 112 female soccer players between 11 and 21 years of age.

Main Outcome Measure(s):

Each participant was tested for generalized joint laxity using the Beighton and Horan Joint Mobility Index (BHJMI; range, 0–9) and was categorized as having either high (BHJMI score ≥4) or low (BHJMI score <4) generalized joint laxity. Peak pressure and maximum force were calculated from a dynamic, barefoot plantar pressure distribution system.

Results:

Peak pressure and maximum force were greater in the 27 participants categorized as having high generalized joint laxity than in the 85 participants categorized as having low generalized joint laxity. The midfoot region exhibited greater loading in participants with high generalized joint laxity than in the other participants. We found an effect of BHJMI classification in the medial midfoot; peak pressure in the dominant (F_1,109  =  11.262, P  =  .001) and nondominant (F_1,109  =  14.32, P < .001) sides and maximum force in the dominant (F_1,109  =  7.88, P  =  .006) and nondominant (F_1,109  =  9.18, P  =  .003) sides were greater in the high generalized joint laxity group than in the low generalized joint laxity group.

Conclusions:

Athletes classified as having high generalized joint laxity demonstrated increased midfoot loading. Delineation of risk factors for medial collapse of the foot, which include hypermobility in athletes, may help clinicians evaluate and prevent lower extremity injury with treatments, such as orthoses.     

慢性非特异性腰痛患者足底压力特征分析和平衡研究

目的 探究慢性非特异性腰痛(chronic nonspecific low back pain, CNLBP)患者和健康受试者的平衡能力差异,以及患者疼痛症状、腰椎灵活性、腹肌耐力、总体功能、生存质量和恐惧逃避心理与平衡能力的相关性,从而指导临床康复评价。方法 选取34例CNLBP患者作为实验组,另选取34例无腰痛史健康志愿者作为对照组,使用足底压力测量系统采集两组受试者静止站立时前足/后足压力比、足底压力中心位移路径长度(L)、前后向位移长度(L_AP)、侧向位移长度(L_ML)、平均速度(v)、前后向位移速度(v_AP)、侧向位移速度(v_ML)、椭圆摆动面积(S)。另外,实验组采用视觉模拟评分法(visual analogue scale, VAS)、指地距离(finger floor distance, FFD)、1 min卷腹个数、Oswestry功能障碍指数问卷表(Oswestry disability index, ODI)、健康状况调查简表(36-item short form survey...     

Aldosterone-to-renin ratio acts as the predictor distinguishing the primary aldosteronism from chronic kidney disease

Aldosterone-to-renin ratio (ARR) is a screening test for primary aldosteronism, but it was impacted by a bunch of clinical covariates. The ARR is associated with chronic kidney disease (CKD), renal artery stenosis, renin adenoma. This study aims to investigate relationship between ARR and primary aldosteronism in CKD patients. A retrospective observational analysis involves 253 attendees from Urology Department of Chengdu Military General Hospital (China), comprising 146 patients with confirmed primary aldosteronism, 56 patients with essential hypertension, and 55 patients with chronic kidney disease accounting for primary kidney disease. Blood samples were drawn from patients with particular restriction for measuring serum aldosteronism, plasma renin activity, and serum potassium. Receiver operating characteristic (ROC) curve of ARR was tested to establish cutoff values and to assess sensitivity and specificity. The results showed that LogARR values were significantly higher (P < 0.001), and PRA and serum potassium values were significantly lower (P < 0.001) in primary aldosteronism patients. By contrast, significantly higher serum aldosterone and plasma renin were observed in CKDs compared with the other two groups (P < 0.001). There was a significantly positive correlation between LogARR and serum potassium (r = -0.0345, P < 0.001, R² = 0.093). The AUC for plasma renin activity, logARR, and serum aldosterone are 0.855, 0.84, and 0.501, respectively. ROC curve of logARR and plasma renin activity in detection of primary aldosteronism with higher sensitivity and specificity. In conclusion, this study indicated that the ARR act as the biomarker for the primary aldosteronism, and could distinguish from chronic kidney disease.     

Estimation of haplotype associated with several quantitative phenotypes based on maximization of area under a receiver operating characteristic (ROC) curve

An algorithm for estimating haplotypes associated with several quantitative phenotypes is proposed. The concept of a receiver operating characteristic (ROC) curve was introduced, and a linear combination of the quantitative phenotypic values was considered. This set of values was divided into two parts: values for subjects with and without a particular haplotype. The goodness of its partition was evaluated by the area under the ROC curve (AUC). The AUC value varied from 0 to 1; this value was close to 1 when the partition had high accuracy. Therefore, the strength of association between phenotypes and haplotypes was considered to be proportional to the AUC value. In our algorithm, the parameters representing a degree of association between the haplotypes and phenotypes were estimated so as to maximize the AUC value; further, the haplotype with the maximum AUC value was considered to be the best haplotype associated with the phenotypes. This algorithm was implemented by using R language. The effectiveness of our algorithm was evaluated by applying it to real genotype data of the Calpine-10 gene obtained from diabetics. The results showed that our algorithm was more reasonable and advantageous for use with several quantitative phenotypes than the generalized linear model or the neural network model.     

Analysis of skin testing and serum-specific immunoglobulin E to predict airway reactivity to cat allergens

BACKGROUND: When the clinical history is not conclusive, it may be difficult to make an accurate interpretation of the value of skin tests and serum-specific IgE to cat allergens in asthma cases. OBJECTIVE: To analyse the diagnostic efficiency of skin testing (ST) and serum-specific IgE to cat allergens, based on the results of bronchial-specific challenge with cat epithelium. METHODS: Sixty-four asthma patients (49 with cat exposure and 15 without) who did not clearly relate their asthma symptoms to cat exposure and had a positive skin prick testing and/or a positive cat dander-specific IgE determination (CAP-system) underwent intradermal skin tests and specific bronchial challenge with cat epithelium. The results were analysed by receiver operating characteristics curves (ROC curves) and logistic regression. Sensitivity, specificity, positive predictive values and negative predictive values were calculated for different cut-off points. RESULTS: Twenty-seven patients (42.2%) had a positive bronchial-specific challenge. The area under the ROC curve for serum-specific IgE quantification is 0.85, which makes a good diagnostic tool out of this test. Intradermal ST predicts the outcome of the bronchoprovocation test better than skin prick testing (area under the ROC curve of 0.74 vs. area under the ROC curve of 0.54, respectively). The logistic regression analysis shows that the estimated probability of a positive bronchial challenge is > or =93% if CAP values are > or =17 kU(A)/L, whereas if CAP values are less than 0.35 kU(A)/L the estimated probability of a positive bronchial challenge is 16%. When the intradermal skin test is negative, the estimated probability of a positive bronchoprovocation test is 9%, being the test that better identifies patients with a negative bronchoprovocation test. CONCLUSIONS: Levels of serum-specific IgE to cat allergens and intradermal ST can be used to diagnose and treat more accurately asthmatic patients sensitized to cat epithelium when there is uncertainty about cat epithelium causality.     

机器学习多类接收机工作特性研究

接收机工作特性(ROC)曲线已经成为误分类代价未知时的两类分类器分析和比较的标准工具,实际上已经取代了分类正确率或错误率。扩展两类ROC曲线到多类ROC曲面已经成为一个增长性的研究热点。本文阐述了ROC曲线的基本概念和应用,重点介绍了多类ROC曲面的历史和具体算法,指出多类ROC曲面的研究趋势是近似计算和可视化。     

Asthma related to Alternaria sensitization: an analysis of skin‐test and serum‐specific IgE efficiency based on the bronchial provocation test

Background It is difficult to find a causal relationship between exposure to Alternaria spores and the development of asthma symptoms in sensitized individuals due to the complexity of clinical situations in which positive diagnostic tests are often found. Objective To analyse the diagnostic efficiency of skin testing (ST) and serum‐specific IgE to Alternaria, based on the results of a bronchial specific challenge with Alternaria extracts. Methods Seventy‐four asthmatic patients sensitized to Alternaria underwent a specific bronchial challenge with this mould. Skin‐testing weal sizes, serum‐specific IgE values (CAP‐system) and bronchial challenge results were analysed by receiver operating characteristics curves (ROC curves) and logistic regression. The sensitivity, specificity, positive and negative predictive values were calculated for different cut‐off points. Results Bronchial challenges to Alternaria elicited a positive result in 45 patients (61%). Skin prick testing almost perfectly predicted the outcome of bronchoprovocation tests (area under the ROC curve of 0.957), whereas intradermal skin testing had moderate efficacy. A negative result for skin prick test (SPT) showed a 4% probability of a positive bronchial challenge in the logistic regression analysis. However, weals around 5.5 mm in diameter had 90% probability of a positive challenge. Quantification of serum‐specific IgE correctly classified 86% of the cases. In the logistic regression analysis, a CAP value 16 kU_A/L predicted a positive bronchial challenge result with 99% accuracy, whereas for a CAP value <0.35 kU_A/L, this probability was 33%. Conclusions and Clinical Relevance Most asthmatic patients with positive SPT results to Alternaria would have a positive bronchial challenge. As atmospheric mould levels may vary significantly with the weather conditions, sensitized patients should be instructed on the risk situations, environmental control measures and the importance of correct medication compliance. Immunotherapy with Alternaria could also be taken into account as a valid therapeutic option. Cite this as: C. Fernández, E. Bevilacqua, N. Fernández, P. Gajate, A. G. de la Cámara, M. Garcimartín, R. Vives and J. Rodríguez, Clinical & Experimental Allergy, 2011 (41) 649–656.