<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-4157</journal-id>
<journal-title><![CDATA[Biomédica]]></journal-title>
<abbrev-journal-title><![CDATA[Biomed.]]></abbrev-journal-title>
<issn>0120-4157</issn>
<publisher>
<publisher-name><![CDATA[Instituto Nacional de Salud]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-41572022000300460</article-id>
<article-id pub-id-type="doi">10.7705/biomedica.6347</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Coloración de Ziehl-Neelsen en el laboratorio de patología: rendimiento y contribución al diagnóstico de micobacterias en el lavado broncoalveolar]]></article-title>
<article-title xml:lang="en"><![CDATA[Ziehl-Neelsen stain in the pathology laboaratory: Performance and diagnostic aid for mycobacteria in bronchoalveolar lavage]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arteta]]></surname>
<given-names><![CDATA[Ariel A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arias]]></surname>
<given-names><![CDATA[Luis F.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
<xref ref-type="aff" rid="A a"/>
<xref ref-type="aff" rid="A3"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cadavid]]></surname>
<given-names><![CDATA[Claudia E.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Antioquia  ]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Antioquia  ]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital San Vicente Fundación  ]]></institution>
<addr-line><![CDATA[Medellín ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2022</year>
</pub-date>
<volume>42</volume>
<numero>3</numero>
<fpage>460</fpage>
<lpage>469</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-41572022000300460&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-41572022000300460&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-41572022000300460&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción. La coloración de Ziehl-Neelsen, con más de 100 años de uso, continúa vigente mundialmente.  Objetivo.  Comparar el rendimiento de las pruebas diagnósticas utilizadas para la determinación de micobacterias en el laboratorio clínico de patología en muestras de lavado broncoalveolar.  Materiales y métodos. Se revisaron retrospectivamente 737 muestras de lavado broncoalveolar procesadas en el 2019 y el 2020 en el Hospital San Vicente Fundación (Medellín, Colombia) y se compararon las características de tres pruebas diagnósticas realizadas en paralelo: la reacción en cadena de la polimerasa (PCR) para micobacterias con detección de resistencia, el cultivo, y la coloración de Ziehl-Neelsen.  Resultados. Se catalogaron como enfermos a 93 de los 737 pacientes a partir de los resultados positivos en alguna de las tres pruebas. El cultivo tuvo una sensibilidad de 0,80, la PCR una de 0,76 y la coloración de Ziehl-Neelsen una de 0,51. Sin embargo, solo 5 de 75 (6,5 %) cultivos fueron positivos a las cuatro semanas y el resto lo fue a las ocho semanas. La PCR combinada con la coloración de Ziehl-Neelsen mejoró la sensibilidad de la PCR por sí sola, de 0,76 a 0,88, diferencia que fue estadísticamente signifcativa (p=0,022)  Conclusión. En las muestras de lavado broncoalveolar, el cultivo sigue siendo la prueba con mejor sensibilidad. El uso conjunto de la prueba de PCR y la coloración de ZiehlNeelsen mejora signifcativamente la sensibilidad de la primera, lo que compensa la demora relativa en la entrega de los resultados debida al tiempo requerido para la tinción de Ziehl-Neelsen.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: With more than 100 years of use, the Ziehl-Neelsen stain is still currently used worldwide.  Objective:  To compare the performance of diagnostic tests used to determine mycobacteria in the clinic and pathology laboratory in bronchoalveolar lavage samples.  Materials and methods:  We retrospectively reviewed 737 bronchoalveolar lavage samples from 2019 to 2020 in the San Vicente Fundación hospital (Medellín, Colombia) comparing the performance of three tests done in parallel: mycobacteria and resistance PCR, culture, and Ziehl-Neelsen stain.  Results:  In total, 93/737 patients were classifed as sick due to a positive result in any of the three tests. The culture, PCR, and Ziehl-Neelsen stain had a sensibility of 0.80, 0.76 y 0.51, respectively. However, only 5/75 (6.5%) of the positive cultures had results within the frst four weeks and the rest in eight weeks. The PCR test combined with the Ziehl-Neelsen stain improved the sensibility of the PCR test alone from 0.76 a 0.88, a change that was statistically signifcant (p = 0.022).  Conclusion: At least in bronchoalveolar lavage samples, culture is still the test with better sensibility. The use in parallel of the PCR test and the Ziehl-Neelsen stain improved in a statistically signifcant manner the performance of the PCR test alone, regardless of the higher turnaround time of the Ziehl-Neelsen stain.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[tuberculosis/diagnóstico]]></kwd>
<kwd lng="es"><![CDATA[lavado broncoalveolar]]></kwd>
<kwd lng="es"><![CDATA[sensibilidad y especifcidad]]></kwd>
<kwd lng="es"><![CDATA[Colombia]]></kwd>
<kwd lng="en"><![CDATA[Tuberculosis/diagnosis]]></kwd>
<kwd lng="en"><![CDATA[bronchoalveolar lavage]]></kwd>
<kwd lng="en"><![CDATA[sensitivity and specifcity]]></kwd>
<kwd lng="en"><![CDATA[Colombia]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[MK]]></given-names>
</name>
<name>
<surname><![CDATA[Islam]]></surname>
<given-names><![CDATA[MN]]></given-names>
</name>
<name>
<surname><![CDATA[Ferdous]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Alam]]></surname>
<given-names><![CDATA[MM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[An overview on epidemiology of tuberculosis]]></article-title>
<source><![CDATA[Mymensingh Med J]]></source>
<year>2019</year>
<volume>28</volume>
<page-range>259-66</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pezzella]]></surname>
<given-names><![CDATA[AT.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[History of pulmonary tuberculosis]]></article-title>
<source><![CDATA[Thorac Surg Clin]]></source>
<year>2019</year>
<volume>29</volume>
<page-range>1-17</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bañuls]]></surname>
<given-names><![CDATA[A-L]]></given-names>
</name>
<name>
<surname><![CDATA[Sanou]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[van Anh]]></surname>
<given-names><![CDATA[NT]]></given-names>
</name>
<name>
<surname><![CDATA[Godreuil]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Mycobacterium tuberculosis: Ecology and evolution of a human bacterium]]></article-title>
<source><![CDATA[J Med Microbiol]]></source>
<year>2015</year>
<volume>64</volume>
<page-range>1261-9</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4.</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fadul]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<source><![CDATA[Vigilancia y análisis del riesgo en salud pública, protocolo de vigilancia en salud pública de tuberculosis farmacorresistente]]></source>
<year>2019</year>
<publisher-loc><![CDATA[Bogotá, D.C. ]]></publisher-loc>
<publisher-name><![CDATA[Instituto Nacional de Salud]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<label>5.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rodríguez-Castillo]]></surname>
<given-names><![CDATA[JG]]></given-names>
</name>
<name>
<surname><![CDATA[Llerena]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Argoty-Chamorro]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Guerra]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Couvin]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Rastogi]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Population structure of multidrug-resistant Mycobacterium tuberculosis clinical isolates in Colombia]]></article-title>
<source><![CDATA[Tuberculosis (Edinb)]]></source>
<year>2020</year>
<volume>125</volume>
<page-range>102011</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Santos-Pereira]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Magalhães]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Araújo]]></surname>
<given-names><![CDATA[PMM]]></given-names>
</name>
<name>
<surname><![CDATA[S Osório]]></surname>
<given-names><![CDATA[N.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evolutionary genetics of Mycobacterium tuberculosis and HIV-1: &#8220;The Tortoise and the Hare.&#8221;]]></article-title>
<source><![CDATA[Microorganisms]]></source>
<year>2021</year>
<volume>9</volume>
<page-range>147</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gopalaswamy]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Subbian]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Corticosteroids for COVID-19 therapy: potential implications on tuberculosis]]></article-title>
<source><![CDATA[Int J Mol Sci]]></source>
<year>2021</year>
<volume>22</volume>
<page-range>3773</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Anastasopoulou]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Ziogas]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Samarkos]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kirkwood]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Gogas]]></surname>
<given-names><![CDATA[H.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: Current evidence and clinical practice recommendations]]></article-title>
<source><![CDATA[J Immunother Cancer]]></source>
<year>2019</year>
<volume>7</volume>
<page-range>239</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Naranjo]]></surname>
<given-names><![CDATA[PJ de]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Caldas]]></surname>
<given-names><![CDATA[ML.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La coloración de Ziehl-Neelsen en histopatología]]></article-title>
<source><![CDATA[Biomédica]]></source>
<year>1988</year>
<volume>8</volume>
<page-range>84-93</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rincón-Caballero]]></surname>
<given-names><![CDATA[OL]]></given-names>
</name>
<name>
<surname><![CDATA[Cano-Romero]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Aristizábal-Bernal]]></surname>
<given-names><![CDATA[BH.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnóstico de tuberculosis pulmonar en lavado broncoalveolar: desempeño de la PCR en comparación con las pruebas microbiológicas de rutina]]></article-title>
<source><![CDATA[Med Lab]]></source>
<year>2017</year>
<volume>23</volume>
<page-range>475-84</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11.</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Balows]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hausler Jr]]></surname>
<given-names><![CDATA[WJ]]></given-names>
</name>
<name>
<surname><![CDATA[Herrmann]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
<name>
<surname><![CDATA[Isenberg]]></surname>
<given-names><![CDATA[HD]]></given-names>
</name>
<name>
<surname><![CDATA[Shadomy]]></surname>
<given-names><![CDATA[HJ.]]></given-names>
</name>
</person-group>
<source><![CDATA[Manual of Clinical Microbiology]]></source>
<year>1991</year>
<edition>5th edition</edition>
<page-range>1384</page-range><publisher-loc><![CDATA[Washington, D.C. ]]></publisher-loc>
<publisher-name><![CDATA[American Society for Microbiology]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bodal VK]]></surname>
<given-names><![CDATA[Bal MS]]></given-names>
</name>
<name>
<surname><![CDATA[Bhagat S]]></surname>
<given-names><![CDATA[Kishan J]]></given-names>
</name>
<name>
<surname><![CDATA[Deepika]]></surname>
<given-names><![CDATA[Brar RK.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fluorescent microscopy and Ziehl- Neelsen staining of bronchoalveolar lavage, bronchial washings, bronchoscopic brushing and post bronchoscopic sputum along with cytological examination in cases of suspected tuberculosis]]></article-title>
<source><![CDATA[Indian J Pathol Microbiol]]></source>
<year>2015</year>
<volume>58</volume>
<page-range>443-7</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Elbrolosy]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[El Helbawy]]></surname>
<given-names><![CDATA[RH]]></given-names>
</name>
<name>
<surname><![CDATA[Mansour]]></surname>
<given-names><![CDATA[OM]]></given-names>
</name>
<name>
<surname><![CDATA[Latif]]></surname>
<given-names><![CDATA[RA.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[agnostic utility of GeneXpert MTB/ RIF assay versus conventional methods for diagnosis of pulmonary and extra-pulmonary tuberculosis]]></article-title>
<source><![CDATA[BMC Microbiol]]></source>
<year>2021</year>
<volume>21</volume>
<page-range>144</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wasim Yusuf]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Iram]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Zeenat]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hussain]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Aslam]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rapid diagnosis of tuberculosis using Xpert MTB/RIF assay - Report from a developing country]]></article-title>
<source><![CDATA[Pak J Med Sci]]></source>
<year>2015</year>
<volume>31</volume>
<page-range>105-10</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zheng]]></surname>
<given-names><![CDATA[L-H]]></given-names>
</name>
<name>
<surname><![CDATA[Jia]]></surname>
<given-names><![CDATA[H-Y]]></given-names>
</name>
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[X-J]]></given-names>
</name>
<name>
<surname><![CDATA[Sun]]></surname>
<given-names><![CDATA[H-S]]></given-names>
</name>
<name>
<surname><![CDATA[Du]]></surname>
<given-names><![CDATA[F-J]]></given-names>
</name>
<name>
<surname><![CDATA[Pan]]></surname>
<given-names><![CDATA[L-P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Modified cytospin slide microscopy method for rapid diagnosis of smear-negative pulmonary tuberculosis]]></article-title>
<source><![CDATA[Int J Tuberc Lung Dis]]></source>
<year>2016</year>
<volume>20</volume>
<page-range>456-61</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[van Deun]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hamid Salim]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Aung]]></surname>
<given-names><![CDATA[KJM]]></given-names>
</name>
<name>
<surname><![CDATA[Hossain]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Chambugonj]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Hye]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Performance of variations of carbolfuchsin staining of sputum smears for AFB under field conditions]]></article-title>
<source><![CDATA[Int J Tuberc Lung Dis]]></source>
<year>2005</year>
<volume>9</volume>
<page-range>1127-33</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17.</label><nlm-citation citation-type="journal">
<collab>Tuberculosis Division - International Union Against Tuberculosis and Lung Disease</collab>
<article-title xml:lang=""><![CDATA[Tuberculosis bacteriology--priorities and indications in high prevalence countries: Position of the technical staff of the Tuberculosis Division of the International Union Against Tuberculosis and Lung Disease]]></article-title>
<source><![CDATA[Int J Tuberc Lung Dis]]></source>
<year>2005</year>
<volume>9</volume>
<page-range>355-61</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Karstaedt]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Jones]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Khoosal]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Crewe-Brown]]></surname>
<given-names><![CDATA[HH.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The bacteriology of pulmonary tuberculosis in a population with high human immunodeficiency virus seroprevalence]]></article-title>
<source><![CDATA[Int J Tuberc Lung Dis]]></source>
<year>1998</year>
<volume>2</volume>
<page-range>312-6</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Starke]]></surname>
<given-names><![CDATA[JR.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis of tuberculosis in children: Increased need for better methods]]></article-title>
<source><![CDATA[Emerg Infect Dis]]></source>
<year>1995</year>
<volume>1</volume>
<page-range>115-23</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
