Novel Polysaccharide H-1-2 from Pseudostellaria Heterophylla Alleviates Type 2 Diabetes Mellitus

Abstract Background/Aims: To investigate the potential therapeutic effect of novel polysaccharide H-1-2 from pseudostellaria heterophylla against type 2 Diabetes Mellitus (T2DM) and elucidate the underling molecular mechanisms. Methods: Relative expression of HIF1α and Sirt1 in T2DM patients was det...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Cellular physiology and biochemistry 2018-01, Vol.49 (3), p.1037-1047
Hauptverfasser: Fang, Zhao-hui , Duan, Xian-chun, Zhao, Jin-dong, Wu, Yuan-jie, Liu, Meng-meng
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1047
container_issue 3
container_start_page 1037
container_title Cellular physiology and biochemistry
container_volume 49
creator Fang, Zhao-hui 
Duan, Xian-chun
Zhao, Jin-dong
Wu, Yuan-jie
Liu, Meng-meng
description Abstract Background/Aims: To investigate the potential therapeutic effect of novel polysaccharide H-1-2 from pseudostellaria heterophylla against type 2 Diabetes Mellitus (T2DM) and elucidate the underling molecular mechanisms. Methods: Relative expression of HIF1α and Sirt1 in T2DM patients was determined via real-time PCR. The direct binding of HIF1α on Sirt1 promoter was validated by ChIP assay. The inhibitory regulation of Sirt1 by HIF1α was analyzed using luciferase reporter assay. The endogenous protein of HIF1α and Sirt1 in response to H-1-2 treatment was quantified by western blotting. The blood glucose, secreted insulin and serous lipid profiles were measured with ELISA kits. Results: We consolidated that HIF1α and Sirt1 was dysregulated in T2DM patients and subjected to H-1-2 modulation. H-1-2 significantly inhibited hypoxia and up-regulated Sirt1 expression in EndoC-βH1 cells. Accordingly, H-1-2 enhanced glucose-stimulation insulin secretion and improved blood glucose and lipid profiles in T2DM cells, and elevated the glucose and insulin tolerance simultaneously. Furthermore, we demonstrated that H-1-2 alleviated T2DM via inhibition of hypoxia and up-regulation of Sirt1 in isolated pancreatic β-cells from T2DM rats. Conclusion: Our data unambiguously demonstrated H-1-2 administration alleviated T2DM by enhancing Sirt1 expression through inhibition of hypoxia.
doi_str_mv 10.1159/000493284
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1159_000493284</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_f3cc29205ed444c3966db9eae069907e</doaj_id><sourcerecordid>2117195846</sourcerecordid><originalsourceid>FETCH-LOGICAL-c501t-6c2b4457dd30ca3c397c554c68a3d4b3bf201e5b670128b89d1dafc86253d7853</originalsourceid><addsrcrecordid>eNpdkTtPHDEUha0IFAhJQY-QpTRJMcTvR4mAZJEIoSC18dh3YJZZvLFnkPbfx5vdbEFlH_u759r3IHRMyRml0n4jhAjLmRHv0CEVjDZWa7NX94TKxlijD9CHUuakSm3Ze3TACbWKWXqIHm7TKwz4Lg2r4kN48rmPgGcNbRjuclrguwJTTGWEYah3Hs9ghJyWT6uq8fkwwGvvRyj4frUEzPBl71tY65-1oB-n8hHtd34o8Gm7HqHf36_uL2bNza8f1xfnN02QhI6NCqwVQuoYOQmeB251kFIEZTyPouVtxwgF2SpNKDOtsZFG3wWjmORRG8mP0PXGNyY_d8vcL3xeueR79-8g5Ufn89iHAVzHQ2CWEQlRCFFbKRVbCx6IspZoqF5fNl7LnP5MUEa36EtYT-AF0lQcq4O1jCvGK_r5DTpPU36pP60U1dRKI1Slvm6okFMpGbrdAylx6wjdLsLKnm4dp3YBcUf-z6wCJxvg2edHyDtgW_8XkMqc7Q</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2117195846</pqid></control><display><type>article</type><title>Novel Polysaccharide H-1-2 from Pseudostellaria Heterophylla Alleviates Type 2 Diabetes Mellitus</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB Electronic Journals Library</source><source>Karger Open Access Journals</source><creator>Fang, Zhao-hui  ; Duan, Xian-chun ; Zhao, Jin-dong ; Wu, Yuan-jie ; Liu, Meng-meng</creator><creatorcontrib>Fang, Zhao-hui  ; Duan, Xian-chun ; Zhao, Jin-dong ; Wu, Yuan-jie ; Liu, Meng-meng</creatorcontrib><description>Abstract Background/Aims: To investigate the potential therapeutic effect of novel polysaccharide H-1-2 from pseudostellaria heterophylla against type 2 Diabetes Mellitus (T2DM) and elucidate the underling molecular mechanisms. Methods: Relative expression of HIF1α and Sirt1 in T2DM patients was determined via real-time PCR. The direct binding of HIF1α on Sirt1 promoter was validated by ChIP assay. The inhibitory regulation of Sirt1 by HIF1α was analyzed using luciferase reporter assay. The endogenous protein of HIF1α and Sirt1 in response to H-1-2 treatment was quantified by western blotting. The blood glucose, secreted insulin and serous lipid profiles were measured with ELISA kits. Results: We consolidated that HIF1α and Sirt1 was dysregulated in T2DM patients and subjected to H-1-2 modulation. H-1-2 significantly inhibited hypoxia and up-regulated Sirt1 expression in EndoC-βH1 cells. Accordingly, H-1-2 enhanced glucose-stimulation insulin secretion and improved blood glucose and lipid profiles in T2DM cells, and elevated the glucose and insulin tolerance simultaneously. Furthermore, we demonstrated that H-1-2 alleviated T2DM via inhibition of hypoxia and up-regulation of Sirt1 in isolated pancreatic β-cells from T2DM rats. Conclusion: Our data unambiguously demonstrated H-1-2 administration alleviated T2DM by enhancing Sirt1 expression through inhibition of hypoxia.</description><identifier>ISSN: 1015-8987</identifier><identifier>EISSN: 1421-9778</identifier><identifier>DOI: 10.1159/000493284</identifier><identifier>PMID: 30196291</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Animals ; Autophagy ; Blood Glucose - analysis ; Caryophyllaceae - metabolism ; Cell cycle ; Cell Line ; Chinese medicine ; Cobalt - pharmacology ; Deoxyribonucleic acid ; Diabetes ; Diabetes Mellitus, Type 2 - metabolism ; Diabetes Mellitus, Type 2 - pathology ; Diabetic retinopathy ; Disease Models, Animal ; DNA ; Female ; Glucose ; Glucose - pharmacology ; H-1-2 ; Humans ; Hypoxia ; Hypoxia-Inducible Factor 1, alpha Subunit - genetics ; Hypoxia-Inducible Factor 1, alpha Subunit - metabolism ; Insulin ; Insulin - metabolism ; Insulin resistance ; Insulin-Secreting Cells - cytology ; Insulin-Secreting Cells - metabolism ; Kidneys ; Male ; MicroRNAs - genetics ; MicroRNAs - metabolism ; Original Paper ; Polysaccharides - metabolism ; Polysaccharides - pharmacology ; Promoter Regions, Genetic ; Rats ; Sirt1 ; Sirtuin 1 - metabolism ; T2DM ; Up-Regulation - drug effects</subject><ispartof>Cellular physiology and biochemistry, 2018-01, Vol.49 (3), p.1037-1047</ispartof><rights>2018 The Author(s). Published by S. Karger AG, Basel</rights><rights>2018 The Author(s). Published by S. Karger AG, Basel.</rights><rights>2018 The Author(s). Published by S. Karger AG, Basel . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the associated terms available at: https://uk.sagepub.com/en-gb/eur/reusing-open-access-and-sage-choice-content</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c501t-6c2b4457dd30ca3c397c554c68a3d4b3bf201e5b670128b89d1dafc86253d7853</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,2096,27612,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30196291$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fang, Zhao-hui </creatorcontrib><creatorcontrib>Duan, Xian-chun</creatorcontrib><creatorcontrib>Zhao, Jin-dong</creatorcontrib><creatorcontrib>Wu, Yuan-jie</creatorcontrib><creatorcontrib>Liu, Meng-meng</creatorcontrib><title>Novel Polysaccharide H-1-2 from Pseudostellaria Heterophylla Alleviates Type 2 Diabetes Mellitus</title><title>Cellular physiology and biochemistry</title><addtitle>Cell Physiol Biochem</addtitle><description>Abstract Background/Aims: To investigate the potential therapeutic effect of novel polysaccharide H-1-2 from pseudostellaria heterophylla against type 2 Diabetes Mellitus (T2DM) and elucidate the underling molecular mechanisms. Methods: Relative expression of HIF1α and Sirt1 in T2DM patients was determined via real-time PCR. The direct binding of HIF1α on Sirt1 promoter was validated by ChIP assay. The inhibitory regulation of Sirt1 by HIF1α was analyzed using luciferase reporter assay. The endogenous protein of HIF1α and Sirt1 in response to H-1-2 treatment was quantified by western blotting. The blood glucose, secreted insulin and serous lipid profiles were measured with ELISA kits. Results: We consolidated that HIF1α and Sirt1 was dysregulated in T2DM patients and subjected to H-1-2 modulation. H-1-2 significantly inhibited hypoxia and up-regulated Sirt1 expression in EndoC-βH1 cells. Accordingly, H-1-2 enhanced glucose-stimulation insulin secretion and improved blood glucose and lipid profiles in T2DM cells, and elevated the glucose and insulin tolerance simultaneously. Furthermore, we demonstrated that H-1-2 alleviated T2DM via inhibition of hypoxia and up-regulation of Sirt1 in isolated pancreatic β-cells from T2DM rats. Conclusion: Our data unambiguously demonstrated H-1-2 administration alleviated T2DM by enhancing Sirt1 expression through inhibition of hypoxia.</description><subject>Animals</subject><subject>Autophagy</subject><subject>Blood Glucose - analysis</subject><subject>Caryophyllaceae - metabolism</subject><subject>Cell cycle</subject><subject>Cell Line</subject><subject>Chinese medicine</subject><subject>Cobalt - pharmacology</subject><subject>Deoxyribonucleic acid</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - metabolism</subject><subject>Diabetes Mellitus, Type 2 - pathology</subject><subject>Diabetic retinopathy</subject><subject>Disease Models, Animal</subject><subject>DNA</subject><subject>Female</subject><subject>Glucose</subject><subject>Glucose - pharmacology</subject><subject>H-1-2</subject><subject>Humans</subject><subject>Hypoxia</subject><subject>Hypoxia-Inducible Factor 1, alpha Subunit - genetics</subject><subject>Hypoxia-Inducible Factor 1, alpha Subunit - metabolism</subject><subject>Insulin</subject><subject>Insulin - metabolism</subject><subject>Insulin resistance</subject><subject>Insulin-Secreting Cells - cytology</subject><subject>Insulin-Secreting Cells - metabolism</subject><subject>Kidneys</subject><subject>Male</subject><subject>MicroRNAs - genetics</subject><subject>MicroRNAs - metabolism</subject><subject>Original Paper</subject><subject>Polysaccharides - metabolism</subject><subject>Polysaccharides - pharmacology</subject><subject>Promoter Regions, Genetic</subject><subject>Rats</subject><subject>Sirt1</subject><subject>Sirtuin 1 - metabolism</subject><subject>T2DM</subject><subject>Up-Regulation - drug effects</subject><issn>1015-8987</issn><issn>1421-9778</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNpdkTtPHDEUha0IFAhJQY-QpTRJMcTvR4mAZJEIoSC18dh3YJZZvLFnkPbfx5vdbEFlH_u759r3IHRMyRml0n4jhAjLmRHv0CEVjDZWa7NX94TKxlijD9CHUuakSm3Ze3TACbWKWXqIHm7TKwz4Lg2r4kN48rmPgGcNbRjuclrguwJTTGWEYah3Hs9ghJyWT6uq8fkwwGvvRyj4frUEzPBl71tY65-1oB-n8hHtd34o8Gm7HqHf36_uL2bNza8f1xfnN02QhI6NCqwVQuoYOQmeB251kFIEZTyPouVtxwgF2SpNKDOtsZFG3wWjmORRG8mP0PXGNyY_d8vcL3xeueR79-8g5Ufn89iHAVzHQ2CWEQlRCFFbKRVbCx6IspZoqF5fNl7LnP5MUEa36EtYT-AF0lQcq4O1jCvGK_r5DTpPU36pP60U1dRKI1Slvm6okFMpGbrdAylx6wjdLsLKnm4dp3YBcUf-z6wCJxvg2edHyDtgW_8XkMqc7Q</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Fang, Zhao-hui </creator><creator>Duan, Xian-chun</creator><creator>Zhao, Jin-dong</creator><creator>Wu, Yuan-jie</creator><creator>Liu, Meng-meng</creator><general>S. Karger AG</general><general>Cell Physiol Biochem Press GmbH &amp; Co KG</general><scope>M--</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>DOA</scope></search><sort><creationdate>20180101</creationdate><title>Novel Polysaccharide H-1-2 from Pseudostellaria Heterophylla Alleviates Type 2 Diabetes Mellitus</title><author>Fang, Zhao-hui  ; Duan, Xian-chun ; Zhao, Jin-dong ; Wu, Yuan-jie ; Liu, Meng-meng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c501t-6c2b4457dd30ca3c397c554c68a3d4b3bf201e5b670128b89d1dafc86253d7853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Animals</topic><topic>Autophagy</topic><topic>Blood Glucose - analysis</topic><topic>Caryophyllaceae - metabolism</topic><topic>Cell cycle</topic><topic>Cell Line</topic><topic>Chinese medicine</topic><topic>Cobalt - pharmacology</topic><topic>Deoxyribonucleic acid</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - metabolism</topic><topic>Diabetes Mellitus, Type 2 - pathology</topic><topic>Diabetic retinopathy</topic><topic>Disease Models, Animal</topic><topic>DNA</topic><topic>Female</topic><topic>Glucose</topic><topic>Glucose - pharmacology</topic><topic>H-1-2</topic><topic>Humans</topic><topic>Hypoxia</topic><topic>Hypoxia-Inducible Factor 1, alpha Subunit - genetics</topic><topic>Hypoxia-Inducible Factor 1, alpha Subunit - metabolism</topic><topic>Insulin</topic><topic>Insulin - metabolism</topic><topic>Insulin resistance</topic><topic>Insulin-Secreting Cells - cytology</topic><topic>Insulin-Secreting Cells - metabolism</topic><topic>Kidneys</topic><topic>Male</topic><topic>MicroRNAs - genetics</topic><topic>MicroRNAs - metabolism</topic><topic>Original Paper</topic><topic>Polysaccharides - metabolism</topic><topic>Polysaccharides - pharmacology</topic><topic>Promoter Regions, Genetic</topic><topic>Rats</topic><topic>Sirt1</topic><topic>Sirtuin 1 - metabolism</topic><topic>T2DM</topic><topic>Up-Regulation - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fang, Zhao-hui </creatorcontrib><creatorcontrib>Duan, Xian-chun</creatorcontrib><creatorcontrib>Zhao, Jin-dong</creatorcontrib><creatorcontrib>Wu, Yuan-jie</creatorcontrib><creatorcontrib>Liu, Meng-meng</creatorcontrib><collection>Karger Open Access Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Cellular physiology and biochemistry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fang, Zhao-hui </au><au>Duan, Xian-chun</au><au>Zhao, Jin-dong</au><au>Wu, Yuan-jie</au><au>Liu, Meng-meng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Novel Polysaccharide H-1-2 from Pseudostellaria Heterophylla Alleviates Type 2 Diabetes Mellitus</atitle><jtitle>Cellular physiology and biochemistry</jtitle><addtitle>Cell Physiol Biochem</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>49</volume><issue>3</issue><spage>1037</spage><epage>1047</epage><pages>1037-1047</pages><issn>1015-8987</issn><eissn>1421-9778</eissn><abstract>Abstract Background/Aims: To investigate the potential therapeutic effect of novel polysaccharide H-1-2 from pseudostellaria heterophylla against type 2 Diabetes Mellitus (T2DM) and elucidate the underling molecular mechanisms. Methods: Relative expression of HIF1α and Sirt1 in T2DM patients was determined via real-time PCR. The direct binding of HIF1α on Sirt1 promoter was validated by ChIP assay. The inhibitory regulation of Sirt1 by HIF1α was analyzed using luciferase reporter assay. The endogenous protein of HIF1α and Sirt1 in response to H-1-2 treatment was quantified by western blotting. The blood glucose, secreted insulin and serous lipid profiles were measured with ELISA kits. Results: We consolidated that HIF1α and Sirt1 was dysregulated in T2DM patients and subjected to H-1-2 modulation. H-1-2 significantly inhibited hypoxia and up-regulated Sirt1 expression in EndoC-βH1 cells. Accordingly, H-1-2 enhanced glucose-stimulation insulin secretion and improved blood glucose and lipid profiles in T2DM cells, and elevated the glucose and insulin tolerance simultaneously. Furthermore, we demonstrated that H-1-2 alleviated T2DM via inhibition of hypoxia and up-regulation of Sirt1 in isolated pancreatic β-cells from T2DM rats. Conclusion: Our data unambiguously demonstrated H-1-2 administration alleviated T2DM by enhancing Sirt1 expression through inhibition of hypoxia.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>30196291</pmid><doi>10.1159/000493284</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1015-8987
ispartof Cellular physiology and biochemistry, 2018-01, Vol.49 (3), p.1037-1047
issn 1015-8987
1421-9778
language eng
recordid cdi_crossref_primary_10_1159_000493284
source MEDLINE; DOAJ Directory of Open Access Journals; EZB Electronic Journals Library; Karger Open Access Journals
subjects Animals
Autophagy
Blood Glucose - analysis
Caryophyllaceae - metabolism
Cell cycle
Cell Line
Chinese medicine
Cobalt - pharmacology
Deoxyribonucleic acid
Diabetes
Diabetes Mellitus, Type 2 - metabolism
Diabetes Mellitus, Type 2 - pathology
Diabetic retinopathy
Disease Models, Animal
DNA
Female
Glucose
Glucose - pharmacology
H-1-2
Humans
Hypoxia
Hypoxia-Inducible Factor 1, alpha Subunit - genetics
Hypoxia-Inducible Factor 1, alpha Subunit - metabolism
Insulin
Insulin - metabolism
Insulin resistance
Insulin-Secreting Cells - cytology
Insulin-Secreting Cells - metabolism
Kidneys
Male
MicroRNAs - genetics
MicroRNAs - metabolism
Original Paper
Polysaccharides - metabolism
Polysaccharides - pharmacology
Promoter Regions, Genetic
Rats
Sirt1
Sirtuin 1 - metabolism
T2DM
Up-Regulation - drug effects
title Novel Polysaccharide H-1-2 from Pseudostellaria Heterophylla Alleviates Type 2 Diabetes Mellitus
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-11T23%3A58%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Novel%20Polysaccharide%20H-1-2%20from%20Pseudostellaria%20Heterophylla%20Alleviates%20Type%202%20Diabetes%20Mellitus&rft.jtitle=Cellular%20physiology%20and%20biochemistry&rft.au=Fang,%20Zhao-hui%C2%A0&rft.date=2018-01-01&rft.volume=49&rft.issue=3&rft.spage=1037&rft.epage=1047&rft.pages=1037-1047&rft.issn=1015-8987&rft.eissn=1421-9778&rft_id=info:doi/10.1159/000493284&rft_dat=%3Cproquest_cross%3E2117195846%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2117195846&rft_id=info:pmid/30196291&rft_doaj_id=oai_doaj_org_article_f3cc29205ed444c3966db9eae069907e&rfr_iscdi=true