Cerebrovasodilatory contribution of endogenous carbon monoxide during seizures in newborn pigs

Carbon monoxide (CO) and the excitatory amino acid glutamate both dilate cerebral arterioles in newborn pigs. The key enzyme in CO synthesis is heme oxygenase, which is highly expressed in neurons with glutamatergic receptor activity as well as cerebral microvessels. During seizures the extracellula...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Pediatric research 2002-05, Vol.51 (5), p.579-585
Hauptverfasser: POURCYROUS, Massroor, BADA, Henrietta S, PARFENOVA, Helena, DALEY, Michael L, KORONES, Sheldon B, LEFFLER, Charles W
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 585
container_issue 5
container_start_page 579
container_title Pediatric research
container_volume 51
creator POURCYROUS, Massroor
BADA, Henrietta S
PARFENOVA, Helena
DALEY, Michael L
KORONES, Sheldon B
LEFFLER, Charles W
description Carbon monoxide (CO) and the excitatory amino acid glutamate both dilate cerebral arterioles in newborn pigs. The key enzyme in CO synthesis is heme oxygenase, which is highly expressed in neurons with glutamatergic receptor activity as well as cerebral microvessels. During seizures the extracellular level of glutamate is increased, which results in excessive depolarization of neurons. We hypothesized that CO is a mediator of excitatory amino acid-induced dilation of the cerebral microvasculature during seizures. Three groups of piglets were examined: 1) i.v. normal saline (sham control), 2) topical chromium mesoporphyrin (Cr-MP, 15 x 10(-6) M), and 3) i.v. tin-protoporphyrin (Sn-PP, 4 mg/kg). Synthetic metalloporphyrins (Cr-MP and Sn-PP) are heme oxygenase inhibitors, thereby reducing CO synthesis. Implanted closed cranial windows were used to monitor changes in pial arteriolar diameters. Seizures were induced by administration of i.v. bicuculline. Changes in pial arteriolar diameters were monitored during 30 min of status epilepticus. The percent increase in pial arteriolar dilation in the saline group during seizures was 68 +/- 3%. In the metalloporphyrin groups, the pial arteriolar dilation was markedly reduced (35 +/- 3% and 13 +/- 1%, for Cr-MP and Sn-PP, respectively; p < 0.05, compared with the saline group). We conclude that metalloporphyrins by inhibition of heme oxygenase and prevention of CO synthesis attenuate pial arteriolar dilation during seizures. Therefore, CO appears to be involved in cerebral vasodilation caused by glutamatergic seizures.
doi_str_mv 10.1203/00006450-200205000-00006
format Article
fullrecord <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1203_00006450_200205000_00006</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>11978880</sourcerecordid><originalsourceid>FETCH-LOGICAL-c391t-fee84693ca4a3f605230eaa3a71249201092d14e2a9856416b37ef35cadb402c3</originalsourceid><addsrcrecordid>eNpFkEtPwzAQhC0EoqXwF5AvHAPrV2IfUcVLQuICVyLH2VRGrV3ZCVB-PYEWupfRjGb28BFCGVwyDuIKxiulgoIDcFCjK36jAzJlSoxGyuqQTAEEK4QxekJOcn4DYFJpeUwmjJlKaw1T8jrHhE2K7zbH1i9tH9OGuhj65Juh9zHQ2FEMbVxgiEOmzqZmDFcxxE_fIm2H5MOCZvRfQ8JMfaABP5qYAl37RT4lR51dZjzb6Yy83N48z--Lx6e7h_n1Y-GEYX3RIWpZGuGstKIrQXEBaK2wFePScGBgeMskcmu0KiUrG1FhJ5SzbSOBOzEjevvXpZhzwq5eJ7-yaVMzqH-Q1X_I6n9k22icnm-n66FZYbsf7hiNhYtdwWZnl12ywfm874lSQTmi_gaoC3VT</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Cerebrovasodilatory contribution of endogenous carbon monoxide during seizures in newborn pigs</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>POURCYROUS, Massroor ; BADA, Henrietta S ; PARFENOVA, Helena ; DALEY, Michael L ; KORONES, Sheldon B ; LEFFLER, Charles W</creator><creatorcontrib>POURCYROUS, Massroor ; BADA, Henrietta S ; PARFENOVA, Helena ; DALEY, Michael L ; KORONES, Sheldon B ; LEFFLER, Charles W</creatorcontrib><description>Carbon monoxide (CO) and the excitatory amino acid glutamate both dilate cerebral arterioles in newborn pigs. The key enzyme in CO synthesis is heme oxygenase, which is highly expressed in neurons with glutamatergic receptor activity as well as cerebral microvessels. During seizures the extracellular level of glutamate is increased, which results in excessive depolarization of neurons. We hypothesized that CO is a mediator of excitatory amino acid-induced dilation of the cerebral microvasculature during seizures. Three groups of piglets were examined: 1) i.v. normal saline (sham control), 2) topical chromium mesoporphyrin (Cr-MP, 15 x 10(-6) M), and 3) i.v. tin-protoporphyrin (Sn-PP, 4 mg/kg). Synthetic metalloporphyrins (Cr-MP and Sn-PP) are heme oxygenase inhibitors, thereby reducing CO synthesis. Implanted closed cranial windows were used to monitor changes in pial arteriolar diameters. Seizures were induced by administration of i.v. bicuculline. Changes in pial arteriolar diameters were monitored during 30 min of status epilepticus. The percent increase in pial arteriolar dilation in the saline group during seizures was 68 +/- 3%. In the metalloporphyrin groups, the pial arteriolar dilation was markedly reduced (35 +/- 3% and 13 +/- 1%, for Cr-MP and Sn-PP, respectively; p &lt; 0.05, compared with the saline group). We conclude that metalloporphyrins by inhibition of heme oxygenase and prevention of CO synthesis attenuate pial arteriolar dilation during seizures. Therefore, CO appears to be involved in cerebral vasodilation caused by glutamatergic seizures.</description><identifier>ISSN: 0031-3998</identifier><identifier>EISSN: 1530-0447</identifier><identifier>DOI: 10.1203/00006450-200205000-00006</identifier><identifier>PMID: 11978880</identifier><identifier>CODEN: PEREBL</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams &amp; Wilkins</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Animals ; Animals, Newborn ; Arterioles - physiopathology ; Bicuculline - toxicity ; Biological and medical sciences ; Carbon Monoxide - metabolism ; Cerebral Arteries - physiopathology ; Cerebrovascular Circulation ; Convulsants - toxicity ; Cyclic AMP - metabolism ; Cyclic GMP - metabolism ; Delivery. Postpartum. Lactation ; Disorders ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Enzyme Inhibitors - pharmacology ; GABA Antagonists - toxicity ; Glutamates - metabolism ; Gynecology. Andrology. Obstetrics ; Heme - metabolism ; Heme Oxygenase (Decyclizing) - antagonists &amp; inhibitors ; Heme Oxygenase (Decyclizing) - metabolism ; Intensive care medicine ; Medical sciences ; Membrane Potentials - drug effects ; Mesoporphyrins - pharmacology ; Metalloporphyrins - pharmacology ; Nerve Tissue Proteins - antagonists &amp; inhibitors ; Nerve Tissue Proteins - metabolism ; Neurons - enzymology ; Pia Mater - blood supply ; Protoporphyrins - pharmacology ; Seizures - chemically induced ; Seizures - metabolism ; Seizures - physiopathology ; Status Epilepticus - chemically induced ; Status Epilepticus - metabolism ; Status Epilepticus - physiopathology ; Swine ; Vasodilation - physiology</subject><ispartof>Pediatric research, 2002-05, Vol.51 (5), p.579-585</ispartof><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c391t-fee84693ca4a3f605230eaa3a71249201092d14e2a9856416b37ef35cadb402c3</citedby><cites>FETCH-LOGICAL-c391t-fee84693ca4a3f605230eaa3a71249201092d14e2a9856416b37ef35cadb402c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=13650600$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11978880$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>POURCYROUS, Massroor</creatorcontrib><creatorcontrib>BADA, Henrietta S</creatorcontrib><creatorcontrib>PARFENOVA, Helena</creatorcontrib><creatorcontrib>DALEY, Michael L</creatorcontrib><creatorcontrib>KORONES, Sheldon B</creatorcontrib><creatorcontrib>LEFFLER, Charles W</creatorcontrib><title>Cerebrovasodilatory contribution of endogenous carbon monoxide during seizures in newborn pigs</title><title>Pediatric research</title><addtitle>Pediatr Res</addtitle><description>Carbon monoxide (CO) and the excitatory amino acid glutamate both dilate cerebral arterioles in newborn pigs. The key enzyme in CO synthesis is heme oxygenase, which is highly expressed in neurons with glutamatergic receptor activity as well as cerebral microvessels. During seizures the extracellular level of glutamate is increased, which results in excessive depolarization of neurons. We hypothesized that CO is a mediator of excitatory amino acid-induced dilation of the cerebral microvasculature during seizures. Three groups of piglets were examined: 1) i.v. normal saline (sham control), 2) topical chromium mesoporphyrin (Cr-MP, 15 x 10(-6) M), and 3) i.v. tin-protoporphyrin (Sn-PP, 4 mg/kg). Synthetic metalloporphyrins (Cr-MP and Sn-PP) are heme oxygenase inhibitors, thereby reducing CO synthesis. Implanted closed cranial windows were used to monitor changes in pial arteriolar diameters. Seizures were induced by administration of i.v. bicuculline. Changes in pial arteriolar diameters were monitored during 30 min of status epilepticus. The percent increase in pial arteriolar dilation in the saline group during seizures was 68 +/- 3%. In the metalloporphyrin groups, the pial arteriolar dilation was markedly reduced (35 +/- 3% and 13 +/- 1%, for Cr-MP and Sn-PP, respectively; p &lt; 0.05, compared with the saline group). We conclude that metalloporphyrins by inhibition of heme oxygenase and prevention of CO synthesis attenuate pial arteriolar dilation during seizures. Therefore, CO appears to be involved in cerebral vasodilation caused by glutamatergic seizures.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Animals</subject><subject>Animals, Newborn</subject><subject>Arterioles - physiopathology</subject><subject>Bicuculline - toxicity</subject><subject>Biological and medical sciences</subject><subject>Carbon Monoxide - metabolism</subject><subject>Cerebral Arteries - physiopathology</subject><subject>Cerebrovascular Circulation</subject><subject>Convulsants - toxicity</subject><subject>Cyclic AMP - metabolism</subject><subject>Cyclic GMP - metabolism</subject><subject>Delivery. Postpartum. Lactation</subject><subject>Disorders</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Enzyme Inhibitors - pharmacology</subject><subject>GABA Antagonists - toxicity</subject><subject>Glutamates - metabolism</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Heme - metabolism</subject><subject>Heme Oxygenase (Decyclizing) - antagonists &amp; inhibitors</subject><subject>Heme Oxygenase (Decyclizing) - metabolism</subject><subject>Intensive care medicine</subject><subject>Medical sciences</subject><subject>Membrane Potentials - drug effects</subject><subject>Mesoporphyrins - pharmacology</subject><subject>Metalloporphyrins - pharmacology</subject><subject>Nerve Tissue Proteins - antagonists &amp; inhibitors</subject><subject>Nerve Tissue Proteins - metabolism</subject><subject>Neurons - enzymology</subject><subject>Pia Mater - blood supply</subject><subject>Protoporphyrins - pharmacology</subject><subject>Seizures - chemically induced</subject><subject>Seizures - metabolism</subject><subject>Seizures - physiopathology</subject><subject>Status Epilepticus - chemically induced</subject><subject>Status Epilepticus - metabolism</subject><subject>Status Epilepticus - physiopathology</subject><subject>Swine</subject><subject>Vasodilation - physiology</subject><issn>0031-3998</issn><issn>1530-0447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkEtPwzAQhC0EoqXwF5AvHAPrV2IfUcVLQuICVyLH2VRGrV3ZCVB-PYEWupfRjGb28BFCGVwyDuIKxiulgoIDcFCjK36jAzJlSoxGyuqQTAEEK4QxekJOcn4DYFJpeUwmjJlKaw1T8jrHhE2K7zbH1i9tH9OGuhj65Juh9zHQ2FEMbVxgiEOmzqZmDFcxxE_fIm2H5MOCZvRfQ8JMfaABP5qYAl37RT4lR51dZjzb6Yy83N48z--Lx6e7h_n1Y-GEYX3RIWpZGuGstKIrQXEBaK2wFePScGBgeMskcmu0KiUrG1FhJ5SzbSOBOzEjevvXpZhzwq5eJ7-yaVMzqH-Q1X_I6n9k22icnm-n66FZYbsf7hiNhYtdwWZnl12ywfm874lSQTmi_gaoC3VT</recordid><startdate>20020501</startdate><enddate>20020501</enddate><creator>POURCYROUS, Massroor</creator><creator>BADA, Henrietta S</creator><creator>PARFENOVA, Helena</creator><creator>DALEY, Michael L</creator><creator>KORONES, Sheldon B</creator><creator>LEFFLER, Charles W</creator><general>Lippincott Williams &amp; Wilkins</general><scope>IQODW</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></search><sort><creationdate>20020501</creationdate><title>Cerebrovasodilatory contribution of endogenous carbon monoxide during seizures in newborn pigs</title><author>POURCYROUS, Massroor ; BADA, Henrietta S ; PARFENOVA, Helena ; DALEY, Michael L ; KORONES, Sheldon B ; LEFFLER, Charles W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-fee84693ca4a3f605230eaa3a71249201092d14e2a9856416b37ef35cadb402c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Animals</topic><topic>Animals, Newborn</topic><topic>Arterioles - physiopathology</topic><topic>Bicuculline - toxicity</topic><topic>Biological and medical sciences</topic><topic>Carbon Monoxide - metabolism</topic><topic>Cerebral Arteries - physiopathology</topic><topic>Cerebrovascular Circulation</topic><topic>Convulsants - toxicity</topic><topic>Cyclic AMP - metabolism</topic><topic>Cyclic GMP - metabolism</topic><topic>Delivery. Postpartum. Lactation</topic><topic>Disorders</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Enzyme Inhibitors - pharmacology</topic><topic>GABA Antagonists - toxicity</topic><topic>Glutamates - metabolism</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Heme - metabolism</topic><topic>Heme Oxygenase (Decyclizing) - antagonists &amp; inhibitors</topic><topic>Heme Oxygenase (Decyclizing) - metabolism</topic><topic>Intensive care medicine</topic><topic>Medical sciences</topic><topic>Membrane Potentials - drug effects</topic><topic>Mesoporphyrins - pharmacology</topic><topic>Metalloporphyrins - pharmacology</topic><topic>Nerve Tissue Proteins - antagonists &amp; inhibitors</topic><topic>Nerve Tissue Proteins - metabolism</topic><topic>Neurons - enzymology</topic><topic>Pia Mater - blood supply</topic><topic>Protoporphyrins - pharmacology</topic><topic>Seizures - chemically induced</topic><topic>Seizures - metabolism</topic><topic>Seizures - physiopathology</topic><topic>Status Epilepticus - chemically induced</topic><topic>Status Epilepticus - metabolism</topic><topic>Status Epilepticus - physiopathology</topic><topic>Swine</topic><topic>Vasodilation - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>POURCYROUS, Massroor</creatorcontrib><creatorcontrib>BADA, Henrietta S</creatorcontrib><creatorcontrib>PARFENOVA, Helena</creatorcontrib><creatorcontrib>DALEY, Michael L</creatorcontrib><creatorcontrib>KORONES, Sheldon B</creatorcontrib><creatorcontrib>LEFFLER, Charles W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Pediatric research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>POURCYROUS, Massroor</au><au>BADA, Henrietta S</au><au>PARFENOVA, Helena</au><au>DALEY, Michael L</au><au>KORONES, Sheldon B</au><au>LEFFLER, Charles W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cerebrovasodilatory contribution of endogenous carbon monoxide during seizures in newborn pigs</atitle><jtitle>Pediatric research</jtitle><addtitle>Pediatr Res</addtitle><date>2002-05-01</date><risdate>2002</risdate><volume>51</volume><issue>5</issue><spage>579</spage><epage>585</epage><pages>579-585</pages><issn>0031-3998</issn><eissn>1530-0447</eissn><coden>PEREBL</coden><abstract>Carbon monoxide (CO) and the excitatory amino acid glutamate both dilate cerebral arterioles in newborn pigs. The key enzyme in CO synthesis is heme oxygenase, which is highly expressed in neurons with glutamatergic receptor activity as well as cerebral microvessels. During seizures the extracellular level of glutamate is increased, which results in excessive depolarization of neurons. We hypothesized that CO is a mediator of excitatory amino acid-induced dilation of the cerebral microvasculature during seizures. Three groups of piglets were examined: 1) i.v. normal saline (sham control), 2) topical chromium mesoporphyrin (Cr-MP, 15 x 10(-6) M), and 3) i.v. tin-protoporphyrin (Sn-PP, 4 mg/kg). Synthetic metalloporphyrins (Cr-MP and Sn-PP) are heme oxygenase inhibitors, thereby reducing CO synthesis. Implanted closed cranial windows were used to monitor changes in pial arteriolar diameters. Seizures were induced by administration of i.v. bicuculline. Changes in pial arteriolar diameters were monitored during 30 min of status epilepticus. The percent increase in pial arteriolar dilation in the saline group during seizures was 68 +/- 3%. In the metalloporphyrin groups, the pial arteriolar dilation was markedly reduced (35 +/- 3% and 13 +/- 1%, for Cr-MP and Sn-PP, respectively; p &lt; 0.05, compared with the saline group). We conclude that metalloporphyrins by inhibition of heme oxygenase and prevention of CO synthesis attenuate pial arteriolar dilation during seizures. Therefore, CO appears to be involved in cerebral vasodilation caused by glutamatergic seizures.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams &amp; Wilkins</pub><pmid>11978880</pmid><doi>10.1203/00006450-200205000-00006</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0031-3998
ispartof Pediatric research, 2002-05, Vol.51 (5), p.579-585
issn 0031-3998
1530-0447
language eng
recordid cdi_crossref_primary_10_1203_00006450_200205000_00006
source MEDLINE; Springer Nature - Complete Springer Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete
subjects Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Animals
Animals, Newborn
Arterioles - physiopathology
Bicuculline - toxicity
Biological and medical sciences
Carbon Monoxide - metabolism
Cerebral Arteries - physiopathology
Cerebrovascular Circulation
Convulsants - toxicity
Cyclic AMP - metabolism
Cyclic GMP - metabolism
Delivery. Postpartum. Lactation
Disorders
Emergency and intensive care: neonates and children. Prematurity. Sudden death
Enzyme Inhibitors - pharmacology
GABA Antagonists - toxicity
Glutamates - metabolism
Gynecology. Andrology. Obstetrics
Heme - metabolism
Heme Oxygenase (Decyclizing) - antagonists & inhibitors
Heme Oxygenase (Decyclizing) - metabolism
Intensive care medicine
Medical sciences
Membrane Potentials - drug effects
Mesoporphyrins - pharmacology
Metalloporphyrins - pharmacology
Nerve Tissue Proteins - antagonists & inhibitors
Nerve Tissue Proteins - metabolism
Neurons - enzymology
Pia Mater - blood supply
Protoporphyrins - pharmacology
Seizures - chemically induced
Seizures - metabolism
Seizures - physiopathology
Status Epilepticus - chemically induced
Status Epilepticus - metabolism
Status Epilepticus - physiopathology
Swine
Vasodilation - physiology
title Cerebrovasodilatory contribution of endogenous carbon monoxide during seizures in newborn pigs
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T03%3A18%3A31IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-pubmed_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cerebrovasodilatory%20contribution%20of%20endogenous%20carbon%20monoxide%20during%20seizures%20in%20newborn%20pigs&rft.jtitle=Pediatric%20research&rft.au=POURCYROUS,%20Massroor&rft.date=2002-05-01&rft.volume=51&rft.issue=5&rft.spage=579&rft.epage=585&rft.pages=579-585&rft.issn=0031-3998&rft.eissn=1530-0447&rft.coden=PEREBL&rft_id=info:doi/10.1203/00006450-200205000-00006&rft_dat=%3Cpubmed_cross%3E11978880%3C/pubmed_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/11978880&rfr_iscdi=true