Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials
Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs)...
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| description | Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs) was performed to evaluate comprehensively the effects and safety of these two medications.
Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries.
Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P |
| doi_str_mv | 10.1371/journal.pone.0227410 |
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Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries.
Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P<0.00001) compared to the patients receiving magnesium. The effect in decreasing the necessity of using opioid/analgesia was affirmative in dexmedetomidine group (29.13% with magnesium vs 10.78% with dexmedetomidine), and the condition was more favorable in magnesium group in reducing recovery period (SMD -1.98 with 95% CI [-4.27,0.30], P = 0.09). Compared with magnesium, using of dexmedetomidine was associated with higher incidence of bradycardia but lower incidence of nausea and vomiting.
Compared with magnesium, dexmedetomidine is more effective to provide promising surgical field condition, favorable controlled hypotension, and less necessity of opioid or analgesia administration. But long recovery period and high-probability bradycardia should be deliberated.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0227410</identifier><identifier>PMID: 31914454</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analgesia ; Anesthesia ; Anesthesiology ; Bias ; Bleeding ; Blood pressure ; Bradycardia ; Clinical trials ; Collaboration ; Comparative analysis ; Databases, Factual ; Dexmedetomidine ; Dexmedetomidine - adverse effects ; Dexmedetomidine - therapeutic use ; Drugs ; Heart rate ; Hemodynamics ; Hospitals ; Humans ; Hypotension ; Hypotension - drug therapy ; Hypotension - physiopathology ; Incidence ; Laboratories ; Magnesium sulfate ; Magnesium Sulfate - adverse effects ; Magnesium Sulfate - therapeutic use ; Medical personnel ; Medical research ; Medicine and Health Sciences ; Meta-analysis ; Narcotics ; Nausea ; Opioids ; Pain perception ; Pharmacy ; Physical Sciences ; Randomization ; Randomized Controlled Trials as Topic ; Recovery ; Safety ; Studies ; Surgery ; Surgical Procedures, Operative ; Vomiting</subject><ispartof>PloS one, 2020-01, Vol.15 (1), p.e0227410-e0227410</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Lang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Lang et al 2020 Lang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-f8e7fdda2911743e298821f4a742a04d9c450b205e4563160ef19716c194465e3</citedby><cites>FETCH-LOGICAL-c692t-f8e7fdda2911743e298821f4a742a04d9c450b205e4563160ef19716c194465e3</cites><orcidid>0000-0003-1407-8098</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949117/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949117/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31914454$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Farag, Ehab</contributor><creatorcontrib>Lang, Bingchen</creatorcontrib><creatorcontrib>Zhang, Lingli</creatorcontrib><creatorcontrib>Lin, Yunzhu</creatorcontrib><creatorcontrib>Zhang, Wensheng</creatorcontrib><creatorcontrib>Li, Feng-Shan</creatorcontrib><creatorcontrib>Chen, Shouming</creatorcontrib><title>Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs) was performed to evaluate comprehensively the effects and safety of these two medications.
Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries.
Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P<0.00001) compared to the patients receiving magnesium. The effect in decreasing the necessity of using opioid/analgesia was affirmative in dexmedetomidine group (29.13% with magnesium vs 10.78% with dexmedetomidine), and the condition was more favorable in magnesium group in reducing recovery period (SMD -1.98 with 95% CI [-4.27,0.30], P = 0.09). Compared with magnesium, using of dexmedetomidine was associated with higher incidence of bradycardia but lower incidence of nausea and vomiting.
Compared with magnesium, dexmedetomidine is more effective to provide promising surgical field condition, favorable controlled hypotension, and less necessity of opioid or analgesia administration. But long recovery period and high-probability bradycardia should be deliberated.</description><subject>Analgesia</subject><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Bias</subject><subject>Bleeding</subject><subject>Blood pressure</subject><subject>Bradycardia</subject><subject>Clinical trials</subject><subject>Collaboration</subject><subject>Comparative analysis</subject><subject>Databases, Factual</subject><subject>Dexmedetomidine</subject><subject>Dexmedetomidine - adverse effects</subject><subject>Dexmedetomidine - therapeutic use</subject><subject>Drugs</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Hypotension - drug therapy</subject><subject>Hypotension - physiopathology</subject><subject>Incidence</subject><subject>Laboratories</subject><subject>Magnesium sulfate</subject><subject>Magnesium Sulfate - adverse effects</subject><subject>Magnesium Sulfate - therapeutic use</subject><subject>Medical personnel</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Narcotics</subject><subject>Nausea</subject><subject>Opioids</subject><subject>Pain perception</subject><subject>Pharmacy</subject><subject>Physical Sciences</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Recovery</subject><subject>Safety</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical Procedures, Operative</subject><subject>Vomiting</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12L1DAUhoso7rr6D0QLgujFjPlq2nohDIsfAwsLft2GtD3pZGibbpKuO_4t_6DpTHeZyl5IL1JOnvc9OSc5UfQcoyWmKX63NYPtZLPsTQdLREjKMHoQneKckgUniD48-j-Jnji3RSihGeePoxOKc8xYwk6jP-em7aXVznSxUTEoBaV3seyq2EkFfhfrLu6tudaV7uq4NJ23pmmgije73njonA7KarDjrhtsDXYXF-B_AYQw3LRQgTftqIa9ayvrDpwe2kA3_UZ6eB-v4ha8XMhQzs5pNx7EBjbIfodERzm91bJxT6NHKizwbFrPoh-fPn4__7K4uPy8Pl9dLEqeE79QGaSqqiTJMU4ZBZJnGcGKyZQRiViVlyxBBUEJsIRTzBEonKeYlzhnjCdAz6KXB9--MU5M_XaCUMp4RjJEA7E-EJWRW9Fb3Uq7E0ZqsQ8YWwtpvS4bEJwDS5OMFnnIn6dFUckyUyzLKAApstHrw5RtKELXSghVy2ZmOt_p9EbU5lrwnI0VBoM3k4E1VwM4L1rtSmga2YEZ9udOcEpSTgL66h_0_uomqpahAN0pE_KWo6lYcYwyzAhLArW8hwpfBa0OdwdKh_hM8HYmGO8XbnwtB-fE-tvX_2cvf87Z10fsBmTjN840gw8v1M1BdgBLa5yzoO6ajJEYZ-u2G2KcLTHNVpC9OL6gO9HtMNG_WbkigQ</recordid><startdate>20200108</startdate><enddate>20200108</enddate><creator>Lang, Bingchen</creator><creator>Zhang, Lingli</creator><creator>Lin, Yunzhu</creator><creator>Zhang, Wensheng</creator><creator>Li, Feng-Shan</creator><creator>Chen, Shouming</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><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>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1407-8098</orcidid></search><sort><creationdate>20200108</creationdate><title>Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials</title><author>Lang, Bingchen ; Zhang, Lingli ; Lin, Yunzhu ; Zhang, Wensheng ; Li, Feng-Shan ; Chen, Shouming</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-f8e7fdda2911743e298821f4a742a04d9c450b205e4563160ef19716c194465e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Analgesia</topic><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Bias</topic><topic>Bleeding</topic><topic>Blood pressure</topic><topic>Bradycardia</topic><topic>Clinical trials</topic><topic>Collaboration</topic><topic>Comparative analysis</topic><topic>Databases, Factual</topic><topic>Dexmedetomidine</topic><topic>Dexmedetomidine - adverse effects</topic><topic>Dexmedetomidine - therapeutic use</topic><topic>Drugs</topic><topic>Heart rate</topic><topic>Hemodynamics</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Hypotension - drug therapy</topic><topic>Hypotension - physiopathology</topic><topic>Incidence</topic><topic>Laboratories</topic><topic>Magnesium sulfate</topic><topic>Magnesium Sulfate - adverse effects</topic><topic>Magnesium Sulfate - therapeutic use</topic><topic>Medical personnel</topic><topic>Medical research</topic><topic>Medicine and Health Sciences</topic><topic>Meta-analysis</topic><topic>Narcotics</topic><topic>Nausea</topic><topic>Opioids</topic><topic>Pain perception</topic><topic>Pharmacy</topic><topic>Physical Sciences</topic><topic>Randomization</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Recovery</topic><topic>Safety</topic><topic>Studies</topic><topic>Surgery</topic><topic>Surgical Procedures, Operative</topic><topic>Vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lang, Bingchen</creatorcontrib><creatorcontrib>Zhang, Lingli</creatorcontrib><creatorcontrib>Lin, Yunzhu</creatorcontrib><creatorcontrib>Zhang, Wensheng</creatorcontrib><creatorcontrib>Li, Feng-Shan</creatorcontrib><creatorcontrib>Chen, Shouming</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lang, Bingchen</au><au>Zhang, Lingli</au><au>Lin, Yunzhu</au><au>Zhang, Wensheng</au><au>Li, Feng-Shan</au><au>Chen, Shouming</au><au>Farag, Ehab</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-01-08</date><risdate>2020</risdate><volume>15</volume><issue>1</issue><spage>e0227410</spage><epage>e0227410</epage><pages>e0227410-e0227410</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs) was performed to evaluate comprehensively the effects and safety of these two medications.
Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries.
Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P<0.00001) compared to the patients receiving magnesium. The effect in decreasing the necessity of using opioid/analgesia was affirmative in dexmedetomidine group (29.13% with magnesium vs 10.78% with dexmedetomidine), and the condition was more favorable in magnesium group in reducing recovery period (SMD -1.98 with 95% CI [-4.27,0.30], P = 0.09). Compared with magnesium, using of dexmedetomidine was associated with higher incidence of bradycardia but lower incidence of nausea and vomiting.
Compared with magnesium, dexmedetomidine is more effective to provide promising surgical field condition, favorable controlled hypotension, and less necessity of opioid or analgesia administration. But long recovery period and high-probability bradycardia should be deliberated.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31914454</pmid><doi>10.1371/journal.pone.0227410</doi><tpages>e0227410</tpages><orcidid>https://orcid.org/0000-0003-1407-8098</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Analgesia Anesthesia Anesthesiology Bias Bleeding Blood pressure Bradycardia Clinical trials Collaboration Comparative analysis Databases, Factual Dexmedetomidine Dexmedetomidine - adverse effects Dexmedetomidine - therapeutic use Drugs Heart rate Hemodynamics Hospitals Humans Hypotension Hypotension - drug therapy Hypotension - physiopathology Incidence Laboratories Magnesium sulfate Magnesium Sulfate - adverse effects Magnesium Sulfate - therapeutic use Medical personnel Medical research Medicine and Health Sciences Meta-analysis Narcotics Nausea Opioids Pain perception Pharmacy Physical Sciences Randomization Randomized Controlled Trials as Topic Recovery Safety Studies Surgery Surgical Procedures, Operative Vomiting |
| title | Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T01%3A26%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Comparison%20of%20effects%20and%20safety%20in%20providing%20controlled%20hypotension%20during%20surgery%20between%20dexmedetomidine%20and%20magnesium%20sulphate:%20A%20meta-analysis%20of%20randomized%20controlled%20trials&rft.jtitle=PloS%20one&rft.au=Lang,%20Bingchen&rft.date=2020-01-08&rft.volume=15&rft.issue=1&rft.spage=e0227410&rft.epage=e0227410&rft.pages=e0227410-e0227410&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0227410&rft_dat=%3Cgale_plos_%3EA610814245%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2334682803&rft_id=info:pmid/31914454&rft_galeid=A610814245&rft_doaj_id=oai_doaj_org_article_66e47583b9a7497bbdac8f4883ee2b83&rfr_iscdi=true |