AB0477 Arterial Stiffness in Systemic Lupus Erythematosus and Lupus Nephritis Patients as A Potential Predictor of Early Atherosclerosis

BackgroundCardiovascular disease (CVD) is one of the major cause of death in patients with SLE. Arterial stiffness is considered to be an independent risk factor of development CVD and a strong predictor of all-cause mortality. Increased arterial stiffness, due to premature vascular ageing, can be o...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Annals of the rheumatic diseases 2016-06, Vol.75 (Suppl 2), p.1069-1069
Hauptverfasser: Schubertova, M, Smrzova, A, Hermanova, Z, Mrazek, F, Skacelova, M, Horak, P, Zadrazil, J
Format: Artikel
Sprache:eng
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1069
container_issue Suppl 2
container_start_page 1069
container_title Annals of the rheumatic diseases
container_volume 75
creator Schubertova, M
Smrzova, A
Hermanova, Z
Mrazek, F
Skacelova, M
Horak, P
Zadrazil, J
description BackgroundCardiovascular disease (CVD) is one of the major cause of death in patients with SLE. Arterial stiffness is considered to be an independent risk factor of development CVD and a strong predictor of all-cause mortality. Increased arterial stiffness, due to premature vascular ageing, can be observed in patients with SLE as well as in patients with chronic kidney disease.ObjectivesTo evaluate arterial stiffness determined as carotid – femoral puls wave velocity in systemic lupus erythematosus patients. The comparison of traditional risk factor of CVD and markers of subclinical atherosclerosis in SLE, patients with histologically proven Lupus nephritis (LN) and healthy controls.MethodsWe evaluate the data from 41 SLE patients, (37 females, 4 male, mean age 37, mean duration of the SLE of 8years). 21 of these patients with histologically proven Lupus nephritis and chronic kidney disease (CKD). Arterial stiffness, measured as carotid – femoral puls wave velocity (PWV) was established with the SphygmoCor system. This non-invasive technique uses the principle of applanation tonometry. Our control group counted 20 heathy male and female with no history of CVD, CKD or autoimmune disease. We evaluate the influence of traditional CV risk factors as age, smoking, BMI, diabetes mellitus, dyslipidemia, previous history of CV and cerebrovascular morbidity to PWV in SLE patients. Disease activity score (SLEDAI), the level of C3, C4 complement component and anti-dsDNA antibodies, renal function and antifosfolipid antibodies were measured at the same timepoint, correlated with PWV and carotid artery intima media thickness.ResultsMean PWV in Lupus nephritis patients was numerically higher (6,5m/s) than that in other SLE patients (5,7m/s) and healthy controls but it lacked the statistical significance. PWV in LN was positively associated with carotid artery intima media thickness (IMT), hsCRP level, serum creatinine level, C4 complement component (p
doi_str_mv 10.1136/annrheumdis-2016-eular.4763
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1901853159</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4322513167</sourcerecordid><originalsourceid>FETCH-LOGICAL-b1279-8bbcfe05e67ae04624a6515123f575ce166a275a3ffc142abd28e4d57c1d3ea03</originalsourceid><addsrcrecordid>eNqVkL1OwzAUhS0EEqXwDpY6p9hJbCdiClX5kSqoVJgtJ7lWXeWn2M7QjYWFx-RJcCgDK4utc-895159CM0omVOa8GvVdXYLQ1sbF8WE8giGRtl5KnhygiY05Vkoc3KKJoSQJEpzLs7RhXO7IElGswn6LG5JKsTX-0dhPVijGrzxRusOnMOmw5uD89CaCq-G_eDw0h78FlrlexeU6urf-hPst9Z44_BaeQOdD02HC7zufRBj6tpCbSrfW9xrvFS2OeAiRNneVc34GneJzrRqHFz9_lP0erd8WTxEq-f7x0WxikoaizzKyrLSQBhwoYCkPE4VZ5TRONFMsAoo5yoWTCVaVzSNVVnHGaQ1ExWtE1AkmaLZMXdv-7cBnJe7frBdWClpTmjGEsryMHVznKrCcc6ClntrWmUPkhI5wpd_4MsRvvyBL0f4wc2P7rLd_cv4DeHSk5U</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1901853159</pqid></control><display><type>article</type><title>AB0477 Arterial Stiffness in Systemic Lupus Erythematosus and Lupus Nephritis Patients as A Potential Predictor of Early Atherosclerosis</title><source>BMJ Journals Online Archive</source><creator>Schubertova, M ; Smrzova, A ; Hermanova, Z ; Mrazek, F ; Skacelova, M ; Horak, P ; Zadrazil, J</creator><creatorcontrib>Schubertova, M ; Smrzova, A ; Hermanova, Z ; Mrazek, F ; Skacelova, M ; Horak, P ; Zadrazil, J</creatorcontrib><description>BackgroundCardiovascular disease (CVD) is one of the major cause of death in patients with SLE. Arterial stiffness is considered to be an independent risk factor of development CVD and a strong predictor of all-cause mortality. Increased arterial stiffness, due to premature vascular ageing, can be observed in patients with SLE as well as in patients with chronic kidney disease.ObjectivesTo evaluate arterial stiffness determined as carotid – femoral puls wave velocity in systemic lupus erythematosus patients. The comparison of traditional risk factor of CVD and markers of subclinical atherosclerosis in SLE, patients with histologically proven Lupus nephritis (LN) and healthy controls.MethodsWe evaluate the data from 41 SLE patients, (37 females, 4 male, mean age 37, mean duration of the SLE of 8years). 21 of these patients with histologically proven Lupus nephritis and chronic kidney disease (CKD). Arterial stiffness, measured as carotid – femoral puls wave velocity (PWV) was established with the SphygmoCor system. This non-invasive technique uses the principle of applanation tonometry. Our control group counted 20 heathy male and female with no history of CVD, CKD or autoimmune disease. We evaluate the influence of traditional CV risk factors as age, smoking, BMI, diabetes mellitus, dyslipidemia, previous history of CV and cerebrovascular morbidity to PWV in SLE patients. Disease activity score (SLEDAI), the level of C3, C4 complement component and anti-dsDNA antibodies, renal function and antifosfolipid antibodies were measured at the same timepoint, correlated with PWV and carotid artery intima media thickness.ResultsMean PWV in Lupus nephritis patients was numerically higher (6,5m/s) than that in other SLE patients (5,7m/s) and healthy controls but it lacked the statistical significance. PWV in LN was positively associated with carotid artery intima media thickness (IMT), hsCRP level, serum creatinine level, C4 complement component (p&lt;0,05), presence of antiphopholipid syndome and SLICC score (p&lt;0,02).ConclusionsSLE patients are in increased risk of CV disease. PWV is considered as an independent risk factor of CVD and CKD. Despite we did not prove statistical significant difference in PWV in patients with Lupus nephritis in comparison to other SLE patients, there was a trend to increased PVW in this pilot study. The correlation to creatinin levels indicates relation of this parameter to renal function. It seems to be associated more with the fact of renal insufficiency that the pure presence of lupus nephritis. The PVW correlates with another test for early atherosclerosis and with the IMT. Further investigation is needed to establish the role of evaluation of PWV in SLE patients.ReferencesKocabay G, Hasdemir H, Yildiz M. Evaluation of puls wave velocity in systemic lupus erythematosus, rheumatoid arthritis and Behcet's disease. Journal of Cardiology 2012(59), 72–77Bjarnegard N, Bengtsonn C, Brodszki J, et al. Increased aortic puls wave velocity in middle aged women with systemic lupus erythematosus. Lupus 2006(15), 644–650.AcknowledgementMZ CR VES 15–28659A, IGA UP 2016–11Disclosure of InterestNone declared</description><identifier>ISSN: 0003-4967</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/annrheumdis-2016-eular.4763</identifier><identifier>CODEN: ARDIAO</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><ispartof>Annals of the rheumatic diseases, 2016-06, Vol.75 (Suppl 2), p.1069-1069</ispartof><rights>2016, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2016 (c) 2016, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://ard.bmj.com/content/75/Suppl_2/1069.2.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://ard.bmj.com/content/75/Suppl_2/1069.2.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids></links><search><creatorcontrib>Schubertova, M</creatorcontrib><creatorcontrib>Smrzova, A</creatorcontrib><creatorcontrib>Hermanova, Z</creatorcontrib><creatorcontrib>Mrazek, F</creatorcontrib><creatorcontrib>Skacelova, M</creatorcontrib><creatorcontrib>Horak, P</creatorcontrib><creatorcontrib>Zadrazil, J</creatorcontrib><title>AB0477 Arterial Stiffness in Systemic Lupus Erythematosus and Lupus Nephritis Patients as A Potential Predictor of Early Atherosclerosis</title><title>Annals of the rheumatic diseases</title><description>BackgroundCardiovascular disease (CVD) is one of the major cause of death in patients with SLE. Arterial stiffness is considered to be an independent risk factor of development CVD and a strong predictor of all-cause mortality. Increased arterial stiffness, due to premature vascular ageing, can be observed in patients with SLE as well as in patients with chronic kidney disease.ObjectivesTo evaluate arterial stiffness determined as carotid – femoral puls wave velocity in systemic lupus erythematosus patients. The comparison of traditional risk factor of CVD and markers of subclinical atherosclerosis in SLE, patients with histologically proven Lupus nephritis (LN) and healthy controls.MethodsWe evaluate the data from 41 SLE patients, (37 females, 4 male, mean age 37, mean duration of the SLE of 8years). 21 of these patients with histologically proven Lupus nephritis and chronic kidney disease (CKD). Arterial stiffness, measured as carotid – femoral puls wave velocity (PWV) was established with the SphygmoCor system. This non-invasive technique uses the principle of applanation tonometry. Our control group counted 20 heathy male and female with no history of CVD, CKD or autoimmune disease. We evaluate the influence of traditional CV risk factors as age, smoking, BMI, diabetes mellitus, dyslipidemia, previous history of CV and cerebrovascular morbidity to PWV in SLE patients. Disease activity score (SLEDAI), the level of C3, C4 complement component and anti-dsDNA antibodies, renal function and antifosfolipid antibodies were measured at the same timepoint, correlated with PWV and carotid artery intima media thickness.ResultsMean PWV in Lupus nephritis patients was numerically higher (6,5m/s) than that in other SLE patients (5,7m/s) and healthy controls but it lacked the statistical significance. PWV in LN was positively associated with carotid artery intima media thickness (IMT), hsCRP level, serum creatinine level, C4 complement component (p&lt;0,05), presence of antiphopholipid syndome and SLICC score (p&lt;0,02).ConclusionsSLE patients are in increased risk of CV disease. PWV is considered as an independent risk factor of CVD and CKD. Despite we did not prove statistical significant difference in PWV in patients with Lupus nephritis in comparison to other SLE patients, there was a trend to increased PVW in this pilot study. The correlation to creatinin levels indicates relation of this parameter to renal function. It seems to be associated more with the fact of renal insufficiency that the pure presence of lupus nephritis. The PVW correlates with another test for early atherosclerosis and with the IMT. Further investigation is needed to establish the role of evaluation of PWV in SLE patients.ReferencesKocabay G, Hasdemir H, Yildiz M. Evaluation of puls wave velocity in systemic lupus erythematosus, rheumatoid arthritis and Behcet's disease. Journal of Cardiology 2012(59), 72–77Bjarnegard N, Bengtsonn C, Brodszki J, et al. Increased aortic puls wave velocity in middle aged women with systemic lupus erythematosus. Lupus 2006(15), 644–650.AcknowledgementMZ CR VES 15–28659A, IGA UP 2016–11Disclosure of InterestNone declared</description><issn>0003-4967</issn><issn>1468-2060</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqVkL1OwzAUhS0EEqXwDpY6p9hJbCdiClX5kSqoVJgtJ7lWXeWn2M7QjYWFx-RJcCgDK4utc-895159CM0omVOa8GvVdXYLQ1sbF8WE8giGRtl5KnhygiY05Vkoc3KKJoSQJEpzLs7RhXO7IElGswn6LG5JKsTX-0dhPVijGrzxRusOnMOmw5uD89CaCq-G_eDw0h78FlrlexeU6urf-hPst9Z44_BaeQOdD02HC7zufRBj6tpCbSrfW9xrvFS2OeAiRNneVc34GneJzrRqHFz9_lP0erd8WTxEq-f7x0WxikoaizzKyrLSQBhwoYCkPE4VZ5TRONFMsAoo5yoWTCVaVzSNVVnHGaQ1ExWtE1AkmaLZMXdv-7cBnJe7frBdWClpTmjGEsryMHVznKrCcc6ClntrWmUPkhI5wpd_4MsRvvyBL0f4wc2P7rLd_cv4DeHSk5U</recordid><startdate>201606</startdate><enddate>201606</enddate><creator>Schubertova, M</creator><creator>Smrzova, A</creator><creator>Hermanova, Z</creator><creator>Mrazek, F</creator><creator>Skacelova, M</creator><creator>Horak, P</creator><creator>Zadrazil, J</creator><general>BMJ Publishing Group LTD</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>201606</creationdate><title>AB0477 Arterial Stiffness in Systemic Lupus Erythematosus and Lupus Nephritis Patients as A Potential Predictor of Early Atherosclerosis</title><author>Schubertova, M ; Smrzova, A ; Hermanova, Z ; Mrazek, F ; Skacelova, M ; Horak, P ; Zadrazil, J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b1279-8bbcfe05e67ae04624a6515123f575ce166a275a3ffc142abd28e4d57c1d3ea03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schubertova, M</creatorcontrib><creatorcontrib>Smrzova, A</creatorcontrib><creatorcontrib>Hermanova, Z</creatorcontrib><creatorcontrib>Mrazek, F</creatorcontrib><creatorcontrib>Skacelova, M</creatorcontrib><creatorcontrib>Horak, P</creatorcontrib><creatorcontrib>Zadrazil, J</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech 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>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</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>ProQuest Central Basic</collection><jtitle>Annals of the rheumatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schubertova, M</au><au>Smrzova, A</au><au>Hermanova, Z</au><au>Mrazek, F</au><au>Skacelova, M</au><au>Horak, P</au><au>Zadrazil, J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>AB0477 Arterial Stiffness in Systemic Lupus Erythematosus and Lupus Nephritis Patients as A Potential Predictor of Early Atherosclerosis</atitle><jtitle>Annals of the rheumatic diseases</jtitle><date>2016-06</date><risdate>2016</risdate><volume>75</volume><issue>Suppl 2</issue><spage>1069</spage><epage>1069</epage><pages>1069-1069</pages><issn>0003-4967</issn><eissn>1468-2060</eissn><coden>ARDIAO</coden><abstract>BackgroundCardiovascular disease (CVD) is one of the major cause of death in patients with SLE. Arterial stiffness is considered to be an independent risk factor of development CVD and a strong predictor of all-cause mortality. Increased arterial stiffness, due to premature vascular ageing, can be observed in patients with SLE as well as in patients with chronic kidney disease.ObjectivesTo evaluate arterial stiffness determined as carotid – femoral puls wave velocity in systemic lupus erythematosus patients. The comparison of traditional risk factor of CVD and markers of subclinical atherosclerosis in SLE, patients with histologically proven Lupus nephritis (LN) and healthy controls.MethodsWe evaluate the data from 41 SLE patients, (37 females, 4 male, mean age 37, mean duration of the SLE of 8years). 21 of these patients with histologically proven Lupus nephritis and chronic kidney disease (CKD). Arterial stiffness, measured as carotid – femoral puls wave velocity (PWV) was established with the SphygmoCor system. This non-invasive technique uses the principle of applanation tonometry. Our control group counted 20 heathy male and female with no history of CVD, CKD or autoimmune disease. We evaluate the influence of traditional CV risk factors as age, smoking, BMI, diabetes mellitus, dyslipidemia, previous history of CV and cerebrovascular morbidity to PWV in SLE patients. Disease activity score (SLEDAI), the level of C3, C4 complement component and anti-dsDNA antibodies, renal function and antifosfolipid antibodies were measured at the same timepoint, correlated with PWV and carotid artery intima media thickness.ResultsMean PWV in Lupus nephritis patients was numerically higher (6,5m/s) than that in other SLE patients (5,7m/s) and healthy controls but it lacked the statistical significance. PWV in LN was positively associated with carotid artery intima media thickness (IMT), hsCRP level, serum creatinine level, C4 complement component (p&lt;0,05), presence of antiphopholipid syndome and SLICC score (p&lt;0,02).ConclusionsSLE patients are in increased risk of CV disease. PWV is considered as an independent risk factor of CVD and CKD. Despite we did not prove statistical significant difference in PWV in patients with Lupus nephritis in comparison to other SLE patients, there was a trend to increased PVW in this pilot study. The correlation to creatinin levels indicates relation of this parameter to renal function. It seems to be associated more with the fact of renal insufficiency that the pure presence of lupus nephritis. The PVW correlates with another test for early atherosclerosis and with the IMT. Further investigation is needed to establish the role of evaluation of PWV in SLE patients.ReferencesKocabay G, Hasdemir H, Yildiz M. Evaluation of puls wave velocity in systemic lupus erythematosus, rheumatoid arthritis and Behcet's disease. Journal of Cardiology 2012(59), 72–77Bjarnegard N, Bengtsonn C, Brodszki J, et al. Increased aortic puls wave velocity in middle aged women with systemic lupus erythematosus. Lupus 2006(15), 644–650.AcknowledgementMZ CR VES 15–28659A, IGA UP 2016–11Disclosure of InterestNone declared</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><doi>10.1136/annrheumdis-2016-eular.4763</doi><tpages>1</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0003-4967
ispartof Annals of the rheumatic diseases, 2016-06, Vol.75 (Suppl 2), p.1069-1069
issn 0003-4967
1468-2060
language eng
recordid cdi_proquest_journals_1901853159
source BMJ Journals Online Archive
title AB0477 Arterial Stiffness in Systemic Lupus Erythematosus and Lupus Nephritis Patients as A Potential Predictor of Early Atherosclerosis
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-03T08%3A58%3A19IST&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=AB0477%E2%80%85Arterial%20Stiffness%20in%20Systemic%20Lupus%20Erythematosus%20and%20Lupus%20Nephritis%20Patients%20as%20A%20Potential%20Predictor%20of%20Early%20Atherosclerosis&rft.jtitle=Annals%20of%20the%20rheumatic%20diseases&rft.au=Schubertova,%20M&rft.date=2016-06&rft.volume=75&rft.issue=Suppl%202&rft.spage=1069&rft.epage=1069&rft.pages=1069-1069&rft.issn=0003-4967&rft.eissn=1468-2060&rft.coden=ARDIAO&rft_id=info:doi/10.1136/annrheumdis-2016-eular.4763&rft_dat=%3Cproquest_cross%3E4322513167%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=1901853159&rft_id=info:pmid/&rfr_iscdi=true