Prognosis of Patients With Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: the Impact of Urine Output on Mortality
Background Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECM...
Gespeichert in:
| Veröffentlicht in: | The Annals of thoracic surgery 2014-06, Vol.97 (6), p.1939-1944 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1944 |
|---|---|
| container_issue | 6 |
| container_start_page | 1939 |
| container_title | The Annals of thoracic surgery |
| container_volume | 97 |
| creator | Hsiao, Ching-Chung, MD Chang, Chih-Hsiang, MD Fan, Pei-Chun, MD Ho, Heng-Tsan, MD Jenq, Chang-Chyi, MD Kao, Kuo-Chin, MD Chiu, Li-Chung, MD Lee, Shen-Yang, MD Hsu, Hsiang-Hao, MD, PhD Tian, Ya-Chung, MD, PhD Hung, Cheng-Chieh, MD, PhD Fang, Ji-Tseng, MD Yang, Chih-Wei, MD Tsai, Feng-Chun, MD Chen, Yung-Chang, MD |
| description | Background Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. Methods This study reviewed the medical records of 81 ARDS patients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. Results The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p |
| doi_str_mv | 10.1016/j.athoracsur.2014.02.021 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1531956370</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0003497514003555</els_id><sourcerecordid>1531956370</sourcerecordid><originalsourceid>FETCH-LOGICAL-c479t-24484bb16cc890f1001c502bdbe8c282fb5249266bfc8aa55d1f717ebd0d5b773</originalsourceid><addsrcrecordid>eNqNUk1v1DAQtRCILoW_gHzkksV24nxwQCqlQKVWrSgVR8t2Jl0vSRzGDmr-BL8ZR1tA4oQ0kj3ym_fG84YQytmWM16-3m913HnUNsy4FYwXWyZS8Edkw6UUWSlk85hsGGN5VjSVPCLPQtinVKTnp-RIFGXNWc425Oc1-rvRBxeo7-i1jg7GGOhXF3f0xM4R6GcIk0MdPS70vQsRIQR6s4wt-gGoH-nZfUydeJw8gu7pJQwG9Qj06n65gzEx-vENjTug58OkbVx1btGtgDlOc1wpLj1G3bu4PCdPOt0HePFwHpPbD2dfTj9lF1cfz09PLjJbVE3MRFHUhTG8tLZuWMcZ41YyYVoDtRW16IwURSPK0nS21lrKlncVr8C0rJWmqvJj8urAO6H_PkOIanDBQt-nxv0cFJc5b2SZVyxB6wPUog8BoVMTukHjojhTqxtqr_66oVY3FBMpeCp9-aAymwHaP4W_x58A7w4ASH_94QBVsMkAC61DsFG13v2Pytt_SGzvRmd1_w0WCHs_45hmqbgKqUDdrFuxLgUv0kVKmf8CGUm4kw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1531956370</pqid></control><display><type>article</type><title>Prognosis of Patients With Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: the Impact of Urine Output on Mortality</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Hsiao, Ching-Chung, MD ; Chang, Chih-Hsiang, MD ; Fan, Pei-Chun, MD ; Ho, Heng-Tsan, MD ; Jenq, Chang-Chyi, MD ; Kao, Kuo-Chin, MD ; Chiu, Li-Chung, MD ; Lee, Shen-Yang, MD ; Hsu, Hsiang-Hao, MD, PhD ; Tian, Ya-Chung, MD, PhD ; Hung, Cheng-Chieh, MD, PhD ; Fang, Ji-Tseng, MD ; Yang, Chih-Wei, MD ; Tsai, Feng-Chun, MD ; Chen, Yung-Chang, MD</creator><creatorcontrib>Hsiao, Ching-Chung, MD ; Chang, Chih-Hsiang, MD ; Fan, Pei-Chun, MD ; Ho, Heng-Tsan, MD ; Jenq, Chang-Chyi, MD ; Kao, Kuo-Chin, MD ; Chiu, Li-Chung, MD ; Lee, Shen-Yang, MD ; Hsu, Hsiang-Hao, MD, PhD ; Tian, Ya-Chung, MD, PhD ; Hung, Cheng-Chieh, MD, PhD ; Fang, Ji-Tseng, MD ; Yang, Chih-Wei, MD ; Tsai, Feng-Chun, MD ; Chen, Yung-Chang, MD</creatorcontrib><description>Background Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. Methods This study reviewed the medical records of 81 ARDS patients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. Results The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p < 0.001). Urine output had the best discriminative power, the best Youden index, and the highest overall correctness of prediction. Cumulative survival rates at the 6-month follow-up differed significantly ( p < 0.001) for UO 1,432 mL or greater on day 1 of ECMO support versus those with UO less than 1,432 mL on day 1 of ECMO support. Conclusions In ARDS patients receiving ECMO support, UO obtained on the first day of ECMO support showed good prognostic ability in predicting hospital mortality.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2014.02.021</identifier><identifier>PMID: 24681030</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Adult ; APACHE ; Calibration ; Cardiothoracic Surgery ; Extracorporeal Membrane Oxygenation ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Respiratory Distress Syndrome, Adult - mortality ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory Distress Syndrome, Adult - urine ; Surgery</subject><ispartof>The Annals of thoracic surgery, 2014-06, Vol.97 (6), p.1939-1944</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2014 The Society of Thoracic Surgeons</rights><rights>Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-24484bb16cc890f1001c502bdbe8c282fb5249266bfc8aa55d1f717ebd0d5b773</citedby><cites>FETCH-LOGICAL-c479t-24484bb16cc890f1001c502bdbe8c282fb5249266bfc8aa55d1f717ebd0d5b773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24681030$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hsiao, Ching-Chung, MD</creatorcontrib><creatorcontrib>Chang, Chih-Hsiang, MD</creatorcontrib><creatorcontrib>Fan, Pei-Chun, MD</creatorcontrib><creatorcontrib>Ho, Heng-Tsan, MD</creatorcontrib><creatorcontrib>Jenq, Chang-Chyi, MD</creatorcontrib><creatorcontrib>Kao, Kuo-Chin, MD</creatorcontrib><creatorcontrib>Chiu, Li-Chung, MD</creatorcontrib><creatorcontrib>Lee, Shen-Yang, MD</creatorcontrib><creatorcontrib>Hsu, Hsiang-Hao, MD, PhD</creatorcontrib><creatorcontrib>Tian, Ya-Chung, MD, PhD</creatorcontrib><creatorcontrib>Hung, Cheng-Chieh, MD, PhD</creatorcontrib><creatorcontrib>Fang, Ji-Tseng, MD</creatorcontrib><creatorcontrib>Yang, Chih-Wei, MD</creatorcontrib><creatorcontrib>Tsai, Feng-Chun, MD</creatorcontrib><creatorcontrib>Chen, Yung-Chang, MD</creatorcontrib><title>Prognosis of Patients With Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: the Impact of Urine Output on Mortality</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. Methods This study reviewed the medical records of 81 ARDS patients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. Results The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p < 0.001). Urine output had the best discriminative power, the best Youden index, and the highest overall correctness of prediction. Cumulative survival rates at the 6-month follow-up differed significantly ( p < 0.001) for UO 1,432 mL or greater on day 1 of ECMO support versus those with UO less than 1,432 mL on day 1 of ECMO support. Conclusions In ARDS patients receiving ECMO support, UO obtained on the first day of ECMO support showed good prognostic ability in predicting hospital mortality.</description><subject>Adult</subject><subject>APACHE</subject><subject>Calibration</subject><subject>Cardiothoracic Surgery</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Respiratory Distress Syndrome, Adult - mortality</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory Distress Syndrome, Adult - urine</subject><subject>Surgery</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUk1v1DAQtRCILoW_gHzkksV24nxwQCqlQKVWrSgVR8t2Jl0vSRzGDmr-BL8ZR1tA4oQ0kj3ym_fG84YQytmWM16-3m913HnUNsy4FYwXWyZS8Edkw6UUWSlk85hsGGN5VjSVPCLPQtinVKTnp-RIFGXNWc425Oc1-rvRBxeo7-i1jg7GGOhXF3f0xM4R6GcIk0MdPS70vQsRIQR6s4wt-gGoH-nZfUydeJw8gu7pJQwG9Qj06n65gzEx-vENjTug58OkbVx1btGtgDlOc1wpLj1G3bu4PCdPOt0HePFwHpPbD2dfTj9lF1cfz09PLjJbVE3MRFHUhTG8tLZuWMcZ41YyYVoDtRW16IwURSPK0nS21lrKlncVr8C0rJWmqvJj8urAO6H_PkOIanDBQt-nxv0cFJc5b2SZVyxB6wPUog8BoVMTukHjojhTqxtqr_66oVY3FBMpeCp9-aAymwHaP4W_x58A7w4ASH_94QBVsMkAC61DsFG13v2Pytt_SGzvRmd1_w0WCHs_45hmqbgKqUDdrFuxLgUv0kVKmf8CGUm4kw</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Hsiao, Ching-Chung, MD</creator><creator>Chang, Chih-Hsiang, MD</creator><creator>Fan, Pei-Chun, MD</creator><creator>Ho, Heng-Tsan, MD</creator><creator>Jenq, Chang-Chyi, MD</creator><creator>Kao, Kuo-Chin, MD</creator><creator>Chiu, Li-Chung, MD</creator><creator>Lee, Shen-Yang, MD</creator><creator>Hsu, Hsiang-Hao, MD, PhD</creator><creator>Tian, Ya-Chung, MD, PhD</creator><creator>Hung, Cheng-Chieh, MD, PhD</creator><creator>Fang, Ji-Tseng, MD</creator><creator>Yang, Chih-Wei, MD</creator><creator>Tsai, Feng-Chun, MD</creator><creator>Chen, Yung-Chang, MD</creator><general>Elsevier Inc</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>7X8</scope></search><sort><creationdate>20140601</creationdate><title>Prognosis of Patients With Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: the Impact of Urine Output on Mortality</title><author>Hsiao, Ching-Chung, MD ; Chang, Chih-Hsiang, MD ; Fan, Pei-Chun, MD ; Ho, Heng-Tsan, MD ; Jenq, Chang-Chyi, MD ; Kao, Kuo-Chin, MD ; Chiu, Li-Chung, MD ; Lee, Shen-Yang, MD ; Hsu, Hsiang-Hao, MD, PhD ; Tian, Ya-Chung, MD, PhD ; Hung, Cheng-Chieh, MD, PhD ; Fang, Ji-Tseng, MD ; Yang, Chih-Wei, MD ; Tsai, Feng-Chun, MD ; Chen, Yung-Chang, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-24484bb16cc890f1001c502bdbe8c282fb5249266bfc8aa55d1f717ebd0d5b773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>APACHE</topic><topic>Calibration</topic><topic>Cardiothoracic Surgery</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Respiratory Distress Syndrome, Adult - mortality</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory Distress Syndrome, Adult - urine</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hsiao, Ching-Chung, MD</creatorcontrib><creatorcontrib>Chang, Chih-Hsiang, MD</creatorcontrib><creatorcontrib>Fan, Pei-Chun, MD</creatorcontrib><creatorcontrib>Ho, Heng-Tsan, MD</creatorcontrib><creatorcontrib>Jenq, Chang-Chyi, MD</creatorcontrib><creatorcontrib>Kao, Kuo-Chin, MD</creatorcontrib><creatorcontrib>Chiu, Li-Chung, MD</creatorcontrib><creatorcontrib>Lee, Shen-Yang, MD</creatorcontrib><creatorcontrib>Hsu, Hsiang-Hao, MD, PhD</creatorcontrib><creatorcontrib>Tian, Ya-Chung, MD, PhD</creatorcontrib><creatorcontrib>Hung, Cheng-Chieh, MD, PhD</creatorcontrib><creatorcontrib>Fang, Ji-Tseng, MD</creatorcontrib><creatorcontrib>Yang, Chih-Wei, MD</creatorcontrib><creatorcontrib>Tsai, Feng-Chun, MD</creatorcontrib><creatorcontrib>Chen, Yung-Chang, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hsiao, Ching-Chung, MD</au><au>Chang, Chih-Hsiang, MD</au><au>Fan, Pei-Chun, MD</au><au>Ho, Heng-Tsan, MD</au><au>Jenq, Chang-Chyi, MD</au><au>Kao, Kuo-Chin, MD</au><au>Chiu, Li-Chung, MD</au><au>Lee, Shen-Yang, MD</au><au>Hsu, Hsiang-Hao, MD, PhD</au><au>Tian, Ya-Chung, MD, PhD</au><au>Hung, Cheng-Chieh, MD, PhD</au><au>Fang, Ji-Tseng, MD</au><au>Yang, Chih-Wei, MD</au><au>Tsai, Feng-Chun, MD</au><au>Chen, Yung-Chang, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognosis of Patients With Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: the Impact of Urine Output on Mortality</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>97</volume><issue>6</issue><spage>1939</spage><epage>1944</epage><pages>1939-1944</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>Background Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. Methods This study reviewed the medical records of 81 ARDS patients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. Results The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p < 0.001). Urine output had the best discriminative power, the best Youden index, and the highest overall correctness of prediction. Cumulative survival rates at the 6-month follow-up differed significantly ( p < 0.001) for UO 1,432 mL or greater on day 1 of ECMO support versus those with UO less than 1,432 mL on day 1 of ECMO support. Conclusions In ARDS patients receiving ECMO support, UO obtained on the first day of ECMO support showed good prognostic ability in predicting hospital mortality.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>24681030</pmid><doi>10.1016/j.athoracsur.2014.02.021</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0003-4975 |
| ispartof | The Annals of thoracic surgery, 2014-06, Vol.97 (6), p.1939-1944 |
| issn | 0003-4975 1552-6259 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1531956370 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult APACHE Calibration Cardiothoracic Surgery Extracorporeal Membrane Oxygenation Female Hospital Mortality Humans Logistic Models Male Middle Aged Prognosis Respiratory Distress Syndrome, Adult - mortality Respiratory Distress Syndrome, Adult - therapy Respiratory Distress Syndrome, Adult - urine Surgery |
| title | Prognosis of Patients With Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: the Impact of Urine Output on Mortality |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T20%3A59%3A57IST&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=Prognosis%20of%20Patients%20With%20Acute%20Respiratory%20Distress%20Syndrome%20on%20Extracorporeal%20Membrane%20Oxygenation:%20the%20Impact%20of%20Urine%20Output%20on%20Mortality&rft.jtitle=The%20Annals%20of%20thoracic%20surgery&rft.au=Hsiao,%20Ching-Chung,%20MD&rft.date=2014-06-01&rft.volume=97&rft.issue=6&rft.spage=1939&rft.epage=1944&rft.pages=1939-1944&rft.issn=0003-4975&rft.eissn=1552-6259&rft_id=info:doi/10.1016/j.athoracsur.2014.02.021&rft_dat=%3Cproquest_cross%3E1531956370%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=1531956370&rft_id=info:pmid/24681030&rft_els_id=1_s2_0_S0003497514003555&rfr_iscdi=true |