Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction
Background We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG. Patients and Methods PRG was performed in 37 patients (age 31 to...
Gespeichert in:
| Veröffentlicht in: | Journal of gastrointestinal surgery 2016-04, Vol.20 (4), p.772-775 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 775 |
|---|---|
| container_issue | 4 |
| container_start_page | 772 |
| container_title | Journal of gastrointestinal surgery |
| container_volume | 20 |
| creator | Hoya, Yoshiyuki Taki, Tetsuya Watanabe, Atsushi Nakayoshi, Tomoko Okamoto, Tomoyoshi Mitsumori, Norio Yanaga, Katsuhiko |
| description | Background
We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG.
Patients and Methods
PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%).
Results
There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG (
P
= 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 μmol/L,
P
= 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63 %,
P
= 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy.
Conclusion
The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time. |
| doi_str_mv | 10.1007/s11605-015-3022-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1775632092</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3993928241</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-92e2812a5a687795e1f26b12cc7d9261e518198515d6ca96a9965b8026e241723</originalsourceid><addsrcrecordid>eNp1kU1uFDEQhVsIRELgAGyQJTZZYOJyj_-WkJAQKShS-BE7y-N2D47c9mB3h8kBuEfOkpPhzgSEkKiNS1Xfe2XpNc1zIK-BEHFQADhhmADDLaEUbx40uyBFixec8oe1JwowZezrTvOklEtCQBCQj5sdymuxhdxtfh5N2SyDQ8fBrPEXE64c-uBHvzKjTxGlHh1NqXMxrUwZs7fowvVh2rxCtzcXbogmjujkbjP6cntjYlf5Ye3jCn28jl1OQ3VOIaQf8-itDyGn8Rs6rTY2xaqb7HznafOoN6G4Z_fvXvP5-N2nw_f47Pzk9PDNGbatoCNW1FEJ1DDDpRCKOegpXwK1VnSKcnAMJCjJgHXcGsWNUpwtJaHc0QUI2u41-1vfdU7fJ1dGPfhiXQgmujQVDUIw3lKiZvTlP-hlmnKsv7ujiGKSyErBlrI5lZJdr9fZDyZfayB6zkhvM9I1Iz1npDdV8-LeeVoOrvuj-B1KBegWKHUVVy7_dfq_rr8AaX-eXw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1775095808</pqid></control><display><type>article</type><title>Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Hoya, Yoshiyuki ; Taki, Tetsuya ; Watanabe, Atsushi ; Nakayoshi, Tomoko ; Okamoto, Tomoyoshi ; Mitsumori, Norio ; Yanaga, Katsuhiko</creator><creatorcontrib>Hoya, Yoshiyuki ; Taki, Tetsuya ; Watanabe, Atsushi ; Nakayoshi, Tomoko ; Okamoto, Tomoyoshi ; Mitsumori, Norio ; Yanaga, Katsuhiko</creatorcontrib><description>Background
We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG.
Patients and Methods
PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%).
Results
There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG (
P
= 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 μmol/L,
P
= 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63 %,
P
= 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy.
Conclusion
The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-015-3022-x</identifier><identifier>PMID: 26666548</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Dumping syndrome ; Dumping Syndrome - etiology ; Dumping Syndrome - prevention & control ; Duodenogastric Reflux - etiology ; Duodenogastric Reflux - prevention & control ; Endoscopy ; Female ; Follow-Up Studies ; Gastrectomy - adverse effects ; Gastrectomy - methods ; Gastric cancer ; Gastric Stump - surgery ; Gastritis - etiology ; Gastritis - prevention & control ; Gastroenterology ; Gastroenterostomy - adverse effects ; Gastroenterostomy - methods ; Gastrointestinal surgery ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Pylorus - surgery ; Stomach Neoplasms - surgery ; Surgery ; Time Factors ; Weight Loss</subject><ispartof>Journal of gastrointestinal surgery, 2016-04, Vol.20 (4), p.772-775</ispartof><rights>The Society for Surgery of the Alimentary Tract 2015</rights><rights>The Society for Surgery of the Alimentary Tract 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-92e2812a5a687795e1f26b12cc7d9261e518198515d6ca96a9965b8026e241723</citedby><cites>FETCH-LOGICAL-c372t-92e2812a5a687795e1f26b12cc7d9261e518198515d6ca96a9965b8026e241723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-015-3022-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-015-3022-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26666548$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hoya, Yoshiyuki</creatorcontrib><creatorcontrib>Taki, Tetsuya</creatorcontrib><creatorcontrib>Watanabe, Atsushi</creatorcontrib><creatorcontrib>Nakayoshi, Tomoko</creatorcontrib><creatorcontrib>Okamoto, Tomoyoshi</creatorcontrib><creatorcontrib>Mitsumori, Norio</creatorcontrib><creatorcontrib>Yanaga, Katsuhiko</creatorcontrib><title>Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background
We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG.
Patients and Methods
PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%).
Results
There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG (
P
= 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 μmol/L,
P
= 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63 %,
P
= 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy.
Conclusion
The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Dumping syndrome</subject><subject>Dumping Syndrome - etiology</subject><subject>Dumping Syndrome - prevention & control</subject><subject>Duodenogastric Reflux - etiology</subject><subject>Duodenogastric Reflux - prevention & control</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastrectomy - methods</subject><subject>Gastric cancer</subject><subject>Gastric Stump - surgery</subject><subject>Gastritis - etiology</subject><subject>Gastritis - prevention & control</subject><subject>Gastroenterology</subject><subject>Gastroenterostomy - adverse effects</subject><subject>Gastroenterostomy - methods</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Pylorus - surgery</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Weight Loss</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU1uFDEQhVsIRELgAGyQJTZZYOJyj_-WkJAQKShS-BE7y-N2D47c9mB3h8kBuEfOkpPhzgSEkKiNS1Xfe2XpNc1zIK-BEHFQADhhmADDLaEUbx40uyBFixec8oe1JwowZezrTvOklEtCQBCQj5sdymuxhdxtfh5N2SyDQ8fBrPEXE64c-uBHvzKjTxGlHh1NqXMxrUwZs7fowvVh2rxCtzcXbogmjujkbjP6cntjYlf5Ye3jCn28jl1OQ3VOIaQf8-itDyGn8Rs6rTY2xaqb7HznafOoN6G4Z_fvXvP5-N2nw_f47Pzk9PDNGbatoCNW1FEJ1DDDpRCKOegpXwK1VnSKcnAMJCjJgHXcGsWNUpwtJaHc0QUI2u41-1vfdU7fJ1dGPfhiXQgmujQVDUIw3lKiZvTlP-hlmnKsv7ujiGKSyErBlrI5lZJdr9fZDyZfayB6zkhvM9I1Iz1npDdV8-LeeVoOrvuj-B1KBegWKHUVVy7_dfq_rr8AaX-eXw</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Hoya, Yoshiyuki</creator><creator>Taki, Tetsuya</creator><creator>Watanabe, Atsushi</creator><creator>Nakayoshi, Tomoko</creator><creator>Okamoto, Tomoyoshi</creator><creator>Mitsumori, Norio</creator><creator>Yanaga, Katsuhiko</creator><general>Springer US</general><general>Springer Nature B.V</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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</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>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160401</creationdate><title>Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction</title><author>Hoya, Yoshiyuki ; Taki, Tetsuya ; Watanabe, Atsushi ; Nakayoshi, Tomoko ; Okamoto, Tomoyoshi ; Mitsumori, Norio ; Yanaga, Katsuhiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-92e2812a5a687795e1f26b12cc7d9261e518198515d6ca96a9965b8026e241723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Dumping syndrome</topic><topic>Dumping Syndrome - etiology</topic><topic>Dumping Syndrome - prevention & control</topic><topic>Duodenogastric Reflux - etiology</topic><topic>Duodenogastric Reflux - prevention & control</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastrectomy - methods</topic><topic>Gastric cancer</topic><topic>Gastric Stump - surgery</topic><topic>Gastritis - etiology</topic><topic>Gastritis - prevention & control</topic><topic>Gastroenterology</topic><topic>Gastroenterostomy - adverse effects</topic><topic>Gastroenterostomy - methods</topic><topic>Gastrointestinal surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Pylorus - surgery</topic><topic>Stomach Neoplasms - surgery</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hoya, Yoshiyuki</creatorcontrib><creatorcontrib>Taki, Tetsuya</creatorcontrib><creatorcontrib>Watanabe, Atsushi</creatorcontrib><creatorcontrib>Nakayoshi, Tomoko</creatorcontrib><creatorcontrib>Okamoto, Tomoyoshi</creatorcontrib><creatorcontrib>Mitsumori, Norio</creatorcontrib><creatorcontrib>Yanaga, Katsuhiko</creatorcontrib><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>Nursing & Allied Health Database</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>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</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</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><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hoya, Yoshiyuki</au><au>Taki, Tetsuya</au><au>Watanabe, Atsushi</au><au>Nakayoshi, Tomoko</au><au>Okamoto, Tomoyoshi</au><au>Mitsumori, Norio</au><au>Yanaga, Katsuhiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>20</volume><issue>4</issue><spage>772</spage><epage>775</epage><pages>772-775</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Background
We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG.
Patients and Methods
PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%).
Results
There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG (
P
= 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 μmol/L,
P
= 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63 %,
P
= 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy.
Conclusion
The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26666548</pmid><doi>10.1007/s11605-015-3022-x</doi><tpages>4</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1091-255X |
| ispartof | Journal of gastrointestinal surgery, 2016-04, Vol.20 (4), p.772-775 |
| issn | 1091-255X 1873-4626 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1775632092 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Aged, 80 and over Dumping syndrome Dumping Syndrome - etiology Dumping Syndrome - prevention & control Duodenogastric Reflux - etiology Duodenogastric Reflux - prevention & control Endoscopy Female Follow-Up Studies Gastrectomy - adverse effects Gastrectomy - methods Gastric cancer Gastric Stump - surgery Gastritis - etiology Gastritis - prevention & control Gastroenterology Gastroenterostomy - adverse effects Gastroenterostomy - methods Gastrointestinal surgery Humans Male Medicine Medicine & Public Health Middle Aged Original Article Pylorus - surgery Stomach Neoplasms - surgery Surgery Time Factors Weight Loss |
| title | Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T18%3A59%3A02IST&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=Durable%20Flap-Valve%20Mitigation%20of%20Duodenogastric%20Reflux,%20%C2%A0Remnant%20Gastritis%C2%A0and%20Dumping%20Syndrome%20Following%20Billroth%20I%20Reconstruction&rft.jtitle=Journal%20of%20gastrointestinal%20surgery&rft.au=Hoya,%20Yoshiyuki&rft.date=2016-04-01&rft.volume=20&rft.issue=4&rft.spage=772&rft.epage=775&rft.pages=772-775&rft.issn=1091-255X&rft.eissn=1873-4626&rft_id=info:doi/10.1007/s11605-015-3022-x&rft_dat=%3Cproquest_cross%3E3993928241%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=1775095808&rft_id=info:pmid/26666548&rfr_iscdi=true |