Altered striatal circuits underlie characteristic personality traits in Parkinson’s disease

Patients with Parkinson’s disease (PD) have been suggested to share personality traits characterised by low novelty-seeking and high harm-avoidance. Although a link between novelty-seeking and dopamine is hypothesised, the link is not fully supported by 6-[ 18 F]fluoro- l -dopa positron emission tom...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of neurology 2016-09, Vol.263 (9), p.1828-1839
Hauptverfasser: Ishii, Toru, Sawamoto, Nobukatsu, Tabu, Hayato, Kawashima, Hidekazu, Okada, Tomohisa, Togashi, Kaori, Takahashi, Ryosuke, Fukuyama, Hidenao
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1839
container_issue 9
container_start_page 1828
container_title Journal of neurology
container_volume 263
creator Ishii, Toru
Sawamoto, Nobukatsu
Tabu, Hayato
Kawashima, Hidekazu
Okada, Tomohisa
Togashi, Kaori
Takahashi, Ryosuke
Fukuyama, Hidenao
description Patients with Parkinson’s disease (PD) have been suggested to share personality traits characterised by low novelty-seeking and high harm-avoidance. Although a link between novelty-seeking and dopamine is hypothesised, the link is not fully supported by 6-[ 18 F]fluoro- l -dopa positron emission tomography (PET) studies. Meanwhile, tractography studies with magnetic resonance imaging (MRI) link personality to the connectivity of the striatum in healthy subjects. Here, we investigated neurochemical and anatomical correlates of characteristic personality traits in PD. Sixteen PD patients and 28 healthy controls were assessed using the Temperament and Character Inventory. All patients and 17 randomly selected controls were scanned with 2β-carbomethoxy-3β-(4-fluorophenyl)-[ N - 11 C-methyl]tropane ([ 11 C]CFT) PET to measure striatal dopamine transporter availability. All subjects were scanned with MRI to evaluate the connectivity of the striatum using probabilistic tractography. PET findings revealed no correlation of novelty-seeking and harm-avoidance with [ 11 C]CFT uptake in patients or controls. Novelty-seeking correlated positively with the connectivity strength of the striatum with the hippocampus and amygdala in both patients and controls. Harm-avoidance and the fibre connectivity strength of the striatum including ventral area with the amygdala correlated negatively in patients and positively in controls, which differed significantly between the groups. Our data support the notion that the fibre connectivity of the striatum with limbic and frontal areas underlies the personality profile. Furthermore, our findings suggest that higher harm-avoidance in PD is linked to alterations of the network, including the nucleus accumbens and amygdala.
doi_str_mv 10.1007/s00415-016-8206-0
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1827894976</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1817053278</sourcerecordid><originalsourceid>FETCH-LOGICAL-c514t-fb2e3a19d433ca8577324a6436c50e7bbea2067b9a41a7eb8513d43e28ee25513</originalsourceid><addsrcrecordid>eNqN0c1qFEEQB_BGFLNGH8BLGMjFy2j11_TMMQQ_AgE96DE0NT21ScfZmU1XzyE3X8PX80nszSYiAcFTU9Svqin-QryW8FYCuHcMYKStQTZ1q6Cp4YlYSaNVLY3tnooVaAO11dYciBfM1wDQlsZzcaCc1qYDtxIXJ2OmREPFOUXMOFYhprDEzNUyDZTGSFW4woShsMg5hmpLiecJx5hvq5xwR-NUfcH0PU6l8evHT66GyIRML8WzNY5Mr-7fQ_Htw_uvp5_q888fz05Pzutgpcn1ulekUXaD0Tpga53TymBjdBMskOt7wnKe6zs0Eh31rZW6WFItkbKlOBRv9nu3ab5ZiLPfRA40jjjRvLCXrXJtZzrX_AeVDqwuvtDjR_R6XlK5_E41RoHUUJTcq5Bm5kRrv01xg-nWS_C7mPw-Jl9i8ruY_G7m6H7z0m9o-DPxkEsBag-4tKZLSn99_c-tvwHcSJ33</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1816420130</pqid></control><display><type>article</type><title>Altered striatal circuits underlie characteristic personality traits in Parkinson’s disease</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Ishii, Toru ; Sawamoto, Nobukatsu ; Tabu, Hayato ; Kawashima, Hidekazu ; Okada, Tomohisa ; Togashi, Kaori ; Takahashi, Ryosuke ; Fukuyama, Hidenao</creator><creatorcontrib>Ishii, Toru ; Sawamoto, Nobukatsu ; Tabu, Hayato ; Kawashima, Hidekazu ; Okada, Tomohisa ; Togashi, Kaori ; Takahashi, Ryosuke ; Fukuyama, Hidenao</creatorcontrib><description>Patients with Parkinson’s disease (PD) have been suggested to share personality traits characterised by low novelty-seeking and high harm-avoidance. Although a link between novelty-seeking and dopamine is hypothesised, the link is not fully supported by 6-[ 18 F]fluoro- l -dopa positron emission tomography (PET) studies. Meanwhile, tractography studies with magnetic resonance imaging (MRI) link personality to the connectivity of the striatum in healthy subjects. Here, we investigated neurochemical and anatomical correlates of characteristic personality traits in PD. Sixteen PD patients and 28 healthy controls were assessed using the Temperament and Character Inventory. All patients and 17 randomly selected controls were scanned with 2β-carbomethoxy-3β-(4-fluorophenyl)-[ N - 11 C-methyl]tropane ([ 11 C]CFT) PET to measure striatal dopamine transporter availability. All subjects were scanned with MRI to evaluate the connectivity of the striatum using probabilistic tractography. PET findings revealed no correlation of novelty-seeking and harm-avoidance with [ 11 C]CFT uptake in patients or controls. Novelty-seeking correlated positively with the connectivity strength of the striatum with the hippocampus and amygdala in both patients and controls. Harm-avoidance and the fibre connectivity strength of the striatum including ventral area with the amygdala correlated negatively in patients and positively in controls, which differed significantly between the groups. Our data support the notion that the fibre connectivity of the striatum with limbic and frontal areas underlies the personality profile. Furthermore, our findings suggest that higher harm-avoidance in PD is linked to alterations of the network, including the nucleus accumbens and amygdala.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-016-8206-0</identifier><identifier>PMID: 27334907</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Brain Mapping ; Corpus Striatum - diagnostic imaging ; Corpus Striatum - metabolism ; Diffusion Magnetic Resonance Imaging ; Disability Evaluation ; Dopamine Plasma Membrane Transport Proteins - metabolism ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Medicine ; Medicine &amp; Public Health ; Mental Status Schedule ; Middle Aged ; Neural Pathways - diagnostic imaging ; Neural Pathways - metabolism ; Neurology ; Neuropsychological Tests ; Neuroradiology ; Neurosciences ; Original Communication ; Parkinson Disease - diagnostic imaging ; Parkinson Disease - drug therapy ; Parkinson Disease - metabolism ; Parkinson Disease - psychology ; Parkinson's disease ; Personality - physiology ; Personality Tests ; Positron-Emission Tomography ; Severity of Illness Index</subject><ispartof>Journal of neurology, 2016-09, Vol.263 (9), p.1828-1839</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c514t-fb2e3a19d433ca8577324a6436c50e7bbea2067b9a41a7eb8513d43e28ee25513</citedby><cites>FETCH-LOGICAL-c514t-fb2e3a19d433ca8577324a6436c50e7bbea2067b9a41a7eb8513d43e28ee25513</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/s00415-016-8206-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00415-016-8206-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27928,27929,41492,42561,51323</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27334907$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ishii, Toru</creatorcontrib><creatorcontrib>Sawamoto, Nobukatsu</creatorcontrib><creatorcontrib>Tabu, Hayato</creatorcontrib><creatorcontrib>Kawashima, Hidekazu</creatorcontrib><creatorcontrib>Okada, Tomohisa</creatorcontrib><creatorcontrib>Togashi, Kaori</creatorcontrib><creatorcontrib>Takahashi, Ryosuke</creatorcontrib><creatorcontrib>Fukuyama, Hidenao</creatorcontrib><title>Altered striatal circuits underlie characteristic personality traits in Parkinson’s disease</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><addtitle>J Neurol</addtitle><description>Patients with Parkinson’s disease (PD) have been suggested to share personality traits characterised by low novelty-seeking and high harm-avoidance. Although a link between novelty-seeking and dopamine is hypothesised, the link is not fully supported by 6-[ 18 F]fluoro- l -dopa positron emission tomography (PET) studies. Meanwhile, tractography studies with magnetic resonance imaging (MRI) link personality to the connectivity of the striatum in healthy subjects. Here, we investigated neurochemical and anatomical correlates of characteristic personality traits in PD. Sixteen PD patients and 28 healthy controls were assessed using the Temperament and Character Inventory. All patients and 17 randomly selected controls were scanned with 2β-carbomethoxy-3β-(4-fluorophenyl)-[ N - 11 C-methyl]tropane ([ 11 C]CFT) PET to measure striatal dopamine transporter availability. All subjects were scanned with MRI to evaluate the connectivity of the striatum using probabilistic tractography. PET findings revealed no correlation of novelty-seeking and harm-avoidance with [ 11 C]CFT uptake in patients or controls. Novelty-seeking correlated positively with the connectivity strength of the striatum with the hippocampus and amygdala in both patients and controls. Harm-avoidance and the fibre connectivity strength of the striatum including ventral area with the amygdala correlated negatively in patients and positively in controls, which differed significantly between the groups. Our data support the notion that the fibre connectivity of the striatum with limbic and frontal areas underlies the personality profile. Furthermore, our findings suggest that higher harm-avoidance in PD is linked to alterations of the network, including the nucleus accumbens and amygdala.</description><subject>Aged</subject><subject>Brain Mapping</subject><subject>Corpus Striatum - diagnostic imaging</subject><subject>Corpus Striatum - metabolism</subject><subject>Diffusion Magnetic Resonance Imaging</subject><subject>Disability Evaluation</subject><subject>Dopamine Plasma Membrane Transport Proteins - metabolism</subject><subject>Female</subject><subject>Humans</subject><subject>Image Processing, Computer-Assisted</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Mental Status Schedule</subject><subject>Middle Aged</subject><subject>Neural Pathways - diagnostic imaging</subject><subject>Neural Pathways - metabolism</subject><subject>Neurology</subject><subject>Neuropsychological Tests</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Original Communication</subject><subject>Parkinson Disease - diagnostic imaging</subject><subject>Parkinson Disease - drug therapy</subject><subject>Parkinson Disease - metabolism</subject><subject>Parkinson Disease - psychology</subject><subject>Parkinson's disease</subject><subject>Personality - physiology</subject><subject>Personality Tests</subject><subject>Positron-Emission Tomography</subject><subject>Severity of Illness Index</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqN0c1qFEEQB_BGFLNGH8BLGMjFy2j11_TMMQQ_AgE96DE0NT21ScfZmU1XzyE3X8PX80nszSYiAcFTU9Svqin-QryW8FYCuHcMYKStQTZ1q6Cp4YlYSaNVLY3tnooVaAO11dYciBfM1wDQlsZzcaCc1qYDtxIXJ2OmREPFOUXMOFYhprDEzNUyDZTGSFW4woShsMg5hmpLiecJx5hvq5xwR-NUfcH0PU6l8evHT66GyIRML8WzNY5Mr-7fQ_Htw_uvp5_q888fz05Pzutgpcn1ulekUXaD0Tpga53TymBjdBMskOt7wnKe6zs0Eh31rZW6WFItkbKlOBRv9nu3ab5ZiLPfRA40jjjRvLCXrXJtZzrX_AeVDqwuvtDjR_R6XlK5_E41RoHUUJTcq5Bm5kRrv01xg-nWS_C7mPw-Jl9i8ruY_G7m6H7z0m9o-DPxkEsBag-4tKZLSn99_c-tvwHcSJ33</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Ishii, Toru</creator><creator>Sawamoto, Nobukatsu</creator><creator>Tabu, Hayato</creator><creator>Kawashima, Hidekazu</creator><creator>Okada, Tomohisa</creator><creator>Togashi, Kaori</creator><creator>Takahashi, Ryosuke</creator><creator>Fukuyama, Hidenao</creator><general>Springer Berlin Heidelberg</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>7TK</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>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160901</creationdate><title>Altered striatal circuits underlie characteristic personality traits in Parkinson’s disease</title><author>Ishii, Toru ; Sawamoto, Nobukatsu ; Tabu, Hayato ; Kawashima, Hidekazu ; Okada, Tomohisa ; Togashi, Kaori ; Takahashi, Ryosuke ; Fukuyama, Hidenao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c514t-fb2e3a19d433ca8577324a6436c50e7bbea2067b9a41a7eb8513d43e28ee25513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Brain Mapping</topic><topic>Corpus Striatum - diagnostic imaging</topic><topic>Corpus Striatum - metabolism</topic><topic>Diffusion Magnetic Resonance Imaging</topic><topic>Disability Evaluation</topic><topic>Dopamine Plasma Membrane Transport Proteins - metabolism</topic><topic>Female</topic><topic>Humans</topic><topic>Image Processing, Computer-Assisted</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Mental Status Schedule</topic><topic>Middle Aged</topic><topic>Neural Pathways - diagnostic imaging</topic><topic>Neural Pathways - metabolism</topic><topic>Neurology</topic><topic>Neuropsychological Tests</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Original Communication</topic><topic>Parkinson Disease - diagnostic imaging</topic><topic>Parkinson Disease - drug therapy</topic><topic>Parkinson Disease - metabolism</topic><topic>Parkinson Disease - psychology</topic><topic>Parkinson's disease</topic><topic>Personality - physiology</topic><topic>Personality Tests</topic><topic>Positron-Emission Tomography</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ishii, Toru</creatorcontrib><creatorcontrib>Sawamoto, Nobukatsu</creatorcontrib><creatorcontrib>Tabu, Hayato</creatorcontrib><creatorcontrib>Kawashima, Hidekazu</creatorcontrib><creatorcontrib>Okada, Tomohisa</creatorcontrib><creatorcontrib>Togashi, Kaori</creatorcontrib><creatorcontrib>Takahashi, Ryosuke</creatorcontrib><creatorcontrib>Fukuyama, Hidenao</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>Neurosciences Abstracts</collection><collection>Health &amp; 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 &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical 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>MEDLINE - Academic</collection><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ishii, Toru</au><au>Sawamoto, Nobukatsu</au><au>Tabu, Hayato</au><au>Kawashima, Hidekazu</au><au>Okada, Tomohisa</au><au>Togashi, Kaori</au><au>Takahashi, Ryosuke</au><au>Fukuyama, Hidenao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Altered striatal circuits underlie characteristic personality traits in Parkinson’s disease</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><addtitle>J Neurol</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>263</volume><issue>9</issue><spage>1828</spage><epage>1839</epage><pages>1828-1839</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><abstract>Patients with Parkinson’s disease (PD) have been suggested to share personality traits characterised by low novelty-seeking and high harm-avoidance. Although a link between novelty-seeking and dopamine is hypothesised, the link is not fully supported by 6-[ 18 F]fluoro- l -dopa positron emission tomography (PET) studies. Meanwhile, tractography studies with magnetic resonance imaging (MRI) link personality to the connectivity of the striatum in healthy subjects. Here, we investigated neurochemical and anatomical correlates of characteristic personality traits in PD. Sixteen PD patients and 28 healthy controls were assessed using the Temperament and Character Inventory. All patients and 17 randomly selected controls were scanned with 2β-carbomethoxy-3β-(4-fluorophenyl)-[ N - 11 C-methyl]tropane ([ 11 C]CFT) PET to measure striatal dopamine transporter availability. All subjects were scanned with MRI to evaluate the connectivity of the striatum using probabilistic tractography. PET findings revealed no correlation of novelty-seeking and harm-avoidance with [ 11 C]CFT uptake in patients or controls. Novelty-seeking correlated positively with the connectivity strength of the striatum with the hippocampus and amygdala in both patients and controls. Harm-avoidance and the fibre connectivity strength of the striatum including ventral area with the amygdala correlated negatively in patients and positively in controls, which differed significantly between the groups. Our data support the notion that the fibre connectivity of the striatum with limbic and frontal areas underlies the personality profile. Furthermore, our findings suggest that higher harm-avoidance in PD is linked to alterations of the network, including the nucleus accumbens and amygdala.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27334907</pmid><doi>10.1007/s00415-016-8206-0</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0340-5354
ispartof Journal of neurology, 2016-09, Vol.263 (9), p.1828-1839
issn 0340-5354
1432-1459
language eng
recordid cdi_proquest_miscellaneous_1827894976
source MEDLINE; SpringerNature Journals
subjects Aged
Brain Mapping
Corpus Striatum - diagnostic imaging
Corpus Striatum - metabolism
Diffusion Magnetic Resonance Imaging
Disability Evaluation
Dopamine Plasma Membrane Transport Proteins - metabolism
Female
Humans
Image Processing, Computer-Assisted
Male
Medicine
Medicine & Public Health
Mental Status Schedule
Middle Aged
Neural Pathways - diagnostic imaging
Neural Pathways - metabolism
Neurology
Neuropsychological Tests
Neuroradiology
Neurosciences
Original Communication
Parkinson Disease - diagnostic imaging
Parkinson Disease - drug therapy
Parkinson Disease - metabolism
Parkinson Disease - psychology
Parkinson's disease
Personality - physiology
Personality Tests
Positron-Emission Tomography
Severity of Illness Index
title Altered striatal circuits underlie characteristic personality traits in Parkinson’s disease
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-16T13%3A43%3A27IST&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=Altered%20striatal%20circuits%20underlie%20characteristic%20personality%20traits%20in%20Parkinson%E2%80%99s%20disease&rft.jtitle=Journal%20of%20neurology&rft.au=Ishii,%20Toru&rft.date=2016-09-01&rft.volume=263&rft.issue=9&rft.spage=1828&rft.epage=1839&rft.pages=1828-1839&rft.issn=0340-5354&rft.eissn=1432-1459&rft_id=info:doi/10.1007/s00415-016-8206-0&rft_dat=%3Cproquest_cross%3E1817053278%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=1816420130&rft_id=info:pmid/27334907&rfr_iscdi=true