Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy
Abstract Background Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. Methods The medical records of 508 patients who underwent pancreatectomy were retro...
Gespeichert in:
| Veröffentlicht in: | The American journal of surgery 2017-08, Vol.214 (2), p.267-272 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 272 |
|---|---|
| container_issue | 2 |
| container_start_page | 267 |
| container_title | The American journal of surgery |
| container_volume | 214 |
| creator | Ohtsuka, Takao Mori, Yasuhisa Ishigami, Kousei Fujimoto, Takaaki Miyasaka, Yoshihiro Nakata, Kohei Ohuchida, Kenoki Nagai, Eishi Oda, Yoshinao Shimizu, Shuji Nakamura, Masafumi |
| description | Abstract Background Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. Methods The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. Results Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. Conclusions Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly. |
| doi_str_mv | 10.1016/j.amjsurg.2016.11.018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1842599106</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0002961016308613</els_id><sourcerecordid>1842599106</sourcerecordid><originalsourceid>FETCH-LOGICAL-c448t-218ab6ae13cce613c2a8ae2bd3f5ec0573e313438dcecf440c1965183ac18c33</originalsourceid><addsrcrecordid>eNqFkk1r3DAQhkVpabZJf0KDoZce1q5Gsr3yJaUs_YJAD8mxILTj8SLHljaSXdh_X5ndtJBLL5JG884r6dEw9g54ARzqj31hxj7OYV-IFBYABQf1gq1AbZoclJIv2YpzLvKmBn7B3sTYpxCglK_ZhdioDdSKr9iv7WCdRTNk0e6d7dLSIWW-y9AGnMeDD1NKHtJuIBPXmcmCCZShd3tydskZ50czHNeZdU-6iXDy4_GKverMEOnteb5k91-_3G-_57c_v_3Yfr7NsSzVlAtQZlcbAolIdRqFUYbErpVdRcirjSQJspSqRcKuLDlCU1egpEFQKOUl-3CyPQT_OFOc9Ggj0jAYR36OGlQpqqYBXifp-2fS3s_BpctpaIRQlVDQJFV1UmHwMQbq9CHY0YSjBq4X-rrXZ_p6oa8BdKKf6q7P7vNupPZv1RPuJPh0ElCi8dtS0BEtJeCtDQmZbr397xE3zxzw_IEPdKT47zU6Cs313dICSwdALblKbOUfVsOtyg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1922852819</pqid></control><display><type>article</type><title>Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>ProQuest Central UK/Ireland</source><creator>Ohtsuka, Takao ; Mori, Yasuhisa ; Ishigami, Kousei ; Fujimoto, Takaaki ; Miyasaka, Yoshihiro ; Nakata, Kohei ; Ohuchida, Kenoki ; Nagai, Eishi ; Oda, Yoshinao ; Shimizu, Shuji ; Nakamura, Masafumi</creator><creatorcontrib>Ohtsuka, Takao ; Mori, Yasuhisa ; Ishigami, Kousei ; Fujimoto, Takaaki ; Miyasaka, Yoshihiro ; Nakata, Kohei ; Ohuchida, Kenoki ; Nagai, Eishi ; Oda, Yoshinao ; Shimizu, Shuji ; Nakamura, Masafumi</creatorcontrib><description>Abstract Background Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. Methods The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. Results Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. Conclusions Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2016.11.018</identifier><identifier>PMID: 27871680</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Circumportal pancreas ; Classification ; Clinical significance ; Cohort Studies ; Female ; Fistulae ; Hepatic artery ; Hospitals ; Humans ; Incidence ; Male ; Medical imaging ; Medical records ; Middle Aged ; Pancreas ; Pancreas - abnormalities ; Pancreatectomy ; Pancreatectomy - methods ; Pancreatic fistula ; Parenchyma ; Patients ; Portal annular pancreas ; Portal vein ; Postoperative Complications - epidemiology ; Retrospective Studies ; Risk Factors ; Surgery ; Surgical outcomes ; Tomography ; Veins & arteries ; Young Adult</subject><ispartof>The American journal of surgery, 2017-08, Vol.214 (2), p.267-272</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-218ab6ae13cce613c2a8ae2bd3f5ec0573e313438dcecf440c1965183ac18c33</citedby><cites>FETCH-LOGICAL-c448t-218ab6ae13cce613c2a8ae2bd3f5ec0573e313438dcecf440c1965183ac18c33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1922852819?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27871680$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ohtsuka, Takao</creatorcontrib><creatorcontrib>Mori, Yasuhisa</creatorcontrib><creatorcontrib>Ishigami, Kousei</creatorcontrib><creatorcontrib>Fujimoto, Takaaki</creatorcontrib><creatorcontrib>Miyasaka, Yoshihiro</creatorcontrib><creatorcontrib>Nakata, Kohei</creatorcontrib><creatorcontrib>Ohuchida, Kenoki</creatorcontrib><creatorcontrib>Nagai, Eishi</creatorcontrib><creatorcontrib>Oda, Yoshinao</creatorcontrib><creatorcontrib>Shimizu, Shuji</creatorcontrib><creatorcontrib>Nakamura, Masafumi</creatorcontrib><title>Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. Methods The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. Results Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. Conclusions Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Circumportal pancreas</subject><subject>Classification</subject><subject>Clinical significance</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fistulae</subject><subject>Hepatic artery</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Pancreas</subject><subject>Pancreas - abnormalities</subject><subject>Pancreatectomy</subject><subject>Pancreatectomy - methods</subject><subject>Pancreatic fistula</subject><subject>Parenchyma</subject><subject>Patients</subject><subject>Portal annular pancreas</subject><subject>Portal vein</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Tomography</subject><subject>Veins & arteries</subject><subject>Young Adult</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkk1r3DAQhkVpabZJf0KDoZce1q5Gsr3yJaUs_YJAD8mxILTj8SLHljaSXdh_X5ndtJBLL5JG884r6dEw9g54ARzqj31hxj7OYV-IFBYABQf1gq1AbZoclJIv2YpzLvKmBn7B3sTYpxCglK_ZhdioDdSKr9iv7WCdRTNk0e6d7dLSIWW-y9AGnMeDD1NKHtJuIBPXmcmCCZShd3tydskZ50czHNeZdU-6iXDy4_GKverMEOnteb5k91-_3G-_57c_v_3Yfr7NsSzVlAtQZlcbAolIdRqFUYbErpVdRcirjSQJspSqRcKuLDlCU1egpEFQKOUl-3CyPQT_OFOc9Ggj0jAYR36OGlQpqqYBXifp-2fS3s_BpctpaIRQlVDQJFV1UmHwMQbq9CHY0YSjBq4X-rrXZ_p6oa8BdKKf6q7P7vNupPZv1RPuJPh0ElCi8dtS0BEtJeCtDQmZbr397xE3zxzw_IEPdKT47zU6Cs313dICSwdALblKbOUfVsOtyg</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Ohtsuka, Takao</creator><creator>Mori, Yasuhisa</creator><creator>Ishigami, Kousei</creator><creator>Fujimoto, Takaaki</creator><creator>Miyasaka, Yoshihiro</creator><creator>Nakata, Kohei</creator><creator>Ohuchida, Kenoki</creator><creator>Nagai, Eishi</creator><creator>Oda, Yoshinao</creator><creator>Shimizu, Shuji</creator><creator>Nakamura, Masafumi</creator><general>Elsevier Inc</general><general>Elsevier Limited</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>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy</title><author>Ohtsuka, Takao ; Mori, Yasuhisa ; Ishigami, Kousei ; Fujimoto, Takaaki ; Miyasaka, Yoshihiro ; Nakata, Kohei ; Ohuchida, Kenoki ; Nagai, Eishi ; Oda, Yoshinao ; Shimizu, Shuji ; Nakamura, Masafumi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-218ab6ae13cce613c2a8ae2bd3f5ec0573e313438dcecf440c1965183ac18c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Circumportal pancreas</topic><topic>Classification</topic><topic>Clinical significance</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fistulae</topic><topic>Hepatic artery</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Pancreas</topic><topic>Pancreas - abnormalities</topic><topic>Pancreatectomy</topic><topic>Pancreatectomy - methods</topic><topic>Pancreatic fistula</topic><topic>Parenchyma</topic><topic>Patients</topic><topic>Portal annular pancreas</topic><topic>Portal vein</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Tomography</topic><topic>Veins & arteries</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ohtsuka, Takao</creatorcontrib><creatorcontrib>Mori, Yasuhisa</creatorcontrib><creatorcontrib>Ishigami, Kousei</creatorcontrib><creatorcontrib>Fujimoto, Takaaki</creatorcontrib><creatorcontrib>Miyasaka, Yoshihiro</creatorcontrib><creatorcontrib>Nakata, Kohei</creatorcontrib><creatorcontrib>Ohuchida, Kenoki</creatorcontrib><creatorcontrib>Nagai, Eishi</creatorcontrib><creatorcontrib>Oda, Yoshinao</creatorcontrib><creatorcontrib>Shimizu, Shuji</creatorcontrib><creatorcontrib>Nakamura, Masafumi</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>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</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>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</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><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ohtsuka, Takao</au><au>Mori, Yasuhisa</au><au>Ishigami, Kousei</au><au>Fujimoto, Takaaki</au><au>Miyasaka, Yoshihiro</au><au>Nakata, Kohei</au><au>Ohuchida, Kenoki</au><au>Nagai, Eishi</au><au>Oda, Yoshinao</au><au>Shimizu, Shuji</au><au>Nakamura, Masafumi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>214</volume><issue>2</issue><spage>267</spage><epage>272</epage><pages>267-272</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Abstract Background Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. Methods The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. Results Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. Conclusions Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27871680</pmid><doi>10.1016/j.amjsurg.2016.11.018</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9610 |
| ispartof | The American journal of surgery, 2017-08, Vol.214 (2), p.267-272 |
| issn | 0002-9610 1879-1883 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1842599106 |
| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Adolescent Adult Aged Aged, 80 and over Circumportal pancreas Classification Clinical significance Cohort Studies Female Fistulae Hepatic artery Hospitals Humans Incidence Male Medical imaging Medical records Middle Aged Pancreas Pancreas - abnormalities Pancreatectomy Pancreatectomy - methods Pancreatic fistula Parenchyma Patients Portal annular pancreas Portal vein Postoperative Complications - epidemiology Retrospective Studies Risk Factors Surgery Surgical outcomes Tomography Veins & arteries Young Adult |
| title | Clinical significance of circumportal pancreas, a rare congenital anomaly, in pancreatectomy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T07%3A54%3A04IST&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=Clinical%20significance%20of%20circumportal%20pancreas,%20a%20rare%20congenital%20anomaly,%20in%20pancreatectomy&rft.jtitle=The%20American%20journal%20of%20surgery&rft.au=Ohtsuka,%20Takao&rft.date=2017-08-01&rft.volume=214&rft.issue=2&rft.spage=267&rft.epage=272&rft.pages=267-272&rft.issn=0002-9610&rft.eissn=1879-1883&rft_id=info:doi/10.1016/j.amjsurg.2016.11.018&rft_dat=%3Cproquest_cross%3E1842599106%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=1922852819&rft_id=info:pmid/27871680&rft_els_id=1_s2_0_S0002961016308613&rfr_iscdi=true |