Effect of a Homemade Salivary Substitute Prepared Using Chamomile (Matricaria chamomilla L.) Flower and Flax (Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report
Objectives: To evaluate (1) the effect of a salivary substitute prepared using chamomile ( Matricaria chamomilla L .) flower and flax ( Linum usitatissimum L. ) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and M...
Gespeichert in:
| Veröffentlicht in: | The journal of alternative and complementary medicine (New York, N.Y.) N.Y.), 2020-09, Vol.26 (9), p.81-808 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 808 |
|---|---|
| container_issue | 9 |
| container_start_page | 81 |
| container_title | The journal of alternative and complementary medicine (New York, N.Y.) |
| container_volume | 26 |
| creator | Aitken-Saavedra, Juan Chaves Tarquinio, Sandra Beatriz De Oliveira da Rosa, Wellington Luiz Fernandes da Silva, Adriana Almeida Machado, Bruna Macedo Santos Castro, Ingrid Oliveira Wennesheimer, Andressa Morales-Bozo, Irene Uchoa Vasconcelos, Ana Carolina Neutzling Gomes, Ana Paula |
| description | Objectives:
To evaluate (1) the effect of a salivary substitute prepared using chamomile (
Matricaria chamomilla L
.) flower and flax (
Linum usitatissimum L.
) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and MMP9 metalloproteinases, and (3) their potential cellular cytotoxic effect.
Subjects:
40 women aging >40 years with diagnosis of primary BMS.
Settings/Location:
Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Brazil.
Design:
This was an open clinical trial where primary BMS patients used the homemade salivary. At the first appointment, after 30 and 60 days, the authors evaluated the pattern and intensity of BMS and xerostomia symptoms, and then determined and compared the unstimulated salivary flow rate (SFR), viscosity, and salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed using different concentrations of chamomile flower and flax seed separately.
Interventions:
Subjects used the homemade salivary substitute for 3 months and were instructed to rinse their mouth three to four times daily for 1 min.
Outcome measures:
A numeric rating scale to evaluate the intensity of burning sensation and xerostomia symptoms, salivary flow rate (SFR) to determine salivary volume, dynamic rheology technique for viscosity and a digital meter for salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed by zymography and cell viability assay respectively.
Results:
After treatment, severity of BMS symptoms decreased, the SFR increased, salivary viscosity decreased, and severity of xerostomia sensation (in patients who reported having this symptom) improved (
p
|
| doi_str_mv | 10.1089/acm.2019.0478 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2442841349</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2442841349</sourcerecordid><originalsourceid>FETCH-LOGICAL-c295t-ab966bdd51b9a57a371f9eb67a5104e07d43cf81f3ee724e2d586ad9a6612a183</originalsourceid><addsrcrecordid>eNqFkU9v1DAQxSMEon_gyBX5uByy2I4dJ9zKqqVIW4G69BxN4gk1iuPFdgr9inyq2tqFKyePRz-9NzOvKN4wuma0ad_DYNecsnZNhWqeFadMSlUqRZvnqaZKllJW8qQ4C-EHpVSIlr8sTireciFrdlr8uRxHHCJxIwFy7Sxa0Eh2MJkH8I9kt_QhmrhEJF897sGjJnfBzN_J5h6ss2ZCsrqB6M0A3gAZjt0JyHb9jlxN7hd6ArNOJfwmq62ZF0uWYCJEE4Kx6ZfBHSbh6MgtTgYfspmx2f_j4ufsduOWeE92j7P2acYP5CKPMxlr5kzd4t75-Kp4McIU8PXxPS_uri6_ba7L7ZdPnzcX23LgrYwl9G1d91pL1rcgFVSKjS32tQLJqECqtKiGsWFjhai4QK5lU4Nuoa4ZB9ZU58XqoLv37ueCIXbWhAHTzjO6JXRcCN4IVok2oeUBHbwLwePY7Q-LdYx2Ob4uxdfl-LocX-LfHqWX3qL-R__NKwHVAchtmOd0rR59_I_sE17aqbA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2442841349</pqid></control><display><type>article</type><title>Effect of a Homemade Salivary Substitute Prepared Using Chamomile (Matricaria chamomilla L.) Flower and Flax (Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Aitken-Saavedra, Juan ; Chaves Tarquinio, Sandra Beatriz ; De Oliveira da Rosa, Wellington Luiz ; Fernandes da Silva, Adriana ; Almeida Machado, Bruna Macedo ; Santos Castro, Ingrid ; Oliveira Wennesheimer, Andressa ; Morales-Bozo, Irene ; Uchoa Vasconcelos, Ana Carolina ; Neutzling Gomes, Ana Paula</creator><creatorcontrib>Aitken-Saavedra, Juan ; Chaves Tarquinio, Sandra Beatriz ; De Oliveira da Rosa, Wellington Luiz ; Fernandes da Silva, Adriana ; Almeida Machado, Bruna Macedo ; Santos Castro, Ingrid ; Oliveira Wennesheimer, Andressa ; Morales-Bozo, Irene ; Uchoa Vasconcelos, Ana Carolina ; Neutzling Gomes, Ana Paula</creatorcontrib><description>Objectives:
To evaluate (1) the effect of a salivary substitute prepared using chamomile (
Matricaria chamomilla L
.) flower and flax (
Linum usitatissimum L.
) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and MMP9 metalloproteinases, and (3) their potential cellular cytotoxic effect.
Subjects:
40 women aging >40 years with diagnosis of primary BMS.
Settings/Location:
Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Brazil.
Design:
This was an open clinical trial where primary BMS patients used the homemade salivary. At the first appointment, after 30 and 60 days, the authors evaluated the pattern and intensity of BMS and xerostomia symptoms, and then determined and compared the unstimulated salivary flow rate (SFR), viscosity, and salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed using different concentrations of chamomile flower and flax seed separately.
Interventions:
Subjects used the homemade salivary substitute for 3 months and were instructed to rinse their mouth three to four times daily for 1 min.
Outcome measures:
A numeric rating scale to evaluate the intensity of burning sensation and xerostomia symptoms, salivary flow rate (SFR) to determine salivary volume, dynamic rheology technique for viscosity and a digital meter for salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed by zymography and cell viability assay respectively.
Results:
After treatment, severity of BMS symptoms decreased, the SFR increased, salivary viscosity decreased, and severity of xerostomia sensation (in patients who reported having this symptom) improved (
p
< 0.05). Chamomile flower and flax seed had no effect on inhibiting MMP2 and MMP9 activities, and neither showed cellular cytotoxic effects.
Conclusion:
This homemade salivary substitute is an economical, viable, easily manipulated, noncytotoxic, and a practical alternative to relieve BMS symptoms.</description><identifier>ISSN: 1075-5535</identifier><identifier>EISSN: 1557-7708</identifier><identifier>DOI: 10.1089/acm.2019.0478</identifier><identifier>PMID: 32924561</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc., publishers</publisher><subject>Aged ; Aged, 80 and over ; Burning Mouth Syndrome - therapy ; Chamomile ; Female ; Flax ; Flowers ; Humans ; Matricaria ; Middle Aged ; Mouth - drug effects ; Mouth - pathology ; Phytotherapy ; Plant Extracts - pharmacology ; Plant Extracts - therapeutic use ; Saliva ; Seeds ; Xerostomia - therapy</subject><ispartof>The journal of alternative and complementary medicine (New York, N.Y.), 2020-09, Vol.26 (9), p.81-808</ispartof><rights>2020, Mary Ann Liebert, Inc., publishers</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c295t-ab966bdd51b9a57a371f9eb67a5104e07d43cf81f3ee724e2d586ad9a6612a183</citedby><cites>FETCH-LOGICAL-c295t-ab966bdd51b9a57a371f9eb67a5104e07d43cf81f3ee724e2d586ad9a6612a183</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32924561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aitken-Saavedra, Juan</creatorcontrib><creatorcontrib>Chaves Tarquinio, Sandra Beatriz</creatorcontrib><creatorcontrib>De Oliveira da Rosa, Wellington Luiz</creatorcontrib><creatorcontrib>Fernandes da Silva, Adriana</creatorcontrib><creatorcontrib>Almeida Machado, Bruna Macedo</creatorcontrib><creatorcontrib>Santos Castro, Ingrid</creatorcontrib><creatorcontrib>Oliveira Wennesheimer, Andressa</creatorcontrib><creatorcontrib>Morales-Bozo, Irene</creatorcontrib><creatorcontrib>Uchoa Vasconcelos, Ana Carolina</creatorcontrib><creatorcontrib>Neutzling Gomes, Ana Paula</creatorcontrib><title>Effect of a Homemade Salivary Substitute Prepared Using Chamomile (Matricaria chamomilla L.) Flower and Flax (Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report</title><title>The journal of alternative and complementary medicine (New York, N.Y.)</title><addtitle>J Altern Complement Med</addtitle><description>Objectives:
To evaluate (1) the effect of a salivary substitute prepared using chamomile (
Matricaria chamomilla L
.) flower and flax (
Linum usitatissimum L.
) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and MMP9 metalloproteinases, and (3) their potential cellular cytotoxic effect.
Subjects:
40 women aging >40 years with diagnosis of primary BMS.
Settings/Location:
Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Brazil.
Design:
This was an open clinical trial where primary BMS patients used the homemade salivary. At the first appointment, after 30 and 60 days, the authors evaluated the pattern and intensity of BMS and xerostomia symptoms, and then determined and compared the unstimulated salivary flow rate (SFR), viscosity, and salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed using different concentrations of chamomile flower and flax seed separately.
Interventions:
Subjects used the homemade salivary substitute for 3 months and were instructed to rinse their mouth three to four times daily for 1 min.
Outcome measures:
A numeric rating scale to evaluate the intensity of burning sensation and xerostomia symptoms, salivary flow rate (SFR) to determine salivary volume, dynamic rheology technique for viscosity and a digital meter for salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed by zymography and cell viability assay respectively.
Results:
After treatment, severity of BMS symptoms decreased, the SFR increased, salivary viscosity decreased, and severity of xerostomia sensation (in patients who reported having this symptom) improved (
p
< 0.05). Chamomile flower and flax seed had no effect on inhibiting MMP2 and MMP9 activities, and neither showed cellular cytotoxic effects.
Conclusion:
This homemade salivary substitute is an economical, viable, easily manipulated, noncytotoxic, and a practical alternative to relieve BMS symptoms.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Burning Mouth Syndrome - therapy</subject><subject>Chamomile</subject><subject>Female</subject><subject>Flax</subject><subject>Flowers</subject><subject>Humans</subject><subject>Matricaria</subject><subject>Middle Aged</subject><subject>Mouth - drug effects</subject><subject>Mouth - pathology</subject><subject>Phytotherapy</subject><subject>Plant Extracts - pharmacology</subject><subject>Plant Extracts - therapeutic use</subject><subject>Saliva</subject><subject>Seeds</subject><subject>Xerostomia - therapy</subject><issn>1075-5535</issn><issn>1557-7708</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9v1DAQxSMEon_gyBX5uByy2I4dJ9zKqqVIW4G69BxN4gk1iuPFdgr9inyq2tqFKyePRz-9NzOvKN4wuma0ad_DYNecsnZNhWqeFadMSlUqRZvnqaZKllJW8qQ4C-EHpVSIlr8sTireciFrdlr8uRxHHCJxIwFy7Sxa0Eh2MJkH8I9kt_QhmrhEJF897sGjJnfBzN_J5h6ss2ZCsrqB6M0A3gAZjt0JyHb9jlxN7hd6ArNOJfwmq62ZF0uWYCJEE4Kx6ZfBHSbh6MgtTgYfspmx2f_j4ufsduOWeE92j7P2acYP5CKPMxlr5kzd4t75-Kp4McIU8PXxPS_uri6_ba7L7ZdPnzcX23LgrYwl9G1d91pL1rcgFVSKjS32tQLJqECqtKiGsWFjhai4QK5lU4Nuoa4ZB9ZU58XqoLv37ueCIXbWhAHTzjO6JXRcCN4IVok2oeUBHbwLwePY7Q-LdYx2Ob4uxdfl-LocX-LfHqWX3qL-R__NKwHVAchtmOd0rR59_I_sE17aqbA</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Aitken-Saavedra, Juan</creator><creator>Chaves Tarquinio, Sandra Beatriz</creator><creator>De Oliveira da Rosa, Wellington Luiz</creator><creator>Fernandes da Silva, Adriana</creator><creator>Almeida Machado, Bruna Macedo</creator><creator>Santos Castro, Ingrid</creator><creator>Oliveira Wennesheimer, Andressa</creator><creator>Morales-Bozo, Irene</creator><creator>Uchoa Vasconcelos, Ana Carolina</creator><creator>Neutzling Gomes, Ana Paula</creator><general>Mary Ann Liebert, Inc., publishers</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>20200901</creationdate><title>Effect of a Homemade Salivary Substitute Prepared Using Chamomile (Matricaria chamomilla L.) Flower and Flax (Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report</title><author>Aitken-Saavedra, Juan ; Chaves Tarquinio, Sandra Beatriz ; De Oliveira da Rosa, Wellington Luiz ; Fernandes da Silva, Adriana ; Almeida Machado, Bruna Macedo ; Santos Castro, Ingrid ; Oliveira Wennesheimer, Andressa ; Morales-Bozo, Irene ; Uchoa Vasconcelos, Ana Carolina ; Neutzling Gomes, Ana Paula</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c295t-ab966bdd51b9a57a371f9eb67a5104e07d43cf81f3ee724e2d586ad9a6612a183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Burning Mouth Syndrome - therapy</topic><topic>Chamomile</topic><topic>Female</topic><topic>Flax</topic><topic>Flowers</topic><topic>Humans</topic><topic>Matricaria</topic><topic>Middle Aged</topic><topic>Mouth - drug effects</topic><topic>Mouth - pathology</topic><topic>Phytotherapy</topic><topic>Plant Extracts - pharmacology</topic><topic>Plant Extracts - therapeutic use</topic><topic>Saliva</topic><topic>Seeds</topic><topic>Xerostomia - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aitken-Saavedra, Juan</creatorcontrib><creatorcontrib>Chaves Tarquinio, Sandra Beatriz</creatorcontrib><creatorcontrib>De Oliveira da Rosa, Wellington Luiz</creatorcontrib><creatorcontrib>Fernandes da Silva, Adriana</creatorcontrib><creatorcontrib>Almeida Machado, Bruna Macedo</creatorcontrib><creatorcontrib>Santos Castro, Ingrid</creatorcontrib><creatorcontrib>Oliveira Wennesheimer, Andressa</creatorcontrib><creatorcontrib>Morales-Bozo, Irene</creatorcontrib><creatorcontrib>Uchoa Vasconcelos, Ana Carolina</creatorcontrib><creatorcontrib>Neutzling Gomes, Ana Paula</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 journal of alternative and complementary medicine (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aitken-Saavedra, Juan</au><au>Chaves Tarquinio, Sandra Beatriz</au><au>De Oliveira da Rosa, Wellington Luiz</au><au>Fernandes da Silva, Adriana</au><au>Almeida Machado, Bruna Macedo</au><au>Santos Castro, Ingrid</au><au>Oliveira Wennesheimer, Andressa</au><au>Morales-Bozo, Irene</au><au>Uchoa Vasconcelos, Ana Carolina</au><au>Neutzling Gomes, Ana Paula</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of a Homemade Salivary Substitute Prepared Using Chamomile (Matricaria chamomilla L.) Flower and Flax (Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report</atitle><jtitle>The journal of alternative and complementary medicine (New York, N.Y.)</jtitle><addtitle>J Altern Complement Med</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>26</volume><issue>9</issue><spage>81</spage><epage>808</epage><pages>81-808</pages><issn>1075-5535</issn><eissn>1557-7708</eissn><abstract>Objectives:
To evaluate (1) the effect of a salivary substitute prepared using chamomile (
Matricaria chamomilla L
.) flower and flax (
Linum usitatissimum L.
) seed to relieve Primary burning mouth syndrome (BMS) symptoms, (2) their effect on the inhibition of matrix metallopeptidase 2 (MMP2) and MMP9 metalloproteinases, and (3) their potential cellular cytotoxic effect.
Subjects:
40 women aging >40 years with diagnosis of primary BMS.
Settings/Location:
Center of Diagnosis of Diseases of the Mouth, Federal University of Pelotas, Brazil.
Design:
This was an open clinical trial where primary BMS patients used the homemade salivary. At the first appointment, after 30 and 60 days, the authors evaluated the pattern and intensity of BMS and xerostomia symptoms, and then determined and compared the unstimulated salivary flow rate (SFR), viscosity, and salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed using different concentrations of chamomile flower and flax seed separately.
Interventions:
Subjects used the homemade salivary substitute for 3 months and were instructed to rinse their mouth three to four times daily for 1 min.
Outcome measures:
A numeric rating scale to evaluate the intensity of burning sensation and xerostomia symptoms, salivary flow rate (SFR) to determine salivary volume, dynamic rheology technique for viscosity and a digital meter for salivary pH. MMP2 and MMP9 activities in saliva and cytotoxicity were assessed by zymography and cell viability assay respectively.
Results:
After treatment, severity of BMS symptoms decreased, the SFR increased, salivary viscosity decreased, and severity of xerostomia sensation (in patients who reported having this symptom) improved (
p
< 0.05). Chamomile flower and flax seed had no effect on inhibiting MMP2 and MMP9 activities, and neither showed cellular cytotoxic effects.
Conclusion:
This homemade salivary substitute is an economical, viable, easily manipulated, noncytotoxic, and a practical alternative to relieve BMS symptoms.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc., publishers</pub><pmid>32924561</pmid><doi>10.1089/acm.2019.0478</doi><tpages>728</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1075-5535 |
| ispartof | The journal of alternative and complementary medicine (New York, N.Y.), 2020-09, Vol.26 (9), p.81-808 |
| issn | 1075-5535 1557-7708 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2442841349 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Burning Mouth Syndrome - therapy Chamomile Female Flax Flowers Humans Matricaria Middle Aged Mouth - drug effects Mouth - pathology Phytotherapy Plant Extracts - pharmacology Plant Extracts - therapeutic use Saliva Seeds Xerostomia - therapy |
| title | Effect of a Homemade Salivary Substitute Prepared Using Chamomile (Matricaria chamomilla L.) Flower and Flax (Linum usitatissimum L.) Seed to Relieve Primary Burning Mouth Syndrome: A Preliminary Report |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-07T11%3A20%3A39IST&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=Effect%20of%20a%20Homemade%20Salivary%20Substitute%20Prepared%20Using%20Chamomile%20(Matricaria%20chamomilla%20L.)%20Flower%20and%20Flax%20(Linum%20usitatissimum%20L.)%20Seed%20to%20Relieve%20Primary%20Burning%20Mouth%20Syndrome:%20A%20Preliminary%20Report&rft.jtitle=The%20journal%20of%20alternative%20and%20complementary%20medicine%20(New%20York,%20N.Y.)&rft.au=Aitken-Saavedra,%20Juan&rft.date=2020-09-01&rft.volume=26&rft.issue=9&rft.spage=81&rft.epage=808&rft.pages=81-808&rft.issn=1075-5535&rft.eissn=1557-7708&rft_id=info:doi/10.1089/acm.2019.0478&rft_dat=%3Cproquest_cross%3E2442841349%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=2442841349&rft_id=info:pmid/32924561&rfr_iscdi=true |