Characterization of holmium loaded alginate microspheres for multimodality imaging and therapeutic applications

In this paper the preparation and characterization of holmium‐loaded alginate microspheres is described. The rapid development of medical imaging techniques offers new opportunities for the visualisation of (drug‐loaded) microparticles. Therefore, suitable imaging agents have to be incorporated into...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of Biomedical Materials Research Part B 2007-09, Vol.82A (4), p.892-898
Hauptverfasser: Zielhuis, S.W., Seppenwoolde, J.H., Bakker, C.J.G., Jahnz, U., Zonnenberg, B.A., van het Schip, A.D., Hennink, W.E., Nijsen, J.F.W.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 898
container_issue 4
container_start_page 892
container_title Journal of Biomedical Materials Research Part B
container_volume 82A
creator Zielhuis, S.W.
Seppenwoolde, J.H.
Bakker, C.J.G.
Jahnz, U.
Zonnenberg, B.A.
van het Schip, A.D.
Hennink, W.E.
Nijsen, J.F.W.
description In this paper the preparation and characterization of holmium‐loaded alginate microspheres is described. The rapid development of medical imaging techniques offers new opportunities for the visualisation of (drug‐loaded) microparticles. Therefore, suitable imaging agents have to be incorporated into these particles. For this reason, the element holmium was used in this study in order to utilize its unique imaging characteristics. The paramagnetic behaviour of this element allows visualisation with MRI and holmium can also be neutron‐activated resulting in the emission of gamma‐radiation, allowing visualisation with gamma cameras, and beta‐radiation, suitable for therapeutic applications. Almost monodisperse alginate microspheres were obtained by JetCutter technology where alginate droplets of a uniform size were hardened in an aqueous holmium chloride solution. Ho3+ binds via electrostatic interactions to the carboxylate groups of the alginate polymer and as a result alginate microspheres loaded with holmium were obtained. The microspheres had a mean size of 159 μm and a holmium loading of 1.3 ± 0.1% (w/w) (corresponding with a holmium content based on dry alginate of 18.3 ± 0.3% (w/w)). The binding capacity of the alginate polymer for Ho3+ (expressed in molar amounts) is equal to that for Ca2+, which is commonly used for the hardening of alginate. This indicates that Ho3+ has the same binding affinity as Ca2+. In line herewith, dynamic mechanical analyses demonstrated that alginate gels hardened with Ca2+ or Ho3+ had similar viscoelastic properties. The MRI relaxation properties of the microspheres were determined by a MRI phantom experiment, demonstrating a strong R2* effect of the particles. Alginate microspheres could also be labelled with radioactive holmium by adding holmium‐166 to alginate microspheres, previously hardened with calcium (labelling efficiency 96%). The labelled microspheres had a high radiochemical stability (94% after 48 h incubation in human serum), allowing therapeutic applications for treatment of cancer. The potential in vivo application of the microspheres for a MR‐guided renal embolization procedure was illustrated by selective administration of microspheres to the left kidney of a pig. Anatomic MR‐imaging showed the presence of holmium‐loaded microspheres in the kidney. In conclusion, this study demonstrates that the incorporation of holmium into alginate microspheres allows their visualisation with a gamma camera and MRI. Hol
doi_str_mv 10.1002/jbm.a.31183
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68147734</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>68147734</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3983-d5ef6dc08e47355f17f579f13da769f12bc2941ef16fd0dc2af6c5945e4b793c3</originalsourceid><addsrcrecordid>eNqFkTuPUzEQRi0EYh9Q0SNXNOgGP67tuITALqAFGhB0luPHxosdX2xfQfj1OJsAHUgjzRRnjjTzAfAIowVGiDy7WaeFXlCMl_QOOMWMkWGUnN3dz6McKJH8BJzVetNhjhi5D06woJQhLE9BXm100aa5En7qFvIWZg83OaYwJxizts5CHa_DVjcHUzAl12njiqvQ5wLTHFtI2eoY2g6GpDt4DfXWwtYhPbm5BQP1NMVgbu31Abjndazu4bGfg08Xrz6uXg9XHy7frJ5fDYbKJR0sc55bg5ZuFJQxj4VnQnpMrRa8d7I2RI7Yecy9RdYQ7blhcmRuXAtJDT0HTw7eqeRvs6tNpVCNi1FvXZ6r4ks8CkHH_4IUoV6EdvDpAdz_oBbn1VT6xWWnMFL7IFQPQml1G0SnHx-18zo5-5c9fr4D-AB8D9Ht_uVSb1-8-y0dDjuhNvfjz44uXxUXVDD1-f2lYuQl5qx7vtBfW4Gk8Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>30030023</pqid></control><display><type>article</type><title>Characterization of holmium loaded alginate microspheres for multimodality imaging and therapeutic applications</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Zielhuis, S.W. ; Seppenwoolde, J.H. ; Bakker, C.J.G. ; Jahnz, U. ; Zonnenberg, B.A. ; van het Schip, A.D. ; Hennink, W.E. ; Nijsen, J.F.W.</creator><creatorcontrib>Zielhuis, S.W. ; Seppenwoolde, J.H. ; Bakker, C.J.G. ; Jahnz, U. ; Zonnenberg, B.A. ; van het Schip, A.D. ; Hennink, W.E. ; Nijsen, J.F.W.</creatorcontrib><description>In this paper the preparation and characterization of holmium‐loaded alginate microspheres is described. The rapid development of medical imaging techniques offers new opportunities for the visualisation of (drug‐loaded) microparticles. Therefore, suitable imaging agents have to be incorporated into these particles. For this reason, the element holmium was used in this study in order to utilize its unique imaging characteristics. The paramagnetic behaviour of this element allows visualisation with MRI and holmium can also be neutron‐activated resulting in the emission of gamma‐radiation, allowing visualisation with gamma cameras, and beta‐radiation, suitable for therapeutic applications. Almost monodisperse alginate microspheres were obtained by JetCutter technology where alginate droplets of a uniform size were hardened in an aqueous holmium chloride solution. Ho3+ binds via electrostatic interactions to the carboxylate groups of the alginate polymer and as a result alginate microspheres loaded with holmium were obtained. The microspheres had a mean size of 159 μm and a holmium loading of 1.3 ± 0.1% (w/w) (corresponding with a holmium content based on dry alginate of 18.3 ± 0.3% (w/w)). The binding capacity of the alginate polymer for Ho3+ (expressed in molar amounts) is equal to that for Ca2+, which is commonly used for the hardening of alginate. This indicates that Ho3+ has the same binding affinity as Ca2+. In line herewith, dynamic mechanical analyses demonstrated that alginate gels hardened with Ca2+ or Ho3+ had similar viscoelastic properties. The MRI relaxation properties of the microspheres were determined by a MRI phantom experiment, demonstrating a strong R2* effect of the particles. Alginate microspheres could also be labelled with radioactive holmium by adding holmium‐166 to alginate microspheres, previously hardened with calcium (labelling efficiency 96%). The labelled microspheres had a high radiochemical stability (94% after 48 h incubation in human serum), allowing therapeutic applications for treatment of cancer. The potential in vivo application of the microspheres for a MR‐guided renal embolization procedure was illustrated by selective administration of microspheres to the left kidney of a pig. Anatomic MR‐imaging showed the presence of holmium‐loaded microspheres in the kidney. In conclusion, this study demonstrates that the incorporation of holmium into alginate microspheres allows their visualisation with a gamma camera and MRI. Holmium‐loaded alginate microspheres can be used therapeutically for embolization and, when radioactive, for local radiotherapy of tumours. © 2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2007</description><identifier>ISSN: 1549-3296</identifier><identifier>EISSN: 1552-4965</identifier><identifier>EISSN: 1552-4981</identifier><identifier>DOI: 10.1002/jbm.a.31183</identifier><identifier>PMID: 17335019</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>alginate ; Alginates ; Animals ; Biocompatible Materials - therapeutic use ; Contrast Media ; Elasticity ; Embolization, Therapeutic ; Gels ; holmium ; Holmium - therapeutic use ; JetCutter ; Magnetic Resonance Imaging ; Materials Testing ; Microspheres ; MRI ; Phantoms, Imaging ; Radioisotopes - therapeutic use ; Renal Artery ; Sus scrofa ; Viscosity</subject><ispartof>Journal of Biomedical Materials Research Part B, 2007-09, Vol.82A (4), p.892-898</ispartof><rights>Copyright © 2007 Wiley Periodicals, Inc.</rights><rights>Copyright 2007 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3983-d5ef6dc08e47355f17f579f13da769f12bc2941ef16fd0dc2af6c5945e4b793c3</citedby><cites>FETCH-LOGICAL-c3983-d5ef6dc08e47355f17f579f13da769f12bc2941ef16fd0dc2af6c5945e4b793c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjbm.a.31183$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjbm.a.31183$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17335019$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zielhuis, S.W.</creatorcontrib><creatorcontrib>Seppenwoolde, J.H.</creatorcontrib><creatorcontrib>Bakker, C.J.G.</creatorcontrib><creatorcontrib>Jahnz, U.</creatorcontrib><creatorcontrib>Zonnenberg, B.A.</creatorcontrib><creatorcontrib>van het Schip, A.D.</creatorcontrib><creatorcontrib>Hennink, W.E.</creatorcontrib><creatorcontrib>Nijsen, J.F.W.</creatorcontrib><title>Characterization of holmium loaded alginate microspheres for multimodality imaging and therapeutic applications</title><title>Journal of Biomedical Materials Research Part B</title><addtitle>J. Biomed. Mater. Res</addtitle><description>In this paper the preparation and characterization of holmium‐loaded alginate microspheres is described. The rapid development of medical imaging techniques offers new opportunities for the visualisation of (drug‐loaded) microparticles. Therefore, suitable imaging agents have to be incorporated into these particles. For this reason, the element holmium was used in this study in order to utilize its unique imaging characteristics. The paramagnetic behaviour of this element allows visualisation with MRI and holmium can also be neutron‐activated resulting in the emission of gamma‐radiation, allowing visualisation with gamma cameras, and beta‐radiation, suitable for therapeutic applications. Almost monodisperse alginate microspheres were obtained by JetCutter technology where alginate droplets of a uniform size were hardened in an aqueous holmium chloride solution. Ho3+ binds via electrostatic interactions to the carboxylate groups of the alginate polymer and as a result alginate microspheres loaded with holmium were obtained. The microspheres had a mean size of 159 μm and a holmium loading of 1.3 ± 0.1% (w/w) (corresponding with a holmium content based on dry alginate of 18.3 ± 0.3% (w/w)). The binding capacity of the alginate polymer for Ho3+ (expressed in molar amounts) is equal to that for Ca2+, which is commonly used for the hardening of alginate. This indicates that Ho3+ has the same binding affinity as Ca2+. In line herewith, dynamic mechanical analyses demonstrated that alginate gels hardened with Ca2+ or Ho3+ had similar viscoelastic properties. The MRI relaxation properties of the microspheres were determined by a MRI phantom experiment, demonstrating a strong R2* effect of the particles. Alginate microspheres could also be labelled with radioactive holmium by adding holmium‐166 to alginate microspheres, previously hardened with calcium (labelling efficiency 96%). The labelled microspheres had a high radiochemical stability (94% after 48 h incubation in human serum), allowing therapeutic applications for treatment of cancer. The potential in vivo application of the microspheres for a MR‐guided renal embolization procedure was illustrated by selective administration of microspheres to the left kidney of a pig. Anatomic MR‐imaging showed the presence of holmium‐loaded microspheres in the kidney. In conclusion, this study demonstrates that the incorporation of holmium into alginate microspheres allows their visualisation with a gamma camera and MRI. Holmium‐loaded alginate microspheres can be used therapeutically for embolization and, when radioactive, for local radiotherapy of tumours. © 2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2007</description><subject>alginate</subject><subject>Alginates</subject><subject>Animals</subject><subject>Biocompatible Materials - therapeutic use</subject><subject>Contrast Media</subject><subject>Elasticity</subject><subject>Embolization, Therapeutic</subject><subject>Gels</subject><subject>holmium</subject><subject>Holmium - therapeutic use</subject><subject>JetCutter</subject><subject>Magnetic Resonance Imaging</subject><subject>Materials Testing</subject><subject>Microspheres</subject><subject>MRI</subject><subject>Phantoms, Imaging</subject><subject>Radioisotopes - therapeutic use</subject><subject>Renal Artery</subject><subject>Sus scrofa</subject><subject>Viscosity</subject><issn>1549-3296</issn><issn>1552-4965</issn><issn>1552-4981</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkTuPUzEQRi0EYh9Q0SNXNOgGP67tuITALqAFGhB0luPHxosdX2xfQfj1OJsAHUgjzRRnjjTzAfAIowVGiDy7WaeFXlCMl_QOOMWMkWGUnN3dz6McKJH8BJzVetNhjhi5D06woJQhLE9BXm100aa5En7qFvIWZg83OaYwJxizts5CHa_DVjcHUzAl12njiqvQ5wLTHFtI2eoY2g6GpDt4DfXWwtYhPbm5BQP1NMVgbu31Abjndazu4bGfg08Xrz6uXg9XHy7frJ5fDYbKJR0sc55bg5ZuFJQxj4VnQnpMrRa8d7I2RI7Yecy9RdYQ7blhcmRuXAtJDT0HTw7eqeRvs6tNpVCNi1FvXZ6r4ks8CkHH_4IUoV6EdvDpAdz_oBbn1VT6xWWnMFL7IFQPQml1G0SnHx-18zo5-5c9fr4D-AB8D9Ht_uVSb1-8-y0dDjuhNvfjz44uXxUXVDD1-f2lYuQl5qx7vtBfW4Gk8Q</recordid><startdate>20070915</startdate><enddate>20070915</enddate><creator>Zielhuis, S.W.</creator><creator>Seppenwoolde, J.H.</creator><creator>Bakker, C.J.G.</creator><creator>Jahnz, U.</creator><creator>Zonnenberg, B.A.</creator><creator>van het Schip, A.D.</creator><creator>Hennink, W.E.</creator><creator>Nijsen, J.F.W.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>BSCLL</scope><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>7SR</scope><scope>7TB</scope><scope>7U5</scope><scope>8BQ</scope><scope>8FD</scope><scope>F28</scope><scope>FR3</scope><scope>JG9</scope><scope>L7M</scope><scope>7X8</scope></search><sort><creationdate>20070915</creationdate><title>Characterization of holmium loaded alginate microspheres for multimodality imaging and therapeutic applications</title><author>Zielhuis, S.W. ; Seppenwoolde, J.H. ; Bakker, C.J.G. ; Jahnz, U. ; Zonnenberg, B.A. ; van het Schip, A.D. ; Hennink, W.E. ; Nijsen, J.F.W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3983-d5ef6dc08e47355f17f579f13da769f12bc2941ef16fd0dc2af6c5945e4b793c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>alginate</topic><topic>Alginates</topic><topic>Animals</topic><topic>Biocompatible Materials - therapeutic use</topic><topic>Contrast Media</topic><topic>Elasticity</topic><topic>Embolization, Therapeutic</topic><topic>Gels</topic><topic>holmium</topic><topic>Holmium - therapeutic use</topic><topic>JetCutter</topic><topic>Magnetic Resonance Imaging</topic><topic>Materials Testing</topic><topic>Microspheres</topic><topic>MRI</topic><topic>Phantoms, Imaging</topic><topic>Radioisotopes - therapeutic use</topic><topic>Renal Artery</topic><topic>Sus scrofa</topic><topic>Viscosity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zielhuis, S.W.</creatorcontrib><creatorcontrib>Seppenwoolde, J.H.</creatorcontrib><creatorcontrib>Bakker, C.J.G.</creatorcontrib><creatorcontrib>Jahnz, U.</creatorcontrib><creatorcontrib>Zonnenberg, B.A.</creatorcontrib><creatorcontrib>van het Schip, A.D.</creatorcontrib><creatorcontrib>Hennink, W.E.</creatorcontrib><creatorcontrib>Nijsen, J.F.W.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Engineered Materials Abstracts</collection><collection>Mechanical &amp; Transportation Engineering Abstracts</collection><collection>Solid State and Superconductivity Abstracts</collection><collection>METADEX</collection><collection>Technology Research Database</collection><collection>ANTE: Abstracts in New Technology &amp; Engineering</collection><collection>Engineering Research Database</collection><collection>Materials Research Database</collection><collection>Advanced Technologies Database with Aerospace</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of Biomedical Materials Research Part B</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zielhuis, S.W.</au><au>Seppenwoolde, J.H.</au><au>Bakker, C.J.G.</au><au>Jahnz, U.</au><au>Zonnenberg, B.A.</au><au>van het Schip, A.D.</au><au>Hennink, W.E.</au><au>Nijsen, J.F.W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterization of holmium loaded alginate microspheres for multimodality imaging and therapeutic applications</atitle><jtitle>Journal of Biomedical Materials Research Part B</jtitle><addtitle>J. Biomed. Mater. Res</addtitle><date>2007-09-15</date><risdate>2007</risdate><volume>82A</volume><issue>4</issue><spage>892</spage><epage>898</epage><pages>892-898</pages><issn>1549-3296</issn><eissn>1552-4965</eissn><eissn>1552-4981</eissn><abstract>In this paper the preparation and characterization of holmium‐loaded alginate microspheres is described. The rapid development of medical imaging techniques offers new opportunities for the visualisation of (drug‐loaded) microparticles. Therefore, suitable imaging agents have to be incorporated into these particles. For this reason, the element holmium was used in this study in order to utilize its unique imaging characteristics. The paramagnetic behaviour of this element allows visualisation with MRI and holmium can also be neutron‐activated resulting in the emission of gamma‐radiation, allowing visualisation with gamma cameras, and beta‐radiation, suitable for therapeutic applications. Almost monodisperse alginate microspheres were obtained by JetCutter technology where alginate droplets of a uniform size were hardened in an aqueous holmium chloride solution. Ho3+ binds via electrostatic interactions to the carboxylate groups of the alginate polymer and as a result alginate microspheres loaded with holmium were obtained. The microspheres had a mean size of 159 μm and a holmium loading of 1.3 ± 0.1% (w/w) (corresponding with a holmium content based on dry alginate of 18.3 ± 0.3% (w/w)). The binding capacity of the alginate polymer for Ho3+ (expressed in molar amounts) is equal to that for Ca2+, which is commonly used for the hardening of alginate. This indicates that Ho3+ has the same binding affinity as Ca2+. In line herewith, dynamic mechanical analyses demonstrated that alginate gels hardened with Ca2+ or Ho3+ had similar viscoelastic properties. The MRI relaxation properties of the microspheres were determined by a MRI phantom experiment, demonstrating a strong R2* effect of the particles. Alginate microspheres could also be labelled with radioactive holmium by adding holmium‐166 to alginate microspheres, previously hardened with calcium (labelling efficiency 96%). The labelled microspheres had a high radiochemical stability (94% after 48 h incubation in human serum), allowing therapeutic applications for treatment of cancer. The potential in vivo application of the microspheres for a MR‐guided renal embolization procedure was illustrated by selective administration of microspheres to the left kidney of a pig. Anatomic MR‐imaging showed the presence of holmium‐loaded microspheres in the kidney. In conclusion, this study demonstrates that the incorporation of holmium into alginate microspheres allows their visualisation with a gamma camera and MRI. Holmium‐loaded alginate microspheres can be used therapeutically for embolization and, when radioactive, for local radiotherapy of tumours. © 2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2007</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>17335019</pmid><doi>10.1002/jbm.a.31183</doi><tpages>7</tpages></addata></record>
fulltext fulltext
identifier ISSN: 1549-3296
ispartof Journal of Biomedical Materials Research Part B, 2007-09, Vol.82A (4), p.892-898
issn 1549-3296
1552-4965
1552-4981
language eng
recordid cdi_proquest_miscellaneous_68147734
source MEDLINE; Wiley Online Library Journals Frontfile Complete
subjects alginate
Alginates
Animals
Biocompatible Materials - therapeutic use
Contrast Media
Elasticity
Embolization, Therapeutic
Gels
holmium
Holmium - therapeutic use
JetCutter
Magnetic Resonance Imaging
Materials Testing
Microspheres
MRI
Phantoms, Imaging
Radioisotopes - therapeutic use
Renal Artery
Sus scrofa
Viscosity
title Characterization of holmium loaded alginate microspheres for multimodality imaging and therapeutic applications
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T20%3A00%3A15IST&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=Characterization%20of%20holmium%20loaded%20alginate%20microspheres%20for%20multimodality%20imaging%20and%20therapeutic%20applications&rft.jtitle=Journal%20of%20Biomedical%20Materials%20Research%20Part%20B&rft.au=Zielhuis,%20S.W.&rft.date=2007-09-15&rft.volume=82A&rft.issue=4&rft.spage=892&rft.epage=898&rft.pages=892-898&rft.issn=1549-3296&rft.eissn=1552-4965&rft_id=info:doi/10.1002/jbm.a.31183&rft_dat=%3Cproquest_cross%3E68147734%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=30030023&rft_id=info:pmid/17335019&rfr_iscdi=true