Metastatic basal cell carcinoma exhibits reduced actin expression

Basal cell carcinoma is the most common malignancy in Caucasian individuals. Metastatic basal cell carcinoma is extremely rare (with a rate estimated as 0.03%). Actin has been detected in aggressive forms of basal cell carcinoma, but their expression in metastatic lesions is not known. We compared t...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Modern pathology 2008-05, Vol.21 (5), p.540-543
Hauptverfasser: Uzquiano, Maria C, Prieto, Victor G, Nash, Jason W, Ivan, Doina S, Gong, Yun, Lazar, Alexander J F, Diwan, A Hafeez
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 543
container_issue 5
container_start_page 540
container_title Modern pathology
container_volume 21
creator Uzquiano, Maria C
Prieto, Victor G
Nash, Jason W
Ivan, Doina S
Gong, Yun
Lazar, Alexander J F
Diwan, A Hafeez
description Basal cell carcinoma is the most common malignancy in Caucasian individuals. Metastatic basal cell carcinoma is extremely rare (with a rate estimated as 0.03%). Actin has been detected in aggressive forms of basal cell carcinoma, but their expression in metastatic lesions is not known. We compared the expression of actin and actin-related cytoskeletal proteins in relatively less aggressive basal cell carcinoma (nodular), aggressive basal cell carcinoma (infiltrative/morpheaform), and metastatic basal cell carcinoma. We studied 12 cases of nodular basal cell carcinoma, 10 cases of infiltrative basal cell carcinoma, and 10 cases of metastatic basal cell carcinoma with immunohistochemistry for alpha-smooth muscle actin, calponin, myosin, and E-cadherin. Expression was interpreted as positive when at least 5% of the tumor exhibited at least weak expression. Five of the ten patients with metastatic basal cell carcinoma had an antecedent history of radiotherapy. Actin was present in 3 of 12 (25%) of the nodular, all 10 of the infiltrative, and 3 of 10 of the metastatic basal cell carcinomas (P
doi_str_mv 10.1038/modpathol.3801051
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69128696</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0893395222041254</els_id><sourcerecordid>1467846171</sourcerecordid><originalsourceid>FETCH-LOGICAL-c464t-f925eb430bf8843bd9e264ea78b905a08be60fc945c611156e450ce7028530e33</originalsourceid><addsrcrecordid>eNp9kEtLAzEYRYMotlZ_gBsZXLgbzbsZXBXxBYobXYdM5hsb6UxqkhH996a0WHDRTQLJuTdfDkKnBF8SzNRV55ulSXO_uGQKEyzIHhoTwXCJqRL7aIxVxUpWCTpCRzF-YEy4UPQQjYiilAlBx2j2DMnEZJKzRW2iWRQWFnkxwbred6aA77mrXYpFgGaw0BTGJtfn42WAGJ3vj9FBaxYRTjb7BL3d3b7ePJRPL_ePN7On0nLJU9lWVEDNGa5bpTirmwqo5GCmqq6wMFjVIHFrKy6sJIQICVxgC9PVVxgGxiboYt27DP5zgJh05-JqWNODH6KWFaFKVjKD5__ADz-EPs-mKSVEUjblGSJryAYfY4BWL4PrTPjRBOuVXP0nV2_k5szZpnioO2i2iY3NDNA1EPNV_w5h-_Ku1ut1CLK8L5dD0Tros2oXwCbdeLcj_Qv2UJxK</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>221162374</pqid></control><display><type>article</type><title>Metastatic basal cell carcinoma exhibits reduced actin expression</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Uzquiano, Maria C ; Prieto, Victor G ; Nash, Jason W ; Ivan, Doina S ; Gong, Yun ; Lazar, Alexander J F ; Diwan, A Hafeez</creator><creatorcontrib>Uzquiano, Maria C ; Prieto, Victor G ; Nash, Jason W ; Ivan, Doina S ; Gong, Yun ; Lazar, Alexander J F ; Diwan, A Hafeez</creatorcontrib><description>Basal cell carcinoma is the most common malignancy in Caucasian individuals. Metastatic basal cell carcinoma is extremely rare (with a rate estimated as 0.03%). Actin has been detected in aggressive forms of basal cell carcinoma, but their expression in metastatic lesions is not known. We compared the expression of actin and actin-related cytoskeletal proteins in relatively less aggressive basal cell carcinoma (nodular), aggressive basal cell carcinoma (infiltrative/morpheaform), and metastatic basal cell carcinoma. We studied 12 cases of nodular basal cell carcinoma, 10 cases of infiltrative basal cell carcinoma, and 10 cases of metastatic basal cell carcinoma with immunohistochemistry for alpha-smooth muscle actin, calponin, myosin, and E-cadherin. Expression was interpreted as positive when at least 5% of the tumor exhibited at least weak expression. Five of the ten patients with metastatic basal cell carcinoma had an antecedent history of radiotherapy. Actin was present in 3 of 12 (25%) of the nodular, all 10 of the infiltrative, and 3 of 10 of the metastatic basal cell carcinomas (P&lt;0.05 for metastatic vs infiltrative and nodular vs infiltrative). Calponin was present in 50% of the nodular, 60% of the infiltrative, and 30% of the metastatic basal cell carcinomas (not statistically significant). Myosin expression was not detected in any of the cases. E-cadherin was present in 75% of the nodular, 70% of the infiltrative, and all of the metastatic basal cell carcinomas (P&lt;0.05 for metastatic vs nodular). Our results suggest that increased actin may contribute to local invasiveness, but it is lost in the metastatic phenotype. History of previous radiotherapy may contribute to development of the metastatic phenotype.</description><identifier>ISSN: 0893-3952</identifier><identifier>EISSN: 1530-0285</identifier><identifier>DOI: 10.1038/modpathol.3801051</identifier><identifier>PMID: 18223552</identifier><identifier>CODEN: MODPEO</identifier><language>eng</language><publisher>New York: Elsevier Inc</publisher><subject>actin ; Actins - biosynthesis ; Adult ; Aged ; Aged, 80 and over ; basal cell carcinoma ; Cadherins - biosynthesis ; Calcium-Binding Proteins - biosynthesis ; Calponins ; Cancer ; Carcinoma, Basal Cell - metabolism ; Carcinoma, Basal Cell - pathology ; Female ; Genotype &amp; phenotype ; Humans ; Immunohistochemistry ; Laboratory Medicine ; Male ; Medical prognosis ; Medicine ; Medicine &amp; Public Health ; Metastasis ; Microfilament Proteins - biosynthesis ; Middle Aged ; Monoclonal antibodies ; Myosins - biosynthesis ; Neoplasm Invasiveness ; original-article ; Pathology ; Radiation therapy ; Skin Neoplasms - metabolism ; Skin Neoplasms - pathology ; Smooth muscle ; Tumors ; White people</subject><ispartof>Modern pathology, 2008-05, Vol.21 (5), p.540-543</ispartof><rights>2008 United States &amp; Canadian Academy of Pathology</rights><rights>United States and Canadian Academy of Pathology, Inc. 2008</rights><rights>Copyright Nature Publishing Group May 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-f925eb430bf8843bd9e264ea78b905a08be60fc945c611156e450ce7028530e33</citedby><cites>FETCH-LOGICAL-c464t-f925eb430bf8843bd9e264ea78b905a08be60fc945c611156e450ce7028530e33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18223552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Uzquiano, Maria C</creatorcontrib><creatorcontrib>Prieto, Victor G</creatorcontrib><creatorcontrib>Nash, Jason W</creatorcontrib><creatorcontrib>Ivan, Doina S</creatorcontrib><creatorcontrib>Gong, Yun</creatorcontrib><creatorcontrib>Lazar, Alexander J F</creatorcontrib><creatorcontrib>Diwan, A Hafeez</creatorcontrib><title>Metastatic basal cell carcinoma exhibits reduced actin expression</title><title>Modern pathology</title><addtitle>Mod Pathol</addtitle><addtitle>Mod Pathol</addtitle><description>Basal cell carcinoma is the most common malignancy in Caucasian individuals. Metastatic basal cell carcinoma is extremely rare (with a rate estimated as 0.03%). Actin has been detected in aggressive forms of basal cell carcinoma, but their expression in metastatic lesions is not known. We compared the expression of actin and actin-related cytoskeletal proteins in relatively less aggressive basal cell carcinoma (nodular), aggressive basal cell carcinoma (infiltrative/morpheaform), and metastatic basal cell carcinoma. We studied 12 cases of nodular basal cell carcinoma, 10 cases of infiltrative basal cell carcinoma, and 10 cases of metastatic basal cell carcinoma with immunohistochemistry for alpha-smooth muscle actin, calponin, myosin, and E-cadherin. Expression was interpreted as positive when at least 5% of the tumor exhibited at least weak expression. Five of the ten patients with metastatic basal cell carcinoma had an antecedent history of radiotherapy. Actin was present in 3 of 12 (25%) of the nodular, all 10 of the infiltrative, and 3 of 10 of the metastatic basal cell carcinomas (P&lt;0.05 for metastatic vs infiltrative and nodular vs infiltrative). Calponin was present in 50% of the nodular, 60% of the infiltrative, and 30% of the metastatic basal cell carcinomas (not statistically significant). Myosin expression was not detected in any of the cases. E-cadherin was present in 75% of the nodular, 70% of the infiltrative, and all of the metastatic basal cell carcinomas (P&lt;0.05 for metastatic vs nodular). Our results suggest that increased actin may contribute to local invasiveness, but it is lost in the metastatic phenotype. History of previous radiotherapy may contribute to development of the metastatic phenotype.</description><subject>actin</subject><subject>Actins - biosynthesis</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>basal cell carcinoma</subject><subject>Cadherins - biosynthesis</subject><subject>Calcium-Binding Proteins - biosynthesis</subject><subject>Calponins</subject><subject>Cancer</subject><subject>Carcinoma, Basal Cell - metabolism</subject><subject>Carcinoma, Basal Cell - pathology</subject><subject>Female</subject><subject>Genotype &amp; phenotype</subject><subject>Humans</subject><subject>Immunohistochemistry</subject><subject>Laboratory Medicine</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Metastasis</subject><subject>Microfilament Proteins - biosynthesis</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies</subject><subject>Myosins - biosynthesis</subject><subject>Neoplasm Invasiveness</subject><subject>original-article</subject><subject>Pathology</subject><subject>Radiation therapy</subject><subject>Skin Neoplasms - metabolism</subject><subject>Skin Neoplasms - pathology</subject><subject>Smooth muscle</subject><subject>Tumors</subject><subject>White people</subject><issn>0893-3952</issn><issn>1530-0285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kEtLAzEYRYMotlZ_gBsZXLgbzbsZXBXxBYobXYdM5hsb6UxqkhH996a0WHDRTQLJuTdfDkKnBF8SzNRV55ulSXO_uGQKEyzIHhoTwXCJqRL7aIxVxUpWCTpCRzF-YEy4UPQQjYiilAlBx2j2DMnEZJKzRW2iWRQWFnkxwbred6aA77mrXYpFgGaw0BTGJtfn42WAGJ3vj9FBaxYRTjb7BL3d3b7ePJRPL_ePN7On0nLJU9lWVEDNGa5bpTirmwqo5GCmqq6wMFjVIHFrKy6sJIQICVxgC9PVVxgGxiboYt27DP5zgJh05-JqWNODH6KWFaFKVjKD5__ADz-EPs-mKSVEUjblGSJryAYfY4BWL4PrTPjRBOuVXP0nV2_k5szZpnioO2i2iY3NDNA1EPNV_w5h-_Ku1ut1CLK8L5dD0Tros2oXwCbdeLcj_Qv2UJxK</recordid><startdate>20080501</startdate><enddate>20080501</enddate><creator>Uzquiano, Maria C</creator><creator>Prieto, Victor G</creator><creator>Nash, Jason W</creator><creator>Ivan, Doina S</creator><creator>Gong, Yun</creator><creator>Lazar, Alexander J F</creator><creator>Diwan, A Hafeez</creator><general>Elsevier Inc</general><general>Nature Publishing Group US</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</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>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20080501</creationdate><title>Metastatic basal cell carcinoma exhibits reduced actin expression</title><author>Uzquiano, Maria C ; Prieto, Victor G ; Nash, Jason W ; Ivan, Doina S ; Gong, Yun ; Lazar, Alexander J F ; Diwan, A Hafeez</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-f925eb430bf8843bd9e264ea78b905a08be60fc945c611156e450ce7028530e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>actin</topic><topic>Actins - biosynthesis</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>basal cell carcinoma</topic><topic>Cadherins - biosynthesis</topic><topic>Calcium-Binding Proteins - biosynthesis</topic><topic>Calponins</topic><topic>Cancer</topic><topic>Carcinoma, Basal Cell - metabolism</topic><topic>Carcinoma, Basal Cell - pathology</topic><topic>Female</topic><topic>Genotype &amp; phenotype</topic><topic>Humans</topic><topic>Immunohistochemistry</topic><topic>Laboratory Medicine</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Metastasis</topic><topic>Microfilament Proteins - biosynthesis</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies</topic><topic>Myosins - biosynthesis</topic><topic>Neoplasm Invasiveness</topic><topic>original-article</topic><topic>Pathology</topic><topic>Radiation therapy</topic><topic>Skin Neoplasms - metabolism</topic><topic>Skin Neoplasms - pathology</topic><topic>Smooth muscle</topic><topic>Tumors</topic><topic>White people</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Uzquiano, Maria C</creatorcontrib><creatorcontrib>Prieto, Victor G</creatorcontrib><creatorcontrib>Nash, Jason W</creatorcontrib><creatorcontrib>Ivan, Doina S</creatorcontrib><creatorcontrib>Gong, Yun</creatorcontrib><creatorcontrib>Lazar, Alexander J F</creatorcontrib><creatorcontrib>Diwan, A Hafeez</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><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>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science 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 Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing &amp; 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>Modern pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Uzquiano, Maria C</au><au>Prieto, Victor G</au><au>Nash, Jason W</au><au>Ivan, Doina S</au><au>Gong, Yun</au><au>Lazar, Alexander J F</au><au>Diwan, A Hafeez</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metastatic basal cell carcinoma exhibits reduced actin expression</atitle><jtitle>Modern pathology</jtitle><stitle>Mod Pathol</stitle><addtitle>Mod Pathol</addtitle><date>2008-05-01</date><risdate>2008</risdate><volume>21</volume><issue>5</issue><spage>540</spage><epage>543</epage><pages>540-543</pages><issn>0893-3952</issn><eissn>1530-0285</eissn><coden>MODPEO</coden><abstract>Basal cell carcinoma is the most common malignancy in Caucasian individuals. Metastatic basal cell carcinoma is extremely rare (with a rate estimated as 0.03%). Actin has been detected in aggressive forms of basal cell carcinoma, but their expression in metastatic lesions is not known. We compared the expression of actin and actin-related cytoskeletal proteins in relatively less aggressive basal cell carcinoma (nodular), aggressive basal cell carcinoma (infiltrative/morpheaform), and metastatic basal cell carcinoma. We studied 12 cases of nodular basal cell carcinoma, 10 cases of infiltrative basal cell carcinoma, and 10 cases of metastatic basal cell carcinoma with immunohistochemistry for alpha-smooth muscle actin, calponin, myosin, and E-cadherin. Expression was interpreted as positive when at least 5% of the tumor exhibited at least weak expression. Five of the ten patients with metastatic basal cell carcinoma had an antecedent history of radiotherapy. Actin was present in 3 of 12 (25%) of the nodular, all 10 of the infiltrative, and 3 of 10 of the metastatic basal cell carcinomas (P&lt;0.05 for metastatic vs infiltrative and nodular vs infiltrative). Calponin was present in 50% of the nodular, 60% of the infiltrative, and 30% of the metastatic basal cell carcinomas (not statistically significant). Myosin expression was not detected in any of the cases. E-cadherin was present in 75% of the nodular, 70% of the infiltrative, and all of the metastatic basal cell carcinomas (P&lt;0.05 for metastatic vs nodular). Our results suggest that increased actin may contribute to local invasiveness, but it is lost in the metastatic phenotype. History of previous radiotherapy may contribute to development of the metastatic phenotype.</abstract><cop>New York</cop><pub>Elsevier Inc</pub><pmid>18223552</pmid><doi>10.1038/modpathol.3801051</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0893-3952
ispartof Modern pathology, 2008-05, Vol.21 (5), p.540-543
issn 0893-3952
1530-0285
language eng
recordid cdi_proquest_miscellaneous_69128696
source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection
subjects actin
Actins - biosynthesis
Adult
Aged
Aged, 80 and over
basal cell carcinoma
Cadherins - biosynthesis
Calcium-Binding Proteins - biosynthesis
Calponins
Cancer
Carcinoma, Basal Cell - metabolism
Carcinoma, Basal Cell - pathology
Female
Genotype & phenotype
Humans
Immunohistochemistry
Laboratory Medicine
Male
Medical prognosis
Medicine
Medicine & Public Health
Metastasis
Microfilament Proteins - biosynthesis
Middle Aged
Monoclonal antibodies
Myosins - biosynthesis
Neoplasm Invasiveness
original-article
Pathology
Radiation therapy
Skin Neoplasms - metabolism
Skin Neoplasms - pathology
Smooth muscle
Tumors
White people
title Metastatic basal cell carcinoma exhibits reduced actin expression
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-14T00%3A23%3A42IST&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=Metastatic%20basal%20cell%20carcinoma%20exhibits%20reduced%20actin%20expression&rft.jtitle=Modern%20pathology&rft.au=Uzquiano,%20Maria%20C&rft.date=2008-05-01&rft.volume=21&rft.issue=5&rft.spage=540&rft.epage=543&rft.pages=540-543&rft.issn=0893-3952&rft.eissn=1530-0285&rft.coden=MODPEO&rft_id=info:doi/10.1038/modpathol.3801051&rft_dat=%3Cproquest_cross%3E1467846171%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=221162374&rft_id=info:pmid/18223552&rft_els_id=S0893395222041254&rfr_iscdi=true