Serum sErbB1 and Epidermal Growth Factor Levels As Tumor Biomarkers in Women with Stage III or IV Epithelial Ovarian Cancer

Epithelial ovarian cancer (EOC) has a high mortality rate, which is due primarily to the fact that early clinical symptoms are vague and nonspecific; hence, this disease often goes undetected and untreated until in its advanced stages. Sensitive and reliable methods for detecting earlier stages of E...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 1999-02, Vol.8 (2), p.129-137
Hauptverfasser: Baron, A T, Lafky, J M, Boardman, C H, Balasubramaniam, S, Suman, V J, Podratz, K C, Maihle, N J
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 137
container_issue 2
container_start_page 129
container_title Cancer epidemiology, biomarkers & prevention
container_volume 8
creator Baron, A T
Lafky, J M
Boardman, C H
Balasubramaniam, S
Suman, V J
Podratz, K C
Maihle, N J
description Epithelial ovarian cancer (EOC) has a high mortality rate, which is due primarily to the fact that early clinical symptoms are vague and nonspecific; hence, this disease often goes undetected and untreated until in its advanced stages. Sensitive and reliable methods for detecting earlier stages of EOC are, therefore, urgently needed. Epidermal growth factor (EGF) is a ligand for EGF receptor (ErbB1); this receptor is the product of the c- erbB1 proto-oncogene. ErbB1 overexpression is common in human ovarian carcinoma-derived cell lines and tumors, in which overexpression is thought to play a critical role in tumor etiology and progression. Furthermore, ErbB1 overexpression is associated with disease recurrence and decreased patient survival. Recently, we have developed an acridinium-linked immunosorbent assay that detects a ≈110-kDa soluble analogue of ErbB1, i.e. , sErbB1, in serum samples from healthy men and women (A. T. Baron, et al. , J. Immunol. Methods, 219: 23–43, 1998). Here, we demonstrate that serum p110 sErbB1 levels are significantly lower in EOC patients with stage III or IV disease prior to ( P < 0.0001) and shortly after ( P < 0.0001) cytoreductive staging laparotomy than in healthy women of similar ages, whereas EGF levels are significantly higher than those of age-matched healthy women only in serum samples collected shortly after tumor debulking surgery ( P < 0.0001). We observe that the preoperative serum sErbB1 concentration range of advanced stage EOC patients barely overlaps with the serum sErbB1 concentration range of healthy women. In addition, we show that serum sErbB1 and EGF levels changed temporally for some EOC patients who were surgically debulked of tumor and who provided a second serum sample during the course of combination chemotherapy. Finally, we observe a significant positive association between sErbB1 and EGF levels only in serum samples of EOC patients collected prior to cytoreductive surgery (correlation coefficient = 0.61968; P = 0.0027). These data suggest that epithelial ovarian tumors concomitantly affect serum sErbB1 and EGF levels. In conclusion, these data indicate that serum sErbB1 and EGF (postoperative only) levels are significantly different between EOC patients and healthy women and that altered and/or changing serum sErbB1 and EGF levels may provide important diagnostic and/or prognostic information useful for the management of patients with EOC.
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_69608045</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69608045</sourcerecordid><originalsourceid>FETCH-LOGICAL-h238t-b15f9f9edc3a1b5adecd9358bc4d98d18c7923d50eaff736aa796fa1d954f993</originalsourceid><addsrcrecordid>eNpFkF1LwzAUhosobk7_guTKu0LSLm1yuY1tFga7cOhlOE1O12g_ZtJuiH_eqhOv3nPg4YH3vQjGjMciTFPOL4ebch5KmfBRcOP9K6U0lZxfByNGaZIKRsfB5xO6viZ-6fI5I9AYsjxYg66Giqxde-pKsgLdtY5s8IiVJzNPdn09_HPb1uDe0HliG_LS1tiQkx34pw72SLIsIwOVPX8LuxIrOxi3R3AWGrKARqO7Da4KqDzenXMS7FbL3eIx3GzX2WK2CcsoFl2YM17IQqLRMbCcg0FtZMxFrqdGCsOETmUUG04RiiKNE4BUJgUwI_m0kDKeBA-_2oNr33v0naqt11hV0GDbe5XIhAo65QN4fwb7vEajDs4ODT_U31r_ptLuy5N1qPRPEYcewelSCRUpFsn4C5yCdU8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69608045</pqid></control><display><type>article</type><title>Serum sErbB1 and Epidermal Growth Factor Levels As Tumor Biomarkers in Women with Stage III or IV Epithelial Ovarian Cancer</title><source>MEDLINE</source><source>American Association for Cancer Research</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Baron, A T ; Lafky, J M ; Boardman, C H ; Balasubramaniam, S ; Suman, V J ; Podratz, K C ; Maihle, N J</creator><creatorcontrib>Baron, A T ; Lafky, J M ; Boardman, C H ; Balasubramaniam, S ; Suman, V J ; Podratz, K C ; Maihle, N J</creatorcontrib><description>Epithelial ovarian cancer (EOC) has a high mortality rate, which is due primarily to the fact that early clinical symptoms are vague and nonspecific; hence, this disease often goes undetected and untreated until in its advanced stages. Sensitive and reliable methods for detecting earlier stages of EOC are, therefore, urgently needed. Epidermal growth factor (EGF) is a ligand for EGF receptor (ErbB1); this receptor is the product of the c- erbB1 proto-oncogene. ErbB1 overexpression is common in human ovarian carcinoma-derived cell lines and tumors, in which overexpression is thought to play a critical role in tumor etiology and progression. Furthermore, ErbB1 overexpression is associated with disease recurrence and decreased patient survival. Recently, we have developed an acridinium-linked immunosorbent assay that detects a ≈110-kDa soluble analogue of ErbB1, i.e. , sErbB1, in serum samples from healthy men and women (A. T. Baron, et al. , J. Immunol. Methods, 219: 23–43, 1998). Here, we demonstrate that serum p110 sErbB1 levels are significantly lower in EOC patients with stage III or IV disease prior to ( P &lt; 0.0001) and shortly after ( P &lt; 0.0001) cytoreductive staging laparotomy than in healthy women of similar ages, whereas EGF levels are significantly higher than those of age-matched healthy women only in serum samples collected shortly after tumor debulking surgery ( P &lt; 0.0001). We observe that the preoperative serum sErbB1 concentration range of advanced stage EOC patients barely overlaps with the serum sErbB1 concentration range of healthy women. In addition, we show that serum sErbB1 and EGF levels changed temporally for some EOC patients who were surgically debulked of tumor and who provided a second serum sample during the course of combination chemotherapy. Finally, we observe a significant positive association between sErbB1 and EGF levels only in serum samples of EOC patients collected prior to cytoreductive surgery (correlation coefficient = 0.61968; P = 0.0027). These data suggest that epithelial ovarian tumors concomitantly affect serum sErbB1 and EGF levels. In conclusion, these data indicate that serum sErbB1 and EGF (postoperative only) levels are significantly different between EOC patients and healthy women and that altered and/or changing serum sErbB1 and EGF levels may provide important diagnostic and/or prognostic information useful for the management of patients with EOC.</description><identifier>ISSN: 1055-9965</identifier><identifier>EISSN: 1538-7755</identifier><identifier>PMID: 10067810</identifier><language>eng</language><publisher>United States: American Association for Cancer Research</publisher><subject>Acridines ; Adult ; Aged ; Biomarkers, Tumor - blood ; Biomarkers, Tumor - genetics ; Carcinoma - blood ; Carcinoma - pathology ; Case-Control Studies ; Chemotherapy, Adjuvant ; Disease Progression ; Epidermal Growth Factor - blood ; Epidermal Growth Factor - genetics ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Immunosorbent Techniques ; Laparotomy ; Male ; Middle Aged ; Neoplasm Recurrence, Local - pathology ; Neoplasm Staging ; Neoplasms, Glandular and Epithelial - blood ; Neoplasms, Glandular and Epithelial - pathology ; Neoplasms, Glandular and Epithelial - surgery ; Ovarian Neoplasms - blood ; Ovarian Neoplasms - pathology ; Ovarian Neoplasms - surgery ; Prognosis ; Receptor, Epidermal Growth Factor - blood ; Receptor, Epidermal Growth Factor - genetics ; Reproducibility of Results ; Sensitivity and Specificity ; Survival Rate ; Tumor Cells, Cultured</subject><ispartof>Cancer epidemiology, biomarkers &amp; prevention, 1999-02, Vol.8 (2), p.129-137</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10067810$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baron, A T</creatorcontrib><creatorcontrib>Lafky, J M</creatorcontrib><creatorcontrib>Boardman, C H</creatorcontrib><creatorcontrib>Balasubramaniam, S</creatorcontrib><creatorcontrib>Suman, V J</creatorcontrib><creatorcontrib>Podratz, K C</creatorcontrib><creatorcontrib>Maihle, N J</creatorcontrib><title>Serum sErbB1 and Epidermal Growth Factor Levels As Tumor Biomarkers in Women with Stage III or IV Epithelial Ovarian Cancer</title><title>Cancer epidemiology, biomarkers &amp; prevention</title><addtitle>Cancer Epidemiol Biomarkers Prev</addtitle><description>Epithelial ovarian cancer (EOC) has a high mortality rate, which is due primarily to the fact that early clinical symptoms are vague and nonspecific; hence, this disease often goes undetected and untreated until in its advanced stages. Sensitive and reliable methods for detecting earlier stages of EOC are, therefore, urgently needed. Epidermal growth factor (EGF) is a ligand for EGF receptor (ErbB1); this receptor is the product of the c- erbB1 proto-oncogene. ErbB1 overexpression is common in human ovarian carcinoma-derived cell lines and tumors, in which overexpression is thought to play a critical role in tumor etiology and progression. Furthermore, ErbB1 overexpression is associated with disease recurrence and decreased patient survival. Recently, we have developed an acridinium-linked immunosorbent assay that detects a ≈110-kDa soluble analogue of ErbB1, i.e. , sErbB1, in serum samples from healthy men and women (A. T. Baron, et al. , J. Immunol. Methods, 219: 23–43, 1998). Here, we demonstrate that serum p110 sErbB1 levels are significantly lower in EOC patients with stage III or IV disease prior to ( P &lt; 0.0001) and shortly after ( P &lt; 0.0001) cytoreductive staging laparotomy than in healthy women of similar ages, whereas EGF levels are significantly higher than those of age-matched healthy women only in serum samples collected shortly after tumor debulking surgery ( P &lt; 0.0001). We observe that the preoperative serum sErbB1 concentration range of advanced stage EOC patients barely overlaps with the serum sErbB1 concentration range of healthy women. In addition, we show that serum sErbB1 and EGF levels changed temporally for some EOC patients who were surgically debulked of tumor and who provided a second serum sample during the course of combination chemotherapy. Finally, we observe a significant positive association between sErbB1 and EGF levels only in serum samples of EOC patients collected prior to cytoreductive surgery (correlation coefficient = 0.61968; P = 0.0027). These data suggest that epithelial ovarian tumors concomitantly affect serum sErbB1 and EGF levels. In conclusion, these data indicate that serum sErbB1 and EGF (postoperative only) levels are significantly different between EOC patients and healthy women and that altered and/or changing serum sErbB1 and EGF levels may provide important diagnostic and/or prognostic information useful for the management of patients with EOC.</description><subject>Acridines</subject><subject>Adult</subject><subject>Aged</subject><subject>Biomarkers, Tumor - blood</subject><subject>Biomarkers, Tumor - genetics</subject><subject>Carcinoma - blood</subject><subject>Carcinoma - pathology</subject><subject>Case-Control Studies</subject><subject>Chemotherapy, Adjuvant</subject><subject>Disease Progression</subject><subject>Epidermal Growth Factor - blood</subject><subject>Epidermal Growth Factor - genetics</subject><subject>Female</subject><subject>Gene Expression Regulation, Neoplastic</subject><subject>Humans</subject><subject>Immunosorbent Techniques</subject><subject>Laparotomy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Staging</subject><subject>Neoplasms, Glandular and Epithelial - blood</subject><subject>Neoplasms, Glandular and Epithelial - pathology</subject><subject>Neoplasms, Glandular and Epithelial - surgery</subject><subject>Ovarian Neoplasms - blood</subject><subject>Ovarian Neoplasms - pathology</subject><subject>Ovarian Neoplasms - surgery</subject><subject>Prognosis</subject><subject>Receptor, Epidermal Growth Factor - blood</subject><subject>Receptor, Epidermal Growth Factor - genetics</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Survival Rate</subject><subject>Tumor Cells, Cultured</subject><issn>1055-9965</issn><issn>1538-7755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkF1LwzAUhosobk7_guTKu0LSLm1yuY1tFga7cOhlOE1O12g_ZtJuiH_eqhOv3nPg4YH3vQjGjMciTFPOL4ebch5KmfBRcOP9K6U0lZxfByNGaZIKRsfB5xO6viZ-6fI5I9AYsjxYg66Giqxde-pKsgLdtY5s8IiVJzNPdn09_HPb1uDe0HliG_LS1tiQkx34pw72SLIsIwOVPX8LuxIrOxi3R3AWGrKARqO7Da4KqDzenXMS7FbL3eIx3GzX2WK2CcsoFl2YM17IQqLRMbCcg0FtZMxFrqdGCsOETmUUG04RiiKNE4BUJgUwI_m0kDKeBA-_2oNr33v0naqt11hV0GDbe5XIhAo65QN4fwb7vEajDs4ODT_U31r_ptLuy5N1qPRPEYcewelSCRUpFsn4C5yCdU8</recordid><startdate>19990201</startdate><enddate>19990201</enddate><creator>Baron, A T</creator><creator>Lafky, J M</creator><creator>Boardman, C H</creator><creator>Balasubramaniam, S</creator><creator>Suman, V J</creator><creator>Podratz, K C</creator><creator>Maihle, N J</creator><general>American Association for Cancer Research</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19990201</creationdate><title>Serum sErbB1 and Epidermal Growth Factor Levels As Tumor Biomarkers in Women with Stage III or IV Epithelial Ovarian Cancer</title><author>Baron, A T ; Lafky, J M ; Boardman, C H ; Balasubramaniam, S ; Suman, V J ; Podratz, K C ; Maihle, N J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h238t-b15f9f9edc3a1b5adecd9358bc4d98d18c7923d50eaff736aa796fa1d954f993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Acridines</topic><topic>Adult</topic><topic>Aged</topic><topic>Biomarkers, Tumor - blood</topic><topic>Biomarkers, Tumor - genetics</topic><topic>Carcinoma - blood</topic><topic>Carcinoma - pathology</topic><topic>Case-Control Studies</topic><topic>Chemotherapy, Adjuvant</topic><topic>Disease Progression</topic><topic>Epidermal Growth Factor - blood</topic><topic>Epidermal Growth Factor - genetics</topic><topic>Female</topic><topic>Gene Expression Regulation, Neoplastic</topic><topic>Humans</topic><topic>Immunosorbent Techniques</topic><topic>Laparotomy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Staging</topic><topic>Neoplasms, Glandular and Epithelial - blood</topic><topic>Neoplasms, Glandular and Epithelial - pathology</topic><topic>Neoplasms, Glandular and Epithelial - surgery</topic><topic>Ovarian Neoplasms - blood</topic><topic>Ovarian Neoplasms - pathology</topic><topic>Ovarian Neoplasms - surgery</topic><topic>Prognosis</topic><topic>Receptor, Epidermal Growth Factor - blood</topic><topic>Receptor, Epidermal Growth Factor - genetics</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Survival Rate</topic><topic>Tumor Cells, Cultured</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baron, A T</creatorcontrib><creatorcontrib>Lafky, J M</creatorcontrib><creatorcontrib>Boardman, C H</creatorcontrib><creatorcontrib>Balasubramaniam, S</creatorcontrib><creatorcontrib>Suman, V J</creatorcontrib><creatorcontrib>Podratz, K C</creatorcontrib><creatorcontrib>Maihle, N J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer epidemiology, biomarkers &amp; prevention</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baron, A T</au><au>Lafky, J M</au><au>Boardman, C H</au><au>Balasubramaniam, S</au><au>Suman, V J</au><au>Podratz, K C</au><au>Maihle, N J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serum sErbB1 and Epidermal Growth Factor Levels As Tumor Biomarkers in Women with Stage III or IV Epithelial Ovarian Cancer</atitle><jtitle>Cancer epidemiology, biomarkers &amp; prevention</jtitle><addtitle>Cancer Epidemiol Biomarkers Prev</addtitle><date>1999-02-01</date><risdate>1999</risdate><volume>8</volume><issue>2</issue><spage>129</spage><epage>137</epage><pages>129-137</pages><issn>1055-9965</issn><eissn>1538-7755</eissn><abstract>Epithelial ovarian cancer (EOC) has a high mortality rate, which is due primarily to the fact that early clinical symptoms are vague and nonspecific; hence, this disease often goes undetected and untreated until in its advanced stages. Sensitive and reliable methods for detecting earlier stages of EOC are, therefore, urgently needed. Epidermal growth factor (EGF) is a ligand for EGF receptor (ErbB1); this receptor is the product of the c- erbB1 proto-oncogene. ErbB1 overexpression is common in human ovarian carcinoma-derived cell lines and tumors, in which overexpression is thought to play a critical role in tumor etiology and progression. Furthermore, ErbB1 overexpression is associated with disease recurrence and decreased patient survival. Recently, we have developed an acridinium-linked immunosorbent assay that detects a ≈110-kDa soluble analogue of ErbB1, i.e. , sErbB1, in serum samples from healthy men and women (A. T. Baron, et al. , J. Immunol. Methods, 219: 23–43, 1998). Here, we demonstrate that serum p110 sErbB1 levels are significantly lower in EOC patients with stage III or IV disease prior to ( P &lt; 0.0001) and shortly after ( P &lt; 0.0001) cytoreductive staging laparotomy than in healthy women of similar ages, whereas EGF levels are significantly higher than those of age-matched healthy women only in serum samples collected shortly after tumor debulking surgery ( P &lt; 0.0001). We observe that the preoperative serum sErbB1 concentration range of advanced stage EOC patients barely overlaps with the serum sErbB1 concentration range of healthy women. In addition, we show that serum sErbB1 and EGF levels changed temporally for some EOC patients who were surgically debulked of tumor and who provided a second serum sample during the course of combination chemotherapy. Finally, we observe a significant positive association between sErbB1 and EGF levels only in serum samples of EOC patients collected prior to cytoreductive surgery (correlation coefficient = 0.61968; P = 0.0027). These data suggest that epithelial ovarian tumors concomitantly affect serum sErbB1 and EGF levels. In conclusion, these data indicate that serum sErbB1 and EGF (postoperative only) levels are significantly different between EOC patients and healthy women and that altered and/or changing serum sErbB1 and EGF levels may provide important diagnostic and/or prognostic information useful for the management of patients with EOC.</abstract><cop>United States</cop><pub>American Association for Cancer Research</pub><pmid>10067810</pmid><tpages>9</tpages></addata></record>
fulltext fulltext
identifier ISSN: 1055-9965
ispartof Cancer epidemiology, biomarkers & prevention, 1999-02, Vol.8 (2), p.129-137
issn 1055-9965
1538-7755
language eng
recordid cdi_proquest_miscellaneous_69608045
source MEDLINE; American Association for Cancer Research; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
subjects Acridines
Adult
Aged
Biomarkers, Tumor - blood
Biomarkers, Tumor - genetics
Carcinoma - blood
Carcinoma - pathology
Case-Control Studies
Chemotherapy, Adjuvant
Disease Progression
Epidermal Growth Factor - blood
Epidermal Growth Factor - genetics
Female
Gene Expression Regulation, Neoplastic
Humans
Immunosorbent Techniques
Laparotomy
Male
Middle Aged
Neoplasm Recurrence, Local - pathology
Neoplasm Staging
Neoplasms, Glandular and Epithelial - blood
Neoplasms, Glandular and Epithelial - pathology
Neoplasms, Glandular and Epithelial - surgery
Ovarian Neoplasms - blood
Ovarian Neoplasms - pathology
Ovarian Neoplasms - surgery
Prognosis
Receptor, Epidermal Growth Factor - blood
Receptor, Epidermal Growth Factor - genetics
Reproducibility of Results
Sensitivity and Specificity
Survival Rate
Tumor Cells, Cultured
title Serum sErbB1 and Epidermal Growth Factor Levels As Tumor Biomarkers in Women with Stage III or IV Epithelial Ovarian Cancer
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T22%3A32%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Serum%20sErbB1%20and%20Epidermal%20Growth%20Factor%20Levels%20As%20Tumor%20Biomarkers%20in%20Women%20with%20Stage%20III%20or%20IV%20Epithelial%20Ovarian%20Cancer&rft.jtitle=Cancer%20epidemiology,%20biomarkers%20&%20prevention&rft.au=Baron,%20A%20T&rft.date=1999-02-01&rft.volume=8&rft.issue=2&rft.spage=129&rft.epage=137&rft.pages=129-137&rft.issn=1055-9965&rft.eissn=1538-7755&rft_id=info:doi/&rft_dat=%3Cproquest_pubme%3E69608045%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=69608045&rft_id=info:pmid/10067810&rfr_iscdi=true