High-intensity ultraendurance promotes early release of muscle injury markers
Objective:To evaluate the impact of high-intensity ultraendurance (HIU) cycling, using it as a possible way to understand muscle injury kinetics and blood immune cells’ release during high-intensity prolonged exerciseDesign:Male amateur triathletes enrolled during a cycling race of the International...
Gespeichert in:
Veröffentlicht in: | British journal of sports medicine 2008-11, Vol.42 (11), p.889-893 |
---|---|
Hauptverfasser: | , , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 893 |
---|---|
container_issue | 11 |
container_start_page | 889 |
container_title | British journal of sports medicine |
container_volume | 42 |
creator | Bessa, A Nissenbaum, M Monteiro, A Gandra, P G Nunes, L S Bassini-Cameron, A Werneck-de-Castro, J P S de Macedo, D Vaz Cameron, L-C |
description | Objective:To evaluate the impact of high-intensity ultraendurance (HIU) cycling, using it as a possible way to understand muscle injury kinetics and blood immune cells’ release during high-intensity prolonged exerciseDesign:Male amateur triathletes enrolled during a cycling race of the International Bike Championship 800 km cycling relay (∼23 h). Each athlete alternately cycled 20–25 minutes until exhaustion and performed a total of approximately 200 km.Results:Creatine kinase levels in blood reached a 300% rise in a sigmoidal pattern, while lactate dehydrogenase levels increased by 30–40% following a hyperbolic pattern. Aspartate aminotransferase and alanine aminotransferase levels increased by up to 250% and 140%, respectively. Liver injury markers such as alkaline phosphatase and γ-glutamyltransferase remained stable. Platelets increased by 20–30% from pre-exercise, and there was no change in haematocrit during the race. White blood cells rose by nearly 200%. Leucocytes rose 210% during the race, with a major component coming from neutrophils, which increased more than 300%. Triacylglycerol levels were decreased at the finish and total cholesterol levels remained unchanged. Urate increased (by up to 35%) during the first half of the race, and urea levels increased with a different pattern, increasing by 45% in the second half.Conclusions:This study showed the blood appearance kinetics of muscle injury markers and some metabolites. It is suggested that the increase in these enzymes came primarily from muscle damage, rather than liver damage, and that white blood cells are selectively mobilised independently of haemoconcentration. The early appearance of muscle injury markers in this kind of exercise was also shown. |
doi_str_mv | 10.1136/bjsm.2007.043786 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69760145</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69760145</sourcerecordid><originalsourceid>FETCH-LOGICAL-b426t-5b264ab4f65c5502398207b8e22292bc341e2e9b9b541f2c1298f7cf597dc55c3</originalsourceid><addsrcrecordid>eNqFkUtv1DAUhS1ERaeFPSsUUakblOH6bS-r4VHUAgIBi26s2HMDCXm0diIx_x6PMqISEmLlxf3O9bnnEPKUwppSrl76NvVrBqDXILg26gFZUaF5CcLAQ7ICDqrkSotjcpJSC0CZBPOIHFPDgBulV-T9ZfP9R9kMEw6pmXbF3E2xwmE7x2oIWNzGsR8nTAVWsdsVETusEhZjXfRzCh0WzdDOcVf0VfyJMT0mR3XVJXxyeE_J1zevv2wuy-uPb99tLq5LL5iaSumZEpUXtZJBSmDcZj_aG2SMWeYDFxQZWm-9FLRmgTJrah1qafU2CwI_JefL3uzvbsY0ub5JAbuuGnCck1NWK6BCZvD5X2A7znHI3hy1QhihjM3Q2T8hrS0wkdPKFCxUiGNKEWt3G5t8985RcPs23L4Nt2_DLW1kybPD4tn3uL0XHOLPQLkATZrw1595DtPlqZbuw7eNu3l1Ja4-f-LuJvMvFt737f-__w0Br6GY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1779024203</pqid></control><display><type>article</type><title>High-intensity ultraendurance promotes early release of muscle injury markers</title><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>Bessa, A ; Nissenbaum, M ; Monteiro, A ; Gandra, P G ; Nunes, L S ; Bassini-Cameron, A ; Werneck-de-Castro, J P S ; de Macedo, D Vaz ; Cameron, L-C</creator><creatorcontrib>Bessa, A ; Nissenbaum, M ; Monteiro, A ; Gandra, P G ; Nunes, L S ; Bassini-Cameron, A ; Werneck-de-Castro, J P S ; de Macedo, D Vaz ; Cameron, L-C</creatorcontrib><description>Objective:To evaluate the impact of high-intensity ultraendurance (HIU) cycling, using it as a possible way to understand muscle injury kinetics and blood immune cells’ release during high-intensity prolonged exerciseDesign:Male amateur triathletes enrolled during a cycling race of the International Bike Championship 800 km cycling relay (∼23 h). Each athlete alternately cycled 20–25 minutes until exhaustion and performed a total of approximately 200 km.Results:Creatine kinase levels in blood reached a 300% rise in a sigmoidal pattern, while lactate dehydrogenase levels increased by 30–40% following a hyperbolic pattern. Aspartate aminotransferase and alanine aminotransferase levels increased by up to 250% and 140%, respectively. Liver injury markers such as alkaline phosphatase and γ-glutamyltransferase remained stable. Platelets increased by 20–30% from pre-exercise, and there was no change in haematocrit during the race. White blood cells rose by nearly 200%. Leucocytes rose 210% during the race, with a major component coming from neutrophils, which increased more than 300%. Triacylglycerol levels were decreased at the finish and total cholesterol levels remained unchanged. Urate increased (by up to 35%) during the first half of the race, and urea levels increased with a different pattern, increasing by 45% in the second half.Conclusions:This study showed the blood appearance kinetics of muscle injury markers and some metabolites. It is suggested that the increase in these enzymes came primarily from muscle damage, rather than liver damage, and that white blood cells are selectively mobilised independently of haemoconcentration. The early appearance of muscle injury markers in this kind of exercise was also shown.</description><identifier>ISSN: 0306-3674</identifier><identifier>EISSN: 1473-0480</identifier><identifier>DOI: 10.1136/bjsm.2007.043786</identifier><identifier>PMID: 18203867</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><subject>Adult ; Alanine Transaminase - blood ; Ammonia ; Aspartate Aminotransferases - blood ; Athletes ; Bicycling ; Bicycling - physiology ; Biomarkers - blood ; Blood ; Creatine Kinase - blood ; Effects ; Exercise ; Hematology ; Humans ; Injuries ; L-Lactate Dehydrogenase - blood ; Laboratories ; Male ; Metabolism ; Metabolites ; Muscle, Skeletal - enzymology ; Muscle, Skeletal - injuries ; Muscle, Skeletal - physiology ; Musculoskeletal system ; Physical Endurance - physiology ; Sports medicine ; Studies ; Variance analysis</subject><ispartof>British journal of sports medicine, 2008-11, Vol.42 (11), p.889-893</ispartof><rights>2008 British Journal of Sports Medicine</rights><rights>Copyright: 2008 2008 British Journal of Sports Medicine</rights><rights>Copyright BMJ Publishing Group Nov 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b426t-5b264ab4f65c5502398207b8e22292bc341e2e9b9b541f2c1298f7cf597dc55c3</citedby><cites>FETCH-LOGICAL-b426t-5b264ab4f65c5502398207b8e22292bc341e2e9b9b541f2c1298f7cf597dc55c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bjsm.bmj.com/content/42/11/889.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://bjsm.bmj.com/content/42/11/889.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18203867$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bessa, A</creatorcontrib><creatorcontrib>Nissenbaum, M</creatorcontrib><creatorcontrib>Monteiro, A</creatorcontrib><creatorcontrib>Gandra, P G</creatorcontrib><creatorcontrib>Nunes, L S</creatorcontrib><creatorcontrib>Bassini-Cameron, A</creatorcontrib><creatorcontrib>Werneck-de-Castro, J P S</creatorcontrib><creatorcontrib>de Macedo, D Vaz</creatorcontrib><creatorcontrib>Cameron, L-C</creatorcontrib><title>High-intensity ultraendurance promotes early release of muscle injury markers</title><title>British journal of sports medicine</title><addtitle>Br J Sports Med</addtitle><description>Objective:To evaluate the impact of high-intensity ultraendurance (HIU) cycling, using it as a possible way to understand muscle injury kinetics and blood immune cells’ release during high-intensity prolonged exerciseDesign:Male amateur triathletes enrolled during a cycling race of the International Bike Championship 800 km cycling relay (∼23 h). Each athlete alternately cycled 20–25 minutes until exhaustion and performed a total of approximately 200 km.Results:Creatine kinase levels in blood reached a 300% rise in a sigmoidal pattern, while lactate dehydrogenase levels increased by 30–40% following a hyperbolic pattern. Aspartate aminotransferase and alanine aminotransferase levels increased by up to 250% and 140%, respectively. Liver injury markers such as alkaline phosphatase and γ-glutamyltransferase remained stable. Platelets increased by 20–30% from pre-exercise, and there was no change in haematocrit during the race. White blood cells rose by nearly 200%. Leucocytes rose 210% during the race, with a major component coming from neutrophils, which increased more than 300%. Triacylglycerol levels were decreased at the finish and total cholesterol levels remained unchanged. Urate increased (by up to 35%) during the first half of the race, and urea levels increased with a different pattern, increasing by 45% in the second half.Conclusions:This study showed the blood appearance kinetics of muscle injury markers and some metabolites. It is suggested that the increase in these enzymes came primarily from muscle damage, rather than liver damage, and that white blood cells are selectively mobilised independently of haemoconcentration. The early appearance of muscle injury markers in this kind of exercise was also shown.</description><subject>Adult</subject><subject>Alanine Transaminase - blood</subject><subject>Ammonia</subject><subject>Aspartate Aminotransferases - blood</subject><subject>Athletes</subject><subject>Bicycling</subject><subject>Bicycling - physiology</subject><subject>Biomarkers - blood</subject><subject>Blood</subject><subject>Creatine Kinase - blood</subject><subject>Effects</subject><subject>Exercise</subject><subject>Hematology</subject><subject>Humans</subject><subject>Injuries</subject><subject>L-Lactate Dehydrogenase - blood</subject><subject>Laboratories</subject><subject>Male</subject><subject>Metabolism</subject><subject>Metabolites</subject><subject>Muscle, Skeletal - enzymology</subject><subject>Muscle, Skeletal - injuries</subject><subject>Muscle, Skeletal - physiology</subject><subject>Musculoskeletal system</subject><subject>Physical Endurance - physiology</subject><subject>Sports medicine</subject><subject>Studies</subject><subject>Variance analysis</subject><issn>0306-3674</issn><issn>1473-0480</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</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>eNqFkUtv1DAUhS1ERaeFPSsUUakblOH6bS-r4VHUAgIBi26s2HMDCXm0diIx_x6PMqISEmLlxf3O9bnnEPKUwppSrl76NvVrBqDXILg26gFZUaF5CcLAQ7ICDqrkSotjcpJSC0CZBPOIHFPDgBulV-T9ZfP9R9kMEw6pmXbF3E2xwmE7x2oIWNzGsR8nTAVWsdsVETusEhZjXfRzCh0WzdDOcVf0VfyJMT0mR3XVJXxyeE_J1zevv2wuy-uPb99tLq5LL5iaSumZEpUXtZJBSmDcZj_aG2SMWeYDFxQZWm-9FLRmgTJrah1qafU2CwI_JefL3uzvbsY0ub5JAbuuGnCck1NWK6BCZvD5X2A7znHI3hy1QhihjM3Q2T8hrS0wkdPKFCxUiGNKEWt3G5t8985RcPs23L4Nt2_DLW1kybPD4tn3uL0XHOLPQLkATZrw1595DtPlqZbuw7eNu3l1Ja4-f-LuJvMvFt737f-__w0Br6GY</recordid><startdate>200811</startdate><enddate>200811</enddate><creator>Bessa, A</creator><creator>Nissenbaum, M</creator><creator>Monteiro, A</creator><creator>Gandra, P G</creator><creator>Nunes, L S</creator><creator>Bassini-Cameron, A</creator><creator>Werneck-de-Castro, J P S</creator><creator>de Macedo, D Vaz</creator><creator>Cameron, L-C</creator><general>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</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>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</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>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>200811</creationdate><title>High-intensity ultraendurance promotes early release of muscle injury markers</title><author>Bessa, A ; Nissenbaum, M ; Monteiro, A ; Gandra, P G ; Nunes, L S ; Bassini-Cameron, A ; Werneck-de-Castro, J P S ; de Macedo, D Vaz ; Cameron, L-C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b426t-5b264ab4f65c5502398207b8e22292bc341e2e9b9b541f2c1298f7cf597dc55c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Alanine Transaminase - blood</topic><topic>Ammonia</topic><topic>Aspartate Aminotransferases - blood</topic><topic>Athletes</topic><topic>Bicycling</topic><topic>Bicycling - physiology</topic><topic>Biomarkers - blood</topic><topic>Blood</topic><topic>Creatine Kinase - blood</topic><topic>Effects</topic><topic>Exercise</topic><topic>Hematology</topic><topic>Humans</topic><topic>Injuries</topic><topic>L-Lactate Dehydrogenase - blood</topic><topic>Laboratories</topic><topic>Male</topic><topic>Metabolism</topic><topic>Metabolites</topic><topic>Muscle, Skeletal - enzymology</topic><topic>Muscle, Skeletal - injuries</topic><topic>Muscle, Skeletal - physiology</topic><topic>Musculoskeletal system</topic><topic>Physical Endurance - physiology</topic><topic>Sports medicine</topic><topic>Studies</topic><topic>Variance analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bessa, A</creatorcontrib><creatorcontrib>Nissenbaum, M</creatorcontrib><creatorcontrib>Monteiro, A</creatorcontrib><creatorcontrib>Gandra, P G</creatorcontrib><creatorcontrib>Nunes, L S</creatorcontrib><creatorcontrib>Bassini-Cameron, A</creatorcontrib><creatorcontrib>Werneck-de-Castro, J P S</creatorcontrib><creatorcontrib>de Macedo, D Vaz</creatorcontrib><creatorcontrib>Cameron, L-C</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>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM 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</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</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>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & 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>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bessa, A</au><au>Nissenbaum, M</au><au>Monteiro, A</au><au>Gandra, P G</au><au>Nunes, L S</au><au>Bassini-Cameron, A</au><au>Werneck-de-Castro, J P S</au><au>de Macedo, D Vaz</au><au>Cameron, L-C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-intensity ultraendurance promotes early release of muscle injury markers</atitle><jtitle>British journal of sports medicine</jtitle><addtitle>Br J Sports Med</addtitle><date>2008-11</date><risdate>2008</risdate><volume>42</volume><issue>11</issue><spage>889</spage><epage>893</epage><pages>889-893</pages><issn>0306-3674</issn><eissn>1473-0480</eissn><abstract>Objective:To evaluate the impact of high-intensity ultraendurance (HIU) cycling, using it as a possible way to understand muscle injury kinetics and blood immune cells’ release during high-intensity prolonged exerciseDesign:Male amateur triathletes enrolled during a cycling race of the International Bike Championship 800 km cycling relay (∼23 h). Each athlete alternately cycled 20–25 minutes until exhaustion and performed a total of approximately 200 km.Results:Creatine kinase levels in blood reached a 300% rise in a sigmoidal pattern, while lactate dehydrogenase levels increased by 30–40% following a hyperbolic pattern. Aspartate aminotransferase and alanine aminotransferase levels increased by up to 250% and 140%, respectively. Liver injury markers such as alkaline phosphatase and γ-glutamyltransferase remained stable. Platelets increased by 20–30% from pre-exercise, and there was no change in haematocrit during the race. White blood cells rose by nearly 200%. Leucocytes rose 210% during the race, with a major component coming from neutrophils, which increased more than 300%. Triacylglycerol levels were decreased at the finish and total cholesterol levels remained unchanged. Urate increased (by up to 35%) during the first half of the race, and urea levels increased with a different pattern, increasing by 45% in the second half.Conclusions:This study showed the blood appearance kinetics of muscle injury markers and some metabolites. It is suggested that the increase in these enzymes came primarily from muscle damage, rather than liver damage, and that white blood cells are selectively mobilised independently of haemoconcentration. The early appearance of muscle injury markers in this kind of exercise was also shown.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</pub><pmid>18203867</pmid><doi>10.1136/bjsm.2007.043786</doi><tpages>5</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0306-3674 |
ispartof | British journal of sports medicine, 2008-11, Vol.42 (11), p.889-893 |
issn | 0306-3674 1473-0480 |
language | eng |
recordid | cdi_proquest_miscellaneous_69760145 |
source | MEDLINE; BMJ Journals - NESLi2 |
subjects | Adult Alanine Transaminase - blood Ammonia Aspartate Aminotransferases - blood Athletes Bicycling Bicycling - physiology Biomarkers - blood Blood Creatine Kinase - blood Effects Exercise Hematology Humans Injuries L-Lactate Dehydrogenase - blood Laboratories Male Metabolism Metabolites Muscle, Skeletal - enzymology Muscle, Skeletal - injuries Muscle, Skeletal - physiology Musculoskeletal system Physical Endurance - physiology Sports medicine Studies Variance analysis |
title | High-intensity ultraendurance promotes early release of muscle injury markers |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-20T16%3A53%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=High-intensity%20ultraendurance%20promotes%20early%20release%20of%20muscle%20injury%20markers&rft.jtitle=British%20journal%20of%20sports%20medicine&rft.au=Bessa,%20A&rft.date=2008-11&rft.volume=42&rft.issue=11&rft.spage=889&rft.epage=893&rft.pages=889-893&rft.issn=0306-3674&rft.eissn=1473-0480&rft_id=info:doi/10.1136/bjsm.2007.043786&rft_dat=%3Cproquest_cross%3E69760145%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=1779024203&rft_id=info:pmid/18203867&rfr_iscdi=true |