Twin-to-twin transfusion syndrome: an antiangiogenic state?
Objective An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotropho...
Gespeichert in:
| Veröffentlicht in: | American journal of obstetrics and gynecology 2008-04, Vol.198 (4), p.382.e1-382.e8 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 382.e8 |
|---|---|
| container_issue | 4 |
| container_start_page | 382.e1 |
| container_title | American journal of obstetrics and gynecology |
| container_volume | 198 |
| creator | Kusanovic, Juan Pedro, MD Romero, Roberto, MD Espinoza, Jimmy, MD Nien, Jyh Kae, MD Kim, Chong Jai, MD Mittal, Pooja, MD Edwin, Sam, PhD Erez, Offer, MD Gotsch, Francesca, MD Mazaki-Tovi, Shali, MD Than, Nandor G., MD, PhD Soto, Eleazar, MD Camacho, Natalia, MD Gomez, Ricardo, MD Quintero, Ruben, MD Hassan, Sonia S., MD |
| description | Objective An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS. Study Design This case-control study included monochorionic-diamniotic pregnancies between 16-26 weeks with and without TTTS. Maternal plasma concentrations of PlGF, sVEGFR-1, and s-Eng were determined with ELISA. A P value < .05 was considered statistically significant. Results Patients with TTTS had higher median plasma concentrations of s-Eng (14.8 ng/mL vs 7.8 ng/mL; P < .001) and sVEGFR-1 (6383.1 pg/mL vs 3220.1 pg/mL; P < .001]; and lower median plasma concentrations of PlGF (115.5 pg/mL vs 359.3 pg/mL; P = .002) than those without TTTS. Conclusion We propose that an antiangiogenic state may be present in some cases of TTTS. |
| doi_str_mv | 10.1016/j.ajog.2008.02.016 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70482221</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S000293780800152X</els_id><sourcerecordid>70482221</sourcerecordid><originalsourceid>FETCH-LOGICAL-c483t-cc393165260a9397b1dbe237dde3996add56ffc66b734b7edd63bc4f46c5fe763</originalsourceid><addsrcrecordid>eNp9kVGL1DAQx4N4eOvpF_BB9kXf2pskbdqoKHLoKRz44Am-hTSZLqnd5EzSk_32puyi4IMQGDL8_sPwG0KeUagpUHE51XoKu5oB9DWwurQekA0F2VWiF_1DsgEAVkne9efkcUrT-mWSPSLntOeyBc425PXtL-erHKpc6jZH7dO4JBf8Nh28jWGPr7bal5ed9jsXduid2aasM757Qs5GPSd8eqoX5NvHD7dXn6qbL9efr97fVKbpea6M4ZJT0TIBWnLZDdQOyHhnLXIphba2FeNohBg63gwdWiv4YJqxEaYdsRP8grw8zr2L4eeCKau9SwbnWXsMS1IdND1jjBaQHUETQ0oRR3UX3V7Hg6KgVmVqUqsytSpTwFRpldDz0_Rl2KP9Gzk5KsCLE6CT0fNYHBmX_nAMWCOoaAr35shhcXHvMKpkHHqD1kU0Wdng_r_H23_iZnZFtp5_4AHTFJboi2VFVSoB9XW95npb6AFoy77z35tvns0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>70482221</pqid></control><display><type>article</type><title>Twin-to-twin transfusion syndrome: an antiangiogenic state?</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><creator>Kusanovic, Juan Pedro, MD ; Romero, Roberto, MD ; Espinoza, Jimmy, MD ; Nien, Jyh Kae, MD ; Kim, Chong Jai, MD ; Mittal, Pooja, MD ; Edwin, Sam, PhD ; Erez, Offer, MD ; Gotsch, Francesca, MD ; Mazaki-Tovi, Shali, MD ; Than, Nandor G., MD, PhD ; Soto, Eleazar, MD ; Camacho, Natalia, MD ; Gomez, Ricardo, MD ; Quintero, Ruben, MD ; Hassan, Sonia S., MD</creator><creatorcontrib>Kusanovic, Juan Pedro, MD ; Romero, Roberto, MD ; Espinoza, Jimmy, MD ; Nien, Jyh Kae, MD ; Kim, Chong Jai, MD ; Mittal, Pooja, MD ; Edwin, Sam, PhD ; Erez, Offer, MD ; Gotsch, Francesca, MD ; Mazaki-Tovi, Shali, MD ; Than, Nandor G., MD, PhD ; Soto, Eleazar, MD ; Camacho, Natalia, MD ; Gomez, Ricardo, MD ; Quintero, Ruben, MD ; Hassan, Sonia S., MD</creatorcontrib><description>Objective An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS. Study Design This case-control study included monochorionic-diamniotic pregnancies between 16-26 weeks with and without TTTS. Maternal plasma concentrations of PlGF, sVEGFR-1, and s-Eng were determined with ELISA. A P value < .05 was considered statistically significant. Results Patients with TTTS had higher median plasma concentrations of s-Eng (14.8 ng/mL vs 7.8 ng/mL; P < .001) and sVEGFR-1 (6383.1 pg/mL vs 3220.1 pg/mL; P < .001]; and lower median plasma concentrations of PlGF (115.5 pg/mL vs 359.3 pg/mL; P = .002) than those without TTTS. Conclusion We propose that an antiangiogenic state may be present in some cases of TTTS.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2008.02.016</identifier><identifier>PMID: 18395032</identifier><identifier>CODEN: AJOGAH</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Adult ; angiogenesis ; angiogenic factors ; Antigens, CD - blood ; Biological and medical sciences ; birthweight discordancy ; Case-Control Studies ; Endoglin ; Enzyme-Linked Immunosorbent Assay ; Female ; Fetofetal Transfusion - blood ; Gynecology. Andrology. Obstetrics ; Humans ; Medical sciences ; monochorionic ; Neovascularization, Physiologic ; Obstetrics and Gynecology ; Placenta Growth Factor ; placental growth factor ; PlGF ; Pregnancy ; Pregnancy Proteins - blood ; Receptors, Cell Surface - blood ; sFlt1 ; sVEGFR-1 ; TTTS ; twin pregnancy ; Vascular Endothelial Growth Factor Receptor-1 - blood</subject><ispartof>American journal of obstetrics and gynecology, 2008-04, Vol.198 (4), p.382.e1-382.e8</ispartof><rights>Mosby, Inc.</rights><rights>2008 Mosby, Inc.</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-cc393165260a9397b1dbe237dde3996add56ffc66b734b7edd63bc4f46c5fe763</citedby><cites>FETCH-LOGICAL-c483t-cc393165260a9397b1dbe237dde3996add56ffc66b734b7edd63bc4f46c5fe763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ajog.2008.02.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3541,27915,27916,45986</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20246164$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18395032$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kusanovic, Juan Pedro, MD</creatorcontrib><creatorcontrib>Romero, Roberto, MD</creatorcontrib><creatorcontrib>Espinoza, Jimmy, MD</creatorcontrib><creatorcontrib>Nien, Jyh Kae, MD</creatorcontrib><creatorcontrib>Kim, Chong Jai, MD</creatorcontrib><creatorcontrib>Mittal, Pooja, MD</creatorcontrib><creatorcontrib>Edwin, Sam, PhD</creatorcontrib><creatorcontrib>Erez, Offer, MD</creatorcontrib><creatorcontrib>Gotsch, Francesca, MD</creatorcontrib><creatorcontrib>Mazaki-Tovi, Shali, MD</creatorcontrib><creatorcontrib>Than, Nandor G., MD, PhD</creatorcontrib><creatorcontrib>Soto, Eleazar, MD</creatorcontrib><creatorcontrib>Camacho, Natalia, MD</creatorcontrib><creatorcontrib>Gomez, Ricardo, MD</creatorcontrib><creatorcontrib>Quintero, Ruben, MD</creatorcontrib><creatorcontrib>Hassan, Sonia S., MD</creatorcontrib><title>Twin-to-twin transfusion syndrome: an antiangiogenic state?</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>Objective An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS. Study Design This case-control study included monochorionic-diamniotic pregnancies between 16-26 weeks with and without TTTS. Maternal plasma concentrations of PlGF, sVEGFR-1, and s-Eng were determined with ELISA. A P value < .05 was considered statistically significant. Results Patients with TTTS had higher median plasma concentrations of s-Eng (14.8 ng/mL vs 7.8 ng/mL; P < .001) and sVEGFR-1 (6383.1 pg/mL vs 3220.1 pg/mL; P < .001]; and lower median plasma concentrations of PlGF (115.5 pg/mL vs 359.3 pg/mL; P = .002) than those without TTTS. Conclusion We propose that an antiangiogenic state may be present in some cases of TTTS.</description><subject>Adult</subject><subject>angiogenesis</subject><subject>angiogenic factors</subject><subject>Antigens, CD - blood</subject><subject>Biological and medical sciences</subject><subject>birthweight discordancy</subject><subject>Case-Control Studies</subject><subject>Endoglin</subject><subject>Enzyme-Linked Immunosorbent Assay</subject><subject>Female</subject><subject>Fetofetal Transfusion - blood</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>monochorionic</subject><subject>Neovascularization, Physiologic</subject><subject>Obstetrics and Gynecology</subject><subject>Placenta Growth Factor</subject><subject>placental growth factor</subject><subject>PlGF</subject><subject>Pregnancy</subject><subject>Pregnancy Proteins - blood</subject><subject>Receptors, Cell Surface - blood</subject><subject>sFlt1</subject><subject>sVEGFR-1</subject><subject>TTTS</subject><subject>twin pregnancy</subject><subject>Vascular Endothelial Growth Factor Receptor-1 - blood</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVGL1DAQx4N4eOvpF_BB9kXf2pskbdqoKHLoKRz44Am-hTSZLqnd5EzSk_32puyi4IMQGDL8_sPwG0KeUagpUHE51XoKu5oB9DWwurQekA0F2VWiF_1DsgEAVkne9efkcUrT-mWSPSLntOeyBc425PXtL-erHKpc6jZH7dO4JBf8Nh28jWGPr7bal5ed9jsXduid2aasM757Qs5GPSd8eqoX5NvHD7dXn6qbL9efr97fVKbpea6M4ZJT0TIBWnLZDdQOyHhnLXIphba2FeNohBg63gwdWiv4YJqxEaYdsRP8grw8zr2L4eeCKau9SwbnWXsMS1IdND1jjBaQHUETQ0oRR3UX3V7Hg6KgVmVqUqsytSpTwFRpldDz0_Rl2KP9Gzk5KsCLE6CT0fNYHBmX_nAMWCOoaAr35shhcXHvMKpkHHqD1kU0Wdng_r_H23_iZnZFtp5_4AHTFJboi2VFVSoB9XW95npb6AFoy77z35tvns0</recordid><startdate>20080401</startdate><enddate>20080401</enddate><creator>Kusanovic, Juan Pedro, MD</creator><creator>Romero, Roberto, MD</creator><creator>Espinoza, Jimmy, MD</creator><creator>Nien, Jyh Kae, MD</creator><creator>Kim, Chong Jai, MD</creator><creator>Mittal, Pooja, MD</creator><creator>Edwin, Sam, PhD</creator><creator>Erez, Offer, MD</creator><creator>Gotsch, Francesca, MD</creator><creator>Mazaki-Tovi, Shali, MD</creator><creator>Than, Nandor G., MD, PhD</creator><creator>Soto, Eleazar, MD</creator><creator>Camacho, Natalia, MD</creator><creator>Gomez, Ricardo, MD</creator><creator>Quintero, Ruben, MD</creator><creator>Hassan, Sonia S., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</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>7X8</scope></search><sort><creationdate>20080401</creationdate><title>Twin-to-twin transfusion syndrome: an antiangiogenic state?</title><author>Kusanovic, Juan Pedro, MD ; Romero, Roberto, MD ; Espinoza, Jimmy, MD ; Nien, Jyh Kae, MD ; Kim, Chong Jai, MD ; Mittal, Pooja, MD ; Edwin, Sam, PhD ; Erez, Offer, MD ; Gotsch, Francesca, MD ; Mazaki-Tovi, Shali, MD ; Than, Nandor G., MD, PhD ; Soto, Eleazar, MD ; Camacho, Natalia, MD ; Gomez, Ricardo, MD ; Quintero, Ruben, MD ; Hassan, Sonia S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-cc393165260a9397b1dbe237dde3996add56ffc66b734b7edd63bc4f46c5fe763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>angiogenesis</topic><topic>angiogenic factors</topic><topic>Antigens, CD - blood</topic><topic>Biological and medical sciences</topic><topic>birthweight discordancy</topic><topic>Case-Control Studies</topic><topic>Endoglin</topic><topic>Enzyme-Linked Immunosorbent Assay</topic><topic>Female</topic><topic>Fetofetal Transfusion - blood</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>monochorionic</topic><topic>Neovascularization, Physiologic</topic><topic>Obstetrics and Gynecology</topic><topic>Placenta Growth Factor</topic><topic>placental growth factor</topic><topic>PlGF</topic><topic>Pregnancy</topic><topic>Pregnancy Proteins - blood</topic><topic>Receptors, Cell Surface - blood</topic><topic>sFlt1</topic><topic>sVEGFR-1</topic><topic>TTTS</topic><topic>twin pregnancy</topic><topic>Vascular Endothelial Growth Factor Receptor-1 - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kusanovic, Juan Pedro, MD</creatorcontrib><creatorcontrib>Romero, Roberto, MD</creatorcontrib><creatorcontrib>Espinoza, Jimmy, MD</creatorcontrib><creatorcontrib>Nien, Jyh Kae, MD</creatorcontrib><creatorcontrib>Kim, Chong Jai, MD</creatorcontrib><creatorcontrib>Mittal, Pooja, MD</creatorcontrib><creatorcontrib>Edwin, Sam, PhD</creatorcontrib><creatorcontrib>Erez, Offer, MD</creatorcontrib><creatorcontrib>Gotsch, Francesca, MD</creatorcontrib><creatorcontrib>Mazaki-Tovi, Shali, MD</creatorcontrib><creatorcontrib>Than, Nandor G., MD, PhD</creatorcontrib><creatorcontrib>Soto, Eleazar, MD</creatorcontrib><creatorcontrib>Camacho, Natalia, MD</creatorcontrib><creatorcontrib>Gomez, Ricardo, MD</creatorcontrib><creatorcontrib>Quintero, Ruben, MD</creatorcontrib><creatorcontrib>Hassan, Sonia S., MD</creatorcontrib><collection>Pascal-Francis</collection><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>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kusanovic, Juan Pedro, MD</au><au>Romero, Roberto, MD</au><au>Espinoza, Jimmy, MD</au><au>Nien, Jyh Kae, MD</au><au>Kim, Chong Jai, MD</au><au>Mittal, Pooja, MD</au><au>Edwin, Sam, PhD</au><au>Erez, Offer, MD</au><au>Gotsch, Francesca, MD</au><au>Mazaki-Tovi, Shali, MD</au><au>Than, Nandor G., MD, PhD</au><au>Soto, Eleazar, MD</au><au>Camacho, Natalia, MD</au><au>Gomez, Ricardo, MD</au><au>Quintero, Ruben, MD</au><au>Hassan, Sonia S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Twin-to-twin transfusion syndrome: an antiangiogenic state?</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2008-04-01</date><risdate>2008</risdate><volume>198</volume><issue>4</issue><spage>382.e1</spage><epage>382.e8</epage><pages>382.e1-382.e8</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><coden>AJOGAH</coden><abstract>Objective An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS. Study Design This case-control study included monochorionic-diamniotic pregnancies between 16-26 weeks with and without TTTS. Maternal plasma concentrations of PlGF, sVEGFR-1, and s-Eng were determined with ELISA. A P value < .05 was considered statistically significant. Results Patients with TTTS had higher median plasma concentrations of s-Eng (14.8 ng/mL vs 7.8 ng/mL; P < .001) and sVEGFR-1 (6383.1 pg/mL vs 3220.1 pg/mL; P < .001]; and lower median plasma concentrations of PlGF (115.5 pg/mL vs 359.3 pg/mL; P = .002) than those without TTTS. Conclusion We propose that an antiangiogenic state may be present in some cases of TTTS.</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>18395032</pmid><doi>10.1016/j.ajog.2008.02.016</doi><tpages>3</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9378 |
| ispartof | American journal of obstetrics and gynecology, 2008-04, Vol.198 (4), p.382.e1-382.e8 |
| issn | 0002-9378 1097-6868 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70482221 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult angiogenesis angiogenic factors Antigens, CD - blood Biological and medical sciences birthweight discordancy Case-Control Studies Endoglin Enzyme-Linked Immunosorbent Assay Female Fetofetal Transfusion - blood Gynecology. Andrology. Obstetrics Humans Medical sciences monochorionic Neovascularization, Physiologic Obstetrics and Gynecology Placenta Growth Factor placental growth factor PlGF Pregnancy Pregnancy Proteins - blood Receptors, Cell Surface - blood sFlt1 sVEGFR-1 TTTS twin pregnancy Vascular Endothelial Growth Factor Receptor-1 - blood |
| title | Twin-to-twin transfusion syndrome: an antiangiogenic state? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T22%3A46%3A46IST&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=Twin-to-twin%20transfusion%20syndrome:%20an%20antiangiogenic%20state?&rft.jtitle=American%20journal%20of%20obstetrics%20and%20gynecology&rft.au=Kusanovic,%20Juan%20Pedro,%20MD&rft.date=2008-04-01&rft.volume=198&rft.issue=4&rft.spage=382.e1&rft.epage=382.e8&rft.pages=382.e1-382.e8&rft.issn=0002-9378&rft.eissn=1097-6868&rft.coden=AJOGAH&rft_id=info:doi/10.1016/j.ajog.2008.02.016&rft_dat=%3Cproquest_cross%3E70482221%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=70482221&rft_id=info:pmid/18395032&rft_els_id=S000293780800152X&rfr_iscdi=true |