Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial
To evaluate the safety and effectiveness of a self-closing surgical clip with an interrupted technique in left internal thoracic artery to left anterior descending artery bypass grafting. Eighty-two patients were enrolled and treated (February 2000 through August 2001) in a prospective, nonrandomize...
Gespeichert in:
| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2003-07, Vol.126 (1), p.168-177 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 177 |
|---|---|
| container_issue | 1 |
| container_start_page | 168 |
| container_title | The Journal of thoracic and cardiovascular surgery |
| container_volume | 126 |
| creator | Wolf, Randall K. Alderman, Edwin L Caskey, Michael P Raczkowski, Allen R Dullum, Mercedes K Lundell, Dwight C Hill, Arthur C Wang, Nan Daniel, Michael A |
| description | To evaluate the safety and effectiveness of a self-closing surgical clip with an interrupted technique in left internal thoracic artery to left anterior descending artery bypass grafting.
Eighty-two patients were enrolled and treated (February 2000 through August 2001) in a prospective, nonrandomized, multicenter trial. Left internal thoracic artery to left anterior descending artery anastomoses were performed in 60 off-pump coronary artery bypasses (73%), 12 conventional coronary artery bypass grafting (15%), and 10 minimally invasive direct coronary artery bypass (12%) procedures. Angiograms (64 to 383 days, mean 200 days) were obtained on 63 patients (77%). Qualitative and quantitative angiographic assessment was performed by an independent core laboratory.
The self-closing surgical clip was used for 82 left internal thoracic artery to left anterior descending artery interrupted anastomoses without the requirement for knot tying or primary suture management. Minimum left internal thoracic artery to left anterior descending artery anastomosis time was 3 minutes. There was one perioperative and one late death (both not heart related) and one reexploration for bleeding unrelated to the anastomotic site. FitzGibbon grades were as follows: A (n = 60, 95.2%), B (n = 3, 4.8%) including one kinked left internal thoracic artery, and O (n = 0, 0%). Quantitative analysis (n = 57) showed mean lumen diameters of left internal thoracic artery proximal to the anastomosis of 2.1 mm, at anastomosis of 2.0 mm, and in the left anterior descending artery distal to the anastomosis of 1.9 mm. The average ratio of the anastomosis to the left anterior descending artery diameter was 1.14 (0.45 to 1.93). Anastomotic stenosis as a percentage of average left internal thoracic artery to left anterior descending artery diameter was −2.3%, comparing favorably with results (23% to 24%) reported from the Patency, Outcomes, Economics, Minimally invasive direct coronary artery (POEM) bypass study.
The interrupted technique, facilitated by a self-closing anastomotic clip, yields favorable 6-month angiographic results when compared with other published studies. |
| doi_str_mv | 10.1016/S0022-5223(03)00234-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_73435289</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022522303002344</els_id><sourcerecordid>73435289</sourcerecordid><originalsourceid>FETCH-LOGICAL-c506t-7a9072075c950697a06cb236ba5a5891cf86289de79ae2627807a1a3f8db4de23</originalsourceid><addsrcrecordid>eNqFkcuO1DAQRS0EYpqBTwB5xWMRsJ2Hk9kg1OIljcQCkNhZjlPp9sixg-00zF_xiVRIC5ZIluwrn1tVqkvIY85ecsabV58ZE6KohSifs_IFirIqqjtkx1kni6atv90lu7_IBXmQ0g1jTDLe3ScXXLSy7WqxI7_2znprtKPaDzTZn8UUfD6iOthwiHo-WkPhpN2isw2ehpGaEIPX8ZbqmCFatCI3Zmo9yrjMGQa065TDFBIk2t_SJcHq1DSBGwvjQrL-QI2zMx3gZA1c4d-0uIzPtQqdY0gzmGxPsGLbhHlt9pDcG7VL8Oh8X5Kv795-2X8orj-9_7h_c12YmjW5kLpjUjBZmw51JzVrTC_Kpte1rtuOm7FtRNsNIDsNohGyZVJzXY7t0FcDiPKSPN3q4ijfF0hZTTYZcE57CEtSsqzKGisgWG-gwZlThFHN0U64H8WZWqNSf6JSaw6K4VmjUhX6npwbLP0Ewz_XORsEnm3A0R6OP2wElSbtHOJc3WSTuGgUV7xpkXy9kYALOVmIKhkL3sCALpPVEOx_hvkNBjq1Iw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>73435289</pqid></control><display><type>article</type><title>Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB Electronic Journals Library</source><creator>Wolf, Randall K. ; Alderman, Edwin L ; Caskey, Michael P ; Raczkowski, Allen R ; Dullum, Mercedes K ; Lundell, Dwight C ; Hill, Arthur C ; Wang, Nan ; Daniel, Michael A</creator><creatorcontrib>Wolf, Randall K. ; Alderman, Edwin L ; Caskey, Michael P ; Raczkowski, Allen R ; Dullum, Mercedes K ; Lundell, Dwight C ; Hill, Arthur C ; Wang, Nan ; Daniel, Michael A</creatorcontrib><description>To evaluate the safety and effectiveness of a self-closing surgical clip with an interrupted technique in left internal thoracic artery to left anterior descending artery bypass grafting.
Eighty-two patients were enrolled and treated (February 2000 through August 2001) in a prospective, nonrandomized, multicenter trial. Left internal thoracic artery to left anterior descending artery anastomoses were performed in 60 off-pump coronary artery bypasses (73%), 12 conventional coronary artery bypass grafting (15%), and 10 minimally invasive direct coronary artery bypass (12%) procedures. Angiograms (64 to 383 days, mean 200 days) were obtained on 63 patients (77%). Qualitative and quantitative angiographic assessment was performed by an independent core laboratory.
The self-closing surgical clip was used for 82 left internal thoracic artery to left anterior descending artery interrupted anastomoses without the requirement for knot tying or primary suture management. Minimum left internal thoracic artery to left anterior descending artery anastomosis time was 3 minutes. There was one perioperative and one late death (both not heart related) and one reexploration for bleeding unrelated to the anastomotic site. FitzGibbon grades were as follows: A (n = 60, 95.2%), B (n = 3, 4.8%) including one kinked left internal thoracic artery, and O (n = 0, 0%). Quantitative analysis (n = 57) showed mean lumen diameters of left internal thoracic artery proximal to the anastomosis of 2.1 mm, at anastomosis of 2.0 mm, and in the left anterior descending artery distal to the anastomosis of 1.9 mm. The average ratio of the anastomosis to the left anterior descending artery diameter was 1.14 (0.45 to 1.93). Anastomotic stenosis as a percentage of average left internal thoracic artery to left anterior descending artery diameter was −2.3%, comparing favorably with results (23% to 24%) reported from the Patency, Outcomes, Economics, Minimally invasive direct coronary artery (POEM) bypass study.
The interrupted technique, facilitated by a self-closing anastomotic clip, yields favorable 6-month angiographic results when compared with other published studies.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/S0022-5223(03)00234-4</identifier><identifier>PMID: 12878952</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Blood Flow Velocity - physiology ; Coronary Angiography ; Coronary Artery Bypass - instrumentation ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - surgery ; Coronary Vessels - physiopathology ; Coronary Vessels - surgery ; Equipment Safety - instrumentation ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - etiology ; Postoperative Complications - physiopathology ; Prospective Studies ; Severity of Illness Index ; Surgical Instruments ; Treatment Outcome ; Vascular Patency - physiology</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2003-07, Vol.126 (1), p.168-177</ispartof><rights>2003 The American Association for Thoracic Surgery</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c506t-7a9072075c950697a06cb236ba5a5891cf86289de79ae2627807a1a3f8db4de23</citedby><cites>FETCH-LOGICAL-c506t-7a9072075c950697a06cb236ba5a5891cf86289de79ae2627807a1a3f8db4de23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522303002344$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12878952$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wolf, Randall K.</creatorcontrib><creatorcontrib>Alderman, Edwin L</creatorcontrib><creatorcontrib>Caskey, Michael P</creatorcontrib><creatorcontrib>Raczkowski, Allen R</creatorcontrib><creatorcontrib>Dullum, Mercedes K</creatorcontrib><creatorcontrib>Lundell, Dwight C</creatorcontrib><creatorcontrib>Hill, Arthur C</creatorcontrib><creatorcontrib>Wang, Nan</creatorcontrib><creatorcontrib>Daniel, Michael A</creatorcontrib><title>Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>To evaluate the safety and effectiveness of a self-closing surgical clip with an interrupted technique in left internal thoracic artery to left anterior descending artery bypass grafting.
Eighty-two patients were enrolled and treated (February 2000 through August 2001) in a prospective, nonrandomized, multicenter trial. Left internal thoracic artery to left anterior descending artery anastomoses were performed in 60 off-pump coronary artery bypasses (73%), 12 conventional coronary artery bypass grafting (15%), and 10 minimally invasive direct coronary artery bypass (12%) procedures. Angiograms (64 to 383 days, mean 200 days) were obtained on 63 patients (77%). Qualitative and quantitative angiographic assessment was performed by an independent core laboratory.
The self-closing surgical clip was used for 82 left internal thoracic artery to left anterior descending artery interrupted anastomoses without the requirement for knot tying or primary suture management. Minimum left internal thoracic artery to left anterior descending artery anastomosis time was 3 minutes. There was one perioperative and one late death (both not heart related) and one reexploration for bleeding unrelated to the anastomotic site. FitzGibbon grades were as follows: A (n = 60, 95.2%), B (n = 3, 4.8%) including one kinked left internal thoracic artery, and O (n = 0, 0%). Quantitative analysis (n = 57) showed mean lumen diameters of left internal thoracic artery proximal to the anastomosis of 2.1 mm, at anastomosis of 2.0 mm, and in the left anterior descending artery distal to the anastomosis of 1.9 mm. The average ratio of the anastomosis to the left anterior descending artery diameter was 1.14 (0.45 to 1.93). Anastomotic stenosis as a percentage of average left internal thoracic artery to left anterior descending artery diameter was −2.3%, comparing favorably with results (23% to 24%) reported from the Patency, Outcomes, Economics, Minimally invasive direct coronary artery (POEM) bypass study.
The interrupted technique, facilitated by a self-closing anastomotic clip, yields favorable 6-month angiographic results when compared with other published studies.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical</subject><subject>Blood Flow Velocity - physiology</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass - instrumentation</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary Vessels - physiopathology</subject><subject>Coronary Vessels - surgery</subject><subject>Equipment Safety - instrumentation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>Surgical Instruments</subject><subject>Treatment Outcome</subject><subject>Vascular Patency - physiology</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcuO1DAQRS0EYpqBTwB5xWMRsJ2Hk9kg1OIljcQCkNhZjlPp9sixg-00zF_xiVRIC5ZIluwrn1tVqkvIY85ecsabV58ZE6KohSifs_IFirIqqjtkx1kni6atv90lu7_IBXmQ0g1jTDLe3ScXXLSy7WqxI7_2znprtKPaDzTZn8UUfD6iOthwiHo-WkPhpN2isw2ehpGaEIPX8ZbqmCFatCI3Zmo9yrjMGQa065TDFBIk2t_SJcHq1DSBGwvjQrL-QI2zMx3gZA1c4d-0uIzPtQqdY0gzmGxPsGLbhHlt9pDcG7VL8Oh8X5Kv795-2X8orj-9_7h_c12YmjW5kLpjUjBZmw51JzVrTC_Kpte1rtuOm7FtRNsNIDsNohGyZVJzXY7t0FcDiPKSPN3q4ijfF0hZTTYZcE57CEtSsqzKGisgWG-gwZlThFHN0U64H8WZWqNSf6JSaw6K4VmjUhX6npwbLP0Ewz_XORsEnm3A0R6OP2wElSbtHOJc3WSTuGgUV7xpkXy9kYALOVmIKhkL3sCALpPVEOx_hvkNBjq1Iw</recordid><startdate>20030701</startdate><enddate>20030701</enddate><creator>Wolf, Randall K.</creator><creator>Alderman, Edwin L</creator><creator>Caskey, Michael P</creator><creator>Raczkowski, Allen R</creator><creator>Dullum, Mercedes K</creator><creator>Lundell, Dwight C</creator><creator>Hill, Arthur C</creator><creator>Wang, Nan</creator><creator>Daniel, Michael A</creator><general>Mosby, Inc</general><general>AATS/WTSA</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>7X8</scope></search><sort><creationdate>20030701</creationdate><title>Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial</title><author>Wolf, Randall K. ; Alderman, Edwin L ; Caskey, Michael P ; Raczkowski, Allen R ; Dullum, Mercedes K ; Lundell, Dwight C ; Hill, Arthur C ; Wang, Nan ; Daniel, Michael A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-7a9072075c950697a06cb236ba5a5891cf86289de79ae2627807a1a3f8db4de23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical</topic><topic>Blood Flow Velocity - physiology</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Bypass - instrumentation</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary Vessels - physiopathology</topic><topic>Coronary Vessels - surgery</topic><topic>Equipment Safety - instrumentation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>Surgical Instruments</topic><topic>Treatment Outcome</topic><topic>Vascular Patency - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wolf, Randall K.</creatorcontrib><creatorcontrib>Alderman, Edwin L</creatorcontrib><creatorcontrib>Caskey, Michael P</creatorcontrib><creatorcontrib>Raczkowski, Allen R</creatorcontrib><creatorcontrib>Dullum, Mercedes K</creatorcontrib><creatorcontrib>Lundell, Dwight C</creatorcontrib><creatorcontrib>Hill, Arthur C</creatorcontrib><creatorcontrib>Wang, Nan</creatorcontrib><creatorcontrib>Daniel, Michael A</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>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wolf, Randall K.</au><au>Alderman, Edwin L</au><au>Caskey, Michael P</au><au>Raczkowski, Allen R</au><au>Dullum, Mercedes K</au><au>Lundell, Dwight C</au><au>Hill, Arthur C</au><au>Wang, Nan</au><au>Daniel, Michael A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2003-07-01</date><risdate>2003</risdate><volume>126</volume><issue>1</issue><spage>168</spage><epage>177</epage><pages>168-177</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>To evaluate the safety and effectiveness of a self-closing surgical clip with an interrupted technique in left internal thoracic artery to left anterior descending artery bypass grafting.
Eighty-two patients were enrolled and treated (February 2000 through August 2001) in a prospective, nonrandomized, multicenter trial. Left internal thoracic artery to left anterior descending artery anastomoses were performed in 60 off-pump coronary artery bypasses (73%), 12 conventional coronary artery bypass grafting (15%), and 10 minimally invasive direct coronary artery bypass (12%) procedures. Angiograms (64 to 383 days, mean 200 days) were obtained on 63 patients (77%). Qualitative and quantitative angiographic assessment was performed by an independent core laboratory.
The self-closing surgical clip was used for 82 left internal thoracic artery to left anterior descending artery interrupted anastomoses without the requirement for knot tying or primary suture management. Minimum left internal thoracic artery to left anterior descending artery anastomosis time was 3 minutes. There was one perioperative and one late death (both not heart related) and one reexploration for bleeding unrelated to the anastomotic site. FitzGibbon grades were as follows: A (n = 60, 95.2%), B (n = 3, 4.8%) including one kinked left internal thoracic artery, and O (n = 0, 0%). Quantitative analysis (n = 57) showed mean lumen diameters of left internal thoracic artery proximal to the anastomosis of 2.1 mm, at anastomosis of 2.0 mm, and in the left anterior descending artery distal to the anastomosis of 1.9 mm. The average ratio of the anastomosis to the left anterior descending artery diameter was 1.14 (0.45 to 1.93). Anastomotic stenosis as a percentage of average left internal thoracic artery to left anterior descending artery diameter was −2.3%, comparing favorably with results (23% to 24%) reported from the Patency, Outcomes, Economics, Minimally invasive direct coronary artery (POEM) bypass study.
The interrupted technique, facilitated by a self-closing anastomotic clip, yields favorable 6-month angiographic results when compared with other published studies.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>12878952</pmid><doi>10.1016/S0022-5223(03)00234-4</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-5223 |
| ispartof | The Journal of thoracic and cardiovascular surgery, 2003-07, Vol.126 (1), p.168-177 |
| issn | 0022-5223 1097-685X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_73435289 |
| source | MEDLINE; Elsevier ScienceDirect Journals; EZB Electronic Journals Library |
| subjects | Adult Aged Aged, 80 and over Anastomosis, Surgical Blood Flow Velocity - physiology Coronary Angiography Coronary Artery Bypass - instrumentation Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - physiopathology Coronary Artery Disease - surgery Coronary Vessels - physiopathology Coronary Vessels - surgery Equipment Safety - instrumentation Female Follow-Up Studies Humans Male Middle Aged Postoperative Complications - diagnostic imaging Postoperative Complications - etiology Postoperative Complications - physiopathology Prospective Studies Severity of Illness Index Surgical Instruments Treatment Outcome Vascular Patency - physiology |
| title | Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T20%3A36%3A14IST&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=Clinical%20and%20six-month%20angiographic%20evaluation%20of%20coronary%20arterial%20graft%20interrupted%20anastomoses%20by%20use%20of%20a%20self-closing%20clip%20device:%20a%20multicenter%20prospective%20clinical%20trial&rft.jtitle=The%20Journal%20of%20thoracic%20and%20cardiovascular%20surgery&rft.au=Wolf,%20Randall%20K.&rft.date=2003-07-01&rft.volume=126&rft.issue=1&rft.spage=168&rft.epage=177&rft.pages=168-177&rft.issn=0022-5223&rft.eissn=1097-685X&rft_id=info:doi/10.1016/S0022-5223(03)00234-4&rft_dat=%3Cproquest_cross%3E73435289%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=73435289&rft_id=info:pmid/12878952&rft_els_id=S0022522303002344&rfr_iscdi=true |