Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS
Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural p...
Gespeichert in:
Veröffentlicht in: | Chest 1986-07, Vol.90 (1), p.74-80 |
---|---|
Hauptverfasser: | , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 80 |
---|---|
container_issue | 1 |
container_start_page | 74 |
container_title | Chest |
container_volume | 90 |
creator | Dhainaut, Jean F. Devaux, Jean Y. Monsallier, Julien F. Brunet, Fabrice Villemant, Didier Huyghebaert, Marie-F. |
description | Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H2O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H2O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance. |
doi_str_mv | 10.1378/chest.90.1.74 |
format | Article |
fullrecord | <record><control><sourceid>proquest_osti_</sourceid><recordid>TN_cdi_proquest_miscellaneous_76900227</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0012369215427072</els_id><sourcerecordid>76900227</sourcerecordid><originalsourceid>FETCH-LOGICAL-c525t-8343c91706d764050d22778c7ef5e76102ee8af1f4fcdc0f72bec1f6bfb7eedb3</originalsourceid><addsrcrecordid>eNp1kEtv1DAUhS0EKtPCkiWShVB3GfxI4mRZTXlJg6h4bS3HuW5cOXaxnSL-PZ5m1K5YWUf3u_f4HIReUbKlXHTv9AQpb_uitqJ-gja057TiTc2fog0hlFW87dlzdJrSDSma9u0JOuENY5SxDZq-gJ6Ut2lOOBh8CTqCSjDiPZiMf4HP0erFqYivIrigRjwu0fprvAs-W7-EJeGrkGy2d3BAUloi3O9Zp7INHluPL75dfn-BnhnlErw8vmfo54f3P3afqv3Xj593F_tKN6zJVcdrrnsqSDuKtiYNGRkTotMCTAOipYQBdMpQUxs9amIEG0BT0w5mEADjwM_Qm_VuSNnKpG0uAXXwHnSWDWGECFqg8xW6jeH3UvqTs00anFMeSiIp2p6QYlzAagV1DClFMPI22lnFv5ISeahf3tcv-6KkqAv_-nh4GWYYH-hj32X-9jhXSStnovLapgesE51oOX20nez19MdGkGlWzpWjfDW8CUv0yj3aipWH0uydhXgIDl7DWHZL7jHY_3z4H136svA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>76900227</pqid></control><display><type>article</type><title>Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Dhainaut, Jean F. ; Devaux, Jean Y. ; Monsallier, Julien F. ; Brunet, Fabrice ; Villemant, Didier ; Huyghebaert, Marie-F.</creator><creatorcontrib>Dhainaut, Jean F. ; Devaux, Jean Y. ; Monsallier, Julien F. ; Brunet, Fabrice ; Villemant, Didier ; Huyghebaert, Marie-F.</creatorcontrib><description>Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H2O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H2O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.90.1.74</identifier><identifier>PMID: 3522122</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>550601 - Medicine- Unsealed Radionuclides in Diagnostics ; Adult ; Aged ; BETA DECAY RADIOISOTOPES ; BETA-MINUS DECAY RADIOISOTOPES ; Biological and medical sciences ; BLOOD FLOW ; BODY ; Cardiac Catheterization ; Cardiac Output ; CARDIOVASCULAR SYSTEM ; COUNTING TECHNIQUES ; DIAGNOSTIC TECHNIQUES ; DISEASES ; Female ; HEART ; Heart - diagnostic imaging ; Heart - physiopathology ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; HOURS LIVING RADIOISOTOPES ; Humans ; INTERMEDIATE MASS NUCLEI ; ISOMERIC TRANSITION ISOTOPES ; ISOTOPES ; Male ; Medical sciences ; Middle Aged ; NUCLEI ; ODD-EVEN NUCLEI ; ORGANS ; PATHOGENESIS ; PATIENTS ; Pneumology ; Positive-Pressure Respiration ; PRESSURE EFFECTS ; RADIOISOTOPE SCANNING ; RADIOISOTOPES ; RADIOLOGY AND NUCLEAR MEDICINE ; Radionuclide Imaging ; RESPIRATION ; Respiratory Distress Syndrome, Adult - diagnostic imaging ; Respiratory Distress Syndrome, Adult - physiopathology ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory system : syndromes and miscellaneous diseases ; RESPIRATORY SYSTEM DISEASES ; SCINTISCANNING ; Stroke Volume ; Technetium ; TECHNETIUM 99 ; TECHNETIUM ISOTOPES ; YEARS LIVING RADIOISOTOPES</subject><ispartof>Chest, 1986-07, Vol.90 (1), p.74-80</ispartof><rights>1986 The American College of Chest Physicians</rights><rights>1986 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-8343c91706d764050d22778c7ef5e76102ee8af1f4fcdc0f72bec1f6bfb7eedb3</citedby><cites>FETCH-LOGICAL-c525t-8343c91706d764050d22778c7ef5e76102ee8af1f4fcdc0f72bec1f6bfb7eedb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=8787631$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3522122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/5020071$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhainaut, Jean F.</creatorcontrib><creatorcontrib>Devaux, Jean Y.</creatorcontrib><creatorcontrib>Monsallier, Julien F.</creatorcontrib><creatorcontrib>Brunet, Fabrice</creatorcontrib><creatorcontrib>Villemant, Didier</creatorcontrib><creatorcontrib>Huyghebaert, Marie-F.</creatorcontrib><title>Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS</title><title>Chest</title><addtitle>Chest</addtitle><description>Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H2O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H2O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.</description><subject>550601 - Medicine- Unsealed Radionuclides in Diagnostics</subject><subject>Adult</subject><subject>Aged</subject><subject>BETA DECAY RADIOISOTOPES</subject><subject>BETA-MINUS DECAY RADIOISOTOPES</subject><subject>Biological and medical sciences</subject><subject>BLOOD FLOW</subject><subject>BODY</subject><subject>Cardiac Catheterization</subject><subject>Cardiac Output</subject><subject>CARDIOVASCULAR SYSTEM</subject><subject>COUNTING TECHNIQUES</subject><subject>DIAGNOSTIC TECHNIQUES</subject><subject>DISEASES</subject><subject>Female</subject><subject>HEART</subject><subject>Heart - diagnostic imaging</subject><subject>Heart - physiopathology</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>HOURS LIVING RADIOISOTOPES</subject><subject>Humans</subject><subject>INTERMEDIATE MASS NUCLEI</subject><subject>ISOMERIC TRANSITION ISOTOPES</subject><subject>ISOTOPES</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>NUCLEI</subject><subject>ODD-EVEN NUCLEI</subject><subject>ORGANS</subject><subject>PATHOGENESIS</subject><subject>PATIENTS</subject><subject>Pneumology</subject><subject>Positive-Pressure Respiration</subject><subject>PRESSURE EFFECTS</subject><subject>RADIOISOTOPE SCANNING</subject><subject>RADIOISOTOPES</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radionuclide Imaging</subject><subject>RESPIRATION</subject><subject>Respiratory Distress Syndrome, Adult - diagnostic imaging</subject><subject>Respiratory Distress Syndrome, Adult - physiopathology</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>RESPIRATORY SYSTEM DISEASES</subject><subject>SCINTISCANNING</subject><subject>Stroke Volume</subject><subject>Technetium</subject><subject>TECHNETIUM 99</subject><subject>TECHNETIUM ISOTOPES</subject><subject>YEARS LIVING RADIOISOTOPES</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1986</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtv1DAUhS0EKtPCkiWShVB3GfxI4mRZTXlJg6h4bS3HuW5cOXaxnSL-PZ5m1K5YWUf3u_f4HIReUbKlXHTv9AQpb_uitqJ-gja057TiTc2fog0hlFW87dlzdJrSDSma9u0JOuENY5SxDZq-gJ6Ut2lOOBh8CTqCSjDiPZiMf4HP0erFqYivIrigRjwu0fprvAs-W7-EJeGrkGy2d3BAUloi3O9Zp7INHluPL75dfn-BnhnlErw8vmfo54f3P3afqv3Xj593F_tKN6zJVcdrrnsqSDuKtiYNGRkTotMCTAOipYQBdMpQUxs9amIEG0BT0w5mEADjwM_Qm_VuSNnKpG0uAXXwHnSWDWGECFqg8xW6jeH3UvqTs00anFMeSiIp2p6QYlzAagV1DClFMPI22lnFv5ISeahf3tcv-6KkqAv_-nh4GWYYH-hj32X-9jhXSStnovLapgesE51oOX20nez19MdGkGlWzpWjfDW8CUv0yj3aipWH0uydhXgIDl7DWHZL7jHY_3z4H136svA</recordid><startdate>19860701</startdate><enddate>19860701</enddate><creator>Dhainaut, Jean F.</creator><creator>Devaux, Jean Y.</creator><creator>Monsallier, Julien F.</creator><creator>Brunet, Fabrice</creator><creator>Villemant, Didier</creator><creator>Huyghebaert, Marie-F.</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</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><scope>OTOTI</scope></search><sort><creationdate>19860701</creationdate><title>Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS</title><author>Dhainaut, Jean F. ; Devaux, Jean Y. ; Monsallier, Julien F. ; Brunet, Fabrice ; Villemant, Didier ; Huyghebaert, Marie-F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-8343c91706d764050d22778c7ef5e76102ee8af1f4fcdc0f72bec1f6bfb7eedb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1986</creationdate><topic>550601 - Medicine- Unsealed Radionuclides in Diagnostics</topic><topic>Adult</topic><topic>Aged</topic><topic>BETA DECAY RADIOISOTOPES</topic><topic>BETA-MINUS DECAY RADIOISOTOPES</topic><topic>Biological and medical sciences</topic><topic>BLOOD FLOW</topic><topic>BODY</topic><topic>Cardiac Catheterization</topic><topic>Cardiac Output</topic><topic>CARDIOVASCULAR SYSTEM</topic><topic>COUNTING TECHNIQUES</topic><topic>DIAGNOSTIC TECHNIQUES</topic><topic>DISEASES</topic><topic>Female</topic><topic>HEART</topic><topic>Heart - diagnostic imaging</topic><topic>Heart - physiopathology</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>HOURS LIVING RADIOISOTOPES</topic><topic>Humans</topic><topic>INTERMEDIATE MASS NUCLEI</topic><topic>ISOMERIC TRANSITION ISOTOPES</topic><topic>ISOTOPES</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>NUCLEI</topic><topic>ODD-EVEN NUCLEI</topic><topic>ORGANS</topic><topic>PATHOGENESIS</topic><topic>PATIENTS</topic><topic>Pneumology</topic><topic>Positive-Pressure Respiration</topic><topic>PRESSURE EFFECTS</topic><topic>RADIOISOTOPE SCANNING</topic><topic>RADIOISOTOPES</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radionuclide Imaging</topic><topic>RESPIRATION</topic><topic>Respiratory Distress Syndrome, Adult - diagnostic imaging</topic><topic>Respiratory Distress Syndrome, Adult - physiopathology</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>RESPIRATORY SYSTEM DISEASES</topic><topic>SCINTISCANNING</topic><topic>Stroke Volume</topic><topic>Technetium</topic><topic>TECHNETIUM 99</topic><topic>TECHNETIUM ISOTOPES</topic><topic>YEARS LIVING RADIOISOTOPES</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhainaut, Jean F.</creatorcontrib><creatorcontrib>Devaux, Jean Y.</creatorcontrib><creatorcontrib>Monsallier, Julien F.</creatorcontrib><creatorcontrib>Brunet, Fabrice</creatorcontrib><creatorcontrib>Villemant, Didier</creatorcontrib><creatorcontrib>Huyghebaert, Marie-F.</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><collection>OSTI.GOV</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhainaut, Jean F.</au><au>Devaux, Jean Y.</au><au>Monsallier, Julien F.</au><au>Brunet, Fabrice</au><au>Villemant, Didier</au><au>Huyghebaert, Marie-F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1986-07-01</date><risdate>1986</risdate><volume>90</volume><issue>1</issue><spage>74</spage><epage>80</epage><pages>74-80</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H2O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H2O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>3522122</pmid><doi>10.1378/chest.90.1.74</doi><tpages>7</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0012-3692 |
ispartof | Chest, 1986-07, Vol.90 (1), p.74-80 |
issn | 0012-3692 1931-3543 |
language | eng |
recordid | cdi_proquest_miscellaneous_76900227 |
source | MEDLINE; Alma/SFX Local Collection |
subjects | 550601 - Medicine- Unsealed Radionuclides in Diagnostics Adult Aged BETA DECAY RADIOISOTOPES BETA-MINUS DECAY RADIOISOTOPES Biological and medical sciences BLOOD FLOW BODY Cardiac Catheterization Cardiac Output CARDIOVASCULAR SYSTEM COUNTING TECHNIQUES DIAGNOSTIC TECHNIQUES DISEASES Female HEART Heart - diagnostic imaging Heart - physiopathology Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology HOURS LIVING RADIOISOTOPES Humans INTERMEDIATE MASS NUCLEI ISOMERIC TRANSITION ISOTOPES ISOTOPES Male Medical sciences Middle Aged NUCLEI ODD-EVEN NUCLEI ORGANS PATHOGENESIS PATIENTS Pneumology Positive-Pressure Respiration PRESSURE EFFECTS RADIOISOTOPE SCANNING RADIOISOTOPES RADIOLOGY AND NUCLEAR MEDICINE Radionuclide Imaging RESPIRATION Respiratory Distress Syndrome, Adult - diagnostic imaging Respiratory Distress Syndrome, Adult - physiopathology Respiratory Distress Syndrome, Adult - therapy Respiratory system : syndromes and miscellaneous diseases RESPIRATORY SYSTEM DISEASES SCINTISCANNING Stroke Volume Technetium TECHNETIUM 99 TECHNETIUM ISOTOPES YEARS LIVING RADIOISOTOPES |
title | Mechanisms of Decreased Left Ventricular Preload during Continuous Positive Pressure Ventilation in ARDS |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-16T05%3A15%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_osti_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Mechanisms%20of%20Decreased%20Left%20Ventricular%20Preload%20during%20Continuous%20Positive%20Pressure%20Ventilation%20in%20ARDS&rft.jtitle=Chest&rft.au=Dhainaut,%20Jean%20F.&rft.date=1986-07-01&rft.volume=90&rft.issue=1&rft.spage=74&rft.epage=80&rft.pages=74-80&rft.issn=0012-3692&rft.eissn=1931-3543&rft.coden=CHETBF&rft_id=info:doi/10.1378/chest.90.1.74&rft_dat=%3Cproquest_osti_%3E76900227%3C/proquest_osti_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=76900227&rft_id=info:pmid/3522122&rft_els_id=S0012369215427072&rfr_iscdi=true |