Expression of Selectins (CD62 E,L,P) and Cellular Adhesion Molecules in Primary Sjögren's Syndrome: Questions to Immunoregulation
Adhesion molecules are important signal transmitters of the immune system and may mediate the homing of leukocytes to sites of inflammation. The aim of this work was to examine the presence of selectins and cellular adhesion molecules on epithelial and endothelial cells in labial salivary glands (LS...
Gespeichert in:
Veröffentlicht in: | Clinical immunology and immunopathology 1996-07, Vol.80 (1), p.55-66 |
---|---|
Hauptverfasser: | , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 66 |
---|---|
container_issue | 1 |
container_start_page | 55 |
container_title | Clinical immunology and immunopathology |
container_volume | 80 |
creator | Aziz, Karim Elias McCluskey, Peter J. Wakefield, Denis |
description | Adhesion molecules are important signal transmitters of the immune system and may mediate the homing of leukocytes to sites of inflammation. The aim of this work was to examine the presence of selectins and cellular adhesion molecules on epithelial and endothelial cells in labial salivary glands (LSG) in Sjögren's syndrome (SS). LSG biopsies were obtained from patients with primary SS (n= 31) and normal subjects (n= 21). Cryostat sections were examined with indirect immunoperoxidase. Epithelial cells in LSG from both patients and controls expressed LFA-3 (CD58) and Hermes I (CD44). A significantly increased number of acinar and ductal epithelial cells in LSG from patients expressed class I MHC (74%, as mean percentage of ductal epithelial cells) (P< 0.05), HLA-DR (58%) (P< 0.0001), and HLA-DQ (11%) (P< 0.001). To a lesser extent limited ICAM-1 (CD54) epithelial expression (6%) was noted only in a few biopsies from patients but none of the controls. Epithelial cells did not express any of the selectins CD62 E, L, and P and sometimes they expressed sialyl Lex(a ligand for selectins). Although the number of endothelial structures expressing ICAM-1 (CD54), HLA-DR, HLA-DQ, and class I MHC (per surface area) was increased in patients (P< 0.05), this may be due to the total increase of number of endothelial structures (P< 0.05) (Von Willebrand factor +ve) as part of the chronic inflammatory process. A smaller proportion of endothelial structures expressed E-selectin (CD62 E) (32%) and to a lesser extent VCAM-1 (CD106) (∼7%) as detectable only in some LSG from patients. P-selectin (CD62 P) was demonstrated on about one-third of endothelial structures in LSG from patients. Infiltrating mononuclear cells expressed CD11a (68%), CD18 (73%), CD11b (13%), CD11c (21%), CD58 (13%), CD4 (44%), CD8 (17%), CD62L(L-selectin) (18%), CD49d (38%), CD49e (15%), CD2 (56%), and CD44 (77%). The relatively reduced number of CD62 L +ve lymphocytes may be due to shedding of that molecule after activation. Sialyl Lexwas not detectable on infiltrating lymphocytes. Although infiltrating mononuclear cells were activated, as evidenced by their expression of HLA-DR (72%) and ICAM-1 (55%), they did not express IL-2Rα (CD25, confirmed by two antibodies 2A3 and ACT1) or IL-2Rβ (CD122), except rarely (≤1%). In some biopsies, CD106 and CD11c were localized on lymphocytes at the central areas of periductal lymphoid follicles with the appearance of dendritic cells. We conclude that adhesion molecul |
doi_str_mv | 10.1006/clin.1996.0094 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_78102277</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S009012299690094X</els_id><sourcerecordid>78102277</sourcerecordid><originalsourceid>FETCH-LOGICAL-c434t-5af45cce9d68e685fcc96c23301f5ac599273d913c30899870486692433b5b8c3</originalsourceid><addsrcrecordid>eNp1kc9uEzEQhy0EakPh2lslH1ABqQn-t167tyoEqBREUdqz5XhnW1e7dmpnEb3yULwAL4aXRL1xsuX5fqOZzwgdUzKjhMgPrvNhRrWWM0K0eIYmlGgyZVzQ52hCxjtlTB-ilznfkxIQpD5AB0rWggkyQb8WPzcJcvYx4NjiFXTgtj5k_G7-UTK8OFueXb3HNjR4Dl03dDbhi-YO_vFfY4GHDjL2AV8l39v0iFf3f37fJghvM149hibFHs7x9wHytkQy3kZ82fdDiAluS7fx8RV60douw-v9eYRuPi2u51-my2-fL-cXy6kTXGynlW1F5RzoRiqQqmqd09IxzgltK-sqrVnNG02540RprWoilJSaCc7X1Vo5foROd303KT6MA5neZ1e2sgHikE2tKGGsrgs424EuxZwTtGazW85QYkbpZpRuRulmlF4CJ_vOw7qH5gnfWy71N_u6zc52bbLB-fyEcUorQXnB1A6DYuGHh2Sy8xAcND6VXzFN9P-b4C-nbZ2E</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>78102277</pqid></control><display><type>article</type><title>Expression of Selectins (CD62 E,L,P) and Cellular Adhesion Molecules in Primary Sjögren's Syndrome: Questions to Immunoregulation</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Aziz, Karim Elias ; McCluskey, Peter J. ; Wakefield, Denis</creator><creatorcontrib>Aziz, Karim Elias ; McCluskey, Peter J. ; Wakefield, Denis</creatorcontrib><description>Adhesion molecules are important signal transmitters of the immune system and may mediate the homing of leukocytes to sites of inflammation. The aim of this work was to examine the presence of selectins and cellular adhesion molecules on epithelial and endothelial cells in labial salivary glands (LSG) in Sjögren's syndrome (SS). LSG biopsies were obtained from patients with primary SS (n= 31) and normal subjects (n= 21). Cryostat sections were examined with indirect immunoperoxidase. Epithelial cells in LSG from both patients and controls expressed LFA-3 (CD58) and Hermes I (CD44). A significantly increased number of acinar and ductal epithelial cells in LSG from patients expressed class I MHC (74%, as mean percentage of ductal epithelial cells) (P< 0.05), HLA-DR (58%) (P< 0.0001), and HLA-DQ (11%) (P< 0.001). To a lesser extent limited ICAM-1 (CD54) epithelial expression (6%) was noted only in a few biopsies from patients but none of the controls. Epithelial cells did not express any of the selectins CD62 E, L, and P and sometimes they expressed sialyl Lex(a ligand for selectins). Although the number of endothelial structures expressing ICAM-1 (CD54), HLA-DR, HLA-DQ, and class I MHC (per surface area) was increased in patients (P< 0.05), this may be due to the total increase of number of endothelial structures (P< 0.05) (Von Willebrand factor +ve) as part of the chronic inflammatory process. A smaller proportion of endothelial structures expressed E-selectin (CD62 E) (32%) and to a lesser extent VCAM-1 (CD106) (∼7%) as detectable only in some LSG from patients. P-selectin (CD62 P) was demonstrated on about one-third of endothelial structures in LSG from patients. Infiltrating mononuclear cells expressed CD11a (68%), CD18 (73%), CD11b (13%), CD11c (21%), CD58 (13%), CD4 (44%), CD8 (17%), CD62L(L-selectin) (18%), CD49d (38%), CD49e (15%), CD2 (56%), and CD44 (77%). The relatively reduced number of CD62 L +ve lymphocytes may be due to shedding of that molecule after activation. Sialyl Lexwas not detectable on infiltrating lymphocytes. Although infiltrating mononuclear cells were activated, as evidenced by their expression of HLA-DR (72%) and ICAM-1 (55%), they did not express IL-2Rα (CD25, confirmed by two antibodies 2A3 and ACT1) or IL-2Rβ (CD122), except rarely (≤1%). In some biopsies, CD106 and CD11c were localized on lymphocytes at the central areas of periductal lymphoid follicles with the appearance of dendritic cells. We conclude that adhesion molecules probably play a major role in the pathogenesis of SS. The pattern of expression of these molecules demonstrates a regulated altered activation in the glands associated with this disease. The glands may be subject to specific regulatory factors, in addition to proinflammatory cytokines.</description><identifier>ISSN: 0090-1229</identifier><identifier>EISSN: 1090-2341</identifier><identifier>DOI: 10.1006/clin.1996.0094</identifier><identifier>PMID: 8674240</identifier><identifier>CODEN: CLIIAT</identifier><language>eng</language><publisher>San Diego, CA: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cell Adhesion Molecules - biosynthesis ; Cell Movement - immunology ; E-Selectin - biosynthesis ; Endothelium, Vascular - metabolism ; Epithelium - metabolism ; Female ; Humans ; Immunophenotyping ; L-Selectin - biosynthesis ; Ligands ; Male ; Medical sciences ; Middle Aged ; P-Selectin - biosynthesis ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Selectins - biosynthesis ; Sjogren's Syndrome - immunology ; Sjogren's Syndrome - metabolism ; Sjogren's Syndrome - pathology</subject><ispartof>Clinical immunology and immunopathology, 1996-07, Vol.80 (1), p.55-66</ispartof><rights>1996 Academic Press</rights><rights>1996 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-5af45cce9d68e685fcc96c23301f5ac599273d913c30899870486692433b5b8c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3115413$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8674240$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aziz, Karim Elias</creatorcontrib><creatorcontrib>McCluskey, Peter J.</creatorcontrib><creatorcontrib>Wakefield, Denis</creatorcontrib><title>Expression of Selectins (CD62 E,L,P) and Cellular Adhesion Molecules in Primary Sjögren's Syndrome: Questions to Immunoregulation</title><title>Clinical immunology and immunopathology</title><addtitle>Clin Immunol Immunopathol</addtitle><description>Adhesion molecules are important signal transmitters of the immune system and may mediate the homing of leukocytes to sites of inflammation. The aim of this work was to examine the presence of selectins and cellular adhesion molecules on epithelial and endothelial cells in labial salivary glands (LSG) in Sjögren's syndrome (SS). LSG biopsies were obtained from patients with primary SS (n= 31) and normal subjects (n= 21). Cryostat sections were examined with indirect immunoperoxidase. Epithelial cells in LSG from both patients and controls expressed LFA-3 (CD58) and Hermes I (CD44). A significantly increased number of acinar and ductal epithelial cells in LSG from patients expressed class I MHC (74%, as mean percentage of ductal epithelial cells) (P< 0.05), HLA-DR (58%) (P< 0.0001), and HLA-DQ (11%) (P< 0.001). To a lesser extent limited ICAM-1 (CD54) epithelial expression (6%) was noted only in a few biopsies from patients but none of the controls. Epithelial cells did not express any of the selectins CD62 E, L, and P and sometimes they expressed sialyl Lex(a ligand for selectins). Although the number of endothelial structures expressing ICAM-1 (CD54), HLA-DR, HLA-DQ, and class I MHC (per surface area) was increased in patients (P< 0.05), this may be due to the total increase of number of endothelial structures (P< 0.05) (Von Willebrand factor +ve) as part of the chronic inflammatory process. A smaller proportion of endothelial structures expressed E-selectin (CD62 E) (32%) and to a lesser extent VCAM-1 (CD106) (∼7%) as detectable only in some LSG from patients. P-selectin (CD62 P) was demonstrated on about one-third of endothelial structures in LSG from patients. Infiltrating mononuclear cells expressed CD11a (68%), CD18 (73%), CD11b (13%), CD11c (21%), CD58 (13%), CD4 (44%), CD8 (17%), CD62L(L-selectin) (18%), CD49d (38%), CD49e (15%), CD2 (56%), and CD44 (77%). The relatively reduced number of CD62 L +ve lymphocytes may be due to shedding of that molecule after activation. Sialyl Lexwas not detectable on infiltrating lymphocytes. Although infiltrating mononuclear cells were activated, as evidenced by their expression of HLA-DR (72%) and ICAM-1 (55%), they did not express IL-2Rα (CD25, confirmed by two antibodies 2A3 and ACT1) or IL-2Rβ (CD122), except rarely (≤1%). In some biopsies, CD106 and CD11c were localized on lymphocytes at the central areas of periductal lymphoid follicles with the appearance of dendritic cells. We conclude that adhesion molecules probably play a major role in the pathogenesis of SS. The pattern of expression of these molecules demonstrates a regulated altered activation in the glands associated with this disease. The glands may be subject to specific regulatory factors, in addition to proinflammatory cytokines.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cell Adhesion Molecules - biosynthesis</subject><subject>Cell Movement - immunology</subject><subject>E-Selectin - biosynthesis</subject><subject>Endothelium, Vascular - metabolism</subject><subject>Epithelium - metabolism</subject><subject>Female</subject><subject>Humans</subject><subject>Immunophenotyping</subject><subject>L-Selectin - biosynthesis</subject><subject>Ligands</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>P-Selectin - biosynthesis</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Selectins - biosynthesis</subject><subject>Sjogren's Syndrome - immunology</subject><subject>Sjogren's Syndrome - metabolism</subject><subject>Sjogren's Syndrome - pathology</subject><issn>0090-1229</issn><issn>1090-2341</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9uEzEQhy0EakPh2lslH1ABqQn-t167tyoEqBREUdqz5XhnW1e7dmpnEb3yULwAL4aXRL1xsuX5fqOZzwgdUzKjhMgPrvNhRrWWM0K0eIYmlGgyZVzQ52hCxjtlTB-ilznfkxIQpD5AB0rWggkyQb8WPzcJcvYx4NjiFXTgtj5k_G7-UTK8OFueXb3HNjR4Dl03dDbhi-YO_vFfY4GHDjL2AV8l39v0iFf3f37fJghvM149hibFHs7x9wHytkQy3kZ82fdDiAluS7fx8RV60douw-v9eYRuPi2u51-my2-fL-cXy6kTXGynlW1F5RzoRiqQqmqd09IxzgltK-sqrVnNG02540RprWoilJSaCc7X1Vo5foROd303KT6MA5neZ1e2sgHikE2tKGGsrgs424EuxZwTtGazW85QYkbpZpRuRulmlF4CJ_vOw7qH5gnfWy71N_u6zc52bbLB-fyEcUorQXnB1A6DYuGHh2Sy8xAcND6VXzFN9P-b4C-nbZ2E</recordid><startdate>19960701</startdate><enddate>19960701</enddate><creator>Aziz, Karim Elias</creator><creator>McCluskey, Peter J.</creator><creator>Wakefield, Denis</creator><general>Elsevier Inc</general><general>Academic Press</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>19960701</creationdate><title>Expression of Selectins (CD62 E,L,P) and Cellular Adhesion Molecules in Primary Sjögren's Syndrome: Questions to Immunoregulation</title><author>Aziz, Karim Elias ; McCluskey, Peter J. ; Wakefield, Denis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-5af45cce9d68e685fcc96c23301f5ac599273d913c30899870486692433b5b8c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cell Adhesion Molecules - biosynthesis</topic><topic>Cell Movement - immunology</topic><topic>E-Selectin - biosynthesis</topic><topic>Endothelium, Vascular - metabolism</topic><topic>Epithelium - metabolism</topic><topic>Female</topic><topic>Humans</topic><topic>Immunophenotyping</topic><topic>L-Selectin - biosynthesis</topic><topic>Ligands</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>P-Selectin - biosynthesis</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Selectins - biosynthesis</topic><topic>Sjogren's Syndrome - immunology</topic><topic>Sjogren's Syndrome - metabolism</topic><topic>Sjogren's Syndrome - pathology</topic><toplevel>online_resources</toplevel><creatorcontrib>Aziz, Karim Elias</creatorcontrib><creatorcontrib>McCluskey, Peter J.</creatorcontrib><creatorcontrib>Wakefield, Denis</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>Clinical immunology and immunopathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aziz, Karim Elias</au><au>McCluskey, Peter J.</au><au>Wakefield, Denis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Expression of Selectins (CD62 E,L,P) and Cellular Adhesion Molecules in Primary Sjögren's Syndrome: Questions to Immunoregulation</atitle><jtitle>Clinical immunology and immunopathology</jtitle><addtitle>Clin Immunol Immunopathol</addtitle><date>1996-07-01</date><risdate>1996</risdate><volume>80</volume><issue>1</issue><spage>55</spage><epage>66</epage><pages>55-66</pages><issn>0090-1229</issn><eissn>1090-2341</eissn><coden>CLIIAT</coden><abstract>Adhesion molecules are important signal transmitters of the immune system and may mediate the homing of leukocytes to sites of inflammation. The aim of this work was to examine the presence of selectins and cellular adhesion molecules on epithelial and endothelial cells in labial salivary glands (LSG) in Sjögren's syndrome (SS). LSG biopsies were obtained from patients with primary SS (n= 31) and normal subjects (n= 21). Cryostat sections were examined with indirect immunoperoxidase. Epithelial cells in LSG from both patients and controls expressed LFA-3 (CD58) and Hermes I (CD44). A significantly increased number of acinar and ductal epithelial cells in LSG from patients expressed class I MHC (74%, as mean percentage of ductal epithelial cells) (P< 0.05), HLA-DR (58%) (P< 0.0001), and HLA-DQ (11%) (P< 0.001). To a lesser extent limited ICAM-1 (CD54) epithelial expression (6%) was noted only in a few biopsies from patients but none of the controls. Epithelial cells did not express any of the selectins CD62 E, L, and P and sometimes they expressed sialyl Lex(a ligand for selectins). Although the number of endothelial structures expressing ICAM-1 (CD54), HLA-DR, HLA-DQ, and class I MHC (per surface area) was increased in patients (P< 0.05), this may be due to the total increase of number of endothelial structures (P< 0.05) (Von Willebrand factor +ve) as part of the chronic inflammatory process. A smaller proportion of endothelial structures expressed E-selectin (CD62 E) (32%) and to a lesser extent VCAM-1 (CD106) (∼7%) as detectable only in some LSG from patients. P-selectin (CD62 P) was demonstrated on about one-third of endothelial structures in LSG from patients. Infiltrating mononuclear cells expressed CD11a (68%), CD18 (73%), CD11b (13%), CD11c (21%), CD58 (13%), CD4 (44%), CD8 (17%), CD62L(L-selectin) (18%), CD49d (38%), CD49e (15%), CD2 (56%), and CD44 (77%). The relatively reduced number of CD62 L +ve lymphocytes may be due to shedding of that molecule after activation. Sialyl Lexwas not detectable on infiltrating lymphocytes. Although infiltrating mononuclear cells were activated, as evidenced by their expression of HLA-DR (72%) and ICAM-1 (55%), they did not express IL-2Rα (CD25, confirmed by two antibodies 2A3 and ACT1) or IL-2Rβ (CD122), except rarely (≤1%). In some biopsies, CD106 and CD11c were localized on lymphocytes at the central areas of periductal lymphoid follicles with the appearance of dendritic cells. We conclude that adhesion molecules probably play a major role in the pathogenesis of SS. The pattern of expression of these molecules demonstrates a regulated altered activation in the glands associated with this disease. The glands may be subject to specific regulatory factors, in addition to proinflammatory cytokines.</abstract><cop>San Diego, CA</cop><cop>New York, NY</cop><cop>Boston</cop><pub>Elsevier Inc</pub><pmid>8674240</pmid><doi>10.1006/clin.1996.0094</doi><tpages>12</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0090-1229 |
ispartof | Clinical immunology and immunopathology, 1996-07, Vol.80 (1), p.55-66 |
issn | 0090-1229 1090-2341 |
language | eng |
recordid | cdi_proquest_miscellaneous_78102277 |
source | MEDLINE; Alma/SFX Local Collection |
subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cell Adhesion Molecules - biosynthesis Cell Movement - immunology E-Selectin - biosynthesis Endothelium, Vascular - metabolism Epithelium - metabolism Female Humans Immunophenotyping L-Selectin - biosynthesis Ligands Male Medical sciences Middle Aged P-Selectin - biosynthesis Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Selectins - biosynthesis Sjogren's Syndrome - immunology Sjogren's Syndrome - metabolism Sjogren's Syndrome - pathology |
title | Expression of Selectins (CD62 E,L,P) and Cellular Adhesion Molecules in Primary Sjögren's Syndrome: Questions to Immunoregulation |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T00%3A07%3A18IST&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=Expression%20of%20Selectins%20(CD62%20E,L,P)%20and%20Cellular%20Adhesion%20Molecules%20in%20Primary%20Sj%C3%B6gren's%20Syndrome:%20Questions%20to%20Immunoregulation&rft.jtitle=Clinical%20immunology%20and%20immunopathology&rft.au=Aziz,%20Karim%20Elias&rft.date=1996-07-01&rft.volume=80&rft.issue=1&rft.spage=55&rft.epage=66&rft.pages=55-66&rft.issn=0090-1229&rft.eissn=1090-2341&rft.coden=CLIIAT&rft_id=info:doi/10.1006/clin.1996.0094&rft_dat=%3Cproquest_cross%3E78102277%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=78102277&rft_id=info:pmid/8674240&rft_els_id=S009012299690094X&rfr_iscdi=true |