Bisphosphonate modulates proliferation and differentiation of rat periodontal ligament cells during wound healing

Background Periodontal ligament (PL) width is precisely maintained throughout the lifetime of adult mammals, but the biological mechanisms that regulate the spatial locations of the cell populations for bone, cementum, and PL are unknown. Methods As bisphosphonates induce ankylosis in mouse molar te...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The Anatomical record 1997-03, Vol.247 (3), p.329-340
Hauptverfasser: Lekic, P., Rubbino, I., Krasnoshtein, F., Cheifetz, S., McCulloch, C.A.G., Tenenbaum, H.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 340
container_issue 3
container_start_page 329
container_title The Anatomical record
container_volume 247
creator Lekic, P.
Rubbino, I.
Krasnoshtein, F.
Cheifetz, S.
McCulloch, C.A.G.
Tenenbaum, H.
description Background Periodontal ligament (PL) width is precisely maintained throughout the lifetime of adult mammals, but the biological mechanisms that regulate the spatial locations of the cell populations for bone, cementum, and PL are unknown. Methods As bisphosphonates induce ankylosis in mouse molar teeth, we used ethane‐1‐hydroxy‐1, 1‐bisphosphonate—(HEBP, Etidronate; Didronel) in combination with a periodontal window wound model to identify those cell populations involved in the regulation of PL width during the reformation of cellular domains after wounding. Four groups of Wistar rats were wounded by drilling through the alveolar bone and extirpation of the PL. Rats were administered HEBP for 1 week and then sacrificed or allowed to recover for an additional week prior to sacrifice. Control rats were sacrificed after 1 or 2 weeks. One hour prior to sacrifice, rats were injected with 3H‐thymidine to label proliferating cells. Tissue sections were immunohistochemically stained for osteopontin (OPN) or bone sialoprotein (BSP) or were prepared for in situ hybridization (BSP) to identify extra‐ and intracellular expression of these non‐collagenous bone proteins associated with periodontal healing. Results HEBP treatment for 1 week induced a twofold increase in the thickness of the alveolar bone matrix in which weak immuno‐staining for OPN and BSP mRNA signal was seen. During the recovery phase the increased bone width was reduced but was still considerably thicker than in control (P < 0.001). OPN staining as well as the BSP mRNA signal were much more intense than at 1 week. HEBP induced a > 40% reduction of PL width which returned to normal dimensions following the recovery phase. HEBP also modulated PL cell proliferation and differentiation: PL cell counts and labelling indices were reduced fivefold after 1 week of HEBP but returned to control values after the recovery phase. In controls, PL cells did not express OPN and BSP, but after HEBP treatment, and particularly after the recovery phase, PL cells expressed both of these markers intensely. In contrast, gingival and pulp connective tissues that were contiguous with the PL were not stained for OPN and did not express BSP mRNA after HEBP treatment. Conclusions While wounding induced transient increases of proliferation which were followed by repopulation of the extirpated tissue, the effects of HEBP on cell differentiation were independent of wounding. HEBP modulates the differentiation of PL cells and recru
doi_str_mv 10.1002/(SICI)1097-0185(199703)247:3<329::AID-AR4>3.0.CO;2-P
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_78856235</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>78856235</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5014-86f1aa42a11dc12e76e3fd3d6c53795042eb9fdcc90b3492cb150c070519adbb3</originalsourceid><addsrcrecordid>eNqFkctq3DAUhkVpSaZpHqGgVUgWnh5JvoymoTB1bwOBCUkK3R1kSU5UbGti2YS8fWU8ZJNFF0L6dS6_dD5CLhksGQD_dH67LbcXDGSRAFtl50zKAsQFT4u1uBRcrteb7bdkc5N-EUtYlrvPPLl-QxYvBW_JAgBEwov8zzF5H8JfAMbSPD8iRxLyXDJYkMevLuwf_LQ6NVjaejM28RDovveNq22vBuc7qjpDjaujtt3g5jtf0xile9s7b3w3qIY27l61MYNq2zSBmrF33T198mMsf7CqieoDeVerJtjTw35Cfv_4flf-Sq52P7fl5irRGbA0WeU1UyrlijGjGbdFbkVthMl1JgqZQcptJWujtYRKpJLrimWgoYCMSWWqSpyQs7lv_MjjaMOArQvTs1Rn_RiwWK2ynIssJt7Nibr3IfS2xn3vWtU_IwOcSCBOJHAaLE6DxZkERhIoMJJAjCQwkogSsNwhx-vY9uPBf6xaa16aHkYf47dz_Mk19vmV5_8sXztOUvwD0o6ltg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>78856235</pqid></control><display><type>article</type><title>Bisphosphonate modulates proliferation and differentiation of rat periodontal ligament cells during wound healing</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Online Library Free Content</source><creator>Lekic, P. ; Rubbino, I. ; Krasnoshtein, F. ; Cheifetz, S. ; McCulloch, C.A.G. ; Tenenbaum, H.</creator><creatorcontrib>Lekic, P. ; Rubbino, I. ; Krasnoshtein, F. ; Cheifetz, S. ; McCulloch, C.A.G. ; Tenenbaum, H.</creatorcontrib><description>Background Periodontal ligament (PL) width is precisely maintained throughout the lifetime of adult mammals, but the biological mechanisms that regulate the spatial locations of the cell populations for bone, cementum, and PL are unknown. Methods As bisphosphonates induce ankylosis in mouse molar teeth, we used ethane‐1‐hydroxy‐1, 1‐bisphosphonate—(HEBP, Etidronate; Didronel) in combination with a periodontal window wound model to identify those cell populations involved in the regulation of PL width during the reformation of cellular domains after wounding. Four groups of Wistar rats were wounded by drilling through the alveolar bone and extirpation of the PL. Rats were administered HEBP for 1 week and then sacrificed or allowed to recover for an additional week prior to sacrifice. Control rats were sacrificed after 1 or 2 weeks. One hour prior to sacrifice, rats were injected with 3H‐thymidine to label proliferating cells. Tissue sections were immunohistochemically stained for osteopontin (OPN) or bone sialoprotein (BSP) or were prepared for in situ hybridization (BSP) to identify extra‐ and intracellular expression of these non‐collagenous bone proteins associated with periodontal healing. Results HEBP treatment for 1 week induced a twofold increase in the thickness of the alveolar bone matrix in which weak immuno‐staining for OPN and BSP mRNA signal was seen. During the recovery phase the increased bone width was reduced but was still considerably thicker than in control (P &lt; 0.001). OPN staining as well as the BSP mRNA signal were much more intense than at 1 week. HEBP induced a &gt; 40% reduction of PL width which returned to normal dimensions following the recovery phase. HEBP also modulated PL cell proliferation and differentiation: PL cell counts and labelling indices were reduced fivefold after 1 week of HEBP but returned to control values after the recovery phase. In controls, PL cells did not express OPN and BSP, but after HEBP treatment, and particularly after the recovery phase, PL cells expressed both of these markers intensely. In contrast, gingival and pulp connective tissues that were contiguous with the PL were not stained for OPN and did not express BSP mRNA after HEBP treatment. Conclusions While wounding induced transient increases of proliferation which were followed by repopulation of the extirpated tissue, the effects of HEBP on cell differentiation were independent of wounding. HEBP modulates the differentiation of PL cells and recruits cells that contribute to alveolar bone formation and loss of PL width homeostasis. Conceivably, bisphosphonates could be used therapeutically to selectively alter the differentiation of PL cells and promote the formation of alveolar bone and cementum. Anat. Rec. 247:329–340, 1997. © 1997 Wiley‐Liss, Inc.</description><identifier>ISSN: 0003-276X</identifier><identifier>EISSN: 1097-0185</identifier><identifier>DOI: 10.1002/(SICI)1097-0185(199703)247:3&lt;329::AID-AR4&gt;3.0.CO;2-P</identifier><identifier>PMID: 9066910</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>alveolar bone ; Animals ; bisphosphonate ; Cell Differentiation - drug effects ; Cell Division - drug effects ; Etidronic Acid - pharmacology ; fibroblasts ; Immunohistochemistry ; In Situ Hybridization ; Integrin-Binding Sialoprotein ; Male ; osteoblasts ; Osteogenesis - drug effects ; Osteopontin ; periodontal ligament ; Periodontal Ligament - drug effects ; Periodontal Ligament - physiology ; Phosphoproteins - analysis ; Rats ; Rats, Wistar ; RNA, Messenger - analysis ; Sialoglycoproteins - analysis ; Time Factors ; Wound Healing - drug effects</subject><ispartof>The Anatomical record, 1997-03, Vol.247 (3), p.329-340</ispartof><rights>Copyright © 1997 Wiley‐Liss, Inc.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5014-86f1aa42a11dc12e76e3fd3d6c53795042eb9fdcc90b3492cb150c070519adbb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2F%28SICI%291097-0185%28199703%29247%3A3%3C329%3A%3AAID-AR4%3E3.0.CO%3B2-P$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2F%28SICI%291097-0185%28199703%29247%3A3%3C329%3A%3AAID-AR4%3E3.0.CO%3B2-P$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,1430,27907,27908,45557,45558,46392,46816</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9066910$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lekic, P.</creatorcontrib><creatorcontrib>Rubbino, I.</creatorcontrib><creatorcontrib>Krasnoshtein, F.</creatorcontrib><creatorcontrib>Cheifetz, S.</creatorcontrib><creatorcontrib>McCulloch, C.A.G.</creatorcontrib><creatorcontrib>Tenenbaum, H.</creatorcontrib><title>Bisphosphonate modulates proliferation and differentiation of rat periodontal ligament cells during wound healing</title><title>The Anatomical record</title><addtitle>Anat Rec</addtitle><description>Background Periodontal ligament (PL) width is precisely maintained throughout the lifetime of adult mammals, but the biological mechanisms that regulate the spatial locations of the cell populations for bone, cementum, and PL are unknown. Methods As bisphosphonates induce ankylosis in mouse molar teeth, we used ethane‐1‐hydroxy‐1, 1‐bisphosphonate—(HEBP, Etidronate; Didronel) in combination with a periodontal window wound model to identify those cell populations involved in the regulation of PL width during the reformation of cellular domains after wounding. Four groups of Wistar rats were wounded by drilling through the alveolar bone and extirpation of the PL. Rats were administered HEBP for 1 week and then sacrificed or allowed to recover for an additional week prior to sacrifice. Control rats were sacrificed after 1 or 2 weeks. One hour prior to sacrifice, rats were injected with 3H‐thymidine to label proliferating cells. Tissue sections were immunohistochemically stained for osteopontin (OPN) or bone sialoprotein (BSP) or were prepared for in situ hybridization (BSP) to identify extra‐ and intracellular expression of these non‐collagenous bone proteins associated with periodontal healing. Results HEBP treatment for 1 week induced a twofold increase in the thickness of the alveolar bone matrix in which weak immuno‐staining for OPN and BSP mRNA signal was seen. During the recovery phase the increased bone width was reduced but was still considerably thicker than in control (P &lt; 0.001). OPN staining as well as the BSP mRNA signal were much more intense than at 1 week. HEBP induced a &gt; 40% reduction of PL width which returned to normal dimensions following the recovery phase. HEBP also modulated PL cell proliferation and differentiation: PL cell counts and labelling indices were reduced fivefold after 1 week of HEBP but returned to control values after the recovery phase. In controls, PL cells did not express OPN and BSP, but after HEBP treatment, and particularly after the recovery phase, PL cells expressed both of these markers intensely. In contrast, gingival and pulp connective tissues that were contiguous with the PL were not stained for OPN and did not express BSP mRNA after HEBP treatment. Conclusions While wounding induced transient increases of proliferation which were followed by repopulation of the extirpated tissue, the effects of HEBP on cell differentiation were independent of wounding. HEBP modulates the differentiation of PL cells and recruits cells that contribute to alveolar bone formation and loss of PL width homeostasis. Conceivably, bisphosphonates could be used therapeutically to selectively alter the differentiation of PL cells and promote the formation of alveolar bone and cementum. Anat. Rec. 247:329–340, 1997. © 1997 Wiley‐Liss, Inc.</description><subject>alveolar bone</subject><subject>Animals</subject><subject>bisphosphonate</subject><subject>Cell Differentiation - drug effects</subject><subject>Cell Division - drug effects</subject><subject>Etidronic Acid - pharmacology</subject><subject>fibroblasts</subject><subject>Immunohistochemistry</subject><subject>In Situ Hybridization</subject><subject>Integrin-Binding Sialoprotein</subject><subject>Male</subject><subject>osteoblasts</subject><subject>Osteogenesis - drug effects</subject><subject>Osteopontin</subject><subject>periodontal ligament</subject><subject>Periodontal Ligament - drug effects</subject><subject>Periodontal Ligament - physiology</subject><subject>Phosphoproteins - analysis</subject><subject>Rats</subject><subject>Rats, Wistar</subject><subject>RNA, Messenger - analysis</subject><subject>Sialoglycoproteins - analysis</subject><subject>Time Factors</subject><subject>Wound Healing - drug effects</subject><issn>0003-276X</issn><issn>1097-0185</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctq3DAUhkVpSaZpHqGgVUgWnh5JvoymoTB1bwOBCUkK3R1kSU5UbGti2YS8fWU8ZJNFF0L6dS6_dD5CLhksGQD_dH67LbcXDGSRAFtl50zKAsQFT4u1uBRcrteb7bdkc5N-EUtYlrvPPLl-QxYvBW_JAgBEwov8zzF5H8JfAMbSPD8iRxLyXDJYkMevLuwf_LQ6NVjaejM28RDovveNq22vBuc7qjpDjaujtt3g5jtf0xile9s7b3w3qIY27l61MYNq2zSBmrF33T198mMsf7CqieoDeVerJtjTw35Cfv_4flf-Sq52P7fl5irRGbA0WeU1UyrlijGjGbdFbkVthMl1JgqZQcptJWujtYRKpJLrimWgoYCMSWWqSpyQs7lv_MjjaMOArQvTs1Rn_RiwWK2ynIssJt7Nibr3IfS2xn3vWtU_IwOcSCBOJHAaLE6DxZkERhIoMJJAjCQwkogSsNwhx-vY9uPBf6xaa16aHkYf47dz_Mk19vmV5_8sXztOUvwD0o6ltg</recordid><startdate>199703</startdate><enddate>199703</enddate><creator>Lekic, P.</creator><creator>Rubbino, I.</creator><creator>Krasnoshtein, F.</creator><creator>Cheifetz, S.</creator><creator>McCulloch, C.A.G.</creator><creator>Tenenbaum, H.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><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>199703</creationdate><title>Bisphosphonate modulates proliferation and differentiation of rat periodontal ligament cells during wound healing</title><author>Lekic, P. ; Rubbino, I. ; Krasnoshtein, F. ; Cheifetz, S. ; McCulloch, C.A.G. ; Tenenbaum, H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5014-86f1aa42a11dc12e76e3fd3d6c53795042eb9fdcc90b3492cb150c070519adbb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>alveolar bone</topic><topic>Animals</topic><topic>bisphosphonate</topic><topic>Cell Differentiation - drug effects</topic><topic>Cell Division - drug effects</topic><topic>Etidronic Acid - pharmacology</topic><topic>fibroblasts</topic><topic>Immunohistochemistry</topic><topic>In Situ Hybridization</topic><topic>Integrin-Binding Sialoprotein</topic><topic>Male</topic><topic>osteoblasts</topic><topic>Osteogenesis - drug effects</topic><topic>Osteopontin</topic><topic>periodontal ligament</topic><topic>Periodontal Ligament - drug effects</topic><topic>Periodontal Ligament - physiology</topic><topic>Phosphoproteins - analysis</topic><topic>Rats</topic><topic>Rats, Wistar</topic><topic>RNA, Messenger - analysis</topic><topic>Sialoglycoproteins - analysis</topic><topic>Time Factors</topic><topic>Wound Healing - drug effects</topic><toplevel>online_resources</toplevel><creatorcontrib>Lekic, P.</creatorcontrib><creatorcontrib>Rubbino, I.</creatorcontrib><creatorcontrib>Krasnoshtein, F.</creatorcontrib><creatorcontrib>Cheifetz, S.</creatorcontrib><creatorcontrib>McCulloch, C.A.G.</creatorcontrib><creatorcontrib>Tenenbaum, H.</creatorcontrib><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 Anatomical record</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lekic, P.</au><au>Rubbino, I.</au><au>Krasnoshtein, F.</au><au>Cheifetz, S.</au><au>McCulloch, C.A.G.</au><au>Tenenbaum, H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bisphosphonate modulates proliferation and differentiation of rat periodontal ligament cells during wound healing</atitle><jtitle>The Anatomical record</jtitle><addtitle>Anat Rec</addtitle><date>1997-03</date><risdate>1997</risdate><volume>247</volume><issue>3</issue><spage>329</spage><epage>340</epage><pages>329-340</pages><issn>0003-276X</issn><eissn>1097-0185</eissn><abstract>Background Periodontal ligament (PL) width is precisely maintained throughout the lifetime of adult mammals, but the biological mechanisms that regulate the spatial locations of the cell populations for bone, cementum, and PL are unknown. Methods As bisphosphonates induce ankylosis in mouse molar teeth, we used ethane‐1‐hydroxy‐1, 1‐bisphosphonate—(HEBP, Etidronate; Didronel) in combination with a periodontal window wound model to identify those cell populations involved in the regulation of PL width during the reformation of cellular domains after wounding. Four groups of Wistar rats were wounded by drilling through the alveolar bone and extirpation of the PL. Rats were administered HEBP for 1 week and then sacrificed or allowed to recover for an additional week prior to sacrifice. Control rats were sacrificed after 1 or 2 weeks. One hour prior to sacrifice, rats were injected with 3H‐thymidine to label proliferating cells. Tissue sections were immunohistochemically stained for osteopontin (OPN) or bone sialoprotein (BSP) or were prepared for in situ hybridization (BSP) to identify extra‐ and intracellular expression of these non‐collagenous bone proteins associated with periodontal healing. Results HEBP treatment for 1 week induced a twofold increase in the thickness of the alveolar bone matrix in which weak immuno‐staining for OPN and BSP mRNA signal was seen. During the recovery phase the increased bone width was reduced but was still considerably thicker than in control (P &lt; 0.001). OPN staining as well as the BSP mRNA signal were much more intense than at 1 week. HEBP induced a &gt; 40% reduction of PL width which returned to normal dimensions following the recovery phase. HEBP also modulated PL cell proliferation and differentiation: PL cell counts and labelling indices were reduced fivefold after 1 week of HEBP but returned to control values after the recovery phase. In controls, PL cells did not express OPN and BSP, but after HEBP treatment, and particularly after the recovery phase, PL cells expressed both of these markers intensely. In contrast, gingival and pulp connective tissues that were contiguous with the PL were not stained for OPN and did not express BSP mRNA after HEBP treatment. Conclusions While wounding induced transient increases of proliferation which were followed by repopulation of the extirpated tissue, the effects of HEBP on cell differentiation were independent of wounding. HEBP modulates the differentiation of PL cells and recruits cells that contribute to alveolar bone formation and loss of PL width homeostasis. Conceivably, bisphosphonates could be used therapeutically to selectively alter the differentiation of PL cells and promote the formation of alveolar bone and cementum. Anat. Rec. 247:329–340, 1997. © 1997 Wiley‐Liss, Inc.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>9066910</pmid><doi>10.1002/(SICI)1097-0185(199703)247:3&lt;329::AID-AR4&gt;3.0.CO;2-P</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0003-276X
ispartof The Anatomical record, 1997-03, Vol.247 (3), p.329-340
issn 0003-276X
1097-0185
language eng
recordid cdi_proquest_miscellaneous_78856235
source MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content
subjects alveolar bone
Animals
bisphosphonate
Cell Differentiation - drug effects
Cell Division - drug effects
Etidronic Acid - pharmacology
fibroblasts
Immunohistochemistry
In Situ Hybridization
Integrin-Binding Sialoprotein
Male
osteoblasts
Osteogenesis - drug effects
Osteopontin
periodontal ligament
Periodontal Ligament - drug effects
Periodontal Ligament - physiology
Phosphoproteins - analysis
Rats
Rats, Wistar
RNA, Messenger - analysis
Sialoglycoproteins - analysis
Time Factors
Wound Healing - drug effects
title Bisphosphonate modulates proliferation and differentiation of rat periodontal ligament cells during wound healing
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T06%3A55%3A17IST&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=Bisphosphonate%20modulates%20proliferation%20and%20differentiation%20of%20rat%20periodontal%20ligament%20cells%20during%20wound%20healing&rft.jtitle=The%20Anatomical%20record&rft.au=Lekic,%20P.&rft.date=1997-03&rft.volume=247&rft.issue=3&rft.spage=329&rft.epage=340&rft.pages=329-340&rft.issn=0003-276X&rft.eissn=1097-0185&rft_id=info:doi/10.1002/(SICI)1097-0185(199703)247:3%3C329::AID-AR4%3E3.0.CO;2-P&rft_dat=%3Cproquest_cross%3E78856235%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=78856235&rft_id=info:pmid/9066910&rfr_iscdi=true