Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness
Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness. Single-center prospective cohort study....
Gespeichert in:
| Veröffentlicht in: | Critical care medicine 2023-11, Vol.51 (11), p.e209-e220 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e220 |
|---|---|
| container_issue | 11 |
| container_start_page | e209 |
| container_title | Critical care medicine |
| container_volume | 51 |
| creator | Madahar, Purnema Capaccione, Kathleen M. Salvatore, Mary M. Short, Briana Wahab, Romina Abrams, Darryl Parekh, Madhavi Geleris, Joshua D. Furfaro, David Anderson, Michaela R. Zucker, Jason Brodie, Daniel Cummings, Matthew J. O’Donnell, Max McGroder, Claire F. Wei, Ying Garcia, Christine K. Baldwin, Matthew R. |
| description | Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness.
Single-center prospective cohort study.
We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns.
Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020.
None.
We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival.
Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival. |
| doi_str_mv | 10.1097/CCM.0000000000005954 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10615871</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2824685836</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4086-a31030b5992efebadaa7061753f75658b69285dc27544ea16f9309d27d2d5e413</originalsourceid><addsrcrecordid>eNpdkU1v1DAQhi0EokvhHyDkIxcXO7aT-IRWgcJKC1shPo6Wk0waUyfe2k4rxJ_HpUsp-DIHzzzvjB6EnjN6wqiqXjXNhxN670klxQO0YpJTQgvFH6IVpYoSLhQ_Qk9i_E4pE7Lij9ERrwolmOAr9PPUtsEn25GtvQB8trjJzyb8wJ9Mb_15MPvRdvjMpARhjngdAH_0Ca9j9J01CXr8zaYRr_srCBHwbkmdnyBiO-Nm93XzhjCFmzH4OVOaYHOQcXjj3AwxPkWPBuMiPDvUY_Tl9O3n5j3Z7t5tmvWWdILWJTGcUU5bqVQBA7SmN6aiJaskHypZyrotVVHLvisqKQQYVg6KU9UXVV_0EgTjx-j1LXe_tBP0HcwpGKf3wU75Uu2N1f_-zHbU5_5Ksxwj6-qG8PJACP5ygZj0ZGMHzpkZ_BJ1UReirGXNy9wqblu74GMMMNzlMKpvxOksTv8vLo-9uL_j3dAfU3-5195lF_HCLdcQ9AjGpfE3j-cdiFIHKsm2y5L_AlAFo5A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2824685836</pqid></control><display><type>article</type><title>Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Madahar, Purnema ; Capaccione, Kathleen M. ; Salvatore, Mary M. ; Short, Briana ; Wahab, Romina ; Abrams, Darryl ; Parekh, Madhavi ; Geleris, Joshua D. ; Furfaro, David ; Anderson, Michaela R. ; Zucker, Jason ; Brodie, Daniel ; Cummings, Matthew J. ; O’Donnell, Max ; McGroder, Claire F. ; Wei, Ying ; Garcia, Christine K. ; Baldwin, Matthew R.</creator><creatorcontrib>Madahar, Purnema ; Capaccione, Kathleen M. ; Salvatore, Mary M. ; Short, Briana ; Wahab, Romina ; Abrams, Darryl ; Parekh, Madhavi ; Geleris, Joshua D. ; Furfaro, David ; Anderson, Michaela R. ; Zucker, Jason ; Brodie, Daniel ; Cummings, Matthew J. ; O’Donnell, Max ; McGroder, Claire F. ; Wei, Ying ; Garcia, Christine K. ; Baldwin, Matthew R.</creatorcontrib><description>Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness.
Single-center prospective cohort study.
We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns.
Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020.
None.
We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival.
Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.</description><identifier>ISSN: 0090-3493</identifier><identifier>ISSN: 1530-0293</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000005954</identifier><identifier>PMID: 37294143</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Adult ; Biomarkers ; COVID-19 - complications ; COVID-19 - diagnostic imaging ; Critical Illness - therapy ; Humans ; Interleukin-6 ; Prospective Studies ; Respiration, Artificial - adverse effects ; Respiratory Distress Syndrome - diagnostic imaging ; Respiratory Distress Syndrome - etiology ; Respiratory Distress Syndrome - therapy</subject><ispartof>Critical care medicine, 2023-11, Vol.51 (11), p.e209-e220</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4086-a31030b5992efebadaa7061753f75658b69285dc27544ea16f9309d27d2d5e413</citedby><cites>FETCH-LOGICAL-c4086-a31030b5992efebadaa7061753f75658b69285dc27544ea16f9309d27d2d5e413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37294143$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Madahar, Purnema</creatorcontrib><creatorcontrib>Capaccione, Kathleen M.</creatorcontrib><creatorcontrib>Salvatore, Mary M.</creatorcontrib><creatorcontrib>Short, Briana</creatorcontrib><creatorcontrib>Wahab, Romina</creatorcontrib><creatorcontrib>Abrams, Darryl</creatorcontrib><creatorcontrib>Parekh, Madhavi</creatorcontrib><creatorcontrib>Geleris, Joshua D.</creatorcontrib><creatorcontrib>Furfaro, David</creatorcontrib><creatorcontrib>Anderson, Michaela R.</creatorcontrib><creatorcontrib>Zucker, Jason</creatorcontrib><creatorcontrib>Brodie, Daniel</creatorcontrib><creatorcontrib>Cummings, Matthew J.</creatorcontrib><creatorcontrib>O’Donnell, Max</creatorcontrib><creatorcontrib>McGroder, Claire F.</creatorcontrib><creatorcontrib>Wei, Ying</creatorcontrib><creatorcontrib>Garcia, Christine K.</creatorcontrib><creatorcontrib>Baldwin, Matthew R.</creatorcontrib><title>Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness.
Single-center prospective cohort study.
We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns.
Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020.
None.
We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival.
Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.</description><subject>Adult</subject><subject>Biomarkers</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - diagnostic imaging</subject><subject>Critical Illness - therapy</subject><subject>Humans</subject><subject>Interleukin-6</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Respiratory Distress Syndrome - diagnostic imaging</subject><subject>Respiratory Distress Syndrome - etiology</subject><subject>Respiratory Distress Syndrome - therapy</subject><issn>0090-3493</issn><issn>1530-0293</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQhi0EokvhHyDkIxcXO7aT-IRWgcJKC1shPo6Wk0waUyfe2k4rxJ_HpUsp-DIHzzzvjB6EnjN6wqiqXjXNhxN670klxQO0YpJTQgvFH6IVpYoSLhQ_Qk9i_E4pE7Lij9ERrwolmOAr9PPUtsEn25GtvQB8trjJzyb8wJ9Mb_15MPvRdvjMpARhjngdAH_0Ca9j9J01CXr8zaYRr_srCBHwbkmdnyBiO-Nm93XzhjCFmzH4OVOaYHOQcXjj3AwxPkWPBuMiPDvUY_Tl9O3n5j3Z7t5tmvWWdILWJTGcUU5bqVQBA7SmN6aiJaskHypZyrotVVHLvisqKQQYVg6KU9UXVV_0EgTjx-j1LXe_tBP0HcwpGKf3wU75Uu2N1f_-zHbU5_5Ksxwj6-qG8PJACP5ygZj0ZGMHzpkZ_BJ1UReirGXNy9wqblu74GMMMNzlMKpvxOksTv8vLo-9uL_j3dAfU3-5195lF_HCLdcQ9AjGpfE3j-cdiFIHKsm2y5L_AlAFo5A</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Madahar, Purnema</creator><creator>Capaccione, Kathleen M.</creator><creator>Salvatore, Mary M.</creator><creator>Short, Briana</creator><creator>Wahab, Romina</creator><creator>Abrams, Darryl</creator><creator>Parekh, Madhavi</creator><creator>Geleris, Joshua D.</creator><creator>Furfaro, David</creator><creator>Anderson, Michaela R.</creator><creator>Zucker, Jason</creator><creator>Brodie, Daniel</creator><creator>Cummings, Matthew J.</creator><creator>O’Donnell, Max</creator><creator>McGroder, Claire F.</creator><creator>Wei, Ying</creator><creator>Garcia, Christine K.</creator><creator>Baldwin, Matthew R.</creator><general>Lippincott Williams & Wilkins</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><scope>5PM</scope></search><sort><creationdate>20231101</creationdate><title>Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness</title><author>Madahar, Purnema ; Capaccione, Kathleen M. ; Salvatore, Mary M. ; Short, Briana ; Wahab, Romina ; Abrams, Darryl ; Parekh, Madhavi ; Geleris, Joshua D. ; Furfaro, David ; Anderson, Michaela R. ; Zucker, Jason ; Brodie, Daniel ; Cummings, Matthew J. ; O’Donnell, Max ; McGroder, Claire F. ; Wei, Ying ; Garcia, Christine K. ; Baldwin, Matthew R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4086-a31030b5992efebadaa7061753f75658b69285dc27544ea16f9309d27d2d5e413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Biomarkers</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - diagnostic imaging</topic><topic>Critical Illness - therapy</topic><topic>Humans</topic><topic>Interleukin-6</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Respiratory Distress Syndrome - diagnostic imaging</topic><topic>Respiratory Distress Syndrome - etiology</topic><topic>Respiratory Distress Syndrome - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Madahar, Purnema</creatorcontrib><creatorcontrib>Capaccione, Kathleen M.</creatorcontrib><creatorcontrib>Salvatore, Mary M.</creatorcontrib><creatorcontrib>Short, Briana</creatorcontrib><creatorcontrib>Wahab, Romina</creatorcontrib><creatorcontrib>Abrams, Darryl</creatorcontrib><creatorcontrib>Parekh, Madhavi</creatorcontrib><creatorcontrib>Geleris, Joshua D.</creatorcontrib><creatorcontrib>Furfaro, David</creatorcontrib><creatorcontrib>Anderson, Michaela R.</creatorcontrib><creatorcontrib>Zucker, Jason</creatorcontrib><creatorcontrib>Brodie, Daniel</creatorcontrib><creatorcontrib>Cummings, Matthew J.</creatorcontrib><creatorcontrib>O’Donnell, Max</creatorcontrib><creatorcontrib>McGroder, Claire F.</creatorcontrib><creatorcontrib>Wei, Ying</creatorcontrib><creatorcontrib>Garcia, Christine K.</creatorcontrib><creatorcontrib>Baldwin, Matthew R.</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Madahar, Purnema</au><au>Capaccione, Kathleen M.</au><au>Salvatore, Mary M.</au><au>Short, Briana</au><au>Wahab, Romina</au><au>Abrams, Darryl</au><au>Parekh, Madhavi</au><au>Geleris, Joshua D.</au><au>Furfaro, David</au><au>Anderson, Michaela R.</au><au>Zucker, Jason</au><au>Brodie, Daniel</au><au>Cummings, Matthew J.</au><au>O’Donnell, Max</au><au>McGroder, Claire F.</au><au>Wei, Ying</au><au>Garcia, Christine K.</au><au>Baldwin, Matthew R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2023-11-01</date><risdate>2023</risdate><volume>51</volume><issue>11</issue><spage>e209</spage><epage>e220</epage><pages>e209-e220</pages><issn>0090-3493</issn><issn>1530-0293</issn><eissn>1530-0293</eissn><abstract>Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness.
Single-center prospective cohort study.
We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns.
Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020.
None.
We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival.
Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>37294143</pmid><doi>10.1097/CCM.0000000000005954</doi></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0090-3493 |
| ispartof | Critical care medicine, 2023-11, Vol.51 (11), p.e209-e220 |
| issn | 0090-3493 1530-0293 1530-0293 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10615871 |
| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Biomarkers COVID-19 - complications COVID-19 - diagnostic imaging Critical Illness - therapy Humans Interleukin-6 Prospective Studies Respiration, Artificial - adverse effects Respiratory Distress Syndrome - diagnostic imaging Respiratory Distress Syndrome - etiology Respiratory Distress Syndrome - therapy |
| title | Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-04T13%3A35%3A04IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Fibrotic-Like%20Pulmonary%20Radiographic%20Patterns%20Are%20Not%20Associated%20With%20Adverse%20Outcomes%20in%20COVID-19%20Chronic%20Critical%20Illness&rft.jtitle=Critical%20care%20medicine&rft.au=Madahar,%20Purnema&rft.date=2023-11-01&rft.volume=51&rft.issue=11&rft.spage=e209&rft.epage=e220&rft.pages=e209-e220&rft.issn=0090-3493&rft.eissn=1530-0293&rft_id=info:doi/10.1097/CCM.0000000000005954&rft_dat=%3Cproquest_pubme%3E2824685836%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2824685836&rft_id=info:pmid/37294143&rfr_iscdi=true |