The Efficacy and Safety of Liraglutide in Patients Remaining Obese 6 Months after Metabolic Surgery
Introduction The safety and efficacy of liraglutide as a weight loss intervention in individuals who remain obese within 1 year post-metabolic surgery remain unclear. This study aimed to evaluate the effects and safety of liraglutide (1.8 mg) in patients with persistent obesity at 6 months postopera...
Gespeichert in:
| Veröffentlicht in: | Diabetes therapy 2024-12, Vol.15 (12), p.2499-2513 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2513 |
|---|---|
| container_issue | 12 |
| container_start_page | 2499 |
| container_title | Diabetes therapy |
| container_volume | 15 |
| creator | Shen, Yuanyuan Huang, Yuanhao Ouyang, Yuqin Xiang, Xinyue Chu, Xuehui Zhang, Bingqing Han, Tao Tang, Wenjuan Feng, Wenhuan |
| description | Introduction
The safety and efficacy of liraglutide as a weight loss intervention in individuals who remain obese within 1 year post-metabolic surgery remain unclear. This study aimed to evaluate the effects and safety of liraglutide (1.8 mg) in patients with persistent obesity at 6 months postoperatively.
Methods
This retrospective cohort study included 61 patients who remained obese (body mass index [BMI] ≥ 28.0 kg/m
2
) at 6 months postoperatively. Among these patients, 27 were treated with 1.8 mg of liraglutide for 12 weeks, whereas 34 served as controls. The primary endpoint was the change in total weight loss (%TWL) after 24 weeks. Changes in weight, BMI, complications, and adverse events were also assessed.
Results
The liraglutide group showed a greater reduction in %TWL than the control group (11.6% ± 1.1% vs. 4.9% ± 1.0%), with an estimated treatment difference of 6.6% (95% confidence interval [CI], 3.7–9.6%,
P
|
| doi_str_mv | 10.1007/s13300-024-01643-1 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11561203</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A816014608</galeid><sourcerecordid>A816014608</sourcerecordid><originalsourceid>FETCH-LOGICAL-c379t-f36ab21e8e893912141eb9f3c13591778537bb5895156037b36b7585d07904c03</originalsourceid><addsrcrecordid>eNp9klFv1SAUxxujccvcF_DBkPjiSyenFFqezLJMt-QuM24-E0oPvSwtTGiX3G8v1zvvnDEeHiCc3_nDgX9RvAV6ApQ2HxMwRmlJq7qkIGpWwoviEFohSyEFvNyvOTsojlO6ozmYlBLgdXHAZF2zHIeFuV0jObfWGW02RPue3GiL84YES1Yu6mFcZtcjcZ581bNDPyfyDSftvPMDue4wIRHkKvh5nYi2M0ZyhbPuwugMuVnigHHzpnhl9Zjw-HE-Kr5_Pr89uyhX118uz05XpWGNnEvLhO4qwBZbySRUUAN20jIDjEtompazput4KzlwQfOaia7hLe9pI2ltKDsqPu1075duwt7ky0Y9qvvoJh03Kminnme8W6shPCjIglBRlhU-PCrE8GPBNKvJJYPjqD2GJSmWKcob4FVG3_-F3oUl-tzflmopA2DwRA16ROW8DflgsxVVpy0ICrWgbaZO_kHl0ePkTPBoXd5_VlDtCkwMKUW0-yaBqq091M4eKttD_bKH2t7l3Z_Psy_5bYYMsB2Qcsrnn3tq6T-yPwGFRcGC</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3128031131</pqid></control><display><type>article</type><title>The Efficacy and Safety of Liraglutide in Patients Remaining Obese 6 Months after Metabolic Surgery</title><source>Springer Nature OA Free Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Shen, Yuanyuan ; Huang, Yuanhao ; Ouyang, Yuqin ; Xiang, Xinyue ; Chu, Xuehui ; Zhang, Bingqing ; Han, Tao ; Tang, Wenjuan ; Feng, Wenhuan</creator><creatorcontrib>Shen, Yuanyuan ; Huang, Yuanhao ; Ouyang, Yuqin ; Xiang, Xinyue ; Chu, Xuehui ; Zhang, Bingqing ; Han, Tao ; Tang, Wenjuan ; Feng, Wenhuan</creatorcontrib><description>Introduction
The safety and efficacy of liraglutide as a weight loss intervention in individuals who remain obese within 1 year post-metabolic surgery remain unclear. This study aimed to evaluate the effects and safety of liraglutide (1.8 mg) in patients with persistent obesity at 6 months postoperatively.
Methods
This retrospective cohort study included 61 patients who remained obese (body mass index [BMI] ≥ 28.0 kg/m
2
) at 6 months postoperatively. Among these patients, 27 were treated with 1.8 mg of liraglutide for 12 weeks, whereas 34 served as controls. The primary endpoint was the change in total weight loss (%TWL) after 24 weeks. Changes in weight, BMI, complications, and adverse events were also assessed.
Results
The liraglutide group showed a greater reduction in %TWL than the control group (11.6% ± 1.1% vs. 4.9% ± 1.0%), with an estimated treatment difference of 6.6% (95% confidence interval [CI], 3.7–9.6%,
P
< 0.01). The adjusted mean differences in the reduction of weight and BMI between the liraglutide and control groups were − 6.2 kg (95% CI − 8.9 to − 3.4,
P
< 0.01) and − 3.0 kg/m
2
(95% CI − 4.2 to − 1.7,
P
< 0.01), respectively. The liraglutide group exhibited increased rates of remission in non-alcoholic fatty liver disease and hypertension. No serious adverse reactions were observed.
Conclusions
For patients who remained obese at 6 months postoperatively, 12-week liraglutide treatment resulted in increased weight loss, improved metabolic control, and high rate of remission for obesity-related metabolic diseases after 24 weeks. Earlier and more timely adjuvant weight loss medication intervention based on BMI within 1 year postoperatively may enhance weight loss after metabolic surgery.
Graphical abstract available for this article.
Graphical Abstract</description><identifier>ISSN: 1869-6953</identifier><identifier>EISSN: 1869-6961</identifier><identifier>DOI: 10.1007/s13300-024-01643-1</identifier><identifier>PMID: 39443333</identifier><language>eng</language><publisher>Cheshire: Springer Healthcare</publisher><subject>Body mass index ; Cardiology ; Care and treatment ; Diabetes ; Dosage and administration ; Drug therapy ; Endocrinology ; Gastrointestinal surgery ; Health aspects ; Hypertension ; Internal Medicine ; Liraglutide ; Liver diseases ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Metabolism ; Methods ; Obesity ; Original Research ; Patient outcomes ; Surgery ; Type 2 diabetes ; Weight control ; Weight loss</subject><ispartof>Diabetes therapy, 2024-12, Vol.15 (12), p.2499-2513</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>COPYRIGHT 2024 Springer</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c379t-f36ab21e8e893912141eb9f3c13591778537bb5895156037b36b7585d07904c03</cites><orcidid>0009-0002-5185-7840 ; 0009-0002-3816-6201</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561203/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561203/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41120,42189,51576,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39443333$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shen, Yuanyuan</creatorcontrib><creatorcontrib>Huang, Yuanhao</creatorcontrib><creatorcontrib>Ouyang, Yuqin</creatorcontrib><creatorcontrib>Xiang, Xinyue</creatorcontrib><creatorcontrib>Chu, Xuehui</creatorcontrib><creatorcontrib>Zhang, Bingqing</creatorcontrib><creatorcontrib>Han, Tao</creatorcontrib><creatorcontrib>Tang, Wenjuan</creatorcontrib><creatorcontrib>Feng, Wenhuan</creatorcontrib><title>The Efficacy and Safety of Liraglutide in Patients Remaining Obese 6 Months after Metabolic Surgery</title><title>Diabetes therapy</title><addtitle>Diabetes Ther</addtitle><addtitle>Diabetes Ther</addtitle><description>Introduction
The safety and efficacy of liraglutide as a weight loss intervention in individuals who remain obese within 1 year post-metabolic surgery remain unclear. This study aimed to evaluate the effects and safety of liraglutide (1.8 mg) in patients with persistent obesity at 6 months postoperatively.
Methods
This retrospective cohort study included 61 patients who remained obese (body mass index [BMI] ≥ 28.0 kg/m
2
) at 6 months postoperatively. Among these patients, 27 were treated with 1.8 mg of liraglutide for 12 weeks, whereas 34 served as controls. The primary endpoint was the change in total weight loss (%TWL) after 24 weeks. Changes in weight, BMI, complications, and adverse events were also assessed.
Results
The liraglutide group showed a greater reduction in %TWL than the control group (11.6% ± 1.1% vs. 4.9% ± 1.0%), with an estimated treatment difference of 6.6% (95% confidence interval [CI], 3.7–9.6%,
P
< 0.01). The adjusted mean differences in the reduction of weight and BMI between the liraglutide and control groups were − 6.2 kg (95% CI − 8.9 to − 3.4,
P
< 0.01) and − 3.0 kg/m
2
(95% CI − 4.2 to − 1.7,
P
< 0.01), respectively. The liraglutide group exhibited increased rates of remission in non-alcoholic fatty liver disease and hypertension. No serious adverse reactions were observed.
Conclusions
For patients who remained obese at 6 months postoperatively, 12-week liraglutide treatment resulted in increased weight loss, improved metabolic control, and high rate of remission for obesity-related metabolic diseases after 24 weeks. Earlier and more timely adjuvant weight loss medication intervention based on BMI within 1 year postoperatively may enhance weight loss after metabolic surgery.
Graphical abstract available for this article.
Graphical Abstract</description><subject>Body mass index</subject><subject>Cardiology</subject><subject>Care and treatment</subject><subject>Diabetes</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Endocrinology</subject><subject>Gastrointestinal surgery</subject><subject>Health aspects</subject><subject>Hypertension</subject><subject>Internal Medicine</subject><subject>Liraglutide</subject><subject>Liver diseases</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Metabolism</subject><subject>Methods</subject><subject>Obesity</subject><subject>Original Research</subject><subject>Patient outcomes</subject><subject>Surgery</subject><subject>Type 2 diabetes</subject><subject>Weight control</subject><subject>Weight loss</subject><issn>1869-6953</issn><issn>1869-6961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9klFv1SAUxxujccvcF_DBkPjiSyenFFqezLJMt-QuM24-E0oPvSwtTGiX3G8v1zvvnDEeHiCc3_nDgX9RvAV6ApQ2HxMwRmlJq7qkIGpWwoviEFohSyEFvNyvOTsojlO6ozmYlBLgdXHAZF2zHIeFuV0jObfWGW02RPue3GiL84YES1Yu6mFcZtcjcZ581bNDPyfyDSftvPMDue4wIRHkKvh5nYi2M0ZyhbPuwugMuVnigHHzpnhl9Zjw-HE-Kr5_Pr89uyhX118uz05XpWGNnEvLhO4qwBZbySRUUAN20jIDjEtompazput4KzlwQfOaia7hLe9pI2ltKDsqPu1075duwt7ky0Y9qvvoJh03Kminnme8W6shPCjIglBRlhU-PCrE8GPBNKvJJYPjqD2GJSmWKcob4FVG3_-F3oUl-tzflmopA2DwRA16ROW8DflgsxVVpy0ICrWgbaZO_kHl0ePkTPBoXd5_VlDtCkwMKUW0-yaBqq091M4eKttD_bKH2t7l3Z_Psy_5bYYMsB2Qcsrnn3tq6T-yPwGFRcGC</recordid><startdate>20241201</startdate><enddate>20241201</enddate><creator>Shen, Yuanyuan</creator><creator>Huang, Yuanhao</creator><creator>Ouyang, Yuqin</creator><creator>Xiang, Xinyue</creator><creator>Chu, Xuehui</creator><creator>Zhang, Bingqing</creator><creator>Han, Tao</creator><creator>Tang, Wenjuan</creator><creator>Feng, Wenhuan</creator><general>Springer Healthcare</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0009-0002-5185-7840</orcidid><orcidid>https://orcid.org/0009-0002-3816-6201</orcidid></search><sort><creationdate>20241201</creationdate><title>The Efficacy and Safety of Liraglutide in Patients Remaining Obese 6 Months after Metabolic Surgery</title><author>Shen, Yuanyuan ; Huang, Yuanhao ; Ouyang, Yuqin ; Xiang, Xinyue ; Chu, Xuehui ; Zhang, Bingqing ; Han, Tao ; Tang, Wenjuan ; Feng, Wenhuan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c379t-f36ab21e8e893912141eb9f3c13591778537bb5895156037b36b7585d07904c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Body mass index</topic><topic>Cardiology</topic><topic>Care and treatment</topic><topic>Diabetes</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Endocrinology</topic><topic>Gastrointestinal surgery</topic><topic>Health aspects</topic><topic>Hypertension</topic><topic>Internal Medicine</topic><topic>Liraglutide</topic><topic>Liver diseases</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Metabolism</topic><topic>Methods</topic><topic>Obesity</topic><topic>Original Research</topic><topic>Patient outcomes</topic><topic>Surgery</topic><topic>Type 2 diabetes</topic><topic>Weight control</topic><topic>Weight loss</topic><toplevel>online_resources</toplevel><creatorcontrib>Shen, Yuanyuan</creatorcontrib><creatorcontrib>Huang, Yuanhao</creatorcontrib><creatorcontrib>Ouyang, Yuqin</creatorcontrib><creatorcontrib>Xiang, Xinyue</creatorcontrib><creatorcontrib>Chu, Xuehui</creatorcontrib><creatorcontrib>Zhang, Bingqing</creatorcontrib><creatorcontrib>Han, Tao</creatorcontrib><creatorcontrib>Tang, Wenjuan</creatorcontrib><creatorcontrib>Feng, Wenhuan</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetes therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shen, Yuanyuan</au><au>Huang, Yuanhao</au><au>Ouyang, Yuqin</au><au>Xiang, Xinyue</au><au>Chu, Xuehui</au><au>Zhang, Bingqing</au><au>Han, Tao</au><au>Tang, Wenjuan</au><au>Feng, Wenhuan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Efficacy and Safety of Liraglutide in Patients Remaining Obese 6 Months after Metabolic Surgery</atitle><jtitle>Diabetes therapy</jtitle><stitle>Diabetes Ther</stitle><addtitle>Diabetes Ther</addtitle><date>2024-12-01</date><risdate>2024</risdate><volume>15</volume><issue>12</issue><spage>2499</spage><epage>2513</epage><pages>2499-2513</pages><issn>1869-6953</issn><eissn>1869-6961</eissn><abstract>Introduction
The safety and efficacy of liraglutide as a weight loss intervention in individuals who remain obese within 1 year post-metabolic surgery remain unclear. This study aimed to evaluate the effects and safety of liraglutide (1.8 mg) in patients with persistent obesity at 6 months postoperatively.
Methods
This retrospective cohort study included 61 patients who remained obese (body mass index [BMI] ≥ 28.0 kg/m
2
) at 6 months postoperatively. Among these patients, 27 were treated with 1.8 mg of liraglutide for 12 weeks, whereas 34 served as controls. The primary endpoint was the change in total weight loss (%TWL) after 24 weeks. Changes in weight, BMI, complications, and adverse events were also assessed.
Results
The liraglutide group showed a greater reduction in %TWL than the control group (11.6% ± 1.1% vs. 4.9% ± 1.0%), with an estimated treatment difference of 6.6% (95% confidence interval [CI], 3.7–9.6%,
P
< 0.01). The adjusted mean differences in the reduction of weight and BMI between the liraglutide and control groups were − 6.2 kg (95% CI − 8.9 to − 3.4,
P
< 0.01) and − 3.0 kg/m
2
(95% CI − 4.2 to − 1.7,
P
< 0.01), respectively. The liraglutide group exhibited increased rates of remission in non-alcoholic fatty liver disease and hypertension. No serious adverse reactions were observed.
Conclusions
For patients who remained obese at 6 months postoperatively, 12-week liraglutide treatment resulted in increased weight loss, improved metabolic control, and high rate of remission for obesity-related metabolic diseases after 24 weeks. Earlier and more timely adjuvant weight loss medication intervention based on BMI within 1 year postoperatively may enhance weight loss after metabolic surgery.
Graphical abstract available for this article.
Graphical Abstract</abstract><cop>Cheshire</cop><pub>Springer Healthcare</pub><pmid>39443333</pmid><doi>10.1007/s13300-024-01643-1</doi><tpages>15</tpages><orcidid>https://orcid.org/0009-0002-5185-7840</orcidid><orcidid>https://orcid.org/0009-0002-3816-6201</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1869-6953 |
| ispartof | Diabetes therapy, 2024-12, Vol.15 (12), p.2499-2513 |
| issn | 1869-6953 1869-6961 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11561203 |
| source | Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Body mass index Cardiology Care and treatment Diabetes Dosage and administration Drug therapy Endocrinology Gastrointestinal surgery Health aspects Hypertension Internal Medicine Liraglutide Liver diseases Medical research Medicine Medicine & Public Health Medicine, Experimental Metabolism Methods Obesity Original Research Patient outcomes Surgery Type 2 diabetes Weight control Weight loss |
| title | The Efficacy and Safety of Liraglutide in Patients Remaining Obese 6 Months after Metabolic Surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-26T12%3A13%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20Efficacy%20and%20Safety%20of%20Liraglutide%20in%20Patients%20Remaining%20Obese%206%20Months%20after%20Metabolic%20Surgery&rft.jtitle=Diabetes%20therapy&rft.au=Shen,%20Yuanyuan&rft.date=2024-12-01&rft.volume=15&rft.issue=12&rft.spage=2499&rft.epage=2513&rft.pages=2499-2513&rft.issn=1869-6953&rft.eissn=1869-6961&rft_id=info:doi/10.1007/s13300-024-01643-1&rft_dat=%3Cgale_pubme%3EA816014608%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3128031131&rft_id=info:pmid/39443333&rft_galeid=A816014608&rfr_iscdi=true |