Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic
The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the dur...
Gespeichert in:
| Veröffentlicht in: | American journal of respiratory and critical care medicine 2008-01, Vol.12 (6), p.R155-R155, Article R155 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | R155 |
|---|---|
| container_issue | 6 |
| container_start_page | R155 |
| container_title | American journal of respiratory and critical care medicine |
| container_volume | 12 |
| creator | Merouani, Mehdi Guignard, Bruno Vincent, François Borron, Stephen W Karoubi, Philippe Fosse, Jean-Philippe Cohen, Yves Clec'h, Christophe Vicaut, Eric Marbeuf-Gueye, Carole Lapostolle, Frederic Adnet, Frederic |
| description | The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock.
Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation.
Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] microg/kg versus 1.4 [0.6 to 2.7] microg/kg; P < 0.01).
Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion.
Trial registration: Clinicaltrials.gov NCT00763906. |
| doi_str_mv | 10.1186/cc7149 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2646320</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A191404976</galeid><sourcerecordid>A191404976</sourcerecordid><originalsourceid>FETCH-LOGICAL-b583t-5819c581fb7005586e90c3f8a50dd60f938b4cb6fb835d3724af58b36dee686f3</originalsourceid><addsrcrecordid>eNp1kt9rFDEQxxdRbK36J0jwoU9um2x-bPIiHEVt4bAvCoIPIckmd6m7yZrsVq5_vSl7eG1BApMw85mZLzOpqrcIniHE2bkxLSLiWXWMCGM1g-LH8_LGjNScYnpUvcr5BkLUcoZfVkdIQMYRwsfVz68x2dEHO25TseCPVcGHDfABZDtO3oC8jeYXGNXkbZgy0Dtg-phtB_oYR2BimFLsgVb3rhiAm-_udiW28eZ19cKpPts3-_uk-v7507eLy3p9_eXqYrWuNeV4qilHwhTjdAshpZxZAQ12XFHYdQw6gbkmRjOnOaYdbhuiHOUas85axpnDJ9XHpe4468F2puhMqpdj8oNKOxmVl48jwW_lJt7KhhGGG1gKfFgKbJ-kXa7W0ods0yAhxFRw3NyigosF1z7-p9_jiImDXBZUck_3WlP8Pds8ycFnY_teBRvnLBljgjaUFPD9E_AmzimUOUokKKEtorRAZwu0Ub0tSl0s_Uw5nR18WY11vvhXSCACiWjZob1JMedk3T_VCMr7j3TQ-e7hTA_Y_ufgv78BxRw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>195457155</pqid></control><display><type>article</type><title>Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic</title><source>MEDLINE</source><source>American Thoracic Society (ATS) Journals Online</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>SpringerLink Journals - AutoHoldings</source><source>Journals@Ovid Complete</source><source>Springer Nature OA Free Journals</source><creator>Merouani, Mehdi ; Guignard, Bruno ; Vincent, François ; Borron, Stephen W ; Karoubi, Philippe ; Fosse, Jean-Philippe ; Cohen, Yves ; Clec'h, Christophe ; Vicaut, Eric ; Marbeuf-Gueye, Carole ; Lapostolle, Frederic ; Adnet, Frederic</creator><creatorcontrib>Merouani, Mehdi ; Guignard, Bruno ; Vincent, François ; Borron, Stephen W ; Karoubi, Philippe ; Fosse, Jean-Philippe ; Cohen, Yves ; Clec'h, Christophe ; Vicaut, Eric ; Marbeuf-Gueye, Carole ; Lapostolle, Frederic ; Adnet, Frederic</creatorcontrib><description>The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock.
Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation.
Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] microg/kg versus 1.4 [0.6 to 2.7] microg/kg; P < 0.01).
Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion.
Trial registration: Clinicaltrials.gov NCT00763906.</description><identifier>ISSN: 1364-8535</identifier><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1186/cc7149</identifier><identifier>PMID: 19068113</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Care and treatment ; Dosage and administration ; Female ; France ; Fuzzy Logic ; Health aspects ; Humans ; Infusions, Intravenous ; Intensive Care Units ; Life Sciences ; Male ; Middle Aged ; Noradrenaline ; Norepinephrine - administration & dosage ; Norepinephrine - therapeutic use ; Santé publique et épidémiologie ; Septic shock ; Shock, Septic - drug therapy ; Vasoconstrictor Agents - administration & dosage ; Vasoconstrictor Agents - therapeutic use ; Ventilator weaning ; Withholding Treatment</subject><ispartof>American journal of respiratory and critical care medicine, 2008-01, Vol.12 (6), p.R155-R155, Article R155</ispartof><rights>COPYRIGHT 2008 BioMed Central Ltd.</rights><rights>Copyright National Library of Medicine - MEDLINE Abstracts 2008</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><rights>Copyright © 2008 Merouani et al.; licensee BioMed Central Ltd. 2008 Merouani et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b583t-5819c581fb7005586e90c3f8a50dd60f938b4cb6fb835d3724af58b36dee686f3</citedby><cites>FETCH-LOGICAL-b583t-5819c581fb7005586e90c3f8a50dd60f938b4cb6fb835d3724af58b36dee686f3</cites><orcidid>0000-0001-6303-8557</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/PMC2646320/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646320/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19068113$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://inserm.hal.science/inserm-00359832$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Merouani, Mehdi</creatorcontrib><creatorcontrib>Guignard, Bruno</creatorcontrib><creatorcontrib>Vincent, François</creatorcontrib><creatorcontrib>Borron, Stephen W</creatorcontrib><creatorcontrib>Karoubi, Philippe</creatorcontrib><creatorcontrib>Fosse, Jean-Philippe</creatorcontrib><creatorcontrib>Cohen, Yves</creatorcontrib><creatorcontrib>Clec'h, Christophe</creatorcontrib><creatorcontrib>Vicaut, Eric</creatorcontrib><creatorcontrib>Marbeuf-Gueye, Carole</creatorcontrib><creatorcontrib>Lapostolle, Frederic</creatorcontrib><creatorcontrib>Adnet, Frederic</creatorcontrib><title>Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic</title><title>American journal of respiratory and critical care medicine</title><addtitle>Crit Care</addtitle><description>The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock.
Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation.
Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] microg/kg versus 1.4 [0.6 to 2.7] microg/kg; P < 0.01).
Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion.
Trial registration: Clinicaltrials.gov NCT00763906.</description><subject>Adult</subject><subject>Aged</subject><subject>Care and treatment</subject><subject>Dosage and administration</subject><subject>Female</subject><subject>France</subject><subject>Fuzzy Logic</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Intensive Care Units</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Noradrenaline</subject><subject>Norepinephrine - administration & dosage</subject><subject>Norepinephrine - therapeutic use</subject><subject>Santé publique et épidémiologie</subject><subject>Septic shock</subject><subject>Shock, Septic - drug therapy</subject><subject>Vasoconstrictor Agents - administration & dosage</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><subject>Ventilator weaning</subject><subject>Withholding Treatment</subject><issn>1364-8535</issn><issn>1073-449X</issn><issn>1466-609X</issn><issn>1364-8535</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kt9rFDEQxxdRbK36J0jwoU9um2x-bPIiHEVt4bAvCoIPIckmd6m7yZrsVq5_vSl7eG1BApMw85mZLzOpqrcIniHE2bkxLSLiWXWMCGM1g-LH8_LGjNScYnpUvcr5BkLUcoZfVkdIQMYRwsfVz68x2dEHO25TseCPVcGHDfABZDtO3oC8jeYXGNXkbZgy0Dtg-phtB_oYR2BimFLsgVb3rhiAm-_udiW28eZ19cKpPts3-_uk-v7507eLy3p9_eXqYrWuNeV4qilHwhTjdAshpZxZAQ12XFHYdQw6gbkmRjOnOaYdbhuiHOUas85axpnDJ9XHpe4468F2puhMqpdj8oNKOxmVl48jwW_lJt7KhhGGG1gKfFgKbJ-kXa7W0ods0yAhxFRw3NyigosF1z7-p9_jiImDXBZUck_3WlP8Pds8ycFnY_teBRvnLBljgjaUFPD9E_AmzimUOUokKKEtorRAZwu0Ub0tSl0s_Uw5nR18WY11vvhXSCACiWjZob1JMedk3T_VCMr7j3TQ-e7hTA_Y_ufgv78BxRw</recordid><startdate>20080101</startdate><enddate>20080101</enddate><creator>Merouani, Mehdi</creator><creator>Guignard, Bruno</creator><creator>Vincent, François</creator><creator>Borron, Stephen W</creator><creator>Karoubi, Philippe</creator><creator>Fosse, Jean-Philippe</creator><creator>Cohen, Yves</creator><creator>Clec'h, Christophe</creator><creator>Vicaut, Eric</creator><creator>Marbeuf-Gueye, Carole</creator><creator>Lapostolle, Frederic</creator><creator>Adnet, Frederic</creator><general>BioMed Central Ltd</general><general>National Library of Medicine - MEDLINE Abstracts</general><general>American Thoracic Society</general><general>BioMed Central</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>K9.</scope><scope>7X8</scope><scope>1XC</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6303-8557</orcidid></search><sort><creationdate>20080101</creationdate><title>Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic</title><author>Merouani, Mehdi ; Guignard, Bruno ; Vincent, François ; Borron, Stephen W ; Karoubi, Philippe ; Fosse, Jean-Philippe ; Cohen, Yves ; Clec'h, Christophe ; Vicaut, Eric ; Marbeuf-Gueye, Carole ; Lapostolle, Frederic ; Adnet, Frederic</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b583t-5819c581fb7005586e90c3f8a50dd60f938b4cb6fb835d3724af58b36dee686f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Care and treatment</topic><topic>Dosage and administration</topic><topic>Female</topic><topic>France</topic><topic>Fuzzy Logic</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Intensive Care Units</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Noradrenaline</topic><topic>Norepinephrine - administration & dosage</topic><topic>Norepinephrine - therapeutic use</topic><topic>Santé publique et épidémiologie</topic><topic>Septic shock</topic><topic>Shock, Septic - drug therapy</topic><topic>Vasoconstrictor Agents - administration & dosage</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><topic>Ventilator weaning</topic><topic>Withholding Treatment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Merouani, Mehdi</creatorcontrib><creatorcontrib>Guignard, Bruno</creatorcontrib><creatorcontrib>Vincent, François</creatorcontrib><creatorcontrib>Borron, Stephen W</creatorcontrib><creatorcontrib>Karoubi, Philippe</creatorcontrib><creatorcontrib>Fosse, Jean-Philippe</creatorcontrib><creatorcontrib>Cohen, Yves</creatorcontrib><creatorcontrib>Clec'h, Christophe</creatorcontrib><creatorcontrib>Vicaut, Eric</creatorcontrib><creatorcontrib>Marbeuf-Gueye, Carole</creatorcontrib><creatorcontrib>Lapostolle, Frederic</creatorcontrib><creatorcontrib>Adnet, Frederic</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Merouani, Mehdi</au><au>Guignard, Bruno</au><au>Vincent, François</au><au>Borron, Stephen W</au><au>Karoubi, Philippe</au><au>Fosse, Jean-Philippe</au><au>Cohen, Yves</au><au>Clec'h, Christophe</au><au>Vicaut, Eric</au><au>Marbeuf-Gueye, Carole</au><au>Lapostolle, Frederic</au><au>Adnet, Frederic</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Crit Care</addtitle><date>2008-01-01</date><risdate>2008</risdate><volume>12</volume><issue>6</issue><spage>R155</spage><epage>R155</epage><pages>R155-R155</pages><artnum>R155</artnum><issn>1364-8535</issn><issn>1073-449X</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><eissn>1535-4970</eissn><abstract>The rate of weaning of vasopressors drugs is usually an empirical choice made by the treating in critically ill patients. We applied fuzzy logic principles to modify intravenous norepinephrine (noradrenaline) infusion rates during norepinephrine infusion in septic patients in order to reduce the duration of shock.
Septic patients were randomly assigned to norepinephrine infused either at the clinician's discretion (control group) or under closed-loop control based on fuzzy logic (fuzzy group). The infusion rate changed automatically after analysis of mean arterial pressure in the fuzzy group. The primary end-point was time to cessation of norepinephrine. The secondary end-points were 28-day survival, total amount of norepinephine infused and duration of mechanical ventilation.
Nineteen patients were randomly assigned to fuzzy group and 20 to control group. Weaning of norepinephrine was achieved in 18 of the 20 control patients and in all 19 fuzzy group patients. Median (interquartile range) duration of shock was significantly shorter in the fuzzy group than in the control group (28.5 [20.5 to 42] hours versus 57.5 [43.7 to 117.5] hours; P < 0.0001). There was no significant difference in duration of mechanical ventilation or survival at 28 days between the two groups. The median (interquartile range) total amount of norepinephrine infused during shock was significantly lower in the fuzzy group than in the control group (0.6 [0.2 to 1.0] microg/kg versus 1.4 [0.6 to 2.7] microg/kg; P < 0.01).
Our study has shown a reduction in norepinephrine weaning duration in septic patients enrolled in the fuzzy group. We attribute this reduction to fuzzy control of norepinephrine infusion.
Trial registration: Clinicaltrials.gov NCT00763906.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>19068113</pmid><doi>10.1186/cc7149</doi><orcidid>https://orcid.org/0000-0001-6303-8557</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1364-8535 |
| ispartof | American journal of respiratory and critical care medicine, 2008-01, Vol.12 (6), p.R155-R155, Article R155 |
| issn | 1364-8535 1073-449X 1466-609X 1364-8535 1535-4970 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2646320 |
| source | MEDLINE; American Thoracic Society (ATS) Journals Online; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings; Journals@Ovid Complete; Springer Nature OA Free Journals |
| subjects | Adult Aged Care and treatment Dosage and administration Female France Fuzzy Logic Health aspects Humans Infusions, Intravenous Intensive Care Units Life Sciences Male Middle Aged Noradrenaline Norepinephrine - administration & dosage Norepinephrine - therapeutic use Santé publique et épidémiologie Septic shock Shock, Septic - drug therapy Vasoconstrictor Agents - administration & dosage Vasoconstrictor Agents - therapeutic use Ventilator weaning Withholding Treatment |
| title | Norepinephrine weaning in septic shock patients by closed loop control based on fuzzy logic |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-04T10%3A53%3A57IST&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=Norepinephrine%20weaning%20in%20septic%20shock%20patients%20by%20closed%20loop%20control%20based%20on%20fuzzy%20logic&rft.jtitle=American%20journal%20of%20respiratory%20and%20critical%20care%20medicine&rft.au=Merouani,%20Mehdi&rft.date=2008-01-01&rft.volume=12&rft.issue=6&rft.spage=R155&rft.epage=R155&rft.pages=R155-R155&rft.artnum=R155&rft.issn=1364-8535&rft.eissn=1466-609X&rft_id=info:doi/10.1186/cc7149&rft_dat=%3Cgale_pubme%3EA191404976%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=195457155&rft_id=info:pmid/19068113&rft_galeid=A191404976&rfr_iscdi=true |