Short-term antidepressant treatment has long-lasting effects, and reverses stress-induced decreases in bone features in rats

Antidepressants are among the most-prescribed class of drugs in the world and though weight gain is a common outcome of antidepressant treatment, that effect is not well understood. We employed an animal model comprised of 2 weeks of chronic restraint stress with antidepressant treatment, followed b...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Translational psychiatry 2019-01, Vol.9 (1), p.10-10, Article 10
Hauptverfasser: Lee, S. H., Mastronardi, C. A., Li, R. W., Paz-Filho, G., Dutcher, E. G., Lewis, M. D., Vincent, A. D., Smith, P. N., Bornstein, S. R., Licinio, J., Wong, M. L.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 10
container_issue 1
container_start_page 10
container_title Translational psychiatry
container_volume 9
creator Lee, S. H.
Mastronardi, C. A.
Li, R. W.
Paz-Filho, G.
Dutcher, E. G.
Lewis, M. D.
Vincent, A. D.
Smith, P. N.
Bornstein, S. R.
Licinio, J.
Wong, M. L.
description Antidepressants are among the most-prescribed class of drugs in the world and though weight gain is a common outcome of antidepressant treatment, that effect is not well understood. We employed an animal model comprised of 2 weeks of chronic restraint stress with antidepressant treatment, followed by diet-induced obesity. We showed that short-term antidepressant treatment had long-lasting effects, not only leading to weight gain, but also enhancing trabecular and cortical bone features in rats; therefore, weight gain in this model was different from that of the classic diet-induced obesity. Late in the post-restraint recovery period, antidepressant-treated animals were significantly heavier and had better bone features than saline-treated controls, when assessed in the distal femoral metaphysis. The propensity to gain weight might have influenced the rate of catch-up growth and bone allometry, as heavier animals treated with fluoxetine also had enhanced bone features when compared to non-stressed animals. Therefore, short-term antidepressant treatment ameliorated the long-term effects of stress on body growth and bone. Growth and bone structural features were associated with leptin levels, and the interaction between leptin levels and antidepressant was significant for bone mineral content, suggesting that short-term antidepressants in the context of long-term diet-induced obesity modified the role of leptin in bone formation. To our knowledge this is the first study reporting that short-term antidepressant treatment has long-lasting effects in restoring the effects of chronic stress in body weight and bone formation. Our findings may be relevant to the understanding and treatment of osteoporosis, a condition of increasing prevalence due to the aging population.
doi_str_mv 10.1038/s41398-018-0351-z
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6341077</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2169285712</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-a524f3e26b0ff1458a107c80fefdc8cae47c9ebedcbb7bc8d292dacdab52f2763</originalsourceid><addsrcrecordid>eNp1kV-L1TAQxYso7rLuB_BFAr74YDVJ0yZ9EWTxHyz4oD6HNJnc26VNr5l0wcUP71y6rqtgIGTI_M5JhlNVTwV_JXhjXqMSTW9qLmg3rahvHlSnUrSmboQxD-_VJ9U54hWn1SojtHhcnTS865RW4rT6-WW_5FIXyDNzqYwBDhkQqWQlgyszULV3yKYl7erJYRnTjkGM4Au-JElgGa4hIyDDcpTWYwqrh8ACeHI4NsbEhiUBi2S45u0iu4JPqkfRTQjnt-dZ9e39u68XH-vLzx8-Xby9rL3SvNSulSo2ILuBxyhUa5zg2hseIQZvvAOlfQ8DBD8MevAmyF4G54MbWhml7pqz6s3me1iHmTCaKbvJHvI4u_zDLm60f3fSuLe75dp2jaKnNBm8uDXIy_cVsNh5RA_T5BIsK1opdE9xCGUIff4PerWsOdF4RHW9NK0WkiixUT4viBni3WcEt8d47RavpXjtMV57Q5pn96e4U_wOkwC5AUittIP85-n_u_4CTCS1Wg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2169285712</pqid></control><display><type>article</type><title>Short-term antidepressant treatment has long-lasting effects, and reverses stress-induced decreases in bone features in rats</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Springer Nature OA Free Journals</source><source>Nature Free</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Lee, S. H. ; Mastronardi, C. A. ; Li, R. W. ; Paz-Filho, G. ; Dutcher, E. G. ; Lewis, M. D. ; Vincent, A. D. ; Smith, P. N. ; Bornstein, S. R. ; Licinio, J. ; Wong, M. L.</creator><creatorcontrib>Lee, S. H. ; Mastronardi, C. A. ; Li, R. W. ; Paz-Filho, G. ; Dutcher, E. G. ; Lewis, M. D. ; Vincent, A. D. ; Smith, P. N. ; Bornstein, S. R. ; Licinio, J. ; Wong, M. L.</creatorcontrib><description>Antidepressants are among the most-prescribed class of drugs in the world and though weight gain is a common outcome of antidepressant treatment, that effect is not well understood. We employed an animal model comprised of 2 weeks of chronic restraint stress with antidepressant treatment, followed by diet-induced obesity. We showed that short-term antidepressant treatment had long-lasting effects, not only leading to weight gain, but also enhancing trabecular and cortical bone features in rats; therefore, weight gain in this model was different from that of the classic diet-induced obesity. Late in the post-restraint recovery period, antidepressant-treated animals were significantly heavier and had better bone features than saline-treated controls, when assessed in the distal femoral metaphysis. The propensity to gain weight might have influenced the rate of catch-up growth and bone allometry, as heavier animals treated with fluoxetine also had enhanced bone features when compared to non-stressed animals. Therefore, short-term antidepressant treatment ameliorated the long-term effects of stress on body growth and bone. Growth and bone structural features were associated with leptin levels, and the interaction between leptin levels and antidepressant was significant for bone mineral content, suggesting that short-term antidepressants in the context of long-term diet-induced obesity modified the role of leptin in bone formation. To our knowledge this is the first study reporting that short-term antidepressant treatment has long-lasting effects in restoring the effects of chronic stress in body weight and bone formation. Our findings may be relevant to the understanding and treatment of osteoporosis, a condition of increasing prevalence due to the aging population.</description><identifier>ISSN: 2158-3188</identifier><identifier>EISSN: 2158-3188</identifier><identifier>DOI: 10.1038/s41398-018-0351-z</identifier><identifier>PMID: 30664741</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/154/436 ; 692/699/476/1414 ; Animals ; Antidepressants ; Antidepressive Agents - pharmacology ; Behavior, Animal - drug effects ; Behavioral Sciences ; Biological Psychology ; Bone Density - drug effects ; Disease Models, Animal ; Fluoxetine - pharmacology ; Leptin - metabolism ; Male ; Medicine ; Medicine &amp; Public Health ; Neurosciences ; Obesity ; Obesity - metabolism ; Pharmacotherapy ; Psychiatry ; Rats ; Rats, Sprague-Dawley ; Rodents ; Short term ; Stress, Psychological - drug therapy ; Weight Gain - drug effects</subject><ispartof>Translational psychiatry, 2019-01, Vol.9 (1), p.10-10, Article 10</ispartof><rights>The Author(s) 2019</rights><rights>This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-a524f3e26b0ff1458a107c80fefdc8cae47c9ebedcbb7bc8d292dacdab52f2763</citedby><cites>FETCH-LOGICAL-c470t-a524f3e26b0ff1458a107c80fefdc8cae47c9ebedcbb7bc8d292dacdab52f2763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341077/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341077/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,27905,27906,41101,42170,51557,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30664741$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, S. H.</creatorcontrib><creatorcontrib>Mastronardi, C. A.</creatorcontrib><creatorcontrib>Li, R. W.</creatorcontrib><creatorcontrib>Paz-Filho, G.</creatorcontrib><creatorcontrib>Dutcher, E. G.</creatorcontrib><creatorcontrib>Lewis, M. D.</creatorcontrib><creatorcontrib>Vincent, A. D.</creatorcontrib><creatorcontrib>Smith, P. N.</creatorcontrib><creatorcontrib>Bornstein, S. R.</creatorcontrib><creatorcontrib>Licinio, J.</creatorcontrib><creatorcontrib>Wong, M. L.</creatorcontrib><title>Short-term antidepressant treatment has long-lasting effects, and reverses stress-induced decreases in bone features in rats</title><title>Translational psychiatry</title><addtitle>Transl Psychiatry</addtitle><addtitle>Transl Psychiatry</addtitle><description>Antidepressants are among the most-prescribed class of drugs in the world and though weight gain is a common outcome of antidepressant treatment, that effect is not well understood. We employed an animal model comprised of 2 weeks of chronic restraint stress with antidepressant treatment, followed by diet-induced obesity. We showed that short-term antidepressant treatment had long-lasting effects, not only leading to weight gain, but also enhancing trabecular and cortical bone features in rats; therefore, weight gain in this model was different from that of the classic diet-induced obesity. Late in the post-restraint recovery period, antidepressant-treated animals were significantly heavier and had better bone features than saline-treated controls, when assessed in the distal femoral metaphysis. The propensity to gain weight might have influenced the rate of catch-up growth and bone allometry, as heavier animals treated with fluoxetine also had enhanced bone features when compared to non-stressed animals. Therefore, short-term antidepressant treatment ameliorated the long-term effects of stress on body growth and bone. Growth and bone structural features were associated with leptin levels, and the interaction between leptin levels and antidepressant was significant for bone mineral content, suggesting that short-term antidepressants in the context of long-term diet-induced obesity modified the role of leptin in bone formation. To our knowledge this is the first study reporting that short-term antidepressant treatment has long-lasting effects in restoring the effects of chronic stress in body weight and bone formation. Our findings may be relevant to the understanding and treatment of osteoporosis, a condition of increasing prevalence due to the aging population.</description><subject>631/154/436</subject><subject>692/699/476/1414</subject><subject>Animals</subject><subject>Antidepressants</subject><subject>Antidepressive Agents - pharmacology</subject><subject>Behavior, Animal - drug effects</subject><subject>Behavioral Sciences</subject><subject>Biological Psychology</subject><subject>Bone Density - drug effects</subject><subject>Disease Models, Animal</subject><subject>Fluoxetine - pharmacology</subject><subject>Leptin - metabolism</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Neurosciences</subject><subject>Obesity</subject><subject>Obesity - metabolism</subject><subject>Pharmacotherapy</subject><subject>Psychiatry</subject><subject>Rats</subject><subject>Rats, Sprague-Dawley</subject><subject>Rodents</subject><subject>Short term</subject><subject>Stress, Psychological - drug therapy</subject><subject>Weight Gain - drug effects</subject><issn>2158-3188</issn><issn>2158-3188</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kV-L1TAQxYso7rLuB_BFAr74YDVJ0yZ9EWTxHyz4oD6HNJnc26VNr5l0wcUP71y6rqtgIGTI_M5JhlNVTwV_JXhjXqMSTW9qLmg3rahvHlSnUrSmboQxD-_VJ9U54hWn1SojtHhcnTS865RW4rT6-WW_5FIXyDNzqYwBDhkQqWQlgyszULV3yKYl7erJYRnTjkGM4Au-JElgGa4hIyDDcpTWYwqrh8ACeHI4NsbEhiUBi2S45u0iu4JPqkfRTQjnt-dZ9e39u68XH-vLzx8-Xby9rL3SvNSulSo2ILuBxyhUa5zg2hseIQZvvAOlfQ8DBD8MevAmyF4G54MbWhml7pqz6s3me1iHmTCaKbvJHvI4u_zDLm60f3fSuLe75dp2jaKnNBm8uDXIy_cVsNh5RA_T5BIsK1opdE9xCGUIff4PerWsOdF4RHW9NK0WkiixUT4viBni3WcEt8d47RavpXjtMV57Q5pn96e4U_wOkwC5AUittIP85-n_u_4CTCS1Wg</recordid><startdate>20190116</startdate><enddate>20190116</enddate><creator>Lee, S. H.</creator><creator>Mastronardi, C. A.</creator><creator>Li, R. W.</creator><creator>Paz-Filho, G.</creator><creator>Dutcher, E. G.</creator><creator>Lewis, M. D.</creator><creator>Vincent, A. D.</creator><creator>Smith, P. N.</creator><creator>Bornstein, S. R.</creator><creator>Licinio, J.</creator><creator>Wong, M. L.</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>C6C</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>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</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>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190116</creationdate><title>Short-term antidepressant treatment has long-lasting effects, and reverses stress-induced decreases in bone features in rats</title><author>Lee, S. H. ; Mastronardi, C. A. ; Li, R. W. ; Paz-Filho, G. ; Dutcher, E. G. ; Lewis, M. D. ; Vincent, A. D. ; Smith, P. N. ; Bornstein, S. R. ; Licinio, J. ; Wong, M. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-a524f3e26b0ff1458a107c80fefdc8cae47c9ebedcbb7bc8d292dacdab52f2763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>631/154/436</topic><topic>692/699/476/1414</topic><topic>Animals</topic><topic>Antidepressants</topic><topic>Antidepressive Agents - pharmacology</topic><topic>Behavior, Animal - drug effects</topic><topic>Behavioral Sciences</topic><topic>Biological Psychology</topic><topic>Bone Density - drug effects</topic><topic>Disease Models, Animal</topic><topic>Fluoxetine - pharmacology</topic><topic>Leptin - metabolism</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Neurosciences</topic><topic>Obesity</topic><topic>Obesity - metabolism</topic><topic>Pharmacotherapy</topic><topic>Psychiatry</topic><topic>Rats</topic><topic>Rats, Sprague-Dawley</topic><topic>Rodents</topic><topic>Short term</topic><topic>Stress, Psychological - drug therapy</topic><topic>Weight Gain - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, S. H.</creatorcontrib><creatorcontrib>Mastronardi, C. A.</creatorcontrib><creatorcontrib>Li, R. W.</creatorcontrib><creatorcontrib>Paz-Filho, G.</creatorcontrib><creatorcontrib>Dutcher, E. G.</creatorcontrib><creatorcontrib>Lewis, M. D.</creatorcontrib><creatorcontrib>Vincent, A. D.</creatorcontrib><creatorcontrib>Smith, P. N.</creatorcontrib><creatorcontrib>Bornstein, S. R.</creatorcontrib><creatorcontrib>Licinio, J.</creatorcontrib><creatorcontrib>Wong, M. L.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</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>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</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>Translational psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, S. H.</au><au>Mastronardi, C. A.</au><au>Li, R. W.</au><au>Paz-Filho, G.</au><au>Dutcher, E. G.</au><au>Lewis, M. D.</au><au>Vincent, A. D.</au><au>Smith, P. N.</au><au>Bornstein, S. R.</au><au>Licinio, J.</au><au>Wong, M. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Short-term antidepressant treatment has long-lasting effects, and reverses stress-induced decreases in bone features in rats</atitle><jtitle>Translational psychiatry</jtitle><stitle>Transl Psychiatry</stitle><addtitle>Transl Psychiatry</addtitle><date>2019-01-16</date><risdate>2019</risdate><volume>9</volume><issue>1</issue><spage>10</spage><epage>10</epage><pages>10-10</pages><artnum>10</artnum><issn>2158-3188</issn><eissn>2158-3188</eissn><abstract>Antidepressants are among the most-prescribed class of drugs in the world and though weight gain is a common outcome of antidepressant treatment, that effect is not well understood. We employed an animal model comprised of 2 weeks of chronic restraint stress with antidepressant treatment, followed by diet-induced obesity. We showed that short-term antidepressant treatment had long-lasting effects, not only leading to weight gain, but also enhancing trabecular and cortical bone features in rats; therefore, weight gain in this model was different from that of the classic diet-induced obesity. Late in the post-restraint recovery period, antidepressant-treated animals were significantly heavier and had better bone features than saline-treated controls, when assessed in the distal femoral metaphysis. The propensity to gain weight might have influenced the rate of catch-up growth and bone allometry, as heavier animals treated with fluoxetine also had enhanced bone features when compared to non-stressed animals. Therefore, short-term antidepressant treatment ameliorated the long-term effects of stress on body growth and bone. Growth and bone structural features were associated with leptin levels, and the interaction between leptin levels and antidepressant was significant for bone mineral content, suggesting that short-term antidepressants in the context of long-term diet-induced obesity modified the role of leptin in bone formation. To our knowledge this is the first study reporting that short-term antidepressant treatment has long-lasting effects in restoring the effects of chronic stress in body weight and bone formation. Our findings may be relevant to the understanding and treatment of osteoporosis, a condition of increasing prevalence due to the aging population.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>30664741</pmid><doi>10.1038/s41398-018-0351-z</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2158-3188
ispartof Translational psychiatry, 2019-01, Vol.9 (1), p.10-10, Article 10
issn 2158-3188
2158-3188
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6341077
source MEDLINE; DOAJ Directory of Open Access Journals; Springer Nature OA Free Journals; Nature Free; EZB-FREE-00999 freely available EZB journals; PubMed Central
subjects 631/154/436
692/699/476/1414
Animals
Antidepressants
Antidepressive Agents - pharmacology
Behavior, Animal - drug effects
Behavioral Sciences
Biological Psychology
Bone Density - drug effects
Disease Models, Animal
Fluoxetine - pharmacology
Leptin - metabolism
Male
Medicine
Medicine & Public Health
Neurosciences
Obesity
Obesity - metabolism
Pharmacotherapy
Psychiatry
Rats
Rats, Sprague-Dawley
Rodents
Short term
Stress, Psychological - drug therapy
Weight Gain - drug effects
title Short-term antidepressant treatment has long-lasting effects, and reverses stress-induced decreases in bone features in rats
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T23%3A35%3A56IST&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=Short-term%20antidepressant%20treatment%20has%20long-lasting%20effects,%20and%20reverses%20stress-induced%20decreases%20in%20bone%20features%20in%20rats&rft.jtitle=Translational%20psychiatry&rft.au=Lee,%20S.%20H.&rft.date=2019-01-16&rft.volume=9&rft.issue=1&rft.spage=10&rft.epage=10&rft.pages=10-10&rft.artnum=10&rft.issn=2158-3188&rft.eissn=2158-3188&rft_id=info:doi/10.1038/s41398-018-0351-z&rft_dat=%3Cproquest_pubme%3E2169285712%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=2169285712&rft_id=info:pmid/30664741&rfr_iscdi=true