Impact of bacterial probiotics on obesity, diabetes and non-alcoholic fatty liver disease related variables: a systematic review and meta-analysis of randomised controlled trials
ObjectiveTo systematically review the effect of oral intake of bacterial probiotics on 15 variables related to obesity, diabetes and non-alcoholic fatty liver disease.DesignSystematic review and meta-analysis.Data sourcesMedline, EMBASE and COCHRANE from 1990 to June 2018.Eligibility criteriaRandomi...
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| creator | Koutnikova, Hana Genser, Bernd Monteiro-Sepulveda, Milena Faurie, Jean-Michel Rizkalla, Salwa Schrezenmeir, Jürgen Clément, Karine |
| description | ObjectiveTo systematically review the effect of oral intake of bacterial probiotics on 15 variables related to obesity, diabetes and non-alcoholic fatty liver disease.DesignSystematic review and meta-analysis.Data sourcesMedline, EMBASE and COCHRANE from 1990 to June 2018.Eligibility criteriaRandomised controlled trials (≥14 days) excluding hypercholesterolaemia, alcoholic liver disease, polycystic ovary syndrome and children |
| doi_str_mv | 10.1136/bmjopen-2017-017995 |
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In overweight but not obese subjects, probiotics induced improvements in: body weight (k=25 trials, d=−0.94 kg mean difference, 95% CI −1.17 to −0.70, I²=0.0%), body mass index (k=32, d=−0.55 kg/m², 95% CI −0.86 to −0.23, I²=91.9%), waist circumference (k=13, d=−1.31 cm, 95% CI −1.79 to −0.83, I²=14.5%), body fat mass (k=11, d=−0.96 kg, 95% CI −1.21 to −0.71, I²=0.0%) and visceral adipose tissue mass (k=5, d=−6.30 cm², 95% CI −9.05 to −3.56, I²=0.0%). In type 2 diabetics, probiotics reduced fasting glucose (k=19, d=−0.66 mmol/L, 95% CI −1.00 to −0.31, I²=27.7%), glycated haemoglobin (k=13, d=−0.28 pp, 95% CI −0.46 to −0.11, I²=54.1%), insulin (k=13, d=−1.66 mU/L, 95% CI −2.70 to −0.61, I²=37.8%) and homeostatic model of insulin resistance (k=10, d=−1.05 pp, 95% CI −1.48 to −0.61, I²=18.2%). In subjects with fatty liver diseases, probiotics reduced alanine (k=12, d=−10.2 U/L, 95% CI −14.3 to −6.0, I²=93.50%) and aspartate aminotransferases (k=10, d=−9.9 U/L, 95% CI −14.1 to -5.8, I²=96.1%). These improvements were mostly observed with bifidobacteria (Bifidobacterium breve, B. longum), Streptococcus salivarius subsp. thermophilus and lactobacilli (Lactobacillus acidophilus, L. casei, L. delbrueckii) containing mixtures and influenced by trials conducted in one country.ConclusionsThe intake of probiotics resulted in minor but consistent improvements in several metabolic risk factors in subjects with metabolic diseases.Trial registration numberCRD42016033273.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2017-017995</identifier><identifier>PMID: 30928918</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Clinical trials ; Diabetes ; Diabetes Mellitus - metabolism ; Diabetes Mellitus - therapy ; Dietary Supplements ; Endocrinology and metabolism ; Evidence-based medicine ; Food and Nutrition ; Human health and pathology ; Humans ; Insulin resistance ; Life Sciences ; Liver diseases ; Meta-analysis ; Non-alcoholic Fatty Liver Disease - metabolism ; Non-alcoholic Fatty Liver Disease - therapy ; Nutrition and Metabolism ; Obesity ; Obesity - metabolism ; Obesity - therapy ; Probiotics ; Probiotics - pharmacology ; Randomized Controlled Trials as Topic ; Santé publique et épidémiologie ; Systematic review ; Treatment Outcome</subject><ispartof>BMJ open, 2019-03, Vol.9 (3), p.e017995-e017995</ispartof><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b506t-b57ce27fc581bd2f53111a6f778e7e49b8e63081d21996856b1e173871bde14f3</citedby><cites>FETCH-LOGICAL-b506t-b57ce27fc581bd2f53111a6f778e7e49b8e63081d21996856b1e173871bde14f3</cites><orcidid>0000-0003-4619-6785</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopen.bmj.com/content/9/3/e017995.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopen.bmj.com/content/9/3/e017995.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27549,27550,27924,27925,53791,53793,77601,77632</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30928918$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.sorbonne-universite.fr/hal-02165922$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Koutnikova, Hana</creatorcontrib><creatorcontrib>Genser, Bernd</creatorcontrib><creatorcontrib>Monteiro-Sepulveda, Milena</creatorcontrib><creatorcontrib>Faurie, Jean-Michel</creatorcontrib><creatorcontrib>Rizkalla, Salwa</creatorcontrib><creatorcontrib>Schrezenmeir, Jürgen</creatorcontrib><creatorcontrib>Clément, Karine</creatorcontrib><title>Impact of bacterial probiotics on obesity, diabetes and non-alcoholic fatty liver disease related variables: a systematic review and meta-analysis of randomised controlled trials</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectiveTo systematically review the effect of oral intake of bacterial probiotics on 15 variables related to obesity, diabetes and non-alcoholic fatty liver disease.DesignSystematic review and meta-analysis.Data sourcesMedline, EMBASE and COCHRANE from 1990 to June 2018.Eligibility criteriaRandomised controlled trials (≥14 days) excluding hypercholesterolaemia, alcoholic liver disease, polycystic ovary syndrome and children <3 years.ResultsOne hundred and five articles met inclusion criteria, representing 6826 subjects. In overweight but not obese subjects, probiotics induced improvements in: body weight (k=25 trials, d=−0.94 kg mean difference, 95% CI −1.17 to −0.70, I²=0.0%), body mass index (k=32, d=−0.55 kg/m², 95% CI −0.86 to −0.23, I²=91.9%), waist circumference (k=13, d=−1.31 cm, 95% CI −1.79 to −0.83, I²=14.5%), body fat mass (k=11, d=−0.96 kg, 95% CI −1.21 to −0.71, I²=0.0%) and visceral adipose tissue mass (k=5, d=−6.30 cm², 95% CI −9.05 to −3.56, I²=0.0%). In type 2 diabetics, probiotics reduced fasting glucose (k=19, d=−0.66 mmol/L, 95% CI −1.00 to −0.31, I²=27.7%), glycated haemoglobin (k=13, d=−0.28 pp, 95% CI −0.46 to −0.11, I²=54.1%), insulin (k=13, d=−1.66 mU/L, 95% CI −2.70 to −0.61, I²=37.8%) and homeostatic model of insulin resistance (k=10, d=−1.05 pp, 95% CI −1.48 to −0.61, I²=18.2%). In subjects with fatty liver diseases, probiotics reduced alanine (k=12, d=−10.2 U/L, 95% CI −14.3 to −6.0, I²=93.50%) and aspartate aminotransferases (k=10, d=−9.9 U/L, 95% CI −14.1 to -5.8, I²=96.1%). These improvements were mostly observed with bifidobacteria (Bifidobacterium breve, B. longum), Streptococcus salivarius subsp. thermophilus and lactobacilli (Lactobacillus acidophilus, L. casei, L. delbrueckii) containing mixtures and influenced by trials conducted in one country.ConclusionsThe intake of probiotics resulted in minor but consistent improvements in several metabolic risk factors in subjects with metabolic diseases.Trial registration numberCRD42016033273.</description><subject>Clinical trials</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - metabolism</subject><subject>Diabetes Mellitus - therapy</subject><subject>Dietary Supplements</subject><subject>Endocrinology and metabolism</subject><subject>Evidence-based medicine</subject><subject>Food and Nutrition</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Insulin resistance</subject><subject>Life Sciences</subject><subject>Liver diseases</subject><subject>Meta-analysis</subject><subject>Non-alcoholic Fatty Liver Disease - metabolism</subject><subject>Non-alcoholic Fatty Liver Disease - therapy</subject><subject>Nutrition and Metabolism</subject><subject>Obesity</subject><subject>Obesity - metabolism</subject><subject>Obesity - therapy</subject><subject>Probiotics</subject><subject>Probiotics - pharmacology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Santé publique et épidémiologie</subject><subject>Systematic review</subject><subject>Treatment Outcome</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNklFr1TAUx4sobsx9AkECvijYmaRN0_ogjKHb4IIv-hyS9tSbS9rUJPdKv5af0NP1bsw9GUhOSH7nn3-Sk2WvGb1grKg-mmHnJxhzTpnMsTeNeJadclqWeUWFeP5ofpKdx7ij2ErRCMFfZicFbXjdsPo0-3M7TLpNxPfEYIRgtSNT8Mb6ZNtI_Ei8gWjT_IF0VhtIEIkeOzL6Mdeu9VvvbEt6ndJMnD1AQCyCjkACOJ2gIweNosZB_EQ0iXNMMGjUxv2Dhd93YgMknetRuznauHgJuOoHFOpI68cUvHM4TYu7-Cp70WOA82M8y358_fL96ibffLu-vbrc5EbQKuEoW-Cyb0XNTMd7UTDGdNVLWYOEsjE1VAWtWcdZ01S1qAwDJotaIg2s7Iuz7POqO-3NAF0L6EM7NQU76DArr636d2e0W_XTH1RVSsELhgLvV4Htk7Sby41a1ihnlWg4Pyzsu-Nhwf_aQ0wKb9-Cc3oEv4-KLx_N0J9A9O0TdOf3AR_vjqKMS_x6pIqVaoOPMUD_4IBRtZSQOpaQWpTVWkKY9ebxnR9y7gsGgYsVwOz_UvwLxibV7A</recordid><startdate>20190330</startdate><enddate>20190330</enddate><creator>Koutnikova, Hana</creator><creator>Genser, Bernd</creator><creator>Monteiro-Sepulveda, Milena</creator><creator>Faurie, Jean-Michel</creator><creator>Rizkalla, Salwa</creator><creator>Schrezenmeir, Jürgen</creator><creator>Clément, Karine</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</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>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4619-6785</orcidid></search><sort><creationdate>20190330</creationdate><title>Impact of bacterial probiotics on obesity, diabetes and non-alcoholic fatty liver disease related variables: a systematic review and meta-analysis of randomised controlled trials</title><author>Koutnikova, Hana ; Genser, Bernd ; Monteiro-Sepulveda, Milena ; Faurie, Jean-Michel ; Rizkalla, Salwa ; Schrezenmeir, Jürgen ; Clément, Karine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b506t-b57ce27fc581bd2f53111a6f778e7e49b8e63081d21996856b1e173871bde14f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Clinical trials</topic><topic>Diabetes</topic><topic>Diabetes Mellitus - metabolism</topic><topic>Diabetes Mellitus - therapy</topic><topic>Dietary Supplements</topic><topic>Endocrinology and metabolism</topic><topic>Evidence-based medicine</topic><topic>Food and Nutrition</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Insulin resistance</topic><topic>Life Sciences</topic><topic>Liver diseases</topic><topic>Meta-analysis</topic><topic>Non-alcoholic Fatty Liver Disease - metabolism</topic><topic>Non-alcoholic Fatty Liver Disease - therapy</topic><topic>Nutrition and Metabolism</topic><topic>Obesity</topic><topic>Obesity - metabolism</topic><topic>Obesity - therapy</topic><topic>Probiotics</topic><topic>Probiotics - pharmacology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Santé publique et épidémiologie</topic><topic>Systematic review</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koutnikova, Hana</creatorcontrib><creatorcontrib>Genser, Bernd</creatorcontrib><creatorcontrib>Monteiro-Sepulveda, Milena</creatorcontrib><creatorcontrib>Faurie, Jean-Michel</creatorcontrib><creatorcontrib>Rizkalla, Salwa</creatorcontrib><creatorcontrib>Schrezenmeir, Jürgen</creatorcontrib><creatorcontrib>Clément, Karine</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</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>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</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>BMJ Journals</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 Central Student</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>Medical Database</collection><collection>Psychology Database</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>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koutnikova, Hana</au><au>Genser, Bernd</au><au>Monteiro-Sepulveda, Milena</au><au>Faurie, Jean-Michel</au><au>Rizkalla, Salwa</au><au>Schrezenmeir, Jürgen</au><au>Clément, Karine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of bacterial probiotics on obesity, diabetes and non-alcoholic fatty liver disease related variables: a systematic review and meta-analysis of randomised controlled trials</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2019-03-30</date><risdate>2019</risdate><volume>9</volume><issue>3</issue><spage>e017995</spage><epage>e017995</epage><pages>e017995-e017995</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectiveTo systematically review the effect of oral intake of bacterial probiotics on 15 variables related to obesity, diabetes and non-alcoholic fatty liver disease.DesignSystematic review and meta-analysis.Data sourcesMedline, EMBASE and COCHRANE from 1990 to June 2018.Eligibility criteriaRandomised controlled trials (≥14 days) excluding hypercholesterolaemia, alcoholic liver disease, polycystic ovary syndrome and children <3 years.ResultsOne hundred and five articles met inclusion criteria, representing 6826 subjects. In overweight but not obese subjects, probiotics induced improvements in: body weight (k=25 trials, d=−0.94 kg mean difference, 95% CI −1.17 to −0.70, I²=0.0%), body mass index (k=32, d=−0.55 kg/m², 95% CI −0.86 to −0.23, I²=91.9%), waist circumference (k=13, d=−1.31 cm, 95% CI −1.79 to −0.83, I²=14.5%), body fat mass (k=11, d=−0.96 kg, 95% CI −1.21 to −0.71, I²=0.0%) and visceral adipose tissue mass (k=5, d=−6.30 cm², 95% CI −9.05 to −3.56, I²=0.0%). In type 2 diabetics, probiotics reduced fasting glucose (k=19, d=−0.66 mmol/L, 95% CI −1.00 to −0.31, I²=27.7%), glycated haemoglobin (k=13, d=−0.28 pp, 95% CI −0.46 to −0.11, I²=54.1%), insulin (k=13, d=−1.66 mU/L, 95% CI −2.70 to −0.61, I²=37.8%) and homeostatic model of insulin resistance (k=10, d=−1.05 pp, 95% CI −1.48 to −0.61, I²=18.2%). In subjects with fatty liver diseases, probiotics reduced alanine (k=12, d=−10.2 U/L, 95% CI −14.3 to −6.0, I²=93.50%) and aspartate aminotransferases (k=10, d=−9.9 U/L, 95% CI −14.1 to -5.8, I²=96.1%). These improvements were mostly observed with bifidobacteria (Bifidobacterium breve, B. longum), Streptococcus salivarius subsp. thermophilus and lactobacilli (Lactobacillus acidophilus, L. casei, L. delbrueckii) containing mixtures and influenced by trials conducted in one country.ConclusionsThe intake of probiotics resulted in minor but consistent improvements in several metabolic risk factors in subjects with metabolic diseases.Trial registration numberCRD42016033273.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>30928918</pmid><doi>10.1136/bmjopen-2017-017995</doi><orcidid>https://orcid.org/0000-0003-4619-6785</orcidid><oa>free_for_read</oa></addata></record> |
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| source | BMJ Open Access Journals; MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Clinical trials Diabetes Diabetes Mellitus - metabolism Diabetes Mellitus - therapy Dietary Supplements Endocrinology and metabolism Evidence-based medicine Food and Nutrition Human health and pathology Humans Insulin resistance Life Sciences Liver diseases Meta-analysis Non-alcoholic Fatty Liver Disease - metabolism Non-alcoholic Fatty Liver Disease - therapy Nutrition and Metabolism Obesity Obesity - metabolism Obesity - therapy Probiotics Probiotics - pharmacology Randomized Controlled Trials as Topic Santé publique et épidémiologie Systematic review Treatment Outcome |
| title | Impact of bacterial probiotics on obesity, diabetes and non-alcoholic fatty liver disease related variables: a systematic review and meta-analysis of randomised controlled trials |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-03T10%3A30%3A31IST&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=Impact%20of%20bacterial%20probiotics%20on%20obesity,%20diabetes%20and%20non-alcoholic%20fatty%20liver%20disease%20related%20variables:%20a%20systematic%20review%20and%20meta-analysis%20of%20randomised%20controlled%20trials&rft.jtitle=BMJ%20open&rft.au=Koutnikova,%20Hana&rft.date=2019-03-30&rft.volume=9&rft.issue=3&rft.spage=e017995&rft.epage=e017995&rft.pages=e017995-e017995&rft.issn=2044-6055&rft.eissn=2044-6055&rft_id=info:doi/10.1136/bmjopen-2017-017995&rft_dat=%3Cproquest_pubme%3E2200127204%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=2200127204&rft_id=info:pmid/30928918&rfr_iscdi=true |