Impaired brain function improved by l-carnitine in patients with cirrhosis: evaluation using near-infrared spectroscopy
To evaluate the effects of l -carnitine on impaired brain function in patients with liver cirrhosis. We conducted a retrospective cohort study that included sequential 80 liver cirrhosis patients with impaired brain function evaluated using near-infrared spectroscopy (NIRS). Among them, l -carnitine...
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| creator | Nakanishi, Hiroyuki Hayakawa, Yuka Kubota, Youhei Kurosaki, Masayuki Osawa, Leona Inada, Kento Kirino, Sakura Yamashita, Koji Sekiguchi, Shuhei Okada, Mao Wan, Wang Higuchi, Mayu Takaura, Kenta Maeyashiki, Chiaki Kaneko, Shun Tamaki, Nobuharu Yasui, Yutaka Noda, Takamasa Nakanishi, Kaoru Tsuchiya, Kaoru Itakura, Jun Takahashi, Yuka Izumi, Namiki |
| description | To evaluate the effects of
l
-carnitine on impaired brain function in patients with liver cirrhosis. We conducted a retrospective cohort study that included sequential 80 liver cirrhosis patients with impaired brain function evaluated using near-infrared spectroscopy (NIRS). Among them,
l
-carnitine was administered to 48 patients. The NIRS data and blood ammonia level at baseline and after 8 weeks of treatment were compared between patients administered with
l
-carnitine (
l
-carnitine group) and those who were not (control group). The NIRS data at baseline were similar between the
l
-carnitine and control groups (0.04 ± 0.04 vs. 0.04 ± 0.05 mMmm, p = n.s), whereas those in the
l
-carnitine group (n = 48) were significantly better than that of the control group at 8 weeks of treatment (n = 32) (0.103 ± 0.081 vs. 0.040 ± 0.048 mMmm, p |
| doi_str_mv | 10.1038/s41598-020-70585-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7419306</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2432686747</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-398c9b703898a04ecb8b69b6b675f77b75a545e1af72e02eaf6ff88ebc1935ad3</originalsourceid><addsrcrecordid>eNp9kctu1DAUhi0EolXpC7BAltiwMXV8iR0WSKjiUqkSG1hbtudkxlViBzuZKm-Pp1PawgJvfPvOfy4_Qq8b-r6hXF8U0chOE8ooUVRqSdZn6JRRIQnjjD1_cj5B56Xc0Lok60TTvUQnnCnN6uUU3V6Nkw0ZNthlGyLul-jnkCIO45TT_vC-4oF4m2OYQwRcmcnOAeJc8G2Yd9iHnHephPIBw94Oi70LX0qIWxzBZhJin-0hQ5nAzzkVn6b1FXrR26HA-f1-hn5--fzj8hu5_v716vLTNfFCiZnwTvvOqdpwpy0V4J12beda1yrZK-WUtFJIaGyvGFAGtm_7Xmtwvum4tBt-hj4edafFjbDxte5sBzPlMNq8mmSD-fsnhp3Zpr1RdVKctlXg3b1ATr8WKLMZQ_EwDDZCWophgnPGdR12Rd_-g96kJcfa3oFirW6VUJViR8rXUZQM_UMxDTUHa83RWlOtNXfWmrUGvXnaxkPIHyMrwI9AqV9xC_kx939kfwPm2rNA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2432686747</pqid></control><display><type>article</type><title>Impaired brain function improved by l-carnitine in patients with cirrhosis: evaluation using near-infrared spectroscopy</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Nature Free</source><source>PubMed Central</source><source>Springer Nature OA/Free Journals</source><source>Free Full-Text Journals in Chemistry</source><creator>Nakanishi, Hiroyuki ; Hayakawa, Yuka ; Kubota, Youhei ; Kurosaki, Masayuki ; Osawa, Leona ; Inada, Kento ; Kirino, Sakura ; Yamashita, Koji ; Sekiguchi, Shuhei ; Okada, Mao ; Wan, Wang ; Higuchi, Mayu ; Takaura, Kenta ; Maeyashiki, Chiaki ; Kaneko, Shun ; Tamaki, Nobuharu ; Yasui, Yutaka ; Noda, Takamasa ; Nakanishi, Kaoru ; Tsuchiya, Kaoru ; Itakura, Jun ; Takahashi, Yuka ; Izumi, Namiki</creator><creatorcontrib>Nakanishi, Hiroyuki ; Hayakawa, Yuka ; Kubota, Youhei ; Kurosaki, Masayuki ; Osawa, Leona ; Inada, Kento ; Kirino, Sakura ; Yamashita, Koji ; Sekiguchi, Shuhei ; Okada, Mao ; Wan, Wang ; Higuchi, Mayu ; Takaura, Kenta ; Maeyashiki, Chiaki ; Kaneko, Shun ; Tamaki, Nobuharu ; Yasui, Yutaka ; Noda, Takamasa ; Nakanishi, Kaoru ; Tsuchiya, Kaoru ; Itakura, Jun ; Takahashi, Yuka ; Izumi, Namiki</creatorcontrib><description>To evaluate the effects of
l
-carnitine on impaired brain function in patients with liver cirrhosis. We conducted a retrospective cohort study that included sequential 80 liver cirrhosis patients with impaired brain function evaluated using near-infrared spectroscopy (NIRS). Among them,
l
-carnitine was administered to 48 patients. The NIRS data and blood ammonia level at baseline and after 8 weeks of treatment were compared between patients administered with
l
-carnitine (
l
-carnitine group) and those who were not (control group). The NIRS data at baseline were similar between the
l
-carnitine and control groups (0.04 ± 0.04 vs. 0.04 ± 0.05 mMmm, p = n.s), whereas those in the
l
-carnitine group (n = 48) were significantly better than that of the control group at 8 weeks of treatment (n = 32) (0.103 ± 0.081 vs. 0.040 ± 0.048 mMmm, p < 0.001). In the
l
-carnitine group, 35.4% (17/48) of patients had hyperammonemia. The NIRS data of the
l
-carnitine group at 8 weeks of treatment were significantly improved than that of the control group, irrespective of baseline ammonia levels (0.11 ± 0.09 vs. 0.04 ± 0.05 mMmm, p = 0.005, and 0.10 ± 0.06 vs. 0.02 ± 0.03 mMmm, p = 0.003, for normal baseline ammonia and elevated ammonia levels, respectively). In the multivariate analysis,
l
-carnitine administration (odds ratio [OR] 3.51, 95% confidence interval [CI] 1.23–9.99, p = 0.019) and baseline NIRS data of ≤ 0.07 mMmm (OR 5.21, 95% CI 1.69–16.0, p = 0.0041) were found as independent significant factors.
l
-carnitine improves impaired brain function in patients with liver cirrhosis.</description><identifier>ISSN: 2045-2322</identifier><identifier>EISSN: 2045-2322</identifier><identifier>DOI: 10.1038/s41598-020-70585-y</identifier><identifier>PMID: 32782294</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/378/2607 ; 692/4020/4021/1607/1604 ; 692/617/375/2609 ; Aged ; Ammonia ; Brain Diseases - drug therapy ; Brain Diseases - etiology ; Brain Diseases - pathology ; Carnitine ; Carnitine - pharmacology ; Cirrhosis ; Female ; Humanities and Social Sciences ; Humans ; Hyperammonemia ; I.R. radiation ; Infrared spectroscopy ; Liver ; Liver cirrhosis ; Liver Cirrhosis - complications ; Male ; multidisciplinary ; Multivariate analysis ; Prognosis ; Retrospective Studies ; Science ; Science (multidisciplinary) ; Spectroscopy, Near-Infrared - methods ; Spectrum analysis</subject><ispartof>Scientific reports, 2020-08, Vol.10 (1), p.13566-13566, Article 13566</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. 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-c474t-398c9b703898a04ecb8b69b6b675f77b75a545e1af72e02eaf6ff88ebc1935ad3</citedby><cites>FETCH-LOGICAL-c474t-398c9b703898a04ecb8b69b6b675f77b75a545e1af72e02eaf6ff88ebc1935ad3</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/PMC7419306/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419306/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,41120,42189,51576,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32782294$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakanishi, Hiroyuki</creatorcontrib><creatorcontrib>Hayakawa, Yuka</creatorcontrib><creatorcontrib>Kubota, Youhei</creatorcontrib><creatorcontrib>Kurosaki, Masayuki</creatorcontrib><creatorcontrib>Osawa, Leona</creatorcontrib><creatorcontrib>Inada, Kento</creatorcontrib><creatorcontrib>Kirino, Sakura</creatorcontrib><creatorcontrib>Yamashita, Koji</creatorcontrib><creatorcontrib>Sekiguchi, Shuhei</creatorcontrib><creatorcontrib>Okada, Mao</creatorcontrib><creatorcontrib>Wan, Wang</creatorcontrib><creatorcontrib>Higuchi, Mayu</creatorcontrib><creatorcontrib>Takaura, Kenta</creatorcontrib><creatorcontrib>Maeyashiki, Chiaki</creatorcontrib><creatorcontrib>Kaneko, Shun</creatorcontrib><creatorcontrib>Tamaki, Nobuharu</creatorcontrib><creatorcontrib>Yasui, Yutaka</creatorcontrib><creatorcontrib>Noda, Takamasa</creatorcontrib><creatorcontrib>Nakanishi, Kaoru</creatorcontrib><creatorcontrib>Tsuchiya, Kaoru</creatorcontrib><creatorcontrib>Itakura, Jun</creatorcontrib><creatorcontrib>Takahashi, Yuka</creatorcontrib><creatorcontrib>Izumi, Namiki</creatorcontrib><title>Impaired brain function improved by l-carnitine in patients with cirrhosis: evaluation using near-infrared spectroscopy</title><title>Scientific reports</title><addtitle>Sci Rep</addtitle><addtitle>Sci Rep</addtitle><description>To evaluate the effects of
l
-carnitine on impaired brain function in patients with liver cirrhosis. We conducted a retrospective cohort study that included sequential 80 liver cirrhosis patients with impaired brain function evaluated using near-infrared spectroscopy (NIRS). Among them,
l
-carnitine was administered to 48 patients. The NIRS data and blood ammonia level at baseline and after 8 weeks of treatment were compared between patients administered with
l
-carnitine (
l
-carnitine group) and those who were not (control group). The NIRS data at baseline were similar between the
l
-carnitine and control groups (0.04 ± 0.04 vs. 0.04 ± 0.05 mMmm, p = n.s), whereas those in the
l
-carnitine group (n = 48) were significantly better than that of the control group at 8 weeks of treatment (n = 32) (0.103 ± 0.081 vs. 0.040 ± 0.048 mMmm, p < 0.001). In the
l
-carnitine group, 35.4% (17/48) of patients had hyperammonemia. The NIRS data of the
l
-carnitine group at 8 weeks of treatment were significantly improved than that of the control group, irrespective of baseline ammonia levels (0.11 ± 0.09 vs. 0.04 ± 0.05 mMmm, p = 0.005, and 0.10 ± 0.06 vs. 0.02 ± 0.03 mMmm, p = 0.003, for normal baseline ammonia and elevated ammonia levels, respectively). In the multivariate analysis,
l
-carnitine administration (odds ratio [OR] 3.51, 95% confidence interval [CI] 1.23–9.99, p = 0.019) and baseline NIRS data of ≤ 0.07 mMmm (OR 5.21, 95% CI 1.69–16.0, p = 0.0041) were found as independent significant factors.
l
-carnitine improves impaired brain function in patients with liver cirrhosis.</description><subject>631/378/2607</subject><subject>692/4020/4021/1607/1604</subject><subject>692/617/375/2609</subject><subject>Aged</subject><subject>Ammonia</subject><subject>Brain Diseases - drug therapy</subject><subject>Brain Diseases - etiology</subject><subject>Brain Diseases - pathology</subject><subject>Carnitine</subject><subject>Carnitine - pharmacology</subject><subject>Cirrhosis</subject><subject>Female</subject><subject>Humanities and Social Sciences</subject><subject>Humans</subject><subject>Hyperammonemia</subject><subject>I.R. radiation</subject><subject>Infrared spectroscopy</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Male</subject><subject>multidisciplinary</subject><subject>Multivariate analysis</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Science</subject><subject>Science (multidisciplinary)</subject><subject>Spectroscopy, Near-Infrared - 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drug therapy</topic><topic>Brain Diseases - etiology</topic><topic>Brain Diseases - pathology</topic><topic>Carnitine</topic><topic>Carnitine - pharmacology</topic><topic>Cirrhosis</topic><topic>Female</topic><topic>Humanities and Social Sciences</topic><topic>Humans</topic><topic>Hyperammonemia</topic><topic>I.R. radiation</topic><topic>Infrared spectroscopy</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Male</topic><topic>multidisciplinary</topic><topic>Multivariate analysis</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Science</topic><topic>Science (multidisciplinary)</topic><topic>Spectroscopy, Near-Infrared - methods</topic><topic>Spectrum analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakanishi, Hiroyuki</creatorcontrib><creatorcontrib>Hayakawa, Yuka</creatorcontrib><creatorcontrib>Kubota, Youhei</creatorcontrib><creatorcontrib>Kurosaki, Masayuki</creatorcontrib><creatorcontrib>Osawa, Leona</creatorcontrib><creatorcontrib>Inada, Kento</creatorcontrib><creatorcontrib>Kirino, Sakura</creatorcontrib><creatorcontrib>Yamashita, Koji</creatorcontrib><creatorcontrib>Sekiguchi, Shuhei</creatorcontrib><creatorcontrib>Okada, Mao</creatorcontrib><creatorcontrib>Wan, Wang</creatorcontrib><creatorcontrib>Higuchi, Mayu</creatorcontrib><creatorcontrib>Takaura, Kenta</creatorcontrib><creatorcontrib>Maeyashiki, Chiaki</creatorcontrib><creatorcontrib>Kaneko, Shun</creatorcontrib><creatorcontrib>Tamaki, Nobuharu</creatorcontrib><creatorcontrib>Yasui, Yutaka</creatorcontrib><creatorcontrib>Noda, Takamasa</creatorcontrib><creatorcontrib>Nakanishi, Kaoru</creatorcontrib><creatorcontrib>Tsuchiya, Kaoru</creatorcontrib><creatorcontrib>Itakura, Jun</creatorcontrib><creatorcontrib>Takahashi, Yuka</creatorcontrib><creatorcontrib>Izumi, Namiki</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 & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</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>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</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>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science 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 Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Scientific reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakanishi, Hiroyuki</au><au>Hayakawa, Yuka</au><au>Kubota, Youhei</au><au>Kurosaki, Masayuki</au><au>Osawa, Leona</au><au>Inada, Kento</au><au>Kirino, Sakura</au><au>Yamashita, Koji</au><au>Sekiguchi, Shuhei</au><au>Okada, Mao</au><au>Wan, Wang</au><au>Higuchi, Mayu</au><au>Takaura, Kenta</au><au>Maeyashiki, Chiaki</au><au>Kaneko, Shun</au><au>Tamaki, Nobuharu</au><au>Yasui, Yutaka</au><au>Noda, Takamasa</au><au>Nakanishi, Kaoru</au><au>Tsuchiya, Kaoru</au><au>Itakura, Jun</au><au>Takahashi, Yuka</au><au>Izumi, Namiki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impaired brain function improved by l-carnitine in patients with cirrhosis: evaluation using near-infrared spectroscopy</atitle><jtitle>Scientific reports</jtitle><stitle>Sci Rep</stitle><addtitle>Sci Rep</addtitle><date>2020-08-11</date><risdate>2020</risdate><volume>10</volume><issue>1</issue><spage>13566</spage><epage>13566</epage><pages>13566-13566</pages><artnum>13566</artnum><issn>2045-2322</issn><eissn>2045-2322</eissn><abstract>To evaluate the effects of
l
-carnitine on impaired brain function in patients with liver cirrhosis. We conducted a retrospective cohort study that included sequential 80 liver cirrhosis patients with impaired brain function evaluated using near-infrared spectroscopy (NIRS). Among them,
l
-carnitine was administered to 48 patients. The NIRS data and blood ammonia level at baseline and after 8 weeks of treatment were compared between patients administered with
l
-carnitine (
l
-carnitine group) and those who were not (control group). The NIRS data at baseline were similar between the
l
-carnitine and control groups (0.04 ± 0.04 vs. 0.04 ± 0.05 mMmm, p = n.s), whereas those in the
l
-carnitine group (n = 48) were significantly better than that of the control group at 8 weeks of treatment (n = 32) (0.103 ± 0.081 vs. 0.040 ± 0.048 mMmm, p < 0.001). In the
l
-carnitine group, 35.4% (17/48) of patients had hyperammonemia. The NIRS data of the
l
-carnitine group at 8 weeks of treatment were significantly improved than that of the control group, irrespective of baseline ammonia levels (0.11 ± 0.09 vs. 0.04 ± 0.05 mMmm, p = 0.005, and 0.10 ± 0.06 vs. 0.02 ± 0.03 mMmm, p = 0.003, for normal baseline ammonia and elevated ammonia levels, respectively). In the multivariate analysis,
l
-carnitine administration (odds ratio [OR] 3.51, 95% confidence interval [CI] 1.23–9.99, p = 0.019) and baseline NIRS data of ≤ 0.07 mMmm (OR 5.21, 95% CI 1.69–16.0, p = 0.0041) were found as independent significant factors.
l
-carnitine improves impaired brain function in patients with liver cirrhosis.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>32782294</pmid><doi>10.1038/s41598-020-70585-y</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Scientific reports, 2020-08, Vol.10 (1), p.13566-13566, Article 13566 |
| issn | 2045-2322 2045-2322 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7419306 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Nature Free; PubMed Central; Springer Nature OA/Free Journals; Free Full-Text Journals in Chemistry |
| subjects | 631/378/2607 692/4020/4021/1607/1604 692/617/375/2609 Aged Ammonia Brain Diseases - drug therapy Brain Diseases - etiology Brain Diseases - pathology Carnitine Carnitine - pharmacology Cirrhosis Female Humanities and Social Sciences Humans Hyperammonemia I.R. radiation Infrared spectroscopy Liver Liver cirrhosis Liver Cirrhosis - complications Male multidisciplinary Multivariate analysis Prognosis Retrospective Studies Science Science (multidisciplinary) Spectroscopy, Near-Infrared - methods Spectrum analysis |
| title | Impaired brain function improved by l-carnitine in patients with cirrhosis: evaluation using near-infrared spectroscopy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T18%3A43%3A34IST&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=Impaired%20brain%20function%20improved%20by%20l-carnitine%20in%20patients%20with%20cirrhosis:%20evaluation%20using%20near-infrared%20spectroscopy&rft.jtitle=Scientific%20reports&rft.au=Nakanishi,%20Hiroyuki&rft.date=2020-08-11&rft.volume=10&rft.issue=1&rft.spage=13566&rft.epage=13566&rft.pages=13566-13566&rft.artnum=13566&rft.issn=2045-2322&rft.eissn=2045-2322&rft_id=info:doi/10.1038/s41598-020-70585-y&rft_dat=%3Cproquest_pubme%3E2432686747%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=2432686747&rft_id=info:pmid/32782294&rfr_iscdi=true |