Distinct Patterns of HBV Integration and TERT Alterations between in Tumor and Non-Tumor Tissue in Patients with Hepatocellular Carcinoma
Although hepatitis B virus (HBV) integration into the cellular genome is well known in HCC (hepatocellular carcinoma) patients, its biological role still remains uncertain. This study investigated the patterns of HBV integration and correlated them with TERT (telomerase reverse transcriptase) altera...
Gespeichert in:
Veröffentlicht in: | International journal of molecular sciences 2021-07, Vol.22 (13), p.7056 |
---|---|
Hauptverfasser: | , , , , , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | |
---|---|
container_issue | 13 |
container_start_page | 7056 |
container_title | International journal of molecular sciences |
container_volume | 22 |
creator | Jang, Jeong-Won Kim, Hye-Seon Kim, Jin-Seoub Lee, Soon-Kyu Han, Ji-Won Sung, Pil-Soo Bae, Si-Hyun Choi, Jong-Young Yoon, Seung-Kew Han, Dong-Jin Kim, Tae-Min Roberts, Lewis R. |
description | Although hepatitis B virus (HBV) integration into the cellular genome is well known in HCC (hepatocellular carcinoma) patients, its biological role still remains uncertain. This study investigated the patterns of HBV integration and correlated them with TERT (telomerase reverse transcriptase) alterations in paired tumor and non-tumor tissues. Compared to those in non-tumors, tumoral integrations occurred less frequently but with higher read counts and were more preferentially observed in genic regions with significant enrichment of integration into promoters. In HBV-related tumors, TERT promoter was identified as the most frequent site (38.5% (10/26)) of HBV integration. TERT promoter mutation was observed only in tumors (24.2% (8/33)), but not in non-tumors. Only 3.00% (34/1133) of HBV integration sites were shared between tumors and non-tumors. Within the HBV genome, HBV breakpoints were distributed preferentially in the 3’ end of HBx, with more tumoral integrations detected in the preS/S region. The major genes that were recurrently affected by HBV integration included TERT and MLL4 for tumors and FN1 for non-tumors. Functional enrichment analysis of tumoral genes with integrations showed enrichment of cancer-associated genes. The patterns and functions of HBV integration are distinct between tumors and non-tumors. Tumoral integration is often enriched into both human-virus regions with oncogenic regulatory function. The characteristic genomic features of HBV integration together with TERT alteration may dysregulate the affected gene function, thereby contributing to hepatocarcinogenesis. |
doi_str_mv | 10.3390/ijms22137056 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8268258</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2548414040</sourcerecordid><originalsourceid>FETCH-LOGICAL-c389t-c6fe2344197b7960ae068dd74937670e9e5993a013de47d487088abe36a9f3f23</originalsourceid><addsrcrecordid>eNpdkc1u1DAUha2qqH901wewxKYLAje2E9sbpHYoTKUKEApsLU9y03qU2FPboeIR-tZkOhUqrO7fp6NzdQg5K-Ed5xreu_WYGCu5hKreI0elYKwAqOX-i_6QHKe0BmCcVfqAHHLBQIPUR-Txo0vZ-TbTbzZnjD7R0NPl5U967TPeRptd8NT6jjZX3xt6MczM0y7RFeYHRE-dp800hvhEfQm-2E2NS2nC7XVWduhzog8u39ElbmwOLQ7DNNhIFza2zofRviavejskPH2uJ-THp6tmsSxuvn6-XlzcFC1XOhdt3SPjQpRarqSuwSLUquuk0FzWElBjpTW3UPIOheyEkqCUXSGvre55z_gJ-bDT3UyrEbt2dhbtYDbRjTb-NsE68-_FuztzG34ZxWrFKjULnD8LxHA_YcpmdGn7j_UYpmRYJZQoBQiY0Tf_oeswRT-_t6W0KAFkNVNvd1QbQ0oR-79mSjDbjM3LjPkfRpeZ5w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2549410075</pqid></control><display><type>article</type><title>Distinct Patterns of HBV Integration and TERT Alterations between in Tumor and Non-Tumor Tissue in Patients with Hepatocellular Carcinoma</title><source>MDPI - Multidisciplinary Digital Publishing Institute</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Jang, Jeong-Won ; Kim, Hye-Seon ; Kim, Jin-Seoub ; Lee, Soon-Kyu ; Han, Ji-Won ; Sung, Pil-Soo ; Bae, Si-Hyun ; Choi, Jong-Young ; Yoon, Seung-Kew ; Han, Dong-Jin ; Kim, Tae-Min ; Roberts, Lewis R.</creator><creatorcontrib>Jang, Jeong-Won ; Kim, Hye-Seon ; Kim, Jin-Seoub ; Lee, Soon-Kyu ; Han, Ji-Won ; Sung, Pil-Soo ; Bae, Si-Hyun ; Choi, Jong-Young ; Yoon, Seung-Kew ; Han, Dong-Jin ; Kim, Tae-Min ; Roberts, Lewis R.</creatorcontrib><description>Although hepatitis B virus (HBV) integration into the cellular genome is well known in HCC (hepatocellular carcinoma) patients, its biological role still remains uncertain. This study investigated the patterns of HBV integration and correlated them with TERT (telomerase reverse transcriptase) alterations in paired tumor and non-tumor tissues. Compared to those in non-tumors, tumoral integrations occurred less frequently but with higher read counts and were more preferentially observed in genic regions with significant enrichment of integration into promoters. In HBV-related tumors, TERT promoter was identified as the most frequent site (38.5% (10/26)) of HBV integration. TERT promoter mutation was observed only in tumors (24.2% (8/33)), but not in non-tumors. Only 3.00% (34/1133) of HBV integration sites were shared between tumors and non-tumors. Within the HBV genome, HBV breakpoints were distributed preferentially in the 3’ end of HBx, with more tumoral integrations detected in the preS/S region. The major genes that were recurrently affected by HBV integration included TERT and MLL4 for tumors and FN1 for non-tumors. Functional enrichment analysis of tumoral genes with integrations showed enrichment of cancer-associated genes. The patterns and functions of HBV integration are distinct between tumors and non-tumors. Tumoral integration is often enriched into both human-virus regions with oncogenic regulatory function. The characteristic genomic features of HBV integration together with TERT alteration may dysregulate the affected gene function, thereby contributing to hepatocarcinogenesis.</description><identifier>ISSN: 1422-0067</identifier><identifier>ISSN: 1661-6596</identifier><identifier>EISSN: 1422-0067</identifier><identifier>DOI: 10.3390/ijms22137056</identifier><identifier>PMID: 34209079</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Breakpoints ; Chromosomes ; Enrichment ; Genes ; Genomes ; Hepatitis B ; Hepatocellular carcinoma ; Infections ; Integration ; Liver cancer ; Mutation ; RNA-directed DNA polymerase ; Senescence ; Telomerase ; Telomerase reverse transcriptase ; Tumors</subject><ispartof>International journal of molecular sciences, 2021-07, Vol.22 (13), p.7056</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c389t-c6fe2344197b7960ae068dd74937670e9e5993a013de47d487088abe36a9f3f23</citedby><cites>FETCH-LOGICAL-c389t-c6fe2344197b7960ae068dd74937670e9e5993a013de47d487088abe36a9f3f23</cites><orcidid>0000-0003-1456-1450 ; 0000-0002-4476-4868 ; 0000-0003-3255-8474 ; 0000-0001-7885-8574 ; 0000-0002-5780-9607 ; 0000-0003-1865-8225</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/PMC8268258/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268258/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids></links><search><creatorcontrib>Jang, Jeong-Won</creatorcontrib><creatorcontrib>Kim, Hye-Seon</creatorcontrib><creatorcontrib>Kim, Jin-Seoub</creatorcontrib><creatorcontrib>Lee, Soon-Kyu</creatorcontrib><creatorcontrib>Han, Ji-Won</creatorcontrib><creatorcontrib>Sung, Pil-Soo</creatorcontrib><creatorcontrib>Bae, Si-Hyun</creatorcontrib><creatorcontrib>Choi, Jong-Young</creatorcontrib><creatorcontrib>Yoon, Seung-Kew</creatorcontrib><creatorcontrib>Han, Dong-Jin</creatorcontrib><creatorcontrib>Kim, Tae-Min</creatorcontrib><creatorcontrib>Roberts, Lewis R.</creatorcontrib><title>Distinct Patterns of HBV Integration and TERT Alterations between in Tumor and Non-Tumor Tissue in Patients with Hepatocellular Carcinoma</title><title>International journal of molecular sciences</title><description>Although hepatitis B virus (HBV) integration into the cellular genome is well known in HCC (hepatocellular carcinoma) patients, its biological role still remains uncertain. This study investigated the patterns of HBV integration and correlated them with TERT (telomerase reverse transcriptase) alterations in paired tumor and non-tumor tissues. Compared to those in non-tumors, tumoral integrations occurred less frequently but with higher read counts and were more preferentially observed in genic regions with significant enrichment of integration into promoters. In HBV-related tumors, TERT promoter was identified as the most frequent site (38.5% (10/26)) of HBV integration. TERT promoter mutation was observed only in tumors (24.2% (8/33)), but not in non-tumors. Only 3.00% (34/1133) of HBV integration sites were shared between tumors and non-tumors. Within the HBV genome, HBV breakpoints were distributed preferentially in the 3’ end of HBx, with more tumoral integrations detected in the preS/S region. The major genes that were recurrently affected by HBV integration included TERT and MLL4 for tumors and FN1 for non-tumors. Functional enrichment analysis of tumoral genes with integrations showed enrichment of cancer-associated genes. The patterns and functions of HBV integration are distinct between tumors and non-tumors. Tumoral integration is often enriched into both human-virus regions with oncogenic regulatory function. The characteristic genomic features of HBV integration together with TERT alteration may dysregulate the affected gene function, thereby contributing to hepatocarcinogenesis.</description><subject>Breakpoints</subject><subject>Chromosomes</subject><subject>Enrichment</subject><subject>Genes</subject><subject>Genomes</subject><subject>Hepatitis B</subject><subject>Hepatocellular carcinoma</subject><subject>Infections</subject><subject>Integration</subject><subject>Liver cancer</subject><subject>Mutation</subject><subject>RNA-directed DNA polymerase</subject><subject>Senescence</subject><subject>Telomerase</subject><subject>Telomerase reverse transcriptase</subject><subject>Tumors</subject><issn>1422-0067</issn><issn>1661-6596</issn><issn>1422-0067</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpdkc1u1DAUha2qqH901wewxKYLAje2E9sbpHYoTKUKEApsLU9y03qU2FPboeIR-tZkOhUqrO7fp6NzdQg5K-Ed5xreu_WYGCu5hKreI0elYKwAqOX-i_6QHKe0BmCcVfqAHHLBQIPUR-Txo0vZ-TbTbzZnjD7R0NPl5U967TPeRptd8NT6jjZX3xt6MczM0y7RFeYHRE-dp800hvhEfQm-2E2NS2nC7XVWduhzog8u39ElbmwOLQ7DNNhIFza2zofRviavejskPH2uJ-THp6tmsSxuvn6-XlzcFC1XOhdt3SPjQpRarqSuwSLUquuk0FzWElBjpTW3UPIOheyEkqCUXSGvre55z_gJ-bDT3UyrEbt2dhbtYDbRjTb-NsE68-_FuztzG34ZxWrFKjULnD8LxHA_YcpmdGn7j_UYpmRYJZQoBQiY0Tf_oeswRT-_t6W0KAFkNVNvd1QbQ0oR-79mSjDbjM3LjPkfRpeZ5w</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Jang, Jeong-Won</creator><creator>Kim, Hye-Seon</creator><creator>Kim, Jin-Seoub</creator><creator>Lee, Soon-Kyu</creator><creator>Han, Ji-Won</creator><creator>Sung, Pil-Soo</creator><creator>Bae, Si-Hyun</creator><creator>Choi, Jong-Young</creator><creator>Yoon, Seung-Kew</creator><creator>Han, Dong-Jin</creator><creator>Kim, Tae-Min</creator><creator>Roberts, Lewis R.</creator><general>MDPI AG</general><general>MDPI</general><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>8G5</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>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1456-1450</orcidid><orcidid>https://orcid.org/0000-0002-4476-4868</orcidid><orcidid>https://orcid.org/0000-0003-3255-8474</orcidid><orcidid>https://orcid.org/0000-0001-7885-8574</orcidid><orcidid>https://orcid.org/0000-0002-5780-9607</orcidid><orcidid>https://orcid.org/0000-0003-1865-8225</orcidid></search><sort><creationdate>20210701</creationdate><title>Distinct Patterns of HBV Integration and TERT Alterations between in Tumor and Non-Tumor Tissue in Patients with Hepatocellular Carcinoma</title><author>Jang, Jeong-Won ; Kim, Hye-Seon ; Kim, Jin-Seoub ; Lee, Soon-Kyu ; Han, Ji-Won ; Sung, Pil-Soo ; Bae, Si-Hyun ; Choi, Jong-Young ; Yoon, Seung-Kew ; Han, Dong-Jin ; Kim, Tae-Min ; Roberts, Lewis R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-c6fe2344197b7960ae068dd74937670e9e5993a013de47d487088abe36a9f3f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Breakpoints</topic><topic>Chromosomes</topic><topic>Enrichment</topic><topic>Genes</topic><topic>Genomes</topic><topic>Hepatitis B</topic><topic>Hepatocellular carcinoma</topic><topic>Infections</topic><topic>Integration</topic><topic>Liver cancer</topic><topic>Mutation</topic><topic>RNA-directed DNA polymerase</topic><topic>Senescence</topic><topic>Telomerase</topic><topic>Telomerase reverse transcriptase</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jang, Jeong-Won</creatorcontrib><creatorcontrib>Kim, Hye-Seon</creatorcontrib><creatorcontrib>Kim, Jin-Seoub</creatorcontrib><creatorcontrib>Lee, Soon-Kyu</creatorcontrib><creatorcontrib>Han, Ji-Won</creatorcontrib><creatorcontrib>Sung, Pil-Soo</creatorcontrib><creatorcontrib>Bae, Si-Hyun</creatorcontrib><creatorcontrib>Choi, Jong-Young</creatorcontrib><creatorcontrib>Yoon, Seung-Kew</creatorcontrib><creatorcontrib>Han, Dong-Jin</creatorcontrib><creatorcontrib>Kim, Tae-Min</creatorcontrib><creatorcontrib>Roberts, Lewis R.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & 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>Research Library (Alumni Edition)</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 Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</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 Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of molecular sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jang, Jeong-Won</au><au>Kim, Hye-Seon</au><au>Kim, Jin-Seoub</au><au>Lee, Soon-Kyu</au><au>Han, Ji-Won</au><au>Sung, Pil-Soo</au><au>Bae, Si-Hyun</au><au>Choi, Jong-Young</au><au>Yoon, Seung-Kew</au><au>Han, Dong-Jin</au><au>Kim, Tae-Min</au><au>Roberts, Lewis R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distinct Patterns of HBV Integration and TERT Alterations between in Tumor and Non-Tumor Tissue in Patients with Hepatocellular Carcinoma</atitle><jtitle>International journal of molecular sciences</jtitle><date>2021-07-01</date><risdate>2021</risdate><volume>22</volume><issue>13</issue><spage>7056</spage><pages>7056-</pages><issn>1422-0067</issn><issn>1661-6596</issn><eissn>1422-0067</eissn><abstract>Although hepatitis B virus (HBV) integration into the cellular genome is well known in HCC (hepatocellular carcinoma) patients, its biological role still remains uncertain. This study investigated the patterns of HBV integration and correlated them with TERT (telomerase reverse transcriptase) alterations in paired tumor and non-tumor tissues. Compared to those in non-tumors, tumoral integrations occurred less frequently but with higher read counts and were more preferentially observed in genic regions with significant enrichment of integration into promoters. In HBV-related tumors, TERT promoter was identified as the most frequent site (38.5% (10/26)) of HBV integration. TERT promoter mutation was observed only in tumors (24.2% (8/33)), but not in non-tumors. Only 3.00% (34/1133) of HBV integration sites were shared between tumors and non-tumors. Within the HBV genome, HBV breakpoints were distributed preferentially in the 3’ end of HBx, with more tumoral integrations detected in the preS/S region. The major genes that were recurrently affected by HBV integration included TERT and MLL4 for tumors and FN1 for non-tumors. Functional enrichment analysis of tumoral genes with integrations showed enrichment of cancer-associated genes. The patterns and functions of HBV integration are distinct between tumors and non-tumors. Tumoral integration is often enriched into both human-virus regions with oncogenic regulatory function. The characteristic genomic features of HBV integration together with TERT alteration may dysregulate the affected gene function, thereby contributing to hepatocarcinogenesis.</abstract><cop>Basel</cop><pub>MDPI AG</pub><pmid>34209079</pmid><doi>10.3390/ijms22137056</doi><orcidid>https://orcid.org/0000-0003-1456-1450</orcidid><orcidid>https://orcid.org/0000-0002-4476-4868</orcidid><orcidid>https://orcid.org/0000-0003-3255-8474</orcidid><orcidid>https://orcid.org/0000-0001-7885-8574</orcidid><orcidid>https://orcid.org/0000-0002-5780-9607</orcidid><orcidid>https://orcid.org/0000-0003-1865-8225</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1422-0067 |
ispartof | International journal of molecular sciences, 2021-07, Vol.22 (13), p.7056 |
issn | 1422-0067 1661-6596 1422-0067 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8268258 |
source | MDPI - Multidisciplinary Digital Publishing Institute; EZB-FREE-00999 freely available EZB journals; PubMed Central |
subjects | Breakpoints Chromosomes Enrichment Genes Genomes Hepatitis B Hepatocellular carcinoma Infections Integration Liver cancer Mutation RNA-directed DNA polymerase Senescence Telomerase Telomerase reverse transcriptase Tumors |
title | Distinct Patterns of HBV Integration and TERT Alterations between in Tumor and Non-Tumor Tissue in Patients with Hepatocellular Carcinoma |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-10T21%3A00%3A46IST&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=Distinct%20Patterns%20of%20HBV%20Integration%20and%20TERT%20Alterations%20between%20in%20Tumor%20and%20Non-Tumor%20Tissue%20in%20Patients%20with%20Hepatocellular%20Carcinoma&rft.jtitle=International%20journal%20of%20molecular%20sciences&rft.au=Jang,%20Jeong-Won&rft.date=2021-07-01&rft.volume=22&rft.issue=13&rft.spage=7056&rft.pages=7056-&rft.issn=1422-0067&rft.eissn=1422-0067&rft_id=info:doi/10.3390/ijms22137056&rft_dat=%3Cproquest_pubme%3E2548414040%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=2549410075&rft_id=info:pmid/34209079&rfr_iscdi=true |