Morning chronotype and digestive tract cancers: Mendelian randomization study
Morning chronotype has been associated with a reduced risk of prostate and breast cancer. However, few studies have examined whether chronotype is associated with digestive tract cancer risk. We conducted a Mendelian randomization (MR) study to assess the associations of chronotype with major digest...
Gespeichert in:
| Veröffentlicht in: | International journal of cancer 2023-02, Vol.152 (4), p.697-704 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 704 |
|---|---|
| container_issue | 4 |
| container_start_page | 697 |
| container_title | International journal of cancer |
| container_volume | 152 |
| creator | Yuan, Shuai Mason, Amy M. Titova, Olga E. Vithayathil, Mathew Kar, Siddhartha Chen, Jie Li, Xue Burgess, Stephen Larsson, Susanna C. |
| description | Morning chronotype has been associated with a reduced risk of prostate and breast cancer. However, few studies have examined whether chronotype is associated with digestive tract cancer risk. We conducted a Mendelian randomization (MR) study to assess the associations of chronotype with major digestive tract cancers. A total of 317 independent genetic variants associated with chronotype at the genome‐wide significance level (P |
| doi_str_mv | 10.1002/ijc.34284 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_450924</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2757044164</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5184-55c85782f6d7419733d106503f898cec399b8613a54c3f934fc71f91a05f6e7d3</originalsourceid><addsrcrecordid>eNp1kUFP3DAQhS3UChbaQ_9AFaknJAIzsR3HPSChpQUqVr20vVrGcRZvd-3FTkDLr69ptqgcONnyfH7z9B4hHxCOEaA6cQtzTFnVsB0yQZCihAr5GzLJMygF0nqP7Ke0AEDkwHbJHq1BUi74hMxmIXrn54W5jcGHfrO2hfZt0bq5Tb27t0UftekLo72xMX0uZta3dum0L2Lmwso96t4FX6R-aDfvyNtOL5N9vz0PyM-vX35ML8vr7xdX07Pr0nBsWMm5abhoqq5uBUMpKG0Rag60a2RjrKFS3jQ1Us2ZoZ2krDMCO4kaeFdb0dIDUo666cGuhxu1jm6l40YF7dT26Xe-WcU4yIpl_uhV_tz9OlMhztUwKNZwRJHx0xHP7Mq2xvocwvLFr5cT727VPNwrkU1LCVng01YghrshB6kWYYg-R6IqwQUwhvWTq8ORMjGkFG33vAFBPRWrcrHqb7GZ_fi_pWfyX5MZOBmBB7e0m9eV1NW36Sj5B_zSrg4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2757044164</pqid></control><display><type>article</type><title>Morning chronotype and digestive tract cancers: Mendelian randomization study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>SWEPUB Freely available online</source><creator>Yuan, Shuai ; Mason, Amy M. ; Titova, Olga E. ; Vithayathil, Mathew ; Kar, Siddhartha ; Chen, Jie ; Li, Xue ; Burgess, Stephen ; Larsson, Susanna C.</creator><creatorcontrib>Yuan, Shuai ; Mason, Amy M. ; Titova, Olga E. ; Vithayathil, Mathew ; Kar, Siddhartha ; Chen, Jie ; Li, Xue ; Burgess, Stephen ; Larsson, Susanna C.</creatorcontrib><description>Morning chronotype has been associated with a reduced risk of prostate and breast cancer. However, few studies have examined whether chronotype is associated with digestive tract cancer risk. We conducted a Mendelian randomization (MR) study to assess the associations of chronotype with major digestive tract cancers. A total of 317 independent genetic variants associated with chronotype at the genome‐wide significance level (P < 5 × 10−8) were used as instrumental variables from a genome‐wide meta‐analysis of 449 734 individuals. Summary‐level data on overall and six digestive tract cancers, including esophageal, stomach, liver, biliary tract, pancreatic and colorectal cancers, were obtained from the UK Biobank (11 952 cases) and FinnGen (7638 cases) study. Genetic liability to morning chronotype was associated with reduced risk of overall digestive tract cancer and cancers of stomach, biliary tract and colorectum in UK Biobank. The associations for the overall digestive tract, stomach and colorectal cancers were directionally replicated in FinnGen. In the meta‐analysis of the two sources, genetic liability to morning chronotype was associated with a decreased risk of overall digestive tract cancer (odds ratio [OR] 0.94, 95% confidence interval [CI]: 0.90‐0.98), stomach cancer (OR 0.84, 95% CI: 0.73‐0.97) and colorectal cancer (OR 0.92, 95% CI: 0.87‐0.98), but not with the other studied cancers. The associations were consistent in multivariable MR analysis with adjustment for genetically predicted sleep duration, short sleep, insomnia and body mass index. The study provided MR evidence of inverse associations of morning chronotype with digestive tract cancer, particularly stomach and colorectal cancers.
What's new?
Cancers of the digestive tract are associated with various traditional risk factors, including smoking and obesity. A possible novel risk factor may be chronotype, an individual's natural tendency to sleep at a particular time. In our study, the authors assessed potential associations between digestive tract cancers and chronotype using Mendelian randomization analysis of UK Biobank and FinnGen study data. Overall risk of digestive tract cancer, stomach cancer and colorectal cancer was found to be inversely associated with genetic liability to morning chronotype. Analyses further indicate that the associations are independent of sleep duration, short sleep, insomnia and body mass index.</description><identifier>ISSN: 0020-7136</identifier><identifier>ISSN: 1097-0215</identifier><identifier>EISSN: 1097-0215</identifier><identifier>DOI: 10.1002/ijc.34284</identifier><identifier>PMID: 36093575</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Biliary tract ; Biobanks ; Body mass index ; Breast cancer ; Cancer ; Chronotype ; Colorectal cancer ; Colorectal carcinoma ; Colorectal Neoplasms - genetics ; digestive system cancer ; Gastric cancer ; Gastrointestinal Neoplasms - epidemiology ; Gastrointestinal Neoplasms - genetics ; Gastrointestinal tract ; Genetic analysis ; Genetic diversity ; Genome-Wide Association Study ; Genomes ; Humans ; Male ; Medical research ; Mendelian randomization ; Mendelian Randomization Analysis ; Meta-analysis ; Polymorphism, Single Nucleotide ; Prostate cancer ; Risk Factors ; Sleep disorders ; Stomach</subject><ispartof>International journal of cancer, 2023-02, Vol.152 (4), p.697-704</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd on behalf of UICC.</rights><rights>2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.</rights><rights>2022. This article 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-c5184-55c85782f6d7419733d106503f898cec399b8613a54c3f934fc71f91a05f6e7d3</citedby><cites>FETCH-LOGICAL-c5184-55c85782f6d7419733d106503f898cec399b8613a54c3f934fc71f91a05f6e7d3</cites><orcidid>0000-0003-0118-0341 ; 0000-0001-5055-5627</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fijc.34284$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fijc.34284$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,550,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36093575$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-485117$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:150731697$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Yuan, Shuai</creatorcontrib><creatorcontrib>Mason, Amy M.</creatorcontrib><creatorcontrib>Titova, Olga E.</creatorcontrib><creatorcontrib>Vithayathil, Mathew</creatorcontrib><creatorcontrib>Kar, Siddhartha</creatorcontrib><creatorcontrib>Chen, Jie</creatorcontrib><creatorcontrib>Li, Xue</creatorcontrib><creatorcontrib>Burgess, Stephen</creatorcontrib><creatorcontrib>Larsson, Susanna C.</creatorcontrib><title>Morning chronotype and digestive tract cancers: Mendelian randomization study</title><title>International journal of cancer</title><addtitle>Int J Cancer</addtitle><description>Morning chronotype has been associated with a reduced risk of prostate and breast cancer. However, few studies have examined whether chronotype is associated with digestive tract cancer risk. We conducted a Mendelian randomization (MR) study to assess the associations of chronotype with major digestive tract cancers. A total of 317 independent genetic variants associated with chronotype at the genome‐wide significance level (P < 5 × 10−8) were used as instrumental variables from a genome‐wide meta‐analysis of 449 734 individuals. Summary‐level data on overall and six digestive tract cancers, including esophageal, stomach, liver, biliary tract, pancreatic and colorectal cancers, were obtained from the UK Biobank (11 952 cases) and FinnGen (7638 cases) study. Genetic liability to morning chronotype was associated with reduced risk of overall digestive tract cancer and cancers of stomach, biliary tract and colorectum in UK Biobank. The associations for the overall digestive tract, stomach and colorectal cancers were directionally replicated in FinnGen. In the meta‐analysis of the two sources, genetic liability to morning chronotype was associated with a decreased risk of overall digestive tract cancer (odds ratio [OR] 0.94, 95% confidence interval [CI]: 0.90‐0.98), stomach cancer (OR 0.84, 95% CI: 0.73‐0.97) and colorectal cancer (OR 0.92, 95% CI: 0.87‐0.98), but not with the other studied cancers. The associations were consistent in multivariable MR analysis with adjustment for genetically predicted sleep duration, short sleep, insomnia and body mass index. The study provided MR evidence of inverse associations of morning chronotype with digestive tract cancer, particularly stomach and colorectal cancers.
What's new?
Cancers of the digestive tract are associated with various traditional risk factors, including smoking and obesity. A possible novel risk factor may be chronotype, an individual's natural tendency to sleep at a particular time. In our study, the authors assessed potential associations between digestive tract cancers and chronotype using Mendelian randomization analysis of UK Biobank and FinnGen study data. Overall risk of digestive tract cancer, stomach cancer and colorectal cancer was found to be inversely associated with genetic liability to morning chronotype. Analyses further indicate that the associations are independent of sleep duration, short sleep, insomnia and body mass index.</description><subject>Biliary tract</subject><subject>Biobanks</subject><subject>Body mass index</subject><subject>Breast cancer</subject><subject>Cancer</subject><subject>Chronotype</subject><subject>Colorectal cancer</subject><subject>Colorectal carcinoma</subject><subject>Colorectal Neoplasms - genetics</subject><subject>digestive system cancer</subject><subject>Gastric cancer</subject><subject>Gastrointestinal Neoplasms - epidemiology</subject><subject>Gastrointestinal Neoplasms - genetics</subject><subject>Gastrointestinal tract</subject><subject>Genetic analysis</subject><subject>Genetic diversity</subject><subject>Genome-Wide Association Study</subject><subject>Genomes</subject><subject>Humans</subject><subject>Male</subject><subject>Medical research</subject><subject>Mendelian randomization</subject><subject>Mendelian Randomization Analysis</subject><subject>Meta-analysis</subject><subject>Polymorphism, Single Nucleotide</subject><subject>Prostate cancer</subject><subject>Risk Factors</subject><subject>Sleep disorders</subject><subject>Stomach</subject><issn>0020-7136</issn><issn>1097-0215</issn><issn>1097-0215</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNp1kUFP3DAQhS3UChbaQ_9AFaknJAIzsR3HPSChpQUqVr20vVrGcRZvd-3FTkDLr69ptqgcONnyfH7z9B4hHxCOEaA6cQtzTFnVsB0yQZCihAr5GzLJMygF0nqP7Ke0AEDkwHbJHq1BUi74hMxmIXrn54W5jcGHfrO2hfZt0bq5Tb27t0UftekLo72xMX0uZta3dum0L2Lmwso96t4FX6R-aDfvyNtOL5N9vz0PyM-vX35ML8vr7xdX07Pr0nBsWMm5abhoqq5uBUMpKG0Rag60a2RjrKFS3jQ1Us2ZoZ2krDMCO4kaeFdb0dIDUo666cGuhxu1jm6l40YF7dT26Xe-WcU4yIpl_uhV_tz9OlMhztUwKNZwRJHx0xHP7Mq2xvocwvLFr5cT727VPNwrkU1LCVng01YghrshB6kWYYg-R6IqwQUwhvWTq8ORMjGkFG33vAFBPRWrcrHqb7GZ_fi_pWfyX5MZOBmBB7e0m9eV1NW36Sj5B_zSrg4</recordid><startdate>20230215</startdate><enddate>20230215</enddate><creator>Yuan, Shuai</creator><creator>Mason, Amy M.</creator><creator>Titova, Olga E.</creator><creator>Vithayathil, Mathew</creator><creator>Kar, Siddhartha</creator><creator>Chen, Jie</creator><creator>Li, Xue</creator><creator>Burgess, Stephen</creator><creator>Larsson, Susanna C.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>24P</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>7T5</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>5PM</scope><scope>ACNBI</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DF2</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0003-0118-0341</orcidid><orcidid>https://orcid.org/0000-0001-5055-5627</orcidid></search><sort><creationdate>20230215</creationdate><title>Morning chronotype and digestive tract cancers: Mendelian randomization study</title><author>Yuan, Shuai ; Mason, Amy M. ; Titova, Olga E. ; Vithayathil, Mathew ; Kar, Siddhartha ; Chen, Jie ; Li, Xue ; Burgess, Stephen ; Larsson, Susanna C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5184-55c85782f6d7419733d106503f898cec399b8613a54c3f934fc71f91a05f6e7d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Biliary tract</topic><topic>Biobanks</topic><topic>Body mass index</topic><topic>Breast cancer</topic><topic>Cancer</topic><topic>Chronotype</topic><topic>Colorectal cancer</topic><topic>Colorectal carcinoma</topic><topic>Colorectal Neoplasms - genetics</topic><topic>digestive system cancer</topic><topic>Gastric cancer</topic><topic>Gastrointestinal Neoplasms - epidemiology</topic><topic>Gastrointestinal Neoplasms - genetics</topic><topic>Gastrointestinal tract</topic><topic>Genetic analysis</topic><topic>Genetic diversity</topic><topic>Genome-Wide Association Study</topic><topic>Genomes</topic><topic>Humans</topic><topic>Male</topic><topic>Medical research</topic><topic>Mendelian randomization</topic><topic>Mendelian Randomization Analysis</topic><topic>Meta-analysis</topic><topic>Polymorphism, Single Nucleotide</topic><topic>Prostate cancer</topic><topic>Risk Factors</topic><topic>Sleep disorders</topic><topic>Stomach</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yuan, Shuai</creatorcontrib><creatorcontrib>Mason, Amy M.</creatorcontrib><creatorcontrib>Titova, Olga E.</creatorcontrib><creatorcontrib>Vithayathil, Mathew</creatorcontrib><creatorcontrib>Kar, Siddhartha</creatorcontrib><creatorcontrib>Chen, Jie</creatorcontrib><creatorcontrib>Li, Xue</creatorcontrib><creatorcontrib>Burgess, Stephen</creatorcontrib><creatorcontrib>Larsson, Susanna C.</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Uppsala universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Uppsala universitet</collection><collection>SwePub Articles full text</collection><jtitle>International journal of cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yuan, Shuai</au><au>Mason, Amy M.</au><au>Titova, Olga E.</au><au>Vithayathil, Mathew</au><au>Kar, Siddhartha</au><au>Chen, Jie</au><au>Li, Xue</au><au>Burgess, Stephen</au><au>Larsson, Susanna C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Morning chronotype and digestive tract cancers: Mendelian randomization study</atitle><jtitle>International journal of cancer</jtitle><addtitle>Int J Cancer</addtitle><date>2023-02-15</date><risdate>2023</risdate><volume>152</volume><issue>4</issue><spage>697</spage><epage>704</epage><pages>697-704</pages><issn>0020-7136</issn><issn>1097-0215</issn><eissn>1097-0215</eissn><abstract>Morning chronotype has been associated with a reduced risk of prostate and breast cancer. However, few studies have examined whether chronotype is associated with digestive tract cancer risk. We conducted a Mendelian randomization (MR) study to assess the associations of chronotype with major digestive tract cancers. A total of 317 independent genetic variants associated with chronotype at the genome‐wide significance level (P < 5 × 10−8) were used as instrumental variables from a genome‐wide meta‐analysis of 449 734 individuals. Summary‐level data on overall and six digestive tract cancers, including esophageal, stomach, liver, biliary tract, pancreatic and colorectal cancers, were obtained from the UK Biobank (11 952 cases) and FinnGen (7638 cases) study. Genetic liability to morning chronotype was associated with reduced risk of overall digestive tract cancer and cancers of stomach, biliary tract and colorectum in UK Biobank. The associations for the overall digestive tract, stomach and colorectal cancers were directionally replicated in FinnGen. In the meta‐analysis of the two sources, genetic liability to morning chronotype was associated with a decreased risk of overall digestive tract cancer (odds ratio [OR] 0.94, 95% confidence interval [CI]: 0.90‐0.98), stomach cancer (OR 0.84, 95% CI: 0.73‐0.97) and colorectal cancer (OR 0.92, 95% CI: 0.87‐0.98), but not with the other studied cancers. The associations were consistent in multivariable MR analysis with adjustment for genetically predicted sleep duration, short sleep, insomnia and body mass index. The study provided MR evidence of inverse associations of morning chronotype with digestive tract cancer, particularly stomach and colorectal cancers.
What's new?
Cancers of the digestive tract are associated with various traditional risk factors, including smoking and obesity. A possible novel risk factor may be chronotype, an individual's natural tendency to sleep at a particular time. In our study, the authors assessed potential associations between digestive tract cancers and chronotype using Mendelian randomization analysis of UK Biobank and FinnGen study data. Overall risk of digestive tract cancer, stomach cancer and colorectal cancer was found to be inversely associated with genetic liability to morning chronotype. Analyses further indicate that the associations are independent of sleep duration, short sleep, insomnia and body mass index.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>36093575</pmid><doi>10.1002/ijc.34284</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-0118-0341</orcidid><orcidid>https://orcid.org/0000-0001-5055-5627</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0020-7136 |
| ispartof | International journal of cancer, 2023-02, Vol.152 (4), p.697-704 |
| issn | 0020-7136 1097-0215 1097-0215 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_450924 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; SWEPUB Freely available online |
| subjects | Biliary tract Biobanks Body mass index Breast cancer Cancer Chronotype Colorectal cancer Colorectal carcinoma Colorectal Neoplasms - genetics digestive system cancer Gastric cancer Gastrointestinal Neoplasms - epidemiology Gastrointestinal Neoplasms - genetics Gastrointestinal tract Genetic analysis Genetic diversity Genome-Wide Association Study Genomes Humans Male Medical research Mendelian randomization Mendelian Randomization Analysis Meta-analysis Polymorphism, Single Nucleotide Prostate cancer Risk Factors Sleep disorders Stomach |
| title | Morning chronotype and digestive tract cancers: Mendelian randomization study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T20%3A02%3A03IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Morning%20chronotype%20and%20digestive%20tract%20cancers:%20Mendelian%20randomization%20study&rft.jtitle=International%20journal%20of%20cancer&rft.au=Yuan,%20Shuai&rft.date=2023-02-15&rft.volume=152&rft.issue=4&rft.spage=697&rft.epage=704&rft.pages=697-704&rft.issn=0020-7136&rft.eissn=1097-0215&rft_id=info:doi/10.1002/ijc.34284&rft_dat=%3Cproquest_swepu%3E2757044164%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2757044164&rft_id=info:pmid/36093575&rfr_iscdi=true |