Effects of the rodent peroxisome proliferator and hepatocarcinogen, perfluorooctanoic acid, on apoptosis in human hepatoma HepG2 cells

The effects of perfluorooctanoic acid (PFOA), a potent hepatocarcinogen and peroxisome proliferator in rodents, on human cells have not yet been examined. In the present study we demonstrate that treatment of human hepatoblastoma HepG2 cells with PFOA induces apoptosis, as well as perturbs the cell...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Carcinogenesis (New York) 1999-12, Vol.20 (12), p.2237-2246
Hauptverfasser: Shabalina, Irina G., Panaretakis, Theoharis, Bergstrand, Anders, Depierre, Joseph W.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 2246
container_issue 12
container_start_page 2237
container_title Carcinogenesis (New York)
container_volume 20
creator Shabalina, Irina G.
Panaretakis, Theoharis
Bergstrand, Anders
Depierre, Joseph W.
description The effects of perfluorooctanoic acid (PFOA), a potent hepatocarcinogen and peroxisome proliferator in rodents, on human cells have not yet been examined. In the present study we demonstrate that treatment of human hepatoblastoma HepG2 cells with PFOA induces apoptosis, as well as perturbs the cell cycle. This apoptosis was characterized by electron microscopy, which revealed typical nucleosomal fragmentation (also observed as a `DNA ladder' upon electrophoresis on agarose) and was quantitated using propidium iodide staining of cellular DNA and the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. This process was dose- and time-dependent: apoptosis became manifest with 200 μM and maximal (45% of the cells) upon exposure to 450 μM PFOA for 24 h. Electrophoresis of the DNA from HepG2 cells exposed to 500 μM PFOA for 24 h or to 400 μM PFOA for 48 h revealed a smear typical of non-specific degradation. These findings indicate that in the presence of high concentrations of PFOA for long times, HepG2 cells undergo primary and secondary necrosis. Quantitation of trypan blue exclusion supported this conclusion. Flow cytometric analysis revealed that the cell cycle of HepG2 cells was perturbed by exposure to 50–150 μM PFOA. A 50 μM concentration resulted in a significant increase in the proportion of G2/M cells and, simultaneously, a decrease in the number of cells in the S phase, whereas treatment with 100 or 150 μM PFOA increased the proportion of cells in the G0/G1 phase and decreased the number of cells in the G2/M and S phases. Simultaneous flow cytometric analysis of apoptosis-associated DNA strand breaks using the TUNEL procedure and of propidium iodide staining of cellular DNA revealed DNA breaks in HepG2 cells exposed to 150 μM PFOA, prior to nuclear fragmentation.
doi_str_mv 10.1093/carcin/20.12.2237
format Article
fullrecord <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_603450</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>47828568</sourcerecordid><originalsourceid>FETCH-LOGICAL-c543t-3a2ea9656cc4db86a2d156c34ba5501624f24a0c48fca08f8d584d6322a6f33e3</originalsourceid><addsrcrecordid>eNp1kc9u1DAQxi0EokvhAbggC3FsWv_f5Air0q1UCQ4gIS7WrGOzbhM72IkoL8Bz41XSLhdOnrF_34znG4ReU3JOScMvDCTjwwUrKTtnjK-foBUVilSM1uQpWhEqeMU5FyfoRc63hFDFZfMcnVAiG8KoWKE_l85ZM2YcHR73FqfY2jDiwaZ473PsLR5S7LyzCcaYMIQW7-1Q4rl3_GHD2YF23RRTjGaEEL3BYHx7hmPAMMRhjNln7APeTz2ERd8D3trhimFjuy6_RM8cdNm-Ws5T9PXj5ZfNtrr5dHW9eX9TGSn4WHFgFhollTGi3dUKWEtLwsUOpCzTMeGYAGJE7QyQ2tWtrEWrOGOgHOeWn6Jqrpt_2WHa6SH5HtJvHcHr5equRFYrwoUkhV__ly_GtEfRg5A2UineFOXbWVmwn5PNo76NUwplOM1ow3lD1bpAdIZMijkn6x4bUKIPK9azzZqVlOnDiovmzVJ42vW2_Ucx77QA7xYAsoHOJQjG5yPHpGBcHq3webT3j8-Q7nT52Vrq7bfvekOaWsjmg_7M_wIyFMKD</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>219339167</pqid></control><display><type>article</type><title>Effects of the rodent peroxisome proliferator and hepatocarcinogen, perfluorooctanoic acid, on apoptosis in human hepatoma HepG2 cells</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Shabalina, Irina G. ; Panaretakis, Theoharis ; Bergstrand, Anders ; Depierre, Joseph W.</creator><creatorcontrib>Shabalina, Irina G. ; Panaretakis, Theoharis ; Bergstrand, Anders ; Depierre, Joseph W.</creatorcontrib><description>The effects of perfluorooctanoic acid (PFOA), a potent hepatocarcinogen and peroxisome proliferator in rodents, on human cells have not yet been examined. In the present study we demonstrate that treatment of human hepatoblastoma HepG2 cells with PFOA induces apoptosis, as well as perturbs the cell cycle. This apoptosis was characterized by electron microscopy, which revealed typical nucleosomal fragmentation (also observed as a `DNA ladder' upon electrophoresis on agarose) and was quantitated using propidium iodide staining of cellular DNA and the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. This process was dose- and time-dependent: apoptosis became manifest with 200 μM and maximal (45% of the cells) upon exposure to 450 μM PFOA for 24 h. Electrophoresis of the DNA from HepG2 cells exposed to 500 μM PFOA for 24 h or to 400 μM PFOA for 48 h revealed a smear typical of non-specific degradation. These findings indicate that in the presence of high concentrations of PFOA for long times, HepG2 cells undergo primary and secondary necrosis. Quantitation of trypan blue exclusion supported this conclusion. Flow cytometric analysis revealed that the cell cycle of HepG2 cells was perturbed by exposure to 50–150 μM PFOA. A 50 μM concentration resulted in a significant increase in the proportion of G2/M cells and, simultaneously, a decrease in the number of cells in the S phase, whereas treatment with 100 or 150 μM PFOA increased the proportion of cells in the G0/G1 phase and decreased the number of cells in the G2/M and S phases. Simultaneous flow cytometric analysis of apoptosis-associated DNA strand breaks using the TUNEL procedure and of propidium iodide staining of cellular DNA revealed DNA breaks in HepG2 cells exposed to 150 μM PFOA, prior to nuclear fragmentation.</description><identifier>ISSN: 0143-3334</identifier><identifier>EISSN: 1460-2180</identifier><identifier>DOI: 10.1093/carcin/20.12.2237</identifier><identifier>PMID: 10590214</identifier><identifier>CODEN: CRNGDP</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Apoptosis - drug effects ; Biological and medical sciences ; Caprylates - pharmacology ; Carcinogenesis, carcinogens and anticarcinogens ; Carcinogens - pharmacology ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - ultrastructure ; Cell Survival - drug effects ; Chemical agents ; dimethyl sulfoxide ; DMSO ; Dose-Response Relationship, Drug ; EDTA ; Electrophoresis, Agar Gel ; ethylenediamine tetraacetic acid ; Fluorocarbons - pharmacology ; Humans ; In Situ Nick-End Labeling ; Liver Neoplasms - pathology ; Liver Neoplasms - ultrastructure ; Medical sciences ; Medicin och hälsovetenskap ; Microscopy, Electron ; PBS ; perfluorooctanoic acid ; Peroxisome Proliferators - pharmacology ; PFOA ; phosphate-buffered saline ; Tumor Cells, Cultured ; Tumors</subject><ispartof>Carcinogenesis (New York), 1999-12, Vol.20 (12), p.2237-2246</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Dec 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c543t-3a2ea9656cc4db86a2d156c34ba5501624f24a0c48fca08f8d584d6322a6f33e3</citedby><cites>FETCH-LOGICAL-c543t-3a2ea9656cc4db86a2d156c34ba5501624f24a0c48fca08f8d584d6322a6f33e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=1254235$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10590214$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:1956639$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Shabalina, Irina G.</creatorcontrib><creatorcontrib>Panaretakis, Theoharis</creatorcontrib><creatorcontrib>Bergstrand, Anders</creatorcontrib><creatorcontrib>Depierre, Joseph W.</creatorcontrib><title>Effects of the rodent peroxisome proliferator and hepatocarcinogen, perfluorooctanoic acid, on apoptosis in human hepatoma HepG2 cells</title><title>Carcinogenesis (New York)</title><addtitle>Carcinogenesis</addtitle><description>The effects of perfluorooctanoic acid (PFOA), a potent hepatocarcinogen and peroxisome proliferator in rodents, on human cells have not yet been examined. In the present study we demonstrate that treatment of human hepatoblastoma HepG2 cells with PFOA induces apoptosis, as well as perturbs the cell cycle. This apoptosis was characterized by electron microscopy, which revealed typical nucleosomal fragmentation (also observed as a `DNA ladder' upon electrophoresis on agarose) and was quantitated using propidium iodide staining of cellular DNA and the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. This process was dose- and time-dependent: apoptosis became manifest with 200 μM and maximal (45% of the cells) upon exposure to 450 μM PFOA for 24 h. Electrophoresis of the DNA from HepG2 cells exposed to 500 μM PFOA for 24 h or to 400 μM PFOA for 48 h revealed a smear typical of non-specific degradation. These findings indicate that in the presence of high concentrations of PFOA for long times, HepG2 cells undergo primary and secondary necrosis. Quantitation of trypan blue exclusion supported this conclusion. Flow cytometric analysis revealed that the cell cycle of HepG2 cells was perturbed by exposure to 50–150 μM PFOA. A 50 μM concentration resulted in a significant increase in the proportion of G2/M cells and, simultaneously, a decrease in the number of cells in the S phase, whereas treatment with 100 or 150 μM PFOA increased the proportion of cells in the G0/G1 phase and decreased the number of cells in the G2/M and S phases. Simultaneous flow cytometric analysis of apoptosis-associated DNA strand breaks using the TUNEL procedure and of propidium iodide staining of cellular DNA revealed DNA breaks in HepG2 cells exposed to 150 μM PFOA, prior to nuclear fragmentation.</description><subject>Apoptosis - drug effects</subject><subject>Biological and medical sciences</subject><subject>Caprylates - pharmacology</subject><subject>Carcinogenesis, carcinogens and anticarcinogens</subject><subject>Carcinogens - pharmacology</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Carcinoma, Hepatocellular - ultrastructure</subject><subject>Cell Survival - drug effects</subject><subject>Chemical agents</subject><subject>dimethyl sulfoxide</subject><subject>DMSO</subject><subject>Dose-Response Relationship, Drug</subject><subject>EDTA</subject><subject>Electrophoresis, Agar Gel</subject><subject>ethylenediamine tetraacetic acid</subject><subject>Fluorocarbons - pharmacology</subject><subject>Humans</subject><subject>In Situ Nick-End Labeling</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - ultrastructure</subject><subject>Medical sciences</subject><subject>Medicin och hälsovetenskap</subject><subject>Microscopy, Electron</subject><subject>PBS</subject><subject>perfluorooctanoic acid</subject><subject>Peroxisome Proliferators - pharmacology</subject><subject>PFOA</subject><subject>phosphate-buffered saline</subject><subject>Tumor Cells, Cultured</subject><subject>Tumors</subject><issn>0143-3334</issn><issn>1460-2180</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9u1DAQxi0EokvhAbggC3FsWv_f5Air0q1UCQ4gIS7WrGOzbhM72IkoL8Bz41XSLhdOnrF_34znG4ReU3JOScMvDCTjwwUrKTtnjK-foBUVilSM1uQpWhEqeMU5FyfoRc63hFDFZfMcnVAiG8KoWKE_l85ZM2YcHR73FqfY2jDiwaZ473PsLR5S7LyzCcaYMIQW7-1Q4rl3_GHD2YF23RRTjGaEEL3BYHx7hmPAMMRhjNln7APeTz2ERd8D3trhimFjuy6_RM8cdNm-Ws5T9PXj5ZfNtrr5dHW9eX9TGSn4WHFgFhollTGi3dUKWEtLwsUOpCzTMeGYAGJE7QyQ2tWtrEWrOGOgHOeWn6Jqrpt_2WHa6SH5HtJvHcHr5equRFYrwoUkhV__ly_GtEfRg5A2UineFOXbWVmwn5PNo76NUwplOM1ow3lD1bpAdIZMijkn6x4bUKIPK9azzZqVlOnDiovmzVJ42vW2_Ucx77QA7xYAsoHOJQjG5yPHpGBcHq3webT3j8-Q7nT52Vrq7bfvekOaWsjmg_7M_wIyFMKD</recordid><startdate>19991201</startdate><enddate>19991201</enddate><creator>Shabalina, Irina G.</creator><creator>Panaretakis, Theoharis</creator><creator>Bergstrand, Anders</creator><creator>Depierre, Joseph W.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</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>7TM</scope><scope>7TO</scope><scope>7U7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>ADTPV</scope><scope>AOWAS</scope></search><sort><creationdate>19991201</creationdate><title>Effects of the rodent peroxisome proliferator and hepatocarcinogen, perfluorooctanoic acid, on apoptosis in human hepatoma HepG2 cells</title><author>Shabalina, Irina G. ; Panaretakis, Theoharis ; Bergstrand, Anders ; Depierre, Joseph W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c543t-3a2ea9656cc4db86a2d156c34ba5501624f24a0c48fca08f8d584d6322a6f33e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Apoptosis - drug effects</topic><topic>Biological and medical sciences</topic><topic>Caprylates - pharmacology</topic><topic>Carcinogenesis, carcinogens and anticarcinogens</topic><topic>Carcinogens - pharmacology</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Carcinoma, Hepatocellular - ultrastructure</topic><topic>Cell Survival - drug effects</topic><topic>Chemical agents</topic><topic>dimethyl sulfoxide</topic><topic>DMSO</topic><topic>Dose-Response Relationship, Drug</topic><topic>EDTA</topic><topic>Electrophoresis, Agar Gel</topic><topic>ethylenediamine tetraacetic acid</topic><topic>Fluorocarbons - pharmacology</topic><topic>Humans</topic><topic>In Situ Nick-End Labeling</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - ultrastructure</topic><topic>Medical sciences</topic><topic>Medicin och hälsovetenskap</topic><topic>Microscopy, Electron</topic><topic>PBS</topic><topic>perfluorooctanoic acid</topic><topic>Peroxisome Proliferators - pharmacology</topic><topic>PFOA</topic><topic>phosphate-buffered saline</topic><topic>Tumor Cells, Cultured</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shabalina, Irina G.</creatorcontrib><creatorcontrib>Panaretakis, Theoharis</creatorcontrib><creatorcontrib>Bergstrand, Anders</creatorcontrib><creatorcontrib>Depierre, Joseph W.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</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>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>Carcinogenesis (New York)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shabalina, Irina G.</au><au>Panaretakis, Theoharis</au><au>Bergstrand, Anders</au><au>Depierre, Joseph W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of the rodent peroxisome proliferator and hepatocarcinogen, perfluorooctanoic acid, on apoptosis in human hepatoma HepG2 cells</atitle><jtitle>Carcinogenesis (New York)</jtitle><addtitle>Carcinogenesis</addtitle><date>1999-12-01</date><risdate>1999</risdate><volume>20</volume><issue>12</issue><spage>2237</spage><epage>2246</epage><pages>2237-2246</pages><issn>0143-3334</issn><eissn>1460-2180</eissn><coden>CRNGDP</coden><abstract>The effects of perfluorooctanoic acid (PFOA), a potent hepatocarcinogen and peroxisome proliferator in rodents, on human cells have not yet been examined. In the present study we demonstrate that treatment of human hepatoblastoma HepG2 cells with PFOA induces apoptosis, as well as perturbs the cell cycle. This apoptosis was characterized by electron microscopy, which revealed typical nucleosomal fragmentation (also observed as a `DNA ladder' upon electrophoresis on agarose) and was quantitated using propidium iodide staining of cellular DNA and the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. This process was dose- and time-dependent: apoptosis became manifest with 200 μM and maximal (45% of the cells) upon exposure to 450 μM PFOA for 24 h. Electrophoresis of the DNA from HepG2 cells exposed to 500 μM PFOA for 24 h or to 400 μM PFOA for 48 h revealed a smear typical of non-specific degradation. These findings indicate that in the presence of high concentrations of PFOA for long times, HepG2 cells undergo primary and secondary necrosis. Quantitation of trypan blue exclusion supported this conclusion. Flow cytometric analysis revealed that the cell cycle of HepG2 cells was perturbed by exposure to 50–150 μM PFOA. A 50 μM concentration resulted in a significant increase in the proportion of G2/M cells and, simultaneously, a decrease in the number of cells in the S phase, whereas treatment with 100 or 150 μM PFOA increased the proportion of cells in the G0/G1 phase and decreased the number of cells in the G2/M and S phases. Simultaneous flow cytometric analysis of apoptosis-associated DNA strand breaks using the TUNEL procedure and of propidium iodide staining of cellular DNA revealed DNA breaks in HepG2 cells exposed to 150 μM PFOA, prior to nuclear fragmentation.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>10590214</pmid><doi>10.1093/carcin/20.12.2237</doi><tpages>10</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0143-3334
ispartof Carcinogenesis (New York), 1999-12, Vol.20 (12), p.2237-2246
issn 0143-3334
1460-2180
language eng
recordid cdi_swepub_primary_oai_swepub_ki_se_603450
source MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection
subjects Apoptosis - drug effects
Biological and medical sciences
Caprylates - pharmacology
Carcinogenesis, carcinogens and anticarcinogens
Carcinogens - pharmacology
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - ultrastructure
Cell Survival - drug effects
Chemical agents
dimethyl sulfoxide
DMSO
Dose-Response Relationship, Drug
EDTA
Electrophoresis, Agar Gel
ethylenediamine tetraacetic acid
Fluorocarbons - pharmacology
Humans
In Situ Nick-End Labeling
Liver Neoplasms - pathology
Liver Neoplasms - ultrastructure
Medical sciences
Medicin och hälsovetenskap
Microscopy, Electron
PBS
perfluorooctanoic acid
Peroxisome Proliferators - pharmacology
PFOA
phosphate-buffered saline
Tumor Cells, Cultured
Tumors
title Effects of the rodent peroxisome proliferator and hepatocarcinogen, perfluorooctanoic acid, on apoptosis in human hepatoma HepG2 cells
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-09T10%3A26%3A17IST&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=Effects%20of%20the%20rodent%20peroxisome%20proliferator%20and%20hepatocarcinogen,%20perfluorooctanoic%20acid,%20on%20apoptosis%20in%20human%20hepatoma%20HepG2%20cells&rft.jtitle=Carcinogenesis%20(New%20York)&rft.au=Shabalina,%20Irina%20G.&rft.date=1999-12-01&rft.volume=20&rft.issue=12&rft.spage=2237&rft.epage=2246&rft.pages=2237-2246&rft.issn=0143-3334&rft.eissn=1460-2180&rft.coden=CRNGDP&rft_id=info:doi/10.1093/carcin/20.12.2237&rft_dat=%3Cproquest_swepu%3E47828568%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=219339167&rft_id=info:pmid/10590214&rfr_iscdi=true