Loading…

Auditory Brainstem Response to Paired Click Stimulation as an Indicator of Peripheral Synaptic Health in Noise-Induced Cochlear Synaptopathy

A defect in the cochlear afferent synapse between the inner hair cells and spiral ganglion neurons, after noise exposure, without changes in the hearing threshold has been reported. Animal studies on auditory evoked potentials demonstrated changes in the auditory brainstem response (ABR) measurement...

Full description

Saved in:
Bibliographic Details
Published in:Frontiers in neuroscience 2021-01, Vol.14, p.596670-596670
Main Authors: Lee, Jae-Hun, Lee, Min Young, Choi, Ji Eun, Jung, Jae Yun
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c493t-a5a0cdc0a8c70f84305304b1ac92c0932fddcdf9b624aa91f8a46e477a772d8e3
cites cdi_FETCH-LOGICAL-c493t-a5a0cdc0a8c70f84305304b1ac92c0932fddcdf9b624aa91f8a46e477a772d8e3
container_end_page 596670
container_issue
container_start_page 596670
container_title Frontiers in neuroscience
container_volume 14
creator Lee, Jae-Hun
Lee, Min Young
Choi, Ji Eun
Jung, Jae Yun
description A defect in the cochlear afferent synapse between the inner hair cells and spiral ganglion neurons, after noise exposure, without changes in the hearing threshold has been reported. Animal studies on auditory evoked potentials demonstrated changes in the auditory brainstem response (ABR) measurements of peak I amplitude and the loss of synapses, which affect the temporal resolution of complex sounds. Human studies of auditory evoked potential have reported ambiguous results regarding the relationship between peak I amplitude and noise exposure. Paired click stimuli have been used to investigate the temporal processing abilities of humans and animals. In this study, we investigated the utility of measuring auditory evoked potentials in response to paired click stimuli to assess the temporal processing function of ribbon synapses in noise-induced cochlear synaptopathy. Twenty-two Sprague Dawley rats were used in this study, and synaptopathy was induced by narrow-band noise exposure (16 kHz with 1 kHz bandwidth, 105 dB sound pressure level for 2 h). ABRs to tone and paired click stimuli were measured before and 1, 3, 7, and 14 days after noise exposure. For histological analyses, hair cells and ribbon synapses were immunostained and the synapses quantified. The relationships among ABR peak I amplitude, number of synapses, and ABR to paired click stimuli were examined. Our results showed that ABR thresholds increase 1 day after noise exposure but fully recover to baseline levels after 14 days. Further, we demonstrated test frequency-dependent decreases in peak I amplitude and the number of synapses after noise exposure. These decreases were statistically significant at frequencies of 16 and 32 kHz. However, the ABR recovery threshold to paired click stimuli increased, which represent deterioration in the ability of temporal auditory processing. Our results indicate that the ABR recovery threshold is highly correlated with ABR peak I amplitude after noise exposure. We also established a direct correlation between the ABR recovery threshold and histological findings. The result from this study suggests that in animal studies, the ABR to paired click stimuli along with peak I amplitude has potential as an assessment tool for hidden hearing loss.
doi_str_mv 10.3389/fnins.2020.596670
format article
fullrecord <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_780bb95f8f1c48d19b4fe9a666516750</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_780bb95f8f1c48d19b4fe9a666516750</doaj_id><sourcerecordid>2476733052</sourcerecordid><originalsourceid>FETCH-LOGICAL-c493t-a5a0cdc0a8c70f84305304b1ac92c0932fddcdf9b624aa91f8a46e477a772d8e3</originalsourceid><addsrcrecordid>eNpdks1uEzEUhUcIREvgAdggS2zYJHhsj8ezQSoR0EgVVBQkdtYd_zQOE3tqe5DyDjw0ThMiysqWfc7n63tPVb2s8YJS0b213vm0IJjgRdNx3uJH1XnNOZmzhv54fNozcVY9S2mDMSeCkafVGaUNbggV59Xvi0m7HOIOvY9QaNls0VeTxuCTQTmga3DRaLQcnPqJbrLbTgNkFzyChMCjlddOQfGjYNG1iW5cmwgDutl5GLNT6NLAkNfIefQ5uGTmxTCpPTCo9WAgHpVhhLzePa-eWBiSeXFcZ9X3jx--LS_nV18-rZYXV3PFOprn0ABWWmEQqsVWMIobillfg-qIwh0lVmulbddzwgC62gpg3LC2hbYlWhg6q1YHrg6wkWN0W4g7GcDJ-4MQbyXEUv1gZCtw33eNFbZWTOi665k1HXDOm5q3DS6sdwfWOPVbo5XxuTTgAfThjXdreRt-FTLFmLACeHMExHA3mZTl1iVlhgG8CVOShAlSRlvT_Vuv_5NuwhR9aVVRtbyldD_VWVUfVCqGlKKxp2JqLPe5kfe5kfvcyENuiufVv784Of4Ghf4ByE7CDA</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2476733052</pqid></control><display><type>article</type><title>Auditory Brainstem Response to Paired Click Stimulation as an Indicator of Peripheral Synaptic Health in Noise-Induced Cochlear Synaptopathy</title><source>Open Access: PubMed Central</source><source>Publicly Available Content Database</source><creator>Lee, Jae-Hun ; Lee, Min Young ; Choi, Ji Eun ; Jung, Jae Yun</creator><creatorcontrib>Lee, Jae-Hun ; Lee, Min Young ; Choi, Ji Eun ; Jung, Jae Yun</creatorcontrib><description>A defect in the cochlear afferent synapse between the inner hair cells and spiral ganglion neurons, after noise exposure, without changes in the hearing threshold has been reported. Animal studies on auditory evoked potentials demonstrated changes in the auditory brainstem response (ABR) measurements of peak I amplitude and the loss of synapses, which affect the temporal resolution of complex sounds. Human studies of auditory evoked potential have reported ambiguous results regarding the relationship between peak I amplitude and noise exposure. Paired click stimuli have been used to investigate the temporal processing abilities of humans and animals. In this study, we investigated the utility of measuring auditory evoked potentials in response to paired click stimuli to assess the temporal processing function of ribbon synapses in noise-induced cochlear synaptopathy. Twenty-two Sprague Dawley rats were used in this study, and synaptopathy was induced by narrow-band noise exposure (16 kHz with 1 kHz bandwidth, 105 dB sound pressure level for 2 h). ABRs to tone and paired click stimuli were measured before and 1, 3, 7, and 14 days after noise exposure. For histological analyses, hair cells and ribbon synapses were immunostained and the synapses quantified. The relationships among ABR peak I amplitude, number of synapses, and ABR to paired click stimuli were examined. Our results showed that ABR thresholds increase 1 day after noise exposure but fully recover to baseline levels after 14 days. Further, we demonstrated test frequency-dependent decreases in peak I amplitude and the number of synapses after noise exposure. These decreases were statistically significant at frequencies of 16 and 32 kHz. However, the ABR recovery threshold to paired click stimuli increased, which represent deterioration in the ability of temporal auditory processing. Our results indicate that the ABR recovery threshold is highly correlated with ABR peak I amplitude after noise exposure. We also established a direct correlation between the ABR recovery threshold and histological findings. The result from this study suggests that in animal studies, the ABR to paired click stimuli along with peak I amplitude has potential as an assessment tool for hidden hearing loss.</description><identifier>ISSN: 1662-4548</identifier><identifier>ISSN: 1662-453X</identifier><identifier>EISSN: 1662-453X</identifier><identifier>DOI: 10.3389/fnins.2020.596670</identifier><identifier>PMID: 33505238</identifier><language>eng</language><publisher>Switzerland: Frontiers Research Foundation</publisher><subject>Animals ; Antibodies ; auditory brainstem evoked potentials ; Auditory evoked potentials ; auditory peripheral function ; Brain stem ; Cochlea ; excitotoxicity ; Frequency dependence ; Hair cells ; Hearing loss ; Hearing protection ; Immunoglobulins ; Information processing ; Neuroscience ; Noise ; noise induced cochlear synaptopathy ; paired click paradigm ; Sensory neurons ; Sound ; Spiral ganglion ; Statistical analysis ; Synaptic ribbons</subject><ispartof>Frontiers in neuroscience, 2021-01, Vol.14, p.596670-596670</ispartof><rights>Copyright © 2021 Lee, Lee, Choi and Jung.</rights><rights>2021. This work is licensed 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><rights>Copyright © 2021 Lee, Lee, Choi and Jung. 2021 Lee, Lee, Choi and Jung</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c493t-a5a0cdc0a8c70f84305304b1ac92c0932fddcdf9b624aa91f8a46e477a772d8e3</citedby><cites>FETCH-LOGICAL-c493t-a5a0cdc0a8c70f84305304b1ac92c0932fddcdf9b624aa91f8a46e477a772d8e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2476733052/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2476733052?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33505238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Jae-Hun</creatorcontrib><creatorcontrib>Lee, Min Young</creatorcontrib><creatorcontrib>Choi, Ji Eun</creatorcontrib><creatorcontrib>Jung, Jae Yun</creatorcontrib><title>Auditory Brainstem Response to Paired Click Stimulation as an Indicator of Peripheral Synaptic Health in Noise-Induced Cochlear Synaptopathy</title><title>Frontiers in neuroscience</title><addtitle>Front Neurosci</addtitle><description>A defect in the cochlear afferent synapse between the inner hair cells and spiral ganglion neurons, after noise exposure, without changes in the hearing threshold has been reported. Animal studies on auditory evoked potentials demonstrated changes in the auditory brainstem response (ABR) measurements of peak I amplitude and the loss of synapses, which affect the temporal resolution of complex sounds. Human studies of auditory evoked potential have reported ambiguous results regarding the relationship between peak I amplitude and noise exposure. Paired click stimuli have been used to investigate the temporal processing abilities of humans and animals. In this study, we investigated the utility of measuring auditory evoked potentials in response to paired click stimuli to assess the temporal processing function of ribbon synapses in noise-induced cochlear synaptopathy. Twenty-two Sprague Dawley rats were used in this study, and synaptopathy was induced by narrow-band noise exposure (16 kHz with 1 kHz bandwidth, 105 dB sound pressure level for 2 h). ABRs to tone and paired click stimuli were measured before and 1, 3, 7, and 14 days after noise exposure. For histological analyses, hair cells and ribbon synapses were immunostained and the synapses quantified. The relationships among ABR peak I amplitude, number of synapses, and ABR to paired click stimuli were examined. Our results showed that ABR thresholds increase 1 day after noise exposure but fully recover to baseline levels after 14 days. Further, we demonstrated test frequency-dependent decreases in peak I amplitude and the number of synapses after noise exposure. These decreases were statistically significant at frequencies of 16 and 32 kHz. However, the ABR recovery threshold to paired click stimuli increased, which represent deterioration in the ability of temporal auditory processing. Our results indicate that the ABR recovery threshold is highly correlated with ABR peak I amplitude after noise exposure. We also established a direct correlation between the ABR recovery threshold and histological findings. The result from this study suggests that in animal studies, the ABR to paired click stimuli along with peak I amplitude has potential as an assessment tool for hidden hearing loss.</description><subject>Animals</subject><subject>Antibodies</subject><subject>auditory brainstem evoked potentials</subject><subject>Auditory evoked potentials</subject><subject>auditory peripheral function</subject><subject>Brain stem</subject><subject>Cochlea</subject><subject>excitotoxicity</subject><subject>Frequency dependence</subject><subject>Hair cells</subject><subject>Hearing loss</subject><subject>Hearing protection</subject><subject>Immunoglobulins</subject><subject>Information processing</subject><subject>Neuroscience</subject><subject>Noise</subject><subject>noise induced cochlear synaptopathy</subject><subject>paired click paradigm</subject><subject>Sensory neurons</subject><subject>Sound</subject><subject>Spiral ganglion</subject><subject>Statistical analysis</subject><subject>Synaptic ribbons</subject><issn>1662-4548</issn><issn>1662-453X</issn><issn>1662-453X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNpdks1uEzEUhUcIREvgAdggS2zYJHhsj8ezQSoR0EgVVBQkdtYd_zQOE3tqe5DyDjw0ThMiysqWfc7n63tPVb2s8YJS0b213vm0IJjgRdNx3uJH1XnNOZmzhv54fNozcVY9S2mDMSeCkafVGaUNbggV59Xvi0m7HOIOvY9QaNls0VeTxuCTQTmga3DRaLQcnPqJbrLbTgNkFzyChMCjlddOQfGjYNG1iW5cmwgDutl5GLNT6NLAkNfIefQ5uGTmxTCpPTCo9WAgHpVhhLzePa-eWBiSeXFcZ9X3jx--LS_nV18-rZYXV3PFOprn0ABWWmEQqsVWMIobillfg-qIwh0lVmulbddzwgC62gpg3LC2hbYlWhg6q1YHrg6wkWN0W4g7GcDJ-4MQbyXEUv1gZCtw33eNFbZWTOi665k1HXDOm5q3DS6sdwfWOPVbo5XxuTTgAfThjXdreRt-FTLFmLACeHMExHA3mZTl1iVlhgG8CVOShAlSRlvT_Vuv_5NuwhR9aVVRtbyldD_VWVUfVCqGlKKxp2JqLPe5kfe5kfvcyENuiufVv784Of4Ghf4ByE7CDA</recordid><startdate>20210111</startdate><enddate>20210111</enddate><creator>Lee, Jae-Hun</creator><creator>Lee, Min Young</creator><creator>Choi, Ji Eun</creator><creator>Jung, Jae Yun</creator><general>Frontiers Research Foundation</general><general>Frontiers Media S.A</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7XB</scope><scope>88I</scope><scope>8FE</scope><scope>8FH</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M2P</scope><scope>M7P</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><scope>DOA</scope></search><sort><creationdate>20210111</creationdate><title>Auditory Brainstem Response to Paired Click Stimulation as an Indicator of Peripheral Synaptic Health in Noise-Induced Cochlear Synaptopathy</title><author>Lee, Jae-Hun ; Lee, Min Young ; Choi, Ji Eun ; Jung, Jae Yun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c493t-a5a0cdc0a8c70f84305304b1ac92c0932fddcdf9b624aa91f8a46e477a772d8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Animals</topic><topic>Antibodies</topic><topic>auditory brainstem evoked potentials</topic><topic>Auditory evoked potentials</topic><topic>auditory peripheral function</topic><topic>Brain stem</topic><topic>Cochlea</topic><topic>excitotoxicity</topic><topic>Frequency dependence</topic><topic>Hair cells</topic><topic>Hearing loss</topic><topic>Hearing protection</topic><topic>Immunoglobulins</topic><topic>Information processing</topic><topic>Neuroscience</topic><topic>Noise</topic><topic>noise induced cochlear synaptopathy</topic><topic>paired click paradigm</topic><topic>Sensory neurons</topic><topic>Sound</topic><topic>Spiral ganglion</topic><topic>Statistical analysis</topic><topic>Synaptic ribbons</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Jae-Hun</creatorcontrib><creatorcontrib>Lee, Min Young</creatorcontrib><creatorcontrib>Choi, Ji Eun</creatorcontrib><creatorcontrib>Jung, Jae Yun</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Science Database</collection><collection>ProQuest Biological Science Journals</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><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Frontiers in neuroscience</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Jae-Hun</au><au>Lee, Min Young</au><au>Choi, Ji Eun</au><au>Jung, Jae Yun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Auditory Brainstem Response to Paired Click Stimulation as an Indicator of Peripheral Synaptic Health in Noise-Induced Cochlear Synaptopathy</atitle><jtitle>Frontiers in neuroscience</jtitle><addtitle>Front Neurosci</addtitle><date>2021-01-11</date><risdate>2021</risdate><volume>14</volume><spage>596670</spage><epage>596670</epage><pages>596670-596670</pages><issn>1662-4548</issn><issn>1662-453X</issn><eissn>1662-453X</eissn><abstract>A defect in the cochlear afferent synapse between the inner hair cells and spiral ganglion neurons, after noise exposure, without changes in the hearing threshold has been reported. Animal studies on auditory evoked potentials demonstrated changes in the auditory brainstem response (ABR) measurements of peak I amplitude and the loss of synapses, which affect the temporal resolution of complex sounds. Human studies of auditory evoked potential have reported ambiguous results regarding the relationship between peak I amplitude and noise exposure. Paired click stimuli have been used to investigate the temporal processing abilities of humans and animals. In this study, we investigated the utility of measuring auditory evoked potentials in response to paired click stimuli to assess the temporal processing function of ribbon synapses in noise-induced cochlear synaptopathy. Twenty-two Sprague Dawley rats were used in this study, and synaptopathy was induced by narrow-band noise exposure (16 kHz with 1 kHz bandwidth, 105 dB sound pressure level for 2 h). ABRs to tone and paired click stimuli were measured before and 1, 3, 7, and 14 days after noise exposure. For histological analyses, hair cells and ribbon synapses were immunostained and the synapses quantified. The relationships among ABR peak I amplitude, number of synapses, and ABR to paired click stimuli were examined. Our results showed that ABR thresholds increase 1 day after noise exposure but fully recover to baseline levels after 14 days. Further, we demonstrated test frequency-dependent decreases in peak I amplitude and the number of synapses after noise exposure. These decreases were statistically significant at frequencies of 16 and 32 kHz. However, the ABR recovery threshold to paired click stimuli increased, which represent deterioration in the ability of temporal auditory processing. Our results indicate that the ABR recovery threshold is highly correlated with ABR peak I amplitude after noise exposure. We also established a direct correlation between the ABR recovery threshold and histological findings. The result from this study suggests that in animal studies, the ABR to paired click stimuli along with peak I amplitude has potential as an assessment tool for hidden hearing loss.</abstract><cop>Switzerland</cop><pub>Frontiers Research Foundation</pub><pmid>33505238</pmid><doi>10.3389/fnins.2020.596670</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1662-4548
ispartof Frontiers in neuroscience, 2021-01, Vol.14, p.596670-596670
issn 1662-4548
1662-453X
1662-453X
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_780bb95f8f1c48d19b4fe9a666516750
source Open Access: PubMed Central; Publicly Available Content Database
subjects Animals
Antibodies
auditory brainstem evoked potentials
Auditory evoked potentials
auditory peripheral function
Brain stem
Cochlea
excitotoxicity
Frequency dependence
Hair cells
Hearing loss
Hearing protection
Immunoglobulins
Information processing
Neuroscience
Noise
noise induced cochlear synaptopathy
paired click paradigm
Sensory neurons
Sound
Spiral ganglion
Statistical analysis
Synaptic ribbons
title Auditory Brainstem Response to Paired Click Stimulation as an Indicator of Peripheral Synaptic Health in Noise-Induced Cochlear Synaptopathy
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T13%3A36%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Auditory%20Brainstem%20Response%20to%20Paired%20Click%20Stimulation%20as%20an%20Indicator%20of%20Peripheral%20Synaptic%20Health%20in%20Noise-Induced%20Cochlear%20Synaptopathy&rft.jtitle=Frontiers%20in%20neuroscience&rft.au=Lee,%20Jae-Hun&rft.date=2021-01-11&rft.volume=14&rft.spage=596670&rft.epage=596670&rft.pages=596670-596670&rft.issn=1662-4548&rft.eissn=1662-453X&rft_id=info:doi/10.3389/fnins.2020.596670&rft_dat=%3Cproquest_doaj_%3E2476733052%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c493t-a5a0cdc0a8c70f84305304b1ac92c0932fddcdf9b624aa91f8a46e477a772d8e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2476733052&rft_id=info:pmid/33505238&rfr_iscdi=true