Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial)

The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasmino...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of cardiology 2013-01, Vol.111 (2), p.273-277
Main Authors: Sharifi, Mohsen, MD, Bay, Curt, PhD, Skrocki, Laura, DO, Rahimi, Farnoosh, MD, Mehdipour, Mahshid, DMD
Format: Article
Language:English
Subjects:
Arizona - epidemiology
Cardiovascular
Catheters
Drug therapy
Female
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Heart attacks
Humans
Length of Stay - trends
Male
Middle Aged
Prospective Studies
Pulmonary arteries
Pulmonary Embolism - drug therapy
Pulmonary Embolism - mortality
Survival Rate - trends
Thrombolytic Therapy - methods
Treatment Outcome
Veins & arteries
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-c495t-c15cb61596f4d15eff0d48aad57d1493380f5c4a24c44a1e8246e2b18a2792b23
cites cdi_FETCH-LOGICAL-c495t-c15cb61596f4d15eff0d48aad57d1493380f5c4a24c44a1e8246e2b18a2792b23
container_end_page 277
container_issue 2
container_start_page 273
container_title The American journal of cardiology
container_volume 111
creator Sharifi, Mohsen, MD
Bay, Curt, PhD
Skrocki, Laura, DO
Rahimi, Farnoosh, MD
Mehdipour, Mahshid, DMD
description The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this “safe dose” thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a “safe dose” of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p
doi_str_mv 10.1016/j.amjcard.2012.09.027
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1273254117</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002914912022059</els_id><sourcerecordid>1273254117</sourcerecordid><originalsourceid>FETCH-LOGICAL-c495t-c15cb61596f4d15eff0d48aad57d1493380f5c4a24c44a1e8246e2b18a2792b23</originalsourceid><addsrcrecordid>eNqFkc9u1DAQhy0EotvCI4AicSmHBI9jJ_EFhKrlj9SqlRrE0XLsidYh2bR2grS3Pkh5uT4JjnYBqRdO1sjfbzz-hpBXQDOgULzrMj10RnubMQosozKjrHxCVlCVMgUJ-VOyopSyVAKXR-Q4hC6WAKJ4To5YDpRVlViR64vRotcTJldzP4xb7XfJemjG3oUhqT3GG5t8d9MmqTd-XC52wYXktI1FMm0webi7v7i8Wtf1w92vGHC6f_uCPGt1H_Dl4Twh3z6t67Mv6fnl569nH89Tw6WYUgPCNAUIWbTcgsC2pZZXWltR2jhznle0FYZrxg3nGrBivEDWQKVZKVnD8hNyuu9748fbGcOkBhcM9r3e4jgHBazMmeAAZUTfPEK7cfbbOF2kioJGkPNIiT1l_BiCx1bdeDdEJQqoWqyrTh2sq8W6olJF6zH3-tB9bga0f1N_NEfgwx7AqOOnQ6-Ccbg1aJ1HMyk7uv8-8f5RB9O7rTO6_4E7DP9-o0LMqOtl9cvmgVHGqJD5b4FLqh0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1266073244</pqid></control><display><type>article</type><title>Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial)</title><source>ScienceDirect Freedom Collection</source><creator>Sharifi, Mohsen, MD ; Bay, Curt, PhD ; Skrocki, Laura, DO ; Rahimi, Farnoosh, MD ; Mehdipour, Mahshid, DMD</creator><creatorcontrib>Sharifi, Mohsen, MD ; Bay, Curt, PhD ; Skrocki, Laura, DO ; Rahimi, Farnoosh, MD ; Mehdipour, Mahshid, DMD ; “MOPETT” Investigators</creatorcontrib><description>The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this “safe dose” thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a “safe dose” of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p &lt;0.001) and 9 of 58 patients (16%) in the TG and 35 of 56 patients (63%) in the CG (p &lt;0.001), respectively. The secondary end points were total mortality, the duration of hospital stay, bleeding at the index hospitalization, recurrent PE, and the combination of mortality and recurrent PE. The duration of hospitalization was 2.2 ± 0.5 days in the TG and 4.9 ± 0.8 days in the CG (p &lt;0.001). The combination of death plus recurrent PE was 1 (1.6%) in TG and 6 (10%) in the CG (p = 0.0489). No bleeding occurred in any group, and despite a positive trend in favor of a “safe dose” thrombolysis, no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently. In conclusion, the results from the present prospective randomized trial suggests that “safe dose” thrombolysis is safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2012.09.027</identifier><identifier>PMID: 23102885</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arizona - epidemiology ; Cardiovascular ; Catheters ; Drug therapy ; Female ; Fibrinolytic Agents - therapeutic use ; Follow-Up Studies ; Heart attacks ; Humans ; Length of Stay - trends ; Male ; Middle Aged ; Prospective Studies ; Pulmonary arteries ; Pulmonary Embolism - drug therapy ; Pulmonary Embolism - mortality ; Survival Rate - trends ; Thrombolytic Therapy - methods ; Treatment Outcome ; Veins &amp; arteries</subject><ispartof>The American journal of cardiology, 2013-01, Vol.111 (2), p.273-277</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-c15cb61596f4d15eff0d48aad57d1493380f5c4a24c44a1e8246e2b18a2792b23</citedby><cites>FETCH-LOGICAL-c495t-c15cb61596f4d15eff0d48aad57d1493380f5c4a24c44a1e8246e2b18a2792b23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23102885$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sharifi, Mohsen, MD</creatorcontrib><creatorcontrib>Bay, Curt, PhD</creatorcontrib><creatorcontrib>Skrocki, Laura, DO</creatorcontrib><creatorcontrib>Rahimi, Farnoosh, MD</creatorcontrib><creatorcontrib>Mehdipour, Mahshid, DMD</creatorcontrib><creatorcontrib>“MOPETT” Investigators</creatorcontrib><title>Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this “safe dose” thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a “safe dose” of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p &lt;0.001) and 9 of 58 patients (16%) in the TG and 35 of 56 patients (63%) in the CG (p &lt;0.001), respectively. The secondary end points were total mortality, the duration of hospital stay, bleeding at the index hospitalization, recurrent PE, and the combination of mortality and recurrent PE. The duration of hospitalization was 2.2 ± 0.5 days in the TG and 4.9 ± 0.8 days in the CG (p &lt;0.001). The combination of death plus recurrent PE was 1 (1.6%) in TG and 6 (10%) in the CG (p = 0.0489). No bleeding occurred in any group, and despite a positive trend in favor of a “safe dose” thrombolysis, no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently. In conclusion, the results from the present prospective randomized trial suggests that “safe dose” thrombolysis is safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.</description><subject>Arizona - epidemiology</subject><subject>Cardiovascular</subject><subject>Catheters</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Length of Stay - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Pulmonary arteries</subject><subject>Pulmonary Embolism - drug therapy</subject><subject>Pulmonary Embolism - mortality</subject><subject>Survival Rate - trends</subject><subject>Thrombolytic Therapy - methods</subject><subject>Treatment Outcome</subject><subject>Veins &amp; arteries</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNqFkc9u1DAQhy0EotvCI4AicSmHBI9jJ_EFhKrlj9SqlRrE0XLsidYh2bR2grS3Pkh5uT4JjnYBqRdO1sjfbzz-hpBXQDOgULzrMj10RnubMQosozKjrHxCVlCVMgUJ-VOyopSyVAKXR-Q4hC6WAKJ4To5YDpRVlViR64vRotcTJldzP4xb7XfJemjG3oUhqT3GG5t8d9MmqTd-XC52wYXktI1FMm0webi7v7i8Wtf1w92vGHC6f_uCPGt1H_Dl4Twh3z6t67Mv6fnl569nH89Tw6WYUgPCNAUIWbTcgsC2pZZXWltR2jhznle0FYZrxg3nGrBivEDWQKVZKVnD8hNyuu9748fbGcOkBhcM9r3e4jgHBazMmeAAZUTfPEK7cfbbOF2kioJGkPNIiT1l_BiCx1bdeDdEJQqoWqyrTh2sq8W6olJF6zH3-tB9bga0f1N_NEfgwx7AqOOnQ6-Ccbg1aJ1HMyk7uv8-8f5RB9O7rTO6_4E7DP9-o0LMqOtl9cvmgVHGqJD5b4FLqh0</recordid><startdate>20130115</startdate><enddate>20130115</enddate><creator>Sharifi, Mohsen, MD</creator><creator>Bay, Curt, PhD</creator><creator>Skrocki, Laura, DO</creator><creator>Rahimi, Farnoosh, MD</creator><creator>Mehdipour, Mahshid, DMD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><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>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</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>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20130115</creationdate><title>Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial)</title><author>Sharifi, Mohsen, MD ; Bay, Curt, PhD ; Skrocki, Laura, DO ; Rahimi, Farnoosh, MD ; Mehdipour, Mahshid, DMD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-c15cb61596f4d15eff0d48aad57d1493380f5c4a24c44a1e8246e2b18a2792b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Arizona - epidemiology</topic><topic>Cardiovascular</topic><topic>Catheters</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Length of Stay - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Pulmonary arteries</topic><topic>Pulmonary Embolism - drug therapy</topic><topic>Pulmonary Embolism - mortality</topic><topic>Survival Rate - trends</topic><topic>Thrombolytic Therapy - methods</topic><topic>Treatment Outcome</topic><topic>Veins &amp; arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sharifi, Mohsen, MD</creatorcontrib><creatorcontrib>Bay, Curt, PhD</creatorcontrib><creatorcontrib>Skrocki, Laura, DO</creatorcontrib><creatorcontrib>Rahimi, Farnoosh, MD</creatorcontrib><creatorcontrib>Mehdipour, Mahshid, DMD</creatorcontrib><creatorcontrib>“MOPETT” Investigators</creatorcontrib><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>ProQuest Nursing and Allied Health Source</collection><collection>Physical Education Index</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</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)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</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 &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</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><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sharifi, Mohsen, MD</au><au>Bay, Curt, PhD</au><au>Skrocki, Laura, DO</au><au>Rahimi, Farnoosh, MD</au><au>Mehdipour, Mahshid, DMD</au><aucorp>“MOPETT” Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial)</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2013-01-15</date><risdate>2013</risdate><volume>111</volume><issue>2</issue><spage>273</spage><epage>277</epage><pages>273-277</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this “safe dose” thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a “safe dose” of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p &lt;0.001) and 9 of 58 patients (16%) in the TG and 35 of 56 patients (63%) in the CG (p &lt;0.001), respectively. The secondary end points were total mortality, the duration of hospital stay, bleeding at the index hospitalization, recurrent PE, and the combination of mortality and recurrent PE. The duration of hospitalization was 2.2 ± 0.5 days in the TG and 4.9 ± 0.8 days in the CG (p &lt;0.001). The combination of death plus recurrent PE was 1 (1.6%) in TG and 6 (10%) in the CG (p = 0.0489). No bleeding occurred in any group, and despite a positive trend in favor of a “safe dose” thrombolysis, no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently. In conclusion, the results from the present prospective randomized trial suggests that “safe dose” thrombolysis is safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23102885</pmid><doi>10.1016/j.amjcard.2012.09.027</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0002-9149
ispartof The American journal of cardiology, 2013-01, Vol.111 (2), p.273-277
issn 0002-9149
1879-1913
language eng
recordid cdi_proquest_miscellaneous_1273254117
source ScienceDirect Freedom Collection
subjects Arizona - epidemiology
Cardiovascular
Catheters
Drug therapy
Female
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Heart attacks
Humans
Length of Stay - trends
Male
Middle Aged
Prospective Studies
Pulmonary arteries
Pulmonary Embolism - drug therapy
Pulmonary Embolism - mortality
Survival Rate - trends
Thrombolytic Therapy - methods
Treatment Outcome
Veins & arteries
title Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT” Trial)
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T19%3A34%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Moderate%20Pulmonary%20Embolism%20Treated%20With%20Thrombolysis%20(from%20the%20%E2%80%9CMOPETT%E2%80%9D%20Trial)&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=Sharifi,%20Mohsen,%20MD&rft.aucorp=%E2%80%9CMOPETT%E2%80%9D%20Investigators&rft.date=2013-01-15&rft.volume=111&rft.issue=2&rft.spage=273&rft.epage=277&rft.pages=273-277&rft.issn=0002-9149&rft.eissn=1879-1913&rft.coden=AJCDAG&rft_id=info:doi/10.1016/j.amjcard.2012.09.027&rft_dat=%3Cproquest_cross%3E1273254117%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c495t-c15cb61596f4d15eff0d48aad57d1493380f5c4a24c44a1e8246e2b18a2792b23%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1266073244&rft_id=info:pmid/23102885&rfr_iscdi=true