Loading…

Metabolic profiling of hypoxia/reoxygenation injury in H9c2 cells reveals the accumulation of phytosphingosine and the vital role of Dan-Shen in Xin-Ke-Shu

Xin-Ke-Shu (XKS), a patent medicine consisting of five commonly used traditional Chinese herbs, is used for the treatment of coronary heart diseases. A previous study showed that XKS has protective effects for ameliorating myocardial ischemia/reperfusion (I/R) injury. This study was aimed to deeply...

Full description

Saved in:
Bibliographic Details
Published in:Phytomedicine (Stuttgart) 2018-10, Vol.49, p.83-94
Main Authors: Sun, Lili, Jia, Hongmei, Ma, Liyan, Yu, Meng, Yang, Yong, Liu, Yang, Zhang, Hongwu, Zou, Zhongmei
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-c428t-fb8ea2262c97463e78d4551cc07c91dba30329d3e2160fb9a166b39a211d229d3
cites cdi_FETCH-LOGICAL-c428t-fb8ea2262c97463e78d4551cc07c91dba30329d3e2160fb9a166b39a211d229d3
container_end_page 94
container_issue
container_start_page 83
container_title Phytomedicine (Stuttgart)
container_volume 49
creator Sun, Lili
Jia, Hongmei
Ma, Liyan
Yu, Meng
Yang, Yong
Liu, Yang
Zhang, Hongwu
Zou, Zhongmei
description Xin-Ke-Shu (XKS), a patent medicine consisting of five commonly used traditional Chinese herbs, is used for the treatment of coronary heart diseases. A previous study showed that XKS has protective effects for ameliorating myocardial ischemia/reperfusion (I/R) injury. This study was aimed to deeply understand the mechanisms and compatible principle of XKS against hypoxia/reoxygenation (H/R) injury and the contribution of each single herb to the efficacy of XKS. An H/R model in H9c2 cardiomyocytes was applied to mimic I/R injury observed in vivo. The cell viability, the levels of LDH, MDA, SOD, and apoptosis were determined to evaluate the cardioprotection of XKS and its subtracted formula (knocked out one herb) in H/R injury. Cell metabolomics, combined with western blot analysis, was performed to uncover the inert molecular mechanism of XKS against H/R injury. Significant protective effects of XKS against oxidative stress and apoptosis induced by H/R injury were found in the pharmacodynamic evaluation. Moreover, the metabolic profile deviation of the H/R group from the control group was mainly ascribed to thirteen metabolites involved in four aberrant pathways, in which sphingolipid metabolism was revealed as the most relevant pathway involved in H/R injury (impact > 0.1). Notably, the accumulation of phytosphingosine (VIP = 5.84) was considered the most likely characteristic in H/R injury, which is well known to promote the opening of the mitochondrial permeability transition pore (mPTP) and activate cell apoptosis. Furthermore, XKS ameliorated all the abnormalities of the metabolic network in response to H/R injury. In agreement with this, a western blot analysis showed that XKS markedly regulated the over-expression of CaMK II and cleaved caspase-3. However, the subtracted formula showed no significant difference in comparison with the XKS group on protecting H/R injury except for QDS (subtracted Dan-Shen from XKS). The roots of Salvia miltiorrhiza Bge. (Dan-Shen) play an important role in the regulation of Ca2+ overloading, oxidative stress and apoptosis in H/R injury. Our study enabled information from holistic cell metabolomics to be used for mechanism and compatibility rule elucidations of TCMs. The significant cardioprotective effects of XKS against H/R injury in vitro were likely mediated by the inhibition of Ca2+ overloading, oxidative stress and cell apoptosis, wherein Dan-Shen plays an irreplaceable role. [Display omitted]
doi_str_mv 10.1016/j.phymed.2018.06.026
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2105045421</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0944711318302149</els_id><sourcerecordid>2105045421</sourcerecordid><originalsourceid>FETCH-LOGICAL-c428t-fb8ea2262c97463e78d4551cc07c91dba30329d3e2160fb9a166b39a211d229d3</originalsourceid><addsrcrecordid>eNp9kcFu1TAQRS1ERV8Lf4CQl2ySepzESTZIqECLaNUFIHVnOc6k8VOeHezkqfmW_iwOabesRtacuXfGl5D3wFJgIC726dgvB2xTzqBKmUgZF6_IDgRUCauL-9dkx-o8T0qA7JSchbBnDPK6ZG_IacY4lFwUO_J0i5Nq3GA0Hb3rzGDsA3Ud7ZfRPRp14dE9Lg9o1WScpcbuZ7_EQq9rzanGYQjU4xFVrFOPVGk9H-Zho6NMXHFyYeyjqgvGRsC2_8CjmdRAvRtwxb4om_zscTWg98YmPzA-57fkpIvC-O65npPf377-urxObu6uvl9-vkl0zqsp6ZoKFeeC67rMRYZl1eZFAVqzUtfQNipjGa_bDDkI1jW1AiGarFYcoOVr45x83HTjD_yZMUzyYMJ6m7Lo5iA5sILlRc4hovmGau9C8NjJ0ZuD8osEJtdY5F5uscg1FsmEjLHEsQ_PDnOz9l6GXnKIwKcNwHjn0aCXQRu0GlvjUU-ydeb_Dn8BHlKiYg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2105045421</pqid></control><display><type>article</type><title>Metabolic profiling of hypoxia/reoxygenation injury in H9c2 cells reveals the accumulation of phytosphingosine and the vital role of Dan-Shen in Xin-Ke-Shu</title><source>ScienceDirect Freedom Collection 2022-2024</source><creator>Sun, Lili ; Jia, Hongmei ; Ma, Liyan ; Yu, Meng ; Yang, Yong ; Liu, Yang ; Zhang, Hongwu ; Zou, Zhongmei</creator><creatorcontrib>Sun, Lili ; Jia, Hongmei ; Ma, Liyan ; Yu, Meng ; Yang, Yong ; Liu, Yang ; Zhang, Hongwu ; Zou, Zhongmei</creatorcontrib><description>Xin-Ke-Shu (XKS), a patent medicine consisting of five commonly used traditional Chinese herbs, is used for the treatment of coronary heart diseases. A previous study showed that XKS has protective effects for ameliorating myocardial ischemia/reperfusion (I/R) injury. This study was aimed to deeply understand the mechanisms and compatible principle of XKS against hypoxia/reoxygenation (H/R) injury and the contribution of each single herb to the efficacy of XKS. An H/R model in H9c2 cardiomyocytes was applied to mimic I/R injury observed in vivo. The cell viability, the levels of LDH, MDA, SOD, and apoptosis were determined to evaluate the cardioprotection of XKS and its subtracted formula (knocked out one herb) in H/R injury. Cell metabolomics, combined with western blot analysis, was performed to uncover the inert molecular mechanism of XKS against H/R injury. Significant protective effects of XKS against oxidative stress and apoptosis induced by H/R injury were found in the pharmacodynamic evaluation. Moreover, the metabolic profile deviation of the H/R group from the control group was mainly ascribed to thirteen metabolites involved in four aberrant pathways, in which sphingolipid metabolism was revealed as the most relevant pathway involved in H/R injury (impact &gt; 0.1). Notably, the accumulation of phytosphingosine (VIP = 5.84) was considered the most likely characteristic in H/R injury, which is well known to promote the opening of the mitochondrial permeability transition pore (mPTP) and activate cell apoptosis. Furthermore, XKS ameliorated all the abnormalities of the metabolic network in response to H/R injury. In agreement with this, a western blot analysis showed that XKS markedly regulated the over-expression of CaMK II and cleaved caspase-3. However, the subtracted formula showed no significant difference in comparison with the XKS group on protecting H/R injury except for QDS (subtracted Dan-Shen from XKS). The roots of Salvia miltiorrhiza Bge. (Dan-Shen) play an important role in the regulation of Ca2+ overloading, oxidative stress and apoptosis in H/R injury. Our study enabled information from holistic cell metabolomics to be used for mechanism and compatibility rule elucidations of TCMs. The significant cardioprotective effects of XKS against H/R injury in vitro were likely mediated by the inhibition of Ca2+ overloading, oxidative stress and cell apoptosis, wherein Dan-Shen plays an irreplaceable role. [Display omitted]</description><identifier>ISSN: 0944-7113</identifier><identifier>EISSN: 1618-095X</identifier><identifier>DOI: 10.1016/j.phymed.2018.06.026</identifier><identifier>PMID: 30217265</identifier><language>eng</language><publisher>Germany: Elsevier GmbH</publisher><subject>Animals ; Apoptosis - drug effects ; Cardioprotective effect ; Cell Hypoxia ; Cell Survival - drug effects ; Drugs, Chinese Herbal - pharmacology ; H9c2 cells ; Hypoxia/reoxygenation injury ; Metabolomics ; Mitochondrial Membrane Transport Proteins ; Myocardial Reperfusion Injury ; Myocytes, Cardiac - drug effects ; Oxidative Stress - drug effects ; Rats ; Salvia miltiorrhiza ; Sphingosine - analogs &amp; derivatives ; Sphingosine - pharmacology ; UPLC-Q/TOF-MS ; Xin-Ke-Shu</subject><ispartof>Phytomedicine (Stuttgart), 2018-10, Vol.49, p.83-94</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier GmbH.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-fb8ea2262c97463e78d4551cc07c91dba30329d3e2160fb9a166b39a211d229d3</citedby><cites>FETCH-LOGICAL-c428t-fb8ea2262c97463e78d4551cc07c91dba30329d3e2160fb9a166b39a211d229d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30217265$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sun, Lili</creatorcontrib><creatorcontrib>Jia, Hongmei</creatorcontrib><creatorcontrib>Ma, Liyan</creatorcontrib><creatorcontrib>Yu, Meng</creatorcontrib><creatorcontrib>Yang, Yong</creatorcontrib><creatorcontrib>Liu, Yang</creatorcontrib><creatorcontrib>Zhang, Hongwu</creatorcontrib><creatorcontrib>Zou, Zhongmei</creatorcontrib><title>Metabolic profiling of hypoxia/reoxygenation injury in H9c2 cells reveals the accumulation of phytosphingosine and the vital role of Dan-Shen in Xin-Ke-Shu</title><title>Phytomedicine (Stuttgart)</title><addtitle>Phytomedicine</addtitle><description>Xin-Ke-Shu (XKS), a patent medicine consisting of five commonly used traditional Chinese herbs, is used for the treatment of coronary heart diseases. A previous study showed that XKS has protective effects for ameliorating myocardial ischemia/reperfusion (I/R) injury. This study was aimed to deeply understand the mechanisms and compatible principle of XKS against hypoxia/reoxygenation (H/R) injury and the contribution of each single herb to the efficacy of XKS. An H/R model in H9c2 cardiomyocytes was applied to mimic I/R injury observed in vivo. The cell viability, the levels of LDH, MDA, SOD, and apoptosis were determined to evaluate the cardioprotection of XKS and its subtracted formula (knocked out one herb) in H/R injury. Cell metabolomics, combined with western blot analysis, was performed to uncover the inert molecular mechanism of XKS against H/R injury. Significant protective effects of XKS against oxidative stress and apoptosis induced by H/R injury were found in the pharmacodynamic evaluation. Moreover, the metabolic profile deviation of the H/R group from the control group was mainly ascribed to thirteen metabolites involved in four aberrant pathways, in which sphingolipid metabolism was revealed as the most relevant pathway involved in H/R injury (impact &gt; 0.1). Notably, the accumulation of phytosphingosine (VIP = 5.84) was considered the most likely characteristic in H/R injury, which is well known to promote the opening of the mitochondrial permeability transition pore (mPTP) and activate cell apoptosis. Furthermore, XKS ameliorated all the abnormalities of the metabolic network in response to H/R injury. In agreement with this, a western blot analysis showed that XKS markedly regulated the over-expression of CaMK II and cleaved caspase-3. However, the subtracted formula showed no significant difference in comparison with the XKS group on protecting H/R injury except for QDS (subtracted Dan-Shen from XKS). The roots of Salvia miltiorrhiza Bge. (Dan-Shen) play an important role in the regulation of Ca2+ overloading, oxidative stress and apoptosis in H/R injury. Our study enabled information from holistic cell metabolomics to be used for mechanism and compatibility rule elucidations of TCMs. The significant cardioprotective effects of XKS against H/R injury in vitro were likely mediated by the inhibition of Ca2+ overloading, oxidative stress and cell apoptosis, wherein Dan-Shen plays an irreplaceable role. [Display omitted]</description><subject>Animals</subject><subject>Apoptosis - drug effects</subject><subject>Cardioprotective effect</subject><subject>Cell Hypoxia</subject><subject>Cell Survival - drug effects</subject><subject>Drugs, Chinese Herbal - pharmacology</subject><subject>H9c2 cells</subject><subject>Hypoxia/reoxygenation injury</subject><subject>Metabolomics</subject><subject>Mitochondrial Membrane Transport Proteins</subject><subject>Myocardial Reperfusion Injury</subject><subject>Myocytes, Cardiac - drug effects</subject><subject>Oxidative Stress - drug effects</subject><subject>Rats</subject><subject>Salvia miltiorrhiza</subject><subject>Sphingosine - analogs &amp; derivatives</subject><subject>Sphingosine - pharmacology</subject><subject>UPLC-Q/TOF-MS</subject><subject>Xin-Ke-Shu</subject><issn>0944-7113</issn><issn>1618-095X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kcFu1TAQRS1ERV8Lf4CQl2ySepzESTZIqECLaNUFIHVnOc6k8VOeHezkqfmW_iwOabesRtacuXfGl5D3wFJgIC726dgvB2xTzqBKmUgZF6_IDgRUCauL-9dkx-o8T0qA7JSchbBnDPK6ZG_IacY4lFwUO_J0i5Nq3GA0Hb3rzGDsA3Ud7ZfRPRp14dE9Lg9o1WScpcbuZ7_EQq9rzanGYQjU4xFVrFOPVGk9H-Zho6NMXHFyYeyjqgvGRsC2_8CjmdRAvRtwxb4om_zscTWg98YmPzA-57fkpIvC-O65npPf377-urxObu6uvl9-vkl0zqsp6ZoKFeeC67rMRYZl1eZFAVqzUtfQNipjGa_bDDkI1jW1AiGarFYcoOVr45x83HTjD_yZMUzyYMJ6m7Lo5iA5sILlRc4hovmGau9C8NjJ0ZuD8osEJtdY5F5uscg1FsmEjLHEsQ_PDnOz9l6GXnKIwKcNwHjn0aCXQRu0GlvjUU-ydeb_Dn8BHlKiYg</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Sun, Lili</creator><creator>Jia, Hongmei</creator><creator>Ma, Liyan</creator><creator>Yu, Meng</creator><creator>Yang, Yong</creator><creator>Liu, Yang</creator><creator>Zhang, Hongwu</creator><creator>Zou, Zhongmei</creator><general>Elsevier GmbH</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>7X8</scope></search><sort><creationdate>20181001</creationdate><title>Metabolic profiling of hypoxia/reoxygenation injury in H9c2 cells reveals the accumulation of phytosphingosine and the vital role of Dan-Shen in Xin-Ke-Shu</title><author>Sun, Lili ; Jia, Hongmei ; Ma, Liyan ; Yu, Meng ; Yang, Yong ; Liu, Yang ; Zhang, Hongwu ; Zou, Zhongmei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-fb8ea2262c97463e78d4551cc07c91dba30329d3e2160fb9a166b39a211d229d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Animals</topic><topic>Apoptosis - drug effects</topic><topic>Cardioprotective effect</topic><topic>Cell Hypoxia</topic><topic>Cell Survival - drug effects</topic><topic>Drugs, Chinese Herbal - pharmacology</topic><topic>H9c2 cells</topic><topic>Hypoxia/reoxygenation injury</topic><topic>Metabolomics</topic><topic>Mitochondrial Membrane Transport Proteins</topic><topic>Myocardial Reperfusion Injury</topic><topic>Myocytes, Cardiac - drug effects</topic><topic>Oxidative Stress - drug effects</topic><topic>Rats</topic><topic>Salvia miltiorrhiza</topic><topic>Sphingosine - analogs &amp; derivatives</topic><topic>Sphingosine - pharmacology</topic><topic>UPLC-Q/TOF-MS</topic><topic>Xin-Ke-Shu</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sun, Lili</creatorcontrib><creatorcontrib>Jia, Hongmei</creatorcontrib><creatorcontrib>Ma, Liyan</creatorcontrib><creatorcontrib>Yu, Meng</creatorcontrib><creatorcontrib>Yang, Yong</creatorcontrib><creatorcontrib>Liu, Yang</creatorcontrib><creatorcontrib>Zhang, Hongwu</creatorcontrib><creatorcontrib>Zou, Zhongmei</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Phytomedicine (Stuttgart)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sun, Lili</au><au>Jia, Hongmei</au><au>Ma, Liyan</au><au>Yu, Meng</au><au>Yang, Yong</au><au>Liu, Yang</au><au>Zhang, Hongwu</au><au>Zou, Zhongmei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metabolic profiling of hypoxia/reoxygenation injury in H9c2 cells reveals the accumulation of phytosphingosine and the vital role of Dan-Shen in Xin-Ke-Shu</atitle><jtitle>Phytomedicine (Stuttgart)</jtitle><addtitle>Phytomedicine</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>49</volume><spage>83</spage><epage>94</epage><pages>83-94</pages><issn>0944-7113</issn><eissn>1618-095X</eissn><abstract>Xin-Ke-Shu (XKS), a patent medicine consisting of five commonly used traditional Chinese herbs, is used for the treatment of coronary heart diseases. A previous study showed that XKS has protective effects for ameliorating myocardial ischemia/reperfusion (I/R) injury. This study was aimed to deeply understand the mechanisms and compatible principle of XKS against hypoxia/reoxygenation (H/R) injury and the contribution of each single herb to the efficacy of XKS. An H/R model in H9c2 cardiomyocytes was applied to mimic I/R injury observed in vivo. The cell viability, the levels of LDH, MDA, SOD, and apoptosis were determined to evaluate the cardioprotection of XKS and its subtracted formula (knocked out one herb) in H/R injury. Cell metabolomics, combined with western blot analysis, was performed to uncover the inert molecular mechanism of XKS against H/R injury. Significant protective effects of XKS against oxidative stress and apoptosis induced by H/R injury were found in the pharmacodynamic evaluation. Moreover, the metabolic profile deviation of the H/R group from the control group was mainly ascribed to thirteen metabolites involved in four aberrant pathways, in which sphingolipid metabolism was revealed as the most relevant pathway involved in H/R injury (impact &gt; 0.1). Notably, the accumulation of phytosphingosine (VIP = 5.84) was considered the most likely characteristic in H/R injury, which is well known to promote the opening of the mitochondrial permeability transition pore (mPTP) and activate cell apoptosis. Furthermore, XKS ameliorated all the abnormalities of the metabolic network in response to H/R injury. In agreement with this, a western blot analysis showed that XKS markedly regulated the over-expression of CaMK II and cleaved caspase-3. However, the subtracted formula showed no significant difference in comparison with the XKS group on protecting H/R injury except for QDS (subtracted Dan-Shen from XKS). The roots of Salvia miltiorrhiza Bge. (Dan-Shen) play an important role in the regulation of Ca2+ overloading, oxidative stress and apoptosis in H/R injury. Our study enabled information from holistic cell metabolomics to be used for mechanism and compatibility rule elucidations of TCMs. The significant cardioprotective effects of XKS against H/R injury in vitro were likely mediated by the inhibition of Ca2+ overloading, oxidative stress and cell apoptosis, wherein Dan-Shen plays an irreplaceable role. [Display omitted]</abstract><cop>Germany</cop><pub>Elsevier GmbH</pub><pmid>30217265</pmid><doi>10.1016/j.phymed.2018.06.026</doi><tpages>12</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0944-7113
ispartof Phytomedicine (Stuttgart), 2018-10, Vol.49, p.83-94
issn 0944-7113
1618-095X
language eng
recordid cdi_proquest_miscellaneous_2105045421
source ScienceDirect Freedom Collection 2022-2024
subjects Animals
Apoptosis - drug effects
Cardioprotective effect
Cell Hypoxia
Cell Survival - drug effects
Drugs, Chinese Herbal - pharmacology
H9c2 cells
Hypoxia/reoxygenation injury
Metabolomics
Mitochondrial Membrane Transport Proteins
Myocardial Reperfusion Injury
Myocytes, Cardiac - drug effects
Oxidative Stress - drug effects
Rats
Salvia miltiorrhiza
Sphingosine - analogs & derivatives
Sphingosine - pharmacology
UPLC-Q/TOF-MS
Xin-Ke-Shu
title Metabolic profiling of hypoxia/reoxygenation injury in H9c2 cells reveals the accumulation of phytosphingosine and the vital role of Dan-Shen in Xin-Ke-Shu
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T13%3A53%3A49IST&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=Metabolic%20profiling%20of%20hypoxia/reoxygenation%20injury%20in%20H9c2%20cells%20reveals%20the%20accumulation%20of%20phytosphingosine%20and%20the%20vital%20role%20of%20Dan-Shen%20in%20Xin-Ke-Shu&rft.jtitle=Phytomedicine%20(Stuttgart)&rft.au=Sun,%20Lili&rft.date=2018-10-01&rft.volume=49&rft.spage=83&rft.epage=94&rft.pages=83-94&rft.issn=0944-7113&rft.eissn=1618-095X&rft_id=info:doi/10.1016/j.phymed.2018.06.026&rft_dat=%3Cproquest_cross%3E2105045421%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c428t-fb8ea2262c97463e78d4551cc07c91dba30329d3e2160fb9a166b39a211d229d3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2105045421&rft_id=info:pmid/30217265&rfr_iscdi=true