Loading…
Digital x‐ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: A cross‐sectional and longitudinal study
Objective To evaluate digital x‐ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease‐related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA). Methods Using DX...
Saved in:
Published in: | Arthritis and rheumatism 2005-12, Vol.52 (12), p.3850-3859 |
---|---|
Main Authors: | , , , , , , , , , , , |
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-c3536-65d6d71a45d19fe9822e1ba2562bb9e4f0659e2565c16750d9bb2a4af527e4703 |
---|---|
cites | cdi_FETCH-LOGICAL-c3536-65d6d71a45d19fe9822e1ba2562bb9e4f0659e2565c16750d9bb2a4af527e4703 |
container_end_page | 3859 |
container_issue | 12 |
container_start_page | 3850 |
container_title | Arthritis and rheumatism |
container_volume | 52 |
creator | Böttcher, J. Pfeil, A. Rosholm, A. Petrovitch, A. Seidl, B. E. Malich, A. Schäfer, M. L. Kramer, A. Mentzel, H. J. Lehmann, G. Hein, G. Kaiser, W. A. |
description | Objective
To evaluate digital x‐ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease‐related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA).
Methods
Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width (JSW) at the second through the fifth metacarpophalangeal (MCP) joints in these patients.
Results
All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 ≤ R ≤ 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (−0.67 ≤ R ≤ −0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration |
doi_str_mv | 10.1002/art.21606 |
format | article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68879157</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>68879157</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3536-65d6d71a45d19fe9822e1ba2562bb9e4f0659e2565c16750d9bb2a4af527e4703</originalsourceid><addsrcrecordid>eNp1kc-KFDEQxoMo7rh68AUkFwUPvZukO-lpb8P6FxYEWc9NdZKeqaW7MyZpxr75CD6Pj-OTWLszsCchUKnix_fVRzH2UooLKYS6hJgvlDTCPGIrqVVTCFnKx2wlhKiKUjfyjD1L6ZZaVeryKTuTplSiLNWK_XmPW8ww8J9_f_2OsPAIDsM2wjj6HBduw9jh5B0_YN7x5EeEOYcRMo1ggmFJmHjo-W3AKfO0B-sJdXmXONDjkz9wh7CdQspoOez3MYDdcZx43PmZhAKSUsy7iBnTO77hNoaUaJvkbcZAHmTk-BAmWnR2eDdI9Fmesyc9DMm_ONVz9v3jh5urz8X1109frjbXhaWwpjDaGVdLqLSTTe-btVJedqC0UV3X-KoXRjeeWm2lqbVwTdcpqKDXqvZVLcpz9uaoS6v_mH3K7YjJ-mGAyYc5tWa9rhupawLfHsH7BNH37T7iCHFppWjvDtVSzvb-UMS-OonO3ejdA3m6DAGvTwAkC0MfYbKYHriaVKTSxF0euQMOfvm_Y7v5dnO0_gdncLBw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>68879157</pqid></control><display><type>article</type><title>Digital x‐ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: A cross‐sectional and longitudinal study</title><source>Wiley:Jisc Collections:Wiley Read and Publish Open Access 2024-2025 (reading list)</source><creator>Böttcher, J. ; Pfeil, A. ; Rosholm, A. ; Petrovitch, A. ; Seidl, B. E. ; Malich, A. ; Schäfer, M. L. ; Kramer, A. ; Mentzel, H. J. ; Lehmann, G. ; Hein, G. ; Kaiser, W. A.</creator><creatorcontrib>Böttcher, J. ; Pfeil, A. ; Rosholm, A. ; Petrovitch, A. ; Seidl, B. E. ; Malich, A. ; Schäfer, M. L. ; Kramer, A. ; Mentzel, H. J. ; Lehmann, G. ; Hein, G. ; Kaiser, W. A.</creatorcontrib><description>Objective
To evaluate digital x‐ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease‐related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA).
Methods
Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width (JSW) at the second through the fifth metacarpophalangeal (MCP) joints in these patients.
Results
All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 ≤ R ≤ 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (−0.67 ≤ R ≤ −0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration <1 year). In addition, excellent reproducibility of DXR and Radiogrammetry Kit parameters was verified (coefficients of variation <1%).
Conclusion
DXR with the integrated Radiogrammetry Kit program could be a promising, widely available diagnostic tool for supplementing the different RA scoring methods with quantitative data, thus allowing an earlier and improved diagnosis of RA and more precision in determining disease progression.</description><identifier>ISSN: 0004-3591</identifier><identifier>EISSN: 1529-0131</identifier><identifier>DOI: 10.1002/art.21606</identifier><identifier>PMID: 16320332</identifier><identifier>CODEN: ARHEAW</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Absorptiometry, Photon - methods ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arthritis, Rheumatoid - diagnostic imaging ; Biological and medical sciences ; Bone Density ; Cross-Sectional Studies ; Disability Evaluation ; Diseases of the osteoarticular system ; Female ; Humans ; Inflammatory joint diseases ; Investigative techniques, diagnostic techniques (general aspects) ; Longitudinal Studies ; Male ; Medical sciences ; Metacarpophalangeal Joint - diagnostic imaging ; Middle Aged ; Osteoarticular system. Muscles ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiographic Image Enhancement - methods ; Severity of Illness Index</subject><ispartof>Arthritis and rheumatism, 2005-12, Vol.52 (12), p.3850-3859</ispartof><rights>Copyright © 2005 by the American College of Rheumatology</rights><rights>2006 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3536-65d6d71a45d19fe9822e1ba2562bb9e4f0659e2565c16750d9bb2a4af527e4703</citedby><cites>FETCH-LOGICAL-c3536-65d6d71a45d19fe9822e1ba2562bb9e4f0659e2565c16750d9bb2a4af527e4703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17606125$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16320332$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Böttcher, J.</creatorcontrib><creatorcontrib>Pfeil, A.</creatorcontrib><creatorcontrib>Rosholm, A.</creatorcontrib><creatorcontrib>Petrovitch, A.</creatorcontrib><creatorcontrib>Seidl, B. E.</creatorcontrib><creatorcontrib>Malich, A.</creatorcontrib><creatorcontrib>Schäfer, M. L.</creatorcontrib><creatorcontrib>Kramer, A.</creatorcontrib><creatorcontrib>Mentzel, H. J.</creatorcontrib><creatorcontrib>Lehmann, G.</creatorcontrib><creatorcontrib>Hein, G.</creatorcontrib><creatorcontrib>Kaiser, W. A.</creatorcontrib><title>Digital x‐ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: A cross‐sectional and longitudinal study</title><title>Arthritis and rheumatism</title><addtitle>Arthritis Rheum</addtitle><description>Objective
To evaluate digital x‐ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease‐related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA).
Methods
Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width (JSW) at the second through the fifth metacarpophalangeal (MCP) joints in these patients.
Results
All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 ≤ R ≤ 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (−0.67 ≤ R ≤ −0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration <1 year). In addition, excellent reproducibility of DXR and Radiogrammetry Kit parameters was verified (coefficients of variation <1%).
Conclusion
DXR with the integrated Radiogrammetry Kit program could be a promising, widely available diagnostic tool for supplementing the different RA scoring methods with quantitative data, thus allowing an earlier and improved diagnosis of RA and more precision in determining disease progression.</description><subject>Absorptiometry, Photon - methods</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthritis, Rheumatoid - diagnostic imaging</subject><subject>Biological and medical sciences</subject><subject>Bone Density</subject><subject>Cross-Sectional Studies</subject><subject>Disability Evaluation</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Humans</subject><subject>Inflammatory joint diseases</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metacarpophalangeal Joint - diagnostic imaging</subject><subject>Middle Aged</subject><subject>Osteoarticular system. Muscles</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiographic Image Enhancement - methods</subject><subject>Severity of Illness Index</subject><issn>0004-3591</issn><issn>1529-0131</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><recordid>eNp1kc-KFDEQxoMo7rh68AUkFwUPvZukO-lpb8P6FxYEWc9NdZKeqaW7MyZpxr75CD6Pj-OTWLszsCchUKnix_fVRzH2UooLKYS6hJgvlDTCPGIrqVVTCFnKx2wlhKiKUjfyjD1L6ZZaVeryKTuTplSiLNWK_XmPW8ww8J9_f_2OsPAIDsM2wjj6HBduw9jh5B0_YN7x5EeEOYcRMo1ggmFJmHjo-W3AKfO0B-sJdXmXONDjkz9wh7CdQspoOez3MYDdcZx43PmZhAKSUsy7iBnTO77hNoaUaJvkbcZAHmTk-BAmWnR2eDdI9Fmesyc9DMm_ONVz9v3jh5urz8X1109frjbXhaWwpjDaGVdLqLSTTe-btVJedqC0UV3X-KoXRjeeWm2lqbVwTdcpqKDXqvZVLcpz9uaoS6v_mH3K7YjJ-mGAyYc5tWa9rhupawLfHsH7BNH37T7iCHFppWjvDtVSzvb-UMS-OonO3ejdA3m6DAGvTwAkC0MfYbKYHriaVKTSxF0euQMOfvm_Y7v5dnO0_gdncLBw</recordid><startdate>200512</startdate><enddate>200512</enddate><creator>Böttcher, J.</creator><creator>Pfeil, A.</creator><creator>Rosholm, A.</creator><creator>Petrovitch, A.</creator><creator>Seidl, B. E.</creator><creator>Malich, A.</creator><creator>Schäfer, M. L.</creator><creator>Kramer, A.</creator><creator>Mentzel, H. J.</creator><creator>Lehmann, G.</creator><creator>Hein, G.</creator><creator>Kaiser, W. A.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley</general><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>7X8</scope></search><sort><creationdate>200512</creationdate><title>Digital x‐ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: A cross‐sectional and longitudinal study</title><author>Böttcher, J. ; Pfeil, A. ; Rosholm, A. ; Petrovitch, A. ; Seidl, B. E. ; Malich, A. ; Schäfer, M. L. ; Kramer, A. ; Mentzel, H. J. ; Lehmann, G. ; Hein, G. ; Kaiser, W. A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3536-65d6d71a45d19fe9822e1ba2562bb9e4f0659e2565c16750d9bb2a4af527e4703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Absorptiometry, Photon - methods</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthritis, Rheumatoid - diagnostic imaging</topic><topic>Biological and medical sciences</topic><topic>Bone Density</topic><topic>Cross-Sectional Studies</topic><topic>Disability Evaluation</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Humans</topic><topic>Inflammatory joint diseases</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metacarpophalangeal Joint - diagnostic imaging</topic><topic>Middle Aged</topic><topic>Osteoarticular system. Muscles</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Radiographic Image Enhancement - methods</topic><topic>Severity of Illness Index</topic><toplevel>online_resources</toplevel><creatorcontrib>Böttcher, J.</creatorcontrib><creatorcontrib>Pfeil, A.</creatorcontrib><creatorcontrib>Rosholm, A.</creatorcontrib><creatorcontrib>Petrovitch, A.</creatorcontrib><creatorcontrib>Seidl, B. E.</creatorcontrib><creatorcontrib>Malich, A.</creatorcontrib><creatorcontrib>Schäfer, M. L.</creatorcontrib><creatorcontrib>Kramer, A.</creatorcontrib><creatorcontrib>Mentzel, H. J.</creatorcontrib><creatorcontrib>Lehmann, G.</creatorcontrib><creatorcontrib>Hein, G.</creatorcontrib><creatorcontrib>Kaiser, W. A.</creatorcontrib><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>MEDLINE - Academic</collection><jtitle>Arthritis and rheumatism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Böttcher, J.</au><au>Pfeil, A.</au><au>Rosholm, A.</au><au>Petrovitch, A.</au><au>Seidl, B. E.</au><au>Malich, A.</au><au>Schäfer, M. L.</au><au>Kramer, A.</au><au>Mentzel, H. J.</au><au>Lehmann, G.</au><au>Hein, G.</au><au>Kaiser, W. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Digital x‐ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: A cross‐sectional and longitudinal study</atitle><jtitle>Arthritis and rheumatism</jtitle><addtitle>Arthritis Rheum</addtitle><date>2005-12</date><risdate>2005</risdate><volume>52</volume><issue>12</issue><spage>3850</spage><epage>3859</epage><pages>3850-3859</pages><issn>0004-3591</issn><eissn>1529-0131</eissn><coden>ARHEAW</coden><abstract>Objective
To evaluate digital x‐ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease‐related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA).
Methods
Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width (JSW) at the second through the fifth metacarpophalangeal (MCP) joints in these patients.
Results
All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 ≤ R ≤ 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (−0.67 ≤ R ≤ −0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration <1 year). In addition, excellent reproducibility of DXR and Radiogrammetry Kit parameters was verified (coefficients of variation <1%).
Conclusion
DXR with the integrated Radiogrammetry Kit program could be a promising, widely available diagnostic tool for supplementing the different RA scoring methods with quantitative data, thus allowing an earlier and improved diagnosis of RA and more precision in determining disease progression.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>16320332</pmid><doi>10.1002/art.21606</doi><tpages>10</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0004-3591 |
ispartof | Arthritis and rheumatism, 2005-12, Vol.52 (12), p.3850-3859 |
issn | 0004-3591 1529-0131 |
language | eng |
recordid | cdi_proquest_miscellaneous_68879157 |
source | Wiley:Jisc Collections:Wiley Read and Publish Open Access 2024-2025 (reading list) |
subjects | Absorptiometry, Photon - methods Adolescent Adult Aged Aged, 80 and over Arthritis, Rheumatoid - diagnostic imaging Biological and medical sciences Bone Density Cross-Sectional Studies Disability Evaluation Diseases of the osteoarticular system Female Humans Inflammatory joint diseases Investigative techniques, diagnostic techniques (general aspects) Longitudinal Studies Male Medical sciences Metacarpophalangeal Joint - diagnostic imaging Middle Aged Osteoarticular system. Muscles Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiographic Image Enhancement - methods Severity of Illness Index |
title | Digital x‐ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: A cross‐sectional and longitudinal study |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-29T19%3A53%3A01IST&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=Digital%20x%E2%80%90ray%20radiogrammetry%20combined%20with%20semiautomated%20analysis%20of%20joint%20space%20widths%20as%20a%20new%20diagnostic%20approach%20in%20rheumatoid%20arthritis:%20A%20cross%E2%80%90sectional%20and%20longitudinal%20study&rft.jtitle=Arthritis%20and%20rheumatism&rft.au=B%C3%B6ttcher,%20J.&rft.date=2005-12&rft.volume=52&rft.issue=12&rft.spage=3850&rft.epage=3859&rft.pages=3850-3859&rft.issn=0004-3591&rft.eissn=1529-0131&rft.coden=ARHEAW&rft_id=info:doi/10.1002/art.21606&rft_dat=%3Cproquest_cross%3E68879157%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c3536-65d6d71a45d19fe9822e1ba2562bb9e4f0659e2565c16750d9bb2a4af527e4703%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=68879157&rft_id=info:pmid/16320332&rfr_iscdi=true |