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Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia
Introduction Preeclampsia (PE) is a pregnancy‐specific syndrome associated with adverse maternal and fetal outcomes. Patient‐specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome. Methods Women evaluated for suspected PE at a tertiary hospit...
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| Published in: | Prenatal diagnosis 2015-04, Vol.35 (4), p.386-393 |
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| container_start_page | 386 |
| container_title | Prenatal diagnosis |
| container_volume | 35 |
| creator | Palomaki, Glenn E. Haddow, James E. Haddow, Hamish R. M. Salahuddin, Saira Geahchan, Carl Cerdeira, Ana Sofia Verlohren, Stefan Perschel, Frank H. Horowitz, Gary Thadhani, Ravi Karumanchi, S. Ananth Rana, Sarosh |
| description | Introduction
Preeclampsia (PE) is a pregnancy‐specific syndrome associated with adverse maternal and fetal outcomes. Patient‐specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome.
Methods
Women evaluated for suspected PE at a tertiary hospital (2009–2012) had pregnancy outcomes categorized as ‘referent’ or ‘severe’, based solely on maternal/fetal findings. Outcomes that may have been influenced by a PE diagnosis were considered ‘unclassified’. Soluble fms‐like tyrosine kinase (sFlt1) and placental growth factor (PlGF) were subjected to bivariate discriminant modeling, allowing patient‐specific risks to be assigned for severe outcomes.
Results
Three hundred twenty‐eight singleton pregnancies presented at ≤34.0 weeks' gestation. sFlt1 and PlGF levels were adjusted for gestational age. Risks above 5 : 1 (10‐fold over background) occurred in 77% of severe (95% CI 66 to 87%) and 0.7% of referent (95% CI |
| doi_str_mv | 10.1002/pd.4554 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4409832</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3645354381</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5414-227f2fabf065c0bf187387c2e96a65b028ba64b288aba815340609e5997f3793</originalsourceid><addsrcrecordid>eNp10V1rFDEUBuAgit1W8R9IwAsLMjXJ5GNyU9DVVqVqL4p6FzKZM9u0M5MxmWkt_nmz7Lqo4E1OIA8v5-Qg9ISSI0oIezk2R1wIfg8tKNGqIIyV99GC0HwvK0H30H5KVxlWTKuHaI8JySlhaoF-fgwNdH5Y4ejTNW5DxAluIAK2TS4JcJgnF3pIeE5rZoeVDysYvMOtdVP2Pdg0R-hhmBL2A77NOp9-usRpTiO4CRo8Rpgg9usKrrP9mLx9hB60tkvweFsP0MXJ24vlu-Ls8-n75auzwglOecGYallr65ZI4Ujd0kqVlXIMtLRS1Hmo2kpes6qyta2oKDmRRIPQWrWl0uUBOt7EjnPdQ-Nyn9F2Zoy-t_HOBOvN3y-DvzSrcGM4J7oqWQ443AbE8H2GNJneJwddZwcIczJUKsryv1c002f_0KswxyFPl5XUSlKtRVbPN8rFkFKEdtcMJWa9TzM2Zr3PLJ_-2fvO_V5gBi824NZ3cPe_HHP-ZhtXbLRPE_zYaRuvjVSlEubrp1NzTk--8OW31-ZD-Qtt3roq</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1669761995</pqid></control><display><type>article</type><title>Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Palomaki, Glenn E. ; Haddow, James E. ; Haddow, Hamish R. M. ; Salahuddin, Saira ; Geahchan, Carl ; Cerdeira, Ana Sofia ; Verlohren, Stefan ; Perschel, Frank H. ; Horowitz, Gary ; Thadhani, Ravi ; Karumanchi, S. Ananth ; Rana, Sarosh</creator><creatorcontrib>Palomaki, Glenn E. ; Haddow, James E. ; Haddow, Hamish R. M. ; Salahuddin, Saira ; Geahchan, Carl ; Cerdeira, Ana Sofia ; Verlohren, Stefan ; Perschel, Frank H. ; Horowitz, Gary ; Thadhani, Ravi ; Karumanchi, S. Ananth ; Rana, Sarosh</creatorcontrib><description>Introduction
Preeclampsia (PE) is a pregnancy‐specific syndrome associated with adverse maternal and fetal outcomes. Patient‐specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome.
Methods
Women evaluated for suspected PE at a tertiary hospital (2009–2012) had pregnancy outcomes categorized as ‘referent’ or ‘severe’, based solely on maternal/fetal findings. Outcomes that may have been influenced by a PE diagnosis were considered ‘unclassified’. Soluble fms‐like tyrosine kinase (sFlt1) and placental growth factor (PlGF) were subjected to bivariate discriminant modeling, allowing patient‐specific risks to be assigned for severe outcomes.
Results
Three hundred twenty‐eight singleton pregnancies presented at ≤34.0 weeks' gestation. sFlt1 and PlGF levels were adjusted for gestational age. Risks above 5 : 1 (10‐fold over background) occurred in 77% of severe (95% CI 66 to 87%) and 0.7% of referent (95% CI <0.1 to 3.8%) outcomes. Positive likelihood ratios for the modeling and validation datasets were 19 (95% CI 6.2–58) and 15 (95% CI 5.8–40) fold, respectively.
Conclusions
This validated model assigns patient‐specific risks of any severe outcome among women attending PE triage. In practice, women with high risks would receive close surveillance with the added potential for reducing unnecessary preterm deliveries among remaining women. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.
What's already known about this topic?
Angiogenic factors are associated with preeclampsia (PE), a pregnancy‐specific syndrome that can lead to severe adverse outcomes. The sFlt1/PlGF ratio has been shown to identify patients at risk for preeclampsia.
What does this study add?
We define the disorder of interest as any severe adverse outcome among women with suspected PE. Angiogenic test results are combined into patient‐specific risks to optimize translation to patient care to improve overall pregnancy outcomes.</description><identifier>ISSN: 0197-3851</identifier><identifier>EISSN: 1097-0223</identifier><identifier>DOI: 10.1002/pd.4554</identifier><identifier>PMID: 25641027</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Angiogenesis Inducing Agents ; Biomarkers - blood ; Birth weight ; Female ; Humans ; Infant, Newborn ; Original ; Placenta Growth Factor ; Pre-Eclampsia - diagnosis ; Preeclampsia ; Pregnancy ; Pregnancy Outcome ; Pregnancy Proteins - blood ; Risk Assessment ; Vascular Endothelial Growth Factor Receptor-1 - blood</subject><ispartof>Prenatal diagnosis, 2015-04, Vol.35 (4), p.386-393</ispartof><rights>2015 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.</rights><rights>2015 John Wiley & Sons, Ltd.</rights><rights>2015 The Authors. published by John Wiley & Sons Ltd. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5414-227f2fabf065c0bf187387c2e96a65b028ba64b288aba815340609e5997f3793</citedby><cites>FETCH-LOGICAL-c5414-227f2fabf065c0bf187387c2e96a65b028ba64b288aba815340609e5997f3793</cites><orcidid>0000-0001-6154-8449</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25641027$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Palomaki, Glenn E.</creatorcontrib><creatorcontrib>Haddow, James E.</creatorcontrib><creatorcontrib>Haddow, Hamish R. M.</creatorcontrib><creatorcontrib>Salahuddin, Saira</creatorcontrib><creatorcontrib>Geahchan, Carl</creatorcontrib><creatorcontrib>Cerdeira, Ana Sofia</creatorcontrib><creatorcontrib>Verlohren, Stefan</creatorcontrib><creatorcontrib>Perschel, Frank H.</creatorcontrib><creatorcontrib>Horowitz, Gary</creatorcontrib><creatorcontrib>Thadhani, Ravi</creatorcontrib><creatorcontrib>Karumanchi, S. Ananth</creatorcontrib><creatorcontrib>Rana, Sarosh</creatorcontrib><title>Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia</title><title>Prenatal diagnosis</title><addtitle>Prenat Diagn</addtitle><description>Introduction
Preeclampsia (PE) is a pregnancy‐specific syndrome associated with adverse maternal and fetal outcomes. Patient‐specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome.
Methods
Women evaluated for suspected PE at a tertiary hospital (2009–2012) had pregnancy outcomes categorized as ‘referent’ or ‘severe’, based solely on maternal/fetal findings. Outcomes that may have been influenced by a PE diagnosis were considered ‘unclassified’. Soluble fms‐like tyrosine kinase (sFlt1) and placental growth factor (PlGF) were subjected to bivariate discriminant modeling, allowing patient‐specific risks to be assigned for severe outcomes.
Results
Three hundred twenty‐eight singleton pregnancies presented at ≤34.0 weeks' gestation. sFlt1 and PlGF levels were adjusted for gestational age. Risks above 5 : 1 (10‐fold over background) occurred in 77% of severe (95% CI 66 to 87%) and 0.7% of referent (95% CI <0.1 to 3.8%) outcomes. Positive likelihood ratios for the modeling and validation datasets were 19 (95% CI 6.2–58) and 15 (95% CI 5.8–40) fold, respectively.
Conclusions
This validated model assigns patient‐specific risks of any severe outcome among women attending PE triage. In practice, women with high risks would receive close surveillance with the added potential for reducing unnecessary preterm deliveries among remaining women. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.
What's already known about this topic?
Angiogenic factors are associated with preeclampsia (PE), a pregnancy‐specific syndrome that can lead to severe adverse outcomes. The sFlt1/PlGF ratio has been shown to identify patients at risk for preeclampsia.
What does this study add?
We define the disorder of interest as any severe adverse outcome among women with suspected PE. Angiogenic test results are combined into patient‐specific risks to optimize translation to patient care to improve overall pregnancy outcomes.</description><subject>Adult</subject><subject>Angiogenesis Inducing Agents</subject><subject>Biomarkers - blood</subject><subject>Birth weight</subject><subject>Female</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Original</subject><subject>Placenta Growth Factor</subject><subject>Pre-Eclampsia - diagnosis</subject><subject>Preeclampsia</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Pregnancy Proteins - blood</subject><subject>Risk Assessment</subject><subject>Vascular Endothelial Growth Factor Receptor-1 - blood</subject><issn>0197-3851</issn><issn>1097-0223</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp10V1rFDEUBuAgit1W8R9IwAsLMjXJ5GNyU9DVVqVqL4p6FzKZM9u0M5MxmWkt_nmz7Lqo4E1OIA8v5-Qg9ISSI0oIezk2R1wIfg8tKNGqIIyV99GC0HwvK0H30H5KVxlWTKuHaI8JySlhaoF-fgwNdH5Y4ejTNW5DxAluIAK2TS4JcJgnF3pIeE5rZoeVDysYvMOtdVP2Pdg0R-hhmBL2A77NOp9-usRpTiO4CRo8Rpgg9usKrrP9mLx9hB60tkvweFsP0MXJ24vlu-Ls8-n75auzwglOecGYallr65ZI4Ujd0kqVlXIMtLRS1Hmo2kpes6qyta2oKDmRRIPQWrWl0uUBOt7EjnPdQ-Nyn9F2Zoy-t_HOBOvN3y-DvzSrcGM4J7oqWQ443AbE8H2GNJneJwddZwcIczJUKsryv1c002f_0KswxyFPl5XUSlKtRVbPN8rFkFKEdtcMJWa9TzM2Zr3PLJ_-2fvO_V5gBi824NZ3cPe_HHP-ZhtXbLRPE_zYaRuvjVSlEubrp1NzTk--8OW31-ZD-Qtt3roq</recordid><startdate>201504</startdate><enddate>201504</enddate><creator>Palomaki, Glenn E.</creator><creator>Haddow, James E.</creator><creator>Haddow, Hamish R. M.</creator><creator>Salahuddin, Saira</creator><creator>Geahchan, Carl</creator><creator>Cerdeira, Ana Sofia</creator><creator>Verlohren, Stefan</creator><creator>Perschel, Frank H.</creator><creator>Horowitz, Gary</creator><creator>Thadhani, Ravi</creator><creator>Karumanchi, S. Ananth</creator><creator>Rana, Sarosh</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>24P</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>7QP</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>7TM</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6154-8449</orcidid></search><sort><creationdate>201504</creationdate><title>Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia</title><author>Palomaki, Glenn E. ; Haddow, James E. ; Haddow, Hamish R. M. ; Salahuddin, Saira ; Geahchan, Carl ; Cerdeira, Ana Sofia ; Verlohren, Stefan ; Perschel, Frank H. ; Horowitz, Gary ; Thadhani, Ravi ; Karumanchi, S. Ananth ; Rana, Sarosh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5414-227f2fabf065c0bf187387c2e96a65b028ba64b288aba815340609e5997f3793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Angiogenesis Inducing Agents</topic><topic>Biomarkers - blood</topic><topic>Birth weight</topic><topic>Female</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Original</topic><topic>Placenta Growth Factor</topic><topic>Pre-Eclampsia - diagnosis</topic><topic>Preeclampsia</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Pregnancy Proteins - blood</topic><topic>Risk Assessment</topic><topic>Vascular Endothelial Growth Factor Receptor-1 - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Palomaki, Glenn E.</creatorcontrib><creatorcontrib>Haddow, James E.</creatorcontrib><creatorcontrib>Haddow, Hamish R. M.</creatorcontrib><creatorcontrib>Salahuddin, Saira</creatorcontrib><creatorcontrib>Geahchan, Carl</creatorcontrib><creatorcontrib>Cerdeira, Ana Sofia</creatorcontrib><creatorcontrib>Verlohren, Stefan</creatorcontrib><creatorcontrib>Perschel, Frank H.</creatorcontrib><creatorcontrib>Horowitz, Gary</creatorcontrib><creatorcontrib>Thadhani, Ravi</creatorcontrib><creatorcontrib>Karumanchi, S. Ananth</creatorcontrib><creatorcontrib>Rana, Sarosh</creatorcontrib><collection>Istex</collection><collection>Wiley_OA刊</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids 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 & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Prenatal diagnosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Palomaki, Glenn E.</au><au>Haddow, James E.</au><au>Haddow, Hamish R. M.</au><au>Salahuddin, Saira</au><au>Geahchan, Carl</au><au>Cerdeira, Ana Sofia</au><au>Verlohren, Stefan</au><au>Perschel, Frank H.</au><au>Horowitz, Gary</au><au>Thadhani, Ravi</au><au>Karumanchi, S. Ananth</au><au>Rana, Sarosh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia</atitle><jtitle>Prenatal diagnosis</jtitle><addtitle>Prenat Diagn</addtitle><date>2015-04</date><risdate>2015</risdate><volume>35</volume><issue>4</issue><spage>386</spage><epage>393</epage><pages>386-393</pages><issn>0197-3851</issn><eissn>1097-0223</eissn><abstract>Introduction
Preeclampsia (PE) is a pregnancy‐specific syndrome associated with adverse maternal and fetal outcomes. Patient‐specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome.
Methods
Women evaluated for suspected PE at a tertiary hospital (2009–2012) had pregnancy outcomes categorized as ‘referent’ or ‘severe’, based solely on maternal/fetal findings. Outcomes that may have been influenced by a PE diagnosis were considered ‘unclassified’. Soluble fms‐like tyrosine kinase (sFlt1) and placental growth factor (PlGF) were subjected to bivariate discriminant modeling, allowing patient‐specific risks to be assigned for severe outcomes.
Results
Three hundred twenty‐eight singleton pregnancies presented at ≤34.0 weeks' gestation. sFlt1 and PlGF levels were adjusted for gestational age. Risks above 5 : 1 (10‐fold over background) occurred in 77% of severe (95% CI 66 to 87%) and 0.7% of referent (95% CI <0.1 to 3.8%) outcomes. Positive likelihood ratios for the modeling and validation datasets were 19 (95% CI 6.2–58) and 15 (95% CI 5.8–40) fold, respectively.
Conclusions
This validated model assigns patient‐specific risks of any severe outcome among women attending PE triage. In practice, women with high risks would receive close surveillance with the added potential for reducing unnecessary preterm deliveries among remaining women. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.
What's already known about this topic?
Angiogenic factors are associated with preeclampsia (PE), a pregnancy‐specific syndrome that can lead to severe adverse outcomes. The sFlt1/PlGF ratio has been shown to identify patients at risk for preeclampsia.
What does this study add?
We define the disorder of interest as any severe adverse outcome among women with suspected PE. Angiogenic test results are combined into patient‐specific risks to optimize translation to patient care to improve overall pregnancy outcomes.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>25641027</pmid><doi>10.1002/pd.4554</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6154-8449</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Adult Angiogenesis Inducing Agents Biomarkers - blood Birth weight Female Humans Infant, Newborn Original Placenta Growth Factor Pre-Eclampsia - diagnosis Preeclampsia Pregnancy Pregnancy Outcome Pregnancy Proteins - blood Risk Assessment Vascular Endothelial Growth Factor Receptor-1 - blood |
| title | Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia |
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