Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study

The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with...

Full description

Saved in:
Bibliographic Details
Published in:BioMed research international 2016-01, Vol.2016 (2016), p.1-7
Main Authors: Szurowska, Edyta, Szarmach, Arkadiusz, Rybczynska, Dorota, Swieton, Dominik, Piskunowicz, Maciej, Pruijm, Menno
Format: Article
Language:English
Subjects:
Adolescent
Age
Bladder
Child
Child, Preschool
Communication
Contrast Media - adverse effects
Crying
Female
Humans
Infant
Infant, Newborn
Intubation
Male
Microbubbles - adverse effects
Prospective Studies
Sulfur
Ultrasonic imaging
Ultrasonography - methods
Urinary Bladder - diagnostic imaging
Urogenital system
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-c532t-fe870971bdc5c445f24f1e8412317a3c3ee864ba3f4913dd250d0cef777d4a803
cites cdi_FETCH-LOGICAL-c532t-fe870971bdc5c445f24f1e8412317a3c3ee864ba3f4913dd250d0cef777d4a803
container_end_page 7
container_issue 2016
container_start_page 1
container_title BioMed research international
container_volume 2016
creator Szurowska, Edyta
Szarmach, Arkadiusz
Rybczynska, Dorota
Swieton, Dominik
Piskunowicz, Maciej
Pruijm, Menno
description The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with mean age of 3.3 years (range 4 weeks–16.0 years), who underwent ce-VUS examination between 2011 and 2014. Premature destruction of the microbubbles in the urinary bladder during ce-VUS was observed in 11 children (7.8%). In all these cases the voiding phase of ce-VUS examination could not be performed because of destroyed UCA microbubbles. This was noted in anxious, crying infants and children with restricted voiding. The premature destruction of ultrasound contrast agent during ce-VUS is an underreported, important limitation of ce-VUS, which prevents evaluation of the voiding phase and the establishment of vesicoureteric reflux (VUR). This was particularly noted in crying infants and children.
doi_str_mv 10.1155/2016/1764692
format article
fullrecord <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5136419</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A520714515</galeid><sourcerecordid>A520714515</sourcerecordid><originalsourceid>FETCH-LOGICAL-c532t-fe870971bdc5c445f24f1e8412317a3c3ee864ba3f4913dd250d0cef777d4a803</originalsourceid><addsrcrecordid>eNqNkktv1DAUhSMEolXpjjWyxAYJhtrxIwkLpNHwKFIrRoJhazn2zcRVYk_tpCi_hr-KoxmGwqreXEv38_H18cmy5wS_JYTzixwTcUEKwUSVP8pOc0rYQhBGHh_3lJ5k5zHe4LRKInAlnmYneVFVmOX5afZrHaBXwxgAfYA4hFEP1jvkG3RtdfD1WNcdRGTGYN0W_fDWzHUTfPTOb4PatROyDq1a25kADiln0NrHaNMxtHEGQjfNJ65Bt8rZ2Md3c39Al16jpVPdFG1ETfA9GlpA6yS8gzTDHaBvw2imZ9mTRnURzg_1LNt8-vh9dbm4-vr5y2p5tdCc5sOigbLAVUFqo7lmjDc5awiUjCQXCkU1BSgFqxVtWEWoMTnHBmtoiqIwTJWYnmXv97q7se7BaHBDUJ3cBdurMEmvrPy342wrt_5OckIFI1USeHUQCP52TFbK3kYNXacc-DFKUoqSUsw4ewDKSV5hXsxjvfwPvfFjSLbNFBO4LDEr_1Jb1YG0rvFpRD2LyiXPcUEYJzxRb_ZU-tcYAzTH1xEs5zTJOU3ykKaEv7jvyBH-k50EvN4DrXVG_bQPlEtxS3ere3QlKoHpb9Yo3T8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1846088048</pqid></control><display><type>article</type><title>Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study</title><source>Wiley-Blackwell Open Access Collection</source><source>Publicly Available Content Database</source><creator>Szurowska, Edyta ; Szarmach, Arkadiusz ; Rybczynska, Dorota ; Swieton, Dominik ; Piskunowicz, Maciej ; Pruijm, Menno</creator><contributor>Terreno, Enzo</contributor><creatorcontrib>Szurowska, Edyta ; Szarmach, Arkadiusz ; Rybczynska, Dorota ; Swieton, Dominik ; Piskunowicz, Maciej ; Pruijm, Menno ; Terreno, Enzo</creatorcontrib><description>The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with mean age of 3.3 years (range 4 weeks–16.0 years), who underwent ce-VUS examination between 2011 and 2014. Premature destruction of the microbubbles in the urinary bladder during ce-VUS was observed in 11 children (7.8%). In all these cases the voiding phase of ce-VUS examination could not be performed because of destroyed UCA microbubbles. This was noted in anxious, crying infants and children with restricted voiding. The premature destruction of ultrasound contrast agent during ce-VUS is an underreported, important limitation of ce-VUS, which prevents evaluation of the voiding phase and the establishment of vesicoureteric reflux (VUR). This was particularly noted in crying infants and children.</description><identifier>ISSN: 2314-6133</identifier><identifier>EISSN: 2314-6141</identifier><identifier>DOI: 10.1155/2016/1764692</identifier><identifier>PMID: 27990422</identifier><language>eng</language><publisher>Cairo, Egypt: Hindawi Publishing Corporation</publisher><subject>Adolescent ; Age ; Bladder ; Child ; Child, Preschool ; Communication ; Contrast Media - adverse effects ; Crying ; Female ; Humans ; Infant ; Infant, Newborn ; Intubation ; Male ; Microbubbles - adverse effects ; Prospective Studies ; Sulfur ; Ultrasonic imaging ; Ultrasonography - methods ; Urinary Bladder - diagnostic imaging ; Urogenital system</subject><ispartof>BioMed research international, 2016-01, Vol.2016 (2016), p.1-7</ispartof><rights>Copyright © 2016 Maciej Piskunowicz et al.</rights><rights>COPYRIGHT 2016 John Wiley &amp; Sons, Inc.</rights><rights>Copyright © 2016 Maciej Piskunowicz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2016 Maciej Piskunowicz et al. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-fe870971bdc5c445f24f1e8412317a3c3ee864ba3f4913dd250d0cef777d4a803</citedby><cites>FETCH-LOGICAL-c532t-fe870971bdc5c445f24f1e8412317a3c3ee864ba3f4913dd250d0cef777d4a803</cites><orcidid>0000-0002-3154-5463 ; 0000-0003-1027-1851</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1846088048/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1846088048?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,25753,27924,27925,37012,37013,44590,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27990422$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Terreno, Enzo</contributor><creatorcontrib>Szurowska, Edyta</creatorcontrib><creatorcontrib>Szarmach, Arkadiusz</creatorcontrib><creatorcontrib>Rybczynska, Dorota</creatorcontrib><creatorcontrib>Swieton, Dominik</creatorcontrib><creatorcontrib>Piskunowicz, Maciej</creatorcontrib><creatorcontrib>Pruijm, Menno</creatorcontrib><title>Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study</title><title>BioMed research international</title><addtitle>Biomed Res Int</addtitle><description>The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with mean age of 3.3 years (range 4 weeks–16.0 years), who underwent ce-VUS examination between 2011 and 2014. Premature destruction of the microbubbles in the urinary bladder during ce-VUS was observed in 11 children (7.8%). In all these cases the voiding phase of ce-VUS examination could not be performed because of destroyed UCA microbubbles. This was noted in anxious, crying infants and children with restricted voiding. The premature destruction of ultrasound contrast agent during ce-VUS is an underreported, important limitation of ce-VUS, which prevents evaluation of the voiding phase and the establishment of vesicoureteric reflux (VUR). This was particularly noted in crying infants and children.</description><subject>Adolescent</subject><subject>Age</subject><subject>Bladder</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Communication</subject><subject>Contrast Media - adverse effects</subject><subject>Crying</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intubation</subject><subject>Male</subject><subject>Microbubbles - adverse effects</subject><subject>Prospective Studies</subject><subject>Sulfur</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography - methods</subject><subject>Urinary Bladder - diagnostic imaging</subject><subject>Urogenital system</subject><issn>2314-6133</issn><issn>2314-6141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNqNkktv1DAUhSMEolXpjjWyxAYJhtrxIwkLpNHwKFIrRoJhazn2zcRVYk_tpCi_hr-KoxmGwqreXEv38_H18cmy5wS_JYTzixwTcUEKwUSVP8pOc0rYQhBGHh_3lJ5k5zHe4LRKInAlnmYneVFVmOX5afZrHaBXwxgAfYA4hFEP1jvkG3RtdfD1WNcdRGTGYN0W_fDWzHUTfPTOb4PatROyDq1a25kADiln0NrHaNMxtHEGQjfNJ65Bt8rZ2Md3c39Al16jpVPdFG1ETfA9GlpA6yS8gzTDHaBvw2imZ9mTRnURzg_1LNt8-vh9dbm4-vr5y2p5tdCc5sOigbLAVUFqo7lmjDc5awiUjCQXCkU1BSgFqxVtWEWoMTnHBmtoiqIwTJWYnmXv97q7se7BaHBDUJ3cBdurMEmvrPy342wrt_5OckIFI1USeHUQCP52TFbK3kYNXacc-DFKUoqSUsw4ewDKSV5hXsxjvfwPvfFjSLbNFBO4LDEr_1Jb1YG0rvFpRD2LyiXPcUEYJzxRb_ZU-tcYAzTH1xEs5zTJOU3ykKaEv7jvyBH-k50EvN4DrXVG_bQPlEtxS3ere3QlKoHpb9Yo3T8</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Szurowska, Edyta</creator><creator>Szarmach, Arkadiusz</creator><creator>Rybczynska, Dorota</creator><creator>Swieton, Dominik</creator><creator>Piskunowicz, Maciej</creator><creator>Pruijm, Menno</creator><general>Hindawi Publishing Corporation</general><general>John Wiley &amp; Sons, Inc</general><general>Hindawi Limited</general><scope>ADJCN</scope><scope>AHFXO</scope><scope>RHU</scope><scope>RHW</scope><scope>RHX</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>3V.</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>CWDGH</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3154-5463</orcidid><orcidid>https://orcid.org/0000-0003-1027-1851</orcidid></search><sort><creationdate>20160101</creationdate><title>Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study</title><author>Szurowska, Edyta ; Szarmach, Arkadiusz ; Rybczynska, Dorota ; Swieton, Dominik ; Piskunowicz, Maciej ; Pruijm, Menno</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c532t-fe870971bdc5c445f24f1e8412317a3c3ee864ba3f4913dd250d0cef777d4a803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Age</topic><topic>Bladder</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Communication</topic><topic>Contrast Media - adverse effects</topic><topic>Crying</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intubation</topic><topic>Male</topic><topic>Microbubbles - adverse effects</topic><topic>Prospective Studies</topic><topic>Sulfur</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography - methods</topic><topic>Urinary Bladder - diagnostic imaging</topic><topic>Urogenital system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Szurowska, Edyta</creatorcontrib><creatorcontrib>Szarmach, Arkadiusz</creatorcontrib><creatorcontrib>Rybczynska, Dorota</creatorcontrib><creatorcontrib>Swieton, Dominik</creatorcontrib><creatorcontrib>Piskunowicz, Maciej</creatorcontrib><creatorcontrib>Pruijm, Menno</creatorcontrib><collection>الدوريات العلمية والإحصائية - e-Marefa Academic and Statistical Periodicals</collection><collection>معرفة - المحتوى العربي الأكاديمي المتكامل - e-Marefa Academic Complete</collection><collection>Hindawi Publishing Complete</collection><collection>Hindawi Publishing Subscription Journals</collection><collection>Hindawi Publishing Open Access</collection><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>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Advanced Technologies &amp; Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Middle East &amp; Africa Database</collection><collection>ProQuest Central Korea</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>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Advanced Technologies &amp; Aerospace Database</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</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>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BioMed research international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Szurowska, Edyta</au><au>Szarmach, Arkadiusz</au><au>Rybczynska, Dorota</au><au>Swieton, Dominik</au><au>Piskunowicz, Maciej</au><au>Pruijm, Menno</au><au>Terreno, Enzo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study</atitle><jtitle>BioMed research international</jtitle><addtitle>Biomed Res Int</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>2016</volume><issue>2016</issue><spage>1</spage><epage>7</epage><pages>1-7</pages><issn>2314-6133</issn><eissn>2314-6141</eissn><abstract>The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with mean age of 3.3 years (range 4 weeks–16.0 years), who underwent ce-VUS examination between 2011 and 2014. Premature destruction of the microbubbles in the urinary bladder during ce-VUS was observed in 11 children (7.8%). In all these cases the voiding phase of ce-VUS examination could not be performed because of destroyed UCA microbubbles. This was noted in anxious, crying infants and children with restricted voiding. The premature destruction of ultrasound contrast agent during ce-VUS is an underreported, important limitation of ce-VUS, which prevents evaluation of the voiding phase and the establishment of vesicoureteric reflux (VUR). This was particularly noted in crying infants and children.</abstract><cop>Cairo, Egypt</cop><pub>Hindawi Publishing Corporation</pub><pmid>27990422</pmid><doi>10.1155/2016/1764692</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3154-5463</orcidid><orcidid>https://orcid.org/0000-0003-1027-1851</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2314-6133
ispartof BioMed research international, 2016-01, Vol.2016 (2016), p.1-7
issn 2314-6133
2314-6141
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5136419
source Wiley-Blackwell Open Access Collection; Publicly Available Content Database
subjects Adolescent
Age
Bladder
Child
Child, Preschool
Communication
Contrast Media - adverse effects
Crying
Female
Humans
Infant
Infant, Newborn
Intubation
Male
Microbubbles - adverse effects
Prospective Studies
Sulfur
Ultrasonic imaging
Ultrasonography - methods
Urinary Bladder - diagnostic imaging
Urogenital system
title Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T15%3A12%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Premature%20Destruction%20of%20Microbubbles%20during%20Voiding%20Urosonography%20in%20Children%20and%20Possible%20Underlying%20Mechanisms:%20Post%20Hoc%20Analysis%20from%20the%20Prospective%20Study&rft.jtitle=BioMed%20research%20international&rft.au=Szurowska,%20Edyta&rft.date=2016-01-01&rft.volume=2016&rft.issue=2016&rft.spage=1&rft.epage=7&rft.pages=1-7&rft.issn=2314-6133&rft.eissn=2314-6141&rft_id=info:doi/10.1155/2016/1764692&rft_dat=%3Cgale_pubme%3EA520714515%3C/gale_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c532t-fe870971bdc5c445f24f1e8412317a3c3ee864ba3f4913dd250d0cef777d4a803%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1846088048&rft_id=info:pmid/27990422&rft_galeid=A520714515&rfr_iscdi=true