Loading…
CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage
Many survivors of aneurysmal subarachnoid haemorrhage (aSAH) have persistent cognitive deficits. Underlying causes of these deficits have not been elucidated. We aimed to investigate if cerebral perfusion in the acute phase after aSAH measured with CT perfusion (CTP) is associated with cognitive out...
Saved in:
| Published in: | Journal of neurology 2015-03, Vol.262 (3), p.623-628 |
|---|---|
| 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-c475t-14c3e7accc637cb3fb6d825159fe97e7dd1f6269eda06b0918a7ad2c0dbb0d893 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c475t-14c3e7accc637cb3fb6d825159fe97e7dd1f6269eda06b0918a7ad2c0dbb0d893 |
| container_end_page | 628 |
| container_issue | 3 |
| container_start_page | 623 |
| container_title | Journal of neurology |
| container_volume | 262 |
| creator | Huenges Wajer, Irene M. C. Cremers, Charlotte H. P. van Zandvoort, Martine J. E. Vergouwen, Mervyn D. I. van der Schaaf, Irene C. Velthuis, Birgitta K. Dankbaar, Jan Willem Vos, Pieter C. Visser-Meily, Johanna M. A. Rinkel, Gabriel J. E. |
| description | Many survivors of aneurysmal subarachnoid haemorrhage (aSAH) have persistent cognitive deficits. Underlying causes of these deficits have not been elucidated. We aimed to investigate if cerebral perfusion in the acute phase after aSAH measured with CT perfusion (CTP) is associated with cognitive outcome 3 months after aSAH. We included 71 patients admitted to the University Medical Center Utrecht who had CTP performed within 24 h after ictus and neuropsychological examination after 3 months. Perfusion values were measured in predefined regions of interest for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The relationship with global cognitive functioning, as measured with a mean
z
score of all cognitive tests, was examined by linear regression analyses. Adjustments were made for age, education, method of aneurysm treatment, and presence of non-acute medical complications. TTP was associated with cognitive functioning in the univariable analysis (
B
= −0.042, 95 % CI −0.076 to −0.008), but not after adjustment for age (
B
= −0.030, 95 % CI −0.065 to 0.004). For CBF, CBV and MTT no relationship with cognitive functioning was observed. Cerebral perfusion measured with CTP within 24 h after onset of aSAH is not associated with cognitive outcome after 3 months. The lack of an association might be explained by the delay between onset of aSAH and CTP. However, CTP assessment within the first minutes after aSAH is impossible in large series of patients. |
| doi_str_mv | 10.1007/s00415-014-7601-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1673395934</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1673395934</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-14c3e7accc637cb3fb6d825159fe97e7dd1f6269eda06b0918a7ad2c0dbb0d893</originalsourceid><addsrcrecordid>eNqNkc1q3DAUhUVJaSaTPkA3wZBNNm6vrD9rGYakLQS6mayFLMkeD2NpItmBeZs8S56smp-WUAgUBEK63z33XA5CXzB8xQDiWwKgmJWAaSk44FJ8QDNMSVViyuQZmgGhUDLC6Dm6SGkNAHUufELnFWNVxSWboW6xLLYutlPqgy_y0Xbo0-GhvS1M6Hw_9s-uaCdvxvzd-64gry9D8OMqFbodXcykm-IuDXpTpKnRUZuVD70tVtoNIcaV7twl-tjqTXKfT_ccPd7fLRc_yodf338ubh9KQwUbs3FDnNDGGE6EaUjbcFtXDDPZOimcsBa3PDt3VgNvQOJaC20rA7ZpwNaSzNHNUXcbw9Pk0qjyOsZtNtljmJLCXBAimST0P1BOhai5qDN6_Q-6DlP0eZEDlcOQjGQKHykTQ0rRtWob-0HHncKg9oGpY2AqB6b2gSmRe65OylMzOPu3409CGaiOQMol37n4ZvS7qr8BsguibA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1664100953</pqid></control><display><type>article</type><title>CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage</title><source>Springer Link</source><creator>Huenges Wajer, Irene M. C. ; Cremers, Charlotte H. P. ; van Zandvoort, Martine J. E. ; Vergouwen, Mervyn D. I. ; van der Schaaf, Irene C. ; Velthuis, Birgitta K. ; Dankbaar, Jan Willem ; Vos, Pieter C. ; Visser-Meily, Johanna M. A. ; Rinkel, Gabriel J. E.</creator><creatorcontrib>Huenges Wajer, Irene M. C. ; Cremers, Charlotte H. P. ; van Zandvoort, Martine J. E. ; Vergouwen, Mervyn D. I. ; van der Schaaf, Irene C. ; Velthuis, Birgitta K. ; Dankbaar, Jan Willem ; Vos, Pieter C. ; Visser-Meily, Johanna M. A. ; Rinkel, Gabriel J. E.</creatorcontrib><description>Many survivors of aneurysmal subarachnoid haemorrhage (aSAH) have persistent cognitive deficits. Underlying causes of these deficits have not been elucidated. We aimed to investigate if cerebral perfusion in the acute phase after aSAH measured with CT perfusion (CTP) is associated with cognitive outcome 3 months after aSAH. We included 71 patients admitted to the University Medical Center Utrecht who had CTP performed within 24 h after ictus and neuropsychological examination after 3 months. Perfusion values were measured in predefined regions of interest for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The relationship with global cognitive functioning, as measured with a mean
z
score of all cognitive tests, was examined by linear regression analyses. Adjustments were made for age, education, method of aneurysm treatment, and presence of non-acute medical complications. TTP was associated with cognitive functioning in the univariable analysis (
B
= −0.042, 95 % CI −0.076 to −0.008), but not after adjustment for age (
B
= −0.030, 95 % CI −0.065 to 0.004). For CBF, CBV and MTT no relationship with cognitive functioning was observed. Cerebral perfusion measured with CTP within 24 h after onset of aSAH is not associated with cognitive outcome after 3 months. The lack of an association might be explained by the delay between onset of aSAH and CTP. However, CTP assessment within the first minutes after aSAH is impossible in large series of patients.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-014-7601-7</identifier><identifier>PMID: 25522695</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Activities of daily living ; Adult ; Algorithms ; Blood ; Cerebrovascular Circulation - physiology ; Cognition Disorders - diagnosis ; Cognition Disorders - etiology ; Factor Analysis, Statistical ; Female ; Hemorrhage ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurology ; Neuropsychological Tests ; Neuropsychology ; Neuroradiology ; Neurosciences ; Original Communication ; Outpatient care facilities ; Patients ; Perfusion Imaging ; Rehabilitation ; Retrospective Studies ; Subarachnoid Hemorrhage - complications ; Tomography, X-Ray Computed ; Veins & arteries</subject><ispartof>Journal of neurology, 2015-03, Vol.262 (3), p.623-628</ispartof><rights>Springer-Verlag Berlin Heidelberg 2014</rights><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-14c3e7accc637cb3fb6d825159fe97e7dd1f6269eda06b0918a7ad2c0dbb0d893</citedby><cites>FETCH-LOGICAL-c475t-14c3e7accc637cb3fb6d825159fe97e7dd1f6269eda06b0918a7ad2c0dbb0d893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25522695$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huenges Wajer, Irene M. C.</creatorcontrib><creatorcontrib>Cremers, Charlotte H. P.</creatorcontrib><creatorcontrib>van Zandvoort, Martine J. E.</creatorcontrib><creatorcontrib>Vergouwen, Mervyn D. I.</creatorcontrib><creatorcontrib>van der Schaaf, Irene C.</creatorcontrib><creatorcontrib>Velthuis, Birgitta K.</creatorcontrib><creatorcontrib>Dankbaar, Jan Willem</creatorcontrib><creatorcontrib>Vos, Pieter C.</creatorcontrib><creatorcontrib>Visser-Meily, Johanna M. A.</creatorcontrib><creatorcontrib>Rinkel, Gabriel J. E.</creatorcontrib><title>CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><addtitle>J Neurol</addtitle><description>Many survivors of aneurysmal subarachnoid haemorrhage (aSAH) have persistent cognitive deficits. Underlying causes of these deficits have not been elucidated. We aimed to investigate if cerebral perfusion in the acute phase after aSAH measured with CT perfusion (CTP) is associated with cognitive outcome 3 months after aSAH. We included 71 patients admitted to the University Medical Center Utrecht who had CTP performed within 24 h after ictus and neuropsychological examination after 3 months. Perfusion values were measured in predefined regions of interest for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The relationship with global cognitive functioning, as measured with a mean
z
score of all cognitive tests, was examined by linear regression analyses. Adjustments were made for age, education, method of aneurysm treatment, and presence of non-acute medical complications. TTP was associated with cognitive functioning in the univariable analysis (
B
= −0.042, 95 % CI −0.076 to −0.008), but not after adjustment for age (
B
= −0.030, 95 % CI −0.065 to 0.004). For CBF, CBV and MTT no relationship with cognitive functioning was observed. Cerebral perfusion measured with CTP within 24 h after onset of aSAH is not associated with cognitive outcome after 3 months. The lack of an association might be explained by the delay between onset of aSAH and CTP. However, CTP assessment within the first minutes after aSAH is impossible in large series of patients.</description><subject>Activities of daily living</subject><subject>Adult</subject><subject>Algorithms</subject><subject>Blood</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Cognition Disorders - diagnosis</subject><subject>Cognition Disorders - etiology</subject><subject>Factor Analysis, Statistical</subject><subject>Female</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Neuropsychological Tests</subject><subject>Neuropsychology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Original Communication</subject><subject>Outpatient care facilities</subject><subject>Patients</subject><subject>Perfusion Imaging</subject><subject>Rehabilitation</subject><subject>Retrospective Studies</subject><subject>Subarachnoid Hemorrhage - complications</subject><subject>Tomography, X-Ray Computed</subject><subject>Veins & arteries</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqNkc1q3DAUhUVJaSaTPkA3wZBNNm6vrD9rGYakLQS6mayFLMkeD2NpItmBeZs8S56smp-WUAgUBEK63z33XA5CXzB8xQDiWwKgmJWAaSk44FJ8QDNMSVViyuQZmgGhUDLC6Dm6SGkNAHUufELnFWNVxSWboW6xLLYutlPqgy_y0Xbo0-GhvS1M6Hw_9s-uaCdvxvzd-64gry9D8OMqFbodXcykm-IuDXpTpKnRUZuVD70tVtoNIcaV7twl-tjqTXKfT_ccPd7fLRc_yodf338ubh9KQwUbs3FDnNDGGE6EaUjbcFtXDDPZOimcsBa3PDt3VgNvQOJaC20rA7ZpwNaSzNHNUXcbw9Pk0qjyOsZtNtljmJLCXBAimST0P1BOhai5qDN6_Q-6DlP0eZEDlcOQjGQKHykTQ0rRtWob-0HHncKg9oGpY2AqB6b2gSmRe65OylMzOPu3409CGaiOQMol37n4ZvS7qr8BsguibA</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Huenges Wajer, Irene M. C.</creator><creator>Cremers, Charlotte H. P.</creator><creator>van Zandvoort, Martine J. E.</creator><creator>Vergouwen, Mervyn D. I.</creator><creator>van der Schaaf, Irene C.</creator><creator>Velthuis, Birgitta K.</creator><creator>Dankbaar, Jan Willem</creator><creator>Vos, Pieter C.</creator><creator>Visser-Meily, Johanna M. A.</creator><creator>Rinkel, Gabriel J. E.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</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>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150301</creationdate><title>CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage</title><author>Huenges Wajer, Irene M. C. ; Cremers, Charlotte H. P. ; van Zandvoort, Martine J. E. ; Vergouwen, Mervyn D. I. ; van der Schaaf, Irene C. ; Velthuis, Birgitta K. ; Dankbaar, Jan Willem ; Vos, Pieter C. ; Visser-Meily, Johanna M. A. ; Rinkel, Gabriel J. E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-14c3e7accc637cb3fb6d825159fe97e7dd1f6269eda06b0918a7ad2c0dbb0d893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Activities of daily living</topic><topic>Adult</topic><topic>Algorithms</topic><topic>Blood</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Cognition Disorders - diagnosis</topic><topic>Cognition Disorders - etiology</topic><topic>Factor Analysis, Statistical</topic><topic>Female</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Neuropsychological Tests</topic><topic>Neuropsychology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Original Communication</topic><topic>Outpatient care facilities</topic><topic>Patients</topic><topic>Perfusion Imaging</topic><topic>Rehabilitation</topic><topic>Retrospective Studies</topic><topic>Subarachnoid Hemorrhage - complications</topic><topic>Tomography, X-Ray Computed</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huenges Wajer, Irene M. C.</creatorcontrib><creatorcontrib>Cremers, Charlotte H. P.</creatorcontrib><creatorcontrib>van Zandvoort, Martine J. E.</creatorcontrib><creatorcontrib>Vergouwen, Mervyn D. I.</creatorcontrib><creatorcontrib>van der Schaaf, Irene C.</creatorcontrib><creatorcontrib>Velthuis, Birgitta K.</creatorcontrib><creatorcontrib>Dankbaar, Jan Willem</creatorcontrib><creatorcontrib>Vos, Pieter C.</creatorcontrib><creatorcontrib>Visser-Meily, Johanna M. A.</creatorcontrib><creatorcontrib>Rinkel, Gabriel J. E.</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>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma 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>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</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><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huenges Wajer, Irene M. C.</au><au>Cremers, Charlotte H. P.</au><au>van Zandvoort, Martine J. E.</au><au>Vergouwen, Mervyn D. I.</au><au>van der Schaaf, Irene C.</au><au>Velthuis, Birgitta K.</au><au>Dankbaar, Jan Willem</au><au>Vos, Pieter C.</au><au>Visser-Meily, Johanna M. A.</au><au>Rinkel, Gabriel J. E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><addtitle>J Neurol</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>262</volume><issue>3</issue><spage>623</spage><epage>628</epage><pages>623-628</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Many survivors of aneurysmal subarachnoid haemorrhage (aSAH) have persistent cognitive deficits. Underlying causes of these deficits have not been elucidated. We aimed to investigate if cerebral perfusion in the acute phase after aSAH measured with CT perfusion (CTP) is associated with cognitive outcome 3 months after aSAH. We included 71 patients admitted to the University Medical Center Utrecht who had CTP performed within 24 h after ictus and neuropsychological examination after 3 months. Perfusion values were measured in predefined regions of interest for cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The relationship with global cognitive functioning, as measured with a mean
z
score of all cognitive tests, was examined by linear regression analyses. Adjustments were made for age, education, method of aneurysm treatment, and presence of non-acute medical complications. TTP was associated with cognitive functioning in the univariable analysis (
B
= −0.042, 95 % CI −0.076 to −0.008), but not after adjustment for age (
B
= −0.030, 95 % CI −0.065 to 0.004). For CBF, CBV and MTT no relationship with cognitive functioning was observed. Cerebral perfusion measured with CTP within 24 h after onset of aSAH is not associated with cognitive outcome after 3 months. The lack of an association might be explained by the delay between onset of aSAH and CTP. However, CTP assessment within the first minutes after aSAH is impossible in large series of patients.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25522695</pmid><doi>10.1007/s00415-014-7601-7</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0340-5354 |
| ispartof | Journal of neurology, 2015-03, Vol.262 (3), p.623-628 |
| issn | 0340-5354 1432-1459 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1673395934 |
| source | Springer Link |
| subjects | Activities of daily living Adult Algorithms Blood Cerebrovascular Circulation - physiology Cognition Disorders - diagnosis Cognition Disorders - etiology Factor Analysis, Statistical Female Hemorrhage Humans Male Medicine Medicine & Public Health Middle Aged Neurology Neuropsychological Tests Neuropsychology Neuroradiology Neurosciences Original Communication Outpatient care facilities Patients Perfusion Imaging Rehabilitation Retrospective Studies Subarachnoid Hemorrhage - complications Tomography, X-Ray Computed Veins & arteries |
| title | CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-21T11%3A00%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=CT%20perfusion%20on%20admission%20and%20cognitive%20functioning%203%C2%A0months%20after%20aneurysmal%20subarachnoid%20haemorrhage&rft.jtitle=Journal%20of%20neurology&rft.au=Huenges%20Wajer,%20Irene%20M.%20C.&rft.date=2015-03-01&rft.volume=262&rft.issue=3&rft.spage=623&rft.epage=628&rft.pages=623-628&rft.issn=0340-5354&rft.eissn=1432-1459&rft_id=info:doi/10.1007/s00415-014-7601-7&rft_dat=%3Cproquest_cross%3E1673395934%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c475t-14c3e7accc637cb3fb6d825159fe97e7dd1f6269eda06b0918a7ad2c0dbb0d893%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1664100953&rft_id=info:pmid/25522695&rfr_iscdi=true |