HLA class II alleles may influence susceptibility to adult dermatomyositis and polymyositis in a Han Chinese population

Background Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen ( HLA ) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far....

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Published inBMC dermatology Vol. 14; no. 1; p. 9
Main Authors Gao, Xiang, Han, Lei, Yuan, Lan, Yang, Yongchen, Gou, Guimei, Sun, Hengjuan, Lu, Ling, Bao, Liming
Format Journal Article
LanguageEnglish
Published London BioMed Central 04.06.2014
BioMed Central Ltd
Subjects
Adult
Aged
Alleles
Allelomorphism
Analysis
Antigens
Asian Continental Ancestry Group - genetics
Autoimmune diseases
Child development
Children & youth
Confidence intervals
Dermatology
Dermatomyositis
Dermatomyositis - genetics
Disease
Female
Gene Frequency
Genetic aspects
Genetic Predisposition to Disease
Haplotypes
Histocompatibility antigens
Histocompatibility Antigens Class II - genetics
HLA histocompatibility antigens
HLA-DQ alpha-Chains - genetics
HLA-DQ beta-Chains - genetics
HLA-DRB1 Chains - genetics
Hospitals
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
Pathogenesis
Physiological aspects
Polymorphism, Genetic
Polymyositis
Polymyositis - genetics
Population
Research Article
Risk Factors
Statistical methods
Studies
China
Chinese
Polymyositis
Susceptibility
Dermatomyositis
Online AccessGet full text
ISSN1471-5945
1471-5945
DOI10.1186/1471-5945-14-9

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Abstract Background Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen ( HLA ) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far. Methods We studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1 , HLA - DQA1 , and HLA - DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population. Results A positive association was found between HLA-DQA1 * 0104 and DM ( p  = 0.01; corrected p ( p corr ) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18–5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation ( p  = 0.01; p corr NS; OR = 0.25; 95% CI: 0.07–0.73). A positive relationship was also observed between HLA-DRB1*07 and DM ( p  = 0.01; p corr NS; OR = 2.26; 95% CI: 1.12–4.59), while HLA-DRB1*03 seems to be protective against DM ( p  = 0.01; p corr NS; OR = 0.26; 95% CI: 0.06–0.81). The lung complication was closely associated with HLA-DRB1*04 ( p  = 0.01; p corr NS; OR = 2.82; 95% CI: 1.15–6.76) and HLA-DRB1*12 ( p  = 0.02; p corr NS; OR = 2.52; 95% CI: 1.02–6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls ( p  = 0.01; p corr NS; OR = 4.78; 95% CI: 1.03–24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM ( p  = 0.03; p corr NS; OR = 2.90; 95% CI: 1.02–8.93) and the lung complication ( p  = 0.02; p corr NS; OR = 3.45; 95% CI: 1.04–11.58). Conclusions Our results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population.
AbstractList Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far. We studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1, HLA-DQA1, and HLA-DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population. A positive association was found between HLA-DQA1*0104 and DM (p = 0.01; corrected p (p.sub.corr) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18-5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation (p = 0.01; p.sub.corr NS; OR = 0.25; 95% CI: 0.07-0.73). A positive relationship was also observed between HLA-DRB1*07 and DM (p = 0.01; p.sub.corr NS; OR = 2.26; 95% CI: 1.12-4.59), while HLA-DRB1*03 seems to be protective against DM (p = 0.01; p.sub.corr NS; OR = 0.26; 95% CI: 0.06-0.81). The lung complication was closely associated with HLA-DRB1*04 (p = 0.01; p.sub.corr NS; OR = 2.82; 95% CI: 1.15-6.76) and HLA-DRB1*12 (p = 0.02; p.sub.corr NS; OR = 2.52; 95% CI: 1.02-6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls (p = 0.01; p.sub.corr NS; OR = 4.78; 95% CI: 1.03-24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM (p = 0.03; p.sub.corr NS; OR = 2.90; 95% CI: 1.02-8.93) and the lung complication (p = 0.02; p.sub.corr NS; OR = 3.45; 95% CI: 1.04-11.58). Our results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population.
Background Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far. Methods We studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1, HLA-DQA1, and HLA-DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population. Results A positive association was found between HLA-DQA1*0104 and DM (p = 0.01; corrected p (p.sub.corr) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18-5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation (p = 0.01; p.sub.corr NS; OR = 0.25; 95% CI: 0.07-0.73). A positive relationship was also observed between HLA-DRB1*07 and DM (p = 0.01; p.sub.corr NS; OR = 2.26; 95% CI: 1.12-4.59), while HLA-DRB1*03 seems to be protective against DM (p = 0.01; p.sub.corr NS; OR = 0.26; 95% CI: 0.06-0.81). The lung complication was closely associated with HLA-DRB1*04 (p = 0.01; p.sub.corr NS; OR = 2.82; 95% CI: 1.15-6.76) and HLA-DRB1*12 (p = 0.02; p.sub.corr NS; OR = 2.52; 95% CI: 1.02-6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls (p = 0.01; p.sub.corr NS; OR = 4.78; 95% CI: 1.03-24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM (p = 0.03; p.sub.corr NS; OR = 2.90; 95% CI: 1.02-8.93) and the lung complication (p = 0.02; p.sub.corr NS; OR = 3.45; 95% CI: 1.04-11.58). Conclusions Our results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population. Keywords: Polymyositis, Dermatomyositis, HLA, Susceptibility, Chinese
Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far.BACKGROUNDPolymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far.We studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1, HLA-DQA1, and HLA-DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population.METHODSWe studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1, HLA-DQA1, and HLA-DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population.A positive association was found between HLA-DQA1*0104 and DM (p = 0.01; corrected p (pcorr) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18-5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation (p = 0.01; pcorr NS; OR = 0.25; 95% CI: 0.07-0.73). A positive relationship was also observed between HLA-DRB1*07 and DM (p = 0.01; pcorr NS; OR = 2.26; 95% CI: 1.12-4.59), while HLA-DRB1*03 seems to be protective against DM (p = 0.01; pcorr NS; OR = 0.26; 95% CI: 0.06-0.81). The lung complication was closely associated with HLA-DRB1*04 (p = 0.01; pcorr NS; OR = 2.82; 95% CI: 1.15-6.76) and HLA-DRB1*12 (p = 0.02; pcorr NS; OR = 2.52; 95% CI: 1.02-6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls (p = 0.01; pcorr NS; OR = 4.78; 95% CI: 1.03-24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM (p = 0.03; pcorr NS; OR = 2.90; 95% CI: 1.02-8.93) and the lung complication (p = 0.02; pcorr NS; OR = 3.45; 95% CI: 1.04-11.58).RESULTSA positive association was found between HLA-DQA1*0104 and DM (p = 0.01; corrected p (pcorr) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18-5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation (p = 0.01; pcorr NS; OR = 0.25; 95% CI: 0.07-0.73). A positive relationship was also observed between HLA-DRB1*07 and DM (p = 0.01; pcorr NS; OR = 2.26; 95% CI: 1.12-4.59), while HLA-DRB1*03 seems to be protective against DM (p = 0.01; pcorr NS; OR = 0.26; 95% CI: 0.06-0.81). The lung complication was closely associated with HLA-DRB1*04 (p = 0.01; pcorr NS; OR = 2.82; 95% CI: 1.15-6.76) and HLA-DRB1*12 (p = 0.02; pcorr NS; OR = 2.52; 95% CI: 1.02-6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls (p = 0.01; pcorr NS; OR = 4.78; 95% CI: 1.03-24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM (p = 0.03; pcorr NS; OR = 2.90; 95% CI: 1.02-8.93) and the lung complication (p = 0.02; pcorr NS; OR = 3.45; 95% CI: 1.04-11.58).Our results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population.CONCLUSIONSOur results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population.
Doc number: 9 Abstract Background: Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA ) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far. Methods: We studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1 , HLA -DQA1 , and HLA -DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population. Results: A positive association was found between HLA-DQA1 *0104 and DM (p = 0.01; corrected p (p corr ) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18-5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation (p = 0.01; p corr NS; OR = 0.25; 95% CI: 0.07-0.73). A positive relationship was also observed between HLA-DRB1*07 and DM (p = 0.01; p corr NS; OR = 2.26; 95% CI: 1.12-4.59), while HLA-DRB1*03 seems to be protective against DM (p = 0.01; p corr NS; OR = 0.26; 95% CI: 0.06-0.81). The lung complication was closely associated with HLA-DRB1*04 (p = 0.01; p corr NS; OR = 2.82; 95% CI: 1.15-6.76) and HLA-DRB1*12 (p = 0.02; p corr NS; OR = 2.52; 95% CI: 1.02-6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls (p = 0.01; p corr NS; OR = 4.78; 95% CI: 1.03-24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM (p = 0.03; p corr NS; OR = 2.90; 95% CI: 1.02-8.93) and the lung complication (p = 0.02; p corr NS; OR = 3.45; 95% CI: 1.04-11.58). Conclusions: Our results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population.
Background Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen ( HLA ) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far. Methods We studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1 , HLA - DQA1 , and HLA - DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population. Results A positive association was found between HLA-DQA1 * 0104 and DM ( p  = 0.01; corrected p ( p corr ) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18–5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation ( p  = 0.01; p corr NS; OR = 0.25; 95% CI: 0.07–0.73). A positive relationship was also observed between HLA-DRB1*07 and DM ( p  = 0.01; p corr NS; OR = 2.26; 95% CI: 1.12–4.59), while HLA-DRB1*03 seems to be protective against DM ( p  = 0.01; p corr NS; OR = 0.26; 95% CI: 0.06–0.81). The lung complication was closely associated with HLA-DRB1*04 ( p  = 0.01; p corr NS; OR = 2.82; 95% CI: 1.15–6.76) and HLA-DRB1*12 ( p  = 0.02; p corr NS; OR = 2.52; 95% CI: 1.02–6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls ( p  = 0.01; p corr NS; OR = 4.78; 95% CI: 1.03–24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM ( p  = 0.03; p corr NS; OR = 2.90; 95% CI: 1.02–8.93) and the lung complication ( p  = 0.02; p corr NS; OR = 3.45; 95% CI: 1.04–11.58). Conclusions Our results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population.
Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA) genes plays an important role in the pathogenesis of PM and DM. However, few studies on the subject in Chinese populations have been reported thus far. We studied the influence of HLA polymorphisms on DM and PM susceptibility by analyzing HLA-DRB1, HLA-DQA1, and HLA-DQB1 alleles in 71 adult DM patients, 20 adult PM patients, and 113 controls in a Han Chinese population. A positive association was found between HLA-DQA1*0104 and DM (p = 0.01; corrected p (pcorr) NS; odds ratio (OR) = 2.58; 95% confidence interval (CI): 1.18-5.64), while an inverse correlation was noted between HLA-DQB1*0303 and myositis patients with interstitial lung inflammation (p = 0.01; pcorr NS; OR = 0.25; 95% CI: 0.07-0.73). A positive relationship was also observed between HLA-DRB1*07 and DM (p = 0.01; pcorr NS; OR = 2.26; 95% CI: 1.12-4.59), while HLA-DRB1*03 seems to be protective against DM (p = 0.01; pcorr NS; OR = 0.26; 95% CI: 0.06-0.81). The lung complication was closely associated with HLA-DRB1*04 (p = 0.01; pcorr NS; OR = 2.82; 95% CI: 1.15-6.76) and HLA-DRB1*12 (p = 0.02; pcorr NS; OR = 2.52; 95% CI: 1.02-6.07). The frequency of HLA-DRB1*07 was significantly higher among myositis patients with dysphagia than among controls (p = 0.01; pcorr NS; OR = 4.78; 95% CI: 1.03-24.42). The putative haplotype DRB1*07-DQA1*01-DQB1*02 was positively correlated with DM (p = 0.03; pcorr NS; OR = 2.90; 95% CI: 1.02-8.93) and the lung complication (p = 0.02; pcorr NS; OR = 3.45; 95% CI: 1.04-11.58). Our results demonstrate that HLA alleles may be involved in susceptibility to adult DM and PM in the Han Chinese population.
ArticleNumber 9
Audience Academic
Author Yang, Yongchen
Sun, Hengjuan
Gao, Xiang
Han, Lei
Gou, Guimei
Bao, Liming
Yuan, Lan
Lu, Ling
AuthorAffiliation 5 Shanghai Children’s Hospital, Shanghai Children’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
1 The First Department of Health Care, Weifang People’s Hospital, Shandong, China
2 Departments of Rheumatology and Occupational Medicine, Huashan Hospital of Fudan University, Shanghai, China
6 Department of Pathology, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
3 Center for Clinical Molecular Medicine; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing, China
AuthorAffiliation_xml – name: 3 Center for Clinical Molecular Medicine; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing, China
– name: 1 The First Department of Health Care, Weifang People’s Hospital, Shandong, China
– name: 4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
– name: 6 Department of Pathology, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
– name: 2 Departments of Rheumatology and Occupational Medicine, Huashan Hospital of Fudan University, Shanghai, China
– name: 5 Shanghai Children’s Hospital, Shanghai Children’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
Author_xml – sequence: 1
  givenname: Xiang
  surname: Gao
  fullname: Gao, Xiang
  organization: The First Department of Health Care, Weifang People’s Hospital, Departments of Rheumatology and Occupational Medicine, Huashan Hospital of Fudan University
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  givenname: Lei
  surname: Han
  fullname: Han, Lei
  organization: Departments of Rheumatology and Occupational Medicine, Huashan Hospital of Fudan University
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  givenname: Lan
  surname: Yuan
  fullname: Yuan, Lan
  organization: Center for Clinical Molecular Medicine; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital of Chongqing Medical University
– sequence: 4
  givenname: Yongchen
  surname: Yang
  fullname: Yang, Yongchen
  organization: Shanghai Children’s Hospital, Shanghai Children’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
– sequence: 5
  givenname: Guimei
  surname: Gou
  fullname: Gou, Guimei
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  givenname: Hengjuan
  surname: Sun
  fullname: Sun, Hengjuan
  organization: Shanghai Children’s Hospital, Shanghai Children’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
– sequence: 7
  givenname: Ling
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  fullname: Lu, Ling
  email: huashanlvling@sina.com
  organization: Departments of Rheumatology and Occupational Medicine, Huashan Hospital of Fudan University
– sequence: 8
  givenname: Liming
  surname: Bao
  fullname: Bao, Liming
  email: liming.bao@dartmouth.edu
  organization: Center for Clinical Molecular Medicine; Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Department of Pathology, Geisel School of Medicine at Dartmouth College
BackLink https://www.ncbi.nlm.nih.gov/pubmed/24894810$$D View this record in MEDLINE/PubMed
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2014 Gao et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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Issue 1
Keywords Chinese
Polymyositis
Susceptibility
Dermatomyositis
Language English
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Snippet Background Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen ( HLA ) genes...
Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA) genes plays an...
Background Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte antigen (HLA) genes plays...
Doc number: 9 Abstract Background: Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies. Genetic variability in human leukocyte...
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SourceType Open Access Repository
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Publisher
StartPage 9
SubjectTerms Adult
Aged
Alleles
Allelomorphism
Analysis
Antigens
Asian Continental Ancestry Group - genetics
Autoimmune diseases
Child development
Children & youth
Confidence intervals
Dermatology
Dermatomyositis
Dermatomyositis - genetics
Disease
Female
Gene Frequency
Genetic aspects
Genetic Predisposition to Disease
Haplotypes
Histocompatibility antigens
Histocompatibility Antigens Class II - genetics
HLA histocompatibility antigens
HLA-DQ alpha-Chains - genetics
HLA-DQ beta-Chains - genetics
HLA-DRB1 Chains - genetics
Hospitals
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Middle Aged
Pathogenesis
Physiological aspects
Polymorphism, Genetic
Polymyositis
Polymyositis - genetics
Population
Research Article
Risk Factors
Statistical methods
Studies
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Title HLA class II alleles may influence susceptibility to adult dermatomyositis and polymyositis in a Han Chinese population
URI https://link.springer.com/article/10.1186/1471-5945-14-9
https://www.ncbi.nlm.nih.gov/pubmed/24894810
https://www.proquest.com/docview/1537495622
https://www.proquest.com/docview/1539464140
https://pubmed.ncbi.nlm.nih.gov/PMC4062285
Volume 14
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