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Josefson CC, De Moura Pereira L, Skibiel AL. Chronic Stress Decreases Lactation Performance. Integr Comp Biol 2023; 63:557-568. [PMID: 37253624 DOI: 10.1093/icb/icad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/01/2023] Open
Abstract
The ability to provision offspring with milk is a significant adaptive feature of mammals that allows for considerable maternal regulation of offspring beyond gestation, as milk provides complete nutrition for developing neonates. For mothers, lactation is a period of marked increases in energetic and nutritive demands to support milk synthesis; because of this considerable increase in demand imposed on multiple physiological systems, lactation is particularly susceptible to the effects of chronic stress. Here, we present work that explores the impact of chronic stress during lactation on maternal lactation performance (i.e., milk quality and quantity) and the expression of key milk synthesis genes in mammary tissue using a Sprague-Dawley rat model. We induced chronic stress using a well-established, ethologically relevant novel male intruder paradigm for 10 consecutive days during the postpartum period. We hypothesized that the increased energetic burden of mounting a chronic stress response during lactation would decrease lactation performance. Specifically, we predicted that chronic exposure to this social stressor would decrease either milk quality (i.e., composition of proximate components and energy density) or quantity. We also predicted that changes in proximate composition (i.e., lipid, lactose, and protein concentrations) would be associated with changes in gene expression levels of milk synthesis genes. Our results supported our hypothesis that chronic stress impairs lactation performance. Relative to the controls, chronically stressed rats had lower milk yields. We also found that milk quality was decreased; milk from chronically stressed mothers had lower lipid concentration and lower energy density, though protein and lactose concentrations were not different between treatment groups. Although there was a change in proximate composition, chronic stress did not impact mammary gland expression of key milk synthesis genes. Together, this work demonstrates that exposure to a chronic stressor impacts lactation performance, which in turn has the potential to impact offspring development via maternal effects.
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Affiliation(s)
- Chloe C Josefson
- Department of Animal, Veterinary and Food Sciences, University of Idaho, 875 Perimeter Drive, MS 2330, Moscow, ID 83844, USA
| | - Lucelia De Moura Pereira
- Department of Animal, Veterinary and Food Sciences, University of Idaho, 875 Perimeter Drive, MS 2330, Moscow, ID 83844, USA
| | - Amy L Skibiel
- Department of Animal, Veterinary and Food Sciences, University of Idaho, 875 Perimeter Drive, MS 2330, Moscow, ID 83844, USA
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Dai W, White R, Liu J, Liu H. Organelles coordinate milk production and secretion during lactation: Insights into mammary pathologies. Prog Lipid Res 2022; 86:101159. [PMID: 35276245 DOI: 10.1016/j.plipres.2022.101159] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
The mammary gland undergoes a spectacular series of changes during its development and maintains a remarkable capacity to remodel and regenerate during progression through the lactation cycle. This flexibility of the mammary gland requires coordination of multiple processes including cell proliferation, differentiation, regeneration, stress response, immune activity, and metabolic changes under the control of diverse cellular and hormonal signaling pathways. The lactating mammary epithelium orchestrates synthesis and apical secretion of macromolecules including milk lipids, milk proteins, and lactose as well as other minor nutrients that constitute milk. Knowledge about the subcellular compartmentalization of these metabolic and signaling events, as they relate to milk production and secretion during lactation, is expanding. Here we review how major organelles (endoplasmic reticulum, Golgi apparatus, mitochondrion, lysosome, and exosome) within mammary epithelial cells collaborate to initiate, mediate, and maintain lactation, and how study of these organelles provides insight into options to maintain mammary/breast health.
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Affiliation(s)
- Wenting Dai
- College of Animal Sciences, Zhejiang University, Hangzhou, China
| | - Robin White
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA 24060, USA
| | - Jianxin Liu
- College of Animal Sciences, Zhejiang University, Hangzhou, China
| | - Hongyun Liu
- College of Animal Sciences, Zhejiang University, Hangzhou, China.
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Napso T, Yong HEJ, Lopez-Tello J, Sferruzzi-Perri AN. The Role of Placental Hormones in Mediating Maternal Adaptations to Support Pregnancy and Lactation. Front Physiol 2018; 9:1091. [PMID: 30174608 PMCID: PMC6108594 DOI: 10.3389/fphys.2018.01091] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022] Open
Abstract
During pregnancy, the mother must adapt her body systems to support nutrient and oxygen supply for growth of the baby in utero and during the subsequent lactation. These include changes in the cardiovascular, pulmonary, immune and metabolic systems of the mother. Failure to appropriately adjust maternal physiology to the pregnant state may result in pregnancy complications, including gestational diabetes and abnormal birth weight, which can further lead to a range of medically significant complications for the mother and baby. The placenta, which forms the functional interface separating the maternal and fetal circulations, is important for mediating adaptations in maternal physiology. It secretes a plethora of hormones into the maternal circulation which modulate her physiology and transfers the oxygen and nutrients available to the fetus for growth. Among these placental hormones, the prolactin-growth hormone family, steroids and neuropeptides play critical roles in driving maternal physiological adaptations during pregnancy. This review examines the changes that occur in maternal physiology in response to pregnancy and the significance of placental hormone production in mediating such changes.
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Affiliation(s)
- Tina Napso
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
| | - Hannah E J Yong
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
| | - Jorge Lopez-Tello
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
| | - Amanda N Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
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SNP co-association and network analyses identify E2F3, KDM5A and BACH2 as key regulators of the bovine milk fatty acid profile. Sci Rep 2017; 7:17317. [PMID: 29230020 PMCID: PMC5725496 DOI: 10.1038/s41598-017-17434-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/27/2017] [Indexed: 12/19/2022] Open
Abstract
The fatty acid (FA) profile has a considerable impact on the nutritional and technological quality of milk and dairy products. The molecular mechanism underlying the regulation of fat metabolism in bovine mammary gland have been not completely elucidated. We conducted genome-wide association studies (GWAS) across 65 milk FAs and fat percentage in 1,152 Brown Swiss cows. In total, we identified 175 significant single nucleotide polymorphism (SNPs) spanning all chromosomes. Pathway analyses revealed that 12:0 was associated with the greatest number of overrepresented categories/pathways (e.g. mitogen-activated protein kinase (MAPK) activity and protein phosphorylation), suggesting that it might play an important biological role in controlling milk fat composition. An Associated Weight Matrix approach based on SNP co-associations predicted a network of 791 genes related to the milk FA profile, which were involved in several connected molecular pathways (e.g., MAPK, lipid metabolism and hormone signalling) and undetectable through standard GWAS. Analysis of transcription factors and their putative target genes within the network identified BACH2, E2F3 and KDM5A as key regulators of milk FA metabolism. These findings contribute to increasing knowledge of FA metabolism and mammary gland functionality in dairy cows and may be useful in developing targeted breeding practices to improve milk quality.
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Martini M, Salari F, Altomonte I. The Macrostructure of Milk Lipids: The Fat Globules. Crit Rev Food Sci Nutr 2013; 56:1209-21. [DOI: 10.1080/10408398.2012.758626] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Nezamidoust M, Kominakis A, Safari A. Use of Wood's model to analyze the effects of milking methods on lactation curve in sheep. Small Rumin Res 2013. [DOI: 10.1016/j.smallrumres.2013.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Menzies KK, Lefèvre C, Macmillan KL, Nicholas KR. Insulin regulates milk protein synthesis at multiple levels in the bovine mammary gland. Funct Integr Genomics 2008; 9:197-217. [PMID: 19107532 DOI: 10.1007/s10142-008-0103-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/25/2008] [Accepted: 11/25/2008] [Indexed: 01/24/2023]
Abstract
The role of insulin in milk protein synthesis is unresolved in the bovine mammary gland. This study examined the potential role of insulin in the presence of two lactogenic hormones, hydrocortisone and prolactin, in milk protein synthesis. Insulin was shown to stimulate milk protein gene expression, casein synthesis and (14)C-lysine uptake in mammary explants from late pregnant cows. A global assessment of changes in gene expression in mammary explants in response to insulin was undertaken using Affymetrix microarray. The resulting data provided insight into the molecular mechanisms stimulated by insulin and showed that the hormone stimulated the expression of 28 genes directly involved in protein synthesis. These genes included the milk protein transcription factor, ELF5, translation factors, the folate metabolism genes, FOLR1 and MTHFR, as well as several genes encoding enzymes involved in catabolism of essential amino acids and biosynthesis of non-essential amino acids. These data show that insulin is not only essential for milk protein gene expression, but stimulates milk protein synthesis at multiple levels within bovine mammary epithelial cells.
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Affiliation(s)
- Karensa K Menzies
- Department of Zoology, University of Melbourne, Parkville, VIC, Australia.
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Olsson K, Malmgren C, Olsson KK, Hansson K, Häggström J. Vasopressin increases milk flow and milk fat concentration in the goat. ACTA PHYSIOLOGICA SCANDINAVICA 2003; 177:177-84. [PMID: 12558554 DOI: 10.1046/j.1365-201x.2003.01055.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to investigate whether physiological doses of vasopressin affect milk flow and milk composition in goats. METHODS Six goats were given vasopressin intravenously at doses of 0.1 ng kg(-1) min(-1) (a low dose, VL), 0.3 ng kg(-1) min(-1) (a medium dose, VM) and 1.0 ng kg(-1) min(-1) (a high dose, VH), oxytocin at 10 ng kg(-1) min(-1) and 0.15 m NaCl during 90 min at random. RESULTS Milk flow increased from 1.3 +/- 0.2 to 3.5 +/- 1.0 g min(-1) (VL), from 1.8 +/- 0.4 to 4.3 +/- 0.6 g min(-1) (VM) and from 1.5 +/- 0.2 to 7.9 +/- 0.9 g min(-1) (VH) during the first 30-min infusions (all P < 0.001), respectively, and then declined. The response to oxytocin corresponded to that of VH. Milk fat concentration increased from 2.1 +/- 0.1 to 3.3 +/- 0.4% during VH and from 2.8 +/- 0.6 to 4.1 +/- 0.6% during oxytocin (both P < 0.001), and tended to increase during VM and VL. The mammary blood flow of four goats was studied with ultrasound during VH and oxytocin infusion. Milk flow increased from 1.8 +/- 0.4 to 4.7 +/- 1.0 g min(-1) during VH and from 1.9 +/- 0.3 to 12.4 +/- 2.4 g min(-1) during oxytocin (both P < 0.001). Mammary blood flow decreased from 262 +/- 37 to 53 +/- 7 mL min(-1) (P < 0.001) during VH, but did not change during oxytocin. CONCLUSION We conclude that vasopressin increases milk flow and milk fat concentration and suggest that vasopressin, like oxytocin, acts on the myoepithelial cells.
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Affiliation(s)
- K Olsson
- Department of Animal Physiology, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Hodges RR, Dartt DA. Regulatory pathways in lacrimal gland epithelium. INTERNATIONAL REVIEW OF CYTOLOGY 2003; 231:129-96. [PMID: 14713005 DOI: 10.1016/s0074-7696(03)31004-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tears are a complex fluid that continuously cover the exposed surface of the eye, namely the cornea and conjunctiva. Tears are secreted in response to the multitude of environmental stresses that can harm the ocular surface such as cold, mechanical stimulation, physical injury, noxious chemicals, as well as infections from various organisms. Tears also provide nutrients and remove waste from cells of the ocular surface. Because of the varied function of tears, tears are complex and are secreted by several different tissues. Tear secretion is under tight neural control allowing tears to respond rapidly to changing environmental conditions. The lacrimal gland is the main contributor to the aqueous portion of the tear film and the regulation of secretion from this gland has been well studied. Despite multiple redundencies in pathways to stimulate secretion from the lacrimal gland, defects can occur resulting in dry eye syndromes. These diseases can have deleterious effects on vision. In this review, we summarize the latest information regarding the regulatory pathways, which control secretion from the lacrimal gland, and their roles in the pathogenesis of dry eye syndromes.
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Affiliation(s)
- Robin R Hodges
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, USA
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Pooley L. Type IV phosphodiesterase activity specifically regulates cAMP-stimulated casein secretion in the rat mammary gland. BIOCHIMICA ET BIOPHYSICA ACTA 2002; 1590:84-92. [PMID: 12063171 DOI: 10.1016/s0167-4889(02)00199-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates the regulation of cAMP-stimulated casein secretion in rat mammary explants by cAMP phosphodiesterase (cAMP-PDE) activity. cAMP-PDE activity of the lactating rat mammary gland is shown to be provided by three families, types II, III and IV. In mammary explants, general inhibition of the cAMP-PDE activity significantly increased the rate of cAMP-stimulated casein secretion. This effect could be mimicked using the type-IV specific inhibitor rolipram but not by the specific, or combined, inhibition of the type II and type III activity. Only type IV activity significantly affected intracellular accumulation of cAMP whereas all three cAMP-PDE activities were shown to influence the PKA activation ratio in cells. RtPCR analysis showed that the mammary gland apparently expresses just three type IV isozymes, RNPDE4A5, RNPDE4A8 and RNPDE4D3. A specific role for type IV cAMP-PDE activity in the regulation of casein secretion is suggested and possible mechanisms for the effects of PDEIV activity discussed.
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Affiliation(s)
- Linda Pooley
- Hannah Research Institute, Hannah Research Park, Ayr, KA6 5HL, Scotland, UK.
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Clegg R, Barber M, Pooley L, Ernens I, Larondelle Y, Travers M. Milk fat synthesis and secretion: molecular and cellular aspects. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0301-6226(01)00194-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Lkhider M, Pétridou B, Aubourg A, Ollivier-Bousquet M. Prolactin signalling to milk protein secretion but not to gene expression depends on the integrity of the Golgi region. J Cell Sci 2001; 114:1883-91. [PMID: 11329375 DOI: 10.1242/jcs.114.10.1883] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Prolactin added to the incubation medium of lactating mammary epithelial cells is transported from the basal to the apical region of cells through the Golgi region and concomitantly stimulates arachidonic acid release and protein milk secretion. We report that when PRL is added after disorganisation of the Golgi apparatus by brefeldin A treatment, prolactin signalling to expression of genes for milk proteins and prolactin endocytosis are not affected. However, prolactin transport to the apical region of cells (transcytosis), as well as prolactin-induced arachidonic acid release and subsequent stimulation of the secretion of caseins, which are located in a post-Golgi compartment, are inhibited. This inhibition was not a consequence of damage to the secretory machinery, as under the same conditions, protein secretion could be stimulated by the addition of arachidonic acid to the incubation medium. Thus, it is possible to discriminate between prolactin-induced actions that are dependent (signalling to milk protein secretion) or independent (signalling to milk gene expression) on the integrity of the Golgi apparatus. These results suggest that these two biological actions may be transduced via distinct intracellular pathways, and support the hypothesis that prolactin signals may be emitted at various cellular sites.
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Affiliation(s)
- M Lkhider
- Faculté des Sciences, UCD, El Jadida, Maroc
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Mellish JA, Iverson SJ, Don Bowen W. Variation in milk production and lactation performance in grey seals and consequences for pup growth and weaning characteristics. Physiol Biochem Zool 1999; 72:677-90. [PMID: 10603331 DOI: 10.1086/316708] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Phocid seals are one of the few groups of mammals capable of sustaining the energetic demands of lactation entirely through body nutrient stores while fasting. Lactation performance of the female in turn influences the rate and pattern of pup growth. We examined variation in and patterns of milk composition and production, maternal energy output, and pup growth and energy deposition over the entire lactation period in 18 grey seal mother-pup pairs using hydrogen isotope (3H2O and D2O) dilution. Milk composition was independent of maternal mass and nutrient stores, indicating dependence on other physiological and genetic factors. Heavier females lactated longer (r2=0.653, P<0.001), had higher total milk outputs (r2=0.652, P<0.001), and produced larger pups at weaning (r2=0.417, P=0.005). While fatter females lactated for longer periods of time (r2=0.595, P<0.001), females with a larger lean body mass at parturition produced more milk (r2=0.579, P<0.001). Total milk energy output was the strongest predictor of pup weaning mass, which, along with the pup's efficiency of energy storage, accounted for 91% of the variation in weaning mass. Nevertheless, there was sufficient plasticity in milk composition and energy output that some smaller females produced relatively large pups. Few females appeared to deplete body nutrients to the point where it might limit the duration of lactation.
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Affiliation(s)
- J A Mellish
- Department of Biology, Dalhousie University, Halifax, Nova Scotia B3H 4J1, Canada.
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Abstract
Mammary epithelial cells secrete milk proteins in a polarized manner from their apical surface during lactation. These secreted proteins are either synthesized by the mammary cells or are transported by transcytosis from blood plasma. The intracellular trafficking pathways by which milk proteins are secreted are known in general outline. In this review the basic cell biology of the mammary epithelial cell secretory pathway is considered in relation to what is known in more detail for other cell types. In addition, potential points of control of protein secretion are examined. The secretory biology of mammary epithelial cells has not been characterized extensively in recent years and, while some aspects are well understood, other key issues, which still remain to be resolved, have been highlighted.
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Affiliation(s)
- R D Burgoyne
- The Physiological Laboratory, University of Liverpool, United Kingdom.
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Abstract
The cream fraction of milk comprises droplets of triacylglycerol coated with cellular membranes. In this review, we discuss how these droplets are formed and secreted from mammary epithelial cells during lactation. This secretory system is especially interesting because the assembled lipid droplets are secreted from the cytoplasm enveloped by cellular membranes. In other cells, such as hepatocytes and enterocytes, lipid is secreted by exocytosis from membrane-bounded compartments of the secretory pathway. Milk lipids originate as small droplets of triacylglycerol, synthesized in or on the surfaces of rough endoplasmic reticulum (ER)4 membranes. These droplets are released into the cytoplasm as microlipid droplets (MLDs) with a surface coat of protein and polar lipid. MLDs may fuse with each other to form larger cytoplasmic lipid droplets (CLDs). Droplets of varying size, are transported to the apical cytoplasm by unknown mechanisms and are secreted from the cell coated with an outer bilayer membrane. CLDs may increase in size in all regions of the cell, especially at the plasma membrane during secretion. Two possible mechanisms for lipid secretion have been proposed: an apical mechanism, in which lipid droplets are enveloped with apical plasma membrane, and a secretory-vesicle mechanism, in which fat droplets are surrounded by secretory vesicles in the cytoplasm and are released from the surface by exocytosis from intracytoplasmic vacuoles. A combination of both mechanisms may be possible. Following secretion, a fraction of the membrane surrounding the globules may be shed from the droplets and give rise to membrane fragments in the skim milk phase.
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Affiliation(s)
- I H Mather
- Department of Animal and Avian Sciences, University of Maryland, College Park 20742, USA.
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Morand LZ, Morand JN, Matson R, German JB. Effect of insulin and prolactin on acyltransferase activities in MAC-T bovine mammary cells. J Dairy Sci 1998; 81:100-6. [PMID: 9493084 DOI: 10.3168/jds.s0022-0302(98)75556-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The enzymatic activities of sn-glycerol-3-phosphate acyltransferase and lysophosphatidate acyltransferase were investigated in microsomal fractions prepared from MAC-T cells from bovine mammary gland and from FTO-2B cells from rat liver. In both cell lines, sn-glycerol-3-phosphate acyltransferase exhibited similar rates of palmitate and oleate incorporation. However, lysophosphatidate acyltransferase activity in MAC-T cells had a 2.8-fold greater rate of palmitate incorporation than of oleate incorporation. In FTO-2B cells, there was a 1.4-fold greater rate of oleate incorporation than of palmitate incorporation. FTO-2B and MAC-T cells displayed acyltransferase activities that were consistent with liver and mammary tissues, respectively. The acyltransferases were examined from FTO-2B and MAC-T cells that were treated with insulin and prolactin. Insulin suppressed both acyltransferase activities in FTO-2B cells, and prolactin had a stimulatory effect; however, these effects were very small. In contrast, insulin and prolactin had a stimulatory effect on both acyltransferase activities in MAC-T cells; prolactin elicited the largest effect. Treatment of MAC-T cells with cycloheximide inhibited the stimulatory effect of prolactin on acyltransferase activities.
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Affiliation(s)
- L Z Morand
- Department of Food Science and Technology, University of California, Davis 95616, USA
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Barber MC, Clegg RA, Travers MT, Vernon RG. Lipid metabolism in the lactating mammary gland. BIOCHIMICA ET BIOPHYSICA ACTA 1997; 1347:101-26. [PMID: 9295156 DOI: 10.1016/s0005-2760(97)00079-9] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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