Correlation between early sublingual small vessel density and late blood lactate level in critically ill surgical patients

Abstract Background Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intens...

Full description

Saved in:
Bibliographic Details
Published inThe Journal of surgical research Vol. 180; no. 2; pp. 317 - 321
Main Authors Yeh, Yu-Chang, MD, Wang, Ming-Jiuh, PhD, Chao, Anne, MD, Ko, Wen-Je, PhD, Chan, Wing-Sum, MD, Fan, Shou-Zen, PhD, Tsai, Jui-Chang, PhD, Sun, Wei-Zen, MD
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.04.2013
Subjects
Adult
Aged
Critical Illness
Female
Humans
Intensive care
Lactate
Lactic Acid - blood
Male
Microcirculation
Middle Aged
Mouth Floor - blood supply
Prospective Studies
Surgery
Surgical Procedures, Operative
Microcirculation
Intensive care
Lactate
Surgery
Online AccessGet full text

Cover

Abstract Abstract Background Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units. Methods This prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software. Results A total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h ( r = −0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h ( r = −0.476; P  = 0.008). Conclusions Early total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
AbstractList BACKGROUNDSurgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units.METHODSThis prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software.RESULTSA total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h (r = -0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h (r = -0.476; P = 0.008).CONCLUSIONSEarly total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units. This prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software. A total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h (r = −0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h (r = −0.476; P = 0.008). Early total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units. This prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software. A total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h (r = -0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h (r = -0.476; P = 0.008). Early total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
Abstract Background Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory dysfunction may result in anaerobic glycolysis and lead to elevated blood lactate levels in patients admitted to surgical intensive care units. Methods This prospective observational study enrolled adult patients admitted to surgical intensive care units after general surgery or thoracic surgery. We measured blood lactate levels before the operation and at 1 h and 24 h after the operation. We obtained images of sublingual microcirculation using a sidestream dark field video microscope and analyzed them employing automated analysis software. Results A total of 31 patients completed the study. Perioperative total and perfused small vessel densities were lower in patients with a blood lactate level ≥3 mmol/L. We observed a significant correlation between the total small vessel density at 1 h and the blood lactate level at 24 h ( r = −0.573; P = 0.001). In addition, we saw a significant correlation between the perfused small vessel density at 1 h and the blood lactate level at 24 h ( r = −0.476; P  = 0.008). Conclusions Early total and perfused small vessel density may be used as an early predictor or therapeutic goal for critically ill surgical patients in further studies.
Author Sun, Wei-Zen, MD
Tsai, Jui-Chang, PhD
Ko, Wen-Je, PhD
Fan, Shou-Zen, PhD
Chao, Anne, MD
Yeh, Yu-Chang, MD
Wang, Ming-Jiuh, PhD
Chan, Wing-Sum, MD
Author_xml – sequence: 1
  fullname: Yeh, Yu-Chang, MD
– sequence: 2
  fullname: Wang, Ming-Jiuh, PhD
– sequence: 3
  fullname: Chao, Anne, MD
– sequence: 4
  fullname: Ko, Wen-Je, PhD
– sequence: 5
  fullname: Chan, Wing-Sum, MD
– sequence: 6
  fullname: Fan, Shou-Zen, PhD
– sequence: 7
  fullname: Tsai, Jui-Chang, PhD
– sequence: 8
  fullname: Sun, Wei-Zen, MD
BackLink https://www.ncbi.nlm.nih.gov/pubmed/22658494$$D View this record in MEDLINE/PubMed
BookMark eNp9kUGP1CAYholZ486O_gAvhqOXVqAUaExMzETdTTbxoJ4JpV83VAZGaMfUXy_NrB48eIIveZ-X8Hw36CrEAAi9pKSmhIo3Uz3lXDNCWU3amhDxBO0o6dpKCdlcoR0hjFVcEX6NbnKeSJk72TxD14yJVvGO79CvQ0wJvJldDLiH-SdAwGCSX3Feeu_Cw2I8zkfjPT5DzuDxACG7ecUmDLiAgHsf43a18zZ5OJeQC9gmNztbwBW7QuclPWwjPpXHIMz5OXo6Gp_hxeO5R98-fvh6uK3uP3-6O7y_rywnaq7GgUtBO6M4NNL0gpG2GW3f81Ep24EcpbLCcmultK0SgsumyOkUtaOxjMlmj15fek8p_lggz_rosgXvTYC4ZE0bKlXbytK7R_QStSnmnGDUp-SOJq2aEr0p15MuyvWmXJNWF-WFefVYv_RHGP4SfxyXwNtLAMonzw6SzrYIsDC4BHbWQ3T_rX_3D23LVjaR32GFPMUlhWJPU50Lo79sO99WThkhnFPR_Abj7Kpk
CitedBy_id crossref_primary_10_1111_eci_12784
crossref_primary_10_1177_000313481508101231
crossref_primary_10_1186_s13054_017_1842_7
crossref_primary_10_17085_apm_22127
crossref_primary_10_1097_SHK_0000000000001713
crossref_primary_10_1016_j_jep_2016_01_027
crossref_primary_10_1016_j_jointm_2022_09_002
crossref_primary_10_1097_CCM_0000000000001567
crossref_primary_10_1186_s12871_015_0093_x
crossref_primary_10_1186_s13054_018_2081_2
crossref_primary_10_1093_carcin_bgae012
crossref_primary_10_1097_CM9_0000000000000887
crossref_primary_10_1111_micc_12819
crossref_primary_10_1016_j_jss_2013_04_056
crossref_primary_10_1016_j_mvr_2023_104552
crossref_primary_10_1186_s13054_024_04813_6
crossref_primary_10_1053_j_jvca_2020_04_045
Cites_doi 10.1177/0885066610371631
10.1016/S0039-6060(03)00254-X
10.1016/j.ccc.2010.12.013
10.1007/s00134-008-1325-z
10.1016/j.jss.2009.11.739
10.1006/jsre.2000.5874
10.1007/s00134-007-0680-5
10.1164/ajrccm.157.6.9710029
10.1186/cc6118
10.1097/00003246-199907000-00001
10.1164/rccm.200912-1918OC
10.1016/0003-4975(94)90430-8
10.1097/CCM.0b013e3181b02fc1
10.1007/s00134-008-1193-6
10.1152/ajpgi.00359.2003
10.1097/SHK.0b013e3181c6be04
10.1006/jsre.1996.0103
10.1007/s002689900065
10.1378/chest.120.3.923
10.1097/01.CCM.0000125517.28517.74
10.1097/01.md.0000141098.46118.4c
10.1016/j.surg.2006.05.015
10.1097/01.CCM.0000132904.35713.A7
10.1186/cc3756
10.1186/cc9220
10.1097/01.CCM.0000142398.73762.20
10.1016/j.amjsurg.2006.02.014
10.1016/j.jss.2010.01.024
10.1016/j.dld.2010.10.009
10.1007/s11739-009-0297-5
10.1097/shk.0b013e31804f584a
10.1016/j.surg.2009.10.036
10.1164/rccm.200109-016OC
10.1001/jama.2010.158
10.1016/j.jss.2007.12.795
10.1067/msy.2000.107104
ContentType Journal Article
Copyright Elsevier Inc.
2013 Elsevier Inc.
Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright_xml – notice: Elsevier Inc.
– notice: 2013 Elsevier Inc.
– notice: Copyright © 2013 Elsevier Inc. All rights reserved.
DBID CGR
CUY
CVF
ECM
EIF
NPM
AAYXX
CITATION
7X8
DOI 10.1016/j.jss.2012.05.006
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
CrossRef
MEDLINE - Academic
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
CrossRef
MEDLINE - Academic
DatabaseTitleList MEDLINE - Academic

MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
DeliveryMethod fulltext_linktorsrc
EISSN 1095-8673
EndPage 321
ExternalDocumentID 10_1016_j_jss_2012_05_006
22658494
S0022480412004416
1_s2_0_S0022480412004416
Genre Research Support, Non-U.S. Gov't
Journal Article
GroupedDBID ---
--K
--M
.1-
.55
.FO
.GJ
.~1
08R
0R~
1B1
1P~
1RT
1~.
1~5
29L
3O-
4.4
457
4CK
4G.
53G
5GY
5RE
5VS
7-5
71M
8P~
9JM
AABNK
AACTN
AAEDT
AAIAV
AAIKJ
AAKOC
AALMO
AALRI
AAOAW
AAQFI
AAQXK
AAXUO
ABBQC
ABFLS
ABFNM
ABLVK
ABMAC
ABMZM
ABPIF
ABPTK
ABXDB
ABYKQ
ACDAQ
ACGFS
ACRLP
ADBBV
ADEZE
AEBSH
AEKER
AENEX
AEVXI
AFCTW
AFFNX
AFKWA
AFRHN
AFTJW
AFXIZ
AGHFR
AGUBO
AGYEJ
AHAIN
AHHHB
AIEXJ
AIKHN
AITUG
AJBFU
AJOXV
AJRQY
AJUYK
ALMA_UNASSIGNED_HOLDINGS
AMFUW
AMRAJ
ANZVX
ASPBG
AVWKF
AXJTR
AZFZN
BKOJK
BLXMC
BNPGV
CAG
COF
CS3
DM4
DU5
EBS
EFBJH
EFJIC
EJD
EO8
EO9
EP2
EP3
F5P
FDB
FEDTE
FGOYB
FIRID
FNPLU
FYGXN
G-2
G-Q
GBLVA
HEK
HMK
HMO
HZ~
IHE
J1W
J5H
KOM
LCYCR
LG5
M29
M41
MO0
N9A
O-L
O9-
OAUVE
OK-
OW-
OZT
P-8
P-9
P2P
PC.
Q38
R2-
RIG
ROL
RPZ
SAE
SCC
SDF
SDG
SDP
SEL
SES
SEW
SPCBC
SSH
SSZ
T5K
UHS
WUQ
X7M
XPP
Z5R
ZA5
ZGI
ZMT
ZU3
ZXP
~G-
AAEDW
ABJNI
ADFGL
ADMUD
AHPSJ
EFLBG
HVGLF
AKRWK
CGR
CUY
CVF
ECM
EIF
NPM
AAXKI
AAYXX
CITATION
7X8
ID FETCH-LOGICAL-c408t-fd47619a84e37ab62053fcbb4f88c9e7f78c6c4cc77c5866473101981cfac2273
IEDL.DBID .~1
ISSN 0022-4804
IngestDate Fri Aug 16 01:58:34 EDT 2024
Thu Sep 12 17:59:26 EDT 2024
Tue Aug 27 13:47:02 EDT 2024
Fri Feb 23 02:32:43 EST 2024
Thu Mar 09 09:15:27 EST 2023
IsPeerReviewed true
IsScholarly true
Issue 2
Keywords Microcirculation
Intensive care
Lactate
Surgery
Language English
License Copyright © 2013 Elsevier Inc. All rights reserved.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c408t-fd47619a84e37ab62053fcbb4f88c9e7f78c6c4cc77c5866473101981cfac2273
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
PMID 22658494
PQID 1317855705
PQPubID 23479
PageCount 5
ParticipantIDs proquest_miscellaneous_1317855705
crossref_primary_10_1016_j_jss_2012_05_006
pubmed_primary_22658494
elsevier_sciencedirect_doi_10_1016_j_jss_2012_05_006
elsevier_clinicalkeyesjournals_1_s2_0_S0022480412004416
PublicationCentury 2000
PublicationDate 2013-04-01
PublicationDateYYYYMMDD 2013-04-01
PublicationDate_xml – month: 04
  year: 2013
  text: 2013-04-01
  day: 01
PublicationDecade 2010
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle The Journal of surgical research
PublicationTitleAlternate J Surg Res
PublicationYear 2013
Publisher Elsevier Inc
Publisher_xml – name: Elsevier Inc
References Bateman, Walley (bib10) 2005; 9
Daudel, Freise, Westphal (bib27) 2007; 28
Kliegel, Losert, Sterz (bib16) 2004; 83
Jhanji, Lee, Watson (bib19) 2009; 35
Kaplan, Kellum (bib15) 2004; 32
Gonzalo, Grasa, Arruebo (bib38) 2011; 43
Nencioni, Trzeciak, Shapiro (bib8) 2009; 4
Howell, Donnino, Clardy (bib12) 2007; 33
Anup, Balasubramanian (bib28) 2000; 92
Wenkui, Ning, Jianfeng (bib1) 2010; 147
Jansen, van Bommel, Schoonderbeek (bib2) 2010; 182
Watson, Heard (bib18) 2010; 25
Spanos, Jhanji, Vivian-Smith (bib6) 2010; 33
Lazar, Kaszaki, Abraham (bib26) 2003; 134
Pastores, Katz, Kvetan (bib29) 1996; 91
Nguyen, Rivers, Knoblich (bib3) 2004; 32
Jhanji, Vivian-Smith, Lucena-Amaro (bib20) 2010; 14
Marik (bib32) 2001; 120
Zakaria el, Tsakadze, Garrison (bib22) 2006; 140
Swank, Deitch (bib35) 1996; 20
Corno (bib36) 1994; 57
Diller, Stratmann, Helmschmied (bib34) 2008; 150
Overhaus, Togel, Pezzone (bib37) 2004; 287
De Backer, Creteur, Preiser (bib5) 2002; 166
Farquhar, Martin, Lam (bib7) 1996; 61
Zhang, Radulescu, Chen (bib24) 2011; 171
Okorie, Dellinger (bib4) 2011; 27
Boerma, Koopmans, Konijn (bib23) 2010; 38
Nakagawa, Weil, Tang (bib31) 1998; 157
Foitzik, Eibl, Hotz (bib21) 2000; 128
Weil, Nakagawa, Tang (bib30) 1999; 27
Holt, Delaney, Uyehara (bib25) 2011; 171
De Backer, Hollenberg, Boerma (bib11) 2007; 11
Claridge, Crabtree, Pelletier (bib13) 2000; 48
Daley, Welage, Rogers (bib33) 2004; 32
Trzeciak, McCoy, Phillip Dellinger, Arnold, Rizzuto, Abate, Shapiro, Parrillo, Hollenberg (bib9) 2008; 34
Martin, FitzSullivan, Salim (bib14) 2006; 191
Jones, Shapiro, Trzeciak (bib17) 2010; 303
Jansen (10.1016/j.jss.2012.05.006_bib2) 2010; 182
Daley (10.1016/j.jss.2012.05.006_bib33) 2004; 32
Spanos (10.1016/j.jss.2012.05.006_bib6) 2010; 33
Watson (10.1016/j.jss.2012.05.006_bib18) 2010; 25
Zakaria el (10.1016/j.jss.2012.05.006_bib22) 2006; 140
Overhaus (10.1016/j.jss.2012.05.006_bib37) 2004; 287
Nakagawa (10.1016/j.jss.2012.05.006_bib31) 1998; 157
Gonzalo (10.1016/j.jss.2012.05.006_bib38) 2011; 43
De Backer (10.1016/j.jss.2012.05.006_bib11) 2007; 11
Jhanji (10.1016/j.jss.2012.05.006_bib20) 2010; 14
Jones (10.1016/j.jss.2012.05.006_bib17) 2010; 303
Nencioni (10.1016/j.jss.2012.05.006_bib8) 2009; 4
Kliegel (10.1016/j.jss.2012.05.006_bib16) 2004; 83
Weil (10.1016/j.jss.2012.05.006_bib30) 1999; 27
Pastores (10.1016/j.jss.2012.05.006_bib29) 1996; 91
Claridge (10.1016/j.jss.2012.05.006_bib13) 2000; 48
Okorie (10.1016/j.jss.2012.05.006_bib4) 2011; 27
Jhanji (10.1016/j.jss.2012.05.006_bib19) 2009; 35
Martin (10.1016/j.jss.2012.05.006_bib14) 2006; 191
Wenkui (10.1016/j.jss.2012.05.006_bib1) 2010; 147
Anup (10.1016/j.jss.2012.05.006_bib28) 2000; 92
Swank (10.1016/j.jss.2012.05.006_bib35) 1996; 20
Kaplan (10.1016/j.jss.2012.05.006_bib15) 2004; 32
Diller (10.1016/j.jss.2012.05.006_bib34) 2008; 150
Trzeciak (10.1016/j.jss.2012.05.006_bib9) 2008; 34
Corno (10.1016/j.jss.2012.05.006_bib36) 1994; 57
Nguyen (10.1016/j.jss.2012.05.006_bib3) 2004; 32
Lazar (10.1016/j.jss.2012.05.006_bib26) 2003; 134
Holt (10.1016/j.jss.2012.05.006_bib25) 2011; 171
Zhang (10.1016/j.jss.2012.05.006_bib24) 2011; 171
Foitzik (10.1016/j.jss.2012.05.006_bib21) 2000; 128
Boerma (10.1016/j.jss.2012.05.006_bib23) 2010; 38
Daudel (10.1016/j.jss.2012.05.006_bib27) 2007; 28
Howell (10.1016/j.jss.2012.05.006_bib12) 2007; 33
Bateman (10.1016/j.jss.2012.05.006_bib10) 2005; 9
Marik (10.1016/j.jss.2012.05.006_bib32) 2001; 120
De Backer (10.1016/j.jss.2012.05.006_bib5) 2002; 166
Farquhar (10.1016/j.jss.2012.05.006_bib7) 1996; 61
References_xml – volume: 287
  start-page: G685
  year: 2004
  ident: bib37
  article-title: Mechanisms of polymicrobial sepsis-induced ileus
  publication-title: Am J Physiol Gastrointest Liver Physiol
  contributor:
    fullname: Pezzone
– volume: 25
  start-page: 301
  year: 2010
  ident: bib18
  article-title: The use of lactate as a biomarker
  publication-title: J Intensive Care Med
  contributor:
    fullname: Heard
– volume: 14
  start-page: R151
  year: 2010
  ident: bib20
  article-title: Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: A randomised controlled trial
  publication-title: Crit Care
  contributor:
    fullname: Lucena-Amaro
– volume: 38
  start-page: 93
  year: 2010
  ident: bib23
  article-title: Effects of nitroglycerin on sublingual microcirculatory blood flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: A double-blind randomized placebo controlled trial
  publication-title: Crit Care Med
  contributor:
    fullname: Konijn
– volume: 48
  start-page: 8
  year: 2000
  ident: bib13
  article-title: Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients
  publication-title: J Trauma
  contributor:
    fullname: Pelletier
– volume: 57
  start-page: 263
  year: 1994
  ident: bib36
  article-title: Role of the gut in the development of multiple organ dysfunction
  publication-title: Ann Thorac Surg
  contributor:
    fullname: Corno
– volume: 27
  start-page: 1225
  year: 1999
  ident: bib30
  article-title: Sublingual capnometry: A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock
  publication-title: Crit Care Med
  contributor:
    fullname: Tang
– volume: 32
  start-page: 2008
  year: 2004
  ident: bib33
  article-title: Prevention of stress ulceration: Current trends in critical care
  publication-title: Crit Care Med
  contributor:
    fullname: Rogers
– volume: 147
  start-page: 542
  year: 2010
  ident: bib1
  article-title: Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy
  publication-title: Surgery
  contributor:
    fullname: Jianfeng
– volume: 182
  start-page: 752
  year: 2010
  ident: bib2
  article-title: Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial
  publication-title: Am J Respir Crit Care Med
  contributor:
    fullname: Schoonderbeek
– volume: 28
  start-page: 610
  year: 2007
  ident: bib27
  article-title: Continuous thoracic epidural anesthesia improves gut mucosal microcirculation in rats with sepsis
  publication-title: Shock
  contributor:
    fullname: Westphal
– volume: 11
  start-page: R101
  year: 2007
  ident: bib11
  article-title: How to evaluate the microcirculation: Report of a round table conference
  publication-title: Crit Care
  contributor:
    fullname: Boerma
– volume: 120
  start-page: 923
  year: 2001
  ident: bib32
  article-title: Sublingual capnography: A clinical validation study
  publication-title: Chest
  contributor:
    fullname: Marik
– volume: 33
  start-page: 387
  year: 2010
  ident: bib6
  article-title: Early microvascular changes in sepsis and severe sepsis
  publication-title: Shock
  contributor:
    fullname: Vivian-Smith
– volume: 166
  start-page: 98
  year: 2002
  ident: bib5
  article-title: Microvascular blood flow is altered in patients with sepsis
  publication-title: Am J Respir Crit Care Med
  contributor:
    fullname: Preiser
– volume: 303
  start-page: 739
  year: 2010
  ident: bib17
  article-title: Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: A randomized clinical trial
  publication-title: JAMA
  contributor:
    fullname: Trzeciak
– volume: 4
  start-page: 413
  year: 2009
  ident: bib8
  article-title: The microcirculation as a diagnostic and therapeutic target in sepsis
  publication-title: Intern Emerg Med
  contributor:
    fullname: Shapiro
– volume: 35
  start-page: 671
  year: 2009
  ident: bib19
  article-title: Microvascular flow and tissue oxygenation after major abdominal surgery: Association with post-operative complications
  publication-title: Intensive Care Med
  contributor:
    fullname: Watson
– volume: 128
  start-page: 399
  year: 2000
  ident: bib21
  article-title: Endothelin receptor blockade in severe acute pancreatitis leads to systemic enhancement of microcirculation, stabilization of capillary permeability, and improved survival rates
  publication-title: Surgery
  contributor:
    fullname: Hotz
– volume: 20
  start-page: 411
  year: 1996
  ident: bib35
  article-title: Role of the gut in multiple organ failure: Bacterial translocation and permeability changes
  publication-title: World J Surg
  contributor:
    fullname: Deitch
– volume: 32
  start-page: 1120
  year: 2004
  ident: bib15
  article-title: Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury
  publication-title: Crit Care Med
  contributor:
    fullname: Kellum
– volume: 134
  start-page: 799
  year: 2003
  ident: bib26
  article-title: Thoracic epidural anesthesia improves the gastric microcirculation during experimental gastric tube formation
  publication-title: Surgery
  contributor:
    fullname: Abraham
– volume: 171
  start-page: 191
  year: 2011
  ident: bib25
  article-title: Effects of combination dobutamine and vasopressin therapy on microcirculatory blood flow in a porcine model of severe endotoxic shock
  publication-title: J Surg Res
  contributor:
    fullname: Uyehara
– volume: 140
  start-page: 579
  year: 2006
  ident: bib22
  article-title: Hypertonic saline resuscitation improves intestinal microcirculation in a rat model of hemorrhagic shock
  publication-title: Surgery
  contributor:
    fullname: Garrison
– volume: 191
  start-page: 625
  year: 2006
  ident: bib14
  article-title: Discordance between lactate and base deficit in the surgical intensive care unit: Which one do you trust?
  publication-title: Am J Surg
  contributor:
    fullname: Salim
– volume: 92
  start-page: 291
  year: 2000
  ident: bib28
  article-title: Surgical stress and the gastrointestinal tract
  publication-title: J Surg Res
  contributor:
    fullname: Balasubramanian
– volume: 34
  start-page: 2210
  year: 2008
  ident: bib9
  article-title: Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis
  publication-title: Intensive Care Med
  contributor:
    fullname: Hollenberg
– volume: 83
  start-page: 274
  year: 2004
  ident: bib16
  article-title: Serial lactate determinations for prediction of outcome after cardiac arrest
  publication-title: Medicine (Baltimore)
  contributor:
    fullname: Sterz
– volume: 91
  start-page: 1697
  year: 1996
  ident: bib29
  article-title: Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome
  publication-title: Am J Gastroenterol
  contributor:
    fullname: Kvetan
– volume: 157
  start-page: 1838
  year: 1998
  ident: bib31
  article-title: Sublingual capnometry for diagnosis and quantitation of circulatory shock
  publication-title: Am J Respir Crit Care Med
  contributor:
    fullname: Tang
– volume: 150
  start-page: 3
  year: 2008
  ident: bib34
  article-title: Microcirculatory dysfunction in endotoxemic bowel anastomosis: The pathogenetic contribution of microcirculatory dysfunction to endotoxemia-induced healing impairment
  publication-title: J Surg Res
  contributor:
    fullname: Helmschmied
– volume: 32
  start-page: 1637
  year: 2004
  ident: bib3
  article-title: Early lactate clearance is associated with improved outcome in severe sepsis and septic shock
  publication-title: Crit Care Med
  contributor:
    fullname: Knoblich
– volume: 43
  start-page: 277
  year: 2011
  ident: bib38
  article-title: Lipopolysaccharide-induced intestinal motility disturbances are mediated by c-Jun NH2-terminal kinases
  publication-title: Dig Liver Dis
  contributor:
    fullname: Arruebo
– volume: 171
  start-page: 218
  year: 2011
  ident: bib24
  article-title: HB-EGF improves intestinal microcirculation after hemorrhagic shock
  publication-title: J Surg Res
  contributor:
    fullname: Chen
– volume: 27
  start-page: 299
  year: 2011
  ident: bib4
  article-title: Lactate: Biomarker and potential therapeutic target
  publication-title: Crit Care Clin
  contributor:
    fullname: Dellinger
– volume: 33
  start-page: 1892
  year: 2007
  ident: bib12
  article-title: Occult hypoperfusion and mortality in patients with suspected infection
  publication-title: Intensive Care Med
  contributor:
    fullname: Clardy
– volume: 61
  start-page: 190
  year: 1996
  ident: bib7
  article-title: Decreased capillary density in vivo in bowel mucosa of rats with normotensive sepsis
  publication-title: J Surg Res
  contributor:
    fullname: Lam
– volume: 9
  start-page: S27
  year: 2005
  ident: bib10
  article-title: Microvascular resuscitation as a therapeutic goal in severe sepsis
  publication-title: Crit Care
  contributor:
    fullname: Walley
– volume: 25
  start-page: 301
  year: 2010
  ident: 10.1016/j.jss.2012.05.006_bib18
  article-title: The use of lactate as a biomarker
  publication-title: J Intensive Care Med
  doi: 10.1177/0885066610371631
  contributor:
    fullname: Watson
– volume: 134
  start-page: 799
  year: 2003
  ident: 10.1016/j.jss.2012.05.006_bib26
  article-title: Thoracic epidural anesthesia improves the gastric microcirculation during experimental gastric tube formation
  publication-title: Surgery
  doi: 10.1016/S0039-6060(03)00254-X
  contributor:
    fullname: Lazar
– volume: 27
  start-page: 299
  year: 2011
  ident: 10.1016/j.jss.2012.05.006_bib4
  article-title: Lactate: Biomarker and potential therapeutic target
  publication-title: Crit Care Clin
  doi: 10.1016/j.ccc.2010.12.013
  contributor:
    fullname: Okorie
– volume: 35
  start-page: 671
  year: 2009
  ident: 10.1016/j.jss.2012.05.006_bib19
  article-title: Microvascular flow and tissue oxygenation after major abdominal surgery: Association with post-operative complications
  publication-title: Intensive Care Med
  doi: 10.1007/s00134-008-1325-z
  contributor:
    fullname: Jhanji
– volume: 171
  start-page: 191
  year: 2011
  ident: 10.1016/j.jss.2012.05.006_bib25
  article-title: Effects of combination dobutamine and vasopressin therapy on microcirculatory blood flow in a porcine model of severe endotoxic shock
  publication-title: J Surg Res
  doi: 10.1016/j.jss.2009.11.739
  contributor:
    fullname: Holt
– volume: 92
  start-page: 291
  year: 2000
  ident: 10.1016/j.jss.2012.05.006_bib28
  article-title: Surgical stress and the gastrointestinal tract
  publication-title: J Surg Res
  doi: 10.1006/jsre.2000.5874
  contributor:
    fullname: Anup
– volume: 33
  start-page: 1892
  year: 2007
  ident: 10.1016/j.jss.2012.05.006_bib12
  article-title: Occult hypoperfusion and mortality in patients with suspected infection
  publication-title: Intensive Care Med
  doi: 10.1007/s00134-007-0680-5
  contributor:
    fullname: Howell
– volume: 157
  start-page: 1838
  year: 1998
  ident: 10.1016/j.jss.2012.05.006_bib31
  article-title: Sublingual capnometry for diagnosis and quantitation of circulatory shock
  publication-title: Am J Respir Crit Care Med
  doi: 10.1164/ajrccm.157.6.9710029
  contributor:
    fullname: Nakagawa
– volume: 11
  start-page: R101
  year: 2007
  ident: 10.1016/j.jss.2012.05.006_bib11
  article-title: How to evaluate the microcirculation: Report of a round table conference
  publication-title: Crit Care
  doi: 10.1186/cc6118
  contributor:
    fullname: De Backer
– volume: 27
  start-page: 1225
  year: 1999
  ident: 10.1016/j.jss.2012.05.006_bib30
  article-title: Sublingual capnometry: A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock
  publication-title: Crit Care Med
  doi: 10.1097/00003246-199907000-00001
  contributor:
    fullname: Weil
– volume: 182
  start-page: 752
  year: 2010
  ident: 10.1016/j.jss.2012.05.006_bib2
  article-title: Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial
  publication-title: Am J Respir Crit Care Med
  doi: 10.1164/rccm.200912-1918OC
  contributor:
    fullname: Jansen
– volume: 57
  start-page: 263
  year: 1994
  ident: 10.1016/j.jss.2012.05.006_bib36
  article-title: Role of the gut in the development of multiple organ dysfunction
  publication-title: Ann Thorac Surg
  doi: 10.1016/0003-4975(94)90430-8
  contributor:
    fullname: Corno
– volume: 38
  start-page: 93
  year: 2010
  ident: 10.1016/j.jss.2012.05.006_bib23
  article-title: Effects of nitroglycerin on sublingual microcirculatory blood flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: A double-blind randomized placebo controlled trial
  publication-title: Crit Care Med
  doi: 10.1097/CCM.0b013e3181b02fc1
  contributor:
    fullname: Boerma
– volume: 48
  start-page: 8
  year: 2000
  ident: 10.1016/j.jss.2012.05.006_bib13
  article-title: Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients
  publication-title: J Trauma
  contributor:
    fullname: Claridge
– volume: 34
  start-page: 2210
  year: 2008
  ident: 10.1016/j.jss.2012.05.006_bib9
  article-title: Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis
  publication-title: Intensive Care Med
  doi: 10.1007/s00134-008-1193-6
  contributor:
    fullname: Trzeciak
– volume: 287
  start-page: G685
  year: 2004
  ident: 10.1016/j.jss.2012.05.006_bib37
  article-title: Mechanisms of polymicrobial sepsis-induced ileus
  publication-title: Am J Physiol Gastrointest Liver Physiol
  doi: 10.1152/ajpgi.00359.2003
  contributor:
    fullname: Overhaus
– volume: 91
  start-page: 1697
  year: 1996
  ident: 10.1016/j.jss.2012.05.006_bib29
  article-title: Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome
  publication-title: Am J Gastroenterol
  contributor:
    fullname: Pastores
– volume: 33
  start-page: 387
  year: 2010
  ident: 10.1016/j.jss.2012.05.006_bib6
  article-title: Early microvascular changes in sepsis and severe sepsis
  publication-title: Shock
  doi: 10.1097/SHK.0b013e3181c6be04
  contributor:
    fullname: Spanos
– volume: 61
  start-page: 190
  year: 1996
  ident: 10.1016/j.jss.2012.05.006_bib7
  article-title: Decreased capillary density in vivo in bowel mucosa of rats with normotensive sepsis
  publication-title: J Surg Res
  doi: 10.1006/jsre.1996.0103
  contributor:
    fullname: Farquhar
– volume: 20
  start-page: 411
  year: 1996
  ident: 10.1016/j.jss.2012.05.006_bib35
  article-title: Role of the gut in multiple organ failure: Bacterial translocation and permeability changes
  publication-title: World J Surg
  doi: 10.1007/s002689900065
  contributor:
    fullname: Swank
– volume: 120
  start-page: 923
  year: 2001
  ident: 10.1016/j.jss.2012.05.006_bib32
  article-title: Sublingual capnography: A clinical validation study
  publication-title: Chest
  doi: 10.1378/chest.120.3.923
  contributor:
    fullname: Marik
– volume: 32
  start-page: 1120
  year: 2004
  ident: 10.1016/j.jss.2012.05.006_bib15
  article-title: Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury
  publication-title: Crit Care Med
  doi: 10.1097/01.CCM.0000125517.28517.74
  contributor:
    fullname: Kaplan
– volume: 83
  start-page: 274
  year: 2004
  ident: 10.1016/j.jss.2012.05.006_bib16
  article-title: Serial lactate determinations for prediction of outcome after cardiac arrest
  publication-title: Medicine (Baltimore)
  doi: 10.1097/01.md.0000141098.46118.4c
  contributor:
    fullname: Kliegel
– volume: 140
  start-page: 579
  year: 2006
  ident: 10.1016/j.jss.2012.05.006_bib22
  article-title: Hypertonic saline resuscitation improves intestinal microcirculation in a rat model of hemorrhagic shock
  publication-title: Surgery
  doi: 10.1016/j.surg.2006.05.015
  contributor:
    fullname: Zakaria el
– volume: 32
  start-page: 1637
  year: 2004
  ident: 10.1016/j.jss.2012.05.006_bib3
  article-title: Early lactate clearance is associated with improved outcome in severe sepsis and septic shock
  publication-title: Crit Care Med
  doi: 10.1097/01.CCM.0000132904.35713.A7
  contributor:
    fullname: Nguyen
– volume: 9
  start-page: S27
  issue: Suppl 4
  year: 2005
  ident: 10.1016/j.jss.2012.05.006_bib10
  article-title: Microvascular resuscitation as a therapeutic goal in severe sepsis
  publication-title: Crit Care
  doi: 10.1186/cc3756
  contributor:
    fullname: Bateman
– volume: 14
  start-page: R151
  year: 2010
  ident: 10.1016/j.jss.2012.05.006_bib20
  article-title: Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: A randomised controlled trial
  publication-title: Crit Care
  doi: 10.1186/cc9220
  contributor:
    fullname: Jhanji
– volume: 32
  start-page: 2008
  year: 2004
  ident: 10.1016/j.jss.2012.05.006_bib33
  article-title: Prevention of stress ulceration: Current trends in critical care
  publication-title: Crit Care Med
  doi: 10.1097/01.CCM.0000142398.73762.20
  contributor:
    fullname: Daley
– volume: 191
  start-page: 625
  year: 2006
  ident: 10.1016/j.jss.2012.05.006_bib14
  article-title: Discordance between lactate and base deficit in the surgical intensive care unit: Which one do you trust?
  publication-title: Am J Surg
  doi: 10.1016/j.amjsurg.2006.02.014
  contributor:
    fullname: Martin
– volume: 171
  start-page: 218
  year: 2011
  ident: 10.1016/j.jss.2012.05.006_bib24
  article-title: HB-EGF improves intestinal microcirculation after hemorrhagic shock
  publication-title: J Surg Res
  doi: 10.1016/j.jss.2010.01.024
  contributor:
    fullname: Zhang
– volume: 43
  start-page: 277
  year: 2011
  ident: 10.1016/j.jss.2012.05.006_bib38
  article-title: Lipopolysaccharide-induced intestinal motility disturbances are mediated by c-Jun NH2-terminal kinases
  publication-title: Dig Liver Dis
  doi: 10.1016/j.dld.2010.10.009
  contributor:
    fullname: Gonzalo
– volume: 4
  start-page: 413
  year: 2009
  ident: 10.1016/j.jss.2012.05.006_bib8
  article-title: The microcirculation as a diagnostic and therapeutic target in sepsis
  publication-title: Intern Emerg Med
  doi: 10.1007/s11739-009-0297-5
  contributor:
    fullname: Nencioni
– volume: 28
  start-page: 610
  year: 2007
  ident: 10.1016/j.jss.2012.05.006_bib27
  article-title: Continuous thoracic epidural anesthesia improves gut mucosal microcirculation in rats with sepsis
  publication-title: Shock
  doi: 10.1097/shk.0b013e31804f584a
  contributor:
    fullname: Daudel
– volume: 147
  start-page: 542
  year: 2010
  ident: 10.1016/j.jss.2012.05.006_bib1
  article-title: Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy
  publication-title: Surgery
  doi: 10.1016/j.surg.2009.10.036
  contributor:
    fullname: Wenkui
– volume: 166
  start-page: 98
  year: 2002
  ident: 10.1016/j.jss.2012.05.006_bib5
  article-title: Microvascular blood flow is altered in patients with sepsis
  publication-title: Am J Respir Crit Care Med
  doi: 10.1164/rccm.200109-016OC
  contributor:
    fullname: De Backer
– volume: 303
  start-page: 739
  year: 2010
  ident: 10.1016/j.jss.2012.05.006_bib17
  article-title: Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: A randomized clinical trial
  publication-title: JAMA
  doi: 10.1001/jama.2010.158
  contributor:
    fullname: Jones
– volume: 150
  start-page: 3
  year: 2008
  ident: 10.1016/j.jss.2012.05.006_bib34
  article-title: Microcirculatory dysfunction in endotoxemic bowel anastomosis: The pathogenetic contribution of microcirculatory dysfunction to endotoxemia-induced healing impairment
  publication-title: J Surg Res
  doi: 10.1016/j.jss.2007.12.795
  contributor:
    fullname: Diller
– volume: 128
  start-page: 399
  year: 2000
  ident: 10.1016/j.jss.2012.05.006_bib21
  article-title: Endothelin receptor blockade in severe acute pancreatitis leads to systemic enhancement of microcirculation, stabilization of capillary permeability, and improved survival rates
  publication-title: Surgery
  doi: 10.1067/msy.2000.107104
  contributor:
    fullname: Foitzik
SSID ssj0002973
Score 2.173457
Snippet Abstract Background Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early...
Surgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early microcirculatory...
BACKGROUNDSurgical stress may cause excessive inflammation and lead to microcirculatory dysfunction. The hypothesis of this study was that early...
SourceID proquest
crossref
pubmed
elsevier
SourceType Aggregation Database
Index Database
Publisher
StartPage 317
SubjectTerms Adult
Aged
Critical Illness
Female
Humans
Intensive care
Lactate
Lactic Acid - blood
Male
Microcirculation
Middle Aged
Mouth Floor - blood supply
Prospective Studies
Surgery
Surgical Procedures, Operative
Title Correlation between early sublingual small vessel density and late blood lactate level in critically ill surgical patients
URI https://www.clinicalkey.es/playcontent/1-s2.0-S0022480412004416
https://dx.doi.org/10.1016/j.jss.2012.05.006
https://www.ncbi.nlm.nih.gov/pubmed/22658494
https://search.proquest.com/docview/1317855705
Volume 180
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3NS8MwFA9jXryI4tf8GBE8CXXtmrbpcQzHVNzJwW4hTRPYqJ2snaAH_3bfa9OJyDx4KyVpwnvJe7-8_vIeIdfK9QM_9rTjcq0d5vWlI8M0cGIDByIJ_iI1eFB8moTjKXuYBbMWGTZ3YZBWaW1_bdMra23f9Kw0e6_zOd7xBfeD6XNQ0YAr8AY7fBzW9O3nN80DazM1GcOxdfNns-J4LQrM2I3hQIyshNt80zbsWfmg0T7Zs-CRDur5HZCWzg_JxxALbNSUNmppV1Rj3mJaYIwJ45EZLV5kltE3zBSe0RRZ6-U7lXlKoaOmFX0dHhVCT5ohkYjOc6psHQT41Bx6F-tVZSepTcZaHJHp6O55OHZsRQVHMZeXjkkZhi0kZ9qPZBL2YQsalSTMcK5iHZmIq1AxpaJIBTwMWQToz4u5p4xUfUA6x6SdL3N9SqhMPWPg8BQERjIG5ybj-0mkfFC05xvtdchNI0vxWifOEA2jbCFA8AIFL9xAgOA7JGqkLZoboWDDdGE3VCE8UUBj8UvpHcI2PX-sGwEu4a8BrxqdCthP-JNE5nq5hoEAUHHMSxZ0yEmt7M38AaoCXovZ2f8GPSe7_aqYBvJ-Lki7XK31JUCaMulWa7ZLdgb3j-PJF0yT9jY
link.rule.ids 315,786,790,4521,24144,27957,27958,45620,45714
linkProvider Elsevier
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1LS8QwEB5WPehFFF_rM4InobrdJm16lEVZnycFbyFNE1ipVeyuoAd_uzNtuiKiB2-lNE2YSWa-TL7MAByYXiSiNLRBT1ob8LCvAx3nIkgdbog0-ovc0Ubx-iYe3vGLe3HfgUF7F4Zold72Nza9ttb-zbGX5vHzaER3fNH9UPocUjTiihmYIzhP9RuOPr54HlScqU0ZTp-3R5s1yeuhopTdFA-k0Er8m3P6DXzWTuhsCRY9emQnzQCXoWPLFXgfUIWNhtPGPO-KWUpczCoKMlFAsmDVoy4K9kqpwguWE219_MZ0mTNsaFnNX8dHQ9iTFcQkYqOSGV8IAX81wtbV5KU2lMxnY61W4e7s9HYwDHxJhcDwnhwHLucUt9CS2yjRGUpLRM5kGXdSmtQmLpEmNtyYJDFCxjFPEP6FqQyN06aPUGcNZsun0m4A03noHO6ehHCac9w4uSjKEhOhpsPI2bALh60s1XOTOUO1lLIHhYJXJHjVEwoF34WklbZqr4SiEbOVX1GVClWFH6sfWu8Cn7b8NnEU-oS_OtxvdapwQdEpiS7t0wQ7QkQlKTGZ6MJ6o-zp-BGrImBL-eb_Ot2D-eHt9ZW6Or-53IKFfl1Zg0hA2zA7fpnYHcQ342y3nr-f9Ob3yA
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Correlation+between+early+sublingual+small+vessel+density+and+late+blood+lactate+level+in+critically+ill+surgical+patients&rft.jtitle=The+Journal+of+surgical+research&rft.au=Yeh%2C+Yu-Chang&rft.au=Wang%2C+Ming-Jiuh&rft.au=Chao%2C+Anne&rft.au=Ko%2C+Wen-Je&rft.date=2013-04-01&rft.issn=0022-4804&rft.volume=180&rft.issue=2&rft.spage=317&rft.epage=321&rft_id=info:doi/10.1016%2Fj.jss.2012.05.006&rft.externalDBID=n%2Fa&rft.externalDocID=10_1016_j_jss_2012_05_006
thumbnail_m http://utb.summon.serialssolutions.com/2.0.0/image/custom?url=https%3A%2F%2Fcdn.clinicalkey.com%2Fck-thumbnails%2F00224804%2FS0022480413X00034%2Fcov150h.gif