JaLCDOI 10.18926/AMO/65490
FullText URL 77_3_255.pdf
Author Fukushima, Shinnosuke| Hagiya, Hideharu| Uda, Kazuhiro| Gotoh, Kazuyoshi| Otsuka, Fumio|
Abstract Antimicrobial resistance is an emerging global threat that must be addressed using a multidisciplinary approach. This study aimed to raise awareness of high-level antimicrobial-resistant (AMR) pathogens in Japan by comparing their recent prevalences among prefectures, particularly Okayama. Data for the isolation proportions of meropenem-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, cefotaxime-resistant Escherichia coli and Klebsiella pneumoniae, and levofloxacin-resistant E. coli and K. pneumoniae were collected from the Japan Nosocomial Infections Surveillance, a national database sponsored by the Japanese Ministry of Health, Labour, and Welfare, between 2018 and 2021. The average isolated proportions of the seven AMR pathogens were higher in Okayama compared to other prefectures: the worst (19.9%) was meropenem-resistant P. aeruginosa, the sixth worst (57.2%) was methicillin-resistant S. aureus, the eighth worst (3.3%) was vancomycin-resistant E. faecium, the second (37.8%) and fifth worst (17.6%) were cefotaxime-resistant E. coli and K. pneumoniae, respectively, and the fourth (49.9%) and third worst (8.7%) were levofloxacin-resistant E. coli and K. pneumoniae, respectively. Our study highlights the notably high prevalences of representative AMR pathogens in Okayama, suggesting the need for fundamental infection prevention and control by healthcare professionals, promoting antimicrobial stewardship, and educating undergraduates and postgraduates in Okayama.
Keywords antimicrobial resistance antimicrobial stewardship epidemiology infection prevention and control Japan Nosocomial Infections Surveillance
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2023-06
Volume volume77
Issue issue3
Publisher Okayama University Medical School
Start Page 255
End Page 262
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders Copyright Ⓒ 2023 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 37357626
Web of Science KeyUT 001026279600003
JaLCDOI 10.18926/AMO/65488
FullText URL 77_3_235.pdf
Author Kuraoka, Sakiko| Iwamuro, Masaya| Satomi, Takuya| Yamazaki, Tatsuhiro| Hamada, Kenta| Kono, Yoshiyasu| Kanzaki, Hiromitsu| Kato, Hironari| Otsuka, Fumio| Okada, Hiroyuki|
Abstract Changes in hormone levels in patients with cancer cachexia after anamorelin administration have not been fully investigated. This study aimed to determine how anamorelin affects the endocrine system in patients with gastrointestinal cancer and cachexia. We prospectively enrolled 13 patients and comprehensively investigated their body weight and levels of serum albumin, hemoglobin A1c (HbA1c), and hormones before (week 0) and 3 and 12 weeks after anamorelin administration. The variables were evaluated at week 3 in 9 patients and at week 12 in 5 patients. At week 3, anamorelin administration resulted in body weight gain and increased the levels of growth hormone and HbA1c, as well as insulin-like growth factor-1 standard deviation scores (IGF-1 SD scores). At the same time, negative correlations were observed between ΔIGF-1 SD score and Δthyroidstimulating hormone (TSH) and between ΔIGF-1 SD score and Δfree testosterone. ΔBody weight and ΔIGF-1 SD score correlated positively at week 12. These results suggest that TSH and free testosterone levels can be affected 3 weeks after anamorelin administration; however, those variables tend to return to a state of equilibrium, and anabolic effects of anamorelin appear in long-term (≥ 12 weeks) users.
Keywords anamorelin body weight cancer cachexia endocrine system
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2023-06
Volume volume77
Issue issue3
Publisher Okayama University Medical School
Start Page 235
End Page 241
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders Copyright Ⓒ 2023 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 37357624
Web of Science KeyUT 001026279600001
FullText URL fulltext.pdf
Author Fujita, Kana| Otsuka, Yuki| Sunada, Naruhiko| Honda, Hiroyuki| Tokumasu, Kazuki| Nakano, Yasuhiro| Sakurada, Yasue| Obika, Mikako| Hagiya, Hideharu| Otsuka, Fumio|
Keywords COVID-19 aftercare clinic (CAC) headache quality of life (QOL) long COVID post COVID-19 condition (PCC)
Published Date 2023-05-18
Publication Title Journal of Clinical Medicine
Volume volume12
Issue issue10
Publisher MDPI
Start Page 3533
ISSN 2077-0383
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 by the authors.
File Version publisher
PubMed ID 37240639
DOI 10.3390/jcm12103533
Web of Science KeyUT 000997859300001
Related Url isVersionOf https://doi.org/10.3390/jcm12103533
FullText URL fulltext20230512-02.pdf fig20230512-02.pdf
Author Yamamoto, Koichiro| Otsuka, Fumio|
Note © 2022 Mayo Foundation for Medical Education and Research. This manuscript version is made available under the CC-BY-NC-ND 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/. This is the accepted manuscript version. The formal published version is available at https://doi.org/10.1016/j.mayocp.2022.01.010.|
Published Date 2022-04
Publication Title Mayo Clinic Proceedings
Volume volume97
Issue issue4
Publisher Elsevier BV
Start Page 652
End Page 652
ISSN 0025-6196
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 Mayo Foundation for Medical Education and Research
File Version author
PubMed ID 35379418
DOI 10.1016/j.mayocp.2022.01.010
Web of Science KeyUT 000795076500005
Related Url isVersionOf https://doi.org/10.1016/j.mayocp.2022.01.010
FullText URL fulltext20230512-01.pdf fig20230512-01.pdf
Author Yamamoto, Koichiro| Honda, Hiroyuki| Otsuka, Fumio|
Note © 2022 Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/. This is the accepted manuscript version. The formal published version is available at https://doi.org/10.1016/j.amjmed.2022.01.033.| This fulltext file will be available in May 2023.|
Published Date 2022-05
Publication Title The American Journal of Medicine
Volume volume135
Issue issue5
Publisher Elsevier BV
Start Page e106
End Page e106
ISSN 0002-9343
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 Elsevier Inc.
File Version author
PubMed ID 35131304
DOI 10.1016/j.amjmed.2022.01.033
Web of Science KeyUT 000830333300003
Related Url isVersionOf https://doi.org/10.1016/j.amjmed.2022.01.033
FullText URL fulltext20230508-05.pdf table20230508-05.pdf fig20230508-05.pdf
Author Fujimori, Takumi| Hagiya, Hideharu| Iio, Koji| Yamasaki, Osamu| Miyamoto, Yuji| Hoshino, Yoshihiko| Kakehi, Ayaka| Okura, Mami| Minabe, Hiroshi| Yokoyama, Yukika| Otsuka, Fumio| Higashikage, Akihito|
Keywords Buruli ulcer Mycobacterium ulcerans Mycobacterium ulcerans subsp shinshuense 16S rRNA sequencing analysis
Note © 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. This manuscript version is made available under the CC-BY-NC-ND 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/. This is the accepted manuscript version. The formal published version is available at https://doi.org/10.1016/j.jiac.2023.02.009. | This fulltext file will be available in May 2024.|
Published Date 2023-05
Publication Title Journal of Infection and Chemotherapy
Volume volume29
Issue issue5
Publisher Elsevier BV
Start Page 523
End Page 526
ISSN 1341-321X
NCID AA11057978
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.
File Version author
PubMed ID 36813163
DOI 10.1016/j.jiac.2023.02.009
Web of Science KeyUT 000972082300001
Related Url isVersionOf https://doi.org/10.1016/j.jiac.2023.02.009
FullText URL fulltext20230508-04.pdf
Author Hagiya, Hideharu| Otsuka, Yuki| Otsuka, Fumio|
Note © 2022 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/. This is the accepted manuscript version. The formal published version is available at https://doi.org/10.1016/j.jns.2022.120232.| This fulltext file will be available in May 2023.|
Published Date 2022-05-15
Publication Title Journal of the Neurological Sciences
Volume volume436
Publisher Elsevier BV
Start Page 120232
ISSN 0022-510X
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 Elsevier B.V.
File Version author
PubMed ID 35339066
DOI 10.1016/j.jns.2022.120232
Web of Science KeyUT 000795473800002
Related Url isVersionOf https://doi.org/10.1016/j.jns.2022.120232
Title Alternative Experience with a nosocomial cluster of novel coronavirus infection and the cluster response algorithm
FullText URL 135_22.pdf
Author Fujita, Koji| Ocho, Kazuki| Kadowaki, Tomoka| Yorifuji, Takashi| Otsuka, Fumio|
Abstract  The novel coronavirus disease (COVID-19) pandemic that began in 2019 is yet to end, as of the summer of 2022. During the pandemic, community-acquired infections spread easily to healthcare-associated facilities, resulting in COVID-19 clusters among high-risk individuals that have been difficult to contain. Our regional base hospital also experienced a nosocomial cluster of COVID-19 in October 2020 that took 30 days to contain and affected 9 hospital staff and 14 patients. Six patients died due to COVID-19, and six died due to COVID-19-related complications. Two patients were discharged alive. Patient characteristics included ① advanced age (79.0±8.1 years), ② dementia (64.3%), ③ low Prognostic Nutrition Index (31.1 ±7.9), ④ zinc deficiency (50.2±13.1μg/dL), ⑤ vitamin C deficiency (1.6±1.9μg/mL), ⑥ elevated urea nitrogen-to-creatinine ratio (27.4±23.5), ⑦ anticancer and immunosuppressive drug use (78.6%), and ⑧ malignancy (75.6%). This cluster had a very high mortality rate, but the viral spread was contained in a short period. Algorithmizing the cluster response was crucial to controlling this cluster. We report on our actual cluster response algorithm, as well as our strategy and response procedure during the pandemic.
Keywords 新型コロナウイルス感染症 (COVID-19) 院内クラスター (nosocomial cluster) 対応アルゴリズム (response algorithm)
Publication Title Journal of Okayama Medical Association
Published Date 2023-04-01
Volume volume135
Issue issue1
Start Page 22
End Page 33
ISSN 0030-1558
Related Url isVersionOf https://doi.org/10.4044/joma.135.22
language Japanese
Copyright Holders Copyright (c) 2023 岡山医学会
File Version publisher
DOI 10.4044/joma.135.22
FullText URL fulltext.pdf
Author Otsuka, Yuki| Hagiya, Hideharu| Takahashi, Misa| Fukushima, Shinnosuke| Maeda, Ruri| Sunada, Naruhiko| Yamada, Haruto| Kishida, Masayuki| Fujita, Koji| Otsuka, Fumio|
Published Date 2023-01-12
Publication Title Scientific Reports
Volume volume13
Issue issue1
Publisher Nature Research
Start Page 647
ISSN 2045-2322
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © The Author(s) 2023
File Version publisher
PubMed ID 36635328
DOI 10.1038/s41598-022-27330-4
Web of Science KeyUT 000962604100025
Related Url isVersionOf https://doi.org/10.1038/s41598-022-27330-4
JaLCDOI 10.18926/AMO/65151
FullText URL 77_2_203.pdf
Author Fukushima, Shinnosuke| Hagiya, Hideharu| Iio, Koji| Honda, Hiroyuki| Ishida, Tomoharu| Nagaoka, Hirokazu| Hasegawa, Kou| Otsuka, Fumio|
Abstract Granulicatella species are rare, nutritionally variant streptococci that cause infective endocarditis. Their clinical and microbiological characteristics remain unknown. We reviewed five years of Granulicatella cases in our hospital database (Jan 2017-Jun 2022), finding 6 Granulicatella adiacens cases and 1 Granulicatella elegans case. Clinical backgrounds and bacteremia sources were diverse; 3 cases developed polymicrobial bacteremia. Antimicrobial testing showed non-susceptibility to penicillin G in 4 of 7 cases (57.1%), and high susceptibility to carbapenems and vancomycin in all cases. Determining optimal antibiotic therapy for Granulicatella infections is vital in this era of antimicrobial resistance.
Keywords antimicrobial resistance bacteremia Granulicatella species nutritionally variant streptococci
Amo Type Case Report
Publication Title Acta Medica Okayama
Published Date 2023-04
Volume volume77
Issue issue2
Publisher Okayama University Medical School
Start Page 203
End Page 207
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders Copyright Ⓒ 2023 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 37094959
Web of Science KeyUT 000982563800002
FullText URL fulltext.pdf
Author Matsuda, Yui| Tokumasu, Kazuki| Otsuka, Yuki| Sunada, Naruhiko| Honda, Hiroyuki| Sakurada, Yasue| Nakano, Yasuhiro| Hasegawa, Toru| Obika, Mikako| Ueda, Keigo| Otsuka, Fumio|
Keywords dysgeusia dysosmia fatigue hypozincemia long COVID
Published Date 2023-03-06
Publication Title Journal of Clinical Medicine
Volume volume12
Issue issue5
Publisher MDPI
Start Page 2062
ISSN 2077-0383
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 by the authors.
File Version publisher
PubMed ID 36902849
DOI 10.3390/jcm12052062
Web of Science KeyUT 000947564300001
Related Url isVersionOf https://doi.org/10.3390/jcm12052062
FullText URL fulltext.pdf
Author Sakurada, Yasue| Otsuka, Yuki| Tokumasu, Kazuki| Sunada, Naruhiko| Honda, Hiroyuki| Nakano, Yasuhiro| Matsuda, Yui| Hasegawa, Toru| Ochi, Kanako| Hagiya, Hideharu| Ueda, Keigo| Kataoka, Hitomi| Otsuka, Fumio|
Keywords Delta variant schoolchildren teenagers Omicron variant post-COVID-19 condition
Published Date 2023-01-29
Publication Title Medicina
Volume volume59
Issue issue2
Publisher MDPI
Start Page 261
ISSN 1010-660X
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 by the authors.
File Version publisher
PubMed ID 36837463
DOI 10.3390/medicina59020261
Web of Science KeyUT 000940850700001
Related Url isVersionOf https://doi.org/10.3390/medicina59020261
FullText URL fulltext20230508-03.pdf
Author Hagiya, Hideharu| Hikita, Takao| Habu, Tomohiro| Asada, Masaki| Yorifuji, Takashi| Toyooka, Shinichi| Otsuka, Fumio| Nakayama, Masanori|
Note © 2022 The British Infection Association. This manuscript version is made available under the CC-BY-NC-ND 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/. This is the accepted manuscript version. The formal published version is available at https://doi.org/10.1016/j.jinf.2022.07.007. | This fulltext file will be available in Oct. 2023.|
Published Date 2022-10
Publication Title Journal of Infection
Volume volume85
Issue issue4
Publisher Elsevier
Start Page 436
End Page 480
ISSN 0163-4453
NCID AA00258231
Content Type Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 The British Infection Association.
File Version author
PubMed ID 35835411
DOI 10.1016/j.jinf.2022.07.007
Web of Science KeyUT 000883125700028
Related Url isVersionOf https://doi.org/10.1016/j.jinf.2022.07.007
FullText URL fulltext.pdf
Author Fukushima, Shinnosuke| Ocho, Kazuki| Fujita, Koji| Hagiya, Hideharu| Otsuka, Fumio|
Keywords basal meningitis cerebral infarction miliary tuberculosis tuberculous meningitis
Published Date 2023-01-16
Publication Title Clinical Case Reports
Volume volume11
Issue issue1
Publisher Wiley
Start Page e06865
ISSN 2050-0904
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 The Authors.
File Version publisher
PubMed ID 36694639
DOI 10.1002/ccr3.6865
Web of Science KeyUT 000921577100058
Related Url isVersionOf https://doi.org/10.1002/ccr3.6865
FullText URL fulltext.pdf
Author Iwamuro, Masaya| Takahashi, Takahide| Hirabata, Araki| Tanaka, Takehiro| Otsuka, Fumio| Okada, Horoyuki|
Keywords carcinogenesis lymphocytes helicobacter pylori gastric adenocarcinoma flow cytometry
Published Date 2022-11-20
Publication Title Cureus Journal Of Medical Science
Volume volume14
Issue issue11
Publisher Cureus Inc.
Start Page e31713
ISSN 2168-8184
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 Iwamuro et al.
File Version publisher
PubMed ID 36569708
DOI 10.7759/cureus.31713
Web of Science KeyUT 000918257500029
Related Url isVersionOf https://doi.org/10.7759/cureus.31713
JaLCDOI 10.18926/AMO/64355
FullText URL 77_1_1.pdf
Author Nahar, Lutfun| Hagiya, Hideharu| Nada, Takahiro| Iio, Koji| Gotoh, Kazuyoshi| Matsushita, Osamu| Otsuka, Fumio|
Abstract Inducible resistance to the macrolide, lincosamide, and streptogramin B (iMLSB) antibiotic family is a latent mechanism for antimicrobial resistance in Staphylococcus aureus. We here investigated the frequency and genotypic profiles of iMLSB resistance in clindamycin (CLDM)-susceptible S. aureus isolated in Okayama University Hospital from June 2020 to June 2021. We phenotypically screened the iMLSB resistance via D-zone test and performed PCR testing for the erythromycin ribosomal methylase (erm) genes: ermA and ermC. Among 432 CLDM-susceptible S. aureus isolates, 138 (31.9%) exhibited an iMLSB-resistance phenotype, with methicillinresistant S. aureus isolates (MRSA; 61 isolates: 58.6%) exhibiting higher positivity than methicillin-sensitive S. aureus isolates (MSSA; 77 isolates: 23.5%) (p<0.001). Male patients had a higher frequency of iMLSB resistance than females (OR [95%CI]: 1.8 [1.2-2.8]; p=0.007). Genotypically, ermA predominated in both MSSA (70.1%) and MRSA (86.9%) compared to ermC (14.3% in MSSA and 11.5% in MRSA). A single strain of MRSA possessed both ermA and ermC, while 12 (15.6%) MSSA isolates were negative for both ermA and ermC, suggesting the presence of other genetic mechanisms. Collectively, these results show that approximately 33% of CLDM-susceptible S. aureus isolates at our university hospital exhibited iMLSB resistance, predominantly caused by ermA in both MSSA and MRSA.
Keywords antimicrobial resistance clindamycin erm D-zone test inducible MLSB
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2023-02
Volume volume77
Issue issue1
Publisher Okayama University Medical School
Start Page 1
End Page 9
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders Copyright Ⓒ 2023 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 36849140
Web of Science KeyUT 000953663800001
FullText URL fulltext.pdf
Author Tokumasu, Kazuki| Nishimura, Yoshito| Sakamoto, Yoko| Obika, Mikako| Kataoka, Hitomi| Otsuka, Fumio|
Keywords COVID-19 medical student medical education in-person communication online communication stress perception
Published Date 2023-01-15
Publication Title International Journal of Environmental Research and Public Health
Volume volume20
Issue issue2
Publisher MDPI
Start Page 1579
ISSN 1660-4601
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 by the authors.
File Version publisher
PubMed ID 36674333
DOI 10.3390/ijerph20021579
Web of Science KeyUT 000915112800001
Related Url isVersionOf https://doi.org/10.3390/ijerph20021579
FullText URL fulltext20230112-4.pdf figures20230112-4.pdf online-supplemental-figures20230112-4.pdf online-supplemental-Tables20230112-4.pdf
Author Matsumoto, Naomi| Hagiya, Hideharu| Nakayama, Masanori| Furukawa, Masanori| Mitsuhashi, Toshiharu| Takao, Soshi| Otsuka, Fumio| Yorifuji, Takashi|
Keywords SARS-CoV-2 Vaccine Antibody Reactogenicity Adverse reaction Mixed-effects model
Note © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. This manuscript version is made available under the CC-BY-NC-ND 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/. This is the accepted manuscript version. The formal published version is available at [https://doi.org/10.1016/j.jiac.2022.09.012] . | This full-text file will be available in Nov. 2023.|
Published Date 2022-11-12
Publication Title Journal of Infection and Chemotherapy
Volume volume29
Issue issue1
Publisher Elsevier BV
Start Page 39
End Page 42
ISSN 1341-321X
NCID AA11057978
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
File Version author
PubMed ID 36168999
DOI 10.1016/j.jiac.2022.09.012
Web of Science KeyUT 000894818300007
Related Url isVersionOf https://doi.org/10.1016/j.jiac.2022.09.012
FullText URL fulltext.pdf
Author Sunada, Naruhiko| Nakano, Yasuhiro| Otsuka, Yuki| Tokumasu, Kazuki| Honda, Hiroyuki| Sakurada, Yasue| Matsuda, Yui| Hasegawa, Toru| Omura, Daisuke| Ochi, Kanako| Hagiya, Hideharu| Ueda, Keigo| Kataoka, Hitomi| Otsuka, Fumio|
Keywords insomnia myalgic encephalomyelitis chronic fatigue long COVID Omicron variant post COVID-19 condition
Published Date 2022-12-09
Publication Title Journal Of Clinical Medicine
Volume volume11
Issue issue24
Publisher MDPI
Start Page 7332
ISSN 2077-0383
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 by the authors.
File Version publisher
PubMed ID 36555948
DOI 10.3390/jcm11247332
Web of Science KeyUT 000901154300001
Related Url isVersionOf https://doi.org/10.3390/jcm11247332
FullText URL fulltext.pdf
Author Yamamoto, Koichiro| Nakano, Yasuhiro| Otsuka, Fumio|
Keywords collateral artery congenital heart disease hemoptysis
Published Date 2022-11-27
Publication Title Clinical Case Reports
Volume volume10
Issue issue11
Publisher Wiley
Start Page e06652
ISSN 2050-0904
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2022 The Authors.
File Version publisher
PubMed ID 36447660
DOI 10.1002/ccr3.6652
Web of Science KeyUT 000891440900026
Related Url isVersionOf https://doi.org/10.1002/ccr3.6652