{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T03:25:38Z","timestamp":1777519538577,"version":"3.51.4"},"reference-count":64,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background:<\/jats:title><jats:p>The authors examined<jats:italic toggle=\"yes\">in vivo<\/jats:italic>the effects of general anesthetics on evoked substance P release (primary afferent excitability) and c-Fos expression (neuronal activation) in superficial dorsal horn.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Rats received saline, propofol (100\u2009mg\/kg), pentobarbital (50\u2009mg\/kg), isoflurane (2 minimum alveolar concentration), nitrous oxide (66%), or fentanyl (30 \u03bcg\/kg). During anesthesia, rats received intraplantar 5% formalin (50 \u03bcl) to left hind paw. Ten minutes later, rats underwent transcardial perfusion with 4% paraformaldehyde. Substance P release from small primary afferents was assessed by incidence of neurokinin 1 receptor internalization in the superficial dorsal horn. In separate studies, rats were sacrificed after 2\u2009h and c-Fos expression measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Intraplantar formalin-induced robust neurokinin 1 receptor internalization in ipsilateral dorsal horn (ipsilateral: 54\u2009\u00b1\u20096% [mean \u00b1 SEM], contralateral: 12\u2009\u00b1\u20092%;<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.05; n = 4). Fentanyl, but not propofol, pentobarbital, isoflurane, nor nitrous oxide alone inhibited neurokinin 1 receptor internalization. However, 2 minimum alveolar concentration isoflurane + nitrous oxide reduced neurokinin 1 receptor internalization (27\u2009\u00b1\u20093%;<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.05; n = 5). All agents reduced c-Fos expression (control: 34\u2009\u00b1\u20094, fentanyl: 8\u2009\u00b1\u20092, isoflurane: 12\u2009\u00b1\u20093, nitrous oxide: 11\u2009\u00b1\u20092, isoflurane + nitrous oxide: 12\u2009\u00b1\u20091, pentobarbital: 11\u2009\u00b1\u20092, propofol: 13\u2009\u00b1\u20093;<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.05; n = 3).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p>General anesthetics at anesthetic concentrations block spinal neuron activation through a mechanism that is independent of an effect on small primary afferent peptide release. The effect of fentanyl alone and the synergistic effect of isoflurane and nitrous oxide on substance P release suggest a correlative rationale for the therapeutic use of these anesthetic protocols by blocking nociceptive afferent transmitter release and preventing the initiation of cascade, which is immediately postsynaptic to the primary afferent.<\/jats:p><\/jats:sec>","DOI":"10.1097\/aln.0b013e31829996b6","type":"journal-article","created":{"date-parts":[[2013,5,24]],"date-time":"2013-05-24T14:11:45Z","timestamp":1369404705000},"page":"433-442","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Effects of General Anesthetics on Substance P Release and c-Fos Expression in the Spinal Dorsal Horn"],"prefix":"10.1097","volume":"119","author":[{"given":"Toshifumi","family":"Takasusuki","sequence":"first","affiliation":[{"name":"Assistant Professor,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeki","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Professor, Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinsuke","family":"Hamaguchi","sequence":"additional","affiliation":[{"name":"Professor, Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony L.","family":"Yaksh","sequence":"additional","affiliation":[{"name":"Professor of Anesthesiology and Pharmacology, Department of Anesthesiology, University of California, San Diego, La Jolla, California."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20241223","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1097\/00000542-200004000-00024","article-title":"Contrasting synaptic actions of the inhalational general anesthetics isoflurane and xenon.","volume":"92","year":"2000","journal-title":"Anesthesiology"},{"key":"R2-20241223","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1111\/j.1476-5381.1996.tb15430.x","article-title":"Effects of inhalational general anaesthetics on native glycine receptors in rat medullary neurones and recombinant glycine receptors in Xenopus oocytes.","volume":"118","year":"1996","journal-title":"Br J Pharmacol"},{"key":"R3-20241223","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1152\/jn.1991.66.6.2014","article-title":"Effects of two volatile anesthetics and a volatile convulsant on the excitatory and inhibitory amino acid responses in dissociated CNS neurons of the rat.","volume":"66","year":"1991","journal-title":"J Neurophysiol"},{"key":"R4-20241223","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/S0022-3565(25)12380-X","article-title":"Anesthetics produce subunit-selective actions on glutamate receptors.","volume":"276","year":"1996","journal-title":"J Pharmacol Exp Ther"},{"key":"R5-20241223","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/00000542-200308000-00021","article-title":"G-protein activation decreases isoflurane inhibition of N-type Ba2+ currents.","volume":"99","year":"2003","journal-title":"Anesthesiology"},{"key":"R6-20241223","first-page":"2","article-title":"Propofol suppresses synaptic responsiveness of somatosensory relay neurons to excitatory input by potentiating GABA(A) receptor chloride channels.","volume":"1","year":"2005","journal-title":"Mol Pain"},{"key":"R7-20241223","doi-asserted-by":"crossref","first-page":"3211","DOI":"10.1523\/JNEUROSCI.13-08-03211.1993","article-title":"Calcium current block by (\u2212)-pentobarbital, phenobarbital, and CHEB but not (+)-pentobarbital in acutely isolated hippocampal CA1 neurons: Comparison with effects on GABA-activated Cl\u2212 current.","volume":"13","year":"1993","journal-title":"J Neurosci"},{"key":"R8-20241223","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/00000542-200503000-00022","article-title":"Drastic decrease in isoflurane minimum alveolar concentration and limb movement forces after thoracic spinal cooling and chronic spinal transection in rats.","volume":"102","year":"2005","journal-title":"Anesthesiology"},{"key":"R9-20241223","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1213\/00000539-199902000-00036","article-title":"Pre- versus postinjury effects of intravenous GABAergic anesthetics on formalin-induced Fos immunoreactivity in the rat spinal cord.","volume":"88","year":"1999","journal-title":"Anesth Analg"},{"key":"R10-20241223","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1097\/00000539-200212000-00028","article-title":"Isoflurane, but not halothane, depresses c-fos expression in rat spinal cord at concentrations that suppress reflex movement after supramaximal noxious stimulation.","volume":"95","year":"2002","journal-title":"Anesth Analg"},{"key":"R11-20241223","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1213\/ane.0b013e3181678831","article-title":"Suppression of noxious-induced c-fos expression in the rat lumbar spinal cord by isoflurane alone or combined with fentanyl.","volume":"106","year":"2008","journal-title":"Anesth Analg"},{"key":"R12-20241223","first-page":"1718","article-title":"Isoflurane reduces glutamatergic transmission in neurons in the spinal cord superficial dorsal horn: Evidence for a presynaptic site of an analgesic action.","volume":"98","year":"2004","journal-title":"Anesth Analg"},{"key":"R13-20241223","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/0196-9781(89)90003-X","article-title":"Opioid modulation of capsaicin-evoked release of substance P from rat spinal cord in vivo.","volume":"10","year":"1989","journal-title":"Peptides"},{"key":"R14-20241223","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1038\/sj.bjp.0704506","article-title":"CB(1) receptor antagonist SR141716A increases capsaicin-evoked release of Substance P from the adult mouse spinal cord.","volume":"135","year":"2002","journal-title":"Br J Pharmacol"},{"key":"R15-20241223","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/S0306-4522(03)00501-3","article-title":"Neurokinin release produced by capsaicin acting on the central terminals and axons of primary afferents: Relationship with N-methyl-D-aspartate and GABA(B) receptors.","volume":"121","year":"2003","journal-title":"Neuroscience"},{"key":"R16-20241223","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1126\/science.1273597","article-title":"Analgesia mediated by a direct spinal action of narcotics.","volume":"192","year":"1976","journal-title":"Science"},{"key":"R17-20241223","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1038\/284351a0","article-title":"Multiple opiate receptor sites on primary afferent fibres.","volume":"284","year":"1980","journal-title":"Nature"},{"key":"R18-20241223","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1038\/286155a0","article-title":"Intrathecal morphine inhibits substance P release from mammalian spinal cord in vivo.","volume":"286","year":"1980","journal-title":"Nature"},{"key":"R19-20241223","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1113\/jphysiol.1987.sp016731","article-title":"Release of substance P from the cat spinal cord.","volume":"391","year":"1987","journal-title":"J Physiol"},{"key":"R20-20241223","doi-asserted-by":"crossref","first-page":"3651","DOI":"10.1523\/JNEUROSCI.0252-05.2005","article-title":"Inhibition by spinal mu- and delta-opioid agonists of afferent-evoked substance P release.","volume":"25","year":"2005","journal-title":"J Neurosci"},{"key":"R21-20241223","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/ALN.0b013e31821950c2","article-title":"Regulation of spinal substance p release by intrathecal calcium channel blockade.","volume":"115","year":"2011","journal-title":"Anesthesiology"},{"key":"R22-20241223","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/0031-9384(76)90029-9","article-title":"Chronic catheterization of the spinal subarachnoid space.","volume":"17","year":"1976","journal-title":"Physiol Behav"},{"key":"R23-20241223","first-page":"109","article-title":"Intrathecal catheterization and drug delivery in the rat.","volume":"99","year":"2004","journal-title":"Methods Mol Med"},{"key":"R24-20241223","doi-asserted-by":"crossref","first-page":"4882","DOI":"10.1523\/JNEUROSCI.14-08-04882.1994","article-title":"Voltage-sensitive calcium channels in spinal nociceptive processing: Blockade of N- and P-type channels inhibits formalin-induced nociception.","volume":"14","year":"1994","journal-title":"J Neurosci"},{"key":"R25-20241223","doi-asserted-by":"crossref","first-page":"2622","DOI":"10.1073\/pnas.92.7.2622","article-title":"Rapid endocytosis of a G protein-coupled receptor: Substance P evoked internalization of its receptor in the rat striatum in vivo.","volume":"92","year":"1995","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"suppl 11","key":"R26-20241223","first-page":"6","article-title":"Neurobiology of substance P and the NK1 receptor.","volume":"63","year":"2002","journal-title":"J Clin Psychiatry"},{"key":"R27-20241223","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S0306-4522(02)00977-6","article-title":"Relationship between capsaicin-evoked substance P release and neurokinin 1 receptor internalization in the rat spinal cord.","volume":"118","year":"2003","journal-title":"Neuroscience"},{"key":"R28-20241223","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1093\/bja\/aeq023","article-title":"Reduced effect of propofol at human {alpha}1{beta}2(N289M){gamma}2 and {alpha}2{beta}3(N290M){gamma}2 mutant GABA(A) receptors.","volume":"104","year":"2010","journal-title":"Br J Anaesth"},{"key":"R29-20241223","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1038\/367607a0","article-title":"Molecular and cellular mechanisms of general anaesthesia.","volume":"367","year":"1994","journal-title":"Nature"},{"key":"R30-20241223","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S0306-4522(00)00571-6","article-title":"Presynaptic regulation of spinal cord tachykinin signaling via GABA(B) but not GABA(A) receptor activation.","volume":"103","year":"2001","journal-title":"Neuroscience"},{"key":"R31-20241223","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1038\/8084","article-title":"Inhalational anesthetics activate two-pore-domain background K+ channels.","volume":"2","year":"1999","journal-title":"Nat Neurosci"},{"key":"R32-20241223","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/00000542-199407000-00016","article-title":"Isoflurane inhibits multiple voltage-gated calcium currents in hippocampal pyramidal neurons.","volume":"81","year":"1994","journal-title":"Anesthesiology"},{"key":"R33-20241223","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1093\/bja\/82.3.402","article-title":"Isoflurane inhibits neuronal Ca2+ channels through enhancement of current inactivation.","volume":"82","year":"1999","journal-title":"Br J Anaesth"},{"key":"R34-20241223","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1124\/mol.108.051664","article-title":"Mechanisms and functional significance of inhibition of neuronal T-type calcium channels by isoflurane.","volume":"75","year":"2009","journal-title":"Mol Pharmacol"},{"key":"R35-20241223","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1385\/MN:25:2:167","article-title":"Neurobiology of nitrous oxide-induced antinociceptive effects.","volume":"25","year":"2002","journal-title":"Mol Neurobiol"},{"key":"R36-20241223","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/bja\/76.5.702","article-title":"Volatile anaesthetics antagonize nitrous oxide and morphine-induced analgesia in the rat.","volume":"76","year":"1996","journal-title":"Br J Anaesth"},{"key":"R37-20241223","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/00000542-197502000-00014","article-title":"Minimum alveolar concentrations (MAC) of isoflurande with and without nitrous oxide in patients of various ages.","volume":"42","year":"1975","journal-title":"Anesthesiology"},{"key":"R38-20241223","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/00000542-199108000-00003","article-title":"The additive contribution of nitrous oxide to isoflurane MAC in infants and children.","volume":"75","year":"1991","journal-title":"Anesthesiology"},{"key":"R39-20241223","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1213\/01.ANE.0000142423.87593.CE","article-title":"Large concentrations of nitrous oxide decrease the isoflurane minimum alveolar concentration sparing effect of morphine in the rat.","volume":"100","year":"2005","journal-title":"Anesth Analg"},{"key":"R40-20241223","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1038\/328632a0","article-title":"Induction of c-fos-like protein in spinal cord neurons following sensory stimulation.","volume":"328","year":"1987","journal-title":"Nature"},{"key":"R41-20241223","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0306-4522(94)90036-1","article-title":"Effects of descending inhibitory systems on the c-Fos expression in the rat spinal cord during formalin-induced noxious stimulation.","volume":"58","year":"1994","journal-title":"Neuroscience"},{"key":"R42-20241223","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.brainres.2004.11.044","article-title":"Multiple neurotransmitter receptors contribute to the spinal Fos expression.","volume":"1033","year":"2005","journal-title":"Brain Res"},{"key":"R43-20241223","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.pain.2006.10.009","article-title":"Nerve injury-induced tactile allodynia is present in the absence of FOS labeling in retrogradely labeled post-synaptic dorsal column neurons.","volume":"129","year":"2007","journal-title":"Pain"},{"key":"R44-20241223","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1093\/bja\/76.1.99","article-title":"Nitrous oxide or halothane, or both, fail to suppress c-fos expression in rat spinal cord dorsal horn neurones after subcutaneous formalin.","volume":"76","year":"1996","journal-title":"Br J Anaesth"},{"key":"R45-20241223","first-page":"115","article-title":"Nitrous oxide suppresses tonic and phasic nociceptive behaviors but not formalin-induced c-Fos expression in the rat spinal cord dorsal horn.","volume":"41","year":"2003","journal-title":"Acta Anaesthesiol Sin"},{"key":"R46-20241223","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1213\/01.ane.0000230601.64098.cc","article-title":"The involvement of the nociceptin receptor in the antinociceptive action of nitrous oxide.","volume":"103","year":"2006","journal-title":"Anesth Analg"},{"key":"R47-20241223","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1523\/JNEUROSCI.10-01-00323.1990","article-title":"Systemic morphine suppresses noxious stimulus-evoked Fos protein-like immunoreactivity in the rat spinal cord.","volume":"10","year":"1990","journal-title":"J Neurosci"},{"key":"R48-20241223","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/S0006-8993(96)01398-4","article-title":"Inhalation anesthetics suppress the expression of c-Fos protein evoked by noxious somatic stimulation in the deeper layer of the spinal cord in the rat.","volume":"751","year":"1997","journal-title":"Brain Res"},{"key":"R49-20241223","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1097\/00000542-200108000-00031","article-title":"Nitrous oxide activates GABAergic neurons in the spinal cord in Fischer rats.","volume":"95","year":"2001","journal-title":"Anesthesiology"},{"key":"R50-20241223","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1097\/00000542-199212000-00016","article-title":"Propofol and barbiturate depression of spinal nociceptive neurotransmission.","volume":"77","year":"1992","journal-title":"Anesthesiology"},{"key":"R51-20241223","first-page":"1354","article-title":"Enflurane decreases glutamate neurotransmission to spinal cord motor neurons by both pre- and postsynaptic actions.","volume":"96","year":"2003","journal-title":"Anesth Analg"},{"key":"R52-20241223","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/00000542-200502000-00021","article-title":"Action of isoflurane on the substantia gelatinosa neurons of the adult rat spinal cord.","volume":"102","year":"2005","journal-title":"Anesthesiology"},{"key":"R53-20241223","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1097\/00000542-199312000-00015","article-title":"Exaggerated anesthetic requirements in the preferentially anesthetized brain.","volume":"79","year":"1993","journal-title":"Anesthesiology"},{"key":"R54-20241223","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1097\/00000542-199412000-00027","article-title":"Does the brain influence somatic responses to noxious stimuli during isoflurane anesthesia?","volume":"81","year":"1994","journal-title":"Anesthesiology"},{"key":"R55-20241223","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/00000542-199607000-00018","article-title":"Volatile anesthetics depress spinal motor neurons.","volume":"85","year":"1996","journal-title":"Anesthesiology"},{"key":"R56-20241223","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/BF03018926","article-title":"Propofol directly depresses lumbar dorsal horn neuronal responses to noxious stimulation in goats.","volume":"47","year":"2000","journal-title":"Can J Anaesth"},{"key":"R57-20241223","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/00000542-200002000-00040","article-title":"Isoflurane action in the spinal cord blunts electroencephalographic and thalamic-reticular formation responses to noxious stimulation in goats.","volume":"92","year":"2000","journal-title":"Anesthesiology"},{"key":"R58-20241223","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.neuroscience.2005.01.048","article-title":"Imbalance between the expression of NK1 and GABAB receptors in nociceptive spinal neurons during secondary hyperalgesia: A c-Fos study in the monoarthritic rat.","volume":"132","year":"2005","journal-title":"Neuroscience"},{"key":"R59-20241223","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/00000542-199304000-00015","article-title":"Morphine, but not inhalation anesthesia, blocks post-injury facilitation. The role of preemptive suppression of afferent transmission.","volume":"78","year":"1993","journal-title":"Anesthesiology"},{"key":"R60-20241223","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1093\/bja\/80.3.348","article-title":"Effect of continuous spinal remifentanil infusion on behaviour and spinal glutamate release evoked by subcutaneous formalin in the rat.","volume":"80","year":"1998","journal-title":"Br J Anaesth"},{"key":"R61-20241223","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/0014-4886(66)90068-9","article-title":"Physiological properties of unmyelinated fiber projection to the spinal cord.","volume":"16","year":"1966","journal-title":"Exp Neurol"},{"key":"R62-20241223","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0165-6147(90)90228-Z","article-title":"A cure for wind up: NMDA receptor antagonists as potential analgesics.","volume":"11","year":"1990","journal-title":"Trends Pharmacol Sci"},{"key":"R63-20241223","first-page":"250","article-title":"The spinal pharmacology of facilitation of afferent processing evoked by high-threshold afferent input of the postinjury pain state.","volume":"6","year":"1993","journal-title":"Curr Opin Neurol Neurosurg"},{"key":"R64-20241223","doi-asserted-by":"crossref","first-page":"7680","DOI":"10.1073\/pnas.96.14.7680","article-title":"The spinal biology in humans and animals of pain states generated by persistent small afferent input.","volume":"96","year":"1999","journal-title":"Proc Natl Acad Sci U S A"}],"container-title":["Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/pubs.asahq.org\/anesthesiology\/article-pdf\/119\/2\/433\/260433\/20130800_0-00029.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/anesthesiology.pubs.asahq.org\/article.aspx?volume=119&page=433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T11:25:34Z","timestamp":1746012334000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/ALN.0b013e31829996b6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8]]},"references-count":64,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2013]]}},"URL":"https:\/\/doi.org\/10.1097\/aln.0b013e31829996b6","relation":{},"ISSN":["0003-3022"],"issn-type":[{"value":"0003-3022","type":"print"}],"subject":[],"published":{"date-parts":[[2013,8]]}}}