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Version5.0
StatusExpected but not Quantified
Creation Date2012-09-06 15:16:50 UTC
Update Date2022-03-07 02:51:48 UTC
HMDB IDHMDB0014944
Secondary Accession Numbers
  • HMDB14944
Metabolite Identification
Common NamePentoxifylline
DescriptionPentoxifylline, also known as pentoxil or trental, belongs to the class of organic compounds known as xanthines. These are purine derivatives with a ketone group conjugated at carbons 2 and 6 of the purine moiety. Contraindications include intolerance to pentoxifylline or other xanthine derivatives, recent retinal or cerebral haemorrhage, and risk factors for haemorrhage. In addition, pentoxifylline improves red blood cell deformability (known as a haemorrheologic effect), reduces blood viscosity and decreases the potential for platelet aggregation and blood clot formation. Pentoxifylline is a drug which is used for the treatment of patients with intermittent lameness or immobility arising from chronic occlusive arterial disease of the limbs. There is some evidence that pentoxifylline can lower the levels of some biomarkers in non-alcoholic steatohepatitis but evidence is insufficient to determine if the drug is safe and effective for this use. However, pentoxifylline is also recommended for off-label use as an adjunct to compression bandaging for the treatment of chronic venous leg ulcers by the Scottish Intercollegiate Guidelines Network) (SIGN) as this has been shown to improve healing rates. Pentoxifylline, in combination with tocopherol and clodronate, has been found to heal refractory osteoradionecrosis of the jaw,and to be prophylactic against osteoradionecrosis. Like other methylated xanthine derivatives, pentoxifylline is a competitive nonselective phosphodiesterase inhibitor which raises intracellular cAMP, activates PKA, inhibits TNF and leukotriene synthesis, and reduces inflammation and innate immunity. Human studies have been conducted for Peyronie's disease. Pentoxifylline is an extremely weak basic (essentially neutral) compound (based on its pKa). This is its only FDA, MHRA and TGA-labelled indication. Pentoxifylline has also been shown to be of benefit in alcoholic hepatitis, with some studies demonstrating a reduction in risk of hepatorenal syndrome. In a Cochrane systematic review on the use of Pentoxifylline for intermittent claudication in 2015, the following was concluded "The quality of included studies was generally low, and very large variability between studies was noted in reported findings including duration of trials, doses of pentoxifylline and distances participants could walk at the start of trials. Most included studies did not report on randomisation techniques or how treatment allocation was concealed, did not provide adequate information to permit judgement of selective reporting and did not report blinding of outcome assessors. Given all these factors, the role of pentoxifylline in intermittent claudication remains uncertain, although this medication was generally well tolerated by participants". It is generic and sold under many brand names worldwide. Animal studies have been conducted exploring the use of pentoxifylline for erectile dysfunction and hearing loss.
Structure
Data?1582753238
Synonyms
ValueSource
PentoxilKegg
TrentalKegg
EHT0201HMDB
AgapurinHMDB
TorentalHMDB
OxpentifyllineHMDB
Chemical FormulaC13H18N4O3
Average Molecular Weight278.307
Monoisotopic Molecular Weight278.137890462
IUPAC Name3,7-dimethyl-1-(5-oxohexyl)-2,3,6,7-tetrahydro-1H-purine-2,6-dione
Traditional Namepentoxifylline
CAS Registry Number6493-05-6
SMILES
CN1C=NC2=C1C(=O)N(CCCCC(C)=O)C(=O)N2C
InChI Identifier
InChI=1S/C13H18N4O3/c1-9(18)6-4-5-7-17-12(19)10-11(14-8-15(10)2)16(3)13(17)20/h8H,4-7H2,1-3H3
InChI KeyBYPFEZZEUUWMEJ-UHFFFAOYSA-N
Chemical Taxonomy
Description Belongs to the class of organic compounds known as xanthines. These are purine derivatives with a ketone group conjugated at carbons 2 and 6 of the purine moiety.
KingdomOrganic compounds
Super ClassOrganoheterocyclic compounds
ClassImidazopyrimidines
Sub ClassPurines and purine derivatives
Direct ParentXanthines
Alternative Parents
Substituents
  • Xanthine
  • 6-oxopurine
  • Purinone
  • Alkaloid or derivatives
  • Pyrimidone
  • N-substituted imidazole
  • Pyrimidine
  • Azole
  • Imidazole
  • Heteroaromatic compound
  • Vinylogous amide
  • Lactam
  • Ketone
  • Urea
  • Azacycle
  • Hydrocarbon derivative
  • Organic oxide
  • Organopnictogen compound
  • Organooxygen compound
  • Organonitrogen compound
  • Organic oxygen compound
  • Organic nitrogen compound
  • Carbonyl group
  • Aromatic heteropolycyclic compound
Molecular FrameworkAromatic heteropolycyclic compounds
External Descriptors
Ontology
Physiological effectNot Available
Disposition
ProcessNot Available
RoleNot Available
Physical Properties
StateSolid
Experimental Molecular Properties
PropertyValueReference
Melting Point105 °CNot Available
Boiling PointNot AvailableNot Available
Water Solubility5.17 g/LNot Available
LogP0Not Available
Experimental Chromatographic PropertiesNot Available
Predicted Molecular Properties
PropertyValueSource
Water Solubility5.17 g/LALOGPS
logP0.08ALOGPS
logP0.23ChemAxon
logS-1.7ALOGPS
pKa (Strongest Acidic)19.64ChemAxon
pKa (Strongest Basic)-0.93ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count4ChemAxon
Hydrogen Donor Count0ChemAxon
Polar Surface Area75.51 ŲChemAxon
Rotatable Bond Count5ChemAxon
Refractivity73.52 m³·mol⁻¹ChemAxon
Polarizability29.27 ųChemAxon
Number of Rings2ChemAxon
BioavailabilityYesChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted Chromatographic Properties

Predicted Collision Cross Sections

PredictorAdduct TypeCCS Value (Å2)Reference
DarkChem[M+H]+166.21131661259
DarkChem[M-H]-161.33531661259
DeepCCS[M+H]+159.58430932474
DeepCCS[M-H]-157.22630932474
DeepCCS[M-2H]-191.4830932474
DeepCCS[M+Na]+166.49230932474
AllCCS[M+H]+162.932859911
AllCCS[M+H-H2O]+159.532859911
AllCCS[M+NH4]+166.032859911
AllCCS[M+Na]+166.932859911
AllCCS[M-H]-167.732859911
AllCCS[M+Na-2H]-167.932859911
AllCCS[M+HCOO]-168.132859911

Predicted Kovats Retention Indices

Underivatized

MetaboliteSMILESKovats RI ValueColumn TypeReference
PentoxifyllineCN1C=NC2=C1C(=O)N(CCCCC(C)=O)C(=O)N2C2976.4Standard polar33892256
PentoxifyllineCN1C=NC2=C1C(=O)N(CCCCC(C)=O)C(=O)N2C2348.0Standard non polar33892256
PentoxifyllineCN1C=NC2=C1C(=O)N(CCCCC(C)=O)C(=O)N2C2390.7Semi standard non polar33892256

Derivatized

Derivative Name / StructureSMILESKovats RI ValueColumn TypeReference
Pentoxifylline,1TMS,isomer #1CC(=CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C2442.5Semi standard non polar33892256
Pentoxifylline,1TMS,isomer #1CC(=CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C2442.5Standard non polar33892256
Pentoxifylline,1TMS,isomer #1CC(=CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C3384.4Standard polar33892256
Pentoxifylline,1TMS,isomer #2C=C(CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C2396.6Semi standard non polar33892256
Pentoxifylline,1TMS,isomer #2C=C(CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C2377.3Standard non polar33892256
Pentoxifylline,1TMS,isomer #2C=C(CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C3437.2Standard polar33892256
Pentoxifylline,1TBDMS,isomer #1CC(=CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C(C)(C)C2661.7Semi standard non polar33892256
Pentoxifylline,1TBDMS,isomer #1CC(=CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C(C)(C)C2655.2Standard non polar33892256
Pentoxifylline,1TBDMS,isomer #1CC(=CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C(C)(C)C3392.5Standard polar33892256
Pentoxifylline,1TBDMS,isomer #2C=C(CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C(C)(C)C2637.0Semi standard non polar33892256
Pentoxifylline,1TBDMS,isomer #2C=C(CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C(C)(C)C2578.7Standard non polar33892256
Pentoxifylline,1TBDMS,isomer #2C=C(CCCCN1C(=O)C2=C(N=CN2C)N(C)C1=O)O[Si](C)(C)C(C)(C)C3433.6Standard polar33892256
Spectra

GC-MS Spectra

Spectrum TypeDescriptionSplash KeyDeposition DateSourceView
Predicted GC-MSPredicted GC-MS Spectrum - Pentoxifylline GC-MS (Non-derivatized) - 70eV, Positivesplash10-0006-9480000000-5858a0a94add96d629942017-09-01Wishart LabView Spectrum
Predicted GC-MSPredicted GC-MS Spectrum - Pentoxifylline GC-MS (Non-derivatized) - 70eV, PositiveNot Available2021-10-12Wishart LabView Spectrum
Predicted GC-MSPredicted GC-MS Spectrum - Pentoxifylline GC-MS (Non-derivatized) - 70eV, PositiveNot Available2021-10-12Wishart LabView Spectrum

MS/MS Spectra

Spectrum TypeDescriptionSplash KeyDeposition DateSourceView
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline LC-ESI-qTof , Positive-QTOFsplash10-001r-2900000000-d54457aaede5317cef722017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline , positive-QTOFsplash10-0059-1890000000-c9be2fe26b2862cba4f52017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline , positive-QTOFsplash10-001r-2900000000-d54457aaede5317cef722017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline LC-ESI-QFT , positive-QTOFsplash10-0059-2970000000-95d1edcd63b61b13b22e2017-09-14HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline 35V, Positive-QTOFsplash10-0059-2970000000-0c35991320854cec88dd2021-09-20HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline 50V, Positive-QTOFsplash10-0019-0900000000-dd015a4509f33caa03c02021-09-20HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline 40V, Positive-QTOFsplash10-001r-0900000000-65fb6e1754eabaf86ab42021-09-20HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline 35V, Positive-QTOFsplash10-001r-3910000000-848959253dccbbc260a72021-09-20HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline 10V, Positive-QTOFsplash10-004i-0090000000-4f61bb0b4f83421991492021-09-20HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline 30V, Positive-QTOFsplash10-001i-0900000000-79465a5f4259ad7a5fd72021-09-20HMDB team, MONAView Spectrum
Experimental LC-MS/MSLC-MS/MS Spectrum - Pentoxifylline 20V, Positive-QTOFsplash10-001i-0940000000-a097189c3d45a68b66742021-09-20HMDB team, MONAView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 10V, Negative-QTOFsplash10-004i-0390000000-a66c81c066b3055aee272016-08-04Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 20V, Negative-QTOFsplash10-004i-2790000000-10e4eef90ade382bc5f42016-08-04Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 40V, Negative-QTOFsplash10-052f-9500000000-23bd0511497da2b1fc182016-08-04Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 10V, Negative-QTOFsplash10-004i-0290000000-2d198d549fd71c261d882021-10-11Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 20V, Negative-QTOFsplash10-004i-1930000000-cbb2368f24d9797f040a2021-10-11Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 40V, Negative-QTOFsplash10-056r-5950000000-89a80796e36b81a0c4a32021-10-11Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 10V, Positive-QTOFsplash10-01t9-0090000000-e92064736a2f3e194af72016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 20V, Positive-QTOFsplash10-03fr-1590000000-3aa22ac7d56a3f0cb9672016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 40V, Positive-QTOFsplash10-001i-9300000000-9e889c5028746f1415572016-08-03Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 10V, Positive-QTOFsplash10-004i-0390000000-3e633d64da435129d91b2021-10-11Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 20V, Positive-QTOFsplash10-001i-0910000000-285222c9846c41ea2ed22021-10-11Wishart LabView Spectrum
Predicted LC-MS/MSPredicted LC-MS/MS Spectrum - Pentoxifylline 40V, Positive-QTOFsplash10-03di-3900000000-3902c6584393e2a548ed2021-10-11Wishart LabView Spectrum

NMR Spectra

Spectrum TypeDescriptionDeposition DateSourceView
Predicted 1D NMR13C NMR Spectrum (1D, 100 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 100 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 1000 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 1000 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 200 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 200 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 300 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 300 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 400 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 400 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 500 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 500 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 600 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 600 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 700 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 700 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 800 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 800 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR13C NMR Spectrum (1D, 900 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Predicted 1D NMR1H NMR Spectrum (1D, 900 MHz, D2O, predicted)2021-09-25Wishart LabView Spectrum
Biological Properties
Cellular Locations
  • Cytoplasm
  • Membrane
Biospecimen Locations
  • Blood
  • Urine
Tissue LocationsNot Available
Pathways
Normal Concentrations
BiospecimenStatusValueAgeSexConditionReferenceDetails
BloodExpected but not QuantifiedNot QuantifiedNot AvailableNot AvailableTaking drug identified by DrugBank entry DB00806 details
UrineExpected but not QuantifiedNot QuantifiedNot AvailableNot AvailableTaking drug identified by DrugBank entry DB00806 details
Abnormal Concentrations
Not Available
Associated Disorders and Diseases
Disease ReferencesNone
Associated OMIM IDsNone
DrugBank IDDB00806
Phenol Explorer Compound IDNot Available
FooDB IDNot Available
KNApSAcK IDNot Available
Chemspider ID4578
KEGG Compound IDC07424
BioCyc IDNot Available
BiGG IDNot Available
Wikipedia LinkPentoxifylline
METLIN IDNot Available
PubChem Compound4740
PDB IDPNX
ChEBI ID127029
Food Biomarker OntologyNot Available
VMH IDNot Available
MarkerDB IDNot Available
Good Scents IDNot Available
References
Synthesis ReferenceNot Available
Material Safety Data Sheet (MSDS)Download (PDF)
General References
  1. Authors unspecified: European Pentoxifylline Multi-Infarct Dementia Study. Eur Neurol. 1996;36(5):315-21. [PubMed:8864715 ]

Enzymes

General function:
Involved in hydrolase activity
Specific function:
Hydrolyzes extracellular nucleotides into membrane permeable nucleosides.
Gene Name:
NT5E
Uniprot ID:
P21589
Molecular weight:
57948.125
References
  1. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352 ]
  2. Ustunsoy H, Sivrikoz MC, Tarakcioglu M, Bakir K, Guldur E, Celkan MA: The effects of pentoxifylline on the myocardial inflammation and ischemia-reperfusion injury during cardiopulmonary bypass. J Card Surg. 2006 Jan-Feb;21(1):57-61. [PubMed:16426349 ]
General function:
Involved in catalytic activity
Specific function:
Hydrolyzes the second messenger cAMP, which is a key regulator of many important physiological processes. May be involved in mediating central nervous system effects of therapeutic agents ranging from antidepressants to antiasthmatic and anti-inflammatory agents.
Gene Name:
PDE4B
Uniprot ID:
Q07343
Molecular weight:
64351.765
References
  1. Overington JP, Al-Lazikani B, Hopkins AL: How many drug targets are there? Nat Rev Drug Discov. 2006 Dec;5(12):993-6. [PubMed:17139284 ]
  2. Imming P, Sinning C, Meyer A: Drugs, their targets and the nature and number of drug targets. Nat Rev Drug Discov. 2006 Oct;5(10):821-34. [PubMed:17016423 ]
General function:
Involved in 3',5'-cyclic-nucleotide phosphodiesterase activity
Specific function:
Hydrolyzes the second messenger cAMP, which is a key regulator of many important physiological processes.
Gene Name:
PDE4A
Uniprot ID:
P27815
Molecular weight:
98142.155
References
  1. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352 ]
General function:
Involved in catalytic activity
Specific function:
Plays a role in signal transduction by regulating the intracellular concentration of cyclic nucleotides. This phosphodiesterase catalyzes the specific hydrolysis of cGMP to 5'-GMP.
Gene Name:
PDE5A
Uniprot ID:
O76074
Molecular weight:
99984.14
References
  1. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352 ]
General function:
Involved in monooxygenase activity
Specific function:
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally unrelated compounds, including steroids, fatty acids, and xenobiotics. Most active in catalyzing 2-hydroxylation. Caffeine is metabolized primarily by cytochrome CYP1A2 in the liver through an initial N3-demethylation. Also acts in the metabolism of aflatoxin B1 and acetaminophen. Participates in the bioactivation of carcinogenic aromatic and heterocyclic amines. Catalizes the N-hydroxylation of heterocyclic amines and the O-deethylation of phenacetin.
Gene Name:
CYP1A2
Uniprot ID:
P05177
Molecular weight:
58406.915
References
  1. Preissner S, Kroll K, Dunkel M, Senger C, Goldsobel G, Kuzman D, Guenther S, Winnenburg R, Schroeder M, Preissner R: SuperCYP: a comprehensive database on Cytochrome P450 enzymes including a tool for analysis of CYP-drug interactions. Nucleic Acids Res. 2010 Jan;38(Database issue):D237-43. doi: 10.1093/nar/gkp970. Epub 2009 Nov 24. [PubMed:19934256 ]
General function:
Involved in G-protein coupled receptor protein signaling pathway
Specific function:
Receptor for adenosine. The activity of this receptor is mediated by G proteins which inhibit adenylyl cyclase
Gene Name:
ADORA1
Uniprot ID:
P30542
Molecular weight:
36511.3
References
  1. Daly JW, Jacobson KA, Ukena D: Adenosine receptors: development of selective agonists and antagonists. Prog Clin Biol Res. 1987;230:41-63. [PubMed:3588607 ]
General function:
Involved in G-protein coupled receptor protein signaling pathway
Specific function:
Receptor for adenosine. The activity of this receptor is mediated by G proteins which activate adenylyl cyclase
Gene Name:
ADORA2A
Uniprot ID:
P29274
Molecular weight:
44706.9
References
  1. Kreth S, Ledderose C, Luchting B, Weis F, Thiel M: Immunomodulatory properties of pentoxifylline are mediated via adenosine-dependent pathways. Shock. 2010 Jul;34(1):10-6. doi: 10.1097/SHK.0b013e3181cdc3e2. [PubMed:19997047 ]