CINXE.COM

Just a moment...

<!DOCTYPE html><html lang="en-US"><head><title>Just a moment...</title><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge"><meta name="robots" content="noindex,nofollow"><meta name="viewport" content="width=device-width,initial-scale=1"><style>*{box-sizing:border-box;margin:0;padding:0}html{line-height:1.15;-webkit-text-size-adjust:100%;color:#313131;font-family:system-ui,-apple-system,BlinkMacSystemFont,Segoe UI,Roboto,Helvetica Neue,Arial,Noto Sans,sans-serif,Apple Color Emoji,Segoe UI Emoji,Segoe UI Symbol,Noto Color Emoji}body{display:flex;flex-direction:column;height:100vh;min-height:100vh}.main-content{margin:8rem auto;max-width:60rem;padding-left:1.5rem}@media (width <= 720px){.main-content{margin-top:4rem}}.h2{font-size:1.5rem;font-weight:500;line-height:2.25rem}@media (width <= 720px){.h2{font-size:1.25rem;line-height:1.5rem}}#challenge-error-text{background-image:url(data:image/svg+xml;base64,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);background-repeat:no-repeat;background-size:contain;padding-left:34px}@media (prefers-color-scheme:dark){body{background-color:#222;color:#d9d9d9}}</style><meta http-equiv="refresh" content="390"></head><body class="no-js"><div class="main-wrapper" role="main"><div class="main-content"><noscript><div class="h2"><span id="challenge-error-text">Enable JavaScript and cookies to continue</span></div></noscript></div></div><script>(function(){window._cf_chl_opt={cvId: '3',cZone: "jme.bmj.com",cType: 'managed',cRay: '9141b7bc4ba38204',cH: 'GRxauZNRKSoJqZE4zwaL1WUirnDa2hmTc7MTIWrFgss-1739920511-1.2.1.1-jMVyKe4DTNJt4JAQx9blxihhH_aSSGXxBjRb__Up9qljh_MsHTpropP7fARBB4KW',cUPMDTk: "\/lookup\/pmidlookup?view=long&pmid=33741680&__cf_chl_tk=0fpevr6k_3aRf2gZ2sJ3ss68vo4ljE.K5VMisEMaUNA-1739920511-1.0.1.1-36ndp31tsK0eqojuUvtQ9ry62HYsQhu3uCdKkkbKPWo",cFPWv: 'g',cITimeS: '1739920511',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "unsupported-browser",fa: "\/lookup\/pmidlookup?view=long&pmid=33741680&__cf_chl_f_tk=0fpevr6k_3aRf2gZ2sJ3ss68vo4ljE.K5VMisEMaUNA-1739920511-1.0.1.1-36ndp31tsK0eqojuUvtQ9ry62HYsQhu3uCdKkkbKPWo",md: "TsT9NqCNH1YDV9SRhh1ND.lK_RO5XRnd0ldfUcxV9dI-1739920511-1.2.1.1-_xgrM9TP6YKYUewziTLTQcFEtP_8s1vYQ_XsGqNSg._N_Lltix5eRwYeen5CqQxcnc.AAJFHvBSRc0fPxpvaSLjWYACS03Lgu2aC2ijF6UFmDl7j8Ad4R7MLxSiBhfTESHhpxtd_fKlMg8z3cz4QO_SL0f6m0M_JqwJfP_tqu861LAsDa0bnBX3L37Kzau7jJ3F_NDo0f6kFqV6m_HEzoVrn0R5j.v77JJRd4yv_SPm3KhpuGs.Cfh2py8kWOI77TbkxHgOVkE0dDBoQ1SeHARQ2ECSlO5fFkGEhY8LY7i0RqzGMlpNVsFTrFwi0dLsaDBC4ZwpYbPxdlXnZh7C2XjdmDv5JVqIOw7yM.wnGT9bFuWf16m8QbKnHGV..d4BJr9piqvJX_EodqG6jbaelkfXvTBF6vaWcE0xEbB3Fq6dO2.NF.5jhSTyt2yn2q9rw4e89KmAmP9T4Ku7LA_WyhovuM6_ukc3CxF4ZfAcWfsUhhfxiHqziFAiev0kC0Brr8wzmcNuc2C_1YMOW4BCgMPoeU4SmeWUiZ0llkb4L1TL.hz31wS91tXVIzbvut6F29jL68w56PMm9CQW_rdbW4TL9xtRH.KswKqwLDaTlfHKhwESBjFplqayo3qz7OPjok.6LAocJ.YMvLlNcK9vxRkEOleqv0c5tjzOL5iBE8mAPExHZ29zSe25GsVUl6TCrsogB6MUoKUnMh93lEJNrbja1Ap_CBQLll20.tqaNxBENI7QhjFr_Gy_teRkb7y8iDSrxCrzuXICN_CaUkxADPwncCbsoYHKQtDWkR.OBcS2g0_SM5DdU14.Cw6V3X9dWGhiBTbVcV1LS33IQdpSy4_pCwPU8eMR6mxn6Oed0vRq1l9X.WzioeCEhx3ktwpkKLThdpdM8jwe55IrSZF6SLl1kGhaSjI7b4kMgs9vinzYwt7shwuJ6z2FnKxZPMR55cCGgwjKRwvi.iyIEEwMtqyoAoJkFlzYPAY83fIpzNjLvbBhbfo8aZ2.UZvSxuvW5ldlfk5Luh5Pv3iyasuMoKDGKrFQTJdZRdb3QBKbQVscBYw_.W3P8GgkWKZeBXvvguFhgYiPQR0dazeHtuquzzcWpeh6K008BHqrkAELxIGt.4cs4UAVk2J1yi3Sj5VqWtvu8iFiswA0P6wbFoSCdSBEo.RpVcFRgJE73vlnHMTxMT42G2kFtvm4wNEThPBul4U._qXRq1Y3I9Q42JTEqYXStaHb_oyoE7pWCBBTxKeq2wNVms4N99UDioJlQ4YWxT.KwuH9F1IX_v6U_N6KitunwQz7RaKKCHLZiMTGcoBO1WYRuqP4ZEJS5.aE.fqBFDODk2DMtW1x.Lkv0g1WIFh7tLvHtjfuJjkSh6tIYYO2s89avsIzHHWSsyEDyf18Scjz9Di5vIUO8J69ncAK8Hv.AUddYSn9WpnGmuQA5EYubSvHKULkAe7NGk2Z_sCNc_5xDIzcaeRBssRDsMmyYzb.Wfx_6tb5vu9exygzYQt5_1eqUcdTKHNb8.IcPSDbufTILtGp0F.B3EHZZ.vvx9aA4X9BAb.VWuawIosyAOE7.xUuAvctl.4tWi3mVX.GHgpf2amBzUrJevCu5BXsYyCVPVh8ON8jkHxd8kme.fxsNuotis3aqaDpaF62MbfQupMRt5mMckMXi_k7lAX8kma25QRxuxlEcXRMxvLrsVkA0XoCAnsJuvs4fIOaQ3nlS.64pUZ2OVZoIKkzFJiAXn_EBeUazMyCtVUZmsfbf_ts3VfN7ZFAMEA_yhX.2SjnCiW3K.eRzzf6l6aJgVuZ0wNu6uKny8im9gkbPZZtPG6cqrxohrgQaLGCf2h_6tNy0mK1ZD.EwHI8NDbcA59J.1.h5jmFFguNGzxkuX0wWhpTIjmwUoeJqmH89wD3cVsv7wm_YLss4UjxfBbnq4zcdyI2WP.EwW.CQwlruHSHntOMYMkBU5l44bH7GRryYPTkJfjqsvNCR175wSBN6R.9BHqWQP3YwUrZxgLHKmIeqaV_ljMYGDOeUwr_XusX4dq085BWg7dWcd.WtowRttJnpDVqylWvVBW2vq1laozS7aCdI3Yq1daP1z_40V6tre.zPUSielfPrKuPn8C2q3kZ3y0_8ghTCx8ARaKdwz2F8oPrK.CVuqBkoCUdAfV_bpeFIpduP6iluKadE1uIEaE2Ln..K9__eoH6a17A9yzfN3fHdcXXBkmAuFS2UK2XUxr.QNR.eQoOalWhigRpj1MpqlZtruVE7.bQARKqAGmb7iBD5nl1qLpn8tn3.p0zAtWUhqV8bJ1xmZKb7zGTzLXDXhnHduGkuX5aEklNh6Rf0DCCxQDmlf7ZteSzbQtpoi7QneNLOgnd1TmCHfkwOs9goKc8_AG.ocihlxxgrSSMkv3ygeVLlPuxe0WT7qgAYvK85nzC_SEQ7OtnlCBfVdIYkeWWAkxYd7RR8aY6r5X8f8tInZig_yqKu8ddbW91HjWDq.I0wz9cniKHED3qJUM_pSczngm3e1lC7GXzWWCkchf3FylhciNTrrxyN88ARx5HY2IER41wWu9neKadzygrpiw",mdrd: "2ieH2NTS3hyyRYTPlJOVE1w1yBQWadUROY7pbjQApG4-1739920511-1.2.1.1-v2rq6qccQV4Fx0URPzDIOxhRplWbcx2teKe7t3xg5H1pz_VxXyJgj93oO4nZW6jx.j0YztU0y0sTj0hzDzt2Uh.nJ8aDJJ0LM.1Q2WCWJ7pgajGqKBf3iLt6v9Dyo7odorG3CAv8RbMbFKGM5YyPPCzZJ5zjlAsnp.yYPSgwAkVxX85eNJO0rN5lIISFBhKRZJmc7iIiaGXGCQNsRaY3DmVUX4eMmnZUYBnf39vaI5GSaS41YgTrIwtI4bNjLQnXMLp5kfJ4tQqQx7bu3_Ovgj.N0MtQNl.6WkBucGwckcfhND949sfVKIW_Ni1Tnwui2wQkDSOyAAphL_T3U7ibbqMRCqE5_j7OUd0COlpvQ3ZUrlaOBYE.6OAZa0hR4GsFKDFK5sVtY85xdejeOVn.Ge00qtVP9r9VtYJLBVWx2Tp4mwyZjqH2U.aZvZPPbrMyldxYsEATj4WQi_AAkbWRjWvhBdf_jujhmWcFZ3_v__LoCdPib8lDR6bQ6yq8SPb3e1Iz5uirQG__CxKlZxjqS_sGaoGAWeiM6AopxXcikL488_ImXlO0ZqkQWso0eWk4HV0U5QinlJUulvCAmIZlX1NoR_NR7Bzy3WVUHCzEZQC6v0nACXkMZfllsySuSQO4CR0LdnGP54o3b.vJT_mtqaSBsABYA9_Ar830Z9_GxESMtmouauBV9HfPtxfHW63zJOl1mNXaWPJYx7h5PiLlCv3tlzlygkafPNNc31FdgP1H.dG.PAMbIFoIGfzDUyLJLS8vFHnnABijwD76jaBAnE8vnW2bvAS0IVt_gLBJT9a9TxfsSxph3VJHWR9IxhU2_O_FCs7cakP3OF0eedOLtHTLWT5mU3bkfZ2ePq_9Yg7.qDzjmtFRlgVqRswkDEDzybsvRnImeNUeR4dbG0seLzshedLvBLr1lteCQwLTOh8OiRFbuVxdJOCYicw4cZlSw_uaRk_GYBfZZ4273GQ3MA.KInt8ZfDMEblSUoM2AilHAD5kMfDI29ja.6AANabQe_SD8JY4bKuGvRRFrCKREhnxCK84_7ST5O8ZxW62hCTFqJenrUEL_ZQ8lBsCUvV0dl6xUJrbCrm2TlmaPFKoo3Uj5mk5g14f2GThxO5uoFFlv_657VAp7Cxr_3H.RGckn7RXnhVzEtUu9y6pD7PhARv57RxpswhEtXen_MHnXNldwCRS3pbDh7VHvUoSzMcof3tdpoJ8FpDGfQRgg7kYYlL3NJCNcjwdKSIqme_d7ai1mcR1spiqYodArHea29r_JDsBnuJCldwO5MBJEjf3YLrB3UJq0ijVjCuVqBhtacYjy5Dka3XFCMLi_VBUvXhvt5aZUQqG6IJbGuFUtd64rVcEQApXID9A6Yn8_mUXOGeXHv1RLrwrkUO7uy2HJCv0tG7dkKNztb.1QBoZ7.yQh7LBsuQJ1_DiavfM3Ribdc8_Zs1aFIxNQR4Wq1ba1.3HAcm4tpDfIghh2vTVntqvMG3cn2IjGgJTayDyVWIJI5e4bDxhkst.DBv69IQT41Lb9D8Dq7OAX.PtlFnZGff0aS71oNOMMtKyW.MKbi1IStWQpMOtpwW_wl0YlJG7qQ.MeB1adZDsQI1SEQXnO7K_DNSPD8rznb0UQkwZgAeywQn_T.I.xztW.skVxXIQyvwwQLUW62mgvCoMtyjtt8XmBgyD50X3awPd7VbiYqB2kOQjJBKHibVuoA4XY_3UAEP7dOiTFWa1_dlAH_.hXioW5RqRabRXQtcO_J5.9454KrloNJYn3nYVB74Hte6fYQbz6ZQZWlkUzGgCcWGVLW8vnnmfPtGpyqZZJmw4mz2baHTd12OXHzTm2KnjcalYS3rkgsFUpy7sbJvZpKrfz6p3nl6tazwTwQmVtwW60rBa5V9HE.s2DX0d84IInB1VNbphLDdMfQ9hNlWiPAL1SQMfISd8HP2xQyHC83XzO9v_Jjw"};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/g/orchestrate/chl_page/v1?ray=9141b7bc4ba38204';window._cf_chl_opt.cOgUHash = location.hash === '' && location.href.indexOf('#') !== -1 ? '#' : location.hash;window._cf_chl_opt.cOgUQuery = location.search === '' && location.href.slice(0, location.href.length - window._cf_chl_opt.cOgUHash.length).indexOf('?') !== -1 ? '?' : location.search;if (window.history && window.history.replaceState) {var ogU = location.pathname + window._cf_chl_opt.cOgUQuery + window._cf_chl_opt.cOgUHash;history.replaceState(null, null, "\/lookup\/pmidlookup?view=long&pmid=33741680&__cf_chl_rt_tk=0fpevr6k_3aRf2gZ2sJ3ss68vo4ljE.K5VMisEMaUNA-1739920511-1.0.1.1-36ndp31tsK0eqojuUvtQ9ry62HYsQhu3uCdKkkbKPWo" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>