{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T10:11:46Z","timestamp":1787393506013,"version":"build-2736575974"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T00:00:00Z","timestamp":1633305600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T00:00:00Z","timestamp":1633305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Tech Coloproctol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Transanal advancement flap repair of transsphincteric fistulas is a sphincter-preserving procedure, which frequently fails, probably due to ongoing inflammation in the remaining fistula tract. Adipose-derived stromal vascular fraction (SVF) has immunomodulatory properties promoting wound healing and suppressing inflammation. Platelet-rich plasma (PRP) reinforces this biological effect. The aim of this study was to evaluate the efficacy and safety of autologous adipose-derived SVF enriched with PRP in flap repair of transsphincteric cryptoglandular fistulas.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A prospective cohort study was conducted including consecutive patients with transsphincteric cryptoglandular fistula in a tertiary referral center. During flap repair, SVF was obtained by lipoharvesting and mechanical fractionation of adipose tissue and combined with PRP was injected around the internal opening and into the fistulous wall. Endpoints were fistula healing at clinical examination and fistula closure on postoperative magnetic resonance imaging (MRI). Adverse events were documented.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Forty-five patients with transsphincteric cryptoglandular fistula were included (29 males, median age 44\u00a0years [range 36\u201353\u00a0years]). In the total study population, primary fistula healing was observed in 38 patients (84%). Among the 42 patients with intestinal continuity at time of surgery, primary fistula healing was observed in 35 patients (84%). In one patient, the fistula recurred, resulting in a long-term healing rate of 82%. MRI, performed in 37 patients, revealed complete closure of the fistula tract in 33 (89.2%). In the other patients, the tract was almost completely obliterated by scar tissue. During follow-up, none of these patients showed clinical signs of recurrence. The postoperative course was uneventful, except for three cases; venous thromboembolism in one patient and bleeding under the flap, necessitating intervention in two patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Addition of autologous SVF enriched with PRP during flap repair is feasible, safe and might improve outcomes in patients with a transsphincteric cryptoglandular fistula.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Dutch Trial Register, Trial Number: NL8416, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.trialregister.nl\/\">https:\/\/www.trialregister.nl\/<\/jats:ext-link><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10151-021-02524-6","type":"journal-article","created":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T02:50:56Z","timestamp":1633402256000},"page":"1301-1309","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Efficacy and safety of autologous adipose-derived stromal vascular fraction enriched with platelet-rich plasma in flap repair of transsphincteric cryptoglandular fistulas"],"prefix":"10.1007","volume":"25","clinical-trial-number":[{"clinical-trial-number":"nl8416","registry":"10.18810\/dutch-trial-register"}],"author":[{"given":"W. R.","family":"Schouten","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6769-4604","authenticated-orcid":false,"given":"J. H. C.","family":"Arkenbosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. J.","family":"van der Woude","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. C.","family":"de Vries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. P.","family":"Stevens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. M.","family":"Fuhler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. S.","family":"Dwarkasing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"van Ruler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. J. R.","family":"de Graaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,4]]},"reference":[{"issue":"8","key":"2524_CR1","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1097\/DCR.0000000000000154","volume":"57","author":"RS van Onkelen","year":"2014","unstructured":"van Onkelen RS et al (2014) Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas. Dis Colon Rectum 57(8):1007\u20131011","journal-title":"Dis Colon Rectum"},{"issue":"1","key":"2524_CR2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.diagmicrobio.2012.09.012","volume":"75","author":"RS van Onkelen","year":"2013","unstructured":"van Onkelen RS et al (2013) Assessment of microbiota and peptidoglycan in perianal fistulas. Diagn Microbiol Infect Dis 75(1):50\u201354","journal-title":"Diagn Microbiol Infect Dis"},{"issue":"12","key":"2524_CR3","doi-asserted-by":"publisher","first-page":"O436","DOI":"10.1111\/codi.13527","volume":"18","author":"C Ratto","year":"2016","unstructured":"Ratto C et al (2016) Immunopathological characterization of cryptoglandular anal fistula: a pilot study investigating its pathogenesis. Colorectal Dis 18(12):O436\u2013O444","journal-title":"Colorectal Dis"},{"issue":"6","key":"2524_CR4","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s10151-017-1645-5","volume":"21","author":"J Sugrue","year":"2017","unstructured":"Sugrue J et al (2017) Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review. Tech Coloproctol 21(6):425\u2013432","journal-title":"Tech Coloproctol"},{"issue":"9","key":"2524_CR5","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1007\/s10151-016-1494-7","volume":"20","author":"RS van Onkelen","year":"2016","unstructured":"van Onkelen RS et al (2016) Pro-inflammatory cytokines in cryptoglandular anal fistulas. Tech Coloproctol 20(9):619\u2013625","journal-title":"Tech Coloproctol"},{"issue":"2","key":"2524_CR6","first-page":"1435","volume":"17","author":"M Zhu","year":"2019","unstructured":"Zhu M et al (2019) Anti-inflammatory effect of stromal vascular fraction cells in fat transplantation. Exp Ther Med 17(2):1435\u20131439","journal-title":"Exp Ther Med"},{"issue":"4","key":"2524_CR7","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3390\/bioengineering5040091","volume":"5","author":"JA van Dongen","year":"2018","unstructured":"van Dongen JA et al (2018) Augmentation of Dermal Wound Healing by Adipose Tissue-Derived Stromal Cells (ASC). Bioengineering 5(4):91","journal-title":"Bioengineering"},{"key":"2524_CR8","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.3389\/fphar.2019.01695","volume":"10","author":"AES Brooks","year":"2019","unstructured":"Brooks AES et al (2019) Ex Vivo Human Adipose Tissue Derived Mesenchymal Stromal Cells (ASC) Are a Heterogeneous Population That Demonstrate Rapid Culture-Induced Changes. Front Pharmacol 10:1695","journal-title":"Front Pharmacol"},{"issue":"6","key":"2524_CR9","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1111\/wrr.12482","volume":"24","author":"JA van Dongen","year":"2016","unstructured":"van Dongen JA et al (2016) The fractionation of adipose tissue procedure to obtain stromal vascular fractions for regenerative purposes. Wound Repair Regen 24(6):994\u20131003","journal-title":"Wound Repair Regen"},{"issue":"6","key":"2524_CR10","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1089\/ten.2006.0275","volume":"13","author":"ME Wall","year":"2007","unstructured":"Wall ME, Bernacki SH, Loboa EG (2007) Effects of serial passaging on the adipogenic and osteogenic differentiation potential of adipose-derived human mesenchymal stem cells. Tissue Eng 13(6):1291\u20131298","journal-title":"Tissue Eng"},{"issue":"2","key":"2524_CR11","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1177\/0363546517746112","volume":"47","author":"BW Oudelaar","year":"2019","unstructured":"Oudelaar BW et al (2019) Concentrations of blood components in commercial platelet-rich plasma separation systems: a review of the literature. Am J Sports Med 47(2):479\u2013487","journal-title":"Am J Sports Med"},{"issue":"8","key":"2524_CR12","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1093\/asj\/sjy029","volume":"38","author":"HP Stevens","year":"2018","unstructured":"Stevens HP, Donners S, de Bruijn J (2018) Introducing Platelet-Rich Stroma: Platelet-Rich Plasma (PRP) and Stromal Vascular Fraction (SVF) Combined for the Treatment of Androgenetic Alopecia. Aesthet Surg J 38(8):811\u2013822","journal-title":"Aesthet Surg J"},{"issue":"6","key":"2524_CR13","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1097\/DCR.0000000000001546","volume":"63","author":"W Deijl","year":"2020","unstructured":"Deijl W et al (2020) Autologous platelet-rich stroma in complex perianal fistulas. Dis Colon Rectum 63(6):860\u2013861","journal-title":"Dis Colon Rectum"},{"issue":"7","key":"2524_CR14","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1111\/j.1463-1318.2008.01666.x","volume":"11","author":"LE Mitalas","year":"2009","unstructured":"Mitalas LE et al (2009) Required length of follow-up after transanal advancement flap repair of high transsphincteric fistulas. Colorectal Dis 11(7):726\u2013728","journal-title":"Colorectal Dis"},{"issue":"3","key":"2524_CR15","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1002\/bjs5.50129","volume":"3","author":"ME Stellingwerf","year":"2019","unstructured":"Stellingwerf ME et al (2019) Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn\u2019s high perianal fistulas. BJS Open 3(3):231\u2013241","journal-title":"BJS Open"},{"issue":"11","key":"2524_CR16","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1007\/BF02235039","volume":"42","author":"WR Schouten","year":"1999","unstructured":"Schouten WR, Zimmerman DD, Briel JW (1999) Transanal advancement flap repair of transsphincteric fistulas. Dis Colon Rectum 42(11):1419\u20131422 (discussion 1422-1423)","journal-title":"Dis Colon Rectum"},{"issue":"2","key":"2524_CR17","doi-asserted-by":"publisher","first-page":"142","DOI":"10.5966\/sctm.2011-0018","volume":"1","author":"S Maxson","year":"2012","unstructured":"Maxson S et al (2012) Concise review: role of mesenchymal stem cells in wound repair. Stem Cells Transl Med 1(2):142\u2013149","journal-title":"Stem Cells Transl Med"},{"issue":"2","key":"2524_CR18","doi-asserted-by":"publisher","first-page":"111","DOI":"10.2217\/rme-2016-0162","volume":"12","author":"H Shyam","year":"2017","unstructured":"Shyam H et al (2017) Mesenchymal stem cells in regenerative medicine: a new paradigm for degenerative bone diseases. Regen Med 12(2):111\u2013114","journal-title":"Regen Med"},{"issue":"1","key":"2524_CR19","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1186\/s13287-019-1415-6","volume":"10","author":"H Bi","year":"2019","unstructured":"Bi H et al (2019) Stromal vascular fraction promotes migration of fibroblasts and angiogenesis through regulation of extracellular matrix in the skin wound healing process. Stem Cell Res Ther 10(1):302","journal-title":"Stem Cell Res Ther"},{"issue":"1","key":"2524_CR20","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s13287-017-0598-y","volume":"8","author":"P Bora","year":"2017","unstructured":"Bora P, Majumdar AS (2017) Adipose tissue-derived stromal vascular fraction in regenerative medicine: a brief review on biology and translation. Stem Cell Res Ther 8(1):145","journal-title":"Stem Cell Res Ther"},{"issue":"6","key":"2524_CR21","doi-asserted-by":"publisher","first-page":"347","DOI":"10.4252\/wjsc.v11.i6.347","volume":"11","author":"U Kozlowska","year":"2019","unstructured":"Kozlowska U et al (2019) Similarities and differences between mesenchymal stem\/progenitor cells derived from various human tissues. World J Stem Cells 11(6):347\u2013374","journal-title":"World J Stem Cells"},{"issue":"12","key":"2524_CR22","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.1080\/14712598.2019.1671970","volume":"19","author":"I Andia","year":"2019","unstructured":"Andia I, Maffulli N, Burgos-Alonso N (2019) Stromal vascular fraction technologies and clinical applications. Expert Opin Biol Ther 19(12):1289\u20131305","journal-title":"Expert Opin Biol Ther"},{"issue":"1","key":"2524_CR23","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s13287-016-0363-7","volume":"7","author":"JL Spees","year":"2016","unstructured":"Spees JL, Lee RH, Gregory CA (2016) Mechanisms of mesenchymal stem\/stromal cell function. Stem Cell Res Ther 7(1):125","journal-title":"Stem Cell Res Ther"},{"issue":"6","key":"2524_CR24","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1161\/ATVBAHA.119.312425","volume":"39","author":"Y Sun","year":"2019","unstructured":"Sun Y et al (2019) Significance of Cellular Cross-Talk in Stromal Vascular Fraction of Adipose Tissue in Neovascularization. Arterioscler Thromb Vasc Biol 39(6):1034\u20131044","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"11","key":"2524_CR25","doi-asserted-by":"publisher","first-page":"e80364","DOI":"10.1371\/journal.pone.0080364","volume":"8","author":"Z Dong","year":"2013","unstructured":"Dong Z et al (2013) The survival condition and immunoregulatory function of adipose stromal vascular fraction (SVF) in the early stage of nonvascularized adipose transplantation. PLoS ONE 8(11):e80364","journal-title":"PLoS ONE"},{"issue":"1","key":"2524_CR26","doi-asserted-by":"publisher","first-page":"7250","DOI":"10.1038\/s41598-019-43624-6","volume":"9","author":"S Muller","year":"2019","unstructured":"Muller S et al (2019) Human adipose stromal-vascular fraction self-organizes to form vascularized adipose tissue in 3D cultures. Sci Rep 9(1):7250","journal-title":"Sci Rep"},{"issue":"4","key":"2524_CR27","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1089\/ten.teb.2017.0061","volume":"24","author":"VM Ramakrishnan","year":"2018","unstructured":"Ramakrishnan VM, Boyd NL (2018) The Adipose Stromal Vascular Fraction as a Complex Cellular Source for Tissue Engineering Applications. Tissue Eng Part B Rev 24(4):289\u2013299","journal-title":"Tissue Eng Part B Rev"},{"issue":"4","key":"2524_CR28","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1161\/ATVBAHA.108.178962","volume":"29","author":"TG Ebrahimian","year":"2009","unstructured":"Ebrahimian TG et al (2009) Cell therapy based on adipose tissue-derived stromal cells promotes physiological and pathological wound healing. Arterioscler Thromb Vasc Biol 29(4):503\u2013510","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"1","key":"2524_CR29","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s13287-018-0851-z","volume":"9","author":"F Lai","year":"2018","unstructured":"Lai F et al (2018) Platelet-rich plasma enhances the proliferation of human adipose stem cells through multiple signaling pathways. Stem Cell Res Ther 9(1):107","journal-title":"Stem Cell Res Ther"},{"issue":"18","key":"2524_CR30","doi-asserted-by":"publisher","first-page":"3095","DOI":"10.1016\/S0142-9612(03)00114-5","volume":"24","author":"E Lucarelli","year":"2003","unstructured":"Lucarelli E et al (2003) Platelet-derived growth factors enhance proliferation of human stromal stem cells. Biomaterials 24(18):3095\u20133100","journal-title":"Biomaterials"},{"issue":"3","key":"2524_CR31","doi-asserted-by":"publisher","first-page":"554e","DOI":"10.1097\/01.prs.0000479995.04255.bb","volume":"137","author":"JC Willemsen","year":"2016","unstructured":"Willemsen JC et al (2016) Platelet-rich plasma influences expansion and paracrine function of adipose-derived stromal cells in a dose-dependent fashion. Plast Reconstr Surg 137(3):554e\u2013565e","journal-title":"Plast Reconstr Surg"},{"key":"2524_CR32","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s13287-015-0217-8","volume":"6","author":"M Tobita","year":"2015","unstructured":"Tobita M, Tajima S, Mizuno H (2015) Adipose tissue-derived mesenchymal stem cells and platelet-rich plasma: stem cell transplantation methods that enhance stemness. Stem Cell Res Ther 6:215","journal-title":"Stem Cell Res Ther"},{"issue":"3","key":"2524_CR33","doi-asserted-by":"publisher","first-page":"437","DOI":"10.3727\/096368912X656162","volume":"22","author":"SH Bhang","year":"2013","unstructured":"Bhang SH et al (2013) Platelet-rich plasma enhances the dermal regeneration efficacy of human adipose-derived stromal cells administered to skin wounds. Cell Transplant 22(3):437\u2013445","journal-title":"Cell Transplant"},{"issue":"2 Suppl","key":"2524_CR34","doi-asserted-by":"publisher","first-page":"56S","DOI":"10.1097\/PRS.0b013e318191be2d","volume":"123","author":"MW Blanton","year":"2009","unstructured":"Blanton MW et al (2009) Adipose stromal cells and platelet-rich plasma therapies synergistically increase revascularization during wound healing. Plast Reconstr Surg 123(2 Suppl):56S-64S","journal-title":"Plast Reconstr Surg"},{"key":"2524_CR35","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/978-1-4939-9473-1_8","volume":"1993","author":"JA van Dongen","year":"2019","unstructured":"van Dongen JA, Harmsen MC, Stevens HP (2019) Isolation of Stromal Vascular Fraction by fractionation of adipose tissue. Methods Mol Biol 1993:91\u2013103","journal-title":"Methods Mol Biol"},{"issue":"7","key":"2524_CR36","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1097\/DCR.0b013e318255364a","volume":"55","author":"MD Herreros","year":"2012","unstructured":"Herreros MD et al (2012) Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial (FATT 1: fistula advanced therapy trial 1) and long-term evaluation. Dis Colon Rectum 55(7):762\u2013772","journal-title":"Dis Colon Rectum"},{"issue":"1","key":"2524_CR37","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/DCR.0b013e3181973487","volume":"52","author":"D Garcia-Olmo","year":"2009","unstructured":"Garcia-Olmo D et al (2009) Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 52(1):79\u201386","journal-title":"Dis Colon Rectum"},{"issue":"5","key":"2524_CR38","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1007\/s10151-017-1630-z","volume":"21","author":"S Choi","year":"2017","unstructured":"Choi S et al (2017) Autologous adipose tissue-derived stem cells for the treatment of complex perianal fistulas not associated with Crohn\u2019s disease: a phase II clinical trial for safety and efficacy. Tech Coloproctol 21(5):345\u2013353","journal-title":"Tech Coloproctol"},{"issue":"6","key":"2524_CR39","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1177\/1553350615572656","volume":"22","author":"DW Borowski","year":"2015","unstructured":"Borowski DW et al (2015) Adipose tissue-derived regenerative cell-enhanced Lipofilling for treatment of Cryptoglandular Fistulae-in-Ano: the ALFA technique. Surg Innov 22(6):593\u2013600","journal-title":"Surg Innov"},{"issue":"2","key":"2524_CR40","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s10151-018-1755-8","volume":"22","author":"G Naldini","year":"2018","unstructured":"Naldini G et al (2018) Micro-fragmented adipose tissue injection for the treatment of complex anal fistula: a pilot study accessing safety and feasibility. Tech Coloproctol 22(2):107\u2013113","journal-title":"Tech Coloproctol"},{"key":"2524_CR41","doi-asserted-by":"publisher","DOI":"10.1111\/codi.14002","author":"C Wainstein","year":"2018","unstructured":"Wainstein C et al (2018) Stem cell therapy in refractory perineal Crohn\u2019s Disease: long-term follow-up. Colorectal Dis. https:\/\/doi.org\/10.1111\/codi.14002","journal-title":"Colorectal Dis"}],"container-title":["Techniques in Coloproctology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-021-02524-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10151-021-02524-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10151-021-02524-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T10:10:03Z","timestamp":1636539003000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10151-021-02524-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,4]]},"references-count":41,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2524"],"URL":"https:\/\/doi.org\/10.1007\/s10151-021-02524-6","relation":{},"ISSN":["1123-6337","1128-045X"],"issn-type":[{"value":"1123-6337","type":"print"},{"value":"1128-045X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,4]]},"assertion":[{"value":"14 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Written informed consent was obtained from all subjects before entering the study, which was approved by the Medical Ethical Committee of the Erasmus Medical Center.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and Informed consent"}}]}}