{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T06:12:04Z","timestamp":1785564724898,"version":"3.56.0"},"reference-count":54,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003The management of myeloproliferative neoplasms (MPNs) is based on the reduction of thrombotic risk. The incidence, impact, and risk factors of bleedings have been less studied.<\/jats:p><jats:p>Methods\u2003All patients with polycythemia vera (n=339) or essential thrombocythemia (n=528) treated in our center are included in OBENE (Observatoire BrEstois des NEoplasies my\u00e9loprolif\u00e9ratives) cohort (NCT02897297). Major bleeding (MB) and clinically relevant nonmajor bleeding (CRNMB) occurring after diagnosis were included, except after leukemic transformation.<\/jats:p><jats:p>Results\u2003With a median follow-up of 8.3 years, incidence of hemorrhages was 1.85% patient\/year, with an incidence of MB of 0.95% patient\/year. The 10-year bleeding-free survival was 89%. The most frequent locations were digestive tract, \u201cmouth, nose and throat,\u201d and muscular hematoma. The case fatality rate of MB was 25%. The proportion of potentially avoidable postoperative bleeding was remarkable (17.6%). In multivariable analysis, eight risk factors of bleeding were identified: leukocytes &gt;20 G\/L at diagnosis (hazard ratio [HR]=5.13, 95% confidence interval [CI]: 1.77\u201314.86), secondary hemopathies (HR=2.99, 95% CI: 1.27\u20137.04), aspirin use at diagnosis (HR=2.11, 95% CI: 1.24\u20133.6), platelet count &gt;1,000 G\/L at diagnosis (HR=1.93, 95% CI: 1.11\u20133.36), history of hemorrhage (HR=1.82, 95% CI: 1.03\u20133.24), secondary cancers (HR=1.71, 95% CI: 1.01\u20132.89), atrial fibrillation (HR=1.66, 95% CI: 1.01\u20132.72), and male sex (HR=1.54, 95% CI: 1.02\u20132.33). The occurrence of a CRNMB increased the risk of a secondary MB (odds ratio=6.13, 95% CI: 2.86\u201312.6, p&lt;0.00001). Most patients taking hydroxyurea displayed a nonmacrocytic median corpuscular value in the months preceding bleeding (51.4%).<\/jats:p><jats:p>Discussion\u2003The morbidity and mortality of bleedings in MPN should not be underestimated, and patients with platelet count &gt;1,000 G\/L and\/or leukocytes &gt;20 G\/L, and possibly patients who suffered from a CRNMB could benefit from cytoreduction to reducing bleeding risk. Postoperative bleedings represent a substantial proportion of bleeding and could be better prevented.<\/jats:p>","DOI":"10.1055\/a-1849-8477","type":"journal-article","created":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T23:04:20Z","timestamp":1652310260000},"page":"1712-1722","source":"Crossref","is-referenced-by-count":8,"title":["Hemorrhages in Polycythemia Vera and Essential Thrombocythemia: Epidemiology, Description, and Risk Factors\u2014Learnings from a Large Cohort"],"prefix":"10.1055","volume":"122","author":[{"given":"Christophe","family":"Nicol","sequence":"additional","affiliation":[{"name":"Service d'Onco-H\u00e9matologie, Centre Hospitalier des Pays de Morlaix, Morlaix, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Ajzenberg","sequence":"additional","affiliation":[{"name":"Laboratoire d'H\u00e9matologie, H\u00f4pital Bichat, APHP, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karine","family":"Lacut","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine Interne et de Pneumologie, CHRU de Brest, Brest, France"},{"name":"Inserm, UnivBrest, CHRU de Brest, UMR1304, GETBO, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Couturaud","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine Interne et de Pneumologie, CHRU de Brest, Brest, France"},{"name":"Inserm, UnivBrest, CHRU de Brest, UMR1304, GETBO, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lippert","sequence":"additional","affiliation":[{"name":"Laboratoire d'H\u00e9matologie, CHRU de Brest, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Pan-Petesch","sequence":"additional","affiliation":[{"name":"Inserm, UnivBrest, CHRU de Brest, UMR1304, GETBO, Brest, France"},{"name":"Service d'H\u00e9matologie Clinique, Institut de Canc\u00e9ro-H\u00e9matologie, CHRU de Brest, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Christophe","family":"Ianotto","sequence":"additional","affiliation":[{"name":"Inserm, UnivBrest, CHRU de Brest, UMR1304, GETBO, Brest, France"},{"name":"Service d'H\u00e9matologie Clinique, Institut de Canc\u00e9ro-H\u00e9matologie, CHRU de Brest, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"issue":"20","key":"ref1","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","article-title":"The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia","volume":"127","author":"D A Arber","year":"2016","journal-title":"Blood"},{"issue":"16","key":"ref2","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1182\/blood-2014-05-579136","article-title":"Long-term survival and blast transformation in molecularly annotated essential thrombocythemia, polycythemia vera, and myelofibrosis","volume":"124","author":"A Tefferi","year":"2014","journal-title":"Blood"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1038\/leu.2013.163","article-title":"Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study","volume":"27","author":"A Tefferi","year":"2013","journal-title":"Leukemia"},{"issue":"23","key":"ref4","doi-asserted-by":"crossref","first-page":"3179","DOI":"10.1200\/JCO.2010.34.5298","article-title":"Survival and disease progression in essential thrombocythemia are significantly influenced by accurate morphologic diagnosis: an international study","volume":"29","author":"T Barbui","year":"2011","journal-title":"J Clin Oncol"},{"issue":"12","key":"ref5","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.6004\/jnccn.2016.0169","article-title":"Myeloproliferative Neoplasms, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology","volume":"14","author":"R Mesa","year":"2016","journal-title":"J Natl Compr Canc Netw"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1038\/s41375-018-0077-1","article-title":"Philadelphia chromosome-negative classical myeloproliferative neoplasms: revised management recommendations from European LeukemiaNet","volume":"32","author":"T Barbui","year":"2018","journal-title":"Leukemia"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s11899-017-0400-3","article-title":"Risk factors for and management of MPN-associated bleeding and thrombosis","volume":"12","author":"K Martin","year":"2017","journal-title":"Curr Hematol Malig Rep"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1055\/s-0040-1720979","article-title":"Hemorrhage in essential thrombocythemia or polycythemia vera: epidemiology, location, risk factors, and lessons learned from the literature","volume":"121","author":"C Nicol","year":"2021","journal-title":"Thromb Haemost"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s00277-016-2621-2","article-title":"Diagnosis, prevention, and management of bleeding episodes in Philadelphia-negative myeloproliferative neoplasms: recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO) and the Society of Thrombosis and Hemostasis Research (GTH)","volume":"95","author":"I Appelmann","year":"2016","journal-title":"Ann Hematol"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1182\/blood-2002-04-1199","article-title":"The World Health Organization (WHO) classification of the myeloid neoplasms","volume":"100","author":"J W Vardiman","year":"2002","journal-title":"Blood"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1182\/blood-2009-03-209262","article-title":"The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes","volume":"114","author":"J W Vardiman","year":"2009","journal-title":"Blood"},{"issue":"04","key":"ref12","first-page":"339","article-title":"Diagnosis and classification of the polycythemias","volume":"12","author":"N I Berlin","year":"1975","journal-title":"Semin Hematol"},{"issue":"12","key":"ref13","doi-asserted-by":"crossref","first-page":"3835","DOI":"10.1200\/JCO.1999.17.12.3835","article-title":"World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997","volume":"17","author":"N L Harris","year":"1999","journal-title":"J Clin Oncol"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients","volume":"3","author":"S Schulman","year":"2005","journal-title":"J Thromb Haemost"},{"issue":"11","key":"ref15","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1111\/jth.13140","article-title":"Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH","volume":"13","author":"S Kaatz","year":"2015","journal-title":"J Thromb Haemost"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1160\/TH08-06-0396","article-title":"Vascular events in Korean patients with myeloproliferative neoplasms and their relationship to JAK2 mutation","volume":"101","author":"S M Bang","year":"2009","journal-title":"Thromb Haemost"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3324\/haematol.12053","article-title":"Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: incidence, risk factors, and effect of treatments","volume":"93","author":"V De Stefano","year":"2008","journal-title":"Haematologica"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/ejh.12064","article-title":"Leukocytosis in polycythemia vera and splenomegaly in essential thrombocythemia are independent risk factors for hemorrhage","volume":"90","author":"Y S Chou","year":"2013","journal-title":"Eur J Haematol"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1056\/NEJMoa035572","article-title":"Efficacy and safety of low-dose aspirin in polycythemia vera","volume":"350","author":"R Landolfi","year":"2004","journal-title":"N Engl J Med"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1055\/s-0040-1708481","article-title":"A meta-analysis of case fatality rates of recurrent venous thromboembolism and major bleeding in patients with cancer","volume":"120","author":"A Abdulla","year":"2020","journal-title":"Thromb Haemost"},{"issue":"09","key":"ref22","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1056\/NEJMoa1302507","article-title":"Oral apixaban for the treatment of acute venous thromboembolism","volume":"369","author":"G Agnelli","year":"2013","journal-title":"N Engl J Med"},{"issue":"10","key":"ref23","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban versus warfarin in nonvalvular atrial fibrillation","volume":"365","author":"M R Patel","year":"2011","journal-title":"N Engl J Med"},{"issue":"08","key":"ref24","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.amjmed.2006.07.034","article-title":"Death and disability from warfarin-associated intracranial and extracranial hemorrhages","volume":"120","author":"M C Fang","year":"2007","journal-title":"Am J Med"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1182\/blood-2007-07-102665","article-title":"Postsurgery outcomes in patients with polycythemia vera and essential thrombocythemia: a retrospective survey","volume":"111","author":"M Ruggeri","year":"2008","journal-title":"Blood"},{"issue":"07","key":"ref26","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1182\/blood-2012-04-424911","article-title":"Correlation of blood counts with vascular complications in essential thrombocythemia: analysis of the prospective PT1 cohort","volume":"120","author":"P J Campbell","year":"2012","journal-title":"Blood"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.3324\/haematol.2020.250720","article-title":"The never ending success story of tranexamic acid in acquired bleeding","volume":"105","author":"M Franchini","year":"2020","journal-title":"Haematologica"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/SLA.0000000000003793","article-title":"A single preoperative dose of tranexamic acid reduces perioperative blood loss: a metaanalysis","volume":"273","author":"M Heyns","year":"2021","journal-title":"Ann Surg"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"106162","DOI":"10.1016\/j.rmed.2020.106162","article-title":"Prophylactic use of tranexamic acid for prevention of bleeding during transbronchial lung biopsies \u2013 a randomized, double-blind, placebo-controlled trial","volume":"173","author":"R Kuint","year":"2020","journal-title":"Respir Med"},{"issue":"16","key":"ref30","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1056\/NEJMoa1401105","article-title":"Aspirin in patients undergoing noncardiac surgery","volume":"370","author":"P J Devereaux","year":"2014","journal-title":"N Engl J Med"},{"issue":"22","key":"ref31","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1001\/archinte.165.22.2651","article-title":"Long-term outcome of 231 patients with essential thrombocythemia: prognostic factors for thrombosis, bleeding, myelofibrosis, and leukemia","volume":"165","author":"C S Chim","year":"2005","journal-title":"Arch Intern Med"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation","volume":"137","author":"G YH Lip","year":"2010","journal-title":"Chest"},{"issue":"10","key":"ref33","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1038\/leu.2016.85","article-title":"High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists","volume":"30","author":"V De Stefano","year":"2016","journal-title":"Leukemia"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13045-016-0242-9","article-title":"Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry","volume":"9","author":"A Kaifie","year":"2016","journal-title":"J Hematol Oncol"},{"issue":"06","key":"ref35","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1007\/s00277-015-2330-2","article-title":"Oral anticoagulation to prevent thrombosis recurrence in polycythemia vera and essential thrombocythemia","volume":"94","author":"J C Hern\u00e1ndez-Boluda","year":"2015","journal-title":"Ann Hematol"},{"issue":"25","key":"ref36","doi-asserted-by":"crossref","first-page":"6777","DOI":"10.1182\/blood-2010-11-297580","article-title":"How I treat the acquired von Willebrand syndrome","volume":"117","author":"A Tiede","year":"2011","journal-title":"Blood"},{"issue":"12","key":"ref37","doi-asserted-by":"crossref","first-page":"914","DOI":"10.20452\/pamw.3211","article-title":"Prevalence of acquired von Willebrand syndrome during essential thrombocythemia: a retrospective analysis of 170 consecutive patients","volume":"125","author":"A Mital","year":"2015","journal-title":"Pol Arch Med Wewn"},{"issue":"04","key":"ref38","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.thromres.2015.07.029","article-title":"Factors predisposing to acquired von Willebrand syndrome during the course of polycythemia vera - retrospective analysis of 142 consecutive cases","volume":"136","author":"A Mital","year":"2015","journal-title":"Thromb Res"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ejim.2016.11.011","article-title":"Factors related to the development of acquired von Willebrand syndrome in patients with essential thrombocythemia and polycythemia vera","volume":"41","author":"A Rottenstreich","year":"2017","journal-title":"Eur J Intern Med"},{"issue":"05","key":"ref40","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/j.1365-2133.1989.tb08198.x","article-title":"Hydroxyurea in the management of therapy resistant psoriasis","volume":"121","author":"A M Layton","year":"1989","journal-title":"Br J Dermatol"},{"issue":"03","key":"ref41","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/ggi.13194","article-title":"Iron deficiency anemia in older adults: a review","volume":"18","author":"E Joosten","year":"2018","journal-title":"Geriatr Gerontol Int"},{"issue":"06","key":"ref42","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1002\/ajh.23690","article-title":"How common are myeloproliferative neoplasms? A systematic review and meta-analysis","volume":"89","author":"G J Titmarsh","year":"2014","journal-title":"Am J Hematol"},{"issue":"02","key":"ref43","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/ajh.23895","article-title":"Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management","volume":"90","author":"A Tefferi","year":"2015","journal-title":"Am J Hematol"},{"issue":"04","key":"ref44","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1038\/leu.2011.258","article-title":"Incidence and risk factors for bleeding in 1104 patients with essential thrombocythemia or prefibrotic myelofibrosis diagnosed according to the 2008 WHO criteria","volume":"26","author":"G Finazzi","year":"2012","journal-title":"Leukemia"},{"issue":"05","key":"ref45","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s12185-015-1871-4","article-title":"Bleeding complications in BCR-ABL negative myeloproliferative neoplasms: prevalence, type, and risk factors in a single-center cohort","volume":"102","author":"E M Kander","year":"2015","journal-title":"Int J Hematol"},{"issue":"02","key":"ref46","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.thromres.2014.11.006","article-title":"The JAK2V617F mutational status and allele burden may be related with the risk of venous thromboembolic events in patients with Philadelphia-negative myeloproliferative neoplasms","volume":"135","author":"M Borowczyk","year":"2015","journal-title":"Thromb Res"},{"issue":"01","key":"ref47","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13045-016-0242-9","article-title":"Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry","volume":"9","author":"A Kaifie","year":"2016","journal-title":"J Hematol Oncol"},{"issue":"01","key":"ref48","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s12185-016-2105-0","article-title":"Analysis of thrombosis and bleeding complications in patients with polycythemia vera: a Turkish retrospective study","volume":"105","author":"A M Yesilova","year":"2017","journal-title":"Int J Hematol"},{"issue":"10","key":"ref49","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1200\/JCO.2005.07.062","article-title":"Vascular and neoplastic risk in a large cohort of patients with polycythemia vera","volume":"23","author":"R Marchioli","year":"2005","journal-title":"J Clin Oncol"},{"issue":"08","key":"ref50","doi-asserted-by":"crossref","first-page":"926","DOI":"10.3324\/haematol.2016.146654","article-title":"Antiplatelet therapy versus observation in low-risk essential thrombocythemia with a CALR mutation","volume":"101","author":"A Alvarez-Larr\u00e1n","year":"2016","journal-title":"Haematologica"},{"issue":"22","key":"ref51","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1182\/blood.2019001318","article-title":"From Budd-Chiari syndrome to acquired von Willebrand syndrome: thrombosis and bleeding complications in the myeloproliferative neoplasms","volume":"134","author":"B L Stein","year":"2019","journal-title":"Blood"},{"issue":"12","key":"ref52","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1038\/s41408-017-0035-6","article-title":"Risk factors for arterial versus venous thrombosis in polycythemia vera: a single center experience in 587 patients","volume":"7","author":"S Cerquozzi","year":"2017","journal-title":"Blood Cancer J"},{"issue":"02","key":"ref53","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/j.1365-2141.2011.08858.x","article-title":"Bleeding in essential thrombocythaemia: a retrospective analysis on 565 patients","volume":"156","author":"F Palandri","year":"2012","journal-title":"Br J Haematol"},{"issue":"02","key":"ref54","doi-asserted-by":"crossref","first-page":"159","DOI":"10.4065\/81.2.159","article-title":"Essential thrombocythemia beyond the first decade: life expectancy, long-term complication rates, and prognostic factors","volume":"81","author":"A P Wolanskyj","year":"2006","journal-title":"Mayo Clin Proc"},{"issue":"08","key":"ref55","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1007\/s00277-017-3040-8","article-title":"Thromboses and hemorrhages are common in MPN patients with high JAK2V617F allele burden","volume":"96","author":"I Bertozzi","year":"2017","journal-title":"Ann Hematol"}],"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1849-8477.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T13:12:46Z","timestamp":1727183566000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1849-8477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,11]]},"references-count":54,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,9,26]]},"published-print":{"date-parts":[[2022,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1849-8477","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,5,11]]},"published":{"date-parts":[[2022,5,11]]}}}