{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:34:56Z","timestamp":1783114496718,"version":"3.54.6"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Numerous studies on malignant mesothelioma (MM) highlight the prognostic importance of histologic subtype, nuclear grade, and necrosis. This study compares these parameters in paired biopsy and resection specimens of pleural MM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Histologic subtype, percentage of epithelioid morphology, nuclear grade, and the presence or absence of necrosis were compared in 429 paired biopsies and resection specimens of pleural MM from 19 institutions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Histologic subtype was concordant in 81% of cases (\u03ba = 0.58). When compared with resection specimens, epithelioid morphology at biopsy had a positive predictive value (PPV) of 78.9% and a negative predictive value (NPV) of 93.5%; sarcomatoid morphology showed high PPV (92.9%) and NPV (99.3%), and biphasic morphology PPV was 89.7% and NPV was 79.7%. Agreement of the percentage of epithelioid morphology was fair (\u03ba = 0.27). Nuclear grade and necrosis were concordant in 75% (\u03ba = 0.59) and 81% (\u03ba = 0.53) of cases, respectively. Nuclear grade showed moderate (\u03ba = 0.53) and substantial (\u03ba = 0.67) agreement from patients with and without neoadjuvant therapy, respectively, and necrosis showed moderate (\u03ba = 0.47 and \u03ba = 0.60) agreement, respectively, in the same subsets of paired specimens.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Paired biopsy-resection specimens from pleural MM show overall moderate agreement in pathologic parameters. These findings may help guide postbiopsy management and triage of patients with MM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajcp\/aqab054","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T12:29:46Z","timestamp":1615897786000},"page":"989-999","source":"Crossref","is-referenced-by-count":20,"title":["Comparison of Nuclear Grade, Necrosis, and Histologic Subtype Between Biopsy and Resection in Pleural Malignant Mesothelioma: An International Multi-Institutional Analysis"],"prefix":"10.1093","volume":"156","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3920-0301","authenticated-orcid":false,"given":"Jefree J","family":"Schulte","sequence":"first","affiliation":[{"name":"Department of Pathology, University of Chicago , Chicago, IL , USA"},{"name":"Department of Pathology and Lab Medicine, University of Wisconsin , Madison, WI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B","family":"Chapel","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Chicago , Chicago, IL , USA"},{"name":"Department of Pathology, Brigham and Women\u2019s Hospital , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Attanoos","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology, University Hospital of Wales and School of Medicine, Cardiff University , Cardiff , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luka","family":"Brcic","sequence":"additional","affiliation":[{"name":"Diagnostics and Research Institute of Pathology, Medical University of Graz , Graz , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet","family":"Burn","sequence":"additional","affiliation":[{"name":"Douglass Hanly Moir Pathology , Sydney , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly J","family":"Butnor","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Vermont Medical Center , Burlington, VT , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University Health Network , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Chicago , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanja","family":"Dacic","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Pittsburgh Medical Center , Pittsburgh, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"De Perrot","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University Health Network , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Fukuoka","sequence":"additional","affiliation":[{"name":"Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francoise","family":"Galateau-Salle","sequence":"additional","affiliation":[{"name":"Department of Pathology, MESOPATH-MESOBANK, Centre Le\u00f3n B\u00e9rard , Lyon , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Godschachner","sequence":"additional","affiliation":[{"name":"Diagnostics and Research Institute of Pathology, Medical University of Graz , Graz , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenzo","family":"Hiroshima","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tokyo Women\u2019s Medical University Yachiyo Medical Center , Yachiyo , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Klebe","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, SA Pathology, Flinders University , Adelaide , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Krausz","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Chicago , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Litzky","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto M","family":"Marchevsky","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Chicago , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Nabeshima","sequence":"additional","affiliation":[{"name":"Department of Pathology, Fukuoka University Hospital , Fukuoka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prodipto","family":"Pal","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University Health Network , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja C","family":"Roden","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology; Mayo Clinic , Rochester , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Rorvig","sequence":"additional","affiliation":[{"name":"Department of Pathology, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2283-3535","authenticated-orcid":false,"given":"Eric","family":"Santoni-Rugiu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Tazelaar","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic , Scottsdale, AZ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Sound","family":"Tsao","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University Health Network , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann E","family":"Walts","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Weynand","sequence":"additional","affiliation":[{"name":"Department of Pathology, Universitair Ziekenhuis Leuven , Leuven , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Zaizen","sequence":"additional","affiliation":[{"name":"Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6134-980X","authenticated-orcid":false,"given":"Yu Zhi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliya N","family":"Husain","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Chicago , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"key":"2023020912515803400_CIT0001","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/S0140-6736(07)60412-7","article-title":"Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis","volume":"369","author":"Lin","year":"2007","journal-title":"Lancet."},{"key":"2023020912515803400_CIT0002","article-title":"WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. 4th ed. Vol 7","author":"Travis","year":"2015","journal-title":"Lyon, France:"},{"key":"2023020912515803400_CIT0003","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1097\/JTO.0b013e31826915f1","article-title":"Initial analysis of the international association for the study of lung cancer mesothelioma database","volume":"7","author":"Rusch","year":"2012","journal-title":"J Thorac Oncol."},{"key":"2023020912515803400_CIT0004","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5858\/arpa.2017-0124-RA","article-title":"Guidelines for pathologic diagnosis of malignant mesothelioma: 2017 update of the consensus statement from the International Mesothelioma Interest Group","volume":"142","author":"Husain","year":"2018","journal-title":"Arch Pathol Lab Med."},{"key":"2023020912515803400_CIT0005","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1038\/modpathol.2011.146","article-title":"A nuclear grading system is a strong predictor of survival in epitheloid diffuse malignant pleural mesothelioma","volume":"25","author":"Kadota","year":"2012","journal-title":"Mod Pathol."},{"key":"2023020912515803400_CIT0006","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1038\/modpathol.2017.170","article-title":"Nuclear grade and necrosis predict prognosis in malignant epithelioid pleural mesothelioma: a multi-institutional study","volume":"31","author":"Rosen","year":"2018","journal-title":"Mod Pathol."},{"key":"2023020912515803400_CIT0007","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1200\/JCO.2017.76.6394","article-title":"Treatment of malignant pleural mesothelioma: American Society of Clinical Oncology clinical practice guideline","volume":"36","author":"Kindler","year":"2018","journal-title":"J Clin Oncol."},{"key":"2023020912515803400_CIT0008","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.5858\/arpa.2016-0073-OA","article-title":"Dataset for reporting of malignant mesothelioma of the pleura or peritoneum: recommendations from the International Collaboration on Cancer Reporting (ICCR)","volume":"140","author":"Churg","year":"2016","journal-title":"Arch Pathol Lab Med."},{"key":"2023020912515803400_CIT0009","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/annonc\/mdv199","article-title":"Malignant pleural mesothelioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"26","author":"Baas","year":"2015","journal-title":"Ann Oncol."},{"key":"2023020912515803400_CIT0010","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.athoracsur.2016.08.063","article-title":"Amount of epithelioid differentiation is a predictor of survival in malignant pleural mesothelioma","volume":"103","author":"Vigneswaran","year":"2017","journal-title":"Ann Thorac Surg."},{"key":"2023020912515803400_CIT0011","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jtho.2019.08.2506","article-title":"EURACAN\/IASLC proposals for updating the histologic classification of pleural mesothelioma: towards a more multidisciplinary approach","volume":"15","author":"Nicholson","year":"2020","journal-title":"J Thorac Oncol."},{"key":"2023020912515803400_CIT0012","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1097\/JTO.0b013e3182208e3f","article-title":"Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the International Association for the Study of Lung Cancer International Staging Committee and the International Mesothelioma Interest Group","volume":"6","author":"Rice","year":"2011","journal-title":"J Thorac Oncol."},{"key":"2023020912515803400_CIT0013","doi-asserted-by":"crossref","first-page":"747","DOI":"10.5858\/arpa.2017-0295-OA","article-title":"Reproducibility of malignant pleural mesothelioma histopathologic subtyping","volume":"142","author":"Brcic","year":"2018","journal-title":"Arch Pathol Lab Med."},{"key":"2023020912515803400_CIT0014","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1097\/PAS.0000000000001416","article-title":"Utility of nuclear grading system in epithelioid malignant pleural mesothelioma in biopsy-heavy setting: an external validation study of 563 cases","volume":"44","author":"Zhang","year":"2020","journal-title":"Am J Surg Pathol."},{"key":"2023020912515803400_CIT0015","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics."},{"key":"2023020912515803400_CIT0016","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1111\/his.13392","article-title":"The epithelioid BAP1-negative and p16-positive phenotype predicts prolonged survival in pleural mesothelioma","volume":"72","author":"Chou","year":"2018","journal-title":"Histopathology."},{"key":"2023020912515803400_CIT0017","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2217\/fon.15.317","article-title":"Biomarkers and prognostic factors for malignant pleural mesothelioma","volume":"11","author":"Vigneri","year":"2015","journal-title":"Future Oncol."},{"key":"2023020912515803400_CIT0018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.humpath.2017.04.032","article-title":"Expression of ALCAM (CD166) and PD-L1 (CD274) independently predicts shorter survival in malignant pleural mesothelioma","volume":"71","author":"Inaguma","year":"2018","journal-title":"Hum Pathol."},{"key":"2023020912515803400_CIT0019","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/ajco.12788","article-title":"PD-L1 expression associated with worse survival outcome in malignant pleural mesothelioma","volume":"14","author":"Nguyen","year":"2018","journal-title":"Asia Pac J Clin Oncol."},{"key":"2023020912515803400_CIT0020","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s12253-013-9677-2","article-title":"BAP1 protein is a progression factor in malignant pleural mesothelioma","volume":"20","author":"Arzt","year":"2014","journal-title":"Pathol Oncol Res."},{"key":"2023020912515803400_CIT0021","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/carcin\/bgu227","article-title":"Mesothelioma patients with germline BAP1 mutations have 7-fold improved long-term survival","volume":"36","author":"Baumann","year":"2015","journal-title":"Carcinogenesis."},{"key":"2023020912515803400_CIT0022","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/modpathol.2015.121","article-title":"The prognostic significance of BAP1, NF2, and CDKN2A in malignant peritoneal mesothelioma","volume":"29","author":"Singhi","year":"2016","journal-title":"Mod Pathol."},{"key":"2023020912515803400_CIT0023","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s00428-008-0689-3","article-title":"Prognostic significance of p16\/cdkn2a loss in pleural malignant mesotheliomas","volume":"453","author":"Dacic","year":"2008","journal-title":"Virchows Arch."},{"key":"2023020912515803400_CIT0024","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.lungcan.2016.07.011","article-title":"Low homozygous\/high heterozygous deletion status by p16 FISH correlates with a better prognostic group than high homozygous deletion status in malignant pleural mesothelioma","volume":"99","author":"Hamasaki","year":"2016","journal-title":"Lung Cancer."},{"key":"2023020912515803400_CIT0025","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s00428-017-2109-z","article-title":"Histopathologic features predict survival in diffuse pleural malignant mesothelioma on pleural biopsies","volume":"470","author":"Habougit","year":"2017","journal-title":"Virchows Arch."},{"key":"2023020912515803400_CIT0026","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.athoracsur.2017.09.036","article-title":"National trends in the epidemiology of malignant pleural mesothelioma: a National Cancer Data Base study","volume":"105","author":"Saddoughi","year":"2018","journal-title":"Ann Thorac Surg."},{"key":"2023020912515803400_CIT0027","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s00428-014-1664-9","article-title":"Reproducibility of histological subtyping of malignant pleural mesothelioma","volume":"465","author":"Brc\u030cic\u0301","year":"2014","journal-title":"Virchows Arch."},{"key":"2023020912515803400_CIT0028","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1016\/j.athoracsur.2004.05.007","article-title":"Pleural biopsy: a reliable method for determining the diagnosis but not subtype in mesothelioma","volume":"78","author":"Bueno","year":"2004","journal-title":"Ann Thorac Surg."},{"key":"2023020912515803400_CIT0029","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1097\/JTO.0b013e31820ce2c7","article-title":"Accuracy of diagnostic biopsy for the histological subtype of malignant pleural mesothelioma","volume":"6","author":"Kao","year":"2011","journal-title":"J Thorac Oncol."},{"key":"2023020912515803400_CIT0030","doi-asserted-by":"crossref","first-page":"4164","DOI":"10.1002\/cncr.32416","article-title":"Diagnostic value of biopsy sampling in predicting histology in patients with diffuse malignant pleural mesothelioma","volume":"125","author":"Chirieac","year":"2019","journal-title":"Cancer."},{"key":"2023020912515803400_CIT0031","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.jtho.2018.04.023","article-title":"New insights on diagnostic reproducibility of biphasic mesotheliomas: a multi-institutional evaluation by the International Mesothelioma Panel from the MESOPATH Reference Center","volume":"13","author":"Galateau Salle","year":"2018","journal-title":"J Thorac Oncol."},{"key":"2023020912515803400_CIT0032","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1038\/s41379-019-0320-y","article-title":"Interobserver variation in the assessment of the sarcomatoid and transitional components in biphasic mesotheliomas","volume":"33","author":"Dacic","year":"2020","journal-title":"Mod Pathol."},{"key":"2023020912515803400_CIT0033","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.lungcan.2018.07.041","article-title":"Highlights of the 14th International Mesothelioma Interest Group meeting: pathologic separation of benign from malignant mesothelial proliferations and histologic\/molecular analysis of malignant mesothelioma subtypes","volume":"124","author":"Churg","year":"2018","journal-title":"Lung Cancer."},{"key":"2023020912515803400_CIT0034","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.jtho.2018.07.002","article-title":"Pathologic grading of malignant pleural mesothelioma: an evidence-based proposal","volume":"13","author":"Pelosi","year":"2018","journal-title":"J Thorac Oncol."},{"key":"2023020912515803400_CIT0035","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/j.1365-2559.2008.03099.x","article-title":"The comparative accuracy of different pleural biopsy techniques in the diagnosis of malignant mesothelioma","volume":"53","author":"Attanoos","year":"2008","journal-title":"Histopathology."}],"container-title":["American Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/156\/6\/989\/49137549\/aqab054.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/156\/6\/989\/49137549\/aqab054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T14:41:50Z","timestamp":1675953710000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajcp\/article\/156\/6\/989\/6274463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,12]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,5,12]]},"published-print":{"date-parts":[[2021,11,8]]}},"URL":"https:\/\/doi.org\/10.1093\/ajcp\/aqab054","relation":{},"ISSN":["0002-9173","1943-7722"],"issn-type":[{"value":"0002-9173","type":"print"},{"value":"1943-7722","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,12,1]]},"published":{"date-parts":[[2021,5,12]]}}}