{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:37:31Z","timestamp":1792543051645,"version":"4.5.0"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T00:00:00Z","timestamp":1679616000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/ http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Introduction:<\/jats:title>\n            <jats:p>The macrophage activation marker soluble (s)CD163 is associated with disease severity and prognosis in patients with primary biliary cholangitis (PBC). Ursodeoxycholic acid (UDCA) treatment attenuates fibrosis progression in PBC patients, but its effect on macrophage activation is unclear. We examined the effect of UDCA on macrophage activation, as determined by sCD163 levels.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We included 2 cohorts of PBC patients; 1 cohort with prevalent PBC patients, and 1 cohort of incident PBC patients before start of UDCA treatment and with follow-up after 4 weeks and 6 months. We measured sCD163 and liver stiffness in both cohorts. Further, we measured sCD163 and TNF-\u03b1 shedding <jats:italic toggle=\"yes\">in vitro<\/jats:italic> in monocyte-derived macrophages after UDCA and lipopolysaccharide incubation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>We included 100 patients with prevalent PBC [93% women, median age 63\u00a0y (interquartile range: 51\u201370)] and 47 patients with incident PBC [77% women, median age 60\u00a0y (49\u201367)]. Prevalent PBC patients had a lower median sCD163 of 3.54\u00a0mg\/L (2.77\u20134.72) than incident PBC patients with a median sCD163 of 4.33\u00a0mg\/L (2.83\u20135.99) at inclusion. Patients with an incomplete response to UDCA and patients with cirrhosis had higher sCD163 than responders to UDCA and noncirrhosis patients. After 4 weeks and 6 months of UDCA treatment median sCD163 decreased by 4.6% and 9.0%, respectively. In <jats:italic toggle=\"yes\">in vitro<\/jats:italic> experiments, UDCA attenuated shedding of TNF-\u03b1, but not sCD163, from monocyte-derived macrophages.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>In PBC patients, sCD163 levels correlated with liver disease severity and treatment response to UDCA. Further, after 6 months of UDCA treatment, we observed a decrease in sCD163, which may be related to the treatment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/hc9.0000000000000068","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T19:01:35Z","timestamp":1679943695000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["The association between soluble CD163, disease severity, and ursodiol treatment in patients with primary biliary cholangitis"],"prefix":"10.1097","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4641-4500","authenticated-orcid":false,"given":"Lars","family":"Bossen","sequence":"first","affiliation":[{"name":"Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1354-9601","authenticated-orcid":false,"given":"Tobias Stemann","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8974-6869","authenticated-orcid":false,"given":"Mette Bak","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2008-4224","authenticated-orcid":false,"given":"Marlene Christina","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid H\u00f8jmark","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3088-1983","authenticated-orcid":false,"given":"Peter","family":"Ott","sequence":"additional","affiliation":[{"name":"Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Becker","sequence":"additional","affiliation":[{"name":"Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8247-8766","authenticated-orcid":false,"given":"Henning","family":"Glerup","sequence":"additional","affiliation":[{"name":"Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise","family":"Svenningsen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Eivindson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3456-2485","authenticated-orcid":false,"given":"Linda","family":"Kornerup","sequence":"additional","affiliation":[{"name":"Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark"},{"name":"Department of Internal Medicine, Herning Regional Hospital, Herning, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels Bj\u00f8rndal","family":"Kjeldsen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5563-1200","authenticated-orcid":false,"given":"Anders","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7687-5995","authenticated-orcid":false,"given":"Holger Jon","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-1430","authenticated-orcid":false,"given":"Peter","family":"Jepsen","sequence":"additional","affiliation":[{"name":"Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8998-7910","authenticated-orcid":false,"given":"Henning","family":"Gr\u00f8nb\u00e6k","sequence":"additional","affiliation":[{"name":"Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,4]]},"reference":[{"key":"R1-20240826","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/S0140-6736(15)00154-3","article-title":"Primary biliary cirrhosis","volume":"386","author":"Carey","year":"2015","journal-title":"Lancet"},{"key":"R2-20240826","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jhep.2017.03.022","article-title":"EASL Clinical Practice Guidelines: the diagnosis and management of patients with primary biliary cholangitis","volume":"67","year":"2017","journal-title":"J Hepatol"},{"key":"R3-20240826","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1002\/hep.23783","article-title":"Biliary apotopes and anti-mitochondrial antibodies activate innate immune responses in primary biliary cirrhosis","volume":"52","author":"Lleo","year":"2010","journal-title":"Hepatology"},{"key":"R4-20240826","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1146\/annurev-pathol-020712-164014","article-title":"The immunobiology and pathophysiology of primary biliary cirrhosis","volume":"8","author":"Hirschfield","year":"2013","journal-title":"Annu Rev Pathol"},{"key":"R5-20240826","doi-asserted-by":"crossref","first-page":"7","DOI":"10.2152\/jmi.64.7","article-title":"Primary biliary cholangitis: its pathological characteristics and immunopathological mechanisms","volume":"64","author":"Tsuneyama","year":"2017","journal-title":"J Med Invest"},{"key":"R6-20240826","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41395-018-0390-3","article-title":"Diagnosis and management of primary biliary cholangitis","volume":"114","author":"Younossi","year":"2019","journal-title":"Am J Gastroenterol"},{"key":"R7-20240826","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1038\/s41575-019-0226-7","article-title":"Primary biliary cholangitis: pathogenesis and therapeutic opportunities","volume":"17","author":"Gulamhusein","year":"2020","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"R8-20240826","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.bpg.2018.05.008","article-title":"Evolution of our understanding of PBC","volume":"34\u201335","author":"Tanaka","year":"2018","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"R9-20240826","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/0090-1229(86)90049-8","article-title":"In situ characterization of the cell-surface antigens of the mononuclear cell infiltrate and bile duct epithelium in primary biliary cirrhosis","volume":"41","author":"Colucci","year":"1986","journal-title":"Clin Immunol Immunopathol"},{"key":"R10-20240826","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/00365513.2011.626868","article-title":"Soluble CD163","volume":"72","author":"Moller","year":"2012","journal-title":"Scand J Clin Lab Invest"},{"key":"R11-20240826","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1038\/35051594","article-title":"Identification of the haemoglobin scavenger receptor","volume":"409","author":"Kristiansen","year":"2001","journal-title":"Nature"},{"key":"R12-20240826","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1002\/hep.27129","article-title":"Soluble CD163, a macrophage activation marker, is independently associated with fibrosis in patients with chronic viral hepatitis B and C","volume":"60","author":"Kazankov","year":"2014","journal-title":"Hepatology"},{"key":"R13-20240826","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/ijpo.252","article-title":"The macrophage activation marker sCD163 is associated with changes in NAFLD and metabolic profile during lifestyle intervention in obese children","volume":"10","author":"Kazankov","year":"2015","journal-title":"Pediatr Obes"},{"key":"R14-20240826","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1111\/jgh.12943","article-title":"Macrophage activation marker soluble CD163 and non-alcoholic fatty liver disease in morbidly obese patients undergoing bariatric surgery","volume":"30","author":"Kazankov","year":"2015","journal-title":"J Gastroenterol Hepatol"},{"key":"R15-20240826","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1038\/ajg.2014.262","article-title":"Hepatic macrophage activation and the LPS pathway in patients with alcoholic hepatitis: a prospective cohort study","volume":"109","author":"Sandahl","year":"2014","journal-title":"Am J Gastroenterol"},{"key":"R16-20240826","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1136\/gut.2010.234542","article-title":"Kupffer cells are activated in cirrhotic portal hypertension and not normalised by TIPS","volume":"60","author":"Holland-Fischer","year":"2011","journal-title":"Gut"},{"key":"R17-20240826","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/j.1365-2036.2012.05134.x","article-title":"Soluble CD163, a marker of Kupffer cell activation, is related to portal hypertension in patients with liver cirrhosis","volume":"36","author":"Gronbaek","year":"2012","journal-title":"Aliment Pharmacol Ther"},{"key":"R18-20240826","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.jhep.2015.11.021","article-title":"Macrophage activation markers predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure (ACLF)","volume":"64","author":"Gronbaek","year":"2016","journal-title":"J Hepatol"},{"key":"R19-20240826","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1111\/apt.13801","article-title":"Single-centre experience of the macrophage activation marker soluble (s)CD163 - associations with disease activity and treatment response in patients with autoimmune hepatitis","volume":"44","author":"Gronbaek","year":"2016","journal-title":"Aliment Pharmacol Ther"},{"key":"R20-20240826","doi-asserted-by":"crossref","first-page":"e00315","DOI":"10.14309\/ctg.0000000000000315","article-title":"Circulating macrophage activation markers predict transplant-free survival in patients with primary sclerosing cholangitis","volume":"12","author":"Bossen","year":"2021","journal-title":"Clin Transl Gastroenterol"},{"key":"R21-20240826","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/jgh.13849","article-title":"Soluble CD163 and mannose receptor associate with chronic hepatitis B activity and fibrosis and decline with treatment","volume":"33","author":"Laursen","year":"2018","journal-title":"J Gastroenterol Hepatol"},{"key":"R22-20240826","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00365521.2018.1481996","article-title":"Rapid and persistent decline in soluble CD163 with successful direct-acting antiviral therapy and associations with chronic hepatitis C histology","volume":"53","author":"Lund Laursen","year":"2018","journal-title":"Scand J Gastroenterol"},{"key":"R23-20240826","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1111\/liv.14466","article-title":"Soluble CD163 and mannose receptor as markers of liver disease severity and prognosis in patients with primary biliary cholangitis","volume":"40","author":"Bossen","year":"2020","journal-title":"Liver Int"},{"issue":"suppl 1","key":"R24-20240826","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/S2210-7401(12)70015-3","article-title":"Ursodeoxycholic acid and bile-acid mimetics as therapeutic agents for cholestatic liver diseases: an overview of their mechanisms of action","volume":"36","author":"Poupon","year":"2012","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"R25-20240826","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1002\/hep.30145","article-title":"Primary biliary cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases","volume":"69","author":"Lindor","year":"2019","journal-title":"Hepatology"},{"key":"R26-20240826","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/003655102760145852","article-title":"Characterization of an enzyme-linked immunosorbent assay for soluble CD163","volume":"62","author":"Moller","year":"2002","journal-title":"Scand J Clin Lab Invest"},{"key":"R27-20240826","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/00365510310000439","article-title":"Biological variation of soluble CD163","volume":"63","author":"Moller","year":"2003","journal-title":"Scand J Clin Lab Invest"},{"key":"R28-20240826","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1002\/hep.25599","article-title":"Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis","volume":"56","author":"Corpechot","year":"2012","journal-title":"Hepatology"},{"key":"R29-20240826","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1002\/hep.31810","article-title":"Accuracy of transient elastography in assessing fibrosis at diagnosis in naive patients with primary biliary cholangitis: a dual cut-off approach","volume":"74","author":"Cristoferi","year":"2021","journal-title":"Hepatology"},{"key":"R30-20240826","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.jhep.2021.12.022","article-title":"Renewing consensus in portal hypertension","volume":"76","author":"de Franchis","year":"2022","journal-title":"J Hepatol"},{"key":"R31-20240826","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1056\/NEJMoa1509840","article-title":"A placebo-controlled trial of obeticholic acid in primary biliary cholangitis","volume":"375","author":"Nevens","year":"2016","journal-title":"N Engl J Med"},{"key":"R32-20240826","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/BF00432479","article-title":"Staging of chronic nonsuppurative destructive cholangitis (syndrome of primary biliary cirrhosis)","volume":"379","author":"Ludwig","year":"1978","journal-title":"Virchows Arch A Pathol Anat Histol"},{"key":"R33-20240826","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1074\/jbc.M113.520213","article-title":"Structural basis for inflammation-driven shedding of CD163 ectodomain and tumor necrosis factor-alpha in macrophages","volume":"289","author":"Etzerodt","year":"2014","journal-title":"J Biol Chem"},{"key":"R34-20240826","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/1471-230X-13-155","article-title":"Liver protective effect of ursodeoxycholic acid includes regulation of ADAM17 activity","volume":"13","author":"Buryova","year":"2013","journal-title":"BMC Gastroenterol"},{"key":"R35-20240826","doi-asserted-by":"crossref","first-page":"e0189345","DOI":"10.1371\/journal.pone.0189345","article-title":"The soluble mannose receptor (sMR) is elevated in alcoholic liver disease and associated with disease severity, portal hypertension, and mortality in cirrhosis patients","volume":"12","author":"Sandahl","year":"2017","journal-title":"PLoS One"},{"key":"R36-20240826","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.jhep.2020.07.033","article-title":"Macrophage markers and innate immunity in cirrhosis","volume":"73","author":"Gronbaek","year":"2020","journal-title":"J Hepatol"},{"key":"R37-20240826","doi-asserted-by":"crossref","first-page":"9814","DOI":"10.3390\/ijms23179814","article-title":"Macrophage activation markers predict liver-related complications in primary biliary cholangitis","volume":"23","author":"Fujinaga","year":"2022","journal-title":"Int J Mol Sci"},{"key":"R38-20240826","doi-asserted-by":"crossref","first-page":"615599","DOI":"10.3389\/fmed.2020.615599","article-title":"Macrophage activation markers, soluble CD163 and mannose receptor, in liver fibrosis","volume":"7","author":"Gantzel","year":"2020","journal-title":"Front Med (Lausanne)"},{"key":"R39-20240826","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1046\/j.1440-1746.2002.02672.x","article-title":"Tumor necrosis factor-alpha and transforming growth factor-beta reflect severity of liver damage in primary biliary cirrhosis","volume":"17","author":"Neuman","year":"2002","journal-title":"J Gastroenterol Hepatol"},{"key":"R40-20240826","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1002\/hep.1840160213","article-title":"Immunomodulatory effects of ursodeoxycholic acid on immune responses","volume":"16","author":"Yoshikawa","year":"1992","journal-title":"Hepatology"},{"key":"R41-20240826","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.ejphar.2007.08.031","article-title":"Ursodeoxycholic acid protects concanavalin A-induced mouse liver injury through inhibition of intrahepatic tumor necrosis factor-alpha and macrophage inflammatory protein-2 production","volume":"578","author":"Ishizaki","year":"2008","journal-title":"Eur J Pharmacol"},{"key":"R42-20240826","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1189\/jlb.0410235","article-title":"Tumor necrosis factor alpha-converting enzyme (TACE\/ADAM17) mediates ectodomain shedding of the scavenger receptor CD163","volume":"88","author":"Etzerodt","year":"2010","journal-title":"J Leukoc Biol"},{"key":"R43-20240826","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1530\/EC-17-0296","article-title":"Macrophage activation marker sCD163 correlates with accelerated lipolysis following LPS exposure: a human-randomised clinical trial","volume":"7","author":"Rittig","year":"2018","journal-title":"Endocr Connect"},{"key":"R44-20240826","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/jdi.12869","article-title":"Soluble CD163 correlates with lipid metabolic adaptations in type 1 diabetes patients during ketoacidosis","volume":"10","author":"Svart","year":"2019","journal-title":"J Diabetes Investig"},{"key":"R45-20240826","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.dld.2016.05.023","article-title":"Toward precision medicine in primary biliary cholangitis","volume":"48","author":"Carbone","year":"2016","journal-title":"Dig Liver Dis"},{"key":"R46-20240826","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.autrev.2018.02.013","article-title":"Support of precision medicine through risk-stratification in autoimmune liver diseases\u2014histology, scoring systems, and non-invasive markers","volume":"17","author":"Bossen","year":"2018","journal-title":"Autoimmun Rev"},{"key":"R47-20240826","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/S2468-1253(18)30163-8","article-title":"Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score","volume":"3","author":"Carbone","year":"2018","journal-title":"Lancet Gastroenterol Hepatol"}],"container-title":["Hepatology Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/HC9.0000000000000068","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T15:07:10Z","timestamp":1724684830000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/HC9.0000000000000068"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,24]]},"references-count":47,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/hc9.0000000000000068","relation":{},"ISSN":["2471-254X"],"issn-type":[{"value":"2471-254X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,24]]},"assertion":[{"value":"2022-07-22","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}