{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:06:27Z","timestamp":1780063587074,"version":"3.54.0"},"reference-count":52,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Although headgear is rarely used in adult patients, its use in adults is mainly for anchorage control. In the current case report, a 24-year-old patient had a skeletal Class I relationship with a Class II tendency, brachyfacial pattern, significant facial asymmetry, and dental 3\/4 cusp Class II molar and canine relationships on both sides. The patient declined surgery, and facial asymmetry was not his concern. The final treatment goal was to achieve a stable Class I dental relationship and normal occlusion without significantly compromising the patient's profile. The patient was compliant with the use of cervical-pull headgear after he refused the options of orthodontic-orthognathic combined treatment, maxillary premolar extraction, or temporary skeletal anchorage mini-implants. A 5-mm maxillary arch distal movement was accomplished without significant distal tipping of the molar crowns. The active treatment duration was 31 months. Proper overbite and overjet, balanced occlusion, and an acceptable facial profile were achieved. The treatment results inspire reconsideration of the possibility of using headgear in dental Class II correction in adult patients.<\/jats:p>","DOI":"10.2319\/010320-857.1","type":"journal-article","created":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T17:21:55Z","timestamp":1604337715000},"page":"267-278","source":"Crossref","is-referenced-by-count":11,"title":["Total maxillary arch distalization by using headgear in an adult patient:"],"prefix":"10.2319","volume":"91","author":[{"given":"Chenshuang","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Sfogliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlu","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haofu","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Hsi","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-91-2-267-b01","series-title":"Dental Press J Orthod","article-title":"Global distribution of malocclusion traits: a systematic review","author":"Alhammadi","year":"2018","unstructured":"Alhammadi\n              MS,\n            \n            \n              Halboub\n              E,\n            \n            \n              Fayed\n              MS,\n            \n            \n              Labib\n              A,\n            \n            \n              El-Saaidi\n              C.\n            \n          \n          Global distribution of malocclusion traits: a systematic review.\n\t\t\t\t\tDental Press J Orthod.\n\t\t\t\t\t2018;\n\t\t\t\t\t23:40 e41\u201340 e10."},{"key":"i0003-3219-91-2-267-b02","series-title":"Angle Orthod","first-page":"177","article-title":"Components of Class II malocclusion in children 8-10 years of age","volume":"51","author":"McNamara","year":"1981","unstructured":"McNamara\n              JA\n              Jr.\n            \n          \n          Components of Class II malocclusion in children 8-10 years of age.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t1981;\n\t\t\t\t\t51:\n\t\t\t\t\t177\u2013\n\t\t\t\t\t202."},{"key":"i0003-3219-91-2-267-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"502","article-title":"Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition","volume":"111","author":"Baccetti","year":"1997","unstructured":"Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              McNamara\n              JA\n              Jr,\n            \n            \n              Tollaro\n              I.\n            \n          \n          Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t1997;\n\t\t\t\t\t111:\n\t\t\t\t\t502\u2013\n\t\t\t\t\t509."},{"key":"i0003-3219-91-2-267-b04","series-title":"Semin Orthod","first-page":"222","article-title":"Longitudinal evaluation of growth changes in Class II division 1 subjects","volume":"3","author":"Ngan","year":"1997","unstructured":"Ngan\n              PW,\n            \n            \n              Byczek\n              E,\n            \n            \n              Scheick\n              J.\n            \n          \n          Longitudinal evaluation of growth changes in Class II division 1 subjects.\n\t\t\t\t\tSemin Orthod.\n\t\t\t\t\t1997;\n\t\t\t\t\t3:\n\t\t\t\t\t222\u2013\n\t\t\t\t\t231."},{"key":"i0003-3219-91-2-267-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"661","article-title":"Mandibular changes in persons with untreated and treated Class II division 1 malocclusion","volume":"113","author":"Bishara","year":"1998","unstructured":"Bishara\n              SE.\n            \n      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surgery\u2014a cephalometric study to evaluate various therapeutic effects","volume":"70","author":"Kinzinger","year":"2009","unstructured":"Kinzinger\n              G,\n            \n            \n              Frye\n              L,\n            \n            \n              Diedrich\n              P.\n            \n          \n          Class II treatment in adults: comparing camouflage orthodontics, dentofacial orthopedics and orthognathic surgery\u2014a cephalometric study to evaluate various therapeutic effects.\n\t\t\t\t\tJ Orofac Orthop.\n\t\t\t\t\t2009;\n\t\t\t\t\t70:\n\t\t\t\t\t63\u2013\n\t\t\t\t\t91."},{"key":"i0003-3219-91-2-267-b08","series-title":"Am J Orthod Dentofacial Orthop","first-page":"593","article-title":"Treatment effects and anchorage potential of sliding mechanics with titanium screws compared with the Tweed-Merrifield technique","volume":"133","author":"Park","year":"2008","unstructured":"Park\n              HS,\n            \n            \n              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Orthop","first-page":"583","article-title":"Camouflage of a high-angle skeletal Class II open-bite malocclusion in an adult after mini-implant failure during treatment","volume":"151","author":"Franzotti","year":"2017","unstructured":"Franzotti\n              Sant'Anna E,\n            \n            \n              Carneiro da Cunha\n              A,\n            \n            \n              Paludo\n              Brunetto D,\n            \n            \n              Franzotti Sant'Anna\n              C.\n            \n          \n          Camouflage of a high-angle skeletal Class II open-bite malocclusion in an adult after mini-implant failure during treatment.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2017;\n\t\t\t\t\t151:\n\t\t\t\t\t583\u2013\n\t\t\t\t\t597."},{"key":"i0003-3219-91-2-267-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"30","article-title":"Comparison of rate of canine retraction with conventional molar anchorage and titanium implant anchorage","volume":"134","author":"Thiruvenkatachari","year":"2008","unstructured":"Thiruvenkatachari\n              B,\n            \n            \n              Ammayappan\n              P,\n            \n            \n              Kandaswamy\n              R.\n            \n          \n          Comparison of rate of canine retraction with conventional molar anchorage and titanium implant anchorage.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2008;\n\t\t\t\t\t134:\n\t\t\t\t\t30\u2013\n\t\t\t\t\t35."},{"key":"i0003-3219-91-2-267-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"315","article-title":"A cephalometric appraisal of edgewise Class II nonextraction treatment with extraoral force","volume":"93","author":"Cangialosi","year":"1988","unstructured":"Cangialosi\n              TJ,\n            \n            \n              Meistrell\n              ME\n              Jr,\n            \n            \n              Leung\n              MA,\n            \n 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anchorage control: cephalometric comparisons of treatment changes","volume":"144","author":"Lee","year":"2013","unstructured":"Lee\n              J,\n            \n            \n              Miyazawa\n              K,\n            \n            \n              Tabuchi\n              M,\n            \n            \n              Kawaguchi\n              M,\n            \n            \n              Shibata\n              M,\n            \n            \n              Goto\n              S.\n            \n          \n          Midpalatal miniscrews and high-pull headgear for anteroposterior and vertical anchorage control: cephalometric comparisons of treatment changes.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2013;\n\t\t\t\t\t144:\n\t\t\t\t\t238\u2013\n\t\t\t\t\t250."},{"key":"i0003-3219-91-2-267-b17","series-title":"Am J Orthod Dentofacial Orthop","first-page":"465","article-title":"Differences of treatment outcomes between self-ligating brackets with microimplant and headgear anchorages in adults with bimaxillary protrusion","volume":"147","author":"Chen","year":"2015","unstructured":"Chen\n              M,\n            \n            \n              Li\n              ZM,\n            \n            \n              Liu\n              X,\n            \n            \n              Cai\n              B,\n            \n            \n              Wang\n              DW,\n            \n            \n              Feng\n              ZC.\n            \n          \n          Differences of treatment outcomes between self-ligating brackets with microimplant and headgear anchorages in adults with bimaxillary protrusion.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2015;\n\t\t\t\t\t147:\n\t\t\t\t\t465\u2013\n\t\t\t\t\t471."},{"key":"i0003-3219-91-2-267-b18","series-title":"Am J Orthod Dentofacial Orthop","first-page":"105","article-title":"Is traditional treatment a good option for an adult with a Class II deepbite malocclusion?","volume":"141","author":"Abdo Quintao","year":"2012","unstructured":"Abdo Quintao\n              CC,\n            \n            \n              Miguel\n              JA,\n            \n            \n              Brunharo\n              IP,\n            \n            \n              Zanardi\n              G,\n            \n            \n              Feu\n              D.\n            \n          \n          Is traditional treatment a good option for an adult with a Class II deepbite malocclusion?\n          \n            Am J Orthod Dentofacial Orthop\n          .\n\t\t\t\t\t2012;\n\t\t\t\t\t141:\n\t\t\t\t\t105\u2013\n\t\t\t\t\t112."},{"key":"i0003-3219-91-2-267-b19","series-title":"Am J Orthod Dentofacial Orthop","first-page":"75","article-title":"Orthodontic correction of an adult Angle Class II Division 2 deep bite","volume":"116","author":"Vaughan","year":"1999","unstructured":"Vaughan\n              JL.\n            \n          \n          Orthodontic correction of an adult Angle Class II Division 2 deep bite.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t1999;\n\t\t\t\t\t116:\n\t\t\t\t\t75\u2013\n\t\t\t\t\t81."},{"key":"i0003-3219-91-2-267-b20","series-title":"Am J Orthod Dentofacial Orthop","first-page":"S121","article-title":"Treatment of severe Class II Division 1 deep overbite malocclusion without extractions in an adult","volume":"133","author":"Horiuchi","year":"2008","unstructured":"Horiuchi\n              Y,\n            \n            \n              Horiuchi\n              M,\n            \n            \n              Soma\n              K.\n            \n          \n          Treatment of severe Class II Division 1 deep overbite malocclusion without extractions in an adult.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2008;\n\t\t\t\t\t133:\n\t\t\t\t\tS121\u2013\n\t\t\t\t\tS129."},{"key":"i0003-3219-91-2-267-b21","series-title":"Korean J Orthod","first-page":"375","article-title":"Comparison of treatment effects between the modified C-palatal plate and cervical pull headgear for total arch distalization in adults","volume":"47","author":"Park","year":"2017","unstructured":"Park\n              CO,\n            \n            \n              Sa'aed\n              NL,\n            \n            \n              Bayome\n              M,\n            \n            et al.\n          \n          Comparison of treatment effects between the modified C-palatal plate and cervical pull headgear for total arch distalization in adults.\n\t\t\t\t\tKorean J Orthod.\n\t\t\t\t\t2017;\n\t\t\t\t\t47:\n\t\t\t\t\t375\u2013\n\t\t\t\t\t383."},{"key":"i0003-3219-91-2-267-b22","series-title":"Am J Orthod Oral Surg","first-page":"22","article-title":"Indications for the extraction of teeth in orthodontic procedure","volume":"42","author":"Tweed","year":"1944","unstructured":"Tweed\n              CH.\n            \n          \n          Indications for the extraction of teeth in orthodontic procedure.\n\t\t\t\t\tAm J Orthod Oral Surg.\n\t\t\t\t\t1944;\n\t\t\t\t\t42:\n\t\t\t\t\t22\u2013\n\t\t\t\t\t45."},{"key":"i0003-3219-91-2-267-b23","series-title":"Am J Orthod Dentofacial Orthop","first-page":"316","article-title":"Extraction of maxillary first permanent molars in patients with Class II Division 1 malocclusion","volume":"132","author":"Stalpers","year":"2007","unstructured":"Stalpers\n              MJ,\n            \n            \n              Booij\n              JW,\n            \n            \n              Bronkhorst\n              EM,\n            \n            \n              Kuijpers-Jagtman\n              AM,\n            \n            \n              Katsaros\n              C.\n            \n          \n          Extraction of maxillary first permanent molars in patients with Class II Division 1 malocclusion.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2007;\n\t\t\t\t\t132:\n\t\t\t\t\t316\u2013\n\t\t\t\t\t323."},{"key":"i0003-3219-91-2-267-b24","series-title":"Am J Orthod Dentofacial Orthop","first-page":"608","article-title":"Cephalometric comparison of maxillary second molar extraction and nonextraction treatments in patients with Class II malocclusions","volume":"120","author":"Waters","year":"2001","unstructured":"Waters\n              D,\n            \n            \n              Harris\n              EF.\n            \n          \n          Cephalometric comparison of maxillary second molar extraction and nonextraction treatments in patients with Class II malocclusions.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2001;\n\t\t\t\t\t120:\n\t\t\t\t\t608\u2013\n\t\t\t\t\t613."},{"key":"i0003-3219-91-2-267-b25","series-title":"Am J Orthod Dentofacial Orthop","first-page":"467","article-title":"Long- and short-term effects of headgear traction with and without the maxillary second molars","volume":"146","author":"Shpack","year":"2014","unstructured":"Shpack\n              N,\n            \n            \n              Brosh\n              T,\n            \n 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          Halboub\n              E,\n            \n            \n              Fayed\n              MS,\n            \n            \n              Labib\n              A,\n            \n            \n              El-Saaidi\n              C.\n            \n          \n          Global distribution of malocclusion traits: a systematic review.\n\t\t\t\t\tDental Press J Orthod.\n\t\t\t\t\t2018;\n\t\t\t\t\t23:40 e41\u201340 e10."},{"key":"i0003-3219-91-2-267-b02","series-title":"Angle Orthod","first-page":"177","article-title":"Components of Class II malocclusion in children 8-10 years of age","volume":"51","author":"McNamara","year":"1981","unstructured":"McNamara\n              JA\n              Jr.\n            \n          \n          Components of Class II malocclusion in children 8-10 years of age.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t1981;\n\t\t\t\t\t51:\n\t\t\t\t\t177\u2013\n\t\t\t\t\t202."},{"key":"i0003-3219-91-2-267-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"502","article-title":"Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition","volume":"111","author":"Baccetti","year":"1997","unstructured":"Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              McNamara\n              JA\n              Jr,\n            \n            \n              Tollaro\n              I.\n            \n          \n          Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t1997;\n\t\t\t\t\t111:\n\t\t\t\t\t502\u2013\n\t\t\t\t\t509."},{"key":"i0003-3219-91-2-267-b04","series-title":"Semin Orthod","first-page":"222","article-title":"Longitudinal evaluation of growth changes in Class II division 1 subjects","volume":"3","author":"Ngan","year":"1997","unstructured":"Ngan\n              PW,\n            \n            \n              Byczek\n              E,\n            \n            \n              Scheick\n              J.\n            \n          \n          Longitudinal evaluation of growth changes in Class II division 1 subjects.\n\t\t\t\t\tSemin Orthod.\n\t\t\t\t\t1997;\n\t\t\t\t\t3:\n\t\t\t\t\t222\u2013\n\t\t\t\t\t231."},{"key":"i0003-3219-91-2-267-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"661","article-title":"Mandibular changes in persons with untreated and treated Class II division 1 malocclusion","volume":"113","author":"Bishara","year":"1998","unstructured":"Bishara\n              SE.\n            \n          \n          Mandibular changes in persons with untreated and treated Class II division 1 malocclusion.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t1998;\n\t\t\t\t\t113:\n\t\t\t\t\t661\u2013\n\t\t\t\t\t673."},{"key":"i0003-3219-91-2-267-b06","series-title":"Angle Orthod","first-page":"59","article-title":"Soft tissue changes after upper premolar extraction in Class II camouflage therapy","volume":"76","author":"Scott","year":"2006","unstructured":"Scott\n              Conley R,\n            \n            \n              Jernigan\n              C.\n            \n          \n          Soft tissue changes after upper premolar extraction in Class II camouflage therapy.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2006;\n\t\t\t\t\t76:\n\t\t\t\t\t59\u2013\n\t\t\t\t\t65."},{"key":"i0003-3219-91-2-267-b07","series-title":"J Orofac Orthop","first-page":"63","article-title":"Class II treatment in adults: comparing camouflage orthodontics, dentofacial orthopedics and orthognathic surgery\u2014a cephalometric study to evaluate various therapeutic effects","volume":"70","author":"Kinzinger","year":"2009","unstructured":"Kinzinger\n              G,\n            \n            \n              Frye\n              L,\n            \n            \n              Diedrich\n  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          I,\n            \n            \n              List\n              T,\n            \n            \n              Feldmann\n              H,\n            \n            \n              Bondemark\n              L.\n            \n          \n          Pain intensity and discomfort following surgical placement of orthodontic anchoring units and premolar extraction: a randomized controlled trial.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2007;\n\t\t\t\t\t77:\n\t\t\t\t\t578\u2013\n\t\t\t\t\t585."},{"key":"i0003-3219-91-2-267-b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"583","article-title":"Camouflage of a high-angle skeletal Class II open-bite malocclusion in an adult after mini-implant failure during treatment","volume":"151","author":"Franzotti","year":"2017","unstructured":"Franzotti\n              Sant'Anna E,\n            \n            \n              Carneiro da Cunha\n              A,\n            \n            \n              Paludo\n              Brunetto D,\n            \n            \n              Franzotti Sant'Anna\n              C.\n            \n          \n          Camouflage of a high-angle skeletal Class II open-bite malocclusion in an adult after mini-implant failure during treatment.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2017;\n\t\t\t\t\t151:\n\t\t\t\t\t583\u2013\n\t\t\t\t\t597."},{"key":"i0003-3219-91-2-267-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"30","article-title":"Comparison of rate of canine retraction with conventional molar anchorage and titanium implant anchorage","volume":"134","author":"Thiruvenkatachari","year":"2008","unstructured":"Thiruvenkatachari\n              B,\n            \n            \n              Ammayappan\n              P,\n            \n            \n              Kandaswamy\n              R.\n            \n          \n          Comparison of rate of canine retraction with conventional molar anchorage and titanium implant anchorage.\n\t\t\t\t\tAm J 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Class II malocclusion treatment with cervical headgear and mandibular fixed appliances","volume":"30","author":"Freitas","year":"2008","unstructured":"Freitas\n              MR,\n            \n            \n              Lima\n              DV,\n            \n            \n              Freitas\n              KM,\n            \n            \n              Janson\n              G,\n            \n            \n              Henriques\n              JF.\n            \n          \n          Cephalometric evaluation of Class II malocclusion treatment with cervical headgear and mandibular fixed appliances.\n\t\t\t\t\tEur J Orthod.\n\t\t\t\t\t2008;\n\t\t\t\t\t30:\n\t\t\t\t\t477\u2013\n\t\t\t\t\t482."},{"key":"i0003-3219-91-2-267-b15","series-title":"Dental Press J Orthod","first-page":"76","article-title":"Effects of cervical headgear appliance: a systematic review","volume":"20","author":"Henriques","year":"2015","unstructured":"Henriques\n              FP,\n            \n            \n      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Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/91\/2\/article-p267.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/angle-orthodontist\/article-pdf\/91\/2\/267\/2792833\/i0003-3219-91-2-267.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/91\/2\/article-p267.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/91\/2\/article-p267.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T13:17:16Z","timestamp":1780060636000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/91\/2\/article-p267.xml"}},"subtitle":["Reconsidering the traditional strategy in modern orthodontics"],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":52,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.2319\/010320-857.1","relation":{},"ISSN":["0003-3219"],"issn-type":[{"value":"0003-3219","type":"print"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}