{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:42Z","timestamp":1787025762980,"version":"build-2736575974"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This study aimed to clarify the outcomes of postoperative re-irradiation using stereotactic body radiotherapy (SBRT) for metastatic epidural spinal cord compression (MESCC) in the authors\u2019 institution and to identify factors correlated with local control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Cases in which patients with previously irradiated MESCC underwent decompression surgery followed by spine SBRT as re-irradiation between April 2013 and May 2017 were retrospectively reviewed. The surgical procedures were mainly performed by the posterior approach and included decompression and fixation. The prescribed dose for spine SBRT was 24 Gy in 2 fractions. The primary outcome was local control, which was defined as elimination, shrinkage, or no change of the tumor on CT or MRI obtained approximately every 3 months after SBRT. In addition, various patient-, treatment-, and tumor-specific factors were evaluated to determine their predictive value for local control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty-eight cases were identified in the authors\u2019 institutional databases as meeting the inclusion criteria. The histology of the primary disease was thyroid cancer in 7 cases, lung cancer in 6, renal cancer in 3, colorectal cancer in 3, and other cancers in 9. The most common previous radiation dose was 30 Gy in 10 fractions (15 cases). The mean interval since the most recent irradiation was 16 months (range 5\u2013132 months). The median duration of follow-up after SBRT was 13 months (range 4\u201338 months). The 1-year local control rate was 70%. In the analysis of factors related to local control, Bilsky grade, number of vertebral levels in the treatment target, the interval between the latest radiotherapy and SBRT, recursive partitioning analysis (RPA), the prognostic index for spinal metastases (PRISM), and the revised Tokuhashi score were not significantly correlated with local control. The favorable group classified by the Rades prognostic score achieved a significantly higher 1-year local control rate than the unfavorable group (1-year local control rate: 100% vs 33%; p &lt; 0.01). Radiation-induced myelopathy and vertebral compression fracture were observed in 1 and 3 patients, respectively. No other grade 3 or greater toxicities were encountered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The results indicate that spine SBRT as postoperative re-irradiation was effective, and it was especially useful for patients classified as having a good survival prognosis according to the Rades score.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2018.1.spine171155","type":"journal-article","created":{"date-parts":[[2018,6,15]],"date-time":"2018-06-15T10:28:27Z","timestamp":1529058507000},"page":"332-338","source":"Crossref","is-referenced-by-count":27,"title":["Postoperative re-irradiation using stereotactic body radiotherapy for metastatic epidural spinal cord compression"],"prefix":"10.3171","volume":"29","author":[{"given":"Kei","family":"Ito","sequence":"first","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiology, and"},{"name":"Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiji","family":"Nihei","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Shimizuguchi","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohisa","family":"Furuya","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shurei","family":"Sugita","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Hozumi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Keisuke Sasai","sequence":"additional","affiliation":[{"name":"Department of Radiology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuyuki","family":"Karasawa","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Med Phys","doi-asserted-by":"publisher","first-page":"4078","DOI":"10.1118\/1.3438081","article-title":"Stereotactic body radiation therapy: the report of AAPM Task Group 101","volume":"37","author":"Benedict SH","year":"2010","unstructured":"Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, : Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys 37:4078\u20134101, 2010 (Erratum in Med Phys 39:563, 2012)10.1118\/1.343808120879569"},{"key":"b2","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"652","DOI":"10.3171\/2015.6.SPINE15294","article-title":"Patterns of epidural progression following postoperative spine stereotactic body radiotherapy: implications for clinical target volume delineation","volume":"24","author":"Chan MW","year":"2016","unstructured":"Chan MW, Thibault I, Atenafu EG, Yu E, John Cho BC, Letourneau D, : Patterns of epidural progression following postoperative spine stereotactic body radiotherapy: implications for clinical target volume delineation. J Neurosurg Spine 24:652\u2013659, 201610.3171\/2015.6.SPINE1529426682603"},{"key":"b3","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1738","DOI":"10.1016\/j.ijrobp.2011.02.019","article-title":"Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases","volume":"82","author":"Chao ST","year":"2012","unstructured":"Chao ST, Koyfman SA, Woody N, Angelov L, Soeder SL, Reddy CA, : Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases. Int J Radiat Oncol Biol Phys 82:1738\u20131743, 201210.1016\/j.ijrobp.2011.02.01921489717"},{"key":"b4","series-title":"Lancet Oncol","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/S1470-2045(13)70556-4","article-title":"Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial","volume":"15","author":"Chow E","year":"2014","unstructured":"Chow E, van der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JS, : Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial. Lancet Oncol 15:164\u2013171, 20142436911410.1016\/S1470-2045(13)70556-4"},{"key":"b5","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/0360-3016(95)00060-C","article-title":"Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)","volume":"31","author":"Cox JD","year":"1995","unstructured":"Cox JD, Stetz J, Pajak TF: Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341\u20131346, 199510.1016\/0360-3016(95)00060-C7713792"},{"key":"b6","article-title":"Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0","unstructured":"Department of Health and Human Services: Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. (https:\/\/evs.nci.nih.gov\/ftp1\/CTCAE\/CTCAE_4.03\/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf) [Accessed March 14, 2018]"},{"key":"b7","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/S0360-3016(98)00544-6","article-title":"Biophysical characteristics of HIMAC clinical irradiation system for heavy-ion radiation therapy","volume":"44","author":"Kanai T","year":"1999","unstructured":"Kanai T, Endo M, Minohara S, Miyahara N, Koyama-ito H, Tomura H, : Biophysical characteristics of HIMAC clinical irradiation system for heavy-ion radiation therapy. Int J Radiat Oncol Biol Phys 44:201\u2013210, 199910.1016\/S0360-3016(98)00544-610219815"},{"key":"b8","series-title":"Bone Marrow Transplant","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Kanda Y","year":"2013","unstructured":"Kanda Y: Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics. Bone Marrow Transplant 48:452\u2013458, 20132320831310.1038\/bmt.2012.244"},{"key":"b9","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1007\/s007010050199","article-title":"Surgical results for spinal metastases","volume":"140","author":"Klekamp J","year":"1998","unstructured":"Klekamp J, Samii H: Surgical results for spinal metastases. Acta Neurochir (Wien) 140:957\u2013967, 1998984243410.1007\/s007010050199"},{"key":"b10","series-title":"Neuro Oncol","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1215\/S1152851704000262","article-title":"A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease","volume":"7","author":"Klimo P Jr","year":"2005","unstructured":"Klimo P Jr, Thompson CJ, Kestle JR, Schmidt MH: A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol 7:64\u201376, 20051570128310.1215\/S1152851704000262"},{"key":"b11","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1898","DOI":"10.1097\/BRS.0b013e31817c0410","article-title":"Intraoperative radiotherapy combined with posterior decompression and stabilization for non-ambulant paralytic patients due to spinal metastasis","volume":"33","author":"Kondo T","year":"2008","unstructured":"Kondo T, Hozumi T, Goto T, Seichi A, Nakamura K: Intraoperative radiotherapy combined with posterior decompression and stabilization for non-ambulant paralytic patients due to spinal metastasis. Spine (Phila Pa 1976) 33:1898\u20131904, 200810.1097\/BRS.0b013e31817c041018670344"},{"key":"b12","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"207","DOI":"10.3171\/2012.11.SPINE12111","article-title":"Local disease control for spinal metastases following \u201cseparation surgery\u201d and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients","volume":"18","author":"Laufer I","year":"2013","unstructured":"Laufer I, Iorgulescu JB, Chapman T, Lis E, Shi W, Zhang Z, : Local disease control for spinal metastases following \u201cseparation surgery\u201d and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine 18:207\u2013214, 20132333959310.3171\/2012.11.SPINE12111"},{"key":"b13","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/j.ijrobp.2010.11.026","article-title":"Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline","volume":"79","author":"Lutz S","year":"2011","unstructured":"Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, : Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys 79:965\u2013976, 201110.1016\/j.ijrobp.2010.11.02621277118"},{"key":"b14","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3171\/2010.3.SPINE09639","article-title":"Local disease control after decompressive surgery and adjuvant high-dose single-fraction radiosurgery for spine metastases","volume":"13","author":"Moulding HD","year":"2010","unstructured":"Moulding HD, Elder JB, Lis E, Lovelock DM, Zhang Z, Yamada Y, : Local disease control after decompressive surgery and adjuvant high-dose single-fraction radiosurgery for spine metastases. J Neurosurg Spine 13:87\u201393, 201010.3171\/2010.3.SPINE0963920594023"},{"key":"b15","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"428","DOI":"10.3171\/2017.2.SPINE16976","article-title":"Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review","volume":"27","author":"Myrehaug S","year":"2017","unstructured":"Myrehaug S, Sahgal A, Hayashi M, Levivier M, Ma L, Martinez R, : Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review. J Neurosurg Spine 27:428\u2013435, 201710.3171\/2017.2.SPINE1697628708043"},{"key":"b16","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/S0140-6736(05)66954-1","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial","volume":"366","author":"Patchell RA","year":"2005","unstructured":"Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, : Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643\u2013648, 200510.1016\/S0140-6736(05)66954-116112300"},{"key":"b17","series-title":"Lancet Oncol","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/S1470-2045(05)70022-X","article-title":"Malignant spinal-cord compression","volume":"6","author":"Prasad D","year":"2005","unstructured":"Prasad D, Schiff D: Malignant spinal-cord compression. Lancet Oncol 6:15\u201324, 20051562927210.1016\/S1470-2045(05)70022-X"},{"key":"b18","series-title":"Nat Rev Clin Oncol","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1038\/nrclinonc.2010.137","article-title":"The role of radiotherapy for metastatic epidural spinal cord compression","volume":"7","author":"Rades D","year":"2010","unstructured":"Rades D, Abrahm JL: The role of radiotherapy for metastatic epidural spinal cord compression. Nat Rev Clin Oncol 7:590\u2013598, 201010.1038\/nrclinonc.2010.13720808299"},{"key":"b19","series-title":"J Clin Oncol","doi-asserted-by":"publisher","first-page":"3388","DOI":"10.1200\/JCO.2005.05.0542","article-title":"Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression","volume":"24","author":"Rades D","year":"2006","unstructured":"Rades D, Fehlauer F, Schulte R, Veninga T, Stalpers LJ, Basic H, : Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol 24:3388\u20133393, 20061684975210.1200\/JCO.2005.05.0542"},{"key":"b20","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1016\/j.ijrobp.2016.03.027","article-title":"Postoperative stereotactic body radiation therapy (SBRT) for spine metastases: a critical review to guide practice","volume":"95","author":"Redmond KJ","year":"2016","unstructured":"Redmond KJ, Lo SS, Fisher C, Sahgal A: Postoperative stereotactic body radiation therapy (SBRT) for spine metastases: a critical review to guide practice. Int J Radiat Oncol Biol Phys 95:1414\u20131428, 20162747972410.1016\/j.ijrobp.2016.03.027"},{"key":"b21","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.ijrobp.2016.09.014","article-title":"Consensus contouring guidelines for postoperative stereotactic body radiation therapy for metastatic solid tumor malignancies to the spine","volume":"97","author":"Redmond KJ","year":"2017","unstructured":"Redmond KJ, Robertson S, Lo SS, Soltys SG, Ryu S, McNutt T, : Consensus contouring guidelines for postoperative stereotactic body radiation therapy for metastatic solid tumor malignancies to the spine. Int J Radiat Oncol Biol Phys 97:64\u201374, 201710.1016\/j.ijrobp.2016.09.01427843035"},{"key":"b22","series-title":"J Clin Oncol","doi-asserted-by":"publisher","first-page":"3426","DOI":"10.1200\/JCO.2013.50.1411","article-title":"Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score","volume":"31","author":"Sahgal A","year":"2013","unstructured":"Sahgal A, Atenafu EG, Chao S, Al-Omair A, Boehling N, Balagamwala EH, : Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. J Clin Oncol 31:3426\u20133431, 20132396017910.1200\/JCO.2013.50.1411"},{"key":"b23","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.ijrobp.2010.08.021","article-title":"Reirradiation human spinal cord tolerance for stereotactic body radiotherapy","volume":"82","author":"Sahgal A","year":"2012","unstructured":"Sahgal A, Ma L, Weinberg V, Gibbs IC, Chao S, Chang UK, : Reirradiation human spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 82:107\u2013116, 20122095150310.1016\/j.ijrobp.2010.08.021"},{"key":"b24","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.ijrobp.2012.05.007","article-title":"Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice","volume":"85","author":"Sahgal A","year":"2013","unstructured":"Sahgal A, Weinberg V, Ma L, Chang E, Chao S, Muacevic A, : Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys 85:341\u2013347, 201310.1016\/j.ijrobp.2012.05.00722713832"},{"issue":"3","key":"b25","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E12","DOI":"10.3171\/2016.11.FOCUS16348","article-title":"Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors","volume":"42","author":"Stubblefield MD","year":"2017","unstructured":"Stubblefield MD, Ibanez K, Riedel ER, Barzilai O, Laufer I, Lis E, : Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors. Neurosurg Focus 42(3):E12, 201710.3171\/2016.11.FOCUS1634828245730"},{"key":"b26","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.ijrobp.2015.04.050","article-title":"Creation of a prognostic index for spine metastasis to stratify survival in patients treated with spinal stereotactic radiosurgery: secondary analysis of mature prospective trials","volume":"93","author":"Tang C","year":"2015","unstructured":"Tang C, Hess K, Bishop AJ, Pan HY, Christensen EN, Yang JN, : Creation of a prognostic index for spine metastasis to stratify survival in patients treated with spinal stereotactic radiosurgery: secondary analysis of mature prospective trials. Int J Radiat Oncol Biol Phys 93:118\u2013125, 20152613023110.1016\/j.ijrobp.2015.04.050"},{"key":"b27","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/j.ijrobp.2016.03.022","article-title":"Stereotactic body radiation therapy for spinal metastases in the postoperative setting: a secondary analysis of mature phase 1-2 trials","volume":"95","author":"Tao R","year":"2016","unstructured":"Tao R, Bishop AJ, Brownlee Z, Allen PK, Settle SH, Chang EL, : Stereotactic body radiation therapy for spinal metastases in the postoperative setting: a secondary analysis of mature phase 1-2 trials. Int J Radiat Oncol Biol Phys 95:1405\u20131413, 201610.1016\/j.ijrobp.2016.03.02227209509"},{"key":"b28","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1097\/01.brs.0000180401.06919.a5","article-title":"A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis","volume":"30","author":"Tokuhashi Y","year":"2005","unstructured":"Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J: A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 30:2186\u20132191, 20051620534510.1097\/01.brs.0000180401.06919.a5"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/29\/3\/article-p332.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/29\/3\/article-p332.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/29\/3\/article-p332.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T20:15:49Z","timestamp":1681589749000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/29\/3\/article-p332.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9]]},"references-count":28,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2018.1.spine171155","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2018,9]]}}}