{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:16:08Z","timestamp":1786738568913,"version":"build-2736575974"},"reference-count":53,"publisher":"SAGE Publications","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["THC"],"published-print":{"date-parts":[[2023,11,16]]},"abstract":"<jats:p>BACKGROUND: Currently, the frequency of coagulation dysfunction associated with chimeric antigen receptor-T cell (Car-T) therapy cannot yet be determined. OBJECTIVE: We performed a systematic review and meta-analysis to examine the prevalence of abnormal laboratory tests related to coagulation disorders in patients receiving Car-T therapy and provide a reference for future risk assessment mechanisms. METHODS: We searched PubMed, Embase, and Web of Science for relevant studies and evaluated their quality using the methodology index of non-random research (MINORS). 2672 quotations were retrieved via systematic searches. After screening of titles, abstracts and full-text, 45 trials involving 2541 patients were ultimately included. 41 studies reported the incidence of thrombocytopenia, 8 studies reported the rate of low fibrin, 4 trials reported the rate of APTT or PT abnormalities and only 3 trials reported the incidence of venous thromboembolism (VTE). We performed a quantitative meta-analysis to explore the incidence of thrombocytopenia following Car-T treatment. The incidence of hypofibrinogenemia, VTE, and abnormal APTT or PT was only qualitatively assessed, as fewer reports were included in this study. RESULTS: The overall incidence of thrombocytopenia associated with Car-T therapy was 45.8% (95%[CI], 0.384\u20130.533). The highest rates of thrombocytopenia occurred in patients with multiple myeloma (60.1%, 95%[CI], 0.507\u20130.688) and aged between 18 to 60 (50%, 95%[CI], 0.367\u20130.633). There was greater prevalence of thrombocytopenia in BCMA-Car-T therapy of 58.7% (95%[CI], 0.482\u20130.685). Thrombocytopenia occurred most frequently in Car-T patients treated with a dosage of 1 \u00d7 105\u20131 \u00d7 106\u00a0cell\/kg, at a rate of 66.2% (95%[CI], 0.561\u20130.749). CONCLUSION: Overall, 45.8 percent of patients receiving Car-T treatment suffered from thrombocytopenia. Multiple myeloma patients, ages between 18\u201360, a dose of 1 \u00d7 105\u20131 \u00d7 106\u00a0cell\/kg and BCMA-Car-T therapy are all considered high-risk factors.<\/jats:p>","DOI":"10.3233\/thc-220537","type":"journal-article","created":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T12:46:43Z","timestamp":1691153203000},"page":"2363-2380","source":"Crossref","is-referenced-by-count":3,"title":["The risk factors for coagulation disorder of chimeric antigen receptor-T cell therapy in patients with hematological tumors: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"31","author":[{"given":"Yunqing","family":"Xia","sequence":"first","affiliation":[{"name":"Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Tang","sequence":"additional","affiliation":[{"name":"Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Hu","sequence":"additional","affiliation":[{"name":"Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"},{"name":"Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"issue":"4","key":"10.3233\/THC-220537_ref1","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.bbmt.2018.12.758","article-title":"ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells","volume":"25","author":"Lee","year":"2019","journal-title":"Biology of Blood and Marrow Transplantation."},{"key":"10.3233\/THC-220537_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2020-001511"},{"key":"10.3233\/THC-220537_ref3","doi-asserted-by":"publisher","DOI":"10.1158\/1538-7445.AM2014-CT102"},{"issue":"7","key":"10.3233\/THC-220537_ref4","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1007\/s00277-019-03685-z","article-title":"Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy","volume":"98","author":"Jiang","year":"2019","journal-title":"Annals of Hematology."},{"issue":"Suppl 1","key":"10.3233\/THC-220537_ref5","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1182\/blood-2020-142218","article-title":"Bleeding and thrombosis are associated with endothelial dysfunction in CAR-T cell therapy and are increased in patients experiencing neurologic toxicity","volume":"136","author":"Johnsrud","year":"2020","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref6","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01626-4"},{"issue":"9","key":"10.3233\/THC-220537_ref7","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (minors): development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ Journal of Surgery."},{"issue":"7414","key":"10.3233\/THC-220537_ref8","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ (Clinical Research ed.)"},{"issue":"7109","key":"10.3233\/THC-220537_ref9","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ (Clinical Research ed.)."},{"key":"10.3233\/THC-220537_ref10","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1182\/blood-2020-140156","article-title":"Two-Year Follow-up of Investigator-Initiated Phase 1 Trials of the Safety and Efficacy of Fully Human Anti-Bcma CAR T Cells (CT053) in Relapsed\/Refractory Multiple Myeloma","volume":"136","author":"Hao","year":"2020","journal-title":"Blood."},{"issue":"10","key":"10.3233\/THC-220537_ref11","doi-asserted-by":"publisher","first-page":"e54","DOI":"10.1016\/j.clml.2019.09.083","article-title":"CT053, Anti-BCMA CAR T-cell therapy for Relapsed\/Refractory Multiple Myeloma: Proof of Concept results from a Phase I Study, Clinical Lymphoma","volume":"19","author":"Hao","year":"2019","journal-title":"Myeloma and Leukemia."},{"issue":"17","key":"10.3233\/THC-220537_ref12","doi-asserted-by":"publisher","first-page":"4086","DOI":"10.1182\/bloodadvances.2020002060","article-title":"Venous thromboembolism associated with CD19-directed CAR T-cell therapy in large B-cell lymphoma","volume":"4","author":"Hashmi","year":"2020","journal-title":"Blood Advances."},{"issue":"Suppl 2","key":"10.3233\/THC-220537_ref13","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1002\/hon.2880","article-title":"Safety and efficacy of tisagenlecleucel plus pembrolizumab in patients with relapsed\/refractory diffuse large B-cell lymphoma: Updated analysis of the phase 1b portia study","volume":"39","author":"Jaeger","year":"2021","journal-title":"Hematological Oncology."},{"key":"10.3233\/THC-220537_ref14","doi-asserted-by":"publisher","first-page":"S15","DOI":"10.1016\/S2152-2650(21)02098-X","article-title":"OAB-024: Updated results from CARTITUDE-1: Ciltacabtagene autoleucel, a B-cell maturation antigen\u2013directed chimeric antigen receptor T (CAR-T) cell therapy, in relapsed\/refractory multiple myeloma (RRMM), Clinical Lymphoma","volume":"21","author":"Jagannath","year":"2021","journal-title":"Myeloma and Leukemia."},{"key":"10.3233\/THC-220537_ref15","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1182\/blood-2020-142218","article-title":"Bleeding and Thrombosis Are Associated with Endothelial Dysfunction in CAR-T Cell Therapy and Are Increased in Patients Experiencing Neurologic Toxicity","volume":"136","author":"Johnsrud","year":"2020","journal-title":"Blood."},{"issue":"6","key":"10.3233\/THC-220537_ref16","doi-asserted-by":"publisher","first-page":"E684","DOI":"10.3747\/co.27.7151","article-title":"Safety and efficacy of tisagenlecleucel (CTL019) in children, adolescents, and young adults: The Canadian trial and real-world experience","volume":"27","author":"Krueger","year":"2020","journal-title":"Current Oncology."},{"issue":"3","key":"10.3233\/THC-220537_ref17","doi-asserted-by":"publisher","first-page":"S264","DOI":"10.1016\/j.bbmt.2019.12.429","article-title":"Hematologic Toxicities of CAR T-Cell Therapy in Non-Hodgkin Lymphoma","volume":"26","author":"Kubusek","year":"2020","journal-title":"Biology of Blood and Marrow Transplantation."},{"key":"10.3233\/THC-220537_ref18","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2020-002287"},{"key":"10.3233\/THC-220537_ref19","doi-asserted-by":"publisher","first-page":"S439","DOI":"10.1016\/S2152-2650(21)01978-9","article-title":"MM-379: MagnetisMM-1: A Study of Elranatamab (PF-06863135), a B-Cell Maturation Antigen (BCMA)-Targeted, CD3-Engaging Bispecific Antibody, for Patients with Relapsed or Refractory Multiple Myeloma (MM), Clinical Lymphoma","volume":"21","author":"Levy","year":"2021","journal-title":"Myeloma and Leukemia."},{"issue":"12","key":"10.3233\/THC-220537_ref20","doi-asserted-by":"publisher","first-page":"A5","DOI":"10.1089\/hum.2017.29055.abstracts","article-title":"Efficacy, safety, and covariates of outcomes with axicabtagene ciloleucel (axi-cel; KTE-C19) from ZUMA-1, a pivotal trial in patients with refractory, aggressive non-Hodgkin lymphoma (NHL)","volume":"28","author":"Lin","year":"2017","journal-title":"Human Gene Therapy."},{"key":"10.3233\/THC-220537_ref21","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1182\/blood-2020-134324","article-title":"Idecabtagene Vicleucel (ide-cel, bb2121), a BCMA-Directed CAR T Cell Therapy, in Patients with Relapsed and Refractory Multiple Myeloma: Updated Results from Phase 1 CRB-401 Study","volume":"136","author":"Lin","year":"2020","journal-title":"Blood."},{"issue":"Suppl 1","key":"10.3233\/THC-220537_ref22","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1111\/bjh.17490","article-title":"CARTITUDE-1: Phase 1b\/2 study of ciltacabtagene autoleucel in relapsed\/Refractory multiple myeloma","volume":"193","author":"Madduri","year":"2021","journal-title":"British Journal of Haematology."},{"key":"10.3233\/THC-220537_ref23","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2020.38.15_suppl.8504"},{"issue":"Suppl 1","key":"10.3233\/THC-220537_ref24","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1182\/blood-2020-140641","article-title":"Universal: An allogeneic first-in-human study of the anti-BCMA ALLO-715 and the anti-CD52 ALLO-647 in relapsed\/refractory multiple myeloma","volume":"136","author":"Mailankody","year":"2020","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref25","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1182\/blood-2021-146060","article-title":"Updated Results from CARTITUDE-1: Phase 1b\/2Study of Ciltacabtagene Autoleucel, a B-Cell Maturation Antigen-Directed Chimeric Antigen Receptor T Cell Therapy, in Patients With Relapsed\/Refractory Multiple Myeloma","volume":"138","author":"Martin","year":"2021","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref26","doi-asserted-by":"publisher","first-page":"4837","DOI":"10.1182\/blood-2021-150975","article-title":"Dynamics and Management of CAR-T Cells Associated Cytopenias: A Single-Center Experience","volume":"138","author":"Mart\u00edn-Rojas","year":"2021","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref27","first-page":"197","article-title":"Analysis of safety data from 2 multicenter trials of CTL019 in pediatric and young adult patients with relapsed\/refractory (R\/R) B-cell acute lymphoblastic leukemia (B-all)","volume":"102","author":"Maude","year":"2017","journal-title":"Haematologica."},{"key":"10.3233\/THC-220537_ref28","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-021-01170-7"},{"issue":"8","key":"10.3233\/THC-220537_ref29","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1056\/NEJMoa2024850","article-title":"Idecabtagene vicleucel in relapsed and refractory multiple myeloma","volume":"384","author":"Munshi","year":"2021","journal-title":"New England Journal of Medicine."},{"key":"10.3233\/THC-220537_ref30","doi-asserted-by":"crossref","unstructured":"Neelapu SS, Locke FL, Bartlett NL et al., Kte-C19 (anti-CD19 CAR T cells) induces complete remissions in patients with refractory diffuse large B-cell lymphoma (DLBCL): Results from the pivotal phase 2 Zuma-1. Blood. 2016; 128(22).","DOI":"10.1182\/blood.V128.22.LBA-6.LBA-6"},{"key":"10.3233\/THC-220537_ref31","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1182\/blood-2020-136158","article-title":"Safety and Preliminary Efficacy in Patients with Relapsed\/Refractory Mantle Cell Lymphoma Receiving Lisocabtagene Maraleucel in Transcend NHL 001","volume":"136","author":"Palomba","year":"2020","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref32","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1097\/HS9.0000000000000404","article-title":"Phase 1 alexander study of AUTO3 the first bicistronic chimeric antigen receptor (CAR) targeting cd19 and CD22 with pembrolizumab in patients with relapsed\/refractory diffuse large b cell lymphoma","volume":"4","author":"Ramakrishnan","year":"2020","journal-title":"HemaSphere."},{"key":"10.3233\/THC-220537_ref33","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1182\/blood-2019-127640","article-title":"Combination of Anti-CD19 and Anti-CD20 Chimeric Antigen Receptor T Cells for Relapsed and Refractory Diffuse Larger B Cell Lymphoma: An Open-Label, Single-Arm, Phase I\/II Trial","volume":"134","author":"Sang","year":"2019","journal-title":"Blood."},{"issue":"1","key":"10.3233\/THC-220537_ref34","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1056\/NEJMoa1804980","article-title":"Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma","volume":"380","author":"Schuster","year":"2019","journal-title":"New England Journal of Medicine."},{"issue":"10","key":"10.3233\/THC-220537_ref35","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1016\/S1470-2045(21)00375-2","article-title":"Long-term clinical outcomes of tisagenlecleucel in patients with relapsed or refractory aggressive B-cell lymphomas (JULIET): a multicentre, open-label, single-arm, phase 2 study","volume":"22","author":"Schuster","year":"2021","journal-title":"The Lancet Oncology."},{"key":"10.3233\/THC-220537_ref36","doi-asserted-by":"publisher","first-page":"3872","DOI":"10.1182\/blood-2021-149181","article-title":"Safety and Efficacy of Third Generation CD20 Targeted CAR-T (MB-106) for Treatment of Relapsed\/Refractory B-NHL and CLL","volume":"138","author":"Shadman","year":"2021","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref37","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1182\/blood-2020-136440","article-title":"Third Generation CD20 Targeted CAR T-Cell Therapy (MB-106) for Treatment of Patients with Relapsed\/Refractory B-Cell Non-Hodgkin Lymphoma","volume":"136","author":"Shadman","year":"2020","journal-title":"Blood."},{"issue":"3","key":"10.3233\/THC-220537_ref38","doi-asserted-by":"publisher","first-page":"S171","DOI":"10.1016\/j.bbmt.2018.12.311","article-title":"Cytopenias after Chimeric Antigen Receptor T-Cells (CAR-T) Infusion; Patterns and Outcomes","volume":"25","author":"Shaefer","year":"2019","journal-title":"Biology of Blood and Marrow Transplantation."},{"key":"10.3233\/THC-220537_ref39","doi-asserted-by":"publisher","first-page":"v360","DOI":"10.1093\/annonc\/mdx373.013","article-title":"Preliminary results of novel safety interventions in adult patients (pts) with relapsed\/refractory acute lymphoblastic leukemia (R\/R ALL) in the ZUMA-3 Trial","volume":"28","author":"Shah","year":"2017","journal-title":"Annals of Oncology."},{"issue":"7","key":"10.3233\/THC-220537_ref40","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1038\/s41409-021-01226-9","article-title":"CRS-related coagulopathy in BCMA targeted CAR-T therapy: a retrospective analysis in a phase I\/II clinical trial","volume":"56","author":"Shao","year":"2021","journal-title":"Bone Marrow Transplantation."},{"key":"10.3233\/THC-220537_ref41","doi-asserted-by":"publisher","first-page":"4828","DOI":"10.1182\/blood-2021-146283","article-title":"Feasibility of Outpatient CAR T Cell Therapy: Experience of a Single Institution","volume":"138","author":"Shao","year":"2021","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref42","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1182\/blood-2020-143353","article-title":"Incidence and Causes of Prolonged Hematologic Toxicity after Chimeric Antigen Receptor T Cell Therapy: A City of Hope (COH) Experience","volume":"136","author":"Shouse","year":"2020","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref43","doi-asserted-by":"publisher","first-page":"3864","DOI":"10.1182\/blood-2021-146646","article-title":"Phase I Study of PHE885, a Fully Human BCMA-Directed CAR-T Cell Therapy for Relapsed\/Refractory Multiple Myeloma Manufactured in < 2 Days Using the T-Charge TM Platform","volume":"138","author":"Sperling","year":"2021","journal-title":"Blood."},{"key":"10.3233\/THC-220537_ref44","doi-asserted-by":"publisher","first-page":"4812","DOI":"10.1182\/blood-2021-148961","article-title":"Incidence, Risk Factors and Outcomes of Pancytopenia Following Chimeric Antigen Receptor (CAR)-T Cell Therapy in Relapsed Refractory Diffuse Large B Cell Lymphoma","volume":"138","author":"Surapaneni","year":"2021","journal-title":"Blood."},{"issue":"Suppl 2","key":"10.3233\/THC-220537_ref45","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1097\/HS9.0000000000000566","article-title":"Updated cartitude-1 results of ciltacabtagene autoleucel, a b-cell maturation antigen-directed chimeric antigen receptor t cell therapy, in relapsed\/refractory multiple myeloma","volume":"5","author":"Usmani","year":"2021","journal-title":"HemaSphere."},{"key":"10.3233\/THC-220537_ref46","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1038\/s41409-020-01119-3","article-title":"KTE-X19, an anti-CD19 chimeric antigen receptor (CAR) T cell therapy, in patients with relapsed\/ refractory (R\/R) mantle cell lymphoma (MCL): Results from phase 2 of ZUMA-2","volume":"55","author":"Wang","year":"2020","journal-title":"Bone Marrow Transplantation."},{"key":"10.3233\/THC-220537_ref47","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2021.39.15_suppl.7547"},{"issue":"Suppl 1","key":"10.3233\/THC-220537_ref48","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/bjh.17490","article-title":"One year follow-up of ZUMA-2, the multicenter, registrational study of KTE-X19 in patients with relapsed\/Refractory mantle cell lymphoma","volume":"193","author":"Wang","year":"2021","journal-title":"British Journal of Haematology."},{"issue":"5","key":"10.3233\/THC-220537_ref49","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1016\/j.bbmt.2019.11.027","article-title":"Coagulation Disorders after Chimeric Antigen Receptor T Cell Therapy: Analysis of 100 Patients with Relapsed and Refractory Hematologic Malignancies: Coagulation Disorders after CAR-T Cell Therapy","volume":"26","author":"Wang","year":"2020","journal-title":"Biology of Blood and Marrow Transplantation."},{"key":"10.3233\/THC-220537_ref50","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1038\/s41409-020-01119-3","article-title":"Correlative analyses of patient and clinical characteristics associated with efficacy in tisagenlecleucel-treated relapsed\/refractory diffuse large B-cell lymphoma patients in the juliet trial","volume":"55","author":"Westin","year":"2020","journal-title":"Bone Marrow Transplantation."},{"issue":"10","key":"10.3233\/THC-220537_ref51","doi-asserted-by":"publisher","first-page":"e521","DOI":"10.1016\/S2352-3026(19)30115-2","article-title":"A combination of humanised anti-CD19 and anti-BCMA CAR T cells in patients with relapsed or refractory multiple myeloma: a single-arm, phase 2 trial","volume":"6","author":"Yan","year":"2019","journal-title":"The Lancet Haematology."},{"issue":"23","key":"10.3233\/THC-220537_ref52","doi-asserted-by":"publisher","first-page":"6995","DOI":"10.1158\/1078-0432.CCR-19-0101","article-title":"Clinical efficacy and tumor microenvironment influence in a dose-escalation study of anti-CD19 chimeric antigen receptor T cells in refractory B-cell non-Hodgkin\u2019s lymphoma","volume":"25","author":"Yan","year":"2019","journal-title":"Clinical Cancer Research."},{"key":"10.3233\/THC-220537_ref53","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.564099"}],"container-title":["Technology and Health Care"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/THC-220537","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:55:48Z","timestamp":1777614948000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/THC-220537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,16]]},"references-count":53,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3233\/thc-220537","relation":{},"ISSN":["0928-7329","1878-7401"],"issn-type":[{"value":"0928-7329","type":"print"},{"value":"1878-7401","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,16]]}}}