{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T20:14:28Z","timestamp":1793909668676,"version":"4.8.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Sarcopenia describes a generalized loss of skeletal muscle mass, strength, or function. Determined by measuring the total psoas muscle area (tPMA) on cross-sectional imaging, sarcopenia is an independent marker for poor post-surgical outcomes in adults and children. Children with cancer are at high risk for sarcopenia due to immobility, chemotherapy, and cachexia. We hypothesize that sarcopenic children with neuroblastoma are at higher risk for poor post-operative outcomes.<\/jats:p><jats:p><jats:bold>Patients and Methods:<\/jats:bold> Retrospective analysis of children with neuroblastoma ages 1\u201315 years who were treated at our hospital from 2008 to 2016 with follow-up through March 2021. Psoas muscle area (PMA) was measured from cross-sectional images, using computed tomography (CT) and magnetic resonance imaging (MRI) scans at lumbar disc levels L3-4 and L4-5. tPMA is the sum of the left and right PMA. Z-scores were calculated using age- and gender-specific reference values. Sarcopenia was defined as a tPMA z-score below \u22122. A correlation of tPMA z-scores and sarcopenia with clinical variables and outcome was performed.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> One hundred and sixty-four children with workup for neuroblastoma were identified, and 101 children fulfilled inclusion criteria for further analysis, with a mean age of 3.92 years (SD 2.71 years). Mean tPMA z-score at L4-5 was \u22122.37 (SD 1.02). Correlation of tPMA z-score at L4-5 with weight-for-age z-score was moderate (<jats:italic>r<\/jats:italic> = 0.54; 95% CI, 0.38, 0.66). No association between sarcopenia and short-term outcome was observed. Sarcopenia had a sensitivity of 0.82 (95% CI, 0.62\u20130.93) and a specificity of 0.48 (95% CI 0.36\u20130.61) in predicting 5-year survival. In a multiple regression analysis, pre-operative sarcopenia, pre-operative chemotherapy in the NB2004 high-risk group, unfavorable tumor histology, and age at diagnosis were associated with 5-year survival after surgery, with hazard ratios of 4.18 (95% CI 1.01\u201317.26), 2.46 (95% CI 1.02\u20135.92), 2.39 (95% CI 1.03\u20135.54), and 1.01 (95% CI 1.00\u20131.03), respectively.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> In this study, the majority of children had low tPMA z-scores and sarcopenia was a risk factor for decreased 5-year survival in children with neuroblastoma. Therefore, we suggest measuring the tPMA from pre-surgical cross-sectional imaging as a biomarker for additional risk stratification in children with neuroblastoma.<\/jats:p>","DOI":"10.3389\/fsurg.2021.718184","type":"journal-article","created":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T18:08:01Z","timestamp":1629396481000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":54,"title":["Total Psoas Muscle Area as a Marker for Sarcopenia Is Related to Outcome in Children With Neuroblastoma"],"prefix":"10.3389","volume":"8","author":[{"given":"Annika","family":"Ritz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Froeba-Pohl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Kolorz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Vigodski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Hubertus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Ley-Zaporozhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietrich","family":"von Schweinitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"H\u00e4berle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Kappler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eberhard","family":"Lurz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.clnu.2016.09.004","article-title":"ESPEN guidelines on definitions and terminology of clinical nutrition","volume":"36","author":"Cederholm","year":"2017","journal-title":"ClinNutr."},{"key":"B2","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin Nutr (Edinburgh, Scotland)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1007\/s12185-017-2388-9","article-title":"Sarcopenia after induction therapy in childhood acute lymphoblastic leukemia: its clinical significance","volume":"107","author":"Suzuki","year":"2018","journal-title":"Int J Hematol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.jss.2018.10.048","article-title":"The influence of sarcopenia on high-risk neuroblastoma","volume":"236","author":"Kawakubo","year":"2019","journal-title":"J Surg Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.3945\/an.110.000141","article-title":"Important aspects of nutrition in children with cancer","volume":"2","author":"Bauer","year":"2011","journal-title":"Adv Nutr 5 Ed."},{"key":"B6","doi-asserted-by":"publisher","first-page":"86","DOI":"10.21037\/apm.2018.08.02","article-title":"Sarcopenia associated with chemotherapy and targeted agents for cancer therapy","volume":"8","author":"Davis","year":"2019","journal-title":"Ann Palliat Med."},{"key":"B7","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/978-88-470-0552-5_44","article-title":"Proinflammatory Cytokines: Their Role in Multifactorial Cancer Cachexia","volume-title":"Cachexia and Wasting: A Modern Approach","author":"Mantovani","year":"2006"},{"key":"B8","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1002\/lt.25720","article-title":"Deficits in muscle strength and physical performance influence physical activity in sarcopenic children after liver transplantation","volume":"26","author":"Ooi","year":"2020","journal-title":"Liver Transpl."},{"key":"B9","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People","volume":"39","author":"Cruz-Jentoft","year":"2010","journal-title":"Age Ageing"},{"key":"B10","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1002\/jcsm.12514","article-title":"Paediatric reference values for total psoas muscle area","volume":"11","author":"Lurz","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B11","doi-asserted-by":"publisher","first-page":"O20","DOI":"10.1111\/codi.12805","article-title":"Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications","volume":"17","author":"Jones","year":"2015","journal-title":"Colorectal Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1002\/lt.23811","article-title":"Sarcopenia is a prognostic factor in living donor liver transplantation","volume":"20","author":"Masuda","year":"2014","journal-title":"Liver Transpl."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.1016\/j.athoracsur.2016.09.005","article-title":"Psoas muscle area and length of stay in older adults undergoing cardiac operations","volume":"103","author":"Zuckerman","year":"2017","journal-title":"Ann Thorac Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1093\/ejcts\/ezy244","article-title":"Prognostic implications of psoas muscle area in patients undergoing transcatheter aortic valve implantation","volume":"55","author":"Kofler","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s10549-018-4915-7","article-title":"Prognostic impact of skeletal muscle volume derived from cross-sectional computed tomography images in breast cancer","volume":"172","author":"Song","year":"2018","journal-title":"Breast Cancer Res Treat Springer US."},{"key":"B16","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jjcc.2020.06.009","article-title":"Secondary sarcopenia assessed by computed tomography can predict hospitalization for heart failure in adults with Fontan circulation","volume":"77","author":"Shiina","year":"2021","journal-title":"J Cardiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1016\/j.athoracsur.2018.10.006","article-title":"Sarcopenia of the psoas muscles is associated with poor outcomes following lung transplantation","volume":"107","author":"Hsu","year":"2019","journal-title":"Ann Thorac Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.lungcan.2020.09.009","article-title":"Sarcopenia as independent risk factor of postpneumonectomy respiratory failure, ARDS and mortality","volume":"149","author":"Martini","year":"2020","journal-title":"Lung Cancer."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jss.2017.05.059","article-title":"Sarcopenia in children with perforated appendicitis","volume":"220","author":"L\u00f3pez","year":"2017","journal-title":"J Surg Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1097\/MPG.0000000000001792","article-title":"Sarcopenia in children with end-stage liver disease","volume":"66","author":"Lurz","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/MPG.0000000000001651","article-title":"Severe sarcopenia and increased fat stores in pediatric patients with liver, kidney, or intestine failure","volume":"65","author":"Mangus","year":"2017","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e28862","DOI":"10.1002\/pbc.28862","article-title":"Sarcopenia is a prognostic outcome marker in children with high-risk hepatoblastoma","volume":"4","author":"Ritz","year":"2021","journal-title":"Pediatr Blood Cancer."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1200\/JCO.1993.11.8.1466","article-title":"Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment","volume":"11","author":"Brodeur","year":"1993","journal-title":"J Clin Oncol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1056\/NEJM198510313131802","article-title":"Association of multiple copies of the N-myc oncogene with rapid progression of neuroblastomas","volume":"313","author":"Seeger","year":"1985","journal-title":"N Engl J Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1200\/JCO.2008.16.6785","article-title":"The international neuroblastoma risk group (INRG) classification system: an INRG Task Force report","volume":"27","author":"Cohn","year":"2009","journal-title":"J Clin Oncol."},{"key":"B26","unstructured":"The WHO Child Growth Standards"},{"key":"B27","first-page":"264","volume-title":"NB2004 Trial Protocol. 1st ed","author":"Berthold","year":"2004"},{"key":"B28","first-page":"182","volume-title":"NB2004 High Risk Trial Protocol. 3rd ed","author":"Berthold","year":"2007"},{"key":"B29","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1055\/s-0043-103086","article-title":"GPOH guidelines for diagnosis and treatment of patients with neuroblastic tumors","volume":"229","author":"Simon","year":"2017","journal-title":"Klinische Padiatrie"},{"key":"B30","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/MPH.0b013e318279eea2","article-title":"Sarcopenia in children with acute lymphoblastic leukemia","volume":"35","author":"Rayar","year":"2013","journal-title":"J Pediatr Hematol Oncol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"138","DOI":"10.3109\/10428194.2015.1136741","article-title":"Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy","volume":"59","author":"Orgel","year":"2018","journal-title":"Leuk Lymphoma."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-020-68797-3","article-title":"Body composition analysis using CT and MRI: intra-individual intermodal comparison of muscle mass and myosteatosis","volume":"10","author":"Faron","year":"2020","journal-title":"Sci Rep."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2766","DOI":"10.1111\/ajt.13832","article-title":"Comparing the variability between measurements for sarcopenia using magnetic resonance imaging and computed tomography imaging","volume":"16","author":"Tandon","year":"2016","journal-title":"Am J Transplant."},{"key":"B34","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1152\/jappl.1998.85.1.115","article-title":"Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography","volume":"85","author":"Mitsiopoulos","year":"1998","journal-title":"J App Physiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2277","DOI":"10.1111\/ajt.13732","article-title":"Systematic review and meta-analysis of the impact of computed tomography-assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation","volume":"16","author":"van Vugt","year":"2016","journal-title":"Am J Transplant."},{"key":"B36","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1159\/000494887","article-title":"Computed tomography-assessed sarcopenia indexes predict major complications following surgery for hepatopancreatobiliary malignancy: a meta-analysis","volume":"74","author":"Cao","year":"2019","journal-title":"Ann Nutr Metab."},{"key":"B37","doi-asserted-by":"publisher","first-page":"167","DOI":"10.3389\/fmed.2017.00167","article-title":"Biochemical pathways of sarcopenia and their modulation by physical exercise: a narrative review","volume":"4","author":"Ziaaldini","year":"2017","journal-title":"Front Med (Lausanne)."},{"key":"B38","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.psyneuen.2017.11.001","article-title":"Stress hormones concentrations in the normal microenvironment predict risk for chemically induced cancer in rats","volume":"89","author":"Valente","year":"2018","journal-title":"Psychoneuroendocrinology."},{"key":"B39","doi-asserted-by":"publisher","first-page":"3","DOI":"10.21037\/apm.2018.12.01","article-title":"Cancer cachexia is defined by an ongoing loss of skeletal muscle mass","volume":"8","author":"Baracos","year":"2019","journal-title":"Ann Palliat Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1038\/nrc3829","article-title":"Cancer cachexia: understanding the molecular basis","volume":"14","author":"Argil\u00e9s","year":"2014","journal-title":"Nat Rev Cancer."},{"key":"B41","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/j.jsbmb.2014.12.010","article-title":"Could vitamin D sufficiency improve the survival of colorectal cancer patients?","volume":"148","author":"Mohr","year":"2015","journal-title":"J Steroid Biochem Mol Biol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.nut.2018.09.031","article-title":"Vitamin D, muscle recovery, sarcopenia, cachexia, and muscle atrophy","volume":"60","author":"Garcia","year":"2019","journal-title":"Nutrition."},{"key":"B43","first-page":"3710","article-title":"Altered glucose metabolism in metastatic carcinoma","volume":"35","author":"Holroyde","year":"1975","journal-title":"Cancer Res Cancer Res."},{"key":"B44","first-page":"5910","article-title":"Glucose metabolism in cachectic patients with colorectal cancer","volume":"44","author":"Holroyde","year":"1984","journal-title":"Cancer Res Cancer Res."},{"key":"B45","doi-asserted-by":"publisher","first-page":"7028","DOI":"10.1158\/1078-0432.CCR-07-5017","article-title":"Interleukin-6 and soluble interleukin-6 receptor levels as markers of disease extent and prognosis in neuroblastoma","volume":"14","author":"Egler","year":"2008","journal-title":"Clin Cancer Res"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00431-021-04106-y","article-title":"Muscle mass change during chemotherapy in children with high-risk neuroblastoma: a retrospective case series of 24 patients","author":"Nakamura","year":"2021","journal-title":"Eur J Pediatr"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.3390\/cancers4041247","article-title":"Cancer cachexia: muscle physiology and exercise training","volume":"17","author":"Battaglini","year":"2015","journal-title":"Cancers"},{"key":"B48","doi-asserted-by":"publisher","first-page":"2494","DOI":"10.1002\/hep.31552","article-title":"Exercise training decreases hepatic injury via changes in immune response to liver ischemia\/reperfusion in mice","volume":"73","author":"Yazdani","year":"2021","journal-title":"Hepatology"},{"key":"B49","doi-asserted-by":"publisher","first-page":"5482","DOI":"10.1096\/fj.201801862R","article-title":"Moderate exercise in mice improves cancer plus chemotherapy-induced muscle wasting and mitochondrial alterations","volume":"33","author":"Ballar\u00f2","year":"2019","journal-title":"FASEB J."},{"key":"B50","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4235\/agmr.19.0028","article-title":"Pharmacological interventions for treatment of sarcopenia: current status of drug development for sarcopenia","volume":"23","author":"Kwak","year":"2019","journal-title":"Ann Geriatr Med Res"},{"key":"B51","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1002\/jcsm.12525","article-title":"Nutrition interventions to treat low muscle mass in cancer","volume":"11","author":"Prado","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B52","doi-asserted-by":"publisher","first-page":"2055","DOI":"10.1093\/annonc\/mdx345","article-title":"Treating cancer cachexia: an evolving landscape","volume":"28","author":"Laird","year":"2017","journal-title":"Ann Oncol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: revised European consensus on definition and diagnosis","volume":"48","author":"Cruz-Jentoft","year":"2019","journal-title":"Age Ageing"},{"key":"B54","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.jss.2019.01.064","article-title":"The influence of sarcopenia on high-risk neuroblastoma","volume":"239","author":"Isiklar","year":"2019","journal-title":"J Surg Res."},{"key":"B55","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1002\/jpen.1681","article-title":"Pediatric sarcopenia: a paradigm in the overall definition of malnutrition in children?","volume":"37","author":"Ooi","year":"2019","journal-title":"JPEN J."},{"key":"B56","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1002\/hep.30828","article-title":"A North American expert opinion statement on sarcopenia in liver transplantation","volume":"70","author":"Carey","year":"2019","journal-title":"Hepatology."},{"key":"B57","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.jpeds.2017.10.066","article-title":"Frailty in children with liver disease: a prospective multicenter study","volume":"194","author":"Lurz","year":"2018","journal-title":"J Pediatr"},{"key":"B58","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1002\/jcsm.12221","article-title":"Psoas as a sentinel muscle for sarcopenia: a flawed premise","volume":"8","author":"Baracos","year":"2017","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B59","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1002\/jcsm.12180","article-title":"Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer","volume":"8","author":"Rutten","year":"2017","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B60","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1002\/hep.30941","article-title":"Prevalence and outcomes of sarcopenia in pediatric liver transplantation","volume":"70","author":"Woolfson","year":"2019","journal-title":"Hepatology."},{"key":"B61","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1097\/MPG.0000000000002958","article-title":"Establishing reference values for lean muscle mass in the pediatric patient","volume":"72","author":"Metzger","year":"2021","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B62","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/j.jpedsurg.2017.01.030","article-title":"Personalized medicine: enhancing our understanding of pediatric growth with analytic morphomics","volume":"52","author":"Harbaugh","year":"2017","journal-title":"J Pediatr Surg."},{"key":"B63","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1097\/MPG.0000000000002859","article-title":"Body composition of infants with biliary atresia: anthropometric measurements and computed tomography-based body metrics","volume":"71","author":"Grutters","year":"2020","journal-title":"J Pediatr Gastroenterol Nutr."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.718184\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T18:08:07Z","timestamp":1629396487000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.718184\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,19]]},"references-count":63,"alternative-id":["10.3389\/fsurg.2021.718184"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2021.718184","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,19]]},"article-number":"718184"}}