{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T21:48:29Z","timestamp":1773524909593,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,9]],"date-time":"2022-04-09T00:00:00Z","timestamp":1649462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI18-00427"],"award-info":[{"award-number":["PI18-00427"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI20\/00375"],"award-info":[{"award-number":["PI20\/00375"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Conferencia de Rectores de las Universidades Espa\u00f1olas","award":["CRUE-Banco Santander. FONDO SUPERA COVID-19. Ref. IPSA-COVID-19"],"award-info":[{"award-number":["CRUE-Banco Santander. FONDO SUPERA COVID-19. Ref. IPSA-COVID-19"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>The risk of complications following surgical procedures is significantly increased in patients with SARS-CoV-2 infection. However, the mechanisms underlying these correlations are not fully known. Spinal cord injury (SCI) patients who underwent reconstructive surgery for pressure ulcers (PUs) before and during the COVID-19 pandemic were included in this study. The patient\u2019s postoperative progression was registered, and the subcutaneous white adipose tissue (s-WAT) surrounding the ulcers was analyzed by proteomic and immunohistochemical assays to identify the molecular\/cellular signatures of impaired recovery. Patients with SCI and a COVID-19-positive diagnosis showed worse recovery and severe postoperative complications, requiring reintervention. Several proteins were upregulated in the adipose tissue of these patients. Among them, CKMT2 and CKM stood out, and CKM increased for up to 60 days after the COVID-19 diagnosis. Moreover, CKMT2 and CKM were largely found in MGCs within the s-WAT of COVID patients. Some of these proteins presented post-translational modifications and were targeted by autoantibodies in the serum of COVID patients. Overall, our results indicate that CKMT2, CKM, and the presence of MGCs in the adipose tissue surrounding PUs in post-COVID patients could be predictive biomarkers of postsurgical complications. These results suggest that the inflammatory response in adipose tissue may underlie the defective repair seen after surgery.<\/jats:p>","DOI":"10.3390\/cells11081282","type":"journal-article","created":{"date-parts":[[2022,4,10]],"date-time":"2022-04-10T06:02:54Z","timestamp":1649570574000},"page":"1282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Post-COVID Complications after Pressure Ulcer Surgery in Patients with Spinal Cord Injury Associate with Creatine Kinase Upregulation in Adipose Tissue"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6138-8948","authenticated-orcid":false,"given":"Mario","family":"Mart\u00ednez-Torija","sequence":"first","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"},{"name":"Department of Nursing, Hospital Universitario de Toledo (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8760-7512","authenticated-orcid":false,"given":"Pedro F.","family":"Esteban","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco Javier","family":"Espino-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"},{"name":"Plastic and Reconstructive Surgery Service, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Paniagua-Torija","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6693-1682","authenticated-orcid":false,"given":"Eduardo","family":"Molina-Holgado","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Ceruelo","sequence":"additional","affiliation":[{"name":"Department of Physical Rehabilitation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3200-8659","authenticated-orcid":false,"given":"Gemma","family":"Barroso-Garcia","sequence":"additional","affiliation":[{"name":"Proteomics Core Facility, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alba G.","family":"Arandilla","sequence":"additional","affiliation":[{"name":"Proteomics Core Facility, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis F.","family":"Lopez-Almodovar","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Hospital Universitario de Toledo (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel","family":"Arevalo-Martin","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7468-2871","authenticated-orcid":false,"given":"Juan Antonio","family":"Moreno","sequence":"additional","affiliation":[{"name":"Maimonides Biomedical Research Institute of Cordoba (IMIBIC), UGC Nephrology, Hospital Universitario Reina Sofia, 14004 Cordoba, Spain"},{"name":"Cell Biology, Physiology and Immunology Department, Agrifood Campus of International Excellence (ceiA3), University of Cordoba, 14014 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7479-5104","authenticated-orcid":false,"given":"Daniel","family":"Garcia-Ovejero","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00aa Carmen","family":"Dur\u00e1n-Ruiz","sequence":"additional","affiliation":[{"name":"Biomedicine, Biotechnology and Public Health Department, University of Cadiz, 11002 Cadiz, Spain"},{"name":"Institute of Biomedical Research Cadiz (INiBICA), 11002 Cadiz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9840-5078","authenticated-orcid":false,"given":"Rafael","family":"Moreno-Luna","sequence":"additional","affiliation":[{"name":"Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), 45071 Toledo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/sc.2014.179","article-title":"Pressure ulcers in people with spinal cord injury in developing nations","volume":"53","author":"Zakrasek","year":"2015","journal-title":"Spinal Cord"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1038\/s41393-017-0054-y","article-title":"Interventions for pressure ulcers: A summary of evidence for prevention and treatment","volume":"56","author":"Atkinson","year":"2018","journal-title":"Spinal Cord"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Uimonen, M., Kuitunen, I., Paloneva, J., Launonen, A.P., Ponkilainen, V., and Mattila, V.M. (2021). The impact of the COVID-19 pandemic on waiting times for elective surgery patients: A multicenter study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0253875"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"(2021). The Lancet Rheumatology Too long to wait: The impact of COVID-19 on elective surgery. Lancet Rheumatol., 3, e83.","DOI":"10.1016\/S2665-9913(21)00001-1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0140-6736(20)31182-X","article-title":"Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study","volume":"396","author":"Bhangu","year":"2020","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1111\/anae.15458","article-title":"Timing of surgery following SARS-CoV-2 infection: An international prospective cohort study","volume":"76","author":"Collaborative","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/SLA.0000000000005308","article-title":"The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States","volume":"275","author":"Deng","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_9","unstructured":"Black, J., Cuddigan, J., Capasso, V., Cox, J., and Delmore, B.M.N. (2022, April 03). Unavoidable Pressure Injury during COVID-19 Pandemic: A Position Paper from the National Pressure Injury Advisory Panel Previously the National Pressure Ulcer Advisory Panel (NPUAP) 1 \u00a9NPIAP. Available online: https:\/\/cdn.ymaws.com\/npiap.com\/resource\/resmgr\/white_papers\/Unavoidable_in_COVID_Pandemi.pdf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1111\/iwj.13399","article-title":"Challenges in the management of critical ill COVID-19 patients with pressure ulcer","volume":"17","author":"Tang","year":"2020","journal-title":"Int. Wound J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102804","DOI":"10.1016\/j.iccn.2020.102804","article-title":"Under (less) pressure\u2014Facial pressure ulcer development in ventilated ICU patients: A prospective comparative study comparing two types of endotracheal tube fixations","volume":"58","author":"Kuniavsky","year":"2020","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1080\/21623945.2021.1965315","article-title":"Resveratrol supplementation reduces ACE2 expression in human adipose tissue","volume":"10","author":"Hesselink","year":"2021","journal-title":"Adipocyte"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100283","DOI":"10.1016\/j.obmed.2020.100283","article-title":"Association of high level gene expression of ACE2 in adipose tissue with mortality of COVID-19 infection in obese patients","volume":"19","year":"2020","journal-title":"Obes. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1038\/s41574-019-0230-6","article-title":"The endocrine function of adipose tissues in health and cardiometabolic disease","volume":"15","author":"Scheja","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s40618-021-01628-y","article-title":"COVID-19 autopsy cases: Detection of virus in endocrine tissues","volume":"45","author":"Poma","year":"2021","journal-title":"J. Endocrinol. Investig."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1111\/jocd.13887","article-title":"SARS-CoV-2 not found in pressure injury exudates from COVID-19 patients","volume":"20","author":"Yu","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/978-94-007-0763-4_7","article-title":"Macrophage fusion and multinucleated giant cells of inflammation","volume":"713","author":"McNally","year":"2011","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1006\/bbrc.1996.1112","article-title":"A Novel Geneiba1in the Major Histocompatibility Complex Class III Region Encoding an EF Hand Protein Expressed in a Monocytic Lineage","volume":"224","author":"Imai","year":"1996","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/SLA.0000000000004420","article-title":"Perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgical procedures","volume":"273","author":"Knisely","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1093\/oxfordjournals.jbchem.a134470","article-title":"Mitochondrial creatine kinase from human heart muscle: Purification and characterization of the crystallized isoenzyme","volume":"94","author":"Blum","year":"1983","journal-title":"J. Biochem."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","article-title":"Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China","volume":"77","author":"Mao","year":"2020","journal-title":"JAMA Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.dsx.2021.02.012","article-title":"The prognostic value of elevated creatine kinase to predict poor outcome in patients with COVID-19\u2014A systematic review and meta-analysis: Creatinine Kinase in COVID-19","volume":"15","author":"Akbar","year":"2021","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Orsucci, D., Trezzi, M., Anichini, R., Blanc, P., Barontini, L., Biagini, C., Capitanini, A., Comeglio, M., Corsini, P., and Gemignani, F. (2021). Increased creatine kinase may predict a worse covid-19 outcome. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081734"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S0092-8674(00)81688-8","article-title":"Signaling\u20142000 and Beyond","volume":"100","author":"Hunter","year":"2000","journal-title":"Cell"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"536","DOI":"10.2174\/138920309789630598","article-title":"Focus on Phosphoarginine and Phospholysine","volume":"10","author":"Besant","year":"2009","journal-title":"Curr. Protein Pept. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/j.ajpath.2019.02.006","article-title":"An Overview of the Derivation and Function of Multinucleated Giant Cells and Their Role in Pathologic Processes","volume":"189","author":"Brooks","year":"2019","journal-title":"Am. J. Pathol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2802","DOI":"10.2337\/db10-1263","article-title":"Subcutaneous Adipose Tissue Macrophage Infiltration Is Associated with Hepatic and Visceral Fat Deposition, Hyperinsulinemia, and Stimulation of NF-\u03baB Stress Pathway","volume":"60","author":"Mahurkar","year":"2011","journal-title":"Diabetes"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"538","DOI":"10.2337\/db20-0293","article-title":"Multinucleated giant cells in adipose tissue are specialized in adipocyte degradation","volume":"70","author":"Braune","year":"2021","journal-title":"Diabetes"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"E17","DOI":"10.1210\/jc.2012-2697","article-title":"PCOS Is Associated with Increased CD11c Expression and Crown-Like Structures in Adipose Tissue and Increased Central Abdominal Fat Depots Independent of Obesity","volume":"98","author":"Huang","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1161\/ATVBAHA.108.170316","article-title":"Adipose Macrophage Infiltration Is Associated with Insulin Resistance and Vascular Endothelial Dysfunction in Obese Subjects","volume":"28","author":"Apovian","year":"2008","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1089\/ten.teb.2017.0242","article-title":"Multinucleated Giant Cells: Good Guys or Bad Guys?","volume":"24","author":"Miron","year":"2018","journal-title":"Tissue Eng.-Part B Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s00414-020-02319-8","article-title":"Gross and histopathological pulmonary findings in a COVID-19 associated death during self-isolation","volume":"134","author":"Suess","year":"2020","journal-title":"Int. J. Legal Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s00428-020-02829-1","article-title":"Early histologic findings of pulmonary SARS-CoV-2 infection detected in a surgical specimen","volume":"477","author":"Pernazza","year":"2020","journal-title":"Virchows Arch."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s00414-020-02406-w","article-title":"Postmortem examination of three SARS-CoV-2-positive autopsies including histopathologic and immunohistochemical analysis","volume":"135","author":"Oprinca","year":"2021","journal-title":"Int. J. Legal Med."},{"key":"ref_35","first-page":"6","article-title":"Evaluation of Liver Histopathological Findings of Coronavirus Disease 2019 by Minimally Invasive Autopsies","volume":"9","author":"Vishwajeet","year":"2021","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/S2213-2600(20)30076-X","article-title":"Pathological findings of COVID-19 associated with acute respiratory distress syndrome","volume":"8","author":"Xu","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ejcb.2014.11.002","article-title":"Submembranous recruitment of creatine kinase B supports formation of dynamic actin-based protrusions of macrophages and relies on its C-terminal flexible loop","volume":"94","author":"Venter","year":"2015","journal-title":"Eur. J. Cell Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1084\/jem.159.3.746","article-title":"Creatine kinase expression and creatine phosphate accumulation are developmentally regulated during differentiation of mouse and human monocytes","volume":"159","author":"Loike","year":"1984","journal-title":"J. Exp. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"587517","DOI":"10.3389\/fimmu.2020.587517","article-title":"Clinical, Serological, and Histopathological Similarities Between Severe COVID-19 and Acute Exacerbation of Connective Tissue Disease-Associated Interstitial Lung Disease (CTD-ILD)","volume":"11","author":"Gagiannis","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1038\/s41586-021-03631-y","article-title":"Diverse functional autoantibodies in patients with COVID-19","volume":"595","author":"Wang","year":"2021","journal-title":"Nature"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"112518","DOI":"10.1016\/j.biopha.2021.112518","article-title":"Interaction of SARS-CoV-2 with cardiomyocytes: Insight into the underlying molecular mechanisms of cardiac injury and pharmacotherapy","volume":"146","author":"Abdi","year":"2022","journal-title":"Biomed. Pharmacother."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1021\/ac950914h","article-title":"Mass spectrometric sequencing of proteins from silver-stained polyacrylamide gels","volume":"68","author":"Shevchenko","year":"1996","journal-title":"Anal. Chem."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"757","DOI":"10.15252\/msb.20145625","article-title":"Ultrasensitive proteome analysis using paramagnetic bead technology","volume":"10","author":"Hughes","year":"2014","journal-title":"Mol. Syst. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1074\/mcp.T600050-MCP200","article-title":"The paragon algorithm, a next generation search engine that uses sequence temperature values sequence temperature values and feature probabilities to identify peptides from tandem mass spectra","volume":"6","author":"Shilov","year":"2007","journal-title":"Mol. Cell. Proteom."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.3389\/fimmu.2018.02365","article-title":"Elevated autoantibodies in subacute human spinal cord injury are naturally occurring antibodies","volume":"9","author":"Grassner","year":"2018","journal-title":"Front. Immunol."}],"container-title":["Cells"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4409\/11\/8\/1282\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:51:05Z","timestamp":1760136665000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4409\/11\/8\/1282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,9]]},"references-count":45,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["cells11081282"],"URL":"https:\/\/doi.org\/10.3390\/cells11081282","relation":{},"ISSN":["2073-4409"],"issn-type":[{"value":"2073-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,9]]}}}