{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:29:50Z","timestamp":1787956190323,"version":"build-2784847793"},"reference-count":69,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Neonatal sepsis remains a leading cause of morbidity and mortality worldwide. It is widely considered that exchange transfusion (ET) as an adjunctive treatment for neonatal sepsis has the ability to reduce mortality. This review summarizes the current knowledge regarding the efficacy of ET for neonatal sepsis. In neonatal sepsis, immune responses such as proinflammatory and anti-inflammatory cytokines play an important role in pathogenesis and can lead to septic shock, multiple organ failure, and death. Between the 1970s and 1990s several authors reported that ET was effective in the treatment of neonatal sepsis with sclerema. ET removes bacterial toxins and inflammatory cytokines from the blood by replacing it with fresh and immunologically abundant blood, thereby leading to improvement in tissue perfusion and oxygenation. Moreover, ET with fresh whole blood increases neutrophil count and immunoglobulin levels as well as enhancing neutrophil function. However, there is a lack of clear evidence for the clinical efficacy of ET. In addition, adverse events associated with ET have been reported. Although most complications are transient, ET can lead to life-threatening complications. Therefore, ET can be considered a last resort treatment to rescue neonates with severe sepsis with sclerema and disseminated intravascular coagulation.<\/jats:p>","DOI":"10.3390\/jcm11051240","type":"journal-article","created":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T21:11:07Z","timestamp":1645737067000},"page":"1240","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3391-3757","authenticated-orcid":false,"given":"Shigeo","family":"Iijima","sequence":"first","affiliation":[{"name":"Department of Regional Neonatal-Perinatal Medicine, Hamamatsu University School of Medicine, Hamamatsu 4313192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2213-2600(18)30063-8","article-title":"The global burden of paediatric and neonatal sepsis: A systematic review","volume":"6","author":"Goldfarb","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1542\/peds.2009-2959","article-title":"Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network","volume":"126","author":"Stoll","year":"2010","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/PCC.0b013e31816689a8","article-title":"Outcome and prognostic factors in neonates with septic shock","volume":"9","author":"Laborie","year":"2008","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1038\/jp.2008.33","article-title":"Sclerema neonatorum: A review of nomenclature, clinical presentation, histological features, differential diagnoses and management","volume":"28","author":"Zeb","year":"2008","journal-title":"J. Perinatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1891\/0730-0832.37.4.205","article-title":"Disseminated Intravascular Coagulation in the Neonate","volume":"37","author":"VanVooren","year":"2018","journal-title":"Neonatal Netw."},{"key":"ref_6","first-page":"CD003956","article-title":"Granulocyte transfusions for neonates with confirmed or suspected sepsis and neutropenia","volume":"2011","author":"Pammi","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1067\/mpd.2001.114014","article-title":"Administration of recombinant granulocyte colony-stimulating factor to neonates with septicemia: A meta-analysis","volume":"138","author":"Bernstein","year":"2001","journal-title":"J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"INIS Collaborative Group, Brocklehurst, P., Farrell, B., King, A., Juszczak, E., Darlow, B., Haque, K., Salt, A., Stenson, B., and Tarnow-Mordi, W. (2011). Treatment of neonatal sepsis with intravenous immune globulin. N. Engl. J. Med., 365, 1201\u20131211.","DOI":"10.1056\/NEJMoa1100441"},{"key":"ref_9","first-page":"CD001239","article-title":"Intravenous immunoglobulin for suspected or proven infection in neonates","volume":"1","author":"Ohlsson","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","first-page":"CD003066","article-title":"G-CSF and GM-CSF for treating or preventing neonatal infections","volume":"2003","author":"Carr","year":"2003","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1542\/peds.53.2.170","article-title":"Care of the seriously ill neonate with hyaline membrane disease and with sepsis (sclerema neonatorum)","volume":"53","author":"Choffat","year":"1974","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1111\/j.1651-2227.1977.tb07955.x","article-title":"Treatment of septicaemia in the newborn infant: Choice of initial antimicrobial drugs and the role of exchange transfusion","volume":"66","author":"Pohlandt","year":"1977","journal-title":"Acta Paediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1136\/adc.50.11.901","article-title":"Exchange transfusion in severe neonatal infection with sclerema","volume":"50","author":"Xanthou","year":"1975","journal-title":"Arch. Dis. Child."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/S0031-3955(16)36038-2","article-title":"Immunotherapy of neonatal septicemia","volume":"33","author":"Yoder","year":"1986","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1542\/peds.66.5.693","article-title":"Role of exchange transfusion in the treatment of severe septicemia","volume":"66","author":"Vain","year":"1980","journal-title":"Pediatrics"},{"key":"ref_16","first-page":"39","article-title":"Exchange transfusions in neonatal sepsis","volume":"28","author":"Dlavi","year":"1991","journal-title":"Indian Pediatr."},{"key":"ref_17","first-page":"20","article-title":"Exchange transfusion in septic neonates with sclerema: Effect on immunoglobulin and complement levels","volume":"34","author":"Sadana","year":"1997","journal-title":"Indian Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/BF02834557","article-title":"A comparative study on the value of exchange and blood transfusion in the management of severe neonatal septicaemia with sclerema","volume":"49","author":"Narayanan","year":"1982","journal-title":"Indian J. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.clp.2010.04.002","article-title":"Pathophysiology and treatment of septic shock in neonates","volume":"37","author":"Wynn","year":"2010","journal-title":"Clin. Perinatol."},{"key":"ref_20","first-page":"269681","article-title":"Neonatal sepsis and inflammatory mediators","volume":"2014","author":"Machado","year":"2014","journal-title":"Mediat. Inflamm."},{"key":"ref_21","first-page":"34","article-title":"Neonatal septicaemia in poor resource settings","volume":"2","author":"Pius","year":"2017","journal-title":"Pediatric Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1038\/jp.2016.106","article-title":"Extreme hyperbilirubinemia and rescue exchange transfusion in California from 2007 to 2012","volume":"36","author":"Bhutani","year":"2016","journal-title":"J. Perinatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/j.1651-2227.1983.tb09669.x","article-title":"Endotoxin clearance by exchange blood transfusion in septic shock neonate","volume":"72","author":"Togari","year":"1983","journal-title":"Acta Paediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1111\/j.1442-200X.2012.03654.x","article-title":"Effects of exchange transfusion on cytokine profiles in necrotizing enterocolitis","volume":"54","author":"Sugiura","year":"2012","journal-title":"Pediatr. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1620\/tjem.253.269","article-title":"Cytokine profiles before and after exchange transfusions in severe late-onset neonatal group B streptococcus meningitis: A case report","volume":"253","author":"Chishiki","year":"2021","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0022-3476(76)80468-4","article-title":"The role of exchange transfusions in the management of low-birth-weight infants with and without severe respiratory distress syndrome. II. Further observations and studies of mechanisms of action","volume":"89","author":"Gottuso","year":"1976","journal-title":"J. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1203\/00006450-197106000-00001","article-title":"Postnatal changes in oxygen transport of term, premature, and sick infants: The role of red cell 2,3-diphosphoglycerate and adult hemoglobin","volume":"5","author":"Roncevic","year":"1971","journal-title":"Pediatr. Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Pugni, L., Ronchi, A., Bizzarri, B., Consonni, D., Pietrasanta, C., Ghirardi, B., Fumagalli, M., Ghirardello, S., and Mosca, F. (2016). Exchange transfusion in the treatment of neonatal septic shock: A ten-year experience in a neonatal intensive care unit. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17050695"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4314\/njm.v16i2.37303","article-title":"Disseminated intravascular coagulopathy in a neonate: Management challenges","volume":"16","author":"Ugwu","year":"2007","journal-title":"Niger. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/00006454-198309000-00004","article-title":"Serum opsonic activity and peripheral neutrophil counts before and after exchange transfusion in infants with early onset group B streptococcal septicemia","volume":"2","author":"Hall","year":"1983","journal-title":"Pediatric Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1111\/j.1651-2227.1993.tb12604.x","article-title":"Exchange transfusion in neutropenic septicemic neonates: Effect on granulocyte functions","volume":"82","author":"Mathur","year":"1993","journal-title":"Acta Paediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1111\/j.1651-2227.1996.tb18239.x","article-title":"Markers of oxidative stress before and after exchange transfusion for neonatal sepsis","volume":"85","author":"Kokk","year":"1996","journal-title":"Acta Paediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"321","DOI":"10.2739\/kurumemedj.45.321","article-title":"Changes of cerebral hemodynamics and oxygenation in unstable septic newborns during exchange transfusion","volume":"45","author":"Murakami","year":"1998","journal-title":"Kurume Med. J."},{"key":"ref_34","first-page":"93","article-title":"Adverse events associated with exchange transfusion and etiology of severe hyperbilirubinemia in near-term and term newborns","volume":"41","author":"Okan","year":"2011","journal-title":"Turk. J. Med. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3126\/jnps.v34i1.9030","article-title":"Adverse events of exchange transfusion in neonatal hyperbilirubinemia","volume":"34","author":"Chitlangia","year":"2014","journal-title":"J. Nepal Paediatr. Soc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/s12288-015-0534-1","article-title":"Exchange transfusion for severe neonatal hyperbilirubinemia: 17 years\u2019 experience from Vojvodina, Serbia","volume":"32","author":"Bujandric","year":"2016","journal-title":"Indian J. Hematol. Blood Transfus."},{"key":"ref_37","first-page":"168","article-title":"Adverse events related to exchange transfusion in newborn infants with hemolytic disease: Ten years of experience","volume":"27","author":"Santos","year":"2009","journal-title":"Rev. Paul. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.1542\/peds.99.5.e7","article-title":"Adverse events associated with exchange transfusion in healthy and ill newborns","volume":"99","author":"Jackson","year":"1997","journal-title":"Pediatrics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4103\/jcn.JCN_96_18","article-title":"Adverse events following blood exchange transfusion for neonatal hyperbilirubinemia: A prospective study","volume":"8","author":"Chacham","year":"2019","journal-title":"J. Clin. Neonatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"102","DOI":"10.3126\/kumj.v13i2.16781","article-title":"A prospective study on exchange transfusion in neonatal unconjugated hyperbilirubinemia--in a tertiary care hospital, Nepal","volume":"13","author":"Malla","year":"2015","journal-title":"Kathmandu Univ. Med. J."},{"key":"ref_41","first-page":"121","article-title":"Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society","volume":"56","author":"Okulu","year":"2021","journal-title":"Turk. Arch. Pediatr."},{"key":"ref_42","first-page":"421","article-title":"Exchange transfusion in neonatal hyperbilirubinaemia: Experience in Isfahan, Iran","volume":"48","author":"Badiee","year":"2007","journal-title":"Singap. Med. J."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Yu, C., Li, H., Zhang, Q., He, H., Chen, X., and Hua, Z. (2017). Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during an 11-year period, from 2001 to 2011. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0179550"},{"key":"ref_44","first-page":"626","article-title":"Neonatal exchange transfusion for hyperbilirubinemia in Guilan (the north province of Iran): A 3-year experience","volume":"54","author":"Esfandiarpour","year":"2012","journal-title":"Turk. J. Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.3109\/14767058.2014.960832","article-title":"Exchange transfusion for neonatal hyperbilirubinemia: An 8-year single center experience at a tertiary neonatal intensive care unit in Turkey","volume":"28","author":"Hakan","year":"2015","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2147\/JBM.S162191","article-title":"Adoption of the American Academy of Pediatrics\u2019 neonatal hyperbilirubinemia guidelines and its effect on blood exchange transfusion rate in a tertiary care center in Amman, Jordan","volume":"9","author":"Badran","year":"2018","journal-title":"J. Blood Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"21","DOI":"10.5005\/jp-journals-10018-1331","article-title":"Exchange transfusion for hyperbilirubinemia among term and near term in NICU of a tertiary care hospital of Bangladesh: Findings from a prospective study","volume":"11","author":"Dey","year":"2021","journal-title":"Euroasian J. Hepatogastroenterol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1080\/14767058.2020.1844659","article-title":"A single-center experience on exchange transfusion therapy in 123 full-term cases of severe neonatal hyperbilirubinemia in Wuhan","volume":"34","author":"Duan","year":"2021","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.jpeds.2004.01.054","article-title":"Adverse events associated with neonatal exchange transfusion in the 1990s","volume":"144","author":"Patra","year":"2004","journal-title":"J. Pediatr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/jpc.12290","article-title":"Neonatal exchange transfusions in the 21st century: A single hospital study","volume":"49","author":"Chitty","year":"2013","journal-title":"J. Paediatr. Child Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s12098-015-1841-0","article-title":"Double volume exchange transfusion in severe neonatal sepsis","volume":"83","author":"Aradhya","year":"2016","journal-title":"Indian J. Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Verma, A., Pandita, A., Gupta, G., Naranje, K.M., and Singh, A. (2020). Role of DVET in severe neonatal sepsis in an era of high antibiotic resistance: A retrospective observational study. J. Matern. Fetal Neonatal Med., 1\u20136.","DOI":"10.1080\/14767058.2020.1771303"},{"key":"ref_53","first-page":"39","article-title":"The immunoglobulin state of the neonate following surgery: Consequences for immunotherapy of neonatal septicemia","volume":"13","author":"Belohradsky","year":"1979","journal-title":"Prog. Pediatr. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1542\/peds.67.6.941a","article-title":"Exchange transfusion for severe neonatal septicemia","volume":"67","author":"Bossi","year":"1981","journal-title":"Pediatrics"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1179\/146532806X90592","article-title":"Exchange transfusion or intravenous immunoglobulin therapy as an adjunct to antibiotics for neonatal sepsis in developing countries: A pilot study","volume":"26","author":"Gunes","year":"2006","journal-title":"Ann. Trop. Paediatr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"8297","DOI":"10.14260\/jemds\/1456","article-title":"Exchange transfusion in neonatal sepsis dose not reduces overall mortality","volume":"2","author":"Rajput","year":"2013","journal-title":"J. Evol. Med. Dent. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"799","DOI":"10.36347\/sjams.2021.v09i06.006","article-title":"Exchange transfusion in neonatal sepsis- an old wine in new bottle","volume":"9","author":"Chillal","year":"2021","journal-title":"Sch. J. App. Med. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00431-021-04194-w","article-title":"The effect of exchange transfusion on mortality in neonatal sepsis: A meta-analysis","volume":"181","author":"Mathias","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_59","first-page":"138","article-title":"Survey of exchange transfusions for neonates in Japan and availability of blood","volume":"32","author":"Koyama","year":"2020","journal-title":"J. Jpn. Soc. Neonat. Health Dev."},{"key":"ref_60","first-page":"CD012477","article-title":"Effect of exchange transfusion on mortality in neonates with septicemia","volume":"8","author":"Mishra","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_61","unstructured":"Boardman, J., Groves, A., and Ramasethu, J. (2021). Evaluation and management of infection in the newborn. Avery & MacDonald\u2019s Neonatology: Pathophysiology and Management of the Newborn, Wolters Kluwer. [8th ed.]."},{"key":"ref_62","unstructured":"Wilson, C.B., Nizet, V., Maldonado, Y.A., Remington, J.S., and Klein, J.O. (2016). Bacterial sepsis and meningitis. Remington and Klein\u2019s Infectious Diseases of the Fetus and Newborn Infant, Elsevier Saunders. [8th ed.]."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1097\/00003246-199805000-00021","article-title":"Removal of endotoxin and cytokines by plasma exchange in patients with acute hepatic failure","volume":"26","author":"Iwai","year":"1998","journal-title":"Crit. Care Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1186\/s13054-018-2220-9","article-title":"Early therapeutic plasma exchange in septic shock: A prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers","volume":"22","author":"Knaup","year":"2018","journal-title":"Crit. Care"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1055\/s-0039-1692184","article-title":"Therapeutic plasma exchange in neonatal septic shock: A retrospective cohort study","volume":"37","author":"Sawyer","year":"2020","journal-title":"Am. J. Perinatol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/ped.12825","article-title":"Effect of PMX-DHP for sepsis due to ESBL-producing E. coli in an extremely low-birthweight infant","volume":"58","author":"Nishizaki","year":"2016","journal-title":"Pediatr. Int."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"34","DOI":"10.11648\/j.ajp.20190502.11","article-title":"Application of hemoadsorption in neonatal and pediatric hyperinflammatory states: A case series","volume":"5","author":"Milella","year":"2019","journal-title":"Am. J. Pediatr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1177\/0391398820902469","article-title":"Hemoperfusion with Cytosorb in pediatric patients with septic shock: A retrospective observational study","volume":"43","author":"Bottari","year":"2020","journal-title":"Int. J. Artif. Organs"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/5\/1240\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:27:00Z","timestamp":1760135220000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/5\/1240"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,24]]},"references-count":69,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11051240"],"URL":"https:\/\/doi.org\/10.3390\/jcm11051240","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,24]]}}}