{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T19:36:27Z","timestamp":1788550587445,"version":"build-2803163510"},"reference-count":60,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T00:00:00Z","timestamp":1589414400000},"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>This study aimed to determine the incidence and the prognosis of incidental carcinoma of the gallbladder (IGBC) after cholecystectomy through a meta-analysis. This meta-analysis included 51 studies and 436,636 patients with cholecystectomy. The incidence rate of IGBC after cholecystectomy was 0.6% (95% confidence interval (CI) 0.5\u20130.8%). The incidence rate of recent studies was not significantly different from those of past studies. The mean age and female ratio of the IGBC subgroup were not significantly different from those of the overall patient group. The estimated rates of IGBC were 13.0%, 34.1%, 39.7%, 22.7%, and 12.5% in the pTis, pT1, pT2, pT3, and pT4 stages, respectively. Patients with IGBC had a favorable overall survival rate compared to patients with non-IGBC (hazard ratio (HR) 0.574, 95% CI 0.445\u20130.739). However, there was no significant difference of disease-free survival between the IGBC and non-IGBC subgroups (HR 0.931, 95% CI 0.618\u20131.402). IGBC was found in 0.6% of patients with cholecystectomy. The prognosis of patients with IGBC was favorable compared to those with non-IGBC. In the pathologic examination after cholecystectomy for benign diseases, a sufficient examination for histology should be guaranteed to detect IGBC.<\/jats:p>","DOI":"10.3390\/jcm9051484","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T10:53:59Z","timestamp":1589540039000},"page":"1484","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0320-8088","authenticated-orcid":false,"given":"Jung-Soo","family":"Pyo","sequence":"first","affiliation":[{"name":"Department of Pathology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9299-5476","authenticated-orcid":false,"given":"Byoung Kwan","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul 01830, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul 01830, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Il Whan","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul 01830, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8376-3921","authenticated-orcid":false,"given":"Kwang Hyun","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul 01830, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,14]]},"reference":[{"key":"ref_1","unstructured":"WHO Classification of Tumors Editorial Board (2019). WHO Classification of Tumours of the Digestive System, International Agency for Research on Cancer. [5th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1148\/radiographics.22.2.g02mr08387","article-title":"From the archives of the AFIP. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: Radiologic-pathologic correlation. Armed Forces Institute of Pathology","volume":"22","author":"Levy","year":"2002","journal-title":"Radiographics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"131","DOI":"10.4174\/astr.2016.90.3.131","article-title":"Incidental gallbladder cancer after routine cholecystectomy: When should we suspect it preoperatively and what are predictors of patient survival?","volume":"90","author":"Ahn","year":"2016","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s004640080207","article-title":"Is frozen section effective for diagnosis of unsuspected gallbladder cancer during laparoscopic cholecystectomy?","volume":"16","author":"Aoki","year":"2001","journal-title":"Surg. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1590\/0100-69912017003005","article-title":"Preval\u00eancia do c\u00e2ncer de ves\u00edcula biliar em pacientes submetidos \u00e0 colecistectomia: Experi\u00eancia do Hospital de Cl\u00ednicas da Faculdade de Ci\u00eancias M\u00e9dicas da Universidade Estadual de Campinas\u2013UNICAMP","volume":"44","author":"Cazzo","year":"2017","journal-title":"Revista Col\u00e9gio Bras. Cir."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1308\/rcsann.2016.0099","article-title":"Incidental findings during routine pathological evaluation of gallbladder specimens: Review of 1747 elective laparoscopic cholecystectomy cases","volume":"98","author":"Basak","year":"2016","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_7","first-page":"344","article-title":"Gallbladder carcinoma during laparoscopic cholecystectomy: Is it associated with bad prognosis?","volume":"84","author":"Braghetto","year":"1999","journal-title":"Int. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.3748\/wjg.v18.i30.4019","article-title":"Incidental gallbladder cancer during laparoscopic cholecystectomy: Managing an unexpected finding","volume":"18","author":"Cavallaro","year":"2012","journal-title":"World J. Gastroenterol."},{"key":"ref_9","first-page":"175","article-title":"A 10-year experience of unsuspected gallbladder cancer after laparoscopic cholecystectomy","volume":"88","author":"Chan","year":"2003","journal-title":"Int. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.hbpd.2018.06.008","article-title":"Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases","volume":"17","author":"Charfi","year":"2018","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.1007\/s00268-009-0249-2","article-title":"Incidental Gallbladder Cancer Diagnosed Following Laparoscopic Cholecystectomy","volume":"33","author":"Choi","year":"2009","journal-title":"World J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s00423-012-0950-8","article-title":"Outcomes and prognostic factors in gallbladder cancer: A single-centre experience","volume":"397","author":"Cziupka","year":"2012","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.ejso.2013.02.010","article-title":"Carcinoma of the gallbladder: Patterns of presentation, prognostic factors and survival rate. An 11-year single centre experience","volume":"39","author":"Lapointe","year":"2013","journal-title":"Eur. J. Surg. Oncol. (EJSO)"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4913","DOI":"10.2147\/OTT.S106580","article-title":"Incidental gallbladder cancer after cholecystectomy: 1990 to 2014","volume":"9","author":"Chabowski","year":"2016","journal-title":"OncoTargets Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"107","DOI":"10.5152\/UCD.2015.2750","article-title":"Incidental gallbladder cancers: Our clinical experience and review of the literature","volume":"32","author":"Duzkoylu","year":"2015","journal-title":"Turk. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ferrarese, A., Solej, M., Enrico, S., Falcone, A., Catalano, S., Pozzi, G., Marola, S., and Martino, V. (2013). Diagnosis of incidental gallbladder cancer after laparoscopic cholecystectomy: Our experience. BMC Surg., 13.","DOI":"10.1186\/1471-2482-13-S2-S20"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s00423-019-01800-2","article-title":"Prospective multi-center study of surgeon\u2019s assessment of the gallbladder compared to histopathological examination to detect incidental malignancy","volume":"404","author":"Firat","year":"2019","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"513","DOI":"10.4318\/tjg.2011.0250","article-title":"Incidental gallbladder cancer diagnosed during or after laparoscopic cholecystectomy in members of the Turkish population with gallstone disease","volume":"22","author":"Volkan","year":"2011","journal-title":"Turk J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"249","DOI":"10.15171\/mejdd.2018.118","article-title":"Incidental Gall Bladder Adenocarcinoma in Cholecystectomy Specimens; A Single Center Experience and Review of the Literature","volume":"10","author":"Geramizadeh","year":"2018","journal-title":"Middle East J. Dig. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2281","DOI":"10.1007\/s00464-010-0952-y","article-title":"Incidence, management, and outcome of incidental gallbladder carcinoma: Analysis of the database of the Swiss association of laparoscopic and thoracoscopic surgery","volume":"24","author":"Glauser","year":"2010","journal-title":"Surg. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.hbpd.2018.02.001","article-title":"Clues to predict incidental gallbladder cancer","volume":"17","author":"Goussous","year":"2018","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s13193-015-0379-y","article-title":"Incidental Detection of Carcinoma Gall Bladder in Laparoscopic Cholecystectomy Specimens: A Thirteen Year Study of 23 Cases and Literature Review","volume":"6","author":"Gulwani","year":"2015","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Horkoff, M.J., Ahmed, Z., Xu, Y., Sutherland, F.R., Dixon, E., Ball, C.G., and Bathe, O.F. (2019). Adverse Outcomes After Bile Spillage in Incidental Gallbladder Cancers. Ann. Surg.","DOI":"10.1097\/SLA.0000000000003325"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.14735\/amko201331","article-title":"Primary gallbladder cancer discovered postoperatively after elective and emergency cholecystectomy","volume":"26","author":"Ioannidis","year":"2013","journal-title":"Klin. Onkol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/2278-330X.226802","article-title":"Incidental gallbladder carcinoma: Utility of histopathological evaluation of routine cholecystectomy specimens","volume":"7","author":"Jha","year":"2018","journal-title":"South Asian J. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3315","DOI":"10.7314\/APJCP.2013.14.5.3315","article-title":"Impact of routine histopathological examination of gall bladder specimens on early detection of malignancy-a study of 4115 cholecystectomy specimens","volume":"14","author":"Kalita","year":"2013","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s00268-009-0279-9","article-title":"Unsuspected gallbladder cancer diagnosed after laparoscopic cholecystectomy: Focus on acute cholecystitis","volume":"34","author":"Kim","year":"2010","journal-title":"World J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.hpb.2017.11.006","article-title":"The risk of incidental gallbladder cancer is negligible in macroscopically normal cholecystectomy specimens","volume":"20","author":"Koppatz","year":"2018","journal-title":"HPB"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"519","DOI":"10.3346\/jkms.1997.12.6.519","article-title":"A clinicopathological study of unsuspected carcinoma of the gallbladder","volume":"12","author":"Kwon","year":"1997","journal-title":"J. Korean Med. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/jso.20944","article-title":"Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy","volume":"97","author":"Kwon","year":"2008","journal-title":"J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1007\/s00268-017-4215-0","article-title":"Are Incidental Gallbladder Cancers Missed with a Selective Approach of Gallbladder Histology at Cholecystectomy?","volume":"42","author":"Lundgren","year":"2018","journal-title":"World J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1590\/S0004-28032015000300017","article-title":"Prevalence of incidental gallbladder cancer in a tertiary-care hospital from Pernambuco, Brazil","volume":"52","author":"Batista","year":"2015","journal-title":"Arq. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1007\/s11605-012-1901-y","article-title":"Tumor characteristics and survival analysis of incidental versus suspected gallbladder carcinoma","volume":"16","author":"Mazer","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2298\/ACI1002095M","article-title":"Incidental gallbladder carcinoma in regional clinical centre","volume":"57","author":"Mitrovic","year":"2010","journal-title":"Acta Chir. Iugosl."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1007\/BF02384982","article-title":"Unsuspected gallbladder cancer diagnosed by laparoscopic cholecystectomy: A clinicopathological study","volume":"27","author":"Mori","year":"1997","journal-title":"Surg. Today"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.amsu.2018.07.009","article-title":"Surgical strategy for suspected early gallbladder carcinoma including incidental gallbladder carcinoma diagnosed during or after cholecystectomy","volume":"33","author":"Nitta","year":"2018","journal-title":"Ann. Med. Surg."},{"key":"ref_37","first-page":"167","article-title":"Incidental gallbladder carcinoma: Our experience","volume":"34","author":"Panebianco","year":"2013","journal-title":"G. Chir. J. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"685","DOI":"10.4240\/wjgs.v8.i10.685","article-title":"Incidental non-benign gallbladder histopathology after cholecystectomy in an United Kingdom population: Need for routine histological analysis?","volume":"8","author":"Patel","year":"2016","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/SLA.0000000000000485","article-title":"Incidental Gallbladder Cancer at Cholecystectomy","volume":"260","author":"Pitt","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1001\/archsurg.135.11.1340","article-title":"Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer?","volume":"135","author":"Sarli","year":"2000","journal-title":"Arch. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1272\/jnms.73.136","article-title":"Incidental gallbladder cancer diagnosed during and after laparoscopic cholecystectomy","volume":"73","author":"Shimizu","year":"2006","journal-title":"J. Nippon. Med. Sch."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jss.2014.01.064","article-title":"Predictive factors for incidental gallbladder dysplasia and carcinoma","volume":"189","author":"Solaini","year":"2014","journal-title":"J. Surg. Res."},{"key":"ref_43","first-page":"9319147","article-title":"Surgically Resected Gall Bladder: Is Histopathology Needed for All?","volume":"2016","author":"Talreja","year":"2016","journal-title":"Surg. Res. Pract."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1007\/s00464-008-9950-8","article-title":"Incidental carcinoma gall bladder during laparoscopic cholecystectomy for symptomatic gall stone disease","volume":"23","author":"Tantia","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_45","first-page":"399","article-title":"Incidental gallbladder cancer at cholecystectomy","volume":"6","author":"Tatli","year":"2017","journal-title":"Ann. Ital. Chir."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1007\/s00268-014-2864-9","article-title":"Surgical Treatment of Incidental Gallbladder Cancer Discovered During or Following Laparoscopic Cholecystectomy","volume":"39","author":"Tian","year":"2014","journal-title":"World J. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Utsumi, M., Aoki, H., Kunitomo, T., Mushiake, Y., Yasuhara, I., Arata, T., Katsuda, K., Tanakaya, K., and Takeuchi, H. (2017). Evaluation of surgical treatment for incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy: Single center results. BMC Res. Notes, 10.","DOI":"10.1186\/s13104-017-2387-1"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.ejso.2019.01.013","article-title":"Positive cystic duct margin at index cholecystectomy in incidental gallbladder cancer is an important negative prognosticator","volume":"45","author":"Vega","year":"2019","journal-title":"Eur. J. Surg. Oncol. (EJSO)"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/S1001-9294(13)60030-9","article-title":"Unsuspected Gallbladder Cancer During or After Laparoscopic Cholecystectomy","volume":"28","author":"Xu","year":"2013","journal-title":"Chin. Med. Sci. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s00534-005-0996-x","article-title":"Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy","volume":"12","author":"Yamamoto","year":"2005","journal-title":"J. Hepato Biliary Pancreat. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1007\/s12094-012-0988-7","article-title":"Unsuspected gallbladder carcinoma discovered during or after cholecystectomy: Focus on appropriate radical re-resection according to the T-stage","volume":"15","author":"Yi","year":"2013","journal-title":"Clin. Transl. Oncol."},{"key":"ref_52","first-page":"869","article-title":"Surgical approach does not influence the outcome of incidental gallbladder carcinoma","volume":"8","author":"Zhang","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/S1499-3872(14)60292-7","article-title":"Predictors of incidental gallbladder cancer in elderly patients","volume":"14","author":"Zhu","year":"2015","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1097\/SLA.0b013e31806beec2","article-title":"Gallbladder Cancer: The Role of Laparoscopy and Radical Resection","volume":"245","author":"Shih","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"106","DOI":"10.3322\/canjclin.56.2.106","article-title":"Cancer statistics, 2006","volume":"56","author":"Jemal","year":"2006","journal-title":"CA. Cancer J. Clin."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1590\/1516-3180.2015.0250130216","article-title":"Frequency of Cholecystectomy and Associated Sociodemographic and Clinical Risk Factors in the ELSA-Brasil Study","volume":"134","author":"Alves","year":"2016","journal-title":"Sao Paulo Med. J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"172","DOI":"10.5009\/gnl.2012.6.2.172","article-title":"Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer","volume":"6","author":"Stinton","year":"2012","journal-title":"Gut Liver."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S0033-0620(85)80003-7","article-title":"Beta blockade during and after myocardial infarction: An overview of the randomized trials","volume":"27","author":"Yusuf","year":"1985","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.3748\/wjg.v21.i4.1315","article-title":"Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis","volume":"21","author":"Choi","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s00464-005-0121-x","article-title":"Does laparoscopy worsen the prognosis for incidental gallbladder cancer?","volume":"20","author":"Goetze","year":"2005","journal-title":"Surg. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1484\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:28:56Z","timestamp":1760174936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,14]]},"references-count":60,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["jcm9051484"],"URL":"https:\/\/doi.org\/10.3390\/jcm9051484","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,14]]}}}