{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:59:28Z","timestamp":1792839568028,"version":"4.5.0"},"reference-count":45,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T00:00:00Z","timestamp":1598832000000},"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>In patients with liver cirrhosis the contribution of inherited and acquired prothrombotic disorders in the development of non-malignant portal vein thrombosis (PVT) is inconclusive. The purpose of this retrospective study was to examine the prevalence of thrombophilia in this setting at our center from January 2012 to November 2019. Tests included gene mutational analysis for Factor V Leiden, prothrombin G20210A, JAK2 (V617F), Calreticulin (CARL), in addition to activated protein C resistance, antithrombin III, protein C and S levels, and antiphospholipid antibodies. We included 77 patients, six of whom (7.8%) had a thrombophilic disorder: antiphospholipid syndrome in four patients, prothrombin gene mutation in one and factor V Leiden mutation in one. This latter patient had also been diagnosed with polycythemia vera years before PVT development. Complete thrombosis of the main portal vein and re-thrombosis after stopping anticoagulation were more frequent in patients with thrombophilia, but the rates of recanalization under anticoagulant therapy were similar among groups. No other difference was accounted between groups. The low prevalence of acquired and inherited thrombophilia found in patients with cirrhosis and PVT support testing for these disorders on an individual basis and avoiding universal screening to reduce costs and unwarranted testing.<\/jats:p>","DOI":"10.3390\/jcm9092822","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T11:53:49Z","timestamp":1598874829000},"page":"2822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Portal Thrombosis in Cirrhosis: Role of Thrombophilic Disorders"],"prefix":"10.3390","volume":"9","author":[{"given":"Jos\u00e9 Ignacio","family":"Fortea","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"},{"name":"Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00e9s Garc\u00eda","family":"Carrera","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngela","family":"Puente","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"},{"name":"Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cuadrado","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"},{"name":"Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Huelin","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"},{"name":"Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen \u00c1lvarez","family":"Tato","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paloma \u00c1lvarez","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda del Roc\u00edo P\u00e9rez","family":"Montes","sequence":"additional","affiliation":[{"name":"Hematology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier Nu\u00f1ez","family":"C\u00e9spedes","sequence":"additional","affiliation":[{"name":"Hematology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Batlle","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Hematology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Jos\u00e9 Gonz\u00e1lez","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Radiology Department, University Hospital. Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0562-427X","authenticated-orcid":false,"given":"Marcos L\u00f3pez","family":"Hoyos","sequence":"additional","affiliation":[{"name":"Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"},{"name":"Immunology Department, University Hospital Marqu\u00e9s de Valdecilla. 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Crespo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"},{"name":"Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"F\u00e1brega","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department, University Hospital Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"},{"name":"Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqu\u00e9s de Valdecilla (IDIVAL), 39011 Santander, Spain"},{"name":"Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(2016). EASL Clinical Practice Guidelines: Vascular diseases of the liver. J. Hepatol., 64, 179\u2013202.","DOI":"10.1016\/j.jhep.2015.07.040"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1111\/tri.13353","article-title":"Mortality in liver transplant recipients with portal vein thrombosis\u2014An updated meta-analysis","volume":"31","author":"Zanetto","year":"2018","journal-title":"Transpl. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1053\/j.gastro.2019.01.265","article-title":"Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients with and Without Cirrhosis","volume":"156","author":"Intagliata","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1055\/s-0038-1666861","article-title":"Concepts and Controversies in Haemostasis and Thrombosis Associated with Liver Disease: Proceedings of the 7th International Coagulation in Liver Disease Conference","volume":"118","author":"Intagliata","year":"2018","journal-title":"Thromb. Haemost."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1053\/j.gastro.2019.03.070","article-title":"AGA Clinical Practice Update: Coagulation in Cirrhosis","volume":"157","author":"Greenberg","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zanetto, A., and Garcia-Tsao, G. (2020). Some Answers and More Questions About Portal Vein Thrombosis in Patients with Decompensated Cirrhosis. Clin. Gastroenterol. Hepatol., 30485\u201330487.","DOI":"10.1016\/j.cgh.2020.04.004"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1002\/hep.22772","article-title":"Vascular disorders of the liver","volume":"49","author":"DeLeve","year":"2009","journal-title":"Hepatology"},{"key":"ref_8","first-page":"538","article-title":"Vascular diseases of the liver. Clinical Guidelines from the Catalan Society of Digestology and the Spanish Association for the Study of the Liver. Gastroenterol","volume":"40","author":"Albillos","year":"2017","journal-title":"Hepatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.jhep.2009.03.013","article-title":"Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development","volume":"51","author":"Zocco","year":"2009","journal-title":"J. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/liv.13500","article-title":"Decreased portal vein velocity is predictive of the development of portal vein thrombosis: A matched case-control study","volume":"38","author":"Stine","year":"2018","journal-title":"Liver. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1136\/gut.40.6.798","article-title":"Prevalence of the factor V Leiden mutation in hepatic and portal vein thrombosis","volume":"40","author":"Mahmoud","year":"1997","journal-title":"Gut"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1002\/hep.510310213","article-title":"Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis","volume":"31","author":"Amitrano","year":"2000","journal-title":"Hepatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.jhep.2004.01.001","article-title":"Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis","volume":"40","author":"Amitrano","year":"2004","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1160\/TH05-08-0555","article-title":"Increased plasma prothrombin concentration in cirrhotic patients with portal vein thrombosis and prothrombin G20210A mutation","volume":"95","author":"Amitrano","year":"2006","journal-title":"Thromb. Haemost."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1177\/1076029610369797","article-title":"Antiphospholipid antibodies and antiphospholipid syndrome: Role in portal vein thrombosis in patients with and without liver cirrhosis","volume":"17","author":"Amitrano","year":"2011","journal-title":"Clin. Appl. Thromb. Hemost."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1097\/00042737-200507000-00009","article-title":"Causes of portal venous thrombosis in cirrhotic patients: The role of genetic and acquired factors","volume":"17","author":"Mangia","year":"2005","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/j.1478-3231.2005.01215.x","article-title":"MTHFR C677T mutations in liver cirrhosis with and without portal vein thrombosis","volume":"26","author":"Pasta","year":"2006","journal-title":"Liver. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jceh.2015.11.002","article-title":"PAI-1 4G-4G, MTHFR 677TT, V Leiden 506Q, and Prothrombin 20210A in Splanchnic Vein Thrombosis: Analysis of Individual Patient Data from Three Prospective Studies","volume":"6","author":"Pasta","year":"2016","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/MEG.0b013e3282f1cff7","article-title":"Janus kinase-2 mutation, cirrhosis and splanchnic vein thrombosis","volume":"20","author":"Colaizzo","year":"2008","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1111\/j.1872-034X.2010.00628.x","article-title":"Portal vein thrombosis in Egyptian patients with liver cirrhosis: Role of methylenetetrahydrofolate reductase C677T gene mutation","volume":"40","author":"Gabr","year":"2010","journal-title":"Hepatol. Res."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ayala, R., Grande, S., Bustelos, R., Ribera, C., Garc\u00eda-Sesma, A., Jimenez, C., Moreno, E., and Mart\u00ednez-L\u00f3pez, J. (2012). Obesity is an independent risk factor for pre-transplant portal vein thrombosis in liver recipients. BMC Gastroenterol., 12.","DOI":"10.1186\/1471-230X-12-114"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1111\/j.1440-1746.2011.07040.x","article-title":"Prevalence of the JAK2V617F mutation in Chinese patients with Budd-Chiari syndrome and portal vein thrombosis: A prospective study","volume":"27","author":"Qi","year":"2012","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/j.1478-3231.2012.02785.x","article-title":"Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis","volume":"32","author":"Senzolo","year":"2012","journal-title":"Liver. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1007\/s10620-012-2548-y","article-title":"Portal vein thrombosis in patients with end stage liver disease awaiting liver transplantation: Outcome of anticoagulation","volume":"58","author":"Werner","year":"2013","journal-title":"Dig. Dis. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1002\/hep.27546","article-title":"Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: Results of a longitudinal study","volume":"61","author":"Nery","year":"2015","journal-title":"Hepatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"42","DOI":"10.5152\/tjg.2015.5738","article-title":"Diagnostic value of the JAK2 V617F mutation for latent chronic myeloproliferative disorders in patients with Budd-Chiari syndrome and\/or portal vein thrombosis","volume":"26","author":"Zengin","year":"2015","journal-title":"Turk. J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s11239-014-1124-z","article-title":"Thrombophilic factor analysis in cirrhotic patients with portal vein thrombosis","volume":"40","author":"Saugel","year":"2015","journal-title":"J. Thromb. Thrombol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1007\/s11739-016-1467-x","article-title":"Presence of portal vein thrombosis in liver cirrhosis is strongly associated with low levels of ADAMTS-13: A pilot study","volume":"11","author":"Lancellotti","year":"2016","journal-title":"Intern. Emerg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.thromres.2016.03.024","article-title":"Hyperhomocysteinemia and MTHFR C677T polymorphism in patients with portal vein thrombosis complicating liver cirrhosis","volume":"141","author":"Ventura","year":"2016","journal-title":"Thromb. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.gastrohep.2018.06.005","article-title":"Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis","volume":"41","author":"Artaza","year":"2018","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1038\/s41424-018-0043-2","article-title":"Long-Term Outcome of Splanchnic Vein Thrombosis in Cirrhosis","volume":"9","author":"Senzolo","year":"2018","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_32","first-page":"3189","article-title":"The risk factors of portal vein thrombosis in patients with liver cirrhosis","volume":"17","author":"Cagin","year":"2019","journal-title":"Exp. Ther. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/MBC.0000000000000901","article-title":"The utility of thrombophilia testing in patients with newly diagnosed portal vein thrombosis","volume":"31","author":"Tremblay","year":"2020","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1160\/TH07-08-0526","article-title":"Inherited thrombophilic abnormalities and risk of portal vein thrombosis. a meta-analysis","volume":"99","author":"Dentali","year":"2008","journal-title":"Thromb. Haemost."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1016\/j.cgh.2014.04.026","article-title":"Associations of coagulation factor V Leiden and prothrombin G20210A mutations with Budd-Chiari syndrome and portal vein thrombosis: A systematic review and meta-analysis","volume":"12","author":"Qi","year":"2014","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1002\/rth2.12253","article-title":"Inherited thrombophilia and portal vein thrombosis in cirrhosis: A systematic review and meta-analysis","volume":"3","author":"Ma","year":"2019","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/MAJ.0b013e31826485fc","article-title":"Effect of antithrombin, protein C and protein S on portal vein thrombosis in liver cirrhosis: A meta-analysis","volume":"346","author":"Qi","year":"2013","journal-title":"Am. J. Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1007\/s11239-020-02090-y","article-title":"Thrombophilia screening revisited: An issue of personalized medicine","volume":"49","author":"Colucci","year":"2020","journal-title":"J. Thromb. Thrombol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.cgh.2012.01.012","article-title":"Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis","volume":"10","author":"Delgado","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","article-title":"International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)","volume":"4","author":"Miyakis","year":"2006","journal-title":"J. Thromb. Haemost."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","article-title":"The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia","volume":"127","author":"Arber","year":"2016","journal-title":"Blood"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Qi, X., De Stefano, V., Su, C., Bai, M., Guo, X., and Fan, D. (2015). Associations of antiphospholipid antibodies with splanchnic vein thrombosis: A systematic review with meta-analysis. Medicine, 94.","DOI":"10.1097\/MD.0000000000000496"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1056\/NEJMra1700365","article-title":"Thrombophilia Testing and Venous Thrombosis","volume":"377","author":"Connors","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1053\/j.gastro.2017.04.042","article-title":"Effects of Anticoagulants in Patients with Cirrhosis and Portal Vein Thrombosis: A Systematic Review and Meta-analysis","volume":"153","author":"Loffredo","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Magaz, M., Alvarez-Larr\u00e1n, A., Colomer, D., L\u00f3pez-Guerra, M., Garc\u00eda-Criado, M.\u00c1., Mezzano, G., Belmonte, E., Olivas, P., Soy, G., and Cervantes, F. (2020). Next generation sequencing in the diagnosis of non-cirrhotic splanchnic vein thrombosis. J. Hepatol.","DOI":"10.1016\/j.jhep.2020.06.045"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2822\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:05:11Z","timestamp":1760177111000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,31]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["jcm9092822"],"URL":"https:\/\/doi.org\/10.3390\/jcm9092822","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,31]]}}}