{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T23:50:10Z","timestamp":1788911410523,"version":"build-2803163510"},"reference-count":30,"publisher":"King Faisal Specialist Hospital and Research Centre","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Saudi Med"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Data on human papillomavirus (HPV) prevalence and survival rates among HPV-infected women are scarce in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>Assess the prevalence of HPV genotypes in cervical biopsy specimens and its effect on survival over a 10-year timeframe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN:<\/jats:title>\n                    <jats:p>Retrospective, cross-sectional.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTINGS:<\/jats:title>\n                    <jats:p>Saudi referral hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENTS AND METHODS:<\/jats:title>\n                    <jats:p>\n                      Cervical biopsy specimens were collected from women aged 23-95 years old who underwent HPV detection, HPV genotyping, p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      expression measurement using immunohistochemistry. Kaplan-Meier plots were constructed to analyze overall survival rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MAIN OUTCOME MEASURES:<\/jats:title>\n                    <jats:p>Survival rate of HPV-positive cervical cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SAMPLE SIZE:<\/jats:title>\n                    <jats:p>315 cervical biopsy specimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      HPV was detected in 96 patients (30.4%): 37.3% had cervical cancer; 14.2% cervical intraepithelial neoplasia (CIN) III, 4.1% CIN II, and 17.0% CIN I. A significant association was found between HPV presence and cervical cancer (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =56.78;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;.001). The expression of p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      was a significant predictor of survival: women who had p16\n                      <jats:sup>INK4a<\/jats:sup>\n                      overexpression had poorer survival rates (multivariate Cox regression, hazard ratio, 3.2; 95% CI, 1.1\u20138.8). In addition, multivariate models with HPV status and cervical cancer diagnosis showed that HPV status was a significant predictor of survival: HPV-positive women had better survival rates than HPV-negative women.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>These findings suggest that implementing cervical and HPV screening programs may decrease cervical cancer rates and improve survival rates of women in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LIMITATION:<\/jats:title>\n                    <jats:p>Single center and small sample size.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONFLICT OF INTEREST:<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5144\/0256-4947.2021.350","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T07:58:36Z","timestamp":1638863916000},"page":"350-360","source":"Crossref","is-referenced-by-count":10,"title":["Prognostic impact of human papillomavirus infection on cervical dysplasia, cancer, and patient survival in Saudi Arabia: A 10-year retrospective analysis"],"prefix":"10.5144","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1765-4310","authenticated-orcid":true,"given":"Fatimah","family":"Alhamlan","sequence":"first","affiliation":[{"name":"From the Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia","family":"Obeid","sequence":"additional","affiliation":[{"name":"From the Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel","family":"Khayat","sequence":"additional","affiliation":[{"name":"From the Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulbah","family":"Asma","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail A.","family":"Al-Badawi","sequence":"additional","affiliation":[{"name":"From the Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areej","family":"Almutairi","sequence":"additional","affiliation":[{"name":"From the Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihana","family":"Almatrrouk","sequence":"additional","affiliation":[{"name":"From the Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Fageeh","sequence":"additional","affiliation":[{"name":"From the Infection Diseases Program, National Center for Biotechnology, King Abdulaziz City for Science and Technology. Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed","family":"Bakhrbh","sequence":"additional","affiliation":[{"name":"From the Infection Diseases Program, National Center for Biotechnology, King Abdulaziz City for Science and Technology. Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majed","family":"Nassar","sequence":"additional","affiliation":[{"name":"From the Infection Diseases Program, National Center for Biotechnology, King Abdulaziz City for Science and Technology. Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Al-Ahdal","sequence":"additional","affiliation":[{"name":"From the Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3134","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Fernandes J Galv\u00e3o de Ara\u00fajo J Allyrio Ara\u00fajo de Medeiros Fernandes T. Biology and natural history of human papillomavirus infection. Open Access Journal of Clinical Trials. 2013;:1","DOI":"10.2147\/OAJCT.S37741"},{"key":"e_1_3_2_3_2","unstructured":"International Agency for Research on Cancer and World Health Organization. GLOBOCAN 2012: estimated cancer incidence mortality and prevalence worldwide in 2012. Available from: http:\/\/globocan.iarc.fr\/Default.aspx"},{"key":"e_1_3_2_4_2","unstructured":"Canadian Cancer Survivor Network. WHO\/ICO information centre on human papillomavirus (HPV) and cervical cancer. Available from: http:\/\/survivornet.ca\/learn\/health-concerns-for-cancer-patients\/hpvand-cancer\/whoico-information-centre-on-human-papilloma-virus-hpv-and-cervical-cancer\/"},{"key":"e_1_3_2_5_2"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Bondagji NS Gazzaz FS Sait K Abdullah L. Prevalence of high-risk human papillomavirus infections in healthy Saudi women attending gynecologic clinics in the western region of Saudi Arabia. Ann Saudi Med. 2013;33.","DOI":"10.5144\/0256-4947.2013.13"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Al-Ahdal M Al-Arnous W Bohol M Abuzaid S Shoukri M Elrady K et al. Human papillomaviruses in cervical specimens of women residing in Riyadh Saudi Arabia: a hospital-based study. J Infect Dev Ctries [Internet]. 2014 Mar 13;8(03 SE-Original Articles). Available from: https:\/\/jidc.org\/index.php\/journal\/article\/view\/24619263","DOI":"10.3855\/jidc.4220"},{"key":"e_1_3_2_8_2"},{"issue":"1","key":"e_1_3_2_9_2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F","article-title":"Human papillomavirus is a necessary cause of invasive cervical cancer worldwide","volume":"189","author":"Walboomers JMM","year":"1999","unstructured":"Walboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. The Journal of Pathology. 1999;189(1):12\u20139.","journal-title":"The Journal of Pathology."},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jcv.2004.11.019","article-title":"HPV-mediated transformation of the anogenital tract","volume":"32","author":"Steenbergen RD","year":"2005","unstructured":"Steenbergen RD, Wilde JD, Wilting SM, Brink AA, Snijders PJ, Meijer CJ. HPV-mediated transformation of the anogenital tract. Journal of Clinical Virology. 2005;32:25\u201333.","journal-title":"Journal of Clinical Virology."},{"key":"e_1_3_2_11_2","first-page":"992","article-title":"The 2001 Bethesda System terminology","volume":"68","author":"Apgar S","year":"2003","unstructured":"S. Apgar, L. Zoschnick, T.C. Wright Jr. The 2001 Bethesda System terminology Am. Fam. Physician. 2003;68:992\u20131998.","journal-title":"Am. Fam. Physician."},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/B978-0-323-44732-4.00013-3","volume-title":"Diagnostic Gynecologic and Obstetric Pathology","author":"Crum C.P","year":"2018","unstructured":"C.P. Crum, E.E. Meserve, W.A. Peters III Cervical squamous neoplasia. In: Diagnostic Gynecologic and Obstetric Pathology, 3rd Edition Elsevier. 2018:298\u2013374","edition":"3"},{"key":"e_1_3_2_13_2","first-page":"43","article-title":"Molecular diagnosis of human papilloma-virus (HPV) infections J. Clin","volume":"32","author":"Molijn A","year":"2005","unstructured":"Molijn A, Kleter B, Quint W, van Doorn LJ. Molecular diagnosis of human papilloma-virus (HPV) infections J. Clin. Virol. 2005;32 Supp1:43\u201351.","journal-title":"Virol."},{"issue":"2","key":"e_1_3_2_14_2","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1002\/ijc.1174","article-title":"Overexpression of p16INK4A as a specific marker for dysplastic and neoplastic epithelial cells of the cervix uteri","volume":"92","author":"Klaes R","year":"2001","unstructured":"Klaes R, Friedrich T, Spitkovsky D, Ridder R, Rudy W, Petry U, et al. Overexpression of p16INK4A as a specific marker for dysplastic and neoplastic epithelial cells of the cervix uteri. International Journal of Cancer. 2001;92(2):276\u201384.","journal-title":"International Journal of Cancer."},{"issue":"3","key":"e_1_3_2_15_2","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.ctrv.2008.10.005","article-title":"p16INK4a immunostaining in cytological and histological specimens from the uterine cervix: A systematic review and meta-analysis","volume":"35","author":"Tsoumpou I","year":"2009","unstructured":"Tsoumpou I, Arbyn M, Kyrgiou M, Wentzensen N, Koliopoulos G, Martin-Hirsch P, et al. p16INK4a immunostaining in cytological and histological specimens from the uterine cervix: A systematic review and meta-analysis. Cancer Treatment Reviews. 2009;35(3):210\u201320.","journal-title":"Cancer Treatment Reviews."},{"issue":"6","key":"e_1_3_2_16_2","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.7314\/APJCP.2014.15.6.2529","article-title":"Knowledge about Cervical Cancer Early Warning Signs and Symptoms, Risk Factors and Vaccination among Students at a Medical School in Al-Ahsa, Kingdom of Saudi Arabia","volume":"15","author":"Al-Darwish AA","year":"2014","unstructured":"Al-Darwish AA, Al-Naim AF, Al-Mulhim KS, Al-Otaibi NK, Morsi MS, Aleem AM. Knowledge about Cervical Cancer Early Warning Signs and Symptoms, Risk Factors and Vaccination among Students at a Medical School in Al-Ahsa, Kingdom of Saudi Arabia. Asian Pacific Journal of Cancer Prevention. 2014;15(6):2529\u201332.","journal-title":"Asian Pacific Journal of Cancer Prevention."},{"issue":"11","key":"e_1_3_2_17_2","doi-asserted-by":"crossref","first-page":"819","DOI":"10.3855\/jidc.9704","article-title":"Human papillomaviruses: The cervical cancer saga in developing countries","volume":"11","author":"Alhamlan FS","year":"2017","unstructured":"Alhamlan FS, Alahdal MNA, Al-Zahrani AS, Almatrrouk SA. Human papillomaviruses: The cervical cancer saga in developing countries. The Journal of Infection in Developing Countries. 2017;11(11):819\u201325.","journal-title":"The Journal of Infection in Developing Countries."},{"issue":"1","key":"e_1_3_2_18_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/0377-4929.59173","article-title":"Immunohistochemical study of p16INK4A and survivin expressions in cervical squamous neoplasm","volume":"53","author":"Tan G","year":"2010","unstructured":"Tan G, Norlatiffah S, Sharifah N, Razmin G, Shiran M, Hatta A, et al. Immunohistochemical study of p16INK4A and survivin expressions in cervical squamous neoplasm. Indian Journal of Pathology and Microbiology. 2010;53(1):1.","journal-title":"Indian Journal of Pathology and Microbiology."},{"key":"e_1_3_2_19_2","first-page":"377","article-title":"Qasim Correlation of p16 (INK4A) and CK17 to HPV (16E6+18E6) in premalignant and malignant lesions of uterine cervix: a clinicopathologic study Iran J","volume":"11","author":"Chaloob M.K","year":"2016","unstructured":"M.K. Chaloob, A.G. Hussein, B.J. Qasim Correlation of p16 (INK4A) and CK17 to HPV (16E6+18E6) in premalignant and malignant lesions of uterine cervix: a clinicopathologic study Iran J. Pathol., 2016;11:377\u2013390","journal-title":"Pathol.,"},{"issue":"4","key":"e_1_3_2_20_2","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1099\/0022-1317-76-4-1057","article-title":"The use of general primers GP5 and GP6 elongated at their 3\u2019 ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR","volume":"76","author":"Husman A-MDR","year":"1995","unstructured":"Husman A-MDR, Walboomers JMM, Van Den Brule AAJC, Meijer CJLM, Snijders PJF. The use of general primers GP5 and GP6 elongated at their 3\u2019 ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. Journal of General Virology. 1995;76(4):1057\u201362.","journal-title":"Journal of General Virology."},{"key":"e_1_3_2_21_2","article-title":"Clinical comparison of two human papil-lomavirus detection assays: GenoFlow and reverse line blot","volume":"14","author":"Alhamlan FS","year":"2020","unstructured":"Alhamlan FS, Khayat HH, Obeid DA, Tulba AM, Baduwais TS, Alfageeh MB, et al. Clinical comparison of two human papil-lomavirus detection assays: GenoFlow and reverse line blot. J Infect Dev Ctries [Internet]. 2020 Jan 31;14(01 SE-Original Articles). Available from: https:\/\/jidc.org\/index.php\/journal\/article\/view\/32088690","journal-title":"J Infect Dev Ctries [Internet]"},{"issue":"1","key":"e_1_3_2_22_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/1471-0528.13071","article-title":"HPV-negative carcinoma of the uterine cervix: a distinct type of cervical cancer with poor prognosis","volume":"122","author":"Rodr\u00edguez-Carunchio L","year":"2014","unstructured":"Rodr\u00edguez-Carunchio L, Soveral I, Steen-bergen R, Torn\u00e9 A, Martinez S, Fust\u00e9 P, et al. HPV-negative carcinoma of the uterine cervix: a distinct type of cervical cancer with poor prognosis. BJOG: An International Journal of Obstetrics &amp; Gynaecology. 2014;122(1):119\u201327.","journal-title":"BJOG: An International Journal of Obstetrics &amp; Gynaecology."},{"issue":"10","key":"e_1_3_2_23_2","article-title":"High-risk human papillomavirus status and prognosis in invasive cervical cancer: A nationwide cohort study","volume":"15","author":"Lei J","year":"2018","unstructured":"Lei J, Ploner A, Lagheden C, Eklund C, Kleppe SN, Andrae B, et al. High-risk human papillomavirus status and prognosis in invasive cervical cancer: A nationwide cohort study. PLOS Medicine. 2018;15(10).","journal-title":"PLOS Medicine."},{"key":"e_1_3_2_24_2","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1111\/j.1349-7006.2007.00546.x","article-title":"Basic mechanisms of high-risk human papillomavirus-induced carcinogenesis: roles of E6 and E7 proteins","volume":"98","author":"Narisawa-Saito M","year":"2007","unstructured":"M. Narisawa-Saito, T, Kiyono Basic mechanisms of high-risk human papillomavirus-induced carcinogenesis: roles of E6 and E7 proteins Cancer Sci. 2007;98:1505\u20131511.","journal-title":"Cancer Sci"},{"key":"e_1_3_2_25_2","doi-asserted-by":"crossref","first-page":"3935","DOI":"10.1002\/j.1460-2075.1992.tb05487.x","article-title":"Properties of p53 mutations detected in primary and secondary cervical cancers suggest mechanisms of metastasis and involvement of environmental carcinogens","volume":"11","author":"Crook T","year":"1992","unstructured":"T. Crook, K.H. Vousden Properties of p53 mutations detected in primary and secondary cervical cancers suggest mechanisms of metastasis and involvement of environmental carcinogens EMBO J. 1992;11:3935\u20133940.","journal-title":"EMBO J"},{"key":"e_1_3_2_26_2","first-page":"107","article-title":"HPV negative cervical cancers and primary HPV screening Facts Views","volume":"10","author":"Tjalma W","year":"2018","unstructured":"W. Tjalma HPV negative cervical cancers and primary HPV screening Facts Views Vis. Obgyn., 2018;10:107\u2013113.","journal-title":"Vis. Obgyn.,"},{"issue":"5","key":"e_1_3_2_27_2","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1093\/jnci\/djx225","article-title":"Relative Performance of HPV and Cytology Components of Cotesting in Cervical Screening","volume":"110","author":"Schiffman M","year":"2018","unstructured":"Schiffman M, Kinney WK, Cheung LC, Gage JC, Fetterman B, Poitras NE, et al. Relative Performance of HPV and Cytology Components of Cotesting in Cervical Screening. JNCI: Journal of the National Cancer Institute. 2018;110(5):501\u20138.","journal-title":"JNCI: Journal of the National Cancer Institute."},{"key":"e_1_3_2_28_2","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1158\/1055-9965.EPI-08-0306","article-title":"Wentzensen Human papillomavirus mRNA and p16 detection as bio-markers for the improved diagnosis of cervical neoplasia Cancer Epidemiol","volume":"17","author":"Cuschieri K","year":"2008","unstructured":"K. Cuschieri, N. Wentzensen Human papillomavirus mRNA and p16 detection as bio-markers for the improved diagnosis of cervical neoplasia Cancer Epidemiol. Biomarkers Prev. 2008;17:2536\u20132545.","journal-title":"Biomarkers Prev"},{"issue":"10","key":"e_1_3_2_29_2","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1093\/infdis\/jir049","article-title":"Viral Load in the Natural History of Human Papillomavirus Type 16 Infection: A Nested Case\u2013Control Study","volume":"203","author":"Xi LF","year":"2011","unstructured":"Xi LF, Hughes JP, Castle PE, Edelstein ZR, Wang C, Galloway DA, et al. Viral Load in the Natural History of Human Papillomavirus Type 16 Infection: A Nested Case\u2013Control Study. The Journal of Infectious Diseases. 2011;203(10):1425\u201333.","journal-title":"The Journal of Infectious Diseases."},{"issue":"1","key":"e_1_3_2_30_2","doi-asserted-by":"crossref","DOI":"10.1186\/s13027-017-0159-0","article-title":"Introduction of p16INK4a as a surrogate biomarker for HPV in women with invasive cervical cancer in Sudan","volume":"12","author":"Sarwath H","year":"2017","unstructured":"Sarwath H, Bansal D, Husain NE, Mohamed M, Sultan AA, Bedri S. Introduction of p16INK4a as a surrogate biomarker for HPV in women with invasive cervical cancer in Sudan. Infectious Agents and Cancer. 2017;12(1).","journal-title":"Infectious Agents and Cancer."},{"issue":"9","key":"e_1_3_2_31_2","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.2217\/fmb.11.87","article-title":"Human papillomavirus and cervical cancer: biomarkers for improved prevention efforts","volume":"6","author":"Sahasrabuddhe VV","year":"2011","unstructured":"Sahasrabuddhe VV, Luhn P, Wentzensen N. Human papillomavirus and cervical cancer: biomarkers for improved prevention efforts. Future Microbiology. 2011;6(9):1083\u201398.","journal-title":"Future Microbiology."}],"container-title":["Annals of Saudi Medicine"],"original-title":[],"language":"en","deposited":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T04:00:42Z","timestamp":1660708842000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.annsaudimed.net\/doi\/10.5144\/0256-4947.2021.350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.5144\/0256-4947.2021.350"],"URL":"https:\/\/doi.org\/10.5144\/0256-4947.2021.350","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.05.22.20110247","asserted-by":"object"}]},"ISSN":["0256-4947","0975-4466"],"issn-type":[{"value":"0256-4947","type":"print"},{"value":"0975-4466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}