FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1996202150> ?p ?o ?g. }

• W1996202150 endingPage "600" @default.
• W1996202150 startingPage "597" @default.
• W1996202150 abstract "A 67-year-old man with Waldenström's macroglobulinemia had a relapse of chronic idiopathic thrombocytopenic purpura (ITP), which had been refractory to corticosteroids, splenectomy, vinca alkaloids, and high-dose intravenous γ-globulin therapy. A biclonal gammopathy (IgM κ and IgG γ) was detected in his serum and was likely responsible for his refractory thrombocytopenia. He was treated with chlorambucil and prednisone. Plasmapheresis was effective in temporarily maintaining platelet counts and in decreasing morbidity until immunosuppression was completely effective against the production of the monoclonal protein. The previously reported experiences with use of plasmapheresis in patients with chronic ITP are discussed. Plasmapheresis may be of value in the treatment of selected patients with severe ITP and monoclonal gammopathy. A 67-year-old man with Waldenström's macroglobulinemia had a relapse of chronic idiopathic thrombocytopenic purpura (ITP), which had been refractory to corticosteroids, splenectomy, vinca alkaloids, and high-dose intravenous γ-globulin therapy. A biclonal gammopathy (IgM κ and IgG γ) was detected in his serum and was likely responsible for his refractory thrombocytopenia. He was treated with chlorambucil and prednisone. Plasmapheresis was effective in temporarily maintaining platelet counts and in decreasing morbidity until immunosuppression was completely effective against the production of the monoclonal protein. The previously reported experiences with use of plasmapheresis in patients with chronic ITP are discussed. Plasmapheresis may be of value in the treatment of selected patients with severe ITP and monoclonal gammopathy. Idiopathic thrombocytopenic purpura (ITP) is a common hematologic problem. ITP is diagnosed after apparent exogenous factors have been excluded. ITP may be acute or chronic. Acute ITP occurs most frequently in children and is usually self-limited. Chronic ITP occurs at all ages and typically has a fluctuating clinical course. Spontaneous remissions are common in acute ITP but not in chronic ITP. About 70 to 80% of patients with ITP respond to prednisone therapy and splenectomy.1Kelton JG Gibbons S Autoimmune platelet destruction: idiopathic thrombocytopenic purpura.Semin Thromb Hemost. 1982; 8: 83-104Crossref PubMed Scopus (121) Google Scholar Patients whose condition remains refractory to treatment have increased morbidity and mortality, and they may respond poorly to alternative therapy. The current approach to chronic ITP was recently reviewed.2Berchtold P McMillan R Therapy of chronic idiopathic thrombocytopenic purpura in adults.Blood. 1989; 74: 2309-2317PubMed Google Scholar Occasionally, the thrombocytopenia is life threatening, and a rapid increase in the platelet count is necessary. Plasmapheresis is a potentially attractive alternative because of its low associated morbidity. Herein we describe an unusual case of refractory chronic thrombocytopenia associated with Waldenströrri's macroglobulinemia in which plasmapheresis was useful. In addition, we review the previously reported experiences with plasmapheresis in chronic ITP. A 67-year-old man was referred to our institution for assessment of refractory thrombocytopenia. Nine months previously, he had recurrent hemorrhagic bullae, ecchymoses, epistaxis, and a platelet count of 2 × 109/L. He had been treated initially with prednisone, 100 to 120 mg daily, without sustained improvements in his platelet counts. Five months later, he underwent a left upper lobectomy for a grade 3 squamous cell carcinoma of the lung. At that same time, splenectomy was performed. The spleen was enlarged (weight, 856 g), and later pathologic review revealed involvement by malignant non-Hodgkin's lymphoma, small lymphocytic type with plasmacytoid features. His postoperative course was complicated by a bronchopleural fistula, and he underwent complete pneumonectomy 5 weeks later. Throughout this period, he had thrombocytopenia and recurrent epistaxis despite prednisone, danazol, vincristine sulfate, and intravenous immunoglobulin therapy. He was subsequently referred to our institution for further assessment and management of his chronic ITP. At the time of admission, the patient seemed to have cachexia. Multiple ecchymoses were evident on his skin, as well as severe purpura on the extensor surface of his hands and elbows bilaterally. No adenopathy or hepatomegaly was noted. Breath sounds were absent over his left hemithorax. Findings on the rest of his examination were unremarkable. Initial laboratory studies yielded the following results: hemoglobin, 8.8 g/dl; leukocyte count, 9.5 × 109/L (with 39% segmented neutrophils, 6% neutrophil bands, 49% lymphocytes, and 8% monocytes); and platelet count, 8 × 109/L. A peripheral blood smear revealed true thrombocytopenia; target cells and Howell-Jolly bodies were present. The erythrocyte sedimentation rate was 96 mm in 1 hour (normal, o to 22). Results of urinalysis were normal. The total serum protein level was 9.0 g/dL, and serum protein electrophoresis revealed a dense band migrating in the gamma region that was 3.54 g/dL. Quantitative immunoglobulins disclosed an IgA of 170 mg/dL (normal, 60 to 400), IgM of 2,780 mg/dL (normal, 60 to 300), and IgG of 2,030 mg/dL (normal, 700 to 1,500). The serum viscosity was 2.3 centipoises (normal, 1.8 or less). Immunoelectrophoresis showed a biclonal gammopathy with an IgM κ protein and an IgG λ protein. Urine protein electrophoresis revealed a total protein of 530 mg/24 h with Bence Jones proteinuria (monoclonal κ) and a monoclonal IgM κ fragment. The presence of a small monoclonal λ protein was suspected. An immunofluorescence serum platelet antibody test was positive, but no cell-bound platelet antibody was detected with use of the same method. A bone marrow biopsy revealed megakaryocytic hyperplasia. The biopsy specimen was hypercellular with bilateral lymphomatous involvement and plasmacytic differentiation, findings consistent with Waldenstrom's macroglobulinemia. Special stains showed κ light chain positivity. Bone marrow bromodeoxyuridine immunofluorescence labeling index disclosed cytoplasmic immunoglobulin positive cells with mature lymphoid morphology and a labeling index of 0% (very low proliferative rate). Most of the lymphoid cells were monoclonal κ with a few λ staining plasma cells. The patient received oral chlorambucil, 6 mg daily, and oral prednisone therapy, 60 mg daily. He continued to have severe purpura, daily epistaxis, and thrombocytopenia; platelet counts ranged from 2 to 4 × 109/L despite intravenous vincristine (2 mg), vinblastine sulfate (5.2 mg), and immunoglobulin therapy (400 mg/kg for 5 days). Furthermore, the platelet count did not increase with transfusion of apheresis platelets on two occasions. Staphylococcal protein A pheresis was not performed. Because of the ongoing thrombocytopenia and bleeding and the known IgM monoclonal protein, we performed a therapeutic plasma exchange (3,250 mL) with 5% albumin replacement and use of a continuous flow centrifugation device. The patient's response was transient. His platelet count increased to 57 × 109/L, but this increase lasted only a few days; however, he had no further bleeding. On the basis of the response of the platelet count, plasmaphereses were repeated five more times during the next 22 days. A typical exchange consisted of 5% normal serum albumin as the replacement fluid with an exchange volume of 3,250 mL. Three weeks after chlorambucil had been initiated, the dosage was increased to 8 mg daily. After the sixth plasma exchange and 4 weeks after the initiation of chlorambucil therapy, the platelet count increased to 154 × 109/L, and the serum γ-globulin concentration decreased to 1.46 g/dL. Use of corticosteroids was gradually tapered during the next 4 months, and the dosage of chlorambucil was decreased to 4 mg/day. Serum γ-globulin concentrations did not increase; they were 1.75, 1.09, and 1.02 g/dL at 1-, 6-, and 12-month followup, respectively. The patient had no recurrence of epistaxis, and a normal platelet count was maintained throughout the next 2 years. He eventually died of metastatic lung carcinoma. ITP is believed to result from an immunologically mediated peripheral destruction of platelets in which antibody or immune complex-coated platelets are sequestered in the reticuloendothelial system. Most patients with ITP generally respond to corticosteroids and splenectomy.1Kelton JG Gibbons S Autoimmune platelet destruction: idiopathic thrombocytopenic purpura.Semin Thromb Hemost. 1982; 8: 83-104Crossref PubMed Scopus (121) Google Scholar Additional immunosuppressive therapy is considered for patients whose condition remains refractory. Plasmapheresis involves the removal of plasma and the return of all cellular blood components into the patient. In some diseases involving the immune system, it is believed to be effective because of the removal of immune complexes, antibodies, circulating toxins, or antigens. Evolution in techniques and increasing availability have rendered the procedure safe and easy to perform. The indications for the use of plasmapheresis, however, remain controversial. Anecdotal evidence suggests that it may be of value in producing prolonged remissions and may postpone the need for splenectomy in patients with acute ITP.3Marder VJ Nusbacher J Anderson FW One-year follow-up of plasma exchange therapy in 14 patients with idiopathic thrombocytopenic purpura.Transfusion. 1981; 21: 291-298Crossref PubMed Scopus (50) Google Scholar Chronic ITP is believed to be less responsive, and the role of plasmapheresis in patients with this variant remains undefined. The reported experience with the use of plasmapheresis in chronic ITP has been disappointing (Table 1). An initial increase in platelet count was noted in only 43% of the patients reviewed (10 of 23), and only 1 of these was described to have a sustained response. Splenectomy did not seem to affect the response rates to plasma exchange: 43% of patients (6 of 14) who had undergone prior splenectomy responded, as did 44% of patients (4 of 9) who did not undergo prior splenectomy. Because of the general effectiveness of splenectomy in ITP, it should be considered before the use of plasmapheresis in patients with refractory thrombocytopenia. The choice of exchange fluid or the number of exchanges performed might be expected to influ&x00AD; ence the response to plasmapheresis; however, on the basis of the few reported cases, a definite long-term advantage cannot clearly be attributed to the use of plasma as the exchange fluid or to increasing the number of exchanges. Antiplatelet antibodies were measured in nine patients,4Branda RF Moldow CF McCullough JJ Jacob HS Plasma exchange in the treatment of immune disease.Transfusion. 1975; 15: 570-576Crossref PubMed Scopus (75) Google Scholar, 6Blanchette VS Hogan VA McCombie NE Drouin J Bormanis JD Taylor R et al.Intensive plasma exchange therapy in ten patients with idiopathic thrombocytopenic purpura.Transfusion. 1984; 24: 388-394Crossref PubMed Scopus (27) Google Scholar, 7Porter CC Ruley EJ Luban NL Phillips TM Bock GH Salcedo JR et al.Accelerated recovery from immune-mediated thrombocytopenia with plasmapheresis.Am J Med. 1985; 79: 765-768Abstract Full Text PDF PubMed Scopus (8) Google Scholar, 9Flick JT Grush O Morgan S Walls C Lazarchick J The role of apheresis in the support of life-threatening ITP relapse.Am J Med Sci. 1987; 294: 444-447Crossref PubMed Scopus (7) Google Scholar, 10Weir III, AB Poon MC McGowan El Plasma exchange in idiopathic thrombocytopenic purpura.Arch Intern Med. 1980; 140: 1101-1103Crossref PubMed Scopus (13) Google Scholar and a decrease in antiplatelet antibodies was reported in 67% of patients who responded (four of six). One patient in whom plasmapheresis was associated with a decrease in antiplatelet antibody had no response and died of an intracranial bleed.9Flick JT Grush O Morgan S Walls C Lazarchick J The role of apheresis in the support of life-threatening ITP relapse.Am J Med Sci. 1987; 294: 444-447Crossref PubMed Scopus (7) Google ScholarTable 1Reported Use of Plasmapheresis in Chronic Idiopathic Thrombocytopenic Purpura*A = azalhioprine; Alb = albumin; C = cyclophosphamide; Chi = chlorambucit; Dan = danazol; Ig = immunoglobulin; 6-MP = mer-caplopurinc; NM = not measured; P = plasma; Pit = platelet transfusions; V = vincristine; Vbl = vinblastine-loaded platelets.Plasma exchangePlatelet count (× 109/L)ReferenceAge (yr) and sexSplcn-ectomyTreatmentNo.FluidBeforeAfterChange in antibodiesResponseMarder et al3Marder VJ Nusbacher J Anderson FW One-year follow-up of plasma exchange therapy in 14 patients with idiopathic thrombocytopenic purpura.Transfusion. 1981; 21: 291-298Crossref PubMed Scopus (50) Google Scholar49 FYesNone1P……NMNo25 FYesNone3P……NMNo33 FYesNone2P……NMNo34 FYesNone2P……NMNoBranda et al 4Branda RF Moldow CF McCullough JJ Jacob HS Plasma exchange in the treatment of immune disease.Transfusion. 1975; 15: 570-576Crossref PubMed Scopus (75) Google Scholar25 MNoNone1P10-2010-20NMNoNovak & Wilimas3Marder VJ Nusbacher J Anderson FW One-year follow-up of plasma exchange therapy in 14 patients with idiopathic thrombocytopenic purpura.Transfusion. 1981; 21: 291-298Crossref PubMed Scopus (50) Google Scholar12 FYesI'll1P24117DecreasedTransientBlanchette et al63 MNoNone3P32150DecreasedTransient16 MNoNone6P1718No changeNo17 FNoNone7P1610No changeNo64FNoNone5P14245No changeTransient4P16192No change15 FNoNone3P10310No changeTransient3P12313No change1P27144No changePorter et al7Porter CC Ruley EJ Luban NL Phillips TM Bock GH Salcedo JR et al.Accelerated recovery from immune-mediated thrombocytopenia with plasmapheresis.Am J Med. 1985; 79: 765-768Abstract Full Text PDF PubMed Scopus (8) Google Scholar16FYesPit7PIf)638DecreasedYesBusscl et al5Novak R Wilimas J Plasmapheresis in catastrophic complications of idiopathic thrombocytopenic purpura.J Pediatr. 1978; 92: 434-436Abstract Full Text PDF PubMed Scopus (20) Google Scholar36 MNoig3AlbIS74NMTransient36 MYesIg,V,C3Alb4150NMTransient18 MYesA, Ig, C3Alb1383NMTransient56 MYesg,c3Alb17ISNMNo11 FNoig3Alb2628NMNo28 FNo[g3Alb2840NMNo63 MYesig3Alb2725NMNoFlick el al14FYesV, Ig, C, Dan8P1056DecreasedYesWeiretal10Weir III, AB Poon MC McGowan El Plasma exchange in idiopathic thrombocytopenic purpura.Arch Intern Med. 1980; 140: 1101-1103Crossref PubMed Scopus (13) Google Scholar29 MYesV, C, 6-MP, Vbl5P4-207NMNo54 MYesV, C, A, Vbl5P55DecreasedNoCurrent case67 MYesV, Chi, Ig, Dan, Pit6Alb8154NMTransient* A = azalhioprine; Alb = albumin; C = cyclophosphamide; Chi = chlorambucit; Dan = danazol; Ig = immunoglobulin; 6-MP = mer-caplopurinc; NM = not measured; P = plasma; Pit = platelet transfusions; V = vincristine; Vbl = vinblastine-loaded platelets. Open table in a new tab Most patients with ITP have increased platelet-associated IgG, which is generally considered the etiologic factor mediating premature platelet destruction. Platelet-associated IgM has been noted in some patients who have ITP with or without coexistent platelet-associated IgG. 11Nel JD Stevens K Mouton A Pretorius FJ Platelet-bound IgM in autoimmune thrombocytopenia.Blood. 1983; 61: 119-124PubMed Google Scholar12Pawha J Giuliani D Morse BS Platelet-associated IgM levels in thrombocytopenia.Vox Sang. 1983; 45: 97-103Crossref PubMed Scopus (12) Google Scholar The role of the IgM antiplatelet antibodies in mediating immune destruction in these patients is unclear. These antibodies may promote direct platelet agglutination or aggregation due to their structure. IgM antibodies may form immune complexes or attach to platelet-bound IgG in a manner analogous to rheumatoid factor. Our patient had Waldenstrom's macroglobulinemia and severe thrombocytopenia refractory to corticosteroids, splenectomy, vinca alkaloids, and high-dose intravenous immunoglobulin therapy. We do not believe that his lung cancer was related to the Waldenström's macroglobulinemia or thrombocytopenia. The presence of increased megakaryocytes in the bone marrow and the lack of response to platelet transfusions suggested peripheral destruction of platelets. IgM monoclonal proteins have been reported to have antiplatelet activity in patients with Waldenströms macroglobulinemia.13Flury W Riesen W Morell A Keller H Ein Fall von Thrombozytopenie bei Morbus Waldenstrom mit spezifischer antithrombozytarer Eigenschaft des IgM-Paraproteins.Schweiz Med Wochenschr. 1975; 105: 1241-1245PubMed Google Scholar14Varticovski L Pick Al Schattner A Shoenfeld Y Anti-platelet and anti-DNA IgM in Waldenstrom macro-globulinemia and ITP.Am J Hematol. 1987; 24: 351-355Crossref PubMed Scopus (15) Google Scholar and we believe that the thrombocytopenia in our patient was related to the production of monoclonal proteins due to the eventual response to chlorambucil therapy. Plasmapheresis, by removal of the IgM or the IgG protein (or both), was of value in the temporary maintenance of platelet counts until immunosuppressive therapy was effective against the production of these monoclonal proteins. Our experience with this patient is consistent with that of other investigators5Novak R Wilimas J Plasmapheresis in catastrophic complications of idiopathic thrombocytopenic purpura.J Pediatr. 1978; 92: 434-436Abstract Full Text PDF PubMed Scopus (20) Google Scholar6Blanchette VS Hogan VA McCombie NE Drouin J Bormanis JD Taylor R et al.Intensive plasma exchange therapy in ten patients with idiopathic thrombocytopenic purpura.Transfusion. 1984; 24: 388-394Crossref PubMed Scopus (27) Google Scholar8Bussel JB Saal S Gordon B Combined plasma exchange and intravenous gammaglobulin in the treatment of patients with refractory immune thrombocytopenic purpura.Transfusion. 1988; 28: 38-41Crossref PubMed Scopus (25) Google Scholar9Flick JT Grush O Morgan S Walls C Lazarchick J The role of apheresis in the support of life-threatening ITP relapse.Am J Med Sci. 1987; 294: 444-447Crossref PubMed Scopus (7) Google Scholar whose patients had chronic ITP. We are unaware of any previous reports of the use of plasmapheresis in patients with ITP associated with paraproteinemia in other conditions. The efficacy of plasmapheresis in eliminating injurious antibodies depends on the distribution of immunoglobulin between the intravascular and the extravascular spaces. Because of its size, the IgM antibody is mainly intravascular. Thus, plasmapheresis is effective in the removal of IgM. In contrast, IgG is equally distributed between the intravascular and extravascular spaces and rapidly reappears in plasma after plasmapheresis, factors partly due to reequilibration. Therefore, plasmapheresis can be expected to be most beneficial in patients with IgM-mediated thrombocytopenia, but it has a limited role in the routine treatment of patients with chronic ITP. TEXT BITES FROM OTHER JOURNALSLipid-lowering therapy reverses the progression of early, preintrusive atherosclerosis of the carotid artery. Both cholesterol-rich and triglyceride-rich lipoproteins correlate with the progression of early, preintrusive atherosclerosis of the carotid artery.—Ann Intern Med 1996; 124:548-556Diarrhea among expatriates in a highly endemic environment is a persistent risk. The extremely high prevalence of enteric pathogens among asymptomatic persons reflects widespread exposure.—JAMA 1996; 275:533-538The prevalence of SLE [systemic lupus erythematosus] revealed by this survey in Birmingham [UK] women is 200/100000 (95% confidence interval [CI] 80 to 412), whereas the prevalence of diagnosed SLE in this age group [18 to 65 years] is 54/100000 (95% CI 47-62). Thus, a substantial number of undiagnosed cases exist…. …—Lancet 1996; 347:367-369 Lipid-lowering therapy reverses the progression of early, preintrusive atherosclerosis of the carotid artery. Both cholesterol-rich and triglyceride-rich lipoproteins correlate with the progression of early, preintrusive atherosclerosis of the carotid artery. —Ann Intern Med 1996; 124:548-556 Diarrhea among expatriates in a highly endemic environment is a persistent risk. The extremely high prevalence of enteric pathogens among asymptomatic persons reflects widespread exposure. —JAMA 1996; 275:533-538 The prevalence of SLE [systemic lupus erythematosus] revealed by this survey in Birmingham [UK] women is 200/100000 (95% confidence interval [CI] 80 to 412), whereas the prevalence of diagnosed SLE in this age group [18 to 65 years] is 54/100000 (95% CI 47-62). Thus, a substantial number of undiagnosed cases exist…. … —Lancet 1996; 347:367-369" @default.
• W1996202150 created "2016-06-24" @default.
• W1996202150 creator A5004152557 @default.
• W1996202150 creator A5020682209 @default.
• W1996202150 creator A5033423095 @default.
• W1996202150 creator A5080886228 @default.
• W1996202150 date "1996-06-01" @default.
• W1996202150 modified "2023-10-15" @default.
• W1996202150 title "Role of Plasmapheresis in Thrombocytopenic Purpura Associated With Waldenström's Macroglobulinemia" @default.
• W1996202150 cites W1965974922 @default.
• W1996202150 cites W1983859014 @default.
• W1996202150 cites W1997815435 @default.
• W1996202150 cites W2016854507 @default.
• W1996202150 cites W205544733 @default.
• W1996202150 cites W2061524878 @default.
• W1996202150 cites W2063658950 @default.
• W1996202150 cites W2067998240 @default.
• W1996202150 cites W2073422552 @default.
• W1996202150 cites W2147304781 @default.
• W1996202150 cites W2157327699 @default.
• W1996202150 cites W2159735658 @default.
• W1996202150 cites W3117542354 @default.
• W1996202150 doi "https://doi.org/10.4065/71.6.597" @default.
• W1996202150 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/8642891" @default.
• W1996202150 hasPublicationYear "1996" @default.
• W1996202150 type Work @default.
• W1996202150 sameAs 1996202150 @default.
• W1996202150 citedByCount "16" @default.
• W1996202150 countsByYear W19962021502014 @default.
• W1996202150 countsByYear W19962021502021 @default.
• W1996202150 crossrefType "journal-article" @default.
• W1996202150 hasAuthorship W1996202150A5004152557 @default.
• W1996202150 hasAuthorship W1996202150A5020682209 @default.
• W1996202150 hasAuthorship W1996202150A5033423095 @default.
• W1996202150 hasAuthorship W1996202150A5080886228 @default.
• W1996202150 hasBestOaLocation W19962021501 @default.
• W1996202150 hasConcept C159654299 @default.
• W1996202150 hasConcept C203014093 @default.
• W1996202150 hasConcept C2776364478 @default.
• W1996202150 hasConcept C2776391228 @default.
• W1996202150 hasConcept C2778585876 @default.
• W1996202150 hasConcept C2778842783 @default.
• W1996202150 hasConcept C2779338263 @default.
• W1996202150 hasConcept C2781038049 @default.
• W1996202150 hasConcept C71924100 @default.
• W1996202150 hasConcept C89560881 @default.
• W1996202150 hasConceptScore W1996202150C159654299 @default.
• W1996202150 hasConceptScore W1996202150C203014093 @default.
• W1996202150 hasConceptScore W1996202150C2776364478 @default.
• W1996202150 hasConceptScore W1996202150C2776391228 @default.
• W1996202150 hasConceptScore W1996202150C2778585876 @default.
• W1996202150 hasConceptScore W1996202150C2778842783 @default.
• W1996202150 hasConceptScore W1996202150C2779338263 @default.
• W1996202150 hasConceptScore W1996202150C2781038049 @default.
• W1996202150 hasConceptScore W1996202150C71924100 @default.
• W1996202150 hasConceptScore W1996202150C89560881 @default.
• W1996202150 hasIssue "6" @default.
• W1996202150 hasLocation W19962021501 @default.
• W1996202150 hasLocation W19962021502 @default.
• W1996202150 hasOpenAccess W1996202150 @default.
• W1996202150 hasPrimaryLocation W19962021501 @default.
• W1996202150 hasRelatedWork W2005335438 @default.
• W1996202150 hasRelatedWork W2008655444 @default.
• W1996202150 hasRelatedWork W2067798761 @default.
• W1996202150 hasRelatedWork W2082149714 @default.
• W1996202150 hasRelatedWork W2086925700 @default.
• W1996202150 hasRelatedWork W2263812615 @default.
• W1996202150 hasRelatedWork W2410022772 @default.
• W1996202150 hasRelatedWork W2472034063 @default.
• W1996202150 hasRelatedWork W4233937440 @default.
• W1996202150 hasRelatedWork W4236800643 @default.
• W1996202150 hasVolume "71" @default.
• W1996202150 isParatext "false" @default.
• W1996202150 isRetracted "false" @default.
• W1996202150 magId "1996202150" @default.
• W1996202150 workType "article" @default.