Chest CT findings related to mortality of patients with COVID-19: A retrospective case-series study
As the current outbreak of COVID-2019 disease has spread to the other more than 150 countries besides China around the world and the death number constantly increased, the clinical data and radiological findings of death cases need to be explored so that more physicians, radiologists and researchers...
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| Veröffentlicht in: | PloS one 2020-08, Vol.15 (8), p.e0237302-e0237302 |
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| creator | Hu, Yiqi Zhan, Chenao Chen, Chengyang Ai, Tao Xia, Liming |
| description | As the current outbreak of COVID-2019 disease has spread to the other more than 150 countries besides China around the world and the death number constantly increased, the clinical data and radiological findings of death cases need to be explored so that more physicians, radiologists and researchers can gain important information to save more lives.
73 patients who died from COVID-19 were retrospectively included. The clinical and laboratory data of the patients were extracted from electronic medical records. The clinical data, inflammation-related laboratory results, and CT imaging features were summarized. The laboratory results and dynamic changes of imaging features and severity scores of lung involvement based on chest CT were analyzed.
The mean age was 67±12 years. The typical clinical symptoms included fever (88%), cough (62%) and dyspnea (23%). 65% patients had at least one underlying disease. GGO with consolidation was the most common feature for the five lung lobes (47%-53% among the various lobes), with total severity score of 12.97±5.87 for the both lungs. The proportion of GGO with consolidation is markedly increased on follow-up chest CT compared with initial CT scans, as well as the averaging total CT scores (14.53±5.76 vs. 6.60±5.65; P |
| doi_str_mv | 10.1371/journal.pone.0237302 |
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73 patients who died from COVID-19 were retrospectively included. The clinical and laboratory data of the patients were extracted from electronic medical records. The clinical data, inflammation-related laboratory results, and CT imaging features were summarized. The laboratory results and dynamic changes of imaging features and severity scores of lung involvement based on chest CT were analyzed.
The mean age was 67±12 years. The typical clinical symptoms included fever (88%), cough (62%) and dyspnea (23%). 65% patients had at least one underlying disease. GGO with consolidation was the most common feature for the five lung lobes (47%-53% among the various lobes), with total severity score of 12.97±5.87 for the both lungs. The proportion of GGO with consolidation is markedly increased on follow-up chest CT compared with initial CT scans, as well as the averaging total CT scores (14.53±5.76 vs. 6.60±5.65; P<0.001). The severity score was rated as severe (white lung) in 13% patients on initial CT scans, and in 60% on follow-up CT scans. Moderate positive correlations were found between CT scores and leucocytes, neutrophils and IL-2R (r = 0.447-0581, P<0.001).
Chest CT findings and laboratory test results were worsening in patients who died of COVID-19, with moderate positive correlations between CT severity scores and inflammation-related factors of leucocytes, neutrophils, and IL-2R. Chest CT imaging may play an more important role in monitoring disease progression and predicting prognosis.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0237302</identifier><identifier>PMID: 32841294</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; Biology and Life Sciences ; Biomarkers ; CAT scans ; Chest ; China ; Computed tomography ; Consolidation ; Coronavirus Infections - diagnostic imaging ; Coronavirus Infections - mortality ; Coronaviruses ; Correlation ; Cough ; COVID-19 ; Diagnosis ; Dyspnea ; Electronic health records ; Electronic medical records ; Female ; Fever ; Humans ; Interleukin 2 receptors ; Laboratory tests ; Leukocytes ; Leukocytes (neutrophilic) ; Lobes ; Lung - diagnostic imaging ; Lung - pathology ; Lungs ; Male ; Medical imaging ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Pandemics ; Patient outcomes ; Patients ; Physical Sciences ; Physicians ; Pneumonia, Viral - diagnostic imaging ; Pneumonia, Viral - mortality ; Radiography, Thoracic ; Research and Analysis Methods ; Respiration ; Retrospective Studies ; SARS-CoV-2 ; Signs and symptoms ; Thoracic diseases ; Tomography, X-Ray Computed ; Viral diseases</subject><ispartof>PloS one, 2020-08, Vol.15 (8), p.e0237302-e0237302</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Hu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Hu et al 2020 Hu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-7c521486c0c415ef5290cf8b9ef66511c2599aa89b27815758860f43bde372003</citedby><cites>FETCH-LOGICAL-c692t-7c521486c0c415ef5290cf8b9ef66511c2599aa89b27815758860f43bde372003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447035/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447035/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32841294$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Adrish, Muhammad</contributor><creatorcontrib>Hu, Yiqi</creatorcontrib><creatorcontrib>Zhan, Chenao</creatorcontrib><creatorcontrib>Chen, Chengyang</creatorcontrib><creatorcontrib>Ai, Tao</creatorcontrib><creatorcontrib>Xia, Liming</creatorcontrib><title>Chest CT findings related to mortality of patients with COVID-19: A retrospective case-series study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>As the current outbreak of COVID-2019 disease has spread to the other more than 150 countries besides China around the world and the death number constantly increased, the clinical data and radiological findings of death cases need to be explored so that more physicians, radiologists and researchers can gain important information to save more lives.
73 patients who died from COVID-19 were retrospectively included. The clinical and laboratory data of the patients were extracted from electronic medical records. The clinical data, inflammation-related laboratory results, and CT imaging features were summarized. The laboratory results and dynamic changes of imaging features and severity scores of lung involvement based on chest CT were analyzed.
The mean age was 67±12 years. The typical clinical symptoms included fever (88%), cough (62%) and dyspnea (23%). 65% patients had at least one underlying disease. GGO with consolidation was the most common feature for the five lung lobes (47%-53% among the various lobes), with total severity score of 12.97±5.87 for the both lungs. The proportion of GGO with consolidation is markedly increased on follow-up chest CT compared with initial CT scans, as well as the averaging total CT scores (14.53±5.76 vs. 6.60±5.65; P<0.001). The severity score was rated as severe (white lung) in 13% patients on initial CT scans, and in 60% on follow-up CT scans. Moderate positive correlations were found between CT scores and leucocytes, neutrophils and IL-2R (r = 0.447-0581, P<0.001).
Chest CT findings and laboratory test results were worsening in patients who died of COVID-19, with moderate positive correlations between CT severity scores and inflammation-related factors of leucocytes, neutrophils, and IL-2R. Chest CT imaging may play an more important role in monitoring disease progression and predicting prognosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Betacoronavirus</subject><subject>Biology and Life Sciences</subject><subject>Biomarkers</subject><subject>CAT scans</subject><subject>Chest</subject><subject>China</subject><subject>Computed tomography</subject><subject>Consolidation</subject><subject>Coronavirus Infections - diagnostic imaging</subject><subject>Coronavirus Infections - mortality</subject><subject>Coronaviruses</subject><subject>Correlation</subject><subject>Cough</subject><subject>COVID-19</subject><subject>Diagnosis</subject><subject>Dyspnea</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Female</subject><subject>Fever</subject><subject>Humans</subject><subject>Interleukin 2 receptors</subject><subject>Laboratory tests</subject><subject>Leukocytes</subject><subject>Leukocytes (neutrophilic)</subject><subject>Lobes</subject><subject>Lung - diagnostic imaging</subject><subject>Lung - pathology</subject><subject>Lungs</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pandemics</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Physicians</subject><subject>Pneumonia, Viral - diagnostic imaging</subject><subject>Pneumonia, Viral - mortality</subject><subject>Radiography, Thoracic</subject><subject>Research and Analysis Methods</subject><subject>Respiration</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Signs and symptoms</subject><subject>Thoracic diseases</subject><subject>Tomography, X-Ray Computed</subject><subject>Viral diseases</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12LEzEYhQdR3LX6D0QDgujF1HzPjBdCqV-FhYKuexvSTNKmpJOaZFb335va2aUjeyG5mJB5zkly8r5F8RzBKSIVerf1feikm-59p6cQk4pA_KA4Rw3BJceQPDyZnxVPYtxCyEjN-ePijOCaItzQ80LNNzomML8Exnat7dYRBO1k0i1IHux8SNLZdAO8AXuZrO5SBL9s2oD58mrxsUTNezDLihR83GuV7LUGSkZdRh2sjiCmvr15Wjwy0kX9bPhOih-fP13Ov5YXyy-L-eyiVLzBqawUw4jWXEFFEdOG4QYqU68abThnCCnMmkbKulnhqkasYnXNoaFk1WpSYQjJpHh59N07H8WQTxSY5rgg56TJxOJItF5uxT7YnQw3wksr_i74sBYyJKucFi2DUDe8kpBBSrjM56A1VrDlxiCW854UH4bd-tVOtypHE6QbmY7_dHYj1v5aVJRWkLBs8GYwCP5nn19B7GxU2jnZad8fz00hxZRm9NU_6P23G6i1zBewnfF5X3UwFTNOCIMIEp6p6T1UHq3eWZWLydi8PhK8HQkyk_TvtJZ9jGLx_dv_s8urMfv6hN1o6dImetcn67s4BukRVLnKYtDmLmQExaEXbtMQh14QQy9k2YvTB7oT3RY_-QMv_ADZ</recordid><startdate>20200825</startdate><enddate>20200825</enddate><creator>Hu, Yiqi</creator><creator>Zhan, Chenao</creator><creator>Chen, Chengyang</creator><creator>Ai, Tao</creator><creator>Xia, Liming</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>COVID</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20200825</creationdate><title>Chest CT findings related to mortality of patients with COVID-19: A retrospective case-series study</title><author>Hu, Yiqi ; Zhan, Chenao ; Chen, Chengyang ; Ai, Tao ; Xia, Liming</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-7c521486c0c415ef5290cf8b9ef66511c2599aa89b27815758860f43bde372003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Betacoronavirus</topic><topic>Biology and Life Sciences</topic><topic>Biomarkers</topic><topic>CAT scans</topic><topic>Chest</topic><topic>China</topic><topic>Computed tomography</topic><topic>Consolidation</topic><topic>Coronavirus Infections - diagnostic imaging</topic><topic>Coronavirus Infections - mortality</topic><topic>Coronaviruses</topic><topic>Correlation</topic><topic>Cough</topic><topic>COVID-19</topic><topic>Diagnosis</topic><topic>Dyspnea</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>Female</topic><topic>Fever</topic><topic>Humans</topic><topic>Interleukin 2 receptors</topic><topic>Laboratory tests</topic><topic>Leukocytes</topic><topic>Leukocytes (neutrophilic)</topic><topic>Lobes</topic><topic>Lung - diagnostic imaging</topic><topic>Lung - pathology</topic><topic>Lungs</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pandemics</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Physical Sciences</topic><topic>Physicians</topic><topic>Pneumonia, Viral - diagnostic imaging</topic><topic>Pneumonia, Viral - mortality</topic><topic>Radiography, Thoracic</topic><topic>Research and Analysis Methods</topic><topic>Respiration</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Signs and symptoms</topic><topic>Thoracic diseases</topic><topic>Tomography, X-Ray Computed</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hu, Yiqi</creatorcontrib><creatorcontrib>Zhan, Chenao</creatorcontrib><creatorcontrib>Chen, Chengyang</creatorcontrib><creatorcontrib>Ai, Tao</creatorcontrib><creatorcontrib>Xia, Liming</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hu, Yiqi</au><au>Zhan, Chenao</au><au>Chen, Chengyang</au><au>Ai, Tao</au><au>Xia, Liming</au><au>Adrish, Muhammad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chest CT findings related to mortality of patients with COVID-19: A retrospective case-series study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-08-25</date><risdate>2020</risdate><volume>15</volume><issue>8</issue><spage>e0237302</spage><epage>e0237302</epage><pages>e0237302-e0237302</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>As the current outbreak of COVID-2019 disease has spread to the other more than 150 countries besides China around the world and the death number constantly increased, the clinical data and radiological findings of death cases need to be explored so that more physicians, radiologists and researchers can gain important information to save more lives.
73 patients who died from COVID-19 were retrospectively included. The clinical and laboratory data of the patients were extracted from electronic medical records. The clinical data, inflammation-related laboratory results, and CT imaging features were summarized. The laboratory results and dynamic changes of imaging features and severity scores of lung involvement based on chest CT were analyzed.
The mean age was 67±12 years. The typical clinical symptoms included fever (88%), cough (62%) and dyspnea (23%). 65% patients had at least one underlying disease. GGO with consolidation was the most common feature for the five lung lobes (47%-53% among the various lobes), with total severity score of 12.97±5.87 for the both lungs. The proportion of GGO with consolidation is markedly increased on follow-up chest CT compared with initial CT scans, as well as the averaging total CT scores (14.53±5.76 vs. 6.60±5.65; P<0.001). The severity score was rated as severe (white lung) in 13% patients on initial CT scans, and in 60% on follow-up CT scans. Moderate positive correlations were found between CT scores and leucocytes, neutrophils and IL-2R (r = 0.447-0581, P<0.001).
Chest CT findings and laboratory test results were worsening in patients who died of COVID-19, with moderate positive correlations between CT severity scores and inflammation-related factors of leucocytes, neutrophils, and IL-2R. Chest CT imaging may play an more important role in monitoring disease progression and predicting prognosis.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32841294</pmid><doi>10.1371/journal.pone.0237302</doi><tpages>e0237302</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2020-08, Vol.15 (8), p.e0237302-e0237302 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Aged, 80 and over Betacoronavirus Biology and Life Sciences Biomarkers CAT scans Chest China Computed tomography Consolidation Coronavirus Infections - diagnostic imaging Coronavirus Infections - mortality Coronaviruses Correlation Cough COVID-19 Diagnosis Dyspnea Electronic health records Electronic medical records Female Fever Humans Interleukin 2 receptors Laboratory tests Leukocytes Leukocytes (neutrophilic) Lobes Lung - diagnostic imaging Lung - pathology Lungs Male Medical imaging Medicine and Health Sciences Middle Aged Mortality Pandemics Patient outcomes Patients Physical Sciences Physicians Pneumonia, Viral - diagnostic imaging Pneumonia, Viral - mortality Radiography, Thoracic Research and Analysis Methods Respiration Retrospective Studies SARS-CoV-2 Signs and symptoms Thoracic diseases Tomography, X-Ray Computed Viral diseases |
| title | Chest CT findings related to mortality of patients with COVID-19: A retrospective case-series study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-17T12%3A10%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Chest%20CT%20findings%20related%20to%20mortality%20of%20patients%20with%20COVID-19:%20A%20retrospective%20case-series%20study&rft.jtitle=PloS%20one&rft.au=Hu,%20Yiqi&rft.date=2020-08-25&rft.volume=15&rft.issue=8&rft.spage=e0237302&rft.epage=e0237302&rft.pages=e0237302-e0237302&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0237302&rft_dat=%3Cgale_plos_%3EA633501036%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2437106639&rft_id=info:pmid/32841294&rft_galeid=A633501036&rft_doaj_id=oai_doaj_org_article_d500e967a050436a8b9482c0d6ff1502&rfr_iscdi=true |