{"id":"https://openalex.org/W4400737339","doi":"https://doi.org/10.7759/cureus.64723","title":"Spontaneous Hydropneumothorax After Pleurodesis in a Patient With Pulmonary Lymphangioleiomyomatosis With Associated Endometrial Cancer","display_name":"Spontaneous Hydropneumothorax After Pleurodesis in a Patient With Pulmonary Lymphangioleiomyomatosis With Associated Endometrial Cancer","publication_year":2024,"publication_date":"2024-07-17","ids":{"openalex":"https://openalex.org/W4400737339","doi":"https://doi.org/10.7759/cureus.64723","pmid":"https://pubmed.ncbi.nlm.nih.gov/39156285","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/11328156"},"language":"en","primary_location":{"id":"doi:10.7759/cureus.64723","doi":"https://doi.org/10.7759/cureus.64723","is_oa":true,"landing_page_url":"http://dx.doi.org/10.7759/cureus.64723","pdf_url":"https://www.cureus.com/articles/275073-spontaneous-hydropneumothorax-after-pleurodesis-in-a-patient-with-pulmonary-lymphangioleiomyomatosis-with-associated-endometrial-cancer.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.cureus.com/articles/275073-spontaneous-hydropneumothorax-after-pleurodesis-in-a-patient-with-pulmonary-lymphangioleiomyomatosis-with-associated-endometrial-cancer.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5093929504","display_name":"Sabastain F Forsah","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Sabastain F Forsah","raw_affiliation_strings":["Internal Medicine, Richmond University Medical Center, Staten Island, USA",". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]},{"raw_affiliation_string":". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5071865501","display_name":"Gauvain Kankeu Tonpouwo","orcid":"https://orcid.org/0000-0002-2981-4484","observed_orcids":["https://orcid.org/0000-0002-2981-4484"]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Gauvain Kankeu Tonpouwo","raw_affiliation_strings":["Internal Medicine, Richmond University Medical Center, Staten Island, USA",". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]},{"raw_affiliation_string":". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5059889897","display_name":"Derek Fan Ugwendum","orcid":"https://orcid.org/0009-0009-9832-177X","observed_orcids":["https://orcid.org/0009-0009-9832-177X"]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Derek Ugwendum","raw_affiliation_strings":["Internal Medicine, Richmond University Medical Center, Staten Island, USA",". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]},{"raw_affiliation_string":". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5104645943","display_name":"Marvel Changoh","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Marvel Changoh","raw_affiliation_strings":["Internal Medicine, Richmond University Medical Center, Staten Island, USA",". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]},{"raw_affiliation_string":". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092177176","display_name":"Divine Besong Arrey Agbor","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Divine Besong Arrey Agbor","raw_affiliation_strings":["Internal Medicine, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5058236009","display_name":"Bibi S Razak","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Bibi S Razak","raw_affiliation_strings":["Internal Medicine, Richmond University Medical Center, Staten Island, USA",". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]},{"raw_affiliation_string":". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5104645944","display_name":"Justin Muego","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Justin Muego","raw_affiliation_strings":["Internal Medicine, Richmond University Medical Center, Staten Island, USA",". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]},{"raw_affiliation_string":". Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5068101647","display_name":"Keith T. Diaz","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2801651397","display_name":"Richmond University Medical Center","ror":"https://ror.org/01m9rk435","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2801651397"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Keith Diaz","raw_affiliation_strings":["Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA",". Internal Medicine, Richmond University Medical Center, Staten Island, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]},{"raw_affiliation_string":". Internal Medicine, Richmond University Medical Center, Staten Island, USA","institution_ids":["https://openalex.org/I2801651397"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5093929504"],"corresponding_institution_ids":["https://openalex.org/I2801651397"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"16","issue":"7","first_page":"e64723","last_page":"e64723"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12049","display_name":"Tuberous Sclerosis Complex Research","score":0.8833000063896179,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics (clinical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12049","display_name":"Tuberous Sclerosis Complex Research","score":0.8833000063896179,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics (clinical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11356","display_name":"Pleural and Pulmonary Diseases","score":0.10010000318288803,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12818","display_name":"Pneumothorax, Barotrauma, Emphysema","score":0.004900000058114529,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/lymphangioleiomyomatosis","display_name":"lymphangioleiomyomatosis","score":0.9210000038146973},{"id":"https://openalex.org/keywords/endometrial-cancer","display_name":"endometrial cancer","score":0.875},{"id":"https://openalex.org/keywords/hydropneumothorax","display_name":"hydropneumothorax","score":0.9610000252723694},{"id":"https://openalex.org/keywords/pleurodesis","display_name":"pleurodesis","score":0.9419999718666077},{"id":"https://openalex.org/keywords/recurrent-pneumothorax","display_name":"recurrent pneumothorax","score":0.9520000219345093},{"id":"https://openalex.org/keywords/tuberous-sclerosis-complex","display_name":"tuberous sclerosis complex","score":0.9449999928474426},{"id":"https://openalex.org/keywords/mtor-signaling","display_name":"mTOR signaling","score":0.9819999933242798},{"id":"https://openalex.org/keywords/angiomyolipoma","display_name":"angiomyolipoma","score":0.9229999780654907},{"id":"https://openalex.org/keywords/pleurodesis-complications","display_name":"pleurodesis complications","score":0.6110000014305115}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9362318515777588},{"id":"https://openalex.org/C2776979038","wikidata":"https://www.wikidata.org/wiki/Q1229945","display_name":"Pleurodesis","level":3,"score":0.9321703910827637},{"id":"https://openalex.org/C2779997425","wikidata":"https://www.wikidata.org/wiki/Q1878759","display_name":"Lymphangioleiomyomatosis","level":3,"score":0.8985550403594971},{"id":"https://openalex.org/C2778980267","wikidata":"https://www.wikidata.org/wiki/Q1362721","display_name":"Tuberous sclerosis","level":2,"score":0.7518616914749146},{"id":"https://openalex.org/C2778329176","wikidata":"https://www.wikidata.org/wiki/Q203601","display_name":"Pneumothorax","level":2,"score":0.7499457597732544},{"id":"https://openalex.org/C2777088508","wikidata":"https://www.wikidata.org/wiki/Q944777","display_name":"Endometrial cancer","level":3,"score":0.5629329085350037},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.5003378391265869},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.4360438585281372},{"id":"https://openalex.org/C2779494336","wikidata":"https://www.wikidata.org/wiki/Q550675","display_name":"Hysterectomy","level":2,"score":0.41163092851638794},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.37558212876319885},{"id":"https://openalex.org/C143998085","wikidata":"https://www.wikidata.org/wiki/Q162555","display_name":"Oncology","level":1,"score":0.33056700229644775},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.32393667101860046},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.24085235595703125}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.7759/cureus.64723","doi":"https://doi.org/10.7759/cureus.64723","is_oa":true,"landing_page_url":"http://dx.doi.org/10.7759/cureus.64723","pdf_url":"https://www.cureus.com/articles/275073-spontaneous-hydropneumothorax-after-pleurodesis-in-a-patient-with-pulmonary-lymphangioleiomyomatosis-with-associated-endometrial-cancer.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:11328156","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11328156","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC11328156/pdf/cureus-0016-00000064723.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Text"},{"id":"pmid:39156285","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/39156285","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"Case Reports"}],"best_oa_location":{"id":"doi:10.7759/cureus.64723","doi":"https://doi.org/10.7759/cureus.64723","is_oa":true,"landing_page_url":"http://dx.doi.org/10.7759/cureus.64723","pdf_url":"https://www.cureus.com/articles/275073-spontaneous-hydropneumothorax-after-pleurodesis-in-a-patient-with-pulmonary-lymphangioleiomyomatosis-with-associated-endometrial-cancer.pdf","source":{"id":"https://openalex.org/S2738950867","display_name":"Cureus","issn_l":"2168-8184","issn":["2168-8184"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-20","russia-white-list-2","vabb-shw"],"host_organization":"https://openalex.org/P4310316779","host_organization_name":"Cureus, Inc.","host_organization_lineage":["https://openalex.org/P4310316779"],"host_organization_lineage_names":["Cureus, Inc."],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Cureus","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.9922999739646912,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Case Report","id":"https://openalex.org/study-designs/case-report"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4400737339.pdf","grobid_xml":"https://content.openalex.org/works/W4400737339.grobid-xml"},"referenced_works_count":18,"referenced_works":["https://openalex.org/W2036927287","https://openalex.org/W2038028072","https://openalex.org/W2108352877","https://openalex.org/W2110250763","https://openalex.org/W2132555452","https://openalex.org/W2147049625","https://openalex.org/W2157079036","https://openalex.org/W2471859934","https://openalex.org/W2507477761","https://openalex.org/W2514568163","https://openalex.org/W2520077507","https://openalex.org/W2952032234","https://openalex.org/W2980830192","https://openalex.org/W3139537279","https://openalex.org/W3145215962","https://openalex.org/W4200355060","https://openalex.org/W4285592817","https://openalex.org/W4362529415"],"related_works":["https://openalex.org/W4386812050","https://openalex.org/W3169302613","https://openalex.org/W2412135816","https://openalex.org/W4410275428","https://openalex.org/W2333468153","https://openalex.org/W4239891115","https://openalex.org/W1985975732","https://openalex.org/W2067266100","https://openalex.org/W4411364924","https://openalex.org/W2396671445"],"abstract_inverted_index":{"Lymphangioleiomyomatosis":[0],"(LAM)":[1],"is":[2,35,102,129,151],"a":[3,159,168],"rare":[4],"cystic":[5,108],"disease":[6,51],"that":[7,148],"occurs":[8,115],"due":[9],"to":[10,49,106,179],"the":[11,21,50,65,91,99,107,120,123,130,165,195,213,216],"abnormal":[12],"proliferation":[13],"of":[14,41,64,93,110,122,167,198],"smooth":[15],"muscle-like":[16],"cells.":[17],"It":[18,34],"primarily":[19],"affects":[20],"lungs":[22],"but":[23],"can":[24,54,83,88],"also":[25,139],"have":[26,180],"extrapulmonary":[27],"manifestations":[28],"such":[29],"as":[30],"lymphangioleiomyoma":[31],"and":[32,73,95,125,146,173],"angiomyolipomas.":[33],"more":[36],"common":[37],"in":[38,98,134,209],"young":[39],"women":[40],"childbearing":[42],"age,":[43],"with":[44,78,171,188,215],"female":[45,169],"sex":[46],"hormones":[47],"contributing":[48],"course.":[52],"LAM":[53,94,172,189],"develop":[55],"either":[56],"through":[57,61],"sporadic":[58],"mutations":[59],"or":[60],"genetic":[62],"inheritance":[63],"tuberous":[66],"sclerosis":[67],"complex":[68],"(TSC)":[69],"genes.":[70],"TSC,":[71],"LAM,":[72,111],"endometrial":[74,96,174],"cancer":[75,97,175],"are":[76,138],"associated":[77],"mTOR":[79],"pathway":[80],"activation,":[81],"which":[82],"explain":[84],"why":[85],"these":[86],"diseases":[87],"co-exist,":[89],"although":[90],"co-existence":[92],"same":[100],"patient":[101,170],"very":[103,210],"rare.":[104],"Due":[105],"nature":[109],"pneumothorax":[112,160,208],"most":[113,126],"often":[114],"at":[116,140],"least":[117],"once":[118],"during":[119],"course":[121],"disease,":[124],"times,":[127],"it":[128],"first":[131],"manifestation":[132],"observed":[133],"LAM.":[135],"These":[136],"patients":[137],"high":[141],"risk":[142],"for":[143,194,206],"recurrent":[144,207],"pneumothorax,":[145],"when":[147,203],"occurs,":[149],"pleurodesis":[150,154,205],"indicated.":[152],"Unfortunately,":[153],"still":[155],"does":[156],"not":[157],"preclude":[158],"from":[161],"occurring.":[162],"We":[163],"present":[164],"case":[166],"who":[176],"was":[177],"found":[178],"an":[181],"incidental":[182],"spontaneous":[183],"hydropneumothorax":[184],"after":[185],"pleurodesis.":[186],"Patients":[187],"should":[190,220],"be":[191,221],"closely":[192],"monitored":[193],"possible":[196],"development":[197],"other":[199],"mTOR-associated":[200],"diseases.":[201],"Moreover,":[202],"performing":[204],"high-risk":[211],"patients,":[212],"procedure":[214],"lowest":[217],"recurrence":[218],"rate":[219],"utilized.":[222]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2024-07-18T00:00:00"}
