{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:22:59Z","timestamp":1792783379524,"version":"4.5.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","id":[{"id":"https:\/\/ror.org\/00x0ma614","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Curr Cardiol Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose of Review<\/jats:title>\n                    <jats:p>Periodontal disease has been increasingly recognized as a chronic inflammatory condition with potential systemic implications, particularly in the cardiovascular system. Heart failure (HF), a pro-inflammatory syndrome with multisystem involvement, remains a major public health burden. This state-of-the-art narrative review aims to analyze the current scientific evidence on the association between periodontal disease and heart failure, emphasizing epidemiological data, cardiac biomarkers, inflammatory mediators, and future perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent Findings<\/jats:title>\n                    <jats:p>Current evidence indicates a high prevalence of periodontal disease among patients with HF and suggests associations between periodontal disease and elevated cardiac biomarkers, including NT-proBNP and troponin T, as well as systemic inflammatory mediators such as C-reactive protein, IL-6, and TNF-\u03b1. Interventional studies have reported reductions in some of these biomarkers following periodontal treatment, suggesting a potential biological link between periodontal inflammation and HF. However, findings remain heterogeneous, and some studies have failed to demonstrate significant associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Current evidence supports an association between periodontal disease and heart failure, with systemic inflammation representing a potential biological link. Nevertheless, the heterogeneity of study designs, small sample sizes, and predominance of observational and cross-sectional evidence limit causal inference. Longitudinal studies and randomized clinical trials are needed to clarify causal mechanisms and determine whether periodontal prevention and treatment can contribute to integrated strategies for patients with HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11886-026-02438-5","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:07:13Z","timestamp":1792238833000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Periodontal Disease and Heart Failure: Current Evidence and Perspectives"],"prefix":"10.1007","volume":"28","author":[{"given":"Al\u00edcia Eliege","family":"da Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9ria Duarte","family":"de Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilson Aquino","family":"Cavalcante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roque Ribeiro","family":"da Silva J\u00fanior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria Raquel Queiroz","family":"de Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Ver\u00edssimo","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellany Gurgel Cosme","family":"do Nascimento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9ber","family":"de Mesquita Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thales Allyrio Ara\u00fajo","family":"de Medeiros Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"issue":"6","key":"2438_CR1","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1038\/nrcardio.2016.25","volume":"13","author":"B Ziaeian","year":"2016","unstructured":"Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016;13(6):368\u201378.","journal-title":"Nat Rev Cardiol"},{"issue":"15","key":"2438_CR2","doi-asserted-by":"publisher","first-page":"1682","DOI":"10.1093\/eurjpc\/zwaa147","volume":"28","author":"NL Bragazzi","year":"1990","unstructured":"Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. 1990;28(15):1682\u201390.","journal-title":"Eur J Prev Cardiol"},{"issue":"8","key":"2438_CR3","first-page":"829","volume":"17","author":"MS Nieminen","year":"2015","unstructured":"Nieminen MS, Harjola VP, Hochadel M, et al. The burden of heart failure in Europe: a review of the literature. Eur J Heart Fail. 2015;17(8):829\u201338.","journal-title":"Eur J Heart Fail"},{"issue":"34","key":"2438_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/MD.0000000000034878","volume":"102","author":"Y Wang","year":"2023","unstructured":"Wang Y, Xiao Y, Zhang Y. A systematic comparison of machine learning algorithms to develop and validate prediction model to predict heart failure risk in middle-aged and elderly patients with periodontitis (NHANES 2009 to 2014). Medicine (Baltimore). 2023;102(34):1\u20139.","journal-title":"Medicine (Baltimore)"},{"issue":"10","key":"2438_CR5","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.jchf.2022.05.008","volume":"10","author":"RL Molinsky","year":"2022","unstructured":"Molinsky RL, Yuzefpolskaya M, Norby FL, et al. Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure: The ARIC Study. JACC Heart Fail. 2022;10(10):731\u201341.","journal-title":"JACC. Heart Fail"},{"issue":"10","key":"2438_CR6","doi-asserted-by":"publisher","first-page":"2659","DOI":"10.3390\/biomedicines10102659","volume":"10","author":"R Bhuyan","year":"2022","unstructured":"Bhuyan R, Bhuyan SK, Das S, Dey B, Singh A, Singh S. Periodontitis: A chronic inflammatory disease and its systemic impact. Biomedicines. 2022;10(10):2659.","journal-title":"Biomedicines"},{"key":"2438_CR7","unstructured":"Kane J. The effects of oral health on systemic health. Dental Wellness Center of Birmingham. 2025. Available from: https:\/\/dentalwellnesscenterofbirmingham.com\/the-effects-of-oral-health-on-systemic-health\/."},{"issue":"7","key":"2438_CR8","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1038\/s41577-020-00488-6","volume":"21","author":"G Hajishengallis","year":"2021","unstructured":"Hajishengallis G. Interconnection of periodontal disease and comorbidities: Evidence, mechanisms, and implications. Nat Rev Immunol. 2021;21(7):426\u201340.","journal-title":"Nat Rev Immunol"},{"issue":"1","key":"2438_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5334\/gh.400","volume":"15","author":"M Sanz","year":"2020","unstructured":"Sanz M, Marco del Castillo A, Jepsen S, Gonzalez-Juanatey JR, D\u2019Aiuto F, Bouchard P, et al. Periodontitis and cardiovascular diseases: consensus report. Glob Heart. 2020;15(1):1\u201324.","journal-title":"Glob Heart"},{"issue":"52","key":"2438_CR10","first-page":"1","volume":"9","author":"A Schulze","year":"2024","unstructured":"Schulze A, Kwast S, P\u00f6kel C, Busse M. Assessment of the relationship between periodontitis and cardiac parameters in patients with early chronic heart failure: A cross-sectional study. J Funct Morphol Kinesiol. 2024;9(52):1\u201317.","journal-title":"J Funct Morphol Kinesiol"},{"issue":"11","key":"2438_CR11","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1016\/j.jacc.2020.01.014","volume":"75","author":"SP Murphy","year":"2020","unstructured":"Murphy SP. Inflammation in heart failure: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(11):1324\u201340.","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"2438_CR12","first-page":"481","volume":"22","author":"SV Linthout","year":"2017","unstructured":"Linthout SV, Tsch\u00f6pe C. Inflammation \u2013 cause or consequence of heart failure and its comorbidities? Heart Fail Rev. 2017;22(4):481\u20139.","journal-title":"Heart Fail Rev"},{"key":"2438_CR13","first-page":"101350","volume":"47","author":"D Mocan","year":"2025","unstructured":"Mocan D, Guzu C, Dobra M, et al. Unveiling the systemic impact of congestion in heart failure. Int J Cardiol Heart Vasc. 2025;47:101350.","journal-title":"Int J Cardiol Heart Vasc"},{"issue":"9","key":"2438_CR14","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.3390\/diagnostics15091083","volume":"15","author":"M Grigore","year":"2025","unstructured":"Grigore M, Petrescu L, Damian L, et al. Contemporary perspectives on congestion in heart failure. Diagnostics (Basel). 2025;15(9):1083.","journal-title":"Diagnostics (Basel)"},{"issue":"2","key":"2438_CR15","first-page":"123","volume":"65","author":"K Yamazaki","year":"2023","unstructured":"Yamazaki K. Interrelationship between oral and systemic diseases. J Oral Sci. 2023;65(2):123\u201331.","journal-title":"J Oral Sci"},{"key":"2438_CR16","first-page":"112345","volume":"10","author":"M Pisano","year":"2023","unstructured":"Pisano M, Gasparro R, Sammartino P, et al. Oral dysbiosis and systemic diseases: A two-way street. Front Med (Lausanne). 2023;10:112345.","journal-title":"Front Med (Lausanne)"},{"issue":"1","key":"2438_CR17","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1111\/jcpe.13709","volume":"50","author":"S Luthra","year":"2023","unstructured":"Luthra S, Orlandi M, Hussain SB, Leira Y, Botelho J, Machado V, et al. Treatment of periodontitis and C-reactive protein: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2023;50(1):45\u201360.","journal-title":"J Clin Periodontol"},{"issue":"6","key":"2438_CR18","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.3390\/ijms20061414","volume":"20","author":"D Liccardo","year":"2019","unstructured":"Liccardo D, Cannavo A, Spagnuolo G, Ferrara N, Cittadini A, Rengo C, Rengo G. Periodontal disease: A risk factor for diabetes and cardiovascular disease. Int J Mol Sci. 2019;20(6):1414.","journal-title":"Int J Mol Sci"},{"issue":"s14","key":"2438_CR19","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1111\/jcpe.12089","volume":"40","author":"MS Tonetti","year":"2013","unstructured":"Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: Consensus report. J Clin Periodontol. 2013;40(s14):S24\u20139.","journal-title":"J Clin Periodontol"},{"issue":"s14","key":"2438_CR20","doi-asserted-by":"publisher","first-page":"S70","DOI":"10.1111\/jcpe.12062","volume":"40","author":"T Dietrich","year":"2013","unstructured":"Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol. 2013;40(s14):S70\u201384.","journal-title":"J Clin Periodontol"},{"issue":"4","key":"2438_CR21","doi-asserted-by":"publisher","first-page":"297","DOI":"10.14503\/THIJ-15-5200","volume":"43","author":"H Fr\u00f6hlich","year":"2016","unstructured":"Fr\u00f6hlich H, Herrmann K, Franke J, Karimi A, T\u00e4ger T, Cebola R, et al. Periodontitis in chronic heart failure. Tex Heart Inst J. 2016;43(4):297\u2013304.","journal-title":"Tex Heart Inst J"},{"key":"2438_CR22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fphys.2022.854606","volume":"13","author":"Y Yan","year":"2022","unstructured":"Yan Y, Mao M, Li YQ, Chen YJ, Yu HD, Xie WZ, et al. Periodontitis is associated with heart failure: a population-based study (NHANES III). Front Physiol. 2022;13:1\u20138.","journal-title":"Front Physiol"},{"issue":"6","key":"2438_CR23","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1536\/ihj.19-010","volume":"60","author":"N Aoyama","year":"2019","unstructured":"Aoyama N, Kure K, Minabe M, Izumi Y. Increased heart failure prevalence in patients with a high antibody level against periodontal pathogen. Int Heart J. 2019;60(6):1142\u20136.","journal-title":"Int Heart J"},{"issue":"1","key":"2438_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12872-023-03612-1","volume":"23","author":"G Schmalz","year":"2023","unstructured":"Schmalz G, Hennecke A, Haak R, Kottmann T, Garbade J, Binner C, et al. Secondary analysis of potential associations between oral health and infection-related parameters in patients with severe heart failure: Results of a German cohort. BMC Cardiovasc Disord. 2023;23(1):1\u201311.","journal-title":"BMC Cardiovasc Disord"},{"issue":"1","key":"2438_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12872-021-02111-5","volume":"21","author":"D Ziebolz","year":"2021","unstructured":"Ziebolz D, Binner C, Reuschel F, Eisner M, Wagner J, Kottmann T, et al. Comparison of periodontal parameters between patients with ischemic and dilative cardiomyopathy. BMC Cardiovasc Disord. 2021;21(1):1\u20139.","journal-title":"BMC Cardiovasc Disord"},{"issue":"2","key":"2438_CR26","doi-asserted-by":"publisher","first-page":"135","DOI":"10.5603\/KP.a2016.0148","volume":"75","author":"MR Czerniuk","year":"2017","unstructured":"Czerniuk MR, Bartoszewicz Z, Filipiak KJ, Niewiadomska ID, Pilecki T, G\u00f3rska R. Plasmatic NT-proBNP concentrations in patients with coexistent periodontal disease and congestive heart failure: Pilot studies. Kardiol Pol. 2017;75(2):135\u201342.","journal-title":"Kardiol Pol"},{"issue":"6","key":"2438_CR27","doi-asserted-by":"publisher","first-page":"4189","DOI":"10.1002\/ehf2.14150","volume":"9","author":"C Walther","year":"2022","unstructured":"Walther C, Wenzel JP, Schnabel RB, Heydecke G, Seedorf U, Beikler T, et al. Association between periodontitis and heart failure in the general population. ESC Heart Fail. 2022;9(6):4189\u201397.","journal-title":"ESC Heart Fail"},{"issue":"4","key":"2438_CR28","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1111\/j.1600-051X.2007.01173.x","volume":"35","author":"S Paraskevas","year":"2008","unstructured":"Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008;35(4):277\u201390.","journal-title":"J Clin Periodontol"},{"issue":"6","key":"2438_CR29","first-page":"678","volume":"45","author":"Y Leira","year":"2018","unstructured":"Leira Y, Mart\u00edn-L\u00f3pez LM, Blanco J, Mart\u00edn C, Castillo J, P\u00edas-Peleteiro JM, et al. Periodontitis and subclinical atherosclerosis: A systematic review and meta-analysis. J Clin Periodontol. 2018;45(6):678\u201388.","journal-title":"J Clin Periodontol"},{"issue":"13","key":"2438_CR30","first-page":"1437","volume":"26","author":"M Czesnikiewicz-Guzik","year":"2019","unstructured":"Czesnikiewicz-Guzik M, Osmenda G, Siedlinski M, Nosalski R, Pelka P, Nowakowski D, et al. Causal association between periodontitis and hypertension: Evidence from Mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy. Eur J Prev Cardiol. 2019;26(13):1437\u201348.","journal-title":"Eur J Prev Cardiol"},{"issue":"2","key":"2438_CR31","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1177\/1099800416665197","volume":"19","author":"RL Dekker","year":"2017","unstructured":"Dekker RL, Lennie TA, Moser DK, Miller CS, Ebersole JL, Chung ML, et al. Salivary biomarkers, oral inflammation, and functional status in patients with heart failure. Biol Res Nurs. 2017;19(2):153\u201361.","journal-title":"Biol Res Nurs"},{"issue":"17","key":"2438_CR32","doi-asserted-by":"publisher","first-page":"1835","DOI":"10.1177\/2047487319886018","volume":"27","author":"Y Chang","year":"2020","unstructured":"Chang Y, Woo HG, Park J, Lee JS, Song TJ. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: A nationwide population-based cohort study. Eur J Prev Cardiol. 2020;27(17):1835\u201345.","journal-title":"Eur J Prev Cardiol"},{"key":"2438_CR33","doi-asserted-by":"crossref","unstructured":"Loos BG, Van Dyke TE. The role of inflammation and genetics in periodontal disease. Periodontol 2000. 2020;83(1):26\u201339.","DOI":"10.1111\/prd.12297"},{"issue":"3","key":"2438_CR34","first-page":"253","volume":"26","author":"MR Czerniuk","year":"2019","unstructured":"Czerniuk MR, Bartoszewicz Z, Niewiadomska ID, Pilecki T, G\u00f3rska R, Filipiak KJ. Simple platelet markers: Mean platelet volume and congestive heart failure coexistent with periodontal disease. Pilot studies Cardiol J. 2019;26(3):253\u20139.","journal-title":"Pilot studies. Cardiol J"},{"issue":"6","key":"2438_CR35","first-page":"1065","volume":"58","author":"L Guo","year":"2023","unstructured":"Guo L, Li Y, Chen Y, Zhang Y, Zhao Y. Periodontal disease and subsequent risk of cardiovascular outcomes and all-cause mortality: A meta-analysis of cohort studies. J Periodontal Res. 2023;58(6):1065\u201376.","journal-title":"J Periodontal Res"},{"issue":"8","key":"2438_CR36","doi-asserted-by":"publisher","first-page":"e0290028","DOI":"10.1371\/journal.pone.0290028","volume":"18","author":"BS Michalowicz","year":"2023","unstructured":"Michalowicz BS, Hodges JS, DiAngelis AJ, Lupo V, Novak MJ, Ferguson JE, Beck JD. Periodontal treatment and subsequent clinical outcomes and medical care costs: A retrospective cohort study. PLoS One. 2023;18(8):e0290028.","journal-title":"PLoS One"},{"key":"2438_CR37","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1186\/s12903-024-04433-0","volume":"24","author":"R Ma","year":"2024","unstructured":"Ma R, et al. Effect of non-surgical periodontal therapy on risk markers of cardiovascular disease: a systematic review and meta-analysis. BMC Oral Health. 2024;24:665. https:\/\/doi.org\/10.1186\/s12903-024-04433-0.","journal-title":"BMC Oral Health"},{"key":"2438_CR38","unstructured":"Editorial. Periodontal therapy and cardiovascular outcomes: Emerging evidence from clinical trials. Front Dent Med. 2025;6:1613091."},{"issue":"2","key":"2438_CR39","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1111\/idh.12639","volume":"21","author":"AP Kolte","year":"2023","unstructured":"Kolte AP, Kolte RA, Bawankar PV, Bajaj VA. Assessment and correlation of the influence of non-surgical periodontal therapy on serum lipid profile and cytokines in patients with stage III periodontitis. Int J Dent Hyg. 2023;21(2):298\u2013304. https:\/\/doi.org\/10.1111\/idh.12639.","journal-title":"Int J Dent Hyg"},{"key":"2438_CR40","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1389853","volume":"12","author":"LA Church","year":"2024","unstructured":"Church LA, Robins L, Xu F, Qin L, Tran A, Wallace JP, et al. Oral health education strategies for patients living with cardiovascular disease within hospital settings: a scoping review. Front Public Health. 2024;12:1389853. https:\/\/doi.org\/10.3389\/fpubh.2024.1389853.","journal-title":"Front Public Health"},{"issue":"25","key":"2438_CR41","first-page":"2436","volume":"78","author":"E Gianos","year":"2021","unstructured":"Gianos E, Williams KA, Levine R, Fisher EA. Poor oral health is associated with atherosclerotic cardiovascular disease: A review of emerging evidence. J Am Coll Cardiol. 2021;78(25):2436\u201347.","journal-title":"J Am Coll Cardiol"}],"container-title":["Current Cardiology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11886-026-02438-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11886-026-02438-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11886-026-02438-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:03:22Z","timestamp":1792274602000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11886-026-02438-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,17]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2438"],"URL":"https:\/\/doi.org\/10.1007\/s11886-026-02438-5","relation":{},"ISSN":["1534-3170"],"issn-type":[{"value":"1534-3170","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,17]]},"assertion":[{"value":"18 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":1,"name":"Ethics","label":"Human and Animal Rights and Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Artificial intelligence (AI) tools were used exclusively for language and grammar review. AI was not used to generate scientific content, analyze or interpret data, create figures or tables, or draw conclusions. All content was critically reviewed and approved by the authors, who take full responsibility for the final manuscript.","order":2,"name":"Ethics","label":"Use of Artificial Intelligence","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"112"}}