{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:16:41Z","timestamp":1791897401407,"version":"4.3.4"},"reference-count":57,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The use of vasopressors during microsurgical reconstruction is debated. Their effect on the comorbid lower extremity (LE) wound population is unstudied. This study characterizes the impact of intraoperative vasopressor use in LE free tissue transfer (FTT) for limb salvage.<\/jats:p>\n                  <jats:p>A review of LE FTT from February 2017 to June 2024 was conducted. Flap outcomes within 7 and 42 days were evaluated, as well as long-term limb salvage.<\/jats:p>\n                  <jats:p>Of 258 LE FTT performed, vasopressors were used in 177 cases (68.6%). Most vasopressors were administered via intermittent bolus only (75.7%) or combined with continuous infusion (23.7%). American Society of Anesthesiologists Class was significantly higher in the vasopressor group compared with controls (p\u2009=\u20090.001). The vasopressor group trended to have higher median Charlson Comorbidity Indices (4, interquartile range [IQR]: 3 vs. 3, IQR: 3; p\u2009=\u20090.055), and rates of diabetes (65.0% vs. 54.3%, p\u2009=\u20090.103), peripheral vascular disease (63.8% vs. 51.9%, p\u2009=\u20090.068), and chronic kidney disease (14.7% vs. 6.2%, p\u2009=\u20090.063). The rate of reoperation, microvascular thrombosis, or flap success at 7 and 42 days did not differ between groups. By a median long-term follow-up of 24.5 (IQR: 39.2) months, rates of major limb amputation (vasopressor: 10.7% vs. control: 7.4%, p\u2009=\u20090.402) and mortality (6.8% vs. 2.5%, p\u2009=\u20090.237) were similar between groups.<\/jats:p>\n                  <jats:p>In this complex population, intraoperative use of vasopressors does not appear to negatively impact flap viability or limb salvage.<\/jats:p>","DOI":"10.1055\/a-2687-0254","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T22:56:30Z","timestamp":1757112990000},"page":"449-460","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative Vasopressor Use Does Not Adversely Impact Free Flap Outcomes in Lower Extremity Limb Salvage Procedures in a Highly Comorbid Atraumatic Wound Population"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0418-5287","authenticated-orcid":false,"given":"Rachel N.","family":"Rohrich","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole C.","family":"Episalla","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3404-1712","authenticated-orcid":false,"given":"Sami","family":"Ferdousian","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"},{"name":"Georgetown University School of Medicine, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Suh","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maeesha","family":"Noshin","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke J.","family":"Llaurado","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C.","family":"Youn","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E.","family":"Attinger","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron M.","family":"Akbari","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell T.","family":"Wall","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen K.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"issue":"S 01","key":"ref1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1002\/dmrr.2236","article-title":"Amputation and ambulation in diabetic patients: function is the goal","volume":"28","author":"C E Attinger","year":"2012","journal-title":"Diabetes Metab Res Rev"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jdiacomp.2011.02.001","article-title":"The importance of limb preservation in the diabetic population","volume":"25","author":"K K Evans","year":"2011","journal-title":"J Diabetes Complications"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/01.anes.0000270724.40897.8e","article-title":"Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection","volume":"107","author":"J B Bijker","year":"2007","journal-title":"Anesthesiology"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"S135","DOI":"10.1097\/SAP.0000000000000076","article-title":"Impact of intraoperative vasopressor use in free tissue transfer for head, neck, and extremity reconstruction","volume":"72","author":"D A Kelly","year":"2014","journal-title":"Ann Plast Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1213\/01.ANE.0000146521.68059.A1","article-title":"Angiotensin system inhibitors in a general surgical population","volume":"100","author":"T Comfere","year":"2005","journal-title":"Anesth Analg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1213\/00000539-199910000-00002","article-title":"Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery","volume":"89","author":"D L Reich","year":"1999","journal-title":"Anesth Analg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1213\/01.ANE.0000147519.82841.5E","article-title":"Anesthetic management and one-year mortality after noncardiac surgery","volume":"100","author":"T G Monk","year":"2005","journal-title":"Anesth Analg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1159\/000446265","article-title":"Fluid management for critically ill patients: a review of the current state of fluid therapy in the intensive care unit","volume":"2","author":"E Frazee","year":"2016","journal-title":"Kidney Dis (Basel)"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1161\/CIRCULATIONAHA.107.728840","article-title":"Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease","volume":"118","author":"C B Overgaard","year":"2008","journal-title":"Circulation"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/00000542-199901000-00020","article-title":"Laboratory investigations-effects of sodium nitroprusside and phenylephrine on blood flow in free musculocutaneous flaps during general anesthesia-sodium nitroprusside-induced hypotension causes","volume":"90","author":"A Banic","year":"1999","journal-title":"Anesthesiology-Hagerstown"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/00000637-199711000-00013","article-title":"Effects of vasoactive medications on the blood flow of island musculocutaneous flaps in swine","volume":"39","author":"P G Cordeiro","year":"1997","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1177\/019459988609400415","article-title":"The effect of alpha-adrenergic stimulation and blockade on perfusion of myocutaneous flaps","volume":"94","author":"G K Moore","year":"1986","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1002\/micr.20627","article-title":"Nonparallel cutaneous microcirculatory responses to pharmacologic alterations of systemic arterial pressure in rats","volume":"29","author":"T B Sun","year":"2009","journal-title":"Microsurgery"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/lary.20825","article-title":"What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure","volume":"120","author":"K M Pattani","year":"2010","journal-title":"Laryngoscope"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/SAP.0b013e3181bda312","article-title":"Effects of vasopressor administration on the outcomes of microsurgical breast reconstruction","volume":"65","author":"C Chen","year":"2010","journal-title":"Ann Plast Surg"},{"issue":"07","key":"ref16","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1055\/s-0039-1687914","article-title":"Perioperative vasopressor use in free flap surgery: a systematic review and meta-analysis","volume":"35","author":"C SL Goh","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/SAP.0b013e31828d70b3","article-title":"Vasopressors and reconstructive flap perfusion: a review of the literature comparing the effects of various pharmacologic agents","volume":"73","author":"A M Ibrahim","year":"2014","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3233\/CH-189411","article-title":"Impact of intraoperative use of vasopressors in lower extremity reconstruction: single centre analysis of 437 free gracilis muscle and fasciocutaneous anterolateral thigh flaps","volume":"71","author":"A Heine-Geldern","year":"2019","journal-title":"Clin Hemorheol Microcirc"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1002\/micr.30870","article-title":"Impact of perioperative vasopressors on lower extremity free flap reconstruction","volume":"42","author":"H M Hahn","year":"2022","journal-title":"Microsurgery"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1055\/a-2331-8174","article-title":"The impact of intraoperative vasopressor use and fluid status on flap survival in traumatic lower extremity reconstruction","volume":"41","author":"I Roohani","year":"2025","journal-title":"J Reconstr Microsurg"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.3390\/jcm13082406","article-title":"A multidisciplinary approach to end-stage limb salvage in the highly comorbid atraumatic population: an observational study","volume":"13","author":"K R Li","year":"2024","journal-title":"J Clin Med"},{"key":"ref22","first-page":"1097","article-title":"Refining a multidisciplinary \u201cvasculo-plastic\u201d approach to limb salvage: an institutional review examining 300 lower extremity free flaps","volume":"10","author":"K R Li","year":"2021","journal-title":"Plast Reconstr Surg"},{"key":"ref23","first-page":"1","volume-title":"Building It from Scratch: The Team Approach to Functional Diabetic Limb Salvage","author":"A A Abu El Hawa","year":"2023"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1097\/PRS.0000000000006791","article-title":"Limb salvage rates and functional outcomes using a longitudinal slit arteriotomy end-to-side anastomosis for limb-threatening defects in a high-risk patient population","volume":"145","author":"C Black","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"ref25","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-031-27725-2","volume-title":"Functional Limb Salvage: The Multidisciplinary Team Approach","author":"C E Attinger","year":"2023"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1016\/j.ygyno.2008.07.044","article-title":"How to make a hospital-based wound center financially viable: the Georgetown University Hospital model","volume":"111","author":"C E Attinger","year":"2008","journal-title":"Gynecol Oncol"},{"issue":"02","key":"ref27","first-page":"321","article-title":"Free tissue transfer for patients with chronic lower extremity wounds. Contemporary approach to lower extremity reconstruction, an issue of clinics in plastic surgery","volume":"48","author":"C E Attinger","year":"2021","journal-title":"E-Book"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"164e","DOI":"10.1097\/PRS.0000000000006384","article-title":"The utility of preoperative venous testing for lower extremity flap planning in patients with lower extremity wounds","volume":"145","author":"D E Janhofer","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/PRS.0000000000009236","article-title":"Expanding criteria for limb salvage in comorbid patients with nonhealing wounds: The MedStar Georgetown Protocol and Lessons Learned after 200 Lower Extremity Free Flaps","volume":"150","author":"M Nigam","year":"2022","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref30","doi-asserted-by":"crossref","first-page":"1316.e7","DOI":"10.1016\/j.avsg.2015.01.035","article-title":"Free tissue transfer after targeted endovascular reperfusion for complex lower extremity reconstruction: setting the stage for success in the presence of mutlivessel disease","volume":"29","author":"M V DeFazio","year":"2015","journal-title":"Ann Vasc Surg"},{"key":"ref31","first-page":"449","volume-title":"Free Tissue Transfer in Diabetic Limb Salvage: Lessons Learned and Best Practices for Functional Salvage","author":"P K Dekker","year":"2023"},{"issue":"09","key":"ref32","doi-asserted-by":"crossref","first-page":"e4536","DOI":"10.1097\/GOX.0000000000004536","article-title":"Saphenous vein interposition grafts in lower extremity reconstruction: appraisal of technique and case series","volume":"10","author":"P K Dekker","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"05","key":"ref33","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"M E Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1055\/s-0041-1731302","article-title":"Intraoperative vasopressor usage in free tissue transfer: should we be worried?","volume":"38","author":"S P Munro","year":"2022","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref35","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/micr.30341","article-title":"A literature review and meta-analysis of outcomes in microsurgical reconstruction using vasopressors","volume":"39","author":"R Knackstedt","year":"2019","journal-title":"Microsurgery"},{"issue":"03","key":"ref36","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/PRS.0b013e31825dbf73","article-title":"Epinephrine, norepinephrine, dobutamine, and dopexamine effects on free flap skin blood flow","volume":"130","author":"K A Eley","year":"2012","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref37","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.otohns.2009.11.001","article-title":"Vasopressor use in free tissue transfer surgery","volume":"142","author":"M M Monroe","year":"2010","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1177\/0194599811401313","article-title":"Safety of vasopressor use in head and neck microvascular reconstruction: a prospective observational study","volume":"144","author":"M M Monroe","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"05","key":"ref39","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1097\/01.sap.0000137133.08105.73","article-title":"The effect of intravenous dopamine and dobutamine on blood circulation during a microvascular TRAM flap operation","volume":"53","author":"S Suominen","year":"2004","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref40","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/SLA.0000000000002295","article-title":"Intraoperative use of vasopressors does not increase the risk of free flap compromise and failure in cancer patients","volume":"268","author":"L Fang","year":"2018","journal-title":"Ann Surg"},{"issue":"05","key":"ref41","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1080\/2000656X.2016.1269777","article-title":"Intraoperative vasopressors and thrombotic complications in free flap breast reconstruction","volume":"51","author":"J A Nelson","year":"2017","journal-title":"J Plast Surg Hand Surg"},{"issue":"03","key":"ref42","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s11892-013-0375-y","article-title":"Diabetes mellitus and inflammation","volume":"13","author":"E Lontchi-Yimagou","year":"2013","journal-title":"Curr Diab Rep"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/bja\/aes171","article-title":"Intraoperative fluids: how much is too much?","volume":"109","author":"M Doherty","year":"2012","journal-title":"Br J Anaesth"},{"issue":"S 15","key":"ref44","doi-asserted-by":"crossref","first-page":"S2002","DOI":"10.21037\/jtd.2019.06.58","article-title":"Importance of intraoperative fluid management","volume":"11","author":"H Iwata","year":"2019","journal-title":"J Thorac Dis"},{"issue":"05","key":"ref45","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1002\/micr.31047","article-title":"Evidence based recommendations for perioperative vasopressor use and fluid resuscitation in microsurgery","volume":"43","author":"R Safeek","year":"2023","journal-title":"Microsurgery"},{"issue":"01","key":"ref46","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1053\/j.ajkd.2013.06.011","article-title":"Association of fluid overload with kidney disease progression in advanced CKD: a prospective cohort study","volume":"63","author":"Y-C Tsai","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"07","key":"ref47","doi-asserted-by":"crossref","first-page":"e0159335","DOI":"10.1371\/journal.pone.0159335","article-title":"Chronic kidney disease, fluid overload and diuretics: a complicated triangle","volume":"11","author":"Y H Khan","year":"2016","journal-title":"PLoS One"},{"issue":"02","key":"ref48","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ejheart.2008.01.007","article-title":"Fluid overload in acute heart failure\u2013re-distribution and other mechanisms beyond fluid accumulation","volume":"10","author":"G Cotter","year":"2008","journal-title":"Eur J Heart Fail"},{"issue":"06","key":"ref49","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.jamcollsurg.2006.01.003","article-title":"Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery","volume":"202","author":"K Holte","year":"2006","journal-title":"J Am Coll Surg"},{"issue":"05","key":"ref50","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/shk.0b013e318050c78d","article-title":"Continuous versus bolus infusion of terlipressin in ovine endotoxemia","volume":"28","author":"M Lange","year":"2007","journal-title":"Shock"},{"key":"ref51","first-page":"354","volume-title":"Effects of equipotent ephedrine, metaraminol, mephentermine, and methoxamine on uterine blood flow in the pregnant ewe","author":"D H Ralston","year":"1974"},{"issue":"03","key":"ref52","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/CRD.0b013e31824e2294","article-title":"Vasopressor use in adult patients","volume":"20","author":"N Ferguson-Myrthil","year":"2012","journal-title":"Cardiol Rev"},{"issue":"04","key":"ref53","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/ALN.0000000000004774","article-title":"Intraoperative use of phenylephrine versus ephedrine and postoperative delirium: a multicenter retrospective cohort study","volume":"140","author":"H Ma","year":"2024","journal-title":"Anesthesiology"},{"issue":"04","key":"ref54","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1097\/00000539-200204000-00028","article-title":"A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery","volume":"94","author":"A Lee","year":"2002","journal-title":"Anesth Analg"},{"issue":"01","key":"ref55","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1186\/s40001-023-01229-w","article-title":"Early administration of multiple vasopressors is associated with better survival in patients with sepsis: a propensity score-weighted study","volume":"28","author":"X Tong","year":"2023","journal-title":"Eur J Med Res"},{"key":"ref56","volume-title":"Inotropes and vasopressors","author":"D VanValkinburgh","year":"2018"},{"issue":"11","key":"ref57","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1016\/j.bjps.2015.06.019","article-title":"Microvascular vessel preparation: what are we really removing during adventitial stripping?","volume":"68","author":"E K Kim","year":"2015","journal-title":"J Plast Reconstr Aesthet Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2687-0254.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:40:33Z","timestamp":1781649633000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2687-0254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":57,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2687-0254","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,5]]}}}