{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:17:11Z","timestamp":1790252231665,"version":"4.1.0"},"reference-count":59,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Respir Crit Care Med"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Aspergilli may cause various pulmonary diseases in humans, including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), and acute invasive pulmonary aspergillosis (IPA). In addition, chronic colonization may occur in cystic fibrosis (CF). Aspergillus fumigatus represents the main pathogen, which may employ different morphotypes, for example, conidia, hyphal growth, and asexual sporulation, in the various Aspergillus diseases. These morphotypes determine the ease by which A. fumigatus can adapt to stress by antifungal drug exposure, usually resulting in one or more resistance mutations. Key factors that enable the emergence of resistance include genetic variation and selection. The ability to create genetic variation depends on the reproduction mode, including, sexual, parasexual, and asexual, and the population size. These reproduction cycles may take place in the host and\/or in the environment, usually when specific conditions are present. Environmental resistance is commonly characterized by tandem repeat (TR)-mediated mutations, while in-host resistance selection results in single-resistance mutations. Reported cases from the literature indicate that environmental resistance mutations are almost exclusively present in patients with IA indicating that the risk for in-host resistance selection is very low. In aspergilloma, single-point mutations are the dominant resistance genotype, while in other chronic Aspergillus diseases, for example, ABPA, CPA, and CF, both TR-mediated and single-resistance mutations are reported. Insights into the pathogenesis of resistance selection in various Aspergillus diseases may help to improve diagnostic and therapeutic strategies.<\/jats:p>","DOI":"10.1055\/s-0043-1776997","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T03:40:20Z","timestamp":1704858020000},"page":"032-040","source":"Crossref","is-referenced-by-count":10,"title":["Antifungal Resistance in Pulmonary Aspergillosis"],"prefix":"10.1055","volume":"45","author":[{"given":"Paul E.","family":"Verweij","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands"},{"name":"Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands"},{"name":"Center for Infectious Disease Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinggai","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands"},{"name":"Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, China"},{"name":"National Clinical Research Center For Skin and Immune Diseases, Beijing, China"},{"name":"Research Center for Medical Mycology, Peking University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochem B.","family":"Buil","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands"},{"name":"Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem J.G.","family":"Melchers","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands"},{"name":"Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.simyco.2020.05.002","article-title":"Classification of Aspergillus, Penicillium, Talaromyces and related genera (Eurotiales): an overview of families, genera, subgenera, sections, series and species","volume":"95","author":"J Houbraken","year":"2020","journal-title":"Stud Mycol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"e00140","DOI":"10.1128\/CMR.00140-18","article-title":"Aspergillus fumigatus and Aspergillosis in 2019","volume":"33","author":"J P Latg\u00e9","year":"2019","journal-title":"Clin Microbiol Rev"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1007\/s00134-020-06091-6","article-title":"Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion","volume":"46","author":"P E Verweij","year":"2020","journal-title":"Intensive Care Med"},{"issue":"08","key":"ref4","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1038\/s41564-022-01172-2","article-title":"COVID-19-associated fungal infections","volume":"7","author":"M Hoenigl","year":"2022","journal-title":"Nat Microbiol"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1055\/s-0035-1562893","article-title":"Invasive aspergillosis: epidemiology, clinical aspects, and treatment","volume":"36","author":"K S Gregg","year":"2015","journal-title":"Semin Respir Crit Care Med"},{"issue":"S 01","key":"ref6","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.cmi.2018.01.002","article-title":"Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline","volume":"24","author":"A J Ullmann","year":"2018","journal-title":"Clin Microbiol Infect"},{"issue":"12","key":"ref7","doi-asserted-by":"crossref","first-page":"4934","DOI":"10.1111\/1462-2920.15274","article-title":"Mechanisms of triazole resistance in Aspergillus fumigatus","volume":"22","author":"A V Nywening","year":"2020","journal-title":"Environ Microbiol"},{"key":"ref8","volume-title":"Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi","year":"2017"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.cmi.2020.06.007","article-title":"How to interpret MICs of antifungal compounds according to the revised clinical breakpoints v. 10.0 European committee on antimicrobial susceptibility testing (EUCAST)","volume":"26","author":"M C Arendrup","year":"2020","journal-title":"Clin Microbiol Infect"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.cmi.2022.02.024","article-title":"How to: ECOFFs\u2014the why, the how, and the don'ts of EUCAST epidemiological cutoff values","volume":"28","author":"G Kahlmeter","year":"2022","journal-title":"Clin Microbiol Infect"},{"issue":"09","key":"ref11","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1111\/myc.13619","article-title":"Exploring the intersection of Aspergillus fumigatus biofilms, infections, immune response and antifungal resistance","volume":"66","author":"V H Kashyap","year":"2023","journal-title":"Mycoses"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/s41522-022-00347-3","article-title":"Filamentous fungal biofilms: Conserved and unique aspects of extracellular matrix composition, mechanisms of drug resistance and regulatory networks in Aspergillus fumigatus","volume":"8","author":"S Liu","year":"2022","journal-title":"NPJ Biofilms Microbiomes"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"e0134692","DOI":"10.1371\/journal.pone.0134692","article-title":"Inhibition of Aspergillus fumigatus and its biofilm by Pseudomonas aeruginosa is dependent on the source, phenotype and growth conditions of the bacterium","volume":"10","author":"J A Ferreira","year":"2015","journal-title":"PLoS One"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"15009","DOI":"10.1038\/npjbiofilms.2015.9","article-title":"A unique biofilm in human deep mycoses: fungal amyloid is bound by host serum amyloid P component","volume":"1","author":"M C Garcia-Sherman","year":"2015","journal-title":"NPJ Biofilms Microbiomes"},{"issue":"11","key":"ref15","doi-asserted-by":"crossref","first-page":"4130","DOI":"10.1128\/AAC.00234-08","article-title":"Aspergillus fumigatus forms biofilms with reduced antifungal drug susceptibility on bronchial epithelial cells","volume":"52","author":"M J Seidler","year":"2008","journal-title":"Antimicrob Agents Chemother"},{"issue":"12","key":"ref16","doi-asserted-by":"crossref","first-page":"2430","DOI":"10.1038\/s41564-019-0558-7","article-title":"Fungal biofilm morphology impacts hypoxia fitness and disease progression","volume":"4","author":"C H Kowalski","year":"2019","journal-title":"Nat Microbiol"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"5352","DOI":"10.1038\/s41467-022-32249-5","article-title":"The importance of antimicrobial resistance in medical mycology","volume":"13","author":"N AR Gow","year":"2022","journal-title":"Nat Commun"},{"issue":"7228","key":"ref18","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1038\/nature07528","article-title":"Discovery of a sexual cycle in the opportunistic fungal pathogen Aspergillus fumigatus","volume":"457","author":"C M O'Gorman","year":"2009","journal-title":"Nature"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"e3002278","DOI":"10.1371\/journal.pbio.3002278","article-title":"The human fungal pathogen Aspergillus fumigatus can produce the highest known number of meiotic crossovers","volume":"21","author":"B Auxier","year":"2023","journal-title":"PLoS Biol"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"00020","DOI":"10.1183\/23120541.00020-2020","article-title":"Parasexual recombination enables Aspergillus fumigatus to persist in cystic fibrosis","volume":"6","author":"T Engel","year":"2020","journal-title":"ERJ Open Res"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/BF02993465","article-title":"Alternative reproduction pathway in Aspergillus nidulans","volume":"48","author":"F Baptista","year":"2003","journal-title":"Folia Microbiol (Praha)"},{"issue":"10","key":"ref22","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1111\/evo.12763","article-title":"Asexual sporulation facilitates adaptation: the emergence of azole resistance in Aspergillus fumigatus","volume":"69","author":"J Zhang","year":"2015","journal-title":"Evolution"},{"issue":"08","key":"ref23","doi-asserted-by":"crossref","first-page":"599","DOI":"10.3390\/jof7080599","article-title":"Azole-resistance development; How the Aspergillus fumigatus lifecycle defines the potential for adaptation","volume":"7","author":"J Zhang","year":"2021","journal-title":"J Fungi (Basel)"},{"issue":"1896","key":"ref24","first-page":"20182886","article-title":"Relevance of heterokaryosis for adaptation and azole-resistance development in Aspergillus fumigatus","volume":"286","author":"J Zhang","year":"2019","journal-title":"Proc Biol Sci"},{"issue":"11","key":"ref25","doi-asserted-by":"crossref","first-page":"e251","DOI":"10.1016\/S1473-3099(16)30138-4","article-title":"In-host adaptation and acquired triazole resistance in Aspergillus fumigatus: a dilemma for clinical management","volume":"16","author":"P E Verweij","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"07","key":"ref26","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.3201\/eid2507.181625","article-title":"Environmental hotspots for azole resistance selection of Aspergillus fumigatus, the Netherlands","volume":"25","author":"S E Schoustra","year":"2019","journal-title":"Emerg Infect Dis"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"e02295","DOI":"10.1128\/AEM.02295-20","article-title":"Dynamics of Aspergillus fumigatus in azole fungicide-containing plant waste in the Netherlands (2016\u20132017)","volume":"87","author":"J Zhang","year":"2021","journal-title":"Appl Environ Microbiol"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1093\/cid\/civ885","article-title":"Azole resistance in Aspergillus fumigatus: can we retain the clinical use of mold-active antifungal azoles?","volume":"62","author":"P E Verweij","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1128\/AAC.01599-09","article-title":"Azole resistance profile of amino acid changes in Aspergillus fumigatus CYP51A based on protein homology modeling","volume":"54","author":"E Snelders","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/AAC.05088-11","article-title":"Rapid induction of multiple resistance mechanisms in Aspergillus fumigatus during azole therapy: a case study and review of the literature","volume":"56","author":"S M Camps","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"issue":"07","key":"ref31","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1093\/mmy\/myaa110","article-title":"CYP51A polymorphisms of Aspergillus fumigatus in lung transplant recipients: prevalence, correlation with phenotype, and impact on outcomes","volume":"59","author":"B Henry","year":"2021","journal-title":"Med Mycol"},{"issue":"11","key":"ref32","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1371\/journal.pmed.0050219","article-title":"Emergence of azole resistance in Aspergillus fumigatus and spread of a single resistance mechanism","volume":"5","author":"E Snelders","year":"2008","journal-title":"PLoS Med"},{"issue":"04","key":"ref33","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1093\/cid\/cit320","article-title":"Aspergillosis due to voriconazole highly resistant Aspergillus fumigatus and recovery of genetically related resistant isolates from domiciles","volume":"57","author":"J W van der Linden","year":"2013","journal-title":"Clin Infect Dis"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"e31801","DOI":"10.1371\/journal.pone.0031801","article-title":"Triazole fungicides can induce cross-resistance to medical triazoles in Aspergillus fumigatus","volume":"7","author":"E Snelders","year":"2012","journal-title":"PLoS One"},{"issue":"08","key":"ref35","doi-asserted-by":"crossref","first-page":"e1007858","DOI":"10.1371\/journal.ppat.1007858","article-title":"The fading boundaries between patient and environmental routes of triazole resistance selection in Aspergillus fumigatus","volume":"15","author":"J B Buil","year":"2019","journal-title":"PLoS Pathog"},{"issue":"07","key":"ref36","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1128\/JCM.00329-12","article-title":"Resistance to voriconazole due to a G448S substitution in Aspergillus fumigatus in a patient with cerebral aspergillosis","volume":"50","author":"T Pelaez","year":"2012","journal-title":"J Clin Microbiol"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"599233","DOI":"10.3389\/fmicb.2020.599233","article-title":"The multi-fungicide resistance status of Aspergillus fumigatus populations in arable soils and the wider European environment","volume":"11","author":"B Fraaije","year":"2020","journal-title":"Front Microbiol"},{"issue":"03","key":"ref38","doi-asserted-by":"crossref","first-page":"577","DOI":"10.3201\/eid2503.180297","article-title":"In vivo selection of a unique tandem repeat mediated azole resistance mechanism (TR120) in Aspergillus fumigatus cyp51A, Denmark","volume":"25","author":"R K Hare","year":"2019","journal-title":"Emerg Infect Dis"},{"issue":"09","key":"ref39","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1093\/cid\/ciy859","article-title":"Voriconazole resistance and mortality in invasive aspergillosis: a multicenter retrospective cohort study","volume":"68","author":"P P Lestrade","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"09","key":"ref40","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1093\/jac\/dkz258","article-title":"Prevalence of voriconazole-resistant invasive aspergillosis and its impact on mortality in haematology patients","volume":"74","author":"A Resendiz-Sharpe","year":"2019","journal-title":"J Antimicrob Chemother"},{"issue":"05","key":"ref41","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1093\/jac\/dku566","article-title":"Emergence of azole-resistant invasive aspergillosis in HSCT recipients in Germany","volume":"70","author":"J Steinmann","year":"2015","journal-title":"J Antimicrob Chemother"},{"issue":"08","key":"ref42","doi-asserted-by":"crossref","first-page":"4569","DOI":"10.1128\/AAC.00233-15","article-title":"Nationwide surveillance of azole resistance in Aspergillus diseases","volume":"59","author":"E Vermeulen","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"issue":"04","key":"ref43","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/myc.12047","article-title":"Major variations in Aspergillus fumigatus arising within aspergillomas in chronic pulmonary aspergillosis","volume":"56","author":"S J Howard","year":"2013","journal-title":"Mycoses"},{"issue":"02","key":"ref44","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3390\/jof6020067","article-title":"High-frequency direct detection of triazole resistance in Aspergillus fumigatus from patients with chronic pulmonary fungal diseases in India","volume":"6","author":"A Singh","year":"2020","journal-title":"J Fungi (Basel)"},{"issue":"09","key":"ref45","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1093\/cid\/cir179","article-title":"High-frequency triazole resistance found In nonculturable Aspergillus fumigatus from lungs of patients with chronic fungal disease","volume":"52","author":"D W Denning","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"08","key":"ref46","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1093\/jac\/dky147","article-title":"Prevalence and characterization of azole-resistant Aspergillus fumigatus in patients with cystic fibrosis: a prospective multicentre study in Germany","volume":"73","author":"R Seufert","year":"2018","journal-title":"J Antimicrob Chemother"},{"issue":"02","key":"ref47","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1128\/AAC.05077-11","article-title":"High prevalence of azole-resistant Aspergillus fumigatus in adults with cystic fibrosis exposed to itraconazole","volume":"56","author":"P R Burgel","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"issue":"08","key":"ref48","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1093\/jac\/dks160","article-title":"High prevalence of triazole resistance in Aspergillus fumigatus, especially mediated by TR\/L98H, in a French cohort of patients with cystic fibrosis","volume":"67","author":"F Morio","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"ref49","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.3389\/fmicb.2020.01850","article-title":"Azole-resistant Aspergillus fumigatus among Danish cystic fibrosis patients: increasing prevalence and dominance of TR34\/L98H","volume":"11","author":"M Risum","year":"2020","journal-title":"Front Microbiol"},{"issue":"08","key":"ref50","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1164\/rccm.201510-2104LE","article-title":"Voriconazole-susceptible and voriconazole-resistant Aspergillus fumigatus coinfection","volume":"193","author":"E Kolwijck","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"issue":"01","key":"ref51","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3390\/jof8010049","article-title":"Clinical and microbiological characteristics of culture-positive, influenza-associated pulmonary aspergillosis: a single-center study in southern Taiwan, 2016\u20132019","volume":"8","author":"C J Wu","year":"2022","journal-title":"J Fungi (Basel)"},{"issue":"04","key":"ref52","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1111\/myc.13254","article-title":"COVID-19-associated pulmonary aspergillosis: a prospective single-center dual case series","volume":"64","author":"E FJ Meijer","year":"2021","journal-title":"Mycoses"},{"issue":"04","key":"ref53","doi-asserted-by":"crossref","first-page":"e0193732","DOI":"10.1371\/journal.pone.0193732","article-title":"Twelve-month clinical outcomes of 206 patients with chronic pulmonary aspergillosis","volume":"13","author":"F Bongomin","year":"2018","journal-title":"PLoS One"},{"issue":"09","key":"ref54","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1038\/s41579-022-00720-1","article-title":"Tackling the emerging threat of antifungal resistance to human health","volume":"20","author":"M C Fisher","year":"2022","journal-title":"Nat Rev Microbiol"},{"issue":"01","key":"ref55","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1016\/S2666-5247(22)00261-0","article-title":"The current state of laboratory mycology and access to antifungal treatment in Europe: a European Confederation of Medical Mycology survey","volume":"4","author":"J Salmanton-Garc\u00eda","year":"2023","journal-title":"Lancet Microbe"},{"key":"ref56","doi-asserted-by":"crossref","first-page":"515","DOI":"10.3389\/fmicb.2018.00515","article-title":"Molecular detection of azole-resistant Aspergillus fumigatus in clinical samples","volume":"9","author":"J B Buil","year":"2018","journal-title":"Front Microbiol"},{"key":"ref57","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.drup.2015.08.001","article-title":"International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus","volume":"21-22","author":"P E Verweij","year":"2015","journal-title":"Drug Resist Updat"},{"issue":"07","key":"ref58","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1038\/nrmicro1179","article-title":"Evolution of antifungal-drug resistance: mechanisms and pathogen fitness","volume":"3","author":"J B Anderson","year":"2005","journal-title":"Nat Rev Microbiol"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad607","article-title":"FDA public workshop summary-addressing challenges in inhaled antifungal drug development","author":"C J Jjingo","year":"2023","journal-title":"Clin Infect Dis"}],"container-title":["Seminars in Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1776997.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T17:18:40Z","timestamp":1730827120000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1776997"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,9]]},"references-count":59,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,1,29]]},"published-print":{"date-parts":[[2024,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1776997","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1069-3424","1098-9048"],"issn-type":[{"value":"1069-3424","type":"print"},{"value":"1098-9048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,9]]}}}