{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:11:22Z","timestamp":1792725082329,"version":"4.5.0"},"reference-count":47,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T00:00:00Z","timestamp":1716163200000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2024,4,12]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To untangle the association between smoking and systemic sclerosis (SSc).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In the European Scleroderma Trials and Research cohort, the autoantibody status was compared between ever-smokers and never-smokers. Time until disease progression was assessed using Kaplan-Meier curves. Cox models were built to investigate the influence of smoking over 15 years of follow-up. All analyses were performed for the total cohort and stratified for sex and for positivity of anti-centromere (ACA) and anti-topoisomerase antibodies (ATA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 12\u2009314 patients were included in the study. Of these, 10\u2009393 were women (84%), 4637 were ACA-positive (38%), 3919 were ATA-positive (32%) and 4271 (35%) were ever-smokers. In men, but not in women, smoking was associated with mortality (HR 1.63, 95% CI 1.23 to 2.16, p=0.001). Ever-smoking women were at higher risk for skin progression (HR 1.10, 95% CI 1.00 to 1.22, p=0.046) and for \u2018any organ progression\u2019 (HR 1.07, 95% CI 1.00 to 1.13, p=0.036). In women, 34% of never-smokers were ATA-positive compared with 21% of ever-smokers (p&lt;0.001). In the group of ever-smokers, higher exposure rates, reflected by the number of pack-years (OR 0.98, 95% CI 0.97 to 0.99, p&lt;0.001) and by smoking duration (OR 0.96, 95% CI 0.95 to 0.97, p&lt;0.001), were associated with lower frequency of ATA. In ACA-positive patients, the risk of mortality (HR 1.29, 95% CI 1.02 to 1.63, p=0.033), cardiac involvement (HR 1.25, 95% CI 1.03 to 1.43, p=0.001), skin progression (HR 1.21, 95% CI 1.03 to 1.42, p=0.018) and \u2018any organ progression\u2019 (HR 1.14, 95% CI 1.05 to 1.24, p=0.002) was increased among smokers. In ATA-positive smoking patients, mortality (HR 1.40, 95% CI 1.10 to 1.78, p=0.006), skin progression (HR 1.19, 95% CI 1.03 to 1.37, p=0.020) digital ulcers (HR 1.17, 95% CI 1.02 to 1.34, p=0.029) and \u2018any organ progression\u2019 (HR 1.11, 95% CI 1.00 to 1.22, p=0.048) occurred more frequently.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our stratified analysis demonstrates that smoking is associated with an increased risk for mortality in male SSc patients but not in women. Strikingly, smoking is associated with lower prevalence of ATA positivity, in particular in women. In both ATA-positive and ACA-positive patients, smoking is a risk factor for mortality, skin progression and \u2018any organ progression\u2019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2024-004101","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T04:21:07Z","timestamp":1716265267000},"page":"e004101","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Untangling the relationship between smoking and systemic sclerosis: an analysis of the EUSTAR cohort"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-7351","authenticated-orcid":false,"given":"Jacopo","family":"Ciaffi","sequence":"first","affiliation":[{"name":"Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0328-7062","authenticated-orcid":false,"given":"Sophie I E","family":"Liem","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Cannegieter","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands"},{"name":"Department of Internal Medicine, Division of Thrombosis and Haemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva M","family":"Hoekstra","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Wiland","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5657-962X","authenticated-orcid":false,"given":"Tatsuya","family":"Atsumi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Sz\u00fccs","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Balbir Gurman","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e1szl\u00f3","family":"Czirj\u00e1k","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Medical School, University of P\u00e9cs, P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4845-5413","authenticated-orcid":false,"given":"Elisabetta","family":"Zanatta","sequence":"additional","affiliation":[{"name":"Department of Medicine-DIMED, Unit of Rheumatology, Padova University Hospital, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina","family":"Koetter","sequence":"additional","affiliation":[{"name":"Medical Department 4, Rheumatology, Immunology, Nephrology, Asklepios Klinik Altona, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8385-6861","authenticated-orcid":false,"given":"Joerg C","family":"Henes","sequence":"additional","affiliation":[{"name":"Internal Medicine II - Oncology, haematology, clinical immunology and rheumatology, University Hospital and Faculty of Medicine, University of T\u00fcbingen, Tubingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9324-3161","authenticated-orcid":false,"given":"Marco","family":"Matucci-Cerinic","sequence":"additional","affiliation":[{"name":"Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Air\u00f2","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Service, Spedali Civili di Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8194-8642","authenticated-orcid":false,"given":"Francesco","family":"Ursini","sequence":"additional","affiliation":[{"name":"Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy"},{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7033-7520","authenticated-orcid":false,"given":"Tom W J","family":"Huizinga","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5624-1415","authenticated-orcid":false,"given":"Jeska","family":"De Vries-Bouwstra","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EUSTAR","family":"Collaborators","sequence":"additional","affiliation":[{"name":"EUropean Scleroderma Trials And Research group, None, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"key":"2025090312003976000_10.2.e004101.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.091918"},{"key":"2025090312003976000_10.2.e004101.2","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/S0140-6736(17)30933-9","article-title":"Systemic sclerosis","volume":"390","author":"Denton","year":"2017","journal-title":"The Lancet"},{"key":"2025090312003976000_10.2.e004101.3","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1007\/s12016-021-08889-8","article-title":"Current concepts on the pathogenesis of systemic sclerosis","volume":"64","author":"Truchetet","year":"2023","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025090312003976000_10.2.e004101.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-019-0322-7"},{"key":"2025090312003976000_10.2.e004101.5","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1177\/1203475420957950","article-title":"Toward understanding of environmental risk factors in systemic sclerosis","volume":"25","author":"Ouchene","year":"2021","journal-title":"J Cutan Med Surg"},{"key":"2025090312003976000_10.2.e004101.6","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.semarthrit.2018.06.009","article-title":"High serum levels of silica nanoparticles in systemic sclerosis patients with occupational exposure: possible Pathogenetic role in disease phenotypes","volume":"48","author":"Ferri","year":"2018","journal-title":"Semin Arthritis Rheum"},{"key":"2025090312003976000_10.2.e004101.7","doi-asserted-by":"crossref","first-page":"984907","DOI":"10.3389\/fmed.2022.984907","article-title":"Exposure to silica and systemic sclerosis: A retrospective cohort study based on the Canadian scleroderma research group","volume":"9","author":"Muntyanu","year":"2022","journal-title":"Front Med"},{"key":"2025090312003976000_10.2.e004101.8","doi-asserted-by":"publisher","DOI":"10.1002\/art.30071"},{"key":"2025090312003976000_10.2.e004101.9","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1002\/art.30352","article-title":"Cigarette smoking in patients with systemic sclerosis reduces overall survival: comment on the article by Hudson et al","volume":"63","author":"Hissaria","year":"2011","journal-title":"Arthritis Rheum"},{"key":"2025090312003976000_10.2.e004101.10","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1002\/art.40557","article-title":"Brief report: smoking in systemic sclerosis: A longitudinal European scleroderma trials and research group study","volume":"70","author":"Jaeger","year":"2018","journal-title":"Arthritis Rheumatol"},{"key":"2025090312003976000_10.2.e004101.11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cellimm.2017.04.002","article-title":"Association between cigarette smoking and impaired clinical symptoms in systemic sclerosis: A review","volume":"318","author":"Zhang","year":"2017","journal-title":"Cell Immunol"},{"key":"2025090312003976000_10.2.e004101.12","first-page":"177","article-title":"Gender differences in systemic sclerosis: relationship to clinical features, serologic status and outcomes","volume":"1","author":"Peoples","year":"2016","journal-title":"J Scleroderma Relat Disord"},{"key":"2025090312003976000_10.2.e004101.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2014.05.010"},{"key":"2025090312003976000_10.2.e004101.14","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-019-1867-1","article-title":"Survival and prognosis factors in systemic sclerosis: data of a French multicenter cohort, systematic review, and meta-analysis of the literature","volume":"21","author":"Pokeerbux","year":"2019","journal-title":"Arthritis Res Ther"},{"key":"2025090312003976000_10.2.e004101.15","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-021-02672-y","article-title":"Sine scleroderma, limited cutaneous, and diffused cutaneous systemic sclerosis survival and predictors of mortality","volume":"23","author":"De Almeida Chaves","year":"2021","journal-title":"Arthritis Res Ther"},{"key":"2025090312003976000_10.2.e004101.16","first-page":"89","article-title":"Clinical and Epidemiological differences between men and women with systemic sclerosis: a study in a Spanish systemic sclerosis cohort and literature review","volume":"35 Suppl 106","author":"Freire","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"2025090312003976000_10.2.e004101.17","doi-asserted-by":"crossref","first-page":"102494","DOI":"10.1016\/j.autrev.2020.102494","article-title":"Gender-related differences in systemic sclerosis","volume":"19","author":"Hughes","year":"2020","journal-title":"Autoimmun Rev"},{"key":"2025090312003976000_10.2.e004101.18","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2022-002850","article-title":"Real-life efficacy and safety of Nintedanib in systemic sclerosis-interstitial lung disease: data from an Italian Multicentre study","volume":"9","author":"Campochiaro","year":"2023","journal-title":"RMD Open"},{"key":"2025090312003976000_10.2.e004101.19","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2022-002477","article-title":"Effectiveness and safety of Tocilizumab in patients with systemic sclerosis: a propensity score matched controlled observational study of the EUSTAR cohort","volume":"8","author":"Kuster","year":"2022","journal-title":"RMD Open"},{"key":"2025090312003976000_10.2.e004101.20","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2022-002371","article-title":"Recommendations for the execution and reporting of skin ultrasound in systemic sclerosis: an international collaboration under the WSF skin ultrasound group","volume":"8","author":"Santiago","year":"2022","journal-title":"RMD Open"},{"key":"2025090312003976000_10.2.e004101.21","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2023-003512","article-title":"A Stretchable hardness sensor for the assessment of skin disease in systemic sclerosis","volume":"9","author":"Wang","year":"2023","journal-title":"RMD Open"},{"key":"2025090312003976000_10.2.e004101.22","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2018-000782","article-title":"Systemic sclerosis: state of the art on clinical practice guidelines","volume":"4","author":"Smith","year":"2019","journal-title":"RMD Open"},{"key":"2025090312003976000_10.2.e004101.23","doi-asserted-by":"publisher","DOI":"10.1002\/art.30492"},{"key":"2025090312003976000_10.2.e004101.24","first-page":"25","article-title":"Smoking and systemic sclerosis: influence on microangiopathy and expression of anti-Topoisomerase I antibodies in a Monocentric cohort","volume":"38 Suppl 125","author":"Ciaffi","year":"2020","journal-title":"Clin Exp Rheumatol"},{"key":"2025090312003976000_10.2.e004101.25","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1002\/art.40852","article-title":"Complex relationships of smoking, HLA\u2013Drb1 genes, and serologic profiles in patients with early rheumatoid arthritis: update from a Swedish Population\u2010Based case\u2013control study","volume":"71","author":"Hedstr\u00f6m","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2025090312003976000_10.2.e004101.26","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu195"},{"key":"2025090312003976000_10.2.e004101.27","doi-asserted-by":"publisher","DOI":"10.1177\/2397198320924873"},{"key":"2025090312003976000_10.2.e004101.28","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/s12016-022-08946-w","article-title":"Systemic sclerosis-specific antibodies: novel and classical biomarkers","volume":"64","author":"Cavazzana","year":"2022","journal-title":"Clinic Rev Allerg Immunol"},{"key":"2025090312003976000_10.2.e004101.29","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200742"},{"key":"2025090312003976000_10.2.e004101.30","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1080\/1744666X.2021.1836962","article-title":"The power of the EUSTAR cohort: key findings to date and implications for management of systemic sclerosis patients","volume":"16","author":"Benvenuti","year":"2020","journal-title":"Expert Rev Clin Immunol"},{"key":"2025090312003976000_10.2.e004101.31","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780230510"},{"key":"2025090312003976000_10.2.e004101.32","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204424"},{"key":"2025090312003976000_10.2.e004101.33","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1177\/2397198318816915","article-title":"Determining progression of scleroderma-related interstitial lung disease","volume":"4","author":"Volkmann","year":"2019","journal-title":"J Scleroderma Relat Disord"},{"key":"2025090312003976000_10.2.e004101.34","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13075-020-2113-6","article-title":"Early Trajectories of skin thickening are associated with severity and mortality in systemic sclerosis","volume":"22","author":"Ledoult","year":"2020","journal-title":"Arthritis Res Ther"},{"key":"2025090312003976000_10.2.e004101.35","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.210794"},{"key":"2025090312003976000_10.2.e004101.36","first-page":"68","article-title":"Gender differences in early systemic sclerosis patients: a report from the EULAR scleroderma trials and research group (EUSTAR) database","volume":"36 Suppl 113","author":"Carreira","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"2025090312003976000_10.2.e004101.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12931-019-0980-7","article-title":"Interstitial lung disease associated with systemic sclerosis (SSC-ILD)","volume":"20","author":"Cottin","year":"2019","journal-title":"Respir Res"},{"key":"2025090312003976000_10.2.e004101.38","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-016-1177-9","article-title":"Smoking is associated with the concurrent presence of multiple Autoantibodies in rheumatoid arthritis rather than with anti-Citrullinated protein antibodies per se: a multicenter cohort study","volume":"18","author":"van Wesemael","year":"2016","journal-title":"Arthritis Res Ther"},{"key":"2025090312003976000_10.2.e004101.39","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1080\/1744666X.2018.1473035","article-title":"Cigarette smoking and the pathogenesis of systemic lupus erythematosus","volume":"14","author":"Speyer","year":"2018","journal-title":"Expert Rev Clin Immunol"},{"key":"2025090312003976000_10.2.e004101.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2016.01.001"},{"key":"2025090312003976000_10.2.e004101.41","doi-asserted-by":"publisher","DOI":"10.1007\/s12160-009-9142-3"},{"key":"2025090312003976000_10.2.e004101.42","first-page":"155","article-title":"Adjustment for tobacco smoking and alcohol consumption by simultaneous analysis of several types of cancer","volume":"28","author":"Haldorsen","year":"2017","journal-title":"Cancer Causes Control"},{"key":"2025090312003976000_10.2.e004101.43","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/2047487318806658","article-title":"Tobacco smoking and the risk of heart failure: A systematic review and meta-analysis of prospective studies","volume":"26","author":"Aune","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"2025090312003976000_10.2.e004101.44","doi-asserted-by":"publisher","DOI":"10.1177\/1741826711411738"},{"key":"2025090312003976000_10.2.e004101.45","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-019-12760-y","article-title":"GWAS for systemic sclerosis identifies multiple risk Loci and highlights Fibrotic and Vasculopathy pathways","volume":"10","author":"L\u00f3pez-Isac","year":"2019","journal-title":"Nat Commun"},{"key":"2025090312003976000_10.2.e004101.46","doi-asserted-by":"crossref","DOI":"10.1186\/s41232-021-00167-6","article-title":"Updates on Genetics in systemic sclerosis","volume":"41","author":"Ota","year":"2021","journal-title":"Inflamm Regen"},{"key":"2025090312003976000_10.2.e004101.47","doi-asserted-by":"crossref","first-page":"104154","DOI":"10.1016\/j.ebiom.2022.104154","article-title":"Appraising the causal role of smoking in multiple diseases: A systematic review and meta-analysis of Mendelian randomization studies","volume":"82","author":"Larsson","year":"2022","journal-title":"eBioMedicine"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2024-004101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:00:53Z","timestamp":1756926053000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2024-004101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,5,20]]},"published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1136\/rmdopen-2024-004101"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2024-004101","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5]]}}}