{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:17:29Z","timestamp":1792052249867,"version":"4.4.0"},"reference-count":59,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T00:00:00Z","timestamp":1726790400000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2024,9,6]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Systemic sclerosis (SSc) is associated with an increased risk of cancer. We aimed to assess the prevalence of cancer in our cohort and to explore possible associations with clinical, immunological and treatment characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Our retrospective monocentric cohort study of patients with SSc recorded prevalent and incident cases of malignancy, including those diagnosed within 3 years of the SSc onset (defined as cancer-associated scleroderma) and sought associations with the clinical characteristics and the serum autoantibody profiling performed using RNA and protein immunoprecipitation, Western-blot, immunoblot and ELISA at the time of SSc diagnosis, prior to any specific treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 290 patients with SSc, the overall prevalence of cancer was 20%, with 8% of cases being cancer-associated scleroderma. Both conditions were more frequent in elderly patients and in patients with positive anti-Ro52 or anti-U3-RNP. Cancer-associated scleroderma was significantly more prevalent among patients negative for both anti-centromere (ACA) and anti-topoisomerase-1 (TOPO1) antibodies, especially in the case of diffuse SSc. Immunosuppressants were not significantly associated with cancer. Patients triple negative for ACA, TOPO1 and anti-RNA polymerase III antibodies had a significantly higher risk of breast cancer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Cancer surveillance should be particularly careful in patients with diffuse SSc, increased age at disease onset and without classical SSc-related autoantibodies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2024-004492","type":"journal-article","created":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T02:35:22Z","timestamp":1726886122000},"page":"e004492","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Autoantibodies, cutaneous subset and immunosuppressants contribute to the cancer risk in systemic sclerosis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9534-6853","authenticated-orcid":false,"given":"Antonio","family":"Tonutti","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Motta","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9819-8822","authenticated-orcid":false,"given":"Natasa","family":"Isailovic","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Ceribelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Ragusa","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Nappi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-6579","authenticated-orcid":false,"given":"Stefanos","family":"Bonovas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0323-0376","authenticated-orcid":false,"given":"Carlo","family":"Selmi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-1336","authenticated-orcid":false,"given":"Maria","family":"De Santis","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"key":"2025090312204772000_10.3.e004492.1","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s12016-023-08969-x","article-title":"Treatable Traits in Systemic Sclerosis","volume":"65","author":"Amati","year":"2023","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025090312204772000_10.3.e004492.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0806188"},{"key":"2025090312204772000_10.3.e004492.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30933-9"},{"key":"2025090312204772000_10.3.e004492.4","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/S0140-6736(22)01692-0","article-title":"Systemic sclerosis","volume":"401","author":"Volkmann","year":"2023","journal-title":"Lancet"},{"key":"2025090312204772000_10.3.e004492.5","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":"2023","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025090312204772000_10.3.e004492.6","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1038\/s41572-021-00321-x","article-title":"Idiopathic inflammatory myopathies","volume":"7","author":"Lundberg","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"2025090312204772000_10.3.e004492.7","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2018.56"},{"key":"2025090312204772000_10.3.e004492.8","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780360405"},{"key":"2025090312204772000_10.3.e004492.9","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes303"},{"key":"2025090312204772000_10.3.e004492.10","doi-asserted-by":"publisher","DOI":"10.1002\/art.37969"},{"key":"2025090312204772000_10.3.e004492.11","doi-asserted-by":"crossref","first-page":"103167","DOI":"10.1016\/j.autrev.2022.103167","article-title":"Standardized incidence ratios and risk factors for cancer in patients with systemic sclerosis: Data from the Spanish Scleroderma Registry (RESCLE)","volume":"21","author":"Carbonell","year":"2022","journal-title":"Autoimmun Rev"},{"key":"2025090312204772000_10.3.e004492.12","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1002\/acr.24076","article-title":"Incidence, Risk Factors, and Outcomes of Cancer in Systemic Sclerosis","volume":"72","author":"Morrisroe","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312204772000_10.3.e004492.13","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1007\/s12016-022-08930-4","article-title":"Systemic Sclerosis Association with Malignancy","volume":"63","author":"Lepri","year":"2022","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025090312204772000_10.3.e004492.14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s12016-023-08963-3","article-title":"Perspectives on Mycophenolate Mofetil in the Management of Autoimmunity","volume":"65","author":"Bhat","year":"2023","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025090312204772000_10.3.e004492.15","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s12016-022-08944-y","article-title":"Autoantibodies and Cancer Association: the Case of Systemic Sclerosis and Dermatomyositis","volume":"63","author":"Fiorentino","year":"2022","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025090312204772000_10.3.e004492.16","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1002\/art.40065","article-title":"Brief Report: Anti-RNPC-3 Antibodies As a Marker of Cancer-Associated Scleroderma","volume":"69","author":"Shah","year":"2017","journal-title":"Arthritis Rheumatol"},{"key":"2025090312204772000_10.3.e004492.17","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1002\/art.42701","article-title":"Serum autoantibodies and the risk of cancer in systemic sclerosis over time","volume":"76","author":"De Santis","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"2025090312204772000_10.3.e004492.18","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1002\/art.42663","article-title":"Distinct Scleroderma Autoantibody Profiles Stratify Patients for Cancer Risk at Scleroderma Onset and During the Disease Course","volume":"76","author":"Kim","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"2025090312204772000_10.3.e004492.19","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1002\/art.42474","article-title":"Association of Anti-CCAR1 Autoantibodies With Decreased Cancer Risk Relative to the General Population in Patients With Anti-Transcriptional Intermediary Factor 1\u03b3-Positive Dermatomyositis","volume":"75","author":"Fiorentino","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"2025090312204772000_10.3.e004492.20","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-222441"},{"key":"2025090312204772000_10.3.e004492.21","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204424"},{"key":"2025090312204772000_10.3.e004492.22","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2462070712"},{"key":"2025090312204772000_10.3.e004492.23","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/23971983231163413","article-title":"Consensus on the assessment of systemic sclerosis-associated primary heart involvement: World Scleroderma Foundation\/Heart Failure Association guidance on screening, diagnosis, and follow-up assessment","volume":"8","author":"Bruni","year":"2023","journal-title":"J Scleroderma Relat Disord"},{"key":"2025090312204772000_10.3.e004492.24","doi-asserted-by":"crossref","first-page":"152126","DOI":"10.1016\/j.semarthrit.2022.152126","article-title":"Cardiac inflammation and fibrosis patterns in systemic sclerosis, evaluated by magnetic resonance imaging: An update","volume":"58","author":"Mavrogeni","year":"2023","journal-title":"Semin Arthritis Rheum"},{"key":"2025090312204772000_10.3.e004492.25","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2010.60"},{"key":"2025090312204772000_10.3.e004492.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61196-X"},{"key":"2025090312204772000_10.3.e004492.27","doi-asserted-by":"crossref","first-page":"105555","DOI":"10.1016\/j.jbspin.2023.105555","article-title":"Clinical and immunological features of patients with cancer-associated systemic sclerosis: An observational study","volume":"90","author":"Lopez","year":"2023","journal-title":"Joint Bone Spine"},{"key":"2025090312204772000_10.3.e004492.28","first-page":"891","article-title":"Prevalence and clinical significance of anti-MDA5 antibodies in European patients with polymyositis\/dermatomyositis","volume":"32","author":"Ceribelli","year":"2014","journal-title":"Clin Exp Rheumatol"},{"key":"2025090312204772000_10.3.e004492.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jim.2016.02.017"},{"key":"2025090312204772000_10.3.e004492.30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jim.2017.10.001","article-title":"Detection of anti-mitochondrial antibodies by immunoprecipitation in patients with systemic sclerosis","volume":"452","author":"Ceribelli","year":"2018","journal-title":"J Immunol Methods"},{"key":"2025090312204772000_10.3.e004492.31","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2023.1068402","article-title":"Interstitial lung disease associated with inflammatory myositis: Autoantibodies, clinical phenotypes, and progressive fibrosis","volume":"10","author":"Ceribelli","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"2025090312204772000_10.3.e004492.32","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2023-224609"},{"key":"2025090312204772000_10.3.e004492.33","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-212999"},{"key":"2025090312204772000_10.3.e004492.34","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.114264"},{"key":"2025090312204772000_10.3.e004492.35","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.1093\/rheumatology\/keab735","article-title":"Association between autoantibodies in systemic sclerosis and cancer in a national registry","volume":"61","author":"Hoa","year":"2022","journal-title":"Rheumatology (Oxford)"},{"key":"2025090312204772000_10.3.e004492.36","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1002\/art.39022","article-title":"Examination of autoantibody status and clinical features associated with cancer risk and cancer-associated scleroderma","volume":"67","author":"Shah","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"2025090312204772000_10.3.e004492.37","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.160817"},{"key":"2025090312204772000_10.3.e004492.38","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1002\/art.38219","article-title":"Prevalence of anti-RNA polymerase III antibodies in systemic sclerosis: New data from a French cohort and a systematic review and meta-analysis","volume":"66","author":"Sobanski","year":"2014","journal-title":"Arthritis Rheumatol"},{"key":"2025090312204772000_10.3.e004492.39","doi-asserted-by":"crossref","DOI":"10.1172\/JCI150201","article-title":"Immune responses to CCAR1 and other dermatomyositis autoantigens are associated with attenuated cancer emergence","volume":"132","author":"Fiorentino","year":"2022","journal-title":"J Clin Invest"},{"key":"2025090312204772000_10.3.e004492.40","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1002\/art.40893","article-title":"Protective Effect Against Cancer of Antibodies to the Large Subunits of Both RNA Polymerases I and III in Scleroderma","volume":"71","author":"Shah","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2025090312204772000_10.3.e004492.41","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.autrev.2017.03.012","article-title":"Novel risk factors related to cancer in scleroderma","volume":"16","author":"Bernal-Bello","year":"2017","journal-title":"Autoimmun Rev"},{"key":"2025090312204772000_10.3.e004492.42","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1007\/s12016-022-08931-3","article-title":"Clinical Significance of Antinucleolar Antibodies: Biomarkers for Autoimmune Diseases, Malignancies, and others","volume":"63","author":"Satoh","year":"2022","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025090312204772000_10.3.e004492.43","doi-asserted-by":"crossref","first-page":"102724","DOI":"10.1016\/j.jaut.2021.102724","article-title":"Anti-Ro60 and anti-Ro52\/TRIM21: Two distinct autoantibodies in systemic autoimmune diseases","volume":"124","author":"Lee","year":"2021","journal-title":"J Autoimmun"},{"key":"2025090312204772000_10.3.e004492.44","doi-asserted-by":"publisher","DOI":"10.1177\/039463200902200303"},{"key":"2025090312204772000_10.3.e004492.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2013.09.006"},{"key":"2025090312204772000_10.3.e004492.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2012.06.003"},{"key":"2025090312204772000_10.3.e004492.47","article-title":"Haematological Malignancies in Systemic Sclerosis Patients: Case Reports and Review of the World Literature","volume":"2017","author":"Colaci","year":"2017","journal-title":"Case Rep Rheumatol"},{"key":"2025090312204772000_10.3.e004492.48","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1080\/08923973.2021.1910833","article-title":"Presence of anti-TIF-1\u03b3, anti-Ro52, anti-SSA\/Ro60 and anti-Su\/Ago2 antibodies in breast cancer: a cross-sectional study","volume":"43","author":"V\u00e1zquez-Del Mercado","year":"2021","journal-title":"Immunopharmacol Immunotoxicol"},{"key":"2025090312204772000_10.3.e004492.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijbiomac.2018.11.269"},{"key":"2025090312204772000_10.3.e004492.50","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1177\/2397198318766825","article-title":"Interstitial lung disease is associated with an increased risk of lung cancer in systemic sclerosis: Longitudinal data from the Canadian Scleroderma Research Group","volume":"3","author":"Sakr","year":"2018","journal-title":"J Scleroderma Relat Disord"},{"key":"2025090312204772000_10.3.e004492.51","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1080\/1744666X.2019.1649596","article-title":"Predicting lymphoma development in patients with Sj\u00f6gren\u2019s syndrome","volume":"15","author":"De Vita","year":"2019","journal-title":"Expert Rev Clin Immunol"},{"key":"2025090312204772000_10.3.e004492.52","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/bcp.14979","article-title":"Mycophenolic acid and cancer risk in solid organ transplant recipients: Systematic review and meta-analysis","volume":"88","author":"Hirunsatitpron","year":"2022","journal-title":"Br J Clin Pharmacol"},{"key":"2025090312204772000_10.3.e004492.53","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1684\/ejd.2021.4108","article-title":"The association between immunosuppression and skin cancer in solid organ transplant recipients: a control-matched cohort study of 2,852 patients","volume":"31","author":"Gibson","year":"2021","journal-title":"Eur J Dermatol"},{"key":"2025090312204772000_10.3.e004492.54","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines10050801","article-title":"Dose-Dependent Impairment of the Immune Response to the Moderna-1273 mRNA Vaccine by Mycophenolate Mofetil in Patients with Rheumatic and Autoimmune Liver Diseases","volume":"10","author":"De Santis","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"2025090312204772000_10.3.e004492.55","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-immunol-031210-101324"},{"key":"2025090312204772000_10.3.e004492.56","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1038\/nature01322","article-title":"Inflammation and cancer","volume":"420","author":"Coussens","year":"2002","journal-title":"Nature New Biol"},{"key":"2025090312204772000_10.3.e004492.57","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1001\/jamadermatol.2023.1729","article-title":"Cutaneous Manifestations, Clinical Characteristics, and Prognosis of Patients With Systemic Sclerosis Sine Scleroderma: Data From the International EUSTAR Database","volume":"159","author":"Lescoat","year":"2023","journal-title":"JAMA Dermatol"},{"key":"2025090312204772000_10.3.e004492.58","doi-asserted-by":"crossref","unstructured":"Makris A , Panagiotopoulos A , Distler O , et al . Systemic Sclerosis Sine Scleroderma: A Time of Reappraisal. J Rheumatol 2024;2023\u20131113. doi:10.3899\/jrheum.2023-1113","DOI":"10.3899\/jrheum.2023-1113"},{"key":"2025090312204772000_10.3.e004492.59","first-page":"277","article-title":"Agreement between local and central anti-synthetase antibodies detection: results from the Classification Criteria of Anti-Synthetase Syndrome project biobank","volume":"42","author":"Loganathan","year":"2024","journal-title":"Clin Exp Rheumatol"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2024-004492","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:20:59Z","timestamp":1756927259000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2024-004492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":59,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,9,20]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/rmdopen-2024-004492"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2024-004492","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}