{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:07:52Z","timestamp":1788977272263,"version":"build-2803163510"},"reference-count":29,"publisher":"American Veterinary Medical Association (AVMA)","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2026,9,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify variables associated with prolonged hospitalization or nonsurvival in the surgical management of pyometra in dogs and to report uterine bacterial susceptibility in comparison with empirically prescribed antibiotics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective study of dogs that underwent ovariohysterectomy for management of pyometra at 8 tertiary referral centers between December 1, 2008, and December 31, 2023. Data collected included signalment, preoperative\/operative data, antibiotic utilization, and clinical follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>625 dogs met inclusion criteria. Forty dogs (6.4%) experienced major short-term complications, and 604 dogs (96.6%) survived to discharge. Elevated preoperative creatinine concentration and sepsis increased the risk of nonsurvival. Survival to discharge did not differ between nonseptic dogs that received pre- or intraoperative antibiotics and those that did not. Sepsis, elevated creatinine, and interaction between elevated creatinine and altered mentation increased hospitalization duration. At least 1 inappropriate outpatient antibiotic was prescribed in 34.4% (116 of 337) of cases; most dogs that received inappropriate antibiotics were empirically prescribed amoxicillin\u2013clavulanic acid (102 of 116 [87.9%]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Surgical management of pyometra in the tertiary referral setting had a good prognosis regardless of prescribed antibiotic bacterial susceptibility. Elevated creatinine and\/or sepsis increased risk of mortality and prolonged hospitalization. The use of pre- and intraoperative antibiotics in nonseptic dogs was not associated with outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>There was no clear clinical benefit of antibiotic use in the surgical management of pyometra in nonseptic dogs. If empiric antibiotics are indicated, the bacterial susceptibility profile of this patient population suggests a high likelihood of resistance to amoxicillin\u2013clavulanic acid.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2460\/javma.26.05.0367","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:31:15Z","timestamp":1788975075000},"page":"1-10","source":"Crossref","is-referenced-by-count":0,"title":["Sepsis and elevated creatinine predict poor outcomes in uncomplicated canine pyometra, and empirically prescribed antibiotics do not match bacterial susceptibility or improve survival"],"prefix":"10.2460","author":[{"given":"Anna E.","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-1780","authenticated-orcid":true,"given":"Mark","family":"Rishniw","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella L.","family":"Raux","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Rosselli","sequence":"additional","affiliation":[{"name":"VCA West Los Angeles Animal Hospital, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cody","family":"Westmoreland","sequence":"additional","affiliation":[{"name":"Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelley","family":"Thieman","sequence":"additional","affiliation":[{"name":"Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin A.","family":"Coleman","sequence":"additional","affiliation":[{"name":"Gulf Coast Veterinary Specialists, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailey","family":"Gollnick","sequence":"additional","affiliation":[{"name":"Gulf Coast Veterinary Specialists, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0462-7567","authenticated-orcid":true,"given":"Isabella","family":"Hildebrandt","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin A.","family":"Gibson","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte A.","family":"Brison","sequence":"additional","affiliation":[{"name":"Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tillson","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassie N.","family":"Lux","sequence":"additional","affiliation":[{"name":"Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4623-3582","authenticated-orcid":true,"given":"Nicole J.","family":"Buote","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1272","reference":[{"issue":"suppl 6","key":"ref1","series-title":"Reprod Domest Anim","first-page":"323","article-title":"Clinical and molecular characteristics of pyometra in female dogs","volume":"47","author":"Hagman R","year":"2012","unstructured":"Hagman R. Clinical and molecular characteristics of pyometra in female dogs. Reprod Domest Anim. 2012;47(suppl 6):323-325. doi:10.1111\/rda.12031"},{"issue":"6","key":"ref2","series-title":"J Vet Intern Med","first-page":"530","article-title":"Breed risk of pyometra in insured dogs in Sweden","volume":"15","author":"Egenvall A","year":"2001","unstructured":"Egenvall A, Hagman R, Bonnett BN, Hedhammar A, Olson P, Lagerstedt AS. Breed risk of pyometra in insured dogs in Sweden. J Vet Intern Med. 2001;15(6):530-538. doi:10.1111\/j.1939-1676.2001.tb01587.x"},{"issue":"3","key":"ref3","series-title":"Vet Clin North Am Small Anim Pract","first-page":"631","article-title":"Pyometra in small animals 2.0","volume":"52","author":"Hagman R","year":"2022","unstructured":"Hagman R. Pyometra in small animals 2.0. Vet Clin North Am Small Anim Pract. 2022;52(3):631-657. doi:10.1016\/j.cvsm.2022.01.004"},{"key":"ref4","series-title":"Int J Microbiol","first-page":"979584","article-title":"Escherichia coli strains isolated from the uteri horn, mouth, and rectum of bitches suffering from pyometra: virulence factors, antimicrobial susceptibilities, and clonal relationships among strains","volume":"2014","author":"Agostinho JMA","year":"2014","unstructured":"Agostinho JMA, de Souza A, Schocken-Iturrino RP,  Escherichia coli strains isolated from the uteri horn, mouth, and rectum of bitches suffering from pyometra: virulence factors, antimicrobial susceptibilities, and clonal relationships among strains. Int J Microbiol. 2014;2014:979584. doi:10.1155\/2014\/979584"},{"issue":"5","key":"ref5","series-title":"J Am Anim Hosp Assoc","first-page":"391","article-title":"C-reactive protein in the differentiation of pyometra from cystic endometrial hyperplasia\/mucometra in dogs","volume":"40","author":"Fransson BA","year":"2004","unstructured":"Fransson BA, Karlstam E, Bergstrom A,  C-reactive protein in the differentiation of pyometra from cystic endometrial hyperplasia\/mucometra in dogs. J Am Anim Hosp Assoc. 2004;40(5):391-399. doi:10.5326\/0400391"},{"issue":"1","key":"ref6","series-title":"BMC Vet Res","first-page":"273","article-title":"Increased concentrations of serum amyloid A in dogs with sepsis caused by pyometra","volume":"10","author":"Jitpean S","year":"2014","unstructured":"Jitpean S, Pettersson A, H\u00f6glund OV, Holst BS, Olsson U, Hagman R. Increased concentrations of serum amyloid A in dogs with sepsis caused by pyometra. BMC Vet Res. 2014;10(1):273. doi:10.1186\/s12917-014-0273-9"},{"issue":"1","key":"ref7","series-title":"BMC Vet Res","first-page":"6","article-title":"Outcome of pyometra in female dogs and predictors of peritonitis and prolonged postoperative hospitalization in surgically treated cases","volume":"10","author":"Jitpean S","year":"2014","unstructured":"Jitpean S, Str\u00f6m-Holst B, Emanuelson U,  Outcome of pyometra in female dogs and predictors of peritonitis and prolonged postoperative hospitalization in surgically treated cases. BMC Vet Res. 2014;10(1):6. doi:10.1186\/1746-6148-10-6"},{"issue":"9","key":"ref8","series-title":"J Small Anim Pract","first-page":"543","article-title":"The assessment of haematologic and serum chemistry parameters in canine pyometra: a systematic review and meta-analysis","volume":"64","author":"Demeli A","year":"2023","unstructured":"Demeli A, Meyer JC. The assessment of haematologic and serum chemistry parameters in canine pyometra: a systematic review and meta-analysis. J Small Anim Pract. 2023;64(9):543-551. doi:10.1111\/jsap.13641"},{"issue":"2","key":"ref9","series-title":"J Vet Emerg Crit Care (San Antonio)","first-page":"223","article-title":"Retrospective evaluation of the use of quick sepsis-related organ failure assessment (qSOFA) as predictor of mortality and length of hospitalization in dogs with pyometra (2013-2019): 52 cases","volume":"32","author":"Donati P","year":"2022","unstructured":"Donati P, Londo\u00f1o LA, Tunes M, Villalta C, Guillemi EC. Retrospective evaluation of the use of quick sepsis-related organ failure assessment (qSOFA) as predictor of mortality and length of hospitalization in dogs with pyometra (2013-2019): 52 cases. J Vet Emerg Crit Care (San Antonio). 2022;32(2):223-228. doi:10.1111\/vec.13103"},{"key":"ref10","series-title":"Top Companion Anim Med","first-page":"100429","article-title":"Evaluation of biofilm production by Escherichia coli isolated from clinical cases of canine pyometra","volume":"39","author":"Fiamengo TE","year":"2020","unstructured":"Fiamengo TE, Runcan EE, Premanandan C, Blawut B, Coutinho da Silva MA. Evaluation of biofilm production by Escherichia coli isolated from clinical cases of canine pyometra. Top Companion Anim Med. 2020;39:100429. doi:10.1016\/j.tcam.2020.100429"},{"issue":"9","key":"ref11","series-title":"Reprod Domest Anim","first-page":"1063","article-title":"Antimicrobial susceptibility and production of virulence factors by bacteria recovered from bitches with pyometra","volume":"57","author":"Rocha MFG","year":"2022","unstructured":"Rocha MFG, Paiva DDQ, Amando BR,  Antimicrobial susceptibility and production of virulence factors by bacteria recovered from bitches with pyometra. Reprod Domest Anim. 2022;57(9):1063-1073. doi:10.1111\/rda.14181"},{"issue":"1-2","key":"ref12","series-title":"Vet Microbiol","first-page":"143","article-title":"Escherichia coli strains isolated from the uterus and urinary bladder of bitches suffering from pyometra: comparison by restriction enzyme digestion and pulsed-field gel electrophoresis","volume":"84","author":"Hagman R","year":"2002","unstructured":"Hagman R, K\u00fchn I. Escherichia coli strains isolated from the uterus and urinary bladder of bitches suffering from pyometra: comparison by restriction enzyme digestion and pulsed-field gel electrophoresis. Vet Microbiol. 2002;84(1-2):143-153. doi:10.1016\/S0378-1135(01)00449-7"},{"issue":"7","key":"ref13","series-title":"J Small Anim Pract","first-page":"627","article-title":"Multidrug resistance of bacterial pathogens in canine pyometra","volume":"67","author":"Camozzi MGM","year":"2026","unstructured":"Camozzi MGM, Waller SB, Castelhano EC,  Multidrug resistance of bacterial pathogens in canine pyometra. J Small Anim Pract. 2026;67(7):627-634. doi:10.1111\/jsap.70110"},{"issue":"1","key":"ref14","series-title":"Acta Vet Scand","first-page":"11","article-title":"Postoperative complications and antibiotic use in dogs with pyometra: a retrospective review of 140 cases (2019)","volume":"65","author":"Turkki OM","year":"2023","unstructured":"Turkki OM, Sunesson KW, den Hertog E, Varjonen K. Postoperative complications and antibiotic use in dogs with pyometra: a retrospective review of 140 cases (2019). Acta Vet Scand. 2023;65(1):11. doi:10.1186\/s13028-023-00670-5"},{"issue":"3","key":"ref15","series-title":"Vet Med Sci","first-page":"1124","article-title":"Antimicrobial use in the surgical treatment of canine pyometra: a questionnaire survey of Arizona-licensed veterinarians","volume":"9","author":"Lavin LE","year":"2023","unstructured":"Lavin LE, Maki LC. Antimicrobial use in the surgical treatment of canine pyometra: a questionnaire survey of Arizona-licensed veterinarians. Vet Med Sci. 2023;9(3):1124-1133. doi:10.1002\/vms3.1130"},{"issue":"suppl 2","key":"ref16","series-title":"J Am Vet Med Assoc","first-page":"S36","article-title":"Surgery in a veterinary outpatient community medicine setting has a good outcome for dogs with pyometra","volume":"260","author":"McCobb E","year":"2022","unstructured":"McCobb E, Dowling-Guyer S, Pailler S, Intarapanich NP, Rozanski EA. Surgery in a veterinary outpatient community medicine setting has a good outcome for dogs with pyometra. J Am Vet Med Assoc. 2022;260(suppl 2):S36-S41. doi:10.2460\/javma.21.06.0320"},{"issue":"4","key":"ref17","series-title":"J Vet Emerg Crit Care (San Antonio)","first-page":"373","article-title":"C-reactive protein, tumor necrosis factor \u03b1, and interleukin-6 in dogs with pyometra and SIRS","volume":"17","author":"Fransson BA","year":"2007","unstructured":"Fransson BA, Lagerstedt AS, Bergstrom A,  C-reactive protein, tumor necrosis factor \u03b1, and interleukin-6 in dogs with pyometra and SIRS. J Vet Emerg Crit Care (San Antonio). 2007;17(4):373-381. doi:10.1111\/j.1476-4431.2006.00203.x"},{"key":"ref18","series-title":"Vet J","first-page":"106157","article-title":"Antimicrobials administration, treatment outcome and bacterial susceptibility in canine pyometra cases subjected to ovariohysterectomy","volume":"306","author":"Bertero A","year":"2024","unstructured":"Bertero A, Corr\u00f2 M, Spagnolo E, Nervo T, Rota A. Antimicrobials administration, treatment outcome and bacterial susceptibility in canine pyometra cases subjected to ovariohysterectomy. Vet J. 2024;306:106157. doi:10.1016\/j.tvjl.2024.106157"},{"issue":"2","key":"ref19","series-title":"J Vet Emerg Crit Care (San Antonio)","first-page":"97","article-title":"Defining sepsis in small animals","volume":"34","author":"Cortellini S","year":"2024","unstructured":"Cortellini S, DeClue AE, Giunti M,  Defining sepsis in small animals. J Vet Emerg Crit Care (San Antonio). 2024;34(2):97-109. doi:10.1111\/vec.13359"},{"issue":"2","key":"ref20","series-title":"Ann Surg","first-page":"205","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo D","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. doi:10.1097\/01.sla.0000133083.54934.ae"},{"issue":"1","key":"ref21","series-title":"Vet Surg","first-page":"98","article-title":"Comparison of two postoperative complication grading systems after treatment of stifle and shoulder instability in 68 dogs","volume":"52","author":"Barrett FM","year":"2023","unstructured":"Barrett FM, Bleedorn JA, Hutcheson KD, Torres BT, Fox DB. Comparison of two postoperative complication grading systems after treatment of stifle and shoulder instability in 68 dogs. Vet Surg. 2023;52(1):98-105. doi:10.1111\/vsu.13893"},{"issue":"5","key":"ref22","series-title":"J Vet Intern Med","first-page":"1034","article-title":"The acute patient physiologic and laboratory evaluation (APPLE) score: a severity of illness stratification system for hospitalized dogs","volume":"24","author":"Hayes G","year":"2010","unstructured":"Hayes G, Mathews K, Doig G,  The acute patient physiologic and laboratory evaluation (APPLE) score: a severity of illness stratification system for hospitalized dogs. J Vet Intern Med. 2010;24(5):1034-1047. doi:10.1111\/j.1939-1676.2010.0552.x"},{"issue":"16","key":"ref23","series-title":"Vet Rec","first-page":"396","article-title":"A retrospective study of pyometra at five RSPCA hospitals in the UK: 1728 cases from 2006 to 2011","volume":"173","author":"Gibson A","year":"2013","unstructured":"Gibson A, Dean R, Yates D, Stavisky J. A retrospective study of pyometra at five RSPCA hospitals in the UK: 1728 cases from 2006 to 2011. Vet Rec. 2013;173(16):396. doi:10.1136\/vr.101514"},{"issue":"1","key":"ref24","series-title":"BMC Vet Res","first-page":"11","article-title":"Closed cervix is associated with more severe illness in dogs with pyometra","volume":"13","author":"Jitpean S","year":"2017","unstructured":"Jitpean S, Ambrosen A, Emanuelson U, Hagman R. Closed cervix is associated with more severe illness in dogs with pyometra. BMC Vet Res. 2017;13(1):11. doi:10.1186\/s12917-016-0924-0"},{"issue":"4","key":"ref25","series-title":"Can J Vet Res","first-page":"271","article-title":"Comparison of clinical and inflammatory parameters in dogs with pyometra before and after ovariohysterectomy","volume":"85","author":"Ahn S","year":"2021","unstructured":"Ahn S, Bae H, Kim J,  Comparison of clinical and inflammatory parameters in dogs with pyometra before and after ovariohysterectomy. Can J Vet Res. 2021;85(4):271-278. doi:10.21203\/rs.3.rs-143024\/v1"},{"issue":"2","key":"ref26","series-title":"J Am Vet Med Assoc","first-page":"193","article-title":"Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007-2008)","volume":"240","author":"Mayhew PD","year":"2012","unstructured":"Mayhew PD, Freeman L, Kwan T, Brown DC. Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007-2008). J Am Vet Med Assoc. 2012;240(2):193-198. doi:10.2460\/javma.240.2.193"},{"issue":"2","key":"ref27","series-title":"Vet Surg","first-page":"60","article-title":"Surgical wound infection rates in dogs and cats: data from a teaching hospital","volume":"17","author":"Vasseur PB","year":"1988","unstructured":"Vasseur PB, Levy J, Dowd E, Eliot J. Surgical wound infection rates in dogs and cats: data from a teaching hospital. Vet Surg. 1988;17(2):60-64. doi:10.1111\/j.1532-950X.1988.tb00278.x"},{"key":"ref28","series-title":"Front Vet Sci","first-page":"1369533","article-title":"New-onset organ dysfunction as a screening tool for the identification of sepsis and outcome prediction in dogs with systemic inflammation","volume":"11","author":"Ciuffoli E","year":"2024","unstructured":"Ciuffoli E, Troia R, Bulgarelli C, Pontiero A, Buzzurra F, Giunti M. New-onset organ dysfunction as a screening tool for the identification of sepsis and outcome prediction in dogs with systemic inflammation. Front Vet Sci. 2024;11:1369533. doi:10.3389\/fvets.2024.1369533"},{"issue":"suppl 2","key":"ref29","series-title":"J Am Vet Med Assoc","first-page":"S49","article-title":"Findings and prognostic indicators of outcomes for bitches with pyometra treated surgically in a nonspecialized setting","volume":"260","author":"Pailler S","year":"2022","unstructured":"Pailler S, Slater MR, Lesnikowski SM,  Findings and prognostic indicators of outcomes for bitches with pyometra treated surgically in a nonspecialized setting. J Am Vet Med Assoc. 2022;260(suppl 2):S49-S56. doi:10.2460\/javma.20.12.0713"}],"container-title":["Journal of the American Veterinary Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/aop\/javma.26.05.0367\/javma.26.05.0367.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/avmajournals.avma.org\/downloadpdf\/journals\/javma\/aop\/javma.26.05.0367\/javma.26.05.0367.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:31:16Z","timestamp":1788975076000},"score":1,"resource":{"primary":{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/aop\/javma.26.05.0367\/javma.26.05.0367.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":29,"URL":"https:\/\/doi.org\/10.2460\/javma.26.05.0367","relation":{},"ISSN":["0003-1488"],"issn-type":[{"value":"0003-1488","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}