{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:26Z","timestamp":1776096446212,"version":"3.50.1"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Adolescent idiopathic scoliosis (AIS) presents with complex 3D spinal deformities frequently accompanied by pelvic asymmetry. Sacral obliquity (SO), reflecting sacral tilt on the coronal plane, is one of the relevant parameters with clinical significance. There are several methods for measuring SO, but no standardized approach has been established. The aim of this study was to determine the most appropriate method for measuring SO by analyzing the relationship between sacral vertebral morphology and SO across different spinal curve patterns.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Consecutive patients with AIS who underwent corrective surgery from 2013 to 2023 at a single institution were assessed. Cobb angles of the major curve and thoracolumbar\/lumbar (TL\/L) curve, L4 tilt, C7 plumb line to center sacral vertebral line, leg length discrepancy, SO, and iliac obliquity (IO) were measured as radiographic parameters. The S1 angle, S2 angle, and S1 base angle were measured as sacral morphological parameters on multiplanar reconstructed CT. The S1 and S2 angles were defined using the respective vertebral endplates, while the S1 base angle was defined using the transition point of the sacral wing and the superior articular process of the S1 vertebra as anatomical landmarks. Patients were classified into two groups according to Lenke classification: those with TL\/L major curves (TL\/L+, Lenke types 4\u20136) and those without TL\/L major curves (TL\/L\u2212, Lenke types 1\u20133).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n After exclusions, 128 patients (122 females, mean age 16.9 \u00b1 4.0 years) were included in this analysis, with 35 in the TL\/L+ group and 93 in the TL\/L\u2212 group. The S1 angle was significantly greater than both the S1 base angle and S2 angle (mean 2.8\u00b0 \u00b1 2.5\u00b0 vs 1.4\u00b0 \u00b1 1.5\u00b0 and 1.4\u00b0 \u00b1 1.2\u00b0, respectively; p < 0.001). The TL\/L+ group had a significantly greater mean S1 angle (4.6\u00b0 \u00b1 3.2\u00b0 vs 2.1\u00b0 \u00b1 1.7\u00b0, p < 0.001), whereas no significant differences were observed in the S1 base angle and S2 angle. Multivariable analysis confirmed TL\/L curve presence, TL\/L Cobb angle, SO, S1 base angle, and S2 angle as independent determinants of an increased S1 angle.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The S1 endplate was the most reliable landmark for evaluating SO, particularly in patients with AIS with TL\/L major curves. Given the presence of asymmetry within the S1 vertebra, use of the S1 base angle might underestimate the true degree of SO. These findings support the standardized use of the S1 endplate to enhance accuracy of SO assessment and improve precision in surgical planning and bracing strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.9.spine25561","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:11:51Z","timestamp":1770829911000},"page":"547-553","source":"Crossref","is-referenced-by-count":1,"title":["Optimal measurement of sacral obliquity in adolescent idiopathic scoliosis\u2013associated sacral deformity"],"prefix":"10.3171","volume":"44","author":[{"given":"Yuya","family":"Kanie","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kaito","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka;"},{"name":"Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shota","family":"Takenaka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Kitahara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Furuya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichiro","family":"Ukon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahito","family":"Fujimori","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seiji","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"16","key":"b1","series-title":"N Engl J Med","first-page":"1512","article-title":"Effects of bracing in adolescents with idiopathic scoliosis","volume":"369","author":"Weinstein SL","year":"2013","unstructured":"Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512\u20131521."},{"issue":"f2","key":"b2","series-title":"BMJ","first-page":"f2508","article-title":"Adolescent idiopathic scoliosis","volume":"346","author":"Altaf F","year":"2013","unstructured":"Altaf F, Gibson A, Dannawi Z, Noordeen H. Adolescent idiopathic scoliosis. BMJ. 2013;346(f2):f2508."},{"issue":"2","key":"b3","series-title":"J Orthop Surg (Hong Kong)","first-page":"2309499019857250","article-title":"Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: a preoperative analysis of 311 lower limb axis films","volume":"27","author":"Chan CYW","year":"2019","unstructured":"Chan CYW, Naing KS, Chiu CK, Mohamad SM, Kwan MK. Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: a preoperative analysis of 311 lower limb axis films. J Orthop Surg (Hong Kong). 2019;27(2):2309499019857250."},{"issue":"4","key":"b4","series-title":"Asian Spine J","first-page":"527","article-title":"Effect of the discrepancy between sacral and pelvic obliquity on postoperative disk wedging below the lower instrumented vertebra in patients with Lenke type 5 adolescent idiopathic scoliosis: a retrospective study in Japan","volume":"19","author":"Iga T","year":"2025","unstructured":"Iga T, Suzuki S, Takeda K, Effect of the discrepancy between sacral and pelvic obliquity on postoperative disk wedging below the lower instrumented vertebra in patients with Lenke type 5 adolescent idiopathic scoliosis: a retrospective study in Japan. Asian Spine J. 2025;19(4):527\u2013534."},{"issue":"2","key":"b5","series-title":"J Spine Surg","first-page":"255","article-title":"Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study","volume":"10","author":"Kanie Y","year":"2024","unstructured":"Kanie Y, Takenaka S, Kitahara T, Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study. J Spine Surg. 2024;10(2):255\u2013263."},{"key":"b6","series-title":"Medtronic Sofamor Danek USA, Inc.;","article-title":"Spinal Deformity Study Group (SDSG). Radiographic Measurement Manual","author":"O\u2019Brien MF","year":"2008","unstructured":"O\u2019Brien MF, Kuklo TR, Blanke KM, Lenke LG. Spinal Deformity Study Group (SDSG). Radiographic Measurement Manual. Medtronic Sofamor Danek USA, Inc.; 2008."},{"issue":"1","key":"b7","series-title":"Clin Orthop Surg","first-page":"57","article-title":"Association between sacral slanting and adjacent structures in patients with adolescent idiopathic scoliosis","volume":"9","author":"Cho JH","year":"2017","unstructured":"Cho JH, Lee CS, Joo YS, Park J, Hwang CJ, Lee DH. Association between sacral slanting and adjacent structures in patients with adolescent idiopathic scoliosis. Clin Orthop Surg. 2017;9(1):57\u201362."},{"key":"b8","series-title":"McGraw-Hill","article-title":"Fundamental Statistics in Psychology and Education","author":"Guilford JP","year":"1950","unstructured":"Guilford JP. Fundamental Statistics in Psychology and Education. McGraw-Hill; 1950."},{"issue":"6","key":"b9","series-title":"Water Resour Res","first-page":"3756","article-title":"Impact of multicollinearity on small sample hydrologic regression models: impact of multicollinearity on hydrologic regression models","volume":"49","author":"Kroll CN","year":"2013","unstructured":"Kroll CN, Song P. Impact of multicollinearity on small sample hydrologic regression models: impact of multicollinearity on hydrologic regression models. Water Resour Res. 2013;49(6):3756\u20133769."},{"issue":"8","key":"b10","series-title":"PLoS One","first-page":"e71504","article-title":"Three-dimensional vertebral wedging in mild and moderate adolescent idiopathic scoliosis","volume":"8","author":"Scherrer SA","year":"2013","unstructured":"Scherrer SA, Begon M, Leardini A, Coillard C, Rivard CH, Allard P. Three-dimensional vertebral wedging in mild and moderate adolescent idiopathic scoliosis. PLoS One. 2013;8(8):e71504."},{"issue":"5","key":"b11","series-title":"Spine J","first-page":"834","article-title":"The clinical importance of sacral slanting in patients with adolescent idiopathic scoliosis undergoing surgery","volume":"15","author":"Lee CS","year":"2015","unstructured":"Lee CS, Ha JK, Kim DG, The clinical importance of sacral slanting in patients with adolescent idiopathic scoliosis undergoing surgery. Spine J. 2015;15(5):834\u2013840."},{"issue":"1","key":"b12","series-title":"JBJS Open Access","first-page":"e20","article-title":"The variability of pelvic obliquity measurements in patients with neuromuscular scoliosis","volume":"6","author":"Karkenny AJ","year":"2021","unstructured":"Karkenny AJ, Magee LC, Landrum MR, Anari JB, Spiegel D, Baldwin K. The variability of pelvic obliquity measurements in patients with neuromuscular scoliosis. JBJS Open Access. 2021;6(1):e20."},{"issue":"3","key":"b13","series-title":"Clin Biomech (Bristol)","first-page":"296","article-title":"Biomechanical loading of the sacrum in adolescent idiopathic scoliosis","volume":"29","author":"Pasha S","year":"2014","unstructured":"Pasha S, Aubin CE, Parent S, Labelle H, Mac-Thiong JM. Biomechanical loading of the sacrum in adolescent idiopathic scoliosis. Clin Biomech (Bristol). 2014;29(3):296\u2013303."},{"issue":"1","key":"b14","series-title":"BMC Musculoskelet Disord","first-page":"459","article-title":"Differences in vertebral morphology around the apical vertebrae between neuromuscular scoliosis and idiopathic scoliosis in skeletally immature patients: a three-dimensional morphometric analysis","volume":"18","author":"Makino T","year":"2017","unstructured":"Makino T, Sakai Y, Kashii M, Differences in vertebral morphology around the apical vertebrae between neuromuscular scoliosis and idiopathic scoliosis in skeletally immature patients: a three-dimensional morphometric analysis. BMC Musculoskelet Disord. 2017;18(1):459."},{"issue":"6","key":"b15","series-title":"J Pediatr Orthop","first-page":"618","article-title":"Three-dimensional spine parameters can differentiate between progressive and nonprogressive patients with AIS at the initial visit: a retrospective analysis","volume":"33","author":"Nault ML","year":"2013","unstructured":"Nault ML, Mac-Thiong JM, Roy-Beaudry M, deGuise J, Labelle H, Parent S. Three-dimensional spine parameters can differentiate between progressive and nonprogressive patients with AIS at the initial visit: a retrospective analysis. J Pediatr Orthop. 2013;33(6):618\u2013623."},{"issue":"1","key":"b16","series-title":"Scoliosis","first-page":"11","article-title":"Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis \u2013 a cross sectional study in 150 patients","volume":"3","author":"Modi HN","year":"2008","unstructured":"Modi HN, Suh SW, Song HR, Yang JH, Kim HJ, Modi CH. Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis \u2013 a cross sectional study in 150 patients. Scoliosis. 2008;3(1):11."},{"issue":"3","key":"b17","series-title":"Spine J","first-page":"477","article-title":"Three-dimensional vertebral wedging and pelvic asymmetries in the early stages of adolescent idiopathic scoliosis","volume":"15","author":"Begon M","year":"2015","unstructured":"Begon M, Scherrer SA, Coillard C, Rivard CH, Allard P. Three-dimensional vertebral wedging and pelvic asymmetries in the early stages of adolescent idiopathic scoliosis. Spine J. 2015;15(3):477\u2013486."},{"issue":"2","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"159","article-title":"Radiographic changes at the coronal plane in early scoliosis","volume":"19","author":"Xiong B","year":"1994","unstructured":"Xiong B, Sevastik JA, Hedlund R, Sevastik B. Radiographic changes at the coronal plane in early scoliosis. Spine (Phila Pa 1976). 1994;19(2):159\u2013164."},{"issue":"16","key":"b1","series-title":"N Engl J Med","first-page":"1512","article-title":"Effects of bracing in adolescents with idiopathic scoliosis","volume":"369","author":"Weinstein SL","year":"2013","unstructured":"Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512\u20131521."},{"issue":"f2","key":"b2","series-title":"BMJ","first-page":"f2508","article-title":"Adolescent idiopathic scoliosis","volume":"346","author":"Altaf F","year":"2013","unstructured":"Altaf F, Gibson A, Dannawi Z, Noordeen H. Adolescent idiopathic scoliosis. BMJ. 2013;346(f2):f2508."},{"issue":"2","key":"b3","series-title":"J Orthop Surg (Hong Kong)","first-page":"2309499019857250","article-title":"Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: a preoperative analysis of 311 lower limb axis films","volume":"27","author":"Chan CYW","year":"2019","unstructured":"Chan CYW, Naing KS, Chiu CK, Mohamad SM, Kwan MK. Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: a preoperative analysis of 311 lower limb axis films. J Orthop Surg (Hong Kong). 2019;27(2):2309499019857250."},{"issue":"4","key":"b4","series-title":"Asian Spine J","first-page":"527","article-title":"Effect of the discrepancy between sacral and pelvic obliquity on postoperative disk wedging below the lower instrumented vertebra in patients with Lenke type 5 adolescent idiopathic scoliosis: a retrospective study in Japan","volume":"19","author":"Iga T","year":"2025","unstructured":"Iga T, Suzuki S, Takeda K, Effect of the discrepancy between sacral and pelvic obliquity on postoperative disk wedging below the lower instrumented vertebra in patients with Lenke type 5 adolescent idiopathic scoliosis: a retrospective study in Japan. Asian Spine J. 2025;19(4):527\u2013534."},{"issue":"2","key":"b5","series-title":"J Spine Surg","first-page":"255","article-title":"Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study","volume":"10","author":"Kanie Y","year":"2024","unstructured":"Kanie Y, Takenaka S, Kitahara T, Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study. J Spine Surg. 2024;10(2):255\u2013263."},{"key":"b6","series-title":"Medtronic Sofamor Danek USA, Inc.;","article-title":"Spinal Deformity Study Group (SDSG). Radiographic Measurement Manual","author":"O\u2019Brien MF","year":"2008","unstructured":"O\u2019Brien MF, Kuklo TR, Blanke KM, Lenke LG. Spinal Deformity Study Group (SDSG). Radiographic Measurement Manual. Medtronic Sofamor Danek USA, Inc.; 2008."},{"issue":"1","key":"b7","series-title":"Clin Orthop Surg","first-page":"57","article-title":"Association between sacral slanting and adjacent structures in patients with adolescent idiopathic scoliosis","volume":"9","author":"Cho JH","year":"2017","unstructured":"Cho JH, Lee CS, Joo YS, Park J, Hwang CJ, Lee DH. Association between sacral slanting and adjacent structures in patients with adolescent idiopathic scoliosis. Clin Orthop Surg. 2017;9(1):57\u201362."},{"key":"b8","series-title":"McGraw-Hill","article-title":"Fundamental Statistics in Psychology and Education","author":"Guilford JP","year":"1950","unstructured":"Guilford JP. Fundamental Statistics in Psychology and Education. McGraw-Hill; 1950."},{"issue":"6","key":"b9","series-title":"Water Resour Res","first-page":"3756","article-title":"Impact of multicollinearity on small sample hydrologic regression models: impact of multicollinearity on hydrologic regression models","volume":"49","author":"Kroll CN","year":"2013","unstructured":"Kroll CN, Song P. Impact of multicollinearity on small sample hydrologic regression models: impact of multicollinearity on hydrologic regression models. Water Resour Res. 2013;49(6):3756\u20133769."},{"issue":"8","key":"b10","series-title":"PLoS One","first-page":"e71504","article-title":"Three-dimensional vertebral wedging in mild and moderate adolescent idiopathic scoliosis","volume":"8","author":"Scherrer SA","year":"2013","unstructured":"Scherrer SA, Begon M, Leardini A, Coillard C, Rivard CH, Allard P. Three-dimensional vertebral wedging in mild and moderate adolescent idiopathic scoliosis. PLoS One. 2013;8(8):e71504."},{"issue":"5","key":"b11","series-title":"Spine J","first-page":"834","article-title":"The clinical importance of sacral slanting in patients with adolescent idiopathic scoliosis undergoing surgery","volume":"15","author":"Lee CS","year":"2015","unstructured":"Lee CS, Ha JK, Kim DG, The clinical importance of sacral slanting in patients with adolescent idiopathic scoliosis undergoing surgery. Spine J. 2015;15(5):834\u2013840."},{"issue":"1","key":"b12","series-title":"JBJS Open Access","first-page":"e20","article-title":"The variability of pelvic obliquity measurements in patients with neuromuscular scoliosis","volume":"6","author":"Karkenny AJ","year":"2021","unstructured":"Karkenny AJ, Magee LC, Landrum MR, Anari JB, Spiegel D, Baldwin K. The variability of pelvic obliquity measurements in patients with neuromuscular scoliosis. JBJS Open Access. 2021;6(1):e20."},{"issue":"3","key":"b13","series-title":"Clin Biomech (Bristol)","first-page":"296","article-title":"Biomechanical loading of the sacrum in adolescent idiopathic scoliosis","volume":"29","author":"Pasha S","year":"2014","unstructured":"Pasha S, Aubin CE, Parent S, Labelle H, Mac-Thiong JM. Biomechanical loading of the sacrum in adolescent idiopathic scoliosis. Clin Biomech (Bristol). 2014;29(3):296\u2013303."},{"issue":"1","key":"b14","series-title":"BMC Musculoskelet Disord","first-page":"459","article-title":"Differences in vertebral morphology around the apical vertebrae between neuromuscular scoliosis and idiopathic scoliosis in skeletally immature patients: a three-dimensional morphometric analysis","volume":"18","author":"Makino T","year":"2017","unstructured":"Makino T, Sakai Y, Kashii M, Differences in vertebral morphology around the apical vertebrae between neuromuscular scoliosis and idiopathic scoliosis in skeletally immature patients: a three-dimensional morphometric analysis. BMC Musculoskelet Disord. 2017;18(1):459."},{"issue":"6","key":"b15","series-title":"J Pediatr Orthop","first-page":"618","article-title":"Three-dimensional spine parameters can differentiate between progressive and nonprogressive patients with AIS at the initial visit: a retrospective analysis","volume":"33","author":"Nault ML","year":"2013","unstructured":"Nault ML, Mac-Thiong JM, Roy-Beaudry M, deGuise J, Labelle H, Parent S. Three-dimensional spine parameters can differentiate between progressive and nonprogressive patients with AIS at the initial visit: a retrospective analysis. J Pediatr Orthop. 2013;33(6):618\u2013623."},{"issue":"1","key":"b16","series-title":"Scoliosis","first-page":"11","article-title":"Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis \u2013 a cross sectional study in 150 patients","volume":"3","author":"Modi HN","year":"2008","unstructured":"Modi HN, Suh SW, Song HR, Yang JH, Kim HJ, Modi CH. Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis \u2013 a cross sectional study in 150 patients. Scoliosis. 2008;3(1):11."},{"issue":"3","key":"b17","series-title":"Spine J","first-page":"477","article-title":"Three-dimensional vertebral wedging and pelvic asymmetries in the early stages of adolescent idiopathic scoliosis","volume":"15","author":"Begon M","year":"2015","unstructured":"Begon M, Scherrer SA, Coillard C, Rivard CH, Allard P. Three-dimensional vertebral wedging and pelvic asymmetries in the early stages of adolescent idiopathic scoliosis. Spine J. 2015;15(3):477\u2013486."},{"issue":"2","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"159","article-title":"Radiographic changes at the coronal plane in early scoliosis","volume":"19","author":"Xiong B","year":"1994","unstructured":"Xiong B, Sevastik JA, Hedlund R, Sevastik B. Radiographic changes at the coronal plane in early scoliosis. Spine (Phila Pa 1976). 1994;19(2):159\u2013164."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/44\/4\/article-p547.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/44\/4\/article-p547.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/44\/4\/article-p547.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:26:46Z","timestamp":1776094006000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/44\/4\/article-p547.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":36,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2025.9.spine25561","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1,23]]}}}