{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:50:07Z","timestamp":1782967807768,"version":"3.54.5"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T00:00:00Z","timestamp":1678060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Womens Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare mifepristone plus a misoprostol-combined regimen with misoprostol alone in the medical abortion of first trimester pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An internet-based search of available literature was performed using text words contained in titles and abstracts. PubMed\/Medline, Cochrane CENTRAL, EMBASE, and Google scholar were used to locate English-based articles published until December 2021. Studies fulfilling the inclusion criteria were selected, appraised, and assessed for methodological quality. The included studies were pooled for meta-analysis, and the results were presented in risk ratio at a 95% confidence interval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Nine studies comprising 2,052 participants (1,035 intervention and 1,017 controls) were considered. Primary endpoints were complete expulsion, incomplete expulsion, missed abortion, and ongoing pregnancy. The intervention was found to more likely induce complete expulsion irrespective of gestational age (RR: 1.19; 95% CI: 1.14\u20131.25). The administration of misoprostol 800\u2005mcg after 24\u2005h of mifepristone pre-treatment in the intervention group more likely induced complete expulsion (RR: 1.23; 95% CI: 1.17\u20131.30) than after 48\u2005h. The intervention group was also more likely to experience complete expulsion when misoprostol was used either vaginally (RR: 1.16; 95% CI: 1.09\u20131.17) or buccally (RR: 1.23; 95% CI: 1.16\u20131.30). The intervention was more effective in the subgroup with a negative foetal heartbeat at reducing incomplete abortion (RR: 0.45; 95% CI: 0.26\u20130.78) compared with the control group. The intervention more likely reduced both missed abortion (RR: 0.21; 95% CI: 0.08\u20130.91) and ongoing pregnancy (RR: 0.12; 95% CI: 0.05\u20130.26). Fever was less likely to be reported (RR: 0.78; 95% CI: 0.12\u20130.89), whereas the subjective experience of bleeding was more likely to be encountered (RR: 1.31; 95% CI: 1.13\u20131.53) by the intervention group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The review strengthened the theory that a combined mifepristone and misoprostol regimen can be an effective medical management for inducing abortions during first trimester pregnancy in all contexts. Specifically, there is a high-level certainty of evidence on complete expulsion during the early stage and its ability to reduce both missed and ongoing pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42019134213<\/jats:ext-link>, identifier CRD42019134213.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fgwh.2023.1112392","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T05:11:27Z","timestamp":1678079487000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Comparison of mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion: A systematic review and meta-analysis"],"prefix":"10.3389","volume":"4","author":[{"given":"Tariku","family":"Shimels","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melsew","family":"Getnet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mensur","family":"Shafie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lemi","family":"Belay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1016\/j.jogc.2016.01.002","article-title":"Medical abortion","volume":"38","author":"Costescu","year":"2016","journal-title":"J Obstet Gynaecol Can"},{"key":"B2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1097\/AOG.0000000000000603","article-title":"Incidence of emergency department visits and complications after abortion","volume":"125","author":"Upadhyay","year":"2015","journal-title":"Obstet Gynecol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e7146","DOI":"10.1097\/MD.0000000000007146","article-title":"Association between formaldehyde exposure and miscarriage in Chinese women","volume":"96","author":"Xu","year":"2017","journal-title":"BioMed Res Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s00404-015-3966-9","article-title":"Diclofenac\/misoprostol during early pregnancy and the risk of miscarriage: a Danish nationwide cohort study","volume":"294","author":"Andersen","year":"2016","journal-title":"Arch Gynecol Obstet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1363\/47e4215","article-title":"STD and abortion prevalence in adolescent mothers with histories of childhood protection involvement","volume":"47","author":"Cederbaum","year":"2015","journal-title":"Perspect Sex Reprod Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e0186487","DOI":"10.1371\/journal.pone.0186487","article-title":"First trimester medication abortion practice in the United States and Canada","volume":"12","author":"Jones","year":"2017","journal-title":"PloS One"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1111\/1471-0528.14690","article-title":"Self-management of first trimester medical termination of pregnancy: a qualitative study of women\u2019s experiences","volume":"124","author":"Purcell","year":"2017","journal-title":"BJOG"},{"key":"B8","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.ejogrb.2015.09.027","article-title":"The added value of mifepristone to non-surgical treatment regimens for uterine evacuation in case of early pregnancy failure: a systematic review of the literature","volume":"195","author":"van den Berg","year":"2015","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/S0968-8080(15)43824-8","article-title":"The introduction of first trimester medical abortion in Armenia","volume":"22","author":"Louie","year":"2015","journal-title":"Reprod Health Matters"},{"key":"B10","doi-asserted-by":"publisher","first-page":"462","DOI":"10.12809\/hkmj154525","article-title":"First-trimester medical abortion service in Hong Kong","volume":"21","author":"Lo","year":"2015","journal-title":"Hong Kong Med J"},{"key":"B11","author":"Jones","year":""},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7110a","article-title":"Abortion surveillance\u2014United States, 2020","volume":"71","author":"Kortsmit","year":"2022","journal-title":"MMWR Surveill Summ"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2459","DOI":"10.2165\/00003495-200262170-00005","article-title":"Options for early therapeutic abortion: a comparative review","volume":"62","author":"Bygdeman","year":"2002","journal-title":"Drugs"},{"key":"B14","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s00404-016-4205-8","article-title":"Mifepristone combined with ethacridine lactate for the second-trimester pregnancy termination in women with placenta previa and\/or prior cesarean deliveries","volume":"295","author":"Chen","year":"2017","journal-title":"Arch Gynecol Obstet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1177\/1933719116669055","article-title":"Efficacy, safety, and acceptability of low-dose mifepristone and self-administered misoprostol for ultra-early medical abortion: a randomized controlled trial","volume":"24","author":"Li","year":"2017","journal-title":"Reprod Sci"},{"key":"B16","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1111\/ajo.12608","article-title":"Efficacy and safety of mifepristone-buccal misoprostol for early medical abortion in an Australian clinical setting","volume":"57","author":"Goldstone","year":"2017","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"269","DOI":"10.33314\/jnhrc.v16i3.1378","article-title":"Efficacy and acceptability of early first trimester abortion using oral mifepristone and sublingual misoprostol","volume":"16","author":"Shrestha","year":"2018","journal-title":"J Nepal Health Res Counc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"CD002855","DOI":"10.1002\/14651858.CD002855.pub4","article-title":"Medical methods for first trimester abortion","volume":"1","author":"Kulier","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"B19","doi-asserted-by":"crossref","DOI":"10.1007\/978-94-009-3215-9_9","article-title":"The clinical use of prostaglandins for early and late abortion","volume-title":"Eicosanoids and reproduction. Advance in eicosanoid research","author":"Calder","year":"1987"},{"key":"B20","doi-asserted-by":"publisher","first-page":"h217","DOI":"10.1136\/bmj.h217","article-title":"Labour induction with prostaglandins: a systematic review and network meta-analysis","volume":"350","author":"Alfirevic","year":"2015","journal-title":"Br Med J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1016\/S0015-0282(97)00189-1","article-title":"Mifepristone (RU486): a review","volume":"68","author":"Mahajan","year":"1997","journal-title":"Fertil Steril"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0010-7824(98)00150-4","article-title":"Low-dose mifepristone 200mg and vaginal misoprostol for abortion","volume":"59","author":"Schaff","year":"1999","journal-title":"Contraception"},{"key":"B23","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1097\/AOG.0b013e318227214e","article-title":"Mifepristone and misoprostol compared with misoprostol alone for second-trimester abortion: a randomized controlled trial","volume":"118","author":"Ngoc","year":"2011","journal-title":"Obstet Gynecol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"315","DOI":"10.5455\/2320-1770.ijrcog20130911","article-title":"Second trimester abortion-mifepristone and misoprostol or misoprostol alone?","volume":"2","author":"Patel","year":"2013","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1007\/s13224-016-0869-z","article-title":"A comparative study of misoprostol only and mifepristone plus misoprostol in second trimester termination of pregnancy","volume":"66","author":"Akkenapally","year":"2016","journal-title":"J Obstet Gynaecol India"},{"key":"B26","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/S0968-8080(08)31371-8","article-title":"Second trimester medical abortion with mifepristone\u2013misoprostol and misoprostol alone: a review of methods and management","volume":"16","author":"Gemzell-Danielsson","year":"2008","journal-title":"Reprod Health Matters"},{"key":"B27","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.ajog.2008.11.016","article-title":"Recent advances in second-trimester abortion: an evidence-based review","volume":"200","author":"Hammond","year":"2009","journal-title":"Am J Obstet. Gynecol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"CD002865","DOI":"10.1002\/14651858.CD002865.pub2","article-title":"Mifepristone for induction of labour","volume":"8","author":"Hapangama","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"B29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1363\/2018.29199","volume-title":"Abortion worldwide 2017: Uneven progress and unequal access","author":"Singh","year":"2018"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.1056\/NEJMoa1715726","article-title":"Mifepristone pretreatment for the medical management of early pregnancy loss","volume":"378","author":"Schreiber","year":"2018","journal-title":"N Engl J Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1097\/AOG.0000000000000897","article-title":"Mifepristone with buccal misoprostol for medical abortion: a systematic review","volume":"126","author":"Chen","year":"2015","journal-title":"Obstet Gynecol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.contraception.2017.09.006","article-title":"Efficacy of medical abortion prior to 6 gestational weeks: a systematic review","volume":"97","author":"Kapp","year":"2018","journal-title":"Contraception"},{"key":"B33","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.contraception.2009.12.002","article-title":"Two medical abortion regimens for late first-trimester termination of pregnancy: a prospective randomized trial","volume":"81","author":"Dalenda","year":"2010","journal-title":"Contraception"},{"key":"B34","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/j.fertnstert.2006.03.032","article-title":"A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure","volume":"86","author":"Stockheim","year":"2006","journal-title":"Fertil Steril"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1093\/humrep\/17.6.1477","article-title":"A prospective randomized, double-blinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy","volume":"17","author":"Jain","year":"2002","journal-title":"Hum Reprod"},{"key":"B36","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1111\/j.1447-0756.2008.00864.x","article-title":"Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial","volume":"35","author":"Chawdhary","year":"2009","journal-title":"J Obstet Gynaecol Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1007\/s00404-011-2110-8","article-title":"Efficacy and safety of mifepristone and buccal misoprostol versus buccal misoprostol alone for medical abortion","volume":"285","author":"Dahiya","year":"2012","journal-title":"Arch Gynecol Obstet"},{"key":"B38","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.ijgo.2012.03.039","article-title":"Comparison of misoprostol-only and combined mifepristone-misoprostol regimens for home-based early medical abortion in Tunisia and Vietnam","volume":"118","author":"Blum","year":"2012","journal-title":"Int J Gynaecol Obstet"},{"key":"B39","article-title":"Chapter 3: systematic reviews of effectiveness","volume-title":"JBI manual for evidence synthesis","author":"Tufanaru","year":"2020"},{"key":"B40","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1097\/XEB.0000000000000152","article-title":"The development of software to support multiple systematic review types: the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI)","volume":"17","author":"Munn","year":"2019","journal-title":"Int J Evid Based Healthc"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"B42","volume-title":"Review manager (RevMan). version 5.3","year":"2014"},{"key":"B43","year":""},{"key":"B44","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.contraception.2019.03.005","article-title":"Mifepristone and sublingual misoprostol versus sublingual misoprostol alone for missed abortion: results of a randomized placebo-controlled trial","volume":"99","author":"Bracken","year":"2019","journal-title":"Contraception"},{"key":"B45","doi-asserted-by":"publisher","first-page":"S315","DOI":"10.1016\/S0020-7292(12)60585-2","article-title":"Outcomes of a double-blind randomized trial comparing misoprostol-only to mifepristone+misoprostol for home-based early medical abortion","volume":"119","author":"Dabash","year":"2012","journal-title":"Int J Gynaecol Obstet"},{"key":"B46","doi-asserted-by":"publisher","first-page":"E589","DOI":"10.1007\/s00404-011-2110-8","article-title":"Randomized trial of mifepristone and buccal misoprostol vs misoprostol alone for medical abortion","volume":"131","author":"Dahiya","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"B47","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.contraception.2011.06.005","article-title":"Mifepristone+misoprostol vs. misoprostol alone for early medical abortion","volume":"85","author":"Ngo","year":"2012","journal-title":"Contraception"},{"key":"B48","doi-asserted-by":"crossref","first-page":"S286","DOI":"10.1016\/S0020-7292(09)61046-8","article-title":"Medical abortion with misoprostol only versus mifepristone plus misoprostol: results from a randomized controlled trial","volume":"107","author":"Ngoc","year":"2009","journal-title":"Int J Gynaecol Obstet"},{"key":"B49","doi-asserted-by":"publisher","first-page":"P195","DOI":"10.1016\/j.contraception.2009.05.005","article-title":"Medical abortion with misoprostol only vs. mifepristone plus misoprostol: results from a randomized controlled trial","volume":"80","author":"Blum","year":"2009","journal-title":"Contraception"},{"key":"B50","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.ijgo.2009.11.008","article-title":"Sublingual misoprostol for first trimester termination of pregnancy","volume":"109","author":"Fekih","year":"2010","journal-title":"Int J Gynaecol Obstet"},{"key":"B51","first-page":"1060","article-title":"Management of missed abortion: comparison of medical treatment with either mifepristone+misoprostol or misoprostol alone with surgical evacuation. A multi-center trial in Copenhagen county, Denmark","volume":"81","author":"Gr\u00f8nlund","year":"2002","journal-title":"Acta Obstet Gynecol Scand"},{"key":"B52","doi-asserted-by":"publisher","first-page":"3079","DOI":"10.1093\/humrep\/17.12.3079","article-title":"Early pregnancy termination with vaginal misoprostol before and after 42 days gestation","volume":"17","author":"Zikopoulos","year":"2002","journal-title":"Hum Reprod"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1056\/NEJM199804303381801","article-title":"Early pregnancy termination with mifepristone and misoprostol in the United States","volume":"338","author":"Spitz","year":"1998","journal-title":"N Engl J Med"},{"key":"B54","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12905-020-01003-8","article-title":"Medical termination for pregnancy in early first trimester (\u226463 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review","volume":"20","author":"Abubeker","year":"2020","journal-title":"BMC Womens Health"},{"key":"B55","volume-title":"Safe abortion: technical and policy guidance for health systems","year":"2012"},{"key":"B56","first-page":"889","article-title":"Termination of early pregnancy with a reduced oral dose of mifepristone and vaginal misoprostol","volume":"90","author":"Anjum","year":"2000","journal-title":"S Afr Med J"},{"key":"B57","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.contraception.2012.06.011","article-title":"First-trimester medical abortion with mifepristone 200mg and misoprostol: a systematic review","volume":"87","author":"Raymond","year":"2013","journal-title":"Contraception"},{"key":"B58","doi-asserted-by":"publisher","first-page":"23","DOI":"10.15887\/j.cnki.13-1389\/r.2022.11.007","article-title":"Comparison of the efficacy of 400 \u03bcg sublingual misoprostol versus 800 \u03bcg vaginal misoprostol for medical abortion in early pregnancy","volume":"15","author":"Libei","year":"2022","journal-title":"Chin J Clinical Rational Drug Use"},{"key":"B59","first-page":"499","article-title":"Clinical trial of compound mifepristone tablets combined with misoprostol tablets in the treatment of termination pregnancy from 10 to 16 weeks and missed abortion","volume":"33","author":"Bei-ying","year":"2017","journal-title":"Chin J Clin Pharmacol"},{"key":"B60","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1016\/S0140-6736(20)31788-8","article-title":"Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial","volume":"396","author":"Chu","year":"2020","journal-title":"Lancet"},{"key":"B61","doi-asserted-by":"publisher","first-page":"38","DOI":"10.17352\/2455-5479.000037","article-title":"Comparative study for efficacy of termination in first trimester pregnancy using misoprostol and mifepristone","volume":"4","author":"Stanulov","year":"2018","journal-title":"Arch Community Med Public Health"},{"key":"B62","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s13224-011-0118-4","article-title":"Misoprostol vs mifepristone and misoprostol in second trimester termination of pregnancy","volume":"61","author":"Nagaria","year":"2011","journal-title":"J Obstet Gynaecol India"},{"key":"B63","doi-asserted-by":"publisher","first-page":"2372","DOI":"10.1016\/S0140-6736(17)31794-4","article-title":"Global, regional, and subregional classification of abortions by safety, 2010\u201314: estimates from a Bayesian hierarchical model","volume":"390","author":"Ganatra","year":"2017","journal-title":"Lancet"},{"key":"B64","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1080\/02763869.2019.1588072","article-title":"PROSPERO: an international register of systematic review protocols","volume":"38","author":"Schiavo","year":"2019","journal-title":"Med Ref Serv Q"},{"key":"B65","doi-asserted-by":"crossref","first-page":"45","DOI":"10.69614\/ejrh.v14i2.396","article-title":"Comparison of mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion: a systematic review & meta-analysis protocol","volume":"14","author":"Shimels","year":"2022","journal-title":"EJRH"}],"container-title":["Frontiers in Global Women's Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2023.1112392\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T20:08:30Z","timestamp":1729022910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2023.1112392\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,6]]},"references-count":65,"alternative-id":["10.3389\/fgwh.2023.1112392"],"URL":"https:\/\/doi.org\/10.3389\/fgwh.2023.1112392","relation":{},"ISSN":["2673-5059"],"issn-type":[{"value":"2673-5059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,6]]},"article-number":"1112392"}}