{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:36:45Z","timestamp":1792816605614,"version":"4.5.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Veno-venous extracorporeal membrane oxygenation (V-V ECMO) was used for patients with severe COVID-19 pneumonia. The aim of our study was to assess the long-term outcomes and quality of life of the surviving patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center observational study was performed among patients who were discharged after V-V ECMO treatment with COVID-19 pneumonia. During the 2-year follow-up period, different organ functions and quality of life parameters were evaluated three times after discharge. As a control group, SARS-CoV-2 infection positive patients were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty-five patients underwent V-V ECMO treatment, of whom 11 patients survived. The study population consists of 9 patients for the follow-up (2 patients did not consent to follow-up examinations). On lung CT, the occurrence of residual fibrotic banding was 22% at discharge, and increased to 89% at 24th month follow-up, while lung function tests were normal. On echocardiography, patients had a mildly elevated right ventricle end-diastolic diameter at the post discharge period, which normalized during follow-up (baseline: 37.6 \u00b1 2.9 mm, follow-up: 35.6 \u00b1 2.2 mm,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). In the ECMO group both humoral and cellular immune responses remained elevated (Quantiferon Ag1\n                      <jats:italic>p<\/jats:italic>\n                      = 0.005, Quantiferon Ag2\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0059, Quantiferon Ag3\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0012, IgG Roche\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0037).\n                    <\/jats:p>\n                    <jats:p>\n                      Among the psychological factors, significant correlation was observed between ECMO duration and symptoms of depression (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.727;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05), anxiety (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.848;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01), and posttraumatic stress (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.834;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01), furthermore, a negative correlation with positive affectivity (\n                      <jats:italic>r<\/jats:italic>\n                      = \u22120.868;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01) presented itself. SF-36 scores improved significantly from the 6-month to the 24-month follow-up (median 50% vs. 80%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01). The mean body mass index increased from 29 to 35 (kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and physical activity decreased. The Epworth Sleepiness Scale showed higher normal daytime sleepiness values and elevated Fatigue Severity Scale scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>At the 2-year follow-up after discharge from the V-V ECMO treatment, permanent cardio muscular and structural pulmonary damage had been anticipated. However, on one hand, good cardiac and pulmonary function and robust sustained immune response were measured. On the other hand, unforeseen long-term complications arose, such as sleepiness, reduced physical activity, acute depression, and consequently, a deteriorated health related quality of life. These findings highlight the necessity of long-term, structured controlled rehabilitation programs for this patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1731333","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:19:10Z","timestamp":1768205950000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Survival and recovery: 24-month outcomes for critically Ill COVID-19 patients receiving ECMO"],"prefix":"10.3389","volume":"12","author":[{"given":"Zsuzsanna","family":"Ulakcsai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zs\u00f3fia","family":"Dohy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili\u00e1na","family":"Szab\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorottya","family":"Balla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Csongor","family":"Mesk\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1lint","family":"Lakatos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Fontanini Mariastefano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorottya","family":"F\u00e9s\u00fc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zs\u00f3fia","family":"Ocsovszky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f3zsef","family":"Otohal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanka","family":"Ehrenberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zs\u00f3fia","family":"Szab\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tam\u00e1s","family":"Szab\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Endre","family":"N\u00e9meth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gy\u00f6rgy","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajnalka","family":"V\u00e1g\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1056\/NEJMoa1800385","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome.","volume":"378","author":"Combes","year":"2018","journal-title":"N Engl J Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13054-021-03634-1","article-title":"Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis.","volume":"25","author":"Ramanathan","year":"2021","journal-title":"Crit Care."},{"key":"B3","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/S2213-2600(22)00403-9","article-title":"In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study.","volume":"11","author":"Lorusso","year":"2023","journal-title":"Lancet Respir Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1179620","DOI":"10.3389\/fimmu.2023.1179620","article-title":"T cell immune response predicts survival in severely ill COVID-19 patients requiring venovenous extracorporeal membrane oxygenation support.","volume":"14","author":"Ulakcsai","year":"2023","journal-title":"Front Immunol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.surg.2022.01.044","article-title":"Posthospitalization outcomes after extracorporeal membrane oxygenation (ECMO) for COVID-19.","volume":"172","author":"Gribensk","year":"2022","journal-title":"Surgery."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1016\/S0140-6736(20)32008-0","article-title":"Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the extracorporeal life support organization registry.","volume":"396","author":"Barbaro","year":"2020","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/j.hrtlng.2019.08.016","article-title":"Long-term health-related quality of life of adult patients treated with extracorporeal membrane oxygenation (ECMO): an integrative review.","volume":"48","author":"Knudson","year":"2019","journal-title":"Heart Lung."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.3310\/hta14350","article-title":"Randomised controlled trial and parallel economic evaluation of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR).","volume":"14","author":"Peek","year":"2009","journal-title":"Health Technol Assess."},{"key":"B9","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1097\/CCM.0b013e318232da75","article-title":"Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders\u2019 conference.","volume":"40","author":"Needham","year":"2012","journal-title":"Crit Care Med."},{"key":"B10","volume-title":"Clinical management of COVID-19:living guideline.","year":"2023"},{"key":"B11","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1097\/MAT.0000000000001193","article-title":"Extracorporeal life support organization coronavirus disease 2019 interim guidelines: a consensus document from an international group of interdisciplinary extracorporeal membrane oxygenation providers.","volume":"66","author":"Shekar","year":"2020","journal-title":"ASAIO J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of spirometry 2019 update. an official american thoracic society and european respiratory society technical statement.","volume":"200","author":"Graham","year":"2019","journal-title":"Am J Respir Crit Care Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1600016","DOI":"10.1183\/13993003.00016-2016","article-title":"2017 ERS\/ATS standards for single-breath carbon monoxide uptake in the lung.","volume":"49","author":"Graham","year":"2017","journal-title":"Eur Respir J."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the american society of echocardiography.","volume":"32","author":"Mitchell","year":"2019","journal-title":"J Am Soc Echocardiogr."},{"key":"B15","volume-title":"K\u00e9rd\u0151\u00edvek \u00e9s Becsl\u0151sk\u00e1l\u00e1k a Klinikai Pszichol\u00f3gi\u00e1ban.","author":"Perczel-Forintos","year":"2018"},{"key":"B16","first-page":"73","article-title":"Psychometric properties of the hungarian version of the original and the short form of the positive and negative affect schedule (PANAS).","volume":"13","author":"Gyollai","year":"2011","journal-title":"Neuropsychopharmacol Hung."},{"key":"B17","first-page":"4","article-title":"P\u00e1ciens megel\u00e9gedetts\u00e9gi vizsg\u00e1lat SF-36 k\u00e9rd\u0151\u00edvvel, a magyarorsz\u00e1gi norm\u00e1l\u00e9rt\u00e9kek meghat\u00e1roz\u00e1sa. [Patient satisfaction survey with SF-36 questionnaire, determination of normal values in Hungary].","volume":"80","author":"Czimbalmos","year":"1999","journal-title":"Nepegeszseguegy."},{"key":"B18","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s11205-011-9783-z","article-title":"Estimating the reliability of single-item life satisfaction measures: results from four national panel studies.","volume":"105","author":"Lucas","year":"2012","journal-title":"Soc Indic Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/0168-8510(90)90421-9","article-title":"EuroQol - a new facility for the measurement of health-related quality of life.","volume":"16","year":"1990","journal-title":"Health Policy."},{"key":"B20","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The pittsburgh sleep quality index: a new instrument for psychiatric practice and research.","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A new method for measuring daytime sleepiness: the Epworth sleepiness scale.","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1093\/sleep\/31.11.1601","article-title":"Validation of the fatigue severity scale in a Swiss cohort.","volume":"31","author":"Valko","year":"2008","journal-title":"Sleep."},{"key":"B23","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s10787-023-01191-3","article-title":"Post-COVID interstitial lung disease in symptomatic patients after COVID-19 disease.","volume":"31","author":"Fesu","year":"2023","journal-title":"Inflammopharmacology."},{"key":"B24","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1164\/rccm.202206-1145OC","article-title":"One-Year mental and physical health assessment in survivors after extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome.","volume":"207","author":"Chommeloux","year":"2023","journal-title":"Am J Respir Crit Care Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.4049\/jimmunol.137.5.1517","article-title":"Immune deposits formed in situ by a monoclonal antibody recognizing a new intrinsic rat mesangial matrix antigen.","volume":"137","author":"Mendrick","year":"1986","journal-title":"J Immunol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1288679","DOI":"10.3389\/fmed.2023.1288679","article-title":"Post-COVID changes in lung function 6 months after veno-venous extracorporeal membrane oxygenation: a prospective observational clinical trial.","volume":"10","author":"P\u00e1lfi","year":"2023","journal-title":"Front Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.athoracsur.2022.01.003","article-title":"One-Year outcomes with venovenous extracorporeal membrane oxygenation support for severe COVID-19.","volume":"114","author":"Smith","year":"2022","journal-title":"Ann Thorac Surg."},{"key":"B28","doi-asserted-by":"publisher","first-page":"87","DOI":"10.2214\/AJR.20.23034","article-title":"Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients.","volume":"215","author":"Salehi","year":"2020","journal-title":"AJR Am J Roentgenol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e222462","DOI":"10.1148\/radiol.222462","article-title":"Current and emerging knowledge in COVID-19.","volume":"306","author":"Jeong","year":"2023","journal-title":"Radiology."},{"key":"B30","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1148\/radiol.2021212350","article-title":"Residual lung lesions at 1-year CT after COVID-19.","volume":"302","author":"Lee","year":"2022","journal-title":"Radiology."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1007\/s00330-023-10044-0","article-title":"Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort.","volume":"34","author":"Soliman","year":"2024","journal-title":"Eur Radiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"3328","DOI":"10.3390\/diagnostics13213328","article-title":"Quantitative CT at follow-up of COVID-19 pneumonia: relationship with pulmonary function tests.","volume":"13","author":"Colombi","year":"2023","journal-title":"Diagnostics"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2301612","DOI":"10.1183\/13993003.01612-2023","article-title":"Long-term radiological and pulmonary function abnormalities at 3 years after COVID-19 hospitalisation: a longitudinal cohort study.","volume":"64","author":"Han","year":"2024","journal-title":"Eur Respir J."},{"key":"B34","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1093\/ehjqcco\/qcab029","article-title":"Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews.","volume":"7","author":"Harrison","year":"2021","journal-title":"Eur Heart J Qual Care Clin Outcomes."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1001\/jamacardio.2020.3557","article-title":"Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19).","volume":"5","author":"Puntmann","year":"2020","journal-title":"JAMA Cardiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1136\/bjsports-2021-104576","article-title":"Is cardiac involvement prevalent in highly trained athletes after SARS-CoV-2 infection? a cardiac magnetic resonance study using sex-matched and age-matched controls.","volume":"56","author":"Szab\u00f3","year":"2022","journal-title":"Br J Sports Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/jcm13113290","article-title":"Prevalence of abnormal cardiovascular magnetic resonance findings in athletes recovered from COVID-19 infection: a systematic review and meta-analysis.","volume":"13","author":"Tsampasian","year":"2024","journal-title":"J Clin Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1016\/j.jcmg.2020.11.014","article-title":"Cardiac magnetic resonance findings in patients recovered from COVID-19: initial experiences in elite athletes.","volume":"14","author":"Vago","year":"2021","journal-title":"JACC Cardiovasc Imag."},{"key":"B39","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.ijcard.2020.11.043","article-title":"Right ventricular dysfunction in critically ill COVID-19 ARDS.","volume":"327","author":"Bleakley","year":"2021","journal-title":"Int J Cardiol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1007\/s10741-021-10108-7","article-title":"Heart-lung interactions in COVID-19: prognostic impact and usefulness of bedside echocardiography for monitoring of the right ventricle involvement.","volume":"27","author":"Dandel","year":"2022","journal-title":"Heart Fail Rev."},{"key":"B41","doi-asserted-by":"publisher","first-page":"571416","DOI":"10.3389\/fphys.2020.571416","article-title":"Aging, immunity, and COVID-19: how age influences the host immune response to coronavirus infections?","volume":"11","author":"Bajaj","year":"2021","journal-title":"Front Physiol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1093\/gerona\/glaa209","article-title":"Underlying vulnerabilities to the cytokine storm and adverse COVID-19 outcomes in the aging immune system.","volume":"76","author":"Nidadavolu","year":"2021","journal-title":"J Gerontol A Biol Sci Med Sci."},{"key":"B43","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12979-022-00309-5","article-title":"Aging, inflammaging and immunosenescence as risk factors of severe COVID-19.","volume":"19","author":"Tizazu","year":"2022","journal-title":"Immun Ageing."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1108149","DOI":"10.3389\/fragi.2023.1108149","article-title":"Immune cell population and cytokine profiling suggest age dependent differences in the response to SARS-CoV-2 infection.","volume":"4","author":"Aragon","year":"2023","journal-title":"Front Aging."},{"key":"B45","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1002\/iid3.404","article-title":"Age-related differences in the immune response could contribute to determine the spectrum of severity of COVID-19.","volume":"9","author":"Costagliola","year":"2021","journal-title":"Immun Inflamm Dis."},{"key":"B46","doi-asserted-by":"publisher","first-page":"742941","DOI":"10.3389\/fimmu.2021.742941","article-title":"Hyperinflammatory immune response and COVID-19: a double edged sword.","volume":"12","author":"Tan","year":"2021","journal-title":"Front Immunol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1327415","DOI":"10.3389\/fmed.2023.1327415","article-title":"Younger age is associated with cardiovascular pathological phenotype of severe COVID-19 at autopsy.","volume":"10","author":"Giugni","year":"2024","journal-title":"Front Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1827","DOI":"10.1001\/jama.2022.17714","article-title":"Association of extracorporeal membrane oxygenation with new mental health diagnoses in adult survivors of critical illness.","volume":"328","author":"Fernando","year":"2022","journal-title":"JAMA."},{"key":"B49","doi-asserted-by":"publisher","first-page":"e959","DOI":"10.1097\/CCM.0000000000004488","article-title":"Cognitive, psychiatric, and quality of life outcomes in adult survivors of extracorporeal membrane oxygenation therapy: a scoping review of the literature.","volume":"48","author":"Khan","year":"2020","journal-title":"Crit Care Med."},{"key":"B50","doi-asserted-by":"publisher","first-page":"20230017","DOI":"10.2490\/prm.20230017","article-title":"Rehabilitation of patients with Post-COVID-19 syndrome: a narrative review.","volume":"8","author":"Sakai","year":"2023","journal-title":"Prog Rehabil Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1731333\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:19:11Z","timestamp":1768205951000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1731333\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":50,"alternative-id":["10.3389\/fmed.2025.1731333"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1731333","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1731333"}}