{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T10:14:55Z","timestamp":1779099295200,"version":"3.51.4"},"reference-count":49,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: SARS-CoV-2 infection may exacerbate neuroinflammation in patients with multiple sclerosis (MS) and thus accelerate MS progression. Previous studies have reported an increased risk of disability and lesion burden among those infected with SARS-CoV-2 while others reported no differences compared to COVID\u2212 controls. We aimed to determine whether COVID-19 is associated with accelerated radiological progression of MS. Methods: This single-center, retrospective longitudinal study included patients with pre-existing relapsing-remitting MS. We identified 34 SARS-CoV-2\u2013positive MS patients (COVID+) who had at least one brain MRI prior to, and one after, their first positive PCR test. These patients were matched 2:1 by index date to 67 SARS-CoV-2\u2013negative MS patients (COVID\u2212). Baseline demographics and comorbidities were comparable between groups. Two radiologists independently scored pre- and post-index MRIs for new or enlarging T2 lesions, T1 gadolinium-enhancing lesions, and parenchymal brain volume loss. Logistic regression analyses evaluated group differences, adjusting for demographic and clinical covariates. Results: Across an average imaging interval of approximately two years, no significant differences were observed between COVID+ and COVID\u2212 patients in new lesions (8.8% vs. 9.0%), enlarging lesions (2.9% vs. 6.0%), T1-enhancing lesions (5.9% vs. 1.5%), or brain volume loss (35.3% vs. 47.8%; all p &gt; 0.05). Conclusions: There was no detectable association between SARS-CoV-2 infection and accelerated radiological progression in patients with MS over an average two-year follow-up. Longer-term investigations are warranted to clarify whether certain subgroups or more severe COVID-19 cases might be at heightened risk.<\/jats:p>","DOI":"10.3390\/diagnostics16101513","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T08:56:27Z","timestamp":1779094587000},"page":"1513","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19 and Radiological Progression of Multiple Sclerosis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1757-5359","authenticated-orcid":false,"given":"Hien Quang","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2231-0172","authenticated-orcid":false,"given":"Roham","family":"Hadidchi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Eligulashvili","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3588-3838","authenticated-orcid":false,"given":"Shounak","family":"Nandi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aditi","family":"Vichare","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhakti","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7171-8914","authenticated-orcid":false,"given":"Jimmy","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Bisulca","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6471-4569","authenticated-orcid":false,"given":"Sonya","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6113-9909","authenticated-orcid":false,"given":"Jimmy S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6403-2827","authenticated-orcid":false,"given":"Tim Q.","family":"Duong","sequence":"additional","affiliation":[{"name":"Department of Radiology, Montefiore Health System, Albert Einstein College of Medicine, New York, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/s41572-018-0041-4","article-title":"Multiple sclerosis","volume":"4","author":"Filippi","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1212\/01.wnl.0000233834.09743.3b","article-title":"The risk of relapses in multiple sclerosis during systemic infections","volume":"67","author":"Correale","year":"2006","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e200021","DOI":"10.1212\/NXI.0000000000200021","article-title":"Updated Results of the COVID-19 in MS Global Data Sharing Initiative: Anti-CD20 and Other Risk Factors Associated with COVID-19 Severity","volume":"9","author":"Pirmani","year":"2022","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3403","DOI":"10.1111\/ene.14879","article-title":"Impact of the COVID-19 pandemic on access to healthcare services amongst patients with multiple sclerosis in the Lazio region, Italy","volume":"28","author":"Colais","year":"2021","journal-title":"Eur. J. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1001\/jamaneurol.2021.0688","article-title":"Outcomes and Risk Factors Associated with SARS-CoV-2 Infection in a North American Registry of Patients with Multiple Sclerosis","volume":"78","author":"Salter","year":"2021","journal-title":"JAMA Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/13524585211005339","article-title":"Impact of COVID-19 on multiple sclerosis care and management: Results from the European Committee for Treatment and Research in Multiple Sclerosis survey","volume":"28","author":"Portaccio","year":"2022","journal-title":"Mult. Scler."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e3019","DOI":"10.1093\/cid\/ciaa1933","article-title":"Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Encephalitis Is a Cytokine Release Syndrome: Evidences from Cerebrospinal Fluid Analyses","volume":"73","author":"Pilotto","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105715","DOI":"10.1016\/j.nbd.2022.105715","article-title":"Neurological sequela and disruption of neuron-glia homeostasis in SARS-CoV-2 infection","volume":"168","author":"Savelieff","year":"2022","journal-title":"Neurobiol. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3106","DOI":"10.1016\/j.neuron.2022.07.015","article-title":"Neuroinflammatory disease disrupts the blood-CNS barrier via crosstalk between proinflammatory and endothelial-to-mesenchymal-transition signaling","volume":"110","author":"Sun","year":"2022","journal-title":"Neuron"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s00401-020-02187-x","article-title":"Interleukin-1 promotes autoimmune neuroinflammation by suppressing endothelial heme oxygenase-1 at the blood-brain barrier","volume":"140","author":"Hauptmann","year":"2020","journal-title":"Acta Neuropathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1038\/s41467-025-56097-1","article-title":"Microglial NLRP3-gasdermin D activation impairs blood-brain barrier integrity through interleukin-1beta-independent neutrophil chemotaxis upon peripheral inflammation in mice","volume":"16","author":"Yoon","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1038\/s41598-022-27348-8","article-title":"Sequence similarity between SARS-CoV-2 nucleocapsid and multiple sclerosis-associated proteins provides insight into viral neuropathogenesis following infection","volume":"13","author":"Lake","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"MacDougall, M., El-Hajj Sleiman, J., Beauchemin, P., and Rangachari, M. (2022). SARS-CoV-2 and Multiple Sclerosis: Potential for Disease Exacerbation. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.871276"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e2250230","DOI":"10.1002\/eji.202250230","article-title":"Nervous system-related tropism of SARS-CoV-2 and autoimmunity in COVID-19 infection","volume":"54","author":"Weissert","year":"2024","journal-title":"Eur. J. Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.1038\/s41380-022-01831-0","article-title":"SARS-CoV-2 drives NLRP3 inflammasome activation in human microglia through spike protein","volume":"28","author":"Albornoz","year":"2023","journal-title":"Mol. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Etemadifar, M., Abhari, A.P., Nouri, H., Salari, M., Maleki, S., Amin, A., and Sedaghat, N. (2022). Does COVID-19 increase the long-term relapsing-remitting multiple sclerosis clinical activity? A cohort study. BMC Neurol., 22.","DOI":"10.1186\/s12883-022-02590-9"},{"key":"ref_17","first-page":"342","article-title":"COVID-19 has no impact on disease activity, progression and cognitive performance in people with multiple sclerosis: A 2-year study","volume":"95","author":"Montini","year":"2024","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e210149","DOI":"10.1212\/WNL.0000000000210149","article-title":"Effects of COVID-19 Infection on Symptom Severity and Disability in Multiple Sclerosis","volume":"104","author":"Salter","year":"2025","journal-title":"Neurology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.medcli.2022.06.020","article-title":"COVID-19 and its implications on the clinico-radiological course of multiple sclerosis: A case-control study","volume":"160","author":"Rahmani","year":"2023","journal-title":"Med. Clin."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"105613","DOI":"10.1016\/j.msard.2024.105613","article-title":"SARS-CoV-2 infection increases long-term multiple sclerosis disease activity and all-cause mortality in an underserved inner-city population","volume":"86","author":"Hadidchi","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1111\/cns.14050","article-title":"Multiple sclerosis as a model to investigate SARS-CoV-2 effect on brain atrophy","volume":"29","author":"Rebsamen","year":"2023","journal-title":"CNS Neurosci. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pakan, R., Hadidchi, R., Al-Ani, Y., Piskun, H., Duong, K.S., Henry, S., Wang, S., Maurer, C.W., and Duong, T.Q. (2024). Long-Term Outcomes of Patients with Pre-Existing Essential Tremor After SARS-CoV-2 Infection. Diagnostics, 14.","DOI":"10.21203\/rs.3.rs-4535751\/v1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103821","DOI":"10.1016\/j.ebiom.2022.103821","article-title":"Clinical predictors of acute cardiac injury and normalization of troponin after hospital discharge from COVID-19","volume":"76","author":"Lu","year":"2022","journal-title":"eBioMedicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.1093\/ndt\/gfad020","article-title":"Long-term outcomes of COVID-19 survivors with hospital AKI: Association with time to recovery from AKI","volume":"38","author":"Lu","year":"2023","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lu, J.Y., Buczek, A., Fleysher, R., Hoogenboom, W.S., Hou, W., Rodriguez, C.J., Fisher, M.C., and Duong, T.Q. (2021). Outcomes of Hospitalized Patients with COVID-19 with Acute Kidney Injury and Acute Cardiac Injury. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.798897"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e15277","DOI":"10.1016\/j.heliyon.2023.e15277","article-title":"Characteristics of COVID-19 patients with multiorgan injury across the pandemic in a large academic health system in the Bronx, New York","volume":"9","author":"Lu","year":"2023","journal-title":"Heliyon"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"104487","DOI":"10.1016\/j.ebiom.2023.104487","article-title":"Incidence of new-onset in-hospital and persistent diabetes in COVID-19 patients: Comparison with influenza","volume":"90","author":"Lu","year":"2023","journal-title":"eBioMedicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1161\/HYPERTENSIONAHA.123.21174","article-title":"Incidence of New-Onset Hypertension Post-COVID-19: Comparison with Influenza","volume":"80","author":"Zhang","year":"2023","journal-title":"Hypertension"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7743","DOI":"10.1038\/s41598-024-58430-y","article-title":"Patients with unmet social needs are at higher risks of developing severe long COVID-19 symptoms and neuropsychiatric sequela","volume":"14","author":"Eligulashvili","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Eligulashvili, A., Darrell, M., Miller, C., Lee, J., Congdon, S., Lee, J.S., Hsu, K., Yee, J., Hou, W., and Islam, M. (2022). COVID-19 Patients in the COVID-19 Recovery and Engagement (CORE) Clinics in the Bronx. Diagnostics, 13.","DOI":"10.3390\/diagnostics13010119"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Eligulashvili, A., Gordon, M., Lee, J.S., Lee, J., Mehrotra-Varma, S., Mehrotra-Varma, J., Hsu, K., Hilliard, I., Lee, K., and Li, A. (2024). Long-term outcomes of hospitalized patients with SARS-CoV-2\/COVID-19 with and without neurological involvement: 3-year follow-up assessment. PLoS Med., 21.","DOI":"10.1101\/2023.06.26.23291883"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"123477","DOI":"10.1016\/j.jns.2025.123477","article-title":"Long-term outcomes of patients with a pre-existing neurological condition after SARS-CoV-2 infection","volume":"473","author":"Hadidchi","year":"2025","journal-title":"J. Neurol. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Hadidchi, R., Al-Ani, Y., Piskun, H., Pakan, R., Duong, K., Jamil, H., Wang, S., Henry, S., Maurer, C., and Duong, T. (2024). Long-term outcomes of patients with Parkinson\u2019s disease 3.5 years post SARS-CoV-2 infection in an inner-city population in the Bronx. Res. Sq.","DOI":"10.21203\/rs.3.rs-4373059\/v1"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e70013","DOI":"10.1111\/ene.70013","article-title":"Impact of COVID-19 on long-term outcomes in Parkinson\u2019s disease","volume":"32","author":"Hadidchi","year":"2025","journal-title":"Eur. J. Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1177\/13872877241303934","article-title":"Long COVID-19 outcomes of patients with pre-existing dementia","volume":"103","author":"Hadidchi","year":"2024","journal-title":"J. Alzheimers Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Qiu, S., Hadidchi, R., Vichare, A., Lu, J.Y., Hou, W., Henry, S., Akalin, E., and Duong, T.Q. (2025). SARS-CoV-2 Infection Is Associated with an Accelerated eGFR Decline in Kidney Transplant Recipients up to Four Years Post Infection. Diagnostics, 15.","DOI":"10.3390\/diagnostics15091091"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1001\/jamaneurol.2020.4689","article-title":"Diagnosis of Progressive Multiple Sclerosis From the Imaging Perspective: A Review","volume":"78","author":"Filippi","year":"2021","journal-title":"JAMA Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"123552","DOI":"10.1016\/j.jns.2025.123552","article-title":"Impact of brain volume on coronavirus disease of 2019 severity and subsequent cognitive decline in patients with multiple sclerosis","volume":"475","author":"Devogelaere","year":"2025","journal-title":"J. Neurol. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3050","DOI":"10.1111\/ene.15477","article-title":"Long-term outcome after COVID-19 infection in multiple sclerosis: A nation-wide multicenter matched-control study","volume":"29","author":"Bsteh","year":"2022","journal-title":"Eur. J. Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1001\/jamaneurol.2021.3416","article-title":"Health Disparities, Inequities, and Social Determinants of Health in Multiple Sclerosis and Related Disorders in the US: A Review","volume":"78","author":"Amezcua","year":"2021","journal-title":"JAMA Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3846","DOI":"10.1007\/s00330-021-08487-4","article-title":"The central vein sign helps in differentiating multiple sclerosis from its mimickers: Lessons from Fabry disease","volume":"32","author":"Tranfa","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s11547-022-01500-w","article-title":"COVID-19 and low back pain: Previous infections lengthen recovery time after intradiscal ozone therapy in patients with herniated lumbar disc","volume":"127","author":"Somma","year":"2022","journal-title":"Radiol. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/S1474-4422(22)00471-9","article-title":"Epstein-Barr virus as a cause of multiple sclerosis: Opportunities for prevention and therapy","volume":"22","author":"Aloisi","year":"2023","journal-title":"Lancet Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"102947","DOI":"10.1016\/j.msard.2021.102947","article-title":"Can coronavirus disease 2019 (COVID-19) trigger exacerbation of multiple sclerosis? A retrospective study","volume":"52","author":"Barzegar","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"102939","DOI":"10.1016\/j.msard.2021.102939","article-title":"COVID-19 is associated with new symptoms of multiple sclerosis that are prevented by disease modifying therapies","volume":"52","author":"Garjani","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Lotan, I., Nishiyama, S., Manzano, G.S., Lydston, M., and Levy, M. (2022). COVID-19 and the risk of CNS demyelinating diseases: A systematic review. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.970383"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Tavazzi, E., Pichiecchio, A., Colombo, E., Rigoni, E., Asteggiano, C., Vegezzi, E., Masi, F., Greco, G., Bastianello, S., and Bergamaschi, R. (2023). The Potential Role of SARS-CoV-2 Infection and Vaccines in Multiple Sclerosis Onset and Reactivation: A Case Series and Literature Review. Viruses, 15.","DOI":"10.3390\/v15071569"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"102474","DOI":"10.1016\/j.mib.2024.102474","article-title":"Neuroinvasion and neurotropism of severe acute respiratory syndrome coronavirus 2 infection","volume":"79","author":"Jagst","year":"2024","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1146\/annurev-med-052422-020316","article-title":"Treatments for COVID-19","volume":"75","author":"Andrews","year":"2024","journal-title":"Annu. Rev. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1513\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:33:25Z","timestamp":1779096805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,16]]},"references-count":49,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16101513"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16101513","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,16]]}}}