{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:51:03Z","timestamp":1788814263810,"version":"build-2803163510"},"reference-count":129,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Cervical intraepithelial neoplasia (CIN) is a premalignant cervical condition closely linked to persistent high-risk HPV infection, a major risk factor for cervical cancer. This study aims to investigate the relationship between cervicovaginal infections, HPV infection, and CIN development in 94 Romanian women with cervical lesions. Comprehensive assessments included HPV genotyping, cytology, colposcopy, and histopathology. In 53.20% of cases, vaginal infections were identified, with Candida albicans most frequently associated with HPV. Histopathology revealed 48.94% low-grade CIN, 42.55% high-grade CIN, and 8.51% invasive carcinoma. There was a strong correlation between high-risk HPV types (especially HPV 16 and 18), colposcopic findings, histopathology, and age. This study emphasizes the mutual effect of cervicovaginal infections and HPV infection in increasing the risk of developing CIN and cervical cancer among Romanian women. Persistent infection with high-risk HPV types, particularly HPV 16 and 18, has been confirmed as a primary driver of CIN and cervical cancer progression.<\/jats:p>","DOI":"10.3390\/diseases13010018","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T04:55:19Z","timestamp":1737003319000},"page":"18","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The Relationship Between Cervicovaginal Infection, Human Papillomavirus Infection and Cervical Intraepithelial Neoplasia in Romanian Women"],"prefix":"10.3390","volume":"13","author":[{"given":"Anca Daniela","family":"Br\u0103ila","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian-Viorel","family":"Poalelungi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9783-149X","authenticated-orcid":false,"given":"Cristina-Crengu\u0163a","family":"Albu","sequence":"additional","affiliation":[{"name":"Department of Genetics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin Marian","family":"Damian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0534","authenticated-orcid":false,"given":"Lauren\u021biu Mihai","family":"D\u020br\u0103","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea-Mariana","family":"B\u0103n\u0103\u021beanu","sequence":"additional","affiliation":[{"name":"Department of Speciality Disciplines, \u201cTitu Maiorescu\u201d University, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5965-893X","authenticated-orcid":false,"given":"Claudia Florina","family":"Bogdan-Andreescu","sequence":"additional","affiliation":[{"name":"Department of Speciality Disciplines, \u201cTitu Maiorescu\u201d University, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref_1","first-page":"e50291","article-title":"From Diagnosis to Treatment: Exploring the Latest Management Trends in Cervical Intraepithelial Neoplasia","volume":"15","author":"Gupta","year":"2023","journal-title":"Cureus"},{"key":"ref_2","first-page":"e58645","article-title":"Advancements in the Management of Cervical Intraepithelial Neoplasia: A Comprehensive Review","volume":"16","author":"Waghe","year":"2024","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3257939","DOI":"10.1155\/2019\/3257939","article-title":"Human Papillomavirus Infection and Cervical Cancer: Epidemiology, Screening, and Vaccination-Review of Current Perspectives","volume":"2019","author":"Chan","year":"2019","journal-title":"J. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sausen, D.G., Shechter, O., Gallo, E.S., Dahari, H., and Borenstein, R. (2023). Herpes Simplex Virus, Human Papillomavirus, and Cervical Cancer: Overview, Relationship, and Treatment Implications. Cancers, 15.","DOI":"10.3390\/cancers15143692"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/S1470-2045(09)70096-8","article-title":"A review of human carcinogens\u2014Part B: Biological agents","volume":"10","author":"Bouvard","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1086\/657321","article-title":"Cervical human papillomairus prevalence in 5 continents: Meta-analysis of 1 million women with normal cytological findings","volume":"202","author":"Bruni","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1002\/ijc.30716","article-title":"Worldwide burden of cancer attributable to HPV by site, country and HPV type","volume":"141","author":"Plummer","year":"2017","journal-title":"Int. J. Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"290","DOI":"10.3390\/women4030022","article-title":"Cervical Cancer Screening: Impact of Human Papillomavirus mRNA Testing on Detecting High-Grade Lesions in Women with Normal Cytology","volume":"4","author":"Strand","year":"2024","journal-title":"Women"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Almeida, M., Caeiro, V., Costa, D., Silva, L., Sousa, C., Pestana, P., Campelos, S., Vale, J., Ramalhinho, A.C., and Fonseca-Moutinho, J. (2024). High-Risk HPV Detection in Paraffin-Embedded Tissue from Cervical Lesions. Pharmaceuticals, 17.","DOI":"10.20944\/preprints202401.1434.v1"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kafasi, A., Kaparos, G., Pitiriga, V.C., Spanakis, N., Vlachos, N., Thomakos, N., Stournaras, S., and Tsakris, A. (2024). Prevalence of HPV Genotypes among Greek Women in Association with Their Potential to Cause Precancerous Lesions. Microorganisms, 12.","DOI":"10.3390\/microorganisms12071404"},{"key":"ref_11","first-page":"173","article-title":"Risk factors that cause cervical intraepithelial lesion development: A single center cross-sectional study in Turkey","volume":"5","author":"Kaplan","year":"2020","journal-title":"Asian Pac. J. Cancer Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"924","DOI":"10.7150\/jca.17416","article-title":"Risk factors for cervical intraepithelial neoplasia and cervical cancer in Chinese women: Large study in Jiexiu, Shanxi Province, China","volume":"8","author":"Wang","year":"2017","journal-title":"J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Moscicki, A.B., Schiffman, M., and Franceschi, S. (2020). The natural history of human papillomavirus infection in relation to cervical cancer. Human Papillomavirus, Academic Press.","DOI":"10.1016\/B978-0-12-814457-2.00009-X"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kombe Kombe, A.J., Li, B., Zahid, A., Mengist, H.M., Bounda, G.A., Zhou, Y., and Jin, T. (2021). Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.552028"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Milano, G., Guarducci, G., Nante, N., Montomoli, E., and Manini, I. (2023). Human Papillomavirus Epidemiology and Prevention: Is There Still a Gender Gap?. Vaccines, 11.","DOI":"10.20944\/preprints202304.0542.v1"},{"key":"ref_16","first-page":"683","article-title":"Cervical Cancer: Screening and Prevention","volume":"7","author":"Behtash","year":"2006","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_17","unstructured":"Ndifon, C.O., and Al-Eyd, G. (2023, April 24). Atypical Squamous Cells of Undetermined Significance, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557739\/."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/LGT.0000000000000604","article-title":"The Natural History of Cervical Intraepithelial Neoplasia Grades 1, 2, and 3: A Systematic Review and Meta-Analysis","volume":"25","author":"Loopik","year":"2021","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2022466","DOI":"10.1590\/s2237-96222022000300012","article-title":"Evaluation of Histopathological Examinations of the Cervix Diagnosed as \u201cOther Neoplasms\u201d on the Cancer Information System, Brazil, 2013\u20132020: A Descriptive Study","volume":"31","author":"Claro","year":"2022","journal-title":"Epidemiol. Serv. Saude"},{"key":"ref_20","first-page":"37","article-title":"Clinical significance of HPV-DNA testing for precancerous cervical lesions","volume":"7","author":"Georgescu","year":"2014","journal-title":"J. Med. Life"},{"key":"ref_21","unstructured":"Veijalainen, O. (2021). Real-Life Experience with the Use of HPV Tests in Cervical Cancer Screening and in Triage of Equivocal Cytological Results. [Ph.D. Thesis, Tampere University]."},{"key":"ref_22","unstructured":"Ministerul Investi\u021biilor \u0219i Proiectelor Europene (2024, November 28). \u0218ansa la Via\u021b\u0103 S\u0103n\u0103toas\u0103: Screening pentru Depistarea HPV, din Fonduri Europene, Available online: https:\/\/mfe.gov.ro\/sansa-la-viata-sanatoasa-screening-pentru-depistarea-hpv-din-fonduri-europene\/."},{"key":"ref_23","unstructured":"Institutul Na\u021bional de S\u0103n\u0103tate Public\u0103 (2024, November 28). Ianuarie 2024\u2014Campanie de Prevenire a Cancerului de Col Uterin, Available online: https:\/\/insp.gov.ro\/2024\/01\/03\/ianuarie-2024-campanie-de-prevenire-a-cancerului-de-col-uterin\/."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mo, Y., Ma, J., Zhang, H., Shen, J., Chen, J., Hong, J., Xu, Y., and Qian, C. (2022). Prophylactic and Therapeutic HPV Vaccines: Current Scenario and Perspectives. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.909223"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kakotkin, V.V., Semina, E.V., Zadorkina, T.G., and Agapov, M.A. (2023). Prevention Strategies and Early Diagnosis of Cervical Cancer: Current State and Prospects. Diagnostics, 13.","DOI":"10.3390\/diagnostics13040610"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s10147-023-02337-7","article-title":"Carcinogenesis and management of human papillomavirus-associated cervical cancer","volume":"28","author":"Kusakabe","year":"2023","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1136\/ijgc-2022-003703","article-title":"Updates on cervical cancer prevention","volume":"33","author":"Fernandes","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tataru, A.-L., Furau, G., Afilon, J., Ionescu, C., Dimitriu, M., Bratu, O.G., Tit, D.M., Bungau, S., and Furau, C. (2019). The Situation of Cervical Cancers in the Context of Female Genital Cancer Clustering and Burden of Disease in Arad County, Romania. J. Clin. Med., 8.","DOI":"10.3390\/jcm8010096"},{"key":"ref_29","first-page":"893","article-title":"Borderline Brenner Tumors Associated with Ovarian Cyst\u2014Case Presentation","volume":"57","author":"Albu","year":"2016","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Todor, R.D., Bratucu, G., Moga, M.A., Candrea, A.N., Marceanu, L.G., and Anastasiu, C.V. (2021). Challenges in the Prevention of Cervical Cancer in Romania. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18041721"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Simion, L., Rotaru, V., Cirimbei, C., Gales, L., Stefan, D.-C., Ionescu, S.-O., Luca, D., Doran, H., and Chitoran, E. (2023). Inequities in Screening and HPV Vaccination Programs and Their Impact on Cervical Cancer Statistics in Romania. Diagnostics, 13.","DOI":"10.3390\/diagnostics13172776"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"51","DOI":"10.37897\/RJID.2021.1.7","article-title":"Methods for screening and prevention of HPV infection\u2013a retrospective study","volume":"24","author":"Stanica","year":"2021","journal-title":"Rom. J. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"99","DOI":"10.47162\/RJME.65.1.12","article-title":"The importance of combined HPV and CINtec\u00ae PLUS genotyping testing for p16 in women with cervical squamous cell carcinoma","volume":"65","author":"Budianu","year":"2024","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S1470-2045(08)70103-7","article-title":"Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: A retrospective cohort study","volume":"9","author":"McCredie","year":"2008","journal-title":"Lancet Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Mitra, A., MacIntyre, D.A., Marchesi, J.R., Lee, Y.S., Bennett, P.R., and Kyrgiou, M. (2016). The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: What do we know and where are we going next?. Microbiome, 4.","DOI":"10.1186\/s40168-016-0203-0"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Curty, G., de Carvalho, P.S., and Soares, M.A. (2020). The Role of the Cervicovaginal Microbiome on the Genesis and as a Biomarker of Premalignant Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21010222"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"L6","DOI":"10.1530\/RAF-22-0026","article-title":"Exploring the antimicrobial properties of vaginal Lactobacillus crispatus against preterm birth-associated bacteria","volume":"3","author":"Amabebe","year":"2022","journal-title":"Reprod. Fertil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3390\/bacteria3030010","article-title":"Review on Applied Applications of Microbiome on Human Lives","volume":"3","author":"Kamble","year":"2024","journal-title":"Bacteria"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100082","DOI":"10.1016\/j.medmic.2023.100082","article-title":"Bacterial vaginosis: A state of microbial dysbiosis","volume":"16","author":"Mondal","year":"2023","journal-title":"Med. Microecol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Dong, W., Wang, S., Wang, X., Xu, G., Liu, Q., Li, Z., Lv, N., Pan, Y., Xiong, Q., and Liu, D. (2024). Characteristics of Vaginal Microbiota of Women of Reproductive Age with Infections. Microorganisms, 12.","DOI":"10.3390\/microorganisms12051030"},{"key":"ref_41","first-page":"4","article-title":"A meta-analysis of the relationship between vaginal microecology, human papillomavirus infection and cervical intraepithelial neoplasia","volume":"14","author":"Liang","year":"2019","journal-title":"Infect. Agent. Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jcv.2016.12.007","article-title":"Association between high risk human papillomavirus infection and co-infection with Candida spp. and Trichomonas vaginalis in women with cervical premalignant and malignant lesions","volume":"87","author":"Ghosh","year":"2017","journal-title":"J. Clin. Virol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Miko, E., and Barakonyi, A. (2023). The Role of Hydrogen-Peroxide (H2O2) Produced by Vaginal Microbiota in Female Reproductive Health. Antioxidants, 12.","DOI":"10.3390\/antiox12051055"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Pendharkar, S., Skafte-Holm, A., Simsek, G., and Haahr, T. (2023). Lactobacilli and Their Probiotic Effects in the Vagina of Reproductive Age Women. Microorganisms, 11.","DOI":"10.3390\/microorganisms11030636"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"211","DOI":"10.3390\/venereology3040017","article-title":"Unravelling the Biological Interplay Between Genital HPV Infection and Cervicovaginal Microbiota in Sub-Saharan Africa: Implications for Cervical (Pre)cancer Prevention","volume":"3","author":"Onywera","year":"2024","journal-title":"Venereology"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Mizutani, T., Ishizaka, A., Koga, M., Tsutsumi, T., and Yotsuyanagi, H. (2022). Role of Microbiota in Viral Infections and Pathological Progression. Viruses, 14.","DOI":"10.3390\/v14050950"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Pavone, G., Marino, A., Fisicaro, V., Motta, L., Spata, A., Martorana, F., Spampinato, S., Celesia, B.M., Cacopardo, B., and Vigneri, P. (2024). Entangled Connections: HIV and HPV Interplay in Cervical Cancer\u2014A Comprehensive Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms251910358"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13027-024-00573-8","article-title":"Cervicovaginal microbiota: A promising direction for prevention and treatment in cervical cancer","volume":"19","author":"Shen","year":"2024","journal-title":"Infect. Agents Cancer"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.4081\/oncol.2012.e17","article-title":"Mechanisms of virus immune evasion lead to development from chronic inflammation to cancer formation associated with human papillomavirus infection","volume":"6","author":"Senba","year":"2012","journal-title":"Oncol. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Albu, C.-C., Bencze, M.-A., Dragomirescu, A.-O., Suciu, I., T\u0103nase, M., Albu, \u015e.-D., Russu, E.-A., and Ionescu, E. (2023). Folic Acid and Its Role in Oral Health: A Narrative Review. Processes, 11.","DOI":"10.3390\/pr11071994"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1046\/j.1365-2303.2000.00237.x","article-title":"The interaction of Trichomonas vaginalis with epithelial cells, polymorphonuclear leucocytes and erythrocytes on vaginal smears: Light microscopic observation","volume":"11","author":"Demirezen","year":"2000","journal-title":"Cytopathology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"80","DOI":"10.4161\/gmic.1.2.11142","article-title":"Adherent-invasive Escherichia coli target the epithelial barrier","volume":"1","author":"Wine","year":"2010","journal-title":"Gut Microbes"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Albu, \u015e.-D., Suciu, I., Albu, C.-C., Dragomirescu, A.-O., and Ionescu, E. (2024). Impact of Malocclusions on Periodontopathogenic Bacterial Load and Progression of Periodontal Disease: A Quantitative Analysis. Microorganisms, 12.","DOI":"10.3390\/microorganisms12081553"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1038\/s41416-019-0602-7","article-title":"Human papillomavirus as a driver of head and neck cancers","volume":"122","author":"Sabatini","year":"2020","journal-title":"Br. J. Cancer."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/j.molmed.2024.05.009","article-title":"HPV integration and cervical cancer: A failed evolutionary viral trait","volume":"30","author":"Molina","year":"2024","journal-title":"Trends Mol. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.3802\/jgo.2016.27.e21","article-title":"Clinical significance of human papillomavirus genotyping","volume":"27","author":"Choi","year":"2016","journal-title":"J. Gynecol. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0140-6736(03)12120-4","article-title":"Human papillomavirus type 18 and rapidly progressing cervical intraepithelial neoplasia","volume":"361","author":"Woodman","year":"2003","journal-title":"Lancet"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.3802\/jgo.2019.30.e52","article-title":"Human papillomavirus genotype-specific risk in cervical carcinogenesis","volume":"30","author":"So","year":"2019","journal-title":"J. Gynecol. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/CMR.16.1.1-17.2003","article-title":"Human papillomavirus and cervical cancer","volume":"16","author":"Burd","year":"2003","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1080\/21645515.2015.1088616","article-title":"Persistent infection with human papillomavirus 16 or 18 is strongly linked with high-grade cervical disease","volume":"12","author":"Radley","year":"2016","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.ygyno.2023.05.011","article-title":"The combined finding of HPV 16, 18, or 45 and cytologic Atypical Glandular Cells (AGC) indicates a greatly elevated risk of in situ and invasive cervical adenocarcinoma","volume":"174","author":"Schiffman","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Bruno, M.T., Valenti, G., Cavallaro, A.G., Palermo, I., Aiello, T., Farina, J., Panella, M.M., and Mereu, L. (2024). Extended Genotyping to Stratify the Risk of CIN2+ in Women with Persistent HPV Infection, Negative Cytology and Type 3 Transformation Zone. Cancers, 16.","DOI":"10.3390\/cancers16101816"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Goulart, L.R., Colombo, B.F.M., Lima, M.I.S., de Andrade, M.S.A., S\u00e3o Juli\u00e3o, J., Neves, A.F., and Pereira, S.R. (2024). Expanded HPV Genotyping by Single-Tube Nested-Multiplex PCR May Explain HPV-Related Disease Recurrence. Microorganisms, 12.","DOI":"10.3390\/microorganisms12112326"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"683","DOI":"10.21149\/9090","article-title":"HPV vaccine implementation and monitoring in Latin America","volume":"60","author":"Luciani","year":"2018","journal-title":"Salud Publica Mex."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Tobaiqy, M., and MacLure, K. (2024). A Systematic Review of Human Papillomavirus Vaccination Challenges and Strategies to Enhance Uptake. Vaccines, 12.","DOI":"10.3390\/vaccines12070746"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Cai, X., and Xu, L. (2024). Human Papillomavirus-Related Cancer Vaccine Strategies. Vaccines, 12.","DOI":"10.3390\/vaccines12111291"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Gardella, B., Pasquali, M.F., La Verde, M., Cianci, S., Torella, M., and Dominoni, M. (2022). The Complex Interplay between Vaginal Microbiota, HPV Infection, and Immunological Microenvironment in Cervical Intraepithelial Neoplasia: A Literature Review. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23137174"},{"key":"ref_68","unstructured":"Adjorlolo-Johnson, G.T. (2005). Impact of the HIV Epidemic on the Epidemiology of Cervical Cancer. [Ph.D. Thesis, University of California]."},{"key":"ref_69","first-page":"637","article-title":"Human papilloma virus: Apprehending the link with carcinogenesis and unveiling new research avenues (Review)","volume":"52","author":"Boda","year":"2018","journal-title":"Int. J. Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"3946320221125090","DOI":"10.1177\/03946320221125090","article-title":"The Yin and Yang Dualistic Features of Autophagy in Thermal Burn Wound Healing","volume":"36","author":"Greabu","year":"2022","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1001\/jama.285.1.47","article-title":"Serotypes of Chlamydia trachomatis and risk for development of cervical squamous cell carcinoma","volume":"285","author":"Anttila","year":"2001","journal-title":"JAMA"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Martinelli, M., Musumeci, R., Rizzo, A., Muresu, N., Piana, A., Sotgiu, G., Landoni, F., and Cocuzza, C. (2019). Prevalence of Chlamydia trachomatis Infection, Serovar Distribution and Co-Infections with Seven High-Risk HPV Types among Italian Women with a Recent History of Abnormal Cervical Cytology. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16183354"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e29236","DOI":"10.1002\/jmv.29236","article-title":"HPV co-infections with other pathogens in cancer development: A comprehensive review","volume":"95","author":"Akbari","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Gargiulo Isacco, C., Balzanelli, M.G., Garzone, S., Lorusso, M., Inchingolo, F., Nguyen, K.C.D., Santacroce, L., Mosca, A., and Del Prete, R. (2023). Alterations of Vaginal Microbiota and Chlamydia trachomatis as Crucial Co-Causative Factors in Cervical Cancer Genesis Procured by HPV. Microorganisms, 11.","DOI":"10.3390\/microorganisms11030662"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Luvi\u00e1n-Morales, J., Guti\u00e9rrez-Enr\u00edquez, S.O., Granados-Garc\u00eda, V., and Torres-Poveda, K. (2024). Risk factors for the development of cervical cancer: Analysis of the evidence. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1378549"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1111\/cyt.12835","article-title":"The early detection of cervical cancer. The current and changing landscape of cervical disease detection","volume":"31","author":"Shiraz","year":"2020","journal-title":"Cytopathology"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jasc.2018.12.004","article-title":"Challenges in the Pap diagnosis of endocervical adenocarcinoma in situ","volume":"8","author":"Niu","year":"2019","journal-title":"J. Am. Soc. Cytopathol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"810","DOI":"10.7326\/0003-4819-132-10-200005160-00009","article-title":"Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review","volume":"132","author":"Nanda","year":"2000","journal-title":"Ann. Intern. Med."},{"key":"ref_79","first-page":"441","article-title":"Cervical Cancer Screening","volume":"97","author":"Rerucha","year":"2018","journal-title":"Am. Fam. Physician"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1089\/jwh.2020.8918","article-title":"Summary of Current Guidelines for Cervical Cancer Screening and Management of Abnormal Test Results: 2016\u20132020","volume":"30","author":"Perkins","year":"2021","journal-title":"J. Women\u2019s Health"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1001\/jama.2023.13174","article-title":"Cervical Cancer Screening: A Review","volume":"330","author":"Perkins","year":"2023","journal-title":"JAMA"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"40","DOI":"10.3802\/kjgo.2008.19.1.40","article-title":"False-negative results of conventional Papanicolaou cervical cytology in women with cervical conization","volume":"19","author":"Park","year":"2008","journal-title":"Korean J. Gynecol. Oncol."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Macios, A., and Nowakowski, A. (2022). False Negative Results in Cervical Cancer Screening\u2014Risks, Reasons and Implications for Clinical Practice and Public Health. Diagnostics, 12.","DOI":"10.3390\/diagnostics12061508"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1159\/000539637","article-title":"Pitfalls in Gynecological Cytology: Review of the Common and Less Frequent Entities in Pap Test","volume":"68","year":"2024","journal-title":"Acta Cytol."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Stuebs, F.A., Koch, M.C., Dietl, A.K., Adler, W., Geppert, C., Hartmann, A., Kn\u00f6ll, A., Beckmann, M.W., Mehlhorn, G., and Schulmeyer, C.E. (2022). Cytology and High-Risk Human Papillomavirus Test for Cervical Cancer Screening Assessment. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071748"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13027-024-00586-3","article-title":"The performance of single and combination test strategies using visual inspection, cytology, high-risk HPV DNA and HPV16\/18 to screen South African women with and without HIV-infection","volume":"19","author":"Dreyer","year":"2024","journal-title":"Infect. Agents Cancer"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3747\/co.23.2991","article-title":"Using the Cancer Risk Management Model to Evaluate the Health and Economic Impacts of Cytology Compared with Human Papillomavirus DNA Testing for Primary Cervical Cancer Screening in Canada","volume":"23","author":"Popadiuk","year":"2016","journal-title":"Curr. Oncol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.bpobgyn.2020.02.008","article-title":"Primary HPV screening for cervical cancer","volume":"65","author":"Bhatla","year":"2020","journal-title":"Best. Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/LGT.0000000000000494","article-title":"Clinical Utility of Human Papillomavirus Genotyping in Cervical Cancer Screening: A Systematic Review","volume":"24","author":"Bonde","year":"2020","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1038\/s41379-022-01052-4","article-title":"Should screening for cervical cancer go to primary human papillomavirus testing and eliminate cytology?","volume":"35","author":"Swid","year":"2022","journal-title":"Mod. Pathol."},{"key":"ref_91","unstructured":"Ryan, E.T., Hill, D.R., Solomon, T., Aronson, N.E., and Endy, T.P. (2020). 7-Sexually Transmitted Infections. Hunter\u2019s Tropical Medicine and Emerging Infectious Diseases, Content Repository Only!."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Dos Santos, L.M., de Souza, J.D., Mbakwa, H.A., Nobre, A.F.S., Vieira, R.C., Ferrari, S.F., Rodrigues, A.R., Ishikawa, E.A.Y., Guerreiro, J.F., and de Sousa, M.S. (2022). High prevalence of sexual infection by human papillomavirus and Chlamydia trachomatis in sexually-active women from a large city in the Amazon region of Brazil. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270874"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1002\/ijc.33251","article-title":"Role of human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia","volume":"148","author":"Huang","year":"2021","journal-title":"Int. J. Cancer"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13027-021-00386-z","article-title":"Risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) among women with HPV-test in 1990\u20131992, a 30-year follow-up study","volume":"16","author":"Riibe","year":"2021","journal-title":"Infect. Agents Cancer"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Yu, L., Majerciak, V., and Zheng, Z.-M. (2022). HPV16 and HPV18 Genome Structure, Expression, and Post-Transcriptional Regulation. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23094943"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Jain, M., Yadav, D., Jarouliya, U., Chavda, V., Yadav, A.K., Chaurasia, B., and Song, M. (2023). Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis. Pathogens, 12.","DOI":"10.3390\/pathogens12121380"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"10680","DOI":"10.1128\/JVI.01747-15","article-title":"Human Papillomavirus 18 Genetic Variation and Cervical Cancer Risk Worldwide","volume":"89","author":"Chen","year":"2015","journal-title":"J. Virol."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Ramachandran, D., and D\u00f6rk, T. (2021). Genomic Risk Factors for Cervical Cancer. Cancers, 13.","DOI":"10.20944\/preprints202109.0441.v1"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"En\u0103\u0219escu, D.A., Moisescu, M.G., Imre, M., Greabu, M., Ripszky Totan, A., Stanescu-Spinu, I., Burcea, M., Albu, C., and Miricescu, D. (2021). Lutein Treatment Effects on the Redox Status and Metalloproteinase-9 (MMP-9) in Oral Cancer Squamous Cells\u2014Are There Therapeutical Hopes?. Materials, 14.","DOI":"10.3390\/ma14112968"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1016\/S2214-109X(19)30482-6","article-title":"Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis","volume":"8","author":"Arbyn","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Seyoum, A., Seyoum, B., Gure, T., Alemu, A., Belachew, A., Abeje, D., Aseffa, A., Howe, R., Mulu, A., and Mihret, A. (2023). Genotype heterogeneity of high-risk human papillomavirus infection in Ethiopia. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1116685"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ygyno.2023.04.022","article-title":"Risk stratification of HPV-positive results using extended genotyping and cytology: Data from the baseline phase of the Onclarity trial","volume":"174","author":"Stoler","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Kaya Terzi, N., and Yulek, O. (2024). Assessment of Cervicovaginal Smear and HPV DNA Co-Test for Cervical Cancer Screening: Implications for Diagnosis and Follow-Up Strategies. Diagnostics, 14.","DOI":"10.20944\/preprints202401.2187.v1"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"300756","DOI":"10.1016\/j.hpr.2024.300756","article-title":"Something old, something new: Cervical cytopathology in the new era","volume":"37","author":"Tahboub","year":"2024","journal-title":"Hum. Pathol. Rep."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jasc.2017.07.004","article-title":"ASC-H cytological result: Clinical relevance and accuracy of colposcopy in predicting high-grade histological lesions-a 7-year experience of a single institution in Portugal","volume":"6","author":"Marujo","year":"2017","journal-title":"J. Am. Soc. Cytopathol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"16","DOI":"10.25259\/Cytojournal_24_2021","article-title":"Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System","volume":"18","author":"Alrajjal","year":"2021","journal-title":"CytoJournal"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"140","DOI":"10.7150\/jca.89715","article-title":"Prevalence of cervical precancers or cancers in women with ASC-H\/HSIL cytology according to Aptima HPV (AHPV) assay-detected HPV genotypes and age","volume":"15","author":"Liu","year":"2024","journal-title":"J. Cancer"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1001\/archfami.9.8.713","article-title":"Cost-effectiveness of the conventional papanicolaou test with a new adjunct to cytological screening for squamous cell carcinoma of the uterine cervix and its precursors","volume":"9","author":"Taylor","year":"2000","journal-title":"Arch. Fam. Med."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ejogrb.2024.02.032","article-title":"Self-sampling for HPV testing in cervical cancer screening: A scoping review","volume":"296","author":"Colonetti","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_110","first-page":"39","article-title":"Cervical Colposcopy: Indications and Risk Assessment","volume":"102","author":"Burness","year":"2020","journal-title":"Am. Fam. Physician"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"5738","DOI":"10.3390\/curroncol30060431","article-title":"2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia","volume":"30","author":"Willows","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.21873\/invivo.11906","article-title":"Comparison of HPV Testing and Colposcopy in Detecting Cervical Dysplasia in Patients with Cytological Abnormalities","volume":"34","author":"Czajkowski","year":"2020","journal-title":"In Vivo"},{"key":"ref_113","unstructured":"Melnikow, J., Henderson, J.T., Burda, B.U., Senger, C.A., Durbin, S., and Soulsby, M.A. (2025, January 13). Screening for Cervical Cancer with High-Risk Human Papillomavirus Testing: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK526312\/."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1038\/s41416-020-0790-1","article-title":"Real-world data on cervical cancer risk stratification by cytology and HPV genotype to inform the management of HPV-positive women in routine cervical screening","volume":"122","author":"Hashim","year":"2020","journal-title":"Br. J. Cancer"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1158\/1055-9965.EPI-22-0340","article-title":"Randomized Implementation of a Primary Human Papillomavirus Testing-based Cervical Cancer Screening Protocol for Women 34 to 69 Years in Norway","volume":"31","author":"Castle","year":"2022","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_116","unstructured":"(2024, September 29). WHO Recommends DNA Testing as a First-Choice Screening Method for Cervical Cancer Prevention. 11 September 2021. Available online: https:\/\/www.who.int\/europe\/news\/item\/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screening-method-for-cervical-cancer-prevention."},{"key":"ref_117","first-page":"e01889","article-title":"Implementing HPV-DNA Screening as Primary Cervical Cancer Screening Modality in Zimbabwe: Challenges and Recommendations","volume":"21","author":"Murewanhema","year":"2023","journal-title":"Sci. Afr."},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Na, J., Li, Y., Wang, J., Wang, X., Lu, J., and Han, S. (2023). The correlation between multiple HPV infections and the occurrence, development, and prognosis of cervical cancer. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1220522"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/LGT.0b013e31819308d4","article-title":"The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia","volume":"13","author":"Massad","year":"2009","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"909","DOI":"10.31083\/j.ejgo4205138","article-title":"Diagnostic value of colposcopy for cervical intraepithelial neoplasia 2\u20133\/carcinoma in situ and microinvasive cervical cancer","volume":"42","author":"Korolenkova","year":"2021","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Panagakis, G., Papapanagiotou, I.K., Theofanakis, C., Tsetsa, P., Kontogeorgi, A., Thomakos, N., Rodolakis, A., and Haidopoulos, D. (2023). Detection of High-Grade Cervical Intraepithelial Neoplasia by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade Cervical Intraepithelial Neoplasia in Cytology. Life, 13.","DOI":"10.20944\/preprints202309.0919.v1"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1200\/JCO.2014.55.9948","article-title":"Multiple biopsies and detection of cervical cancer precursors at colposcopy","volume":"33","author":"Wentzensen","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Bai, A., Wang, J., Li, Q., Seery, S., Xue, P., and Jiang, Y. (2022). Assessing colposcopic accuracy for high-grade squamous intraepithelial lesion detection: A retrospective, cohort study. BMC Women\u2019s Health, 22.","DOI":"10.1186\/s12905-022-01592-6"},{"key":"ref_124","first-page":"50","article-title":"When to suspect squamous cancer at colposcopy","volume":"26","author":"Wright","year":"2001","journal-title":"Nurse Pract."},{"key":"ref_125","unstructured":"Prendiville, W., and Sankaranarayanan, R. (2025, January 13). Colposcopy and Treatment of Cervical Precancer, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK568376\/."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/S1201-9712(07)60015-0","article-title":"Human papillomavirus infection and the development of cervical cancer and related genital neoplasias","volume":"11","author":"Paavonen","year":"2007","journal-title":"Int. J. Infect. Dis."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"5099","DOI":"10.2147\/CMAR.S225067","article-title":"Histopathological Diagnosis of Cervical Biopsies: Reduction of Sampling Errors with the Evaluation of a Third Histologic Level","volume":"12","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_128","first-page":"637","article-title":"Diagnosis and Treatment Protocols of Cutaneous Melanoma: Latest Approach 2010","volume":"105","author":"Petrescu","year":"2010","journal-title":"Chirurgia"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"6627531","DOI":"10.1155\/2021\/6627531","article-title":"Progression of CIN1\/LSIL HPV Persistent of the Cervix: Actual Progression or CIN3 Coexistence","volume":"2021","author":"Bruno","year":"2021","journal-title":"Infect. Dis. Obstet. Gynecol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/1\/18\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:29:45Z","timestamp":1759919385000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/1\/18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":129,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["diseases13010018"],"URL":"https:\/\/doi.org\/10.3390\/diseases13010018","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}