{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:37:15Z","timestamp":1786628235816,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009018","name":"Shanghai Municipal Talent Work Bureau","doi-asserted-by":"publisher","award":["QNWS2025043"],"award-info":[{"award-number":["QNWS2025043"]}],"id":[{"id":"10.13039\/501100009018","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82401047"],"award-info":[{"award-number":["82401047"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["82401047"],"award-info":[{"award-number":["82401047"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"crossref","award":["2023ZZ02009"],"award-info":[{"award-number":["2023ZZ02009"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"crossref","award":["20254Y0089"],"award-info":[{"award-number":["20254Y0089"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100018684","name":"Nation Key Clinical Program on Orthodontics","doi-asserted-by":"publisher","award":["GJLCZDZK2023-01"],"award-info":[{"award-number":["GJLCZDZK2023-01"]}],"id":[{"id":"10.13039\/501100018684","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Pediatric obstructive sleep apnea (OSA), particularly when accompanied by mandibular retrognathia, presents as a complex, multifactorial condition. Dentofacial orthopedic treatment (DOT) has gained increasing clinical attention; however, high-level evidence specifically demonstrating its efficacy in pediatric OSA remains scarce. This study aimed to evaluate the efficacy of DOT and AT in managing mild to moderate OSA in children with mandibular retrognathia. Methods: This open-label, randomized controlled clinical trial recruited 93 children aged 7\u201310 years with mild to moderate OSA (an AHI of 1\u201310 events per hour) and mandibular retrognathia (ANB angle \u2265 4.5\u00b0). Participants were randomly allocated to four groups: pharmacotherapy, DOT (combined maxillary expansion and mandibular advancement appliance), AT (adenotonsillectomy under general anesthesia), and AT &amp; DOT groups. The primary outcome was the change in apnea\u2013hypopnea index (AHI) from baseline to 7 months post-treatment. Secondary outcomes included assessments of dentofacial development and volumetric changes in the upper airway. Results: Because of the high dropout\/loss-to-follow-up rates in the pharmacotherapy and AT plus DOT groups, the final analysis was restricted to the DOT and AT groups, in which the overall dropout\/loss-to-follow-up rate was 19.6%. Among the 43 participants allocated to the DOT (8 girls and 15 boys) and AT groups (8 girls and 12 boys), 36 completed the follow-up, the median baseline AHI was 3.7 events\/h [IQR, 1.9\u20134.4]. Per protocol analysis revealed a mean reduction in AHI of 1.6 events\/h in the DOT group and 1.3 events\/h in the AT group, with no significant difference between the groups (\u22120.43 [95% CI, \u22121.48 to 0.61], p = 0.40). DOT significantly promoted sagittal mandibular growth without inducing a vertical clockwise rotation tendency, whereas AT had no significant effect on dentofacial development. Total upper airway volume increased significantly in both groups, with the increase concentrated in different regions of the upper airway depending on the group. Conclusions: In children with mild to moderate OSA and mandibular retrognathia, DOT demonstrated comparable efficacy to AT, which may be attributable to favorable anatomical remodeling of the upper airway.<\/jats:p>","DOI":"10.3390\/dj14080511","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:32:16Z","timestamp":1786444336000},"page":"511","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dentofacial Orthopedic Treatment vs. Adenotonsillectomy in Children with Mild to Moderate OSA and Mandibular Retrognathia: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1680-9255","authenticated-orcid":false,"given":"Yuanyuan","family":"Li","sequence":"first","affiliation":[{"name":"Sleep Disordered Breathing Center & Department of Pediatric Dentistry, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 200001, China"},{"name":"Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peipei","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China"},{"name":"Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anqi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Shanghai Ninth People\u2019s Hospital, College of Stomatology, School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University, Shanghai 200011, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7151-3347","authenticated-orcid":false,"given":"Chen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China"},{"name":"Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Yu","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China"},{"name":"Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Yang","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China"},{"name":"Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Biomedical Informatics & Statistics Center, School of Public Health, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5385-7452","authenticated-orcid":false,"given":"Bingjiao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China"},{"name":"Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery, Shanghai Children\u2019s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3033-8873","authenticated-orcid":false,"given":"Yuehua","family":"Liu","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai 200001, China"},{"name":"Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 200001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1136\/thx.2010.134858","article-title":"Epidemiology of obstructive sleep apnoea syndrome in Chinese children: A two-phase community study","volume":"65","author":"Li","year":"2010","journal-title":"Thorax"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101871","DOI":"10.1016\/j.smrv.2023.101871","article-title":"Prevalence of obstructive sleep apnea (OSA) among preschool aged children in the general population: A systematic review","volume":"73","author":"Magnusdottir","year":"2024","journal-title":"Sleep Med. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1183\/13993003.00385-2015","article-title":"Obstructive sleep disordered breathing in 2- to 18-year-old children: Diagnosis and management","volume":"47","author":"Kaditis","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e714","DOI":"10.1542\/peds.2012-1672","article-title":"Diagnosis and management of childhood obstructive sleep apnea syndrome","volume":"130","author":"Marcus","year":"2012","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gulotta, G., Iannella, G., Vicini, C., Polimeni, A., Greco, A., de Vincentiis, M., Visconti, I.C., Meccariello, G., Cammaroto, G., and De Vito, A. (2019). Risk Factors for Obstructive Sleep Apnea Syndrome in Children: State of the Art. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16183235"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111462","DOI":"10.1016\/j.ijporl.2023.111462","article-title":"Efficacy of adenotonsillectomy in the treatment of obstructive apnea in children: A 2-year follow-up","volume":"166","author":"Pizarro","year":"2023","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1056\/NEJMoa1215881","article-title":"A randomized trial of adenotonsillectomy for childhood sleep apnea","volume":"368","author":"Marcus","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1001\/jama.2023.22114","article-title":"Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial","volume":"330","author":"Redline","year":"2023","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e468","DOI":"10.1055\/s-0043-1776747","article-title":"Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review","volume":"16","author":"Albertini","year":"2023","journal-title":"Sleep Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s11325-011-0505-1","article-title":"Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up","volume":"15","author":"Villa","year":"2011","journal-title":"Sleep Breath."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.sleep.2024.01.030","article-title":"Pharmacological interventions for pediatric obstructive sleep apnea (OSA): Network meta-analysis","volume":"116","author":"Zhang","year":"2024","journal-title":"Sleep Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1111\/joor.13325","article-title":"Efficiency of oro-facial myofunctional therapy in treating obstructive sleep apnoea: A meta-analysis of observational studies","volume":"49","author":"Zhang","year":"2022","journal-title":"J. Oral. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00408-020-00342-5","article-title":"Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome","volume":"198","author":"Bitners","year":"2020","journal-title":"Lung"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1586\/ers.11.7","article-title":"Obstructive sleep apnea syndrome in children","volume":"5","author":"Tauman","year":"2011","journal-title":"Expert. Rev. Respir. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.otohns.2009.01.043","article-title":"Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea\/hypopnea syndrome","volume":"140","author":"Friedman","year":"2009","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1164\/rccm.200912-1930OC","article-title":"Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: A multicenter retrospective study","volume":"182","author":"Bhattacharjee","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101733","DOI":"10.1016\/j.smrv.2022.101733","article-title":"The role of rapid maxillary expansion in pediatric obstructive sleep apnea: Efficacy, mechanism and multidisciplinary collaboration","volume":"67","author":"Xie","year":"2023","journal-title":"Sleep Med. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1164\/rccm.202310-1857ST","article-title":"Management of Persistent, Post-adenotonsillectomy Obstructive Sleep Apnea in Children: An Official American Thoracic Society Clinical Practice Guideline","volume":"209","author":"Ehsan","year":"2024","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.ajodo.2026.01.014","article-title":"Sleep-disordered breathing and orthodontics: An American Association of Orthodontists white paper update","volume":"169","author":"Palomo","year":"2026","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1186\/s13063-020-04398-9","article-title":"The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: Study protocol for a multicenter randomized controlled trial","volume":"21","author":"Li","year":"2020","journal-title":"Trials"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s11325-015-1287-7","article-title":"Use of the sleep clinical record in the follow-up of children with obstructive sleep apnea (OSA) after treatment","volume":"20","author":"Villa","year":"2016","journal-title":"Sleep Breath."},{"key":"ref_22","first-page":"S1","article-title":"Clinical Practice Guideline: Tonsillectomy in Children (Update)","volume":"160","author":"Mitchell","year":"2019","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Working Group of Chinese Guidelines for the Diagnosis and Treatment of Childhood OSA, Subspecialty Group of Pediatrics, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association, Subspecialty Group of Respiratory Diseases, Society of Pediatrics, Chinese Medical Association, Society of Pediatric Surgery, Chinese Medical Association, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, and Ni, X. (2021). Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020). World J. Otorhinolaryngol. Head. Neck Surg., 7, 201\u2013220.","DOI":"10.1016\/j.wjorl.2021.04.005"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Samara, P., Athanasopoulos, M., and Athanasopoulos, I. (2023). Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery. Microorganisms, 11.","DOI":"10.3390\/microorganisms11071624"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S2213-2600(22)00262-4","article-title":"Persistent obstructive sleep apnoea in children: Treatment options and management considerations","volume":"11","author":"Ersu","year":"2023","journal-title":"Lancet Respir. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s11325-013-0840-5","article-title":"Effects of twin block appliance on obstructive sleep apnea in children: A preliminary study","volume":"17","author":"Zhang","year":"2013","journal-title":"Sleep Breath."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1002\/lary.26352","article-title":"Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis","volume":"127","author":"Camacho","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ajodo.2019.12.026","article-title":"Analysis of dental and basal bone arch form correlations in skeletal Class II malocclusion","volume":"159","author":"Fu","year":"2021","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ajodo.2011.02.019","article-title":"Does rapid maxillary expansion have long-term effects on airway dimensions and breathing?","volume":"140","author":"Baratieri","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_30","first-page":"e403","article-title":"Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: A pilot study","volume":"21","author":"Signorelli","year":"2016","journal-title":"Med. Oral. Patol. Oral. Cir. Bucal"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.chest.2019.03.007","article-title":"How OSA Evolves From Childhood to Young Adulthood: Natural History From a 10-Year Follow-up Study","volume":"156","author":"Chan","year":"2019","journal-title":"Chest"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/coa.12549","article-title":"Polysomnographic findings after adenotonsillectomy for obstructive sleep apnoea in obese and non-obese children: A systematic review and meta-analysis","volume":"41","author":"Lee","year":"2016","journal-title":"Clin. Otolaryngol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.jpeds.2006.08.067","article-title":"Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy","volume":"149","author":"Tauman","year":"2006","journal-title":"J. Pediatr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1097\/MLG.0b013e318123ee56","article-title":"Adenotonsillectomy for obstructive sleep apnea in children: Outcome evaluated by pre- and postoperative polysomnography","volume":"117","author":"Mitchell","year":"2007","journal-title":"Laryngoscope"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5665\/sleep.3310","article-title":"Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: A prospective longitudinal study","volume":"37","author":"Huang","year":"2014","journal-title":"Sleep"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1259\/0007-1285-54-638-117","article-title":"A longitudinal study of the growth of the nasopharynx and its contents in normal children","volume":"54","author":"Jeans","year":"1981","journal-title":"Br. J. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jpeds.2012.07.041","article-title":"Age-dependent changes in the size of adenotonsillar tissue in childhood: Implications for sleep-disordered breathing","volume":"162","author":"Papaioannou","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Maniaci, A., Lavalle, S., Anzalone, R., Lo Giudice, A., Cocuzza, S., Parisi, F.M., Torrisi, F., Iannella, G., Sireci, F., and Fadda, G. (2024). Oral Health Implications of Obstructive Sleep Apnea: A Literature Review. Biomedicines, 12.","DOI":"10.3390\/biomedicines12071382"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40510-024-00524-4","article-title":"Obstructive sleep apnea: What is an orthodontist\u2019s role?","volume":"25","author":"Kazmierski","year":"2024","journal-title":"Prog. Orthod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e055964","DOI":"10.1136\/bmjopen-2021-055964","article-title":"Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: Study design and protocol for a non-inferiority randomised controlled trial","volume":"12","author":"Li","year":"2022","journal-title":"BMJ Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e081123","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 Statement: Updated guideline for reporting randomised trials","volume":"388","author":"Hopewell","year":"2025","journal-title":"BMJ"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/8\/511\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:01:58Z","timestamp":1786626118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/8\/511"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["dj14080511"],"URL":"https:\/\/doi.org\/10.3390\/dj14080511","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}