{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T15:09:51Z","timestamp":1779116991705,"version":"3.51.4"},"reference-count":51,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS) is a complex, multi-system disease characterized by a multitude of symptoms across various organ systems. Diagnosis has relied heavily on heterogeneous clinical symptom presentation and evolving case definitions, with treatment focused on addressing presenting symptoms due to the paucity of validated biomarkers. Meanwhile, advances have been made in understanding the underlying pathophysiology through strong epidemiologic, clinical, and basic science studies. This narrative review synthesizes recent advances that are likely to drive a shift in understanding from symptom-based classification toward a molecularly defined understanding of the disease. This shift in understanding will likely provide the foundation for future research efforts focused on targeting diagnosis and treatment more effectively. Specifically, we reference the identification of rare genetic risk variants through the HEAL2 deep learning framework, the large-scale DecodeME genome-wide association study, and dynamic epigenetic markers of disease state. In addition, the findings revealed the downstream consequences of this genetic and epigenetic priming: chronic innate immune activation, CD8+ T cell exhaustion characterized by upregulation of the exhaustion-driving transcription factors Thymocyte Selection-Associated HMG Box (TOX) and Eomesodermin (EOMES), and a cellular energy crisis centered on mitochondrial dysfunction. Furthermore, results of recent studies have revealed sex-specific transcriptomic and proteomic signatures of maladaptive recovery. We also highlight the role of machine learning and artificial intelligence integrations in translating high-dimensional multi-omics data into actionable biological insights, including the identification of monocyte subsets via Positive Unlabeled Learning, circulating cell-free RNA diagnostic signatures, and integrated multi-modal disease models such as BioMapAI. The combination of these findings, which highlight multiple identifiable mechanisms of molecular activity, support the feasibility of molecular subtyping, precision diagnostics, and targeted therapeutic strategies for ME\/CFS.<\/jats:p>","DOI":"10.3390\/ijms27104436","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T14:40:31Z","timestamp":1779115231000},"page":"4436","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward a Molecular Reclassification of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: Integrating Multi-Omics, Machine Learning, and Precision Medicine"],"prefix":"10.3390","volume":"27","author":[{"given":"Joshua","family":"Frank","sequence":"first","affiliation":[{"name":"Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Nesterovitch","sequence":"additional","affiliation":[{"name":"Halmos College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale, FL 33328, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chetana","family":"Movva","sequence":"additional","affiliation":[{"name":"Halmos College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale, FL 33328, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1459-3268","authenticated-orcid":false,"given":"Nancy G.","family":"Klimas","sequence":"additional","affiliation":[{"name":"Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1038-9083","authenticated-orcid":false,"given":"Lubov","family":"Nathanson","sequence":"additional","affiliation":[{"name":"Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Arron, H.E., Marsh, B.D., Kell, D.B., Khan, M.A., Jaeger, B.R., and Pretorius, E. (2024). Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: The biology of a neglected disease. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1386607"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zhang, S., Jahanbani, F., Chander, V., Kjellberg, M., Liu, M., Glass, K.A., Iu, D.S., Ahmed, F., Li, H., and Maynard, R.D. (2025). Dissecting the genetic complexity of myalgic encephalomyelitis\/chronic fatigue syndrome via deep learning-powered genome analysis. medRxiv.","DOI":"10.1101\/2025.04.15.25325899"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1476-5918-7-6","article-title":"The Economic impact of ME\/CFS: Individual and societal costs","volume":"7","author":"Jason","year":"2008","journal-title":"Dyn. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cortes Rivera, M., Mastronardi, C., Silva-Aldana, C.T., Arcos-Burgos, M., and Lidbury, B.A. (2019). Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: A Comprehensive Review. Diagnostics, 9.","DOI":"10.3390\/diagnostics9030091"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1177\/1742395316644770","article-title":"Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome","volume":"12","author":"Pendergrast","year":"2016","journal-title":"Chronic Illn."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Seton, K.A., Espejo-Oltra, J.A., Gim\u00e9nez-Orenga, K., Haagmans, R., Ramadan, D.J., and Mehlsen, J. (2024). Advancing Research and Treatment: An Overview of Clinical Trials in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS) and Future Perspectives. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020325"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1186\/s13148-020-00960-z","article-title":"Changes in DNA methylation profiles of myalgic encephalomyelitis\/chronic fatigue syndrome patients reflect systemic dysfunctions","volume":"12","author":"Helliwell","year":"2020","journal-title":"Clin. Epigenetics"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Maksoud, R., Magawa, C., Eaton-Fitch, N., Thapaliya, K., and Marshall-Gradisnik, S. (2023). Biomarkers for myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS): A systematic review. BMC Med., 21.","DOI":"10.1186\/s12916-023-02893-9"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Chu, L., Valencia, I.J., Garvert, D.W., and Montoya, J.G. (2019). Onset Patterns and Course of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00012"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1001\/jama.2020.12603","article-title":"Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19","volume":"324","author":"Bernabei","year":"2020","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tate, W.P., Walker, M.O.M., Peppercorn, K., Blair, A.L.H., and Edgar, C.D. (2023). Towards a Better Understanding of the Complexities of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome and Long COVID. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24065124"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chu, L., Valencia, I.J., Garvert, D.W., and Montoya, J.G. (2018). Deconstructing post-exertional malaise in myalgic encephalomyelitis\/chronic fatigue syndrome: A patient-centered, cross-sectional survey. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197811"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1186\/s12967-024-05410-5","article-title":"Cardiopulmonary and metabolic responses during a 2-day CPET in myalgic encephalomyelitis\/chronic fatigue syndrome: Translating reduced oxygen consumption to impairment status to treatment considerations","volume":"22","author":"Keller","year":"2024","journal-title":"J. Transl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.chest.2021.01.082","article-title":"Insights From Invasive Cardiopulmonary Exercise Testing of Patients With Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"160","author":"Joseph","year":"2021","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/07399332.2018.1521811","article-title":"Dismissing chronic illness: A qualitative analysis of negative health care experiences","volume":"40","author":"McManimen","year":"2019","journal-title":"Health Care Women Int."},{"key":"ref_16","first-page":"103","article-title":"Contrasting Case Definitions: The ME International Consensus Criteria vs. the Fukuda et al. CFS Criteria","volume":"15","author":"Brown","year":"2013","journal-title":"N. Am. J. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1080\/09638288.2022.2043462","article-title":"Evaluating case diagnostic criteria for myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS): Toward an empirical case definition","volume":"45","author":"Conroy","year":"2023","journal-title":"Disabil. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Thoma, M., Froehlich, L., Hattesohl, D.B.R., Quante, S., Jason, L.A., and Scheibenbogen, C. (2023). Why the Psychosomatic View on Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients. Medicina, 60.","DOI":"10.3390\/medicina60010083"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Deumer, U.-S., Varesi, A., Floris, V., Savioli, G., Mantovani, E., L\u00f3pez-Carrasco, P., Rosati, G.M., Prasad, S., and Ricevuti, G. (2021). Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS): An Overview. J. Clin. Med., 10.","DOI":"10.3390\/jcm10204786"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12967-024-05915-z","article-title":"Machine learning and multi-omics in precision medicine for ME\/CFS","volume":"23","author":"Huang","year":"2025","journal-title":"J. Transl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1080\/15592294.2018.1549769","article-title":"Genome-epigenome interactions associated with Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"13","author":"Herrera","year":"2018","journal-title":"Epigenetics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"220","DOI":"10.5808\/GI.2012.10.4.220","article-title":"A short history of the genome-wide association study: Where we were and where we are going","volume":"10","author":"Ikegawa","year":"2012","journal-title":"Genom. Inform."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1016\/j.cell.2018.07.021","article-title":"Decoding the Genomics of Abdominal Aortic Aneurysm","volume":"174","author":"Li","year":"2018","journal-title":"Cell"},{"key":"ref_24","unstructured":"Genetics Delivery Team, Boutin, T., Bretherick, A.D., Dibble, J.J., Ewaoluwagbemiga, E., Northwood, E., Samms, G.L., Vitart, V., Project and Cohort Delivery Team, and Almelid, \u00d8. (2025). Initial findings from the DecodeME genome-wide association study of myalgic encephalomyelitis\/chronic fatigue syndrome. medRxiv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0048-9697(00)00777-4","article-title":"Chronic fatigue syndrome following a toxic exposure","volume":"270","author":"Racciatti","year":"2001","journal-title":"Sci. Total Environ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12967-023-03887-0","article-title":"The persistent viral infections in the development and severity of myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"21","author":"Krumina","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/joim.13792","article-title":"Epigenetic reprograming in myalgic encephalomyelitis\/chronic fatigue syndrome: A narrative of latent viruses","volume":"296","author":"Apostolou","year":"2024","journal-title":"J. Intern. Med."},{"key":"ref_28","first-page":"1","article-title":"Acute psychosocial stress-mediated changes in the expression and methylation of perforin in chronic fatigue syndrome","volume":"5","author":"Falkenberg","year":"2013","journal-title":"Genet. Epigenetics"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Helliwell, A.M., Stockwell, P.A., Edgar, C.D., Chatterjee, A., and Tate, W.P. (2022). Dynamic Epigenetic Changes during a Relapse and Recovery Cycle in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome. Int. J. Mol. Sci., 23.","DOI":"10.1101\/2022.02.24.22270912"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1080\/10408363.2017.1410520","article-title":"Epigenetic biomarkers: Current strategies and future challenges for their use in the clinical laboratory","volume":"54","author":"Tollefsbol","year":"2017","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.clinthera.2019.02.012","article-title":"Epigenetic Components of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome Uncover Potential Transposable Element Activation","volume":"41","author":"Ovejero","year":"2019","journal-title":"Clin. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"de Vega, W.C., Herrera, S., Vernon, S.D., and McGowan, P.O. (2017). Epigenetic modifications and glucocorticoid sensitivity in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS). BMC Med. Genom., 10.","DOI":"10.1186\/s12920-017-0248-3"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Trivedi, M.S., Oltra, E., Sarria, L., Rose, N., Beljanski, V., Fletcher, M.A., Klimas, N.G., and Nathanson, L. (2018). Identification of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome-associated DNA methylation patterns. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0201066"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Sharma, S., Hodges, L.D., Peppercorn, K., Davis, J., Edgar, C.D., Rodger, E.J., Chatterjee, A., and Tate, W.P. (2025). Precision Medicine Study of Post-Exertional Malaise Epigenetic Changes in Myalgic Encephalomyelitis\/Chronic Fatigue Patients During Exercise. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26178563"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1172\/JCI132185","article-title":"Myalgic encephalomyelitis\/chronic fatigue syndrome patients exhibit altered T cell metabolism and cytokine associations","volume":"130","author":"Mandarano","year":"2020","journal-title":"J. Clin. Investig."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s10020-023-00766-8","article-title":"The potential role of ocular and otolaryngological mucus proteins in myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"30","author":"Huitsing","year":"2024","journal-title":"Mol. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101373","DOI":"10.1016\/j.xcrm.2023.101373","article-title":"Single-cell transcriptomics of the immune system in ME\/CFS at baseline and following symptom provocation","volume":"5","author":"Vu","year":"2024","journal-title":"Cell Rep. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2415119121","DOI":"10.1073\/pnas.2415119121","article-title":"Transcriptional reprogramming primes CD8+ T cells toward exhaustion in Myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"121","author":"Iu","year":"2024","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"102449","DOI":"10.1016\/j.xcrm.2025.102449","article-title":"Integrated immune, hormonal, and transcriptomic profiling reveals sex-specific dysregulation in long COVID patients with ME\/CFS","volume":"6","author":"Shahbaz","year":"2025","journal-title":"Cell Rep. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"RP104441","DOI":"10.7554\/eLife.104441.3","article-title":"HERV activation segregates ME\/CFS from fibromyalgia while defining a novel nosologic entity","volume":"14","author":"Nathanson","year":"2025","journal-title":"eLife"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Gamer, J., Van Booven, D.J., Zarnowski, O., Arango, S., Elias, M., Kurian, A., Joseph, A., Perez, M., Collado, F., and Klimas, N. (2023). Sex-Dependent Transcriptional Changes in Response to Stress in Patients with Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: A Pilot Project. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241210255"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Van Booven, D.J., Gamer, J., Joseph, A., Perez, M., Zarnowski, O., Pandya, M., Collado, F., Klimas, N., Oltra, E., and Nathanson, L. (2023). Stress-Induced Transcriptomic Changes in Females with Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome Reveal Disrupted Immune Signatures. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24032698"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.jad.2011.09.004","article-title":"Evidence for inflammation and activation of cell-mediated immunity in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS): Increased interleukin-1, tumor necrosis factor-\u03b1, PMN-elastase, lysozyme and neopterin","volume":"136","author":"Maes","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E7150","DOI":"10.1073\/pnas.1710519114","article-title":"Cytokine signature associated with disease severity in chronic fatigue syndrome patients","volume":"114","author":"Montoya","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1186\/s12967-023-04179-3","article-title":"Proteomics and cytokine analyses distinguish myalgic encephalomyelitis\/chronic fatigue syndrome cases from controls","volume":"21","author":"Giloteaux","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_46","first-page":"E5472","article-title":"Metabolic features of chronic fatigue syndrome","volume":"113","author":"Naviaux","year":"2016","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Fernandez-Guerra, P., Gonzalez-Ebsen, A.C., Boonen, S.E., Courraud, J., Gregersen, N., Mehlsen, J., Palmfeldt, J., Olsen, R.K.J., and Brinth, L.S. (2021). Bioenergetic and Proteomic Profiling of Immune Cells in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome Patients: An Exploratory Study. Biomolecules, 11.","DOI":"10.3390\/biom11070961"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"101467","DOI":"10.1016\/j.mcpro.2025.101467","article-title":"Temporal Dynamics of the Plasma Proteomic Landscape Reveals Maladaptation in ME\/CFS Following Exertion","volume":"24","author":"Germain","year":"2025","journal-title":"Mol. Cell. Proteom."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e2507345122","DOI":"10.1073\/pnas.2507345122","article-title":"Circulating cell-free RNA signatures for the characterization and diagnosis of myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"122","author":"Gardella","year":"2025","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1038\/s43856-024-00669-7","article-title":"Discriminating Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome and comorbid conditions using metabolomics in UK Biobank","volume":"4","author":"Huang","year":"2024","journal-title":"Commun. Med."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Xiong, R., Aiken, E., Caldwell, R., Vernon, S.D., Kozhaya, L., Gunter, C., Bateman, L., Unutmaz, D., and Oh, J. (2025). BioMapAI: Artificial Intelligence Multi-Omics Modeling of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome. bioRxiv.","DOI":"10.1101\/2024.06.24.600378"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/10\/4436\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T14:46:56Z","timestamp":1779115616000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/10\/4436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":51,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijms27104436"],"URL":"https:\/\/doi.org\/10.3390\/ijms27104436","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]}}}