{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:14:41Z","timestamp":1760058881050,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without any antithrombotic therapy in this category of patients. Methods: A total of 129 patients (male 85, mean age 76.6 \u00b1 7.1, CHA2DS2Vasc 3.8 \u00b1 1.5, HASBLED 3.3 \u00b1 1.0; upper GI bleeding 10%, lower GI bleeding 86%, obscure occult 4.6%, on NOACS full dose 77.5%, NOACs reduced dose 13.1%, on anti-vitamin K 9.3%) with atrial fibrillation and history of repetitive gastrointestinal bleeding from ten centers underwent standalone thoracoscopic epicardial appendage closure without antithrombotic therapy for the entire follow up. Results: The observed bleeding rate was 0.91 events per year, equivalent to a relative risk of RR = 0.17 (p = 0.02) and a relative risk reduction (RRR) of 83%. The observed relative risk of stroke was 0.91 events per year, with a relative risk of RR = 0.19 (p = 0.03) and a relative risk reduction (RRR) of 81%. Conclusion: Standalone epicardial appendage occlusion without antithrombotic therapy in patients with repetitive gastrointestinal bleeding is safe and promising when rebleeding and stroke risk reduction need to be optimized.<\/jats:p>","DOI":"10.3390\/jcdd12050173","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:49:02Z","timestamp":1746082142000},"page":"173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7419-1709","authenticated-orcid":false,"given":"Stefano","family":"Branzoli","sequence":"first","affiliation":[{"name":"Cardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"},{"name":"Cardiac Surgery Department, Universitair Ziekenhuis, Av du Laerbeek 101, 1090 Brussel, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9388-3292","authenticated-orcid":false,"given":"Massimiliano","family":"Marini","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"},{"name":"Heart Rhythm Management Center, Universitair Ziekenhuis, Av du Laerbeek 101, 1090 Brussel, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Catanzariti","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0128-9489","authenticated-orcid":false,"given":"Cecilia","family":"Pravadelli","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9769-1511","authenticated-orcid":false,"given":"Luigi","family":"Pannone","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Center, Universitair Ziekenhuis, Av du Laerbeek 101, 1090 Brussel, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"D\u2019Onghia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Fantinel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Maria Hospital, Via Bagnols sur Ceze, 32032 Feltre, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Guarracini","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Niguarda Hospital, Piazza Ospedale Maggiore, 20162 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaia","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirco","family":"Zadro","sequence":"additional","affiliation":[{"name":"Cardiology Department, San Bassiano Hospital, Via Lotti, 36061 Bassano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Baroni","sequence":"additional","affiliation":[{"name":"Cardiology Department, San Bassiano Hospital, Via Lotti, 36061 Bassano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4111-1810","authenticated-orcid":false,"given":"Silvia","family":"Casagrande","sequence":"additional","affiliation":[{"name":"Neurology Unit, Santa Maria del Carmine Hospital, Corso Verona, 38068 Rovereto, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donatella","family":"Ottaviani","sequence":"additional","affiliation":[{"name":"Neurology Unit, Santa Maria del Carmine Hospital, Corso Verona, 38068 Rovereto, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato","family":"Turco","sequence":"additional","affiliation":[{"name":"Geriatrics Department, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6316-4091","authenticated-orcid":false,"given":"Serena","family":"Nicolussi Paolaz","sequence":"additional","affiliation":[{"name":"Geriatrics Department, Santa Maria del Carmine Hospital, Corso Verona, 38068 Rovereto, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciano","family":"Annicchiarico","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Corsini","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4111-1690","authenticated-orcid":false,"given":"Roberto","family":"Rordorf","sequence":"additional","affiliation":[{"name":"Department of Cardiology, IRCCS San Matteo, Via Golgi, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kausilia","family":"Krishnadath","sequence":"additional","affiliation":[{"name":"Gastroneterology Department, Universitair Ziekenhuis Antwerpen, 2650 Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavia","family":"Ravelli","sequence":"additional","affiliation":[{"name":"Laboratory of Biophysic and Translation Cardiology, Department of Cellular Computational and Integrative Biology (CIBIO), Centre for Medical Sciences (CISMed), University of Trento, 38123 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"de Asmundis","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Center, Universitair Ziekenhuis, Av du Laerbeek 101, 1090 Brussel, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"La Meir","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s10840-024-01771-5","article-title":"2024 Eurpean heart Rhythm Association\/Heart Rhythm Society\/Asaia Pacific Heart Rhythm Society\/Latin American Heart Rhythm Society expert consensus statment on catheter and surgical ablation of atrial fibrillation","volume":"67","author":"Tzeis","year":"2024","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","article-title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A metanalysis of randomized trials","volume":"383","author":"Ruff","year":"2014","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1093\/eurheartj\/ehy802","article-title":"Efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: A meta-analysis of randomized controlled trials","volume":"40","author":"Wang","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s10840-023-01585-x","article-title":"Lower\u2013adherence direct oral anticoagulant use is associated with increased risk of thromboembolic events than warfarin","volume":"67","author":"Bawa","year":"2024","journal-title":"Int. J. Card. Electrophys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s10840-020-00873-0","article-title":"Incidence outcomes of patients with atrial fibrillation major bleeding complications:from the TREAT-AFstudy","volume":"62","author":"Perino","year":"2021","journal-title":"J. Interv. Card. Electr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1002\/ccd.30629","article-title":"Clinical outcomes of left atrial appendage occlusion in patients with previous intracranial or gastrointestinal bleeding: Insights from the LOGIC (Left atrial appendage Occlusion in patients with Gastrointestinal or IntraCranial bleeding) International Multicenter Registry","volume":"101","author":"Gallo","year":"2023","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.amjcard.2017.04.046","article-title":"Left atrial appendage occlusion in patients with atrial fibrillation and previous major gastrointestinal bleeding (from the amplatzer cardiac plug multicenter registry)","volume":"120","author":"Lempereur","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kramer, A., Patti, G., Nielsen-Kudsk, J., Beri, S., and Korsholm, K. (2024). Left atrial appendage occlusion and post procedural antithrombotic management. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030803"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.amjcard.2021.05.010","article-title":"Metanalysis comparing antiplatelet therapy versus direct oral anticoagulation in percutaneous left atrial appendage closure","volume":"153","author":"Prasad","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1136\/gutjnl-2020-321585","article-title":"Major GI bleeding in older persons using aspirin: Incidence and risk factors in the ASPREE randomized controlled trial","volume":"70","author":"Mahady","year":"2021","journal-title":"Gut"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1097\/MEG.0b013e32830e491c","article-title":"Risk factors for recurrence of acute gastrointestinal bleeding from angiodysplasia","volume":"21","author":"Saperas","year":"2009","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1055\/a-1496-8969","article-title":"Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gatrointestinal Endoscopy (ESGE) Guidelin","volume":"53","author":"Triantafyllou","year":"2021","journal-title":"Endoscopy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1055\/a-1369-5274","article-title":"Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscoy (ESGE) Guidelines-update","volume":"53","author":"Gralnek","year":"2021","journal-title":"Endoscopy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"AHA Guidelines for diagnosis and management of atrial Fibrillation","volume":"149","author":"Joglar","year":"2024","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1161\/hs1001.096191","article-title":"Validating the Questionnaire for verifying stroke free status QSVS by neurological history and examination","volume":"32","author":"Jones","year":"2001","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1016\/j.athoracsur.2020.04.130","article-title":"Stand alone totally thoracoscopic left appendage clipping: Safe simple standardized","volume":"111","author":"Branzoli","year":"2021","journal-title":"Ann. Thor. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.cgh.2014.11.007","article-title":"Risk of upper and lower gastrointestinal bleeding in patients taking non steroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants","volume":"13","author":"Lanas","year":"2015","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.amjcard.2021.01.020","article-title":"Frequency, trend, predictors, and impact of gastrointestinal bleeding in atrial fibrillation hospitalizations","volume":"146","author":"Dave","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.amjcard.2013.10.044","article-title":"Restarting anticoagulation and outcomes after major gastrointestinal bleeding in atrial fibrillation","volume":"113","author":"Qureshi","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1001\/archinternmed.2012.4261","article-title":"Risk of thromboembolism, recurrent hemorrhage, and death after warfarin therapy interruption for gastrointestinal tract bleeding","volume":"172","author":"Witt","year":"2012","journal-title":"Arch. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1038\/ajg.2014.398","article-title":"The risks of thromboembolism vs. recurrent gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized inpatients with gastrointestinal bleeding: A prospective study","volume":"110","author":"Sengupta","year":"2015","journal-title":"Am. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"542","DOI":"10.14309\/ajg.0000000000001627","article-title":"American College of Gastroenterology\u2013Canadian Association of Gastroenterology practice Guideline: Management of anticoagulants and antiplatelet during acute gastrointestinal bleeding and the periendoscopic period","volume":"117","author":"Abraham","year":"2022","journal-title":"Am. J. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1136\/gutjnl-2021-325184","article-title":"Endoscopy in patients on antiplatelet or anticoagulnat therapy: British Society of GAstroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) Guideline update","volume":"70","author":"Veitch","year":"2021","journal-title":"Gut"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/apt.15441","article-title":"Risk of rebleeding, vascular and death after gastrointestinal bleeding in anticoagulant and\/or antiplatelet users","volume":"50","author":"Sostres","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/MCG.0b013e31811edd13","article-title":"Gastrointestinal bleeding in the setting of anticoagulation and antiplatelet therapy","volume":"43","author":"Barada","year":"2009","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.jacc.2015.06.1323","article-title":"Incidence, predictors, and impact of post-discharge bleeding after percutaneous coronary intervention","volume":"66","author":"Giustino","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejim.2020.11.014","article-title":"Gastroprotection in patients on antiplatelet and\/or anticoagulant therapy: A position paperof national Association of Hospital cardiologist (ANMCO) and the Italian association of Hospital gastroenterologist and endoscopist (AIGO)","volume":"85","author":"Abrignani","year":"2021","journal-title":"Eur. J. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1056\/NEJMoa2108749","article-title":"Dual antiplatelet therapy after PCI in patients at high bleeding risk","volume":"385","author":"Valgimigli","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jacc.2021.10.028","article-title":"Magnetically controlled capsule endoscopy for assessment of antiplatelet therapy-induced gastrointestinal injury","volume":"79","author":"Han","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.amjcard.2016.07.025","article-title":"Temporal trends, predictors, and outcomes of in-hospital gastrointestinal bleeding associated with percutaneous coronary intervention","volume":"118","author":"Patel","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Branzoli, S., Guarracini, F., Marini, M., D\u2019onghia, G., Catanzariti, D., Merola, E., Annicchiarico, L., Casagranda, G., Stegagno, C., and Fantinel, M. (2022). Heart team for left appendage occlusion without the use of antithrombotic therapy: The epicardial perspective. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216492"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1093\/europace\/euaa004","article-title":"A Collective European experience with left atrial appendage suture ligation using the LARIAT device","volume":"22","author":"Tilz","year":"2020","journal-title":"Europace"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1016\/j.hrthm.2018.05.026","article-title":"Thoracoscopic stapler and loop technique for left atrial appendage closure in non valvular atrial fibrillation: Mid term outcomes in 201 patients","volume":"15","author":"Ohtsuka","year":"2018","journal-title":"Heart Rhthm."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2894","DOI":"10.1093\/eurheartj\/ehaa169","article-title":"Left atrial appendage occlusion with the Amplatzer Amulet device: Full results of the prospective global observational study","volume":"41","author":"Landmesser","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1016\/j.jcin.2020.06.003","article-title":"The impact of CHA2DS2-VASc and HAS-BLED scores on clinical outcomes in the Amplatzer Amulet study","volume":"13","author":"Tarantini","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e006841","DOI":"10.1161\/CIRCEP.118.006841","article-title":"Evaluating real-world clinical outcomes in atrial fibrillation patients receiving the Watchman left atrial appendage closure technology","volume":"12","author":"Boersma","year":"2019","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100136","DOI":"10.1016\/j.jacadv.2022.100136","article-title":"Left atrial appendage occlusion, current advances and remaining challenges","volume":"1","author":"Alkhouli","year":"2022","journal-title":"JACC Adv."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/icvts\/ivz156","article-title":"Outcomes of left atrial appendage occlusion using the AtriClip device: A systematic review","volume":"29","author":"Toale","year":"2019","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/icvts\/ivab334","article-title":"Standalone epicardial left appendage exclusion for thromboemolism prevention in atrial fibrillation","volume":"34","author":"Cartledge","year":"2021","journal-title":"Inter. Cardiovasc. Thor. Surg."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/5\/173\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:25:57Z","timestamp":1760030757000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/5\/173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcdd12050173"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12050173","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}