{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:17:01Z","timestamp":1791566221203,"version":"4.3.4"},"reference-count":58,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Nowadays, a classification system for unilateral stiff-knee gait (SKG) kinematic severity in hemiparetic adult patients after stroke does not exist. However, such classification would be useful to the clinicians. We proposed the use of the k-means method in order to define unilateral SKG severity clusters in hemiparetic adults after stroke. A retrospective k-means cluster analysis was applied to five selected knee kinematic parameters collected during gait in 96 hemiparetic adults and 19 healthy adults from our clinical gait analysis database. A total of five discrete knee kinematic clusters were determined. Three clusters of SKG were identified, based on which a three-level severity classification was defined: unbend-knee gait, braked-knee gait, and frozen-limb gait. Preliminary construct validity of the classification was obtained. All selected knee kinematic parameters defining the five clusters and the majority of usual kinematic parameters of the lower limbs showed statistically significant differences between the different clusters. We recommend diagnosing SKG for values strictly below 40\u00b0 of knee flexion during the swing phase. Clinicians and researchers are now able to specify the level of kinematic severity of SKG in order to optimize treatment choices and future clinical trial eligibility criteria.<\/jats:p>","DOI":"10.3390\/jcm11216270","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T23:50:28Z","timestamp":1666741828000},"page":"6270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Classification of Stiff-Knee Gait Kinematic Severity after Stroke Using Retrospective k-Means Clustering Algorithm"],"prefix":"10.3390","volume":"11","author":[{"given":"Fr\u00e9d\u00e9ric","family":"Chantraine","sequence":"first","affiliation":[{"name":"Laboratoire d\u2019Analyse du Mouvement et de la Posture (LAMP), Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, Rue Andr\u00e9 V\u00e9sale 1, 2674 Luxembourg, Luxembourg"},{"name":"Medical Department, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, Rue Andr\u00e9 V\u00e9sale 1, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Schreiber","sequence":"additional","affiliation":[{"name":"Laboratoire d\u2019Analyse du Mouvement et de la Posture (LAMP), Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, Rue Andr\u00e9 V\u00e9sale 1, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Alexandre Carvalho","family":"Pereira","sequence":"additional","affiliation":[{"name":"Medical Department, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, Rue Andr\u00e9 V\u00e9sale 1, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6671-5218","authenticated-orcid":false,"given":"J\u00e9r\u00f4me","family":"Kaps","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, Rue Andr\u00e9 V\u00e9sale 1, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Dierick","sequence":"additional","affiliation":[{"name":"Laboratoire d\u2019Analyse du Mouvement et de la Posture (LAMP), Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, Rue Andr\u00e9 V\u00e9sale 1, 2674 Luxembourg, Luxembourg"},{"name":"Facult\u00e9 des Sciences de la Motricit\u00e9, UCLouvain, Place Pierre de Coubertin 1-2, 1348 Ottignies-Louvain-la-Neuve, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1310\/tsr1605-346","article-title":"Understanding Motor Impairment in the Paretic Lower Limb after a Stroke: A Review of the Literature","volume":"16","author":"Arene","year":"2009","journal-title":"Top. Stroke Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1310\/tsr2005-441","article-title":"Sensory Impairments of the Lower Limb after Stroke: A Pooled Analysis of Individual Patient Data","volume":"20","author":"Tyson","year":"2013","journal-title":"Top. Stroke Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"927","DOI":"10.2106\/00004623-197961060-00022","article-title":"Stiff-Legged Gait in Hemiplegia: Surgical Correction","volume":"61A","author":"Waters","year":"1979","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/00002060-199112000-00003","article-title":"Stiff-Legged Gait in Spastic Paresis","volume":"70","author":"Kerrigan","year":"1991","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_5","first-page":"171","article-title":"Effect of the Rectus Femoris Motor Branch Block on Post-Stroke Stiff-Legged Gait","volume":"105","author":"Chantraine","year":"2005","journal-title":"Acta Neurol. Belg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/00002060-200104000-00002","article-title":"Spastic Paretic Stiff-Legged Gait: Joint Kinetics","volume":"80","author":"Kerrigan","year":"2001","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.2106\/00004623-199610000-00008","article-title":"Gait Pattern in the Early Recovery Period after Stroke","volume":"78","author":"Simon","year":"1996","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.gaitpost.2013.05.003","article-title":"A Method to Differentiate the Causes of Stiff-Knee Gait in Stroke Patients","volume":"38","author":"Campanini","year":"2013","journal-title":"Gait Posture"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.jbiomech.2005.01.015","article-title":"Kinematic and Kinetic Factors That Correlate with Improved Knee Flexion Following Treatment for Stiff-Knee Gait","volume":"39","author":"Goldberg","year":"2006","journal-title":"J. Biomech."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"111","DOI":"10.11336\/jjcrs.7.111","article-title":"Analysis of Strategies Used by Hemiplegic Stroke Patients to Achieve Toe Clearance","volume":"7","author":"Matsuda","year":"2016","journal-title":"Jpn. J. Compr. Rehabil. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Perry, J. (1992). Gait Analysis: Normal and Pathological Function, SLACK.","DOI":"10.1097\/01241398-199211000-00023"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1053\/apmr.2000.5615","article-title":"Motor Branch Block of the Rectus Femoris: Its Effectiveness in Stiff-Legged Gait in Spastic Paresis","volume":"81","author":"Sung","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1016\/j.jbiomech.2008.05.030","article-title":"Importance of Preswing Rectus Femoris Activity in Stiff-Knee Gait","volume":"41","author":"Reinbolt","year":"2008","journal-title":"J. Biomech."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.jbiomech.2003.12.005","article-title":"Muscles That Influence Knee Flexion Velocity in Double Support: Implications for Stiff-Knee Gait","volume":"37","author":"Goldberg","year":"2004","journal-title":"J. Biomech."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"719","DOI":"10.2340\/16501977-2367","article-title":"Influence of Functional Electrical Stimulation of the Hamstrings on Knee Kinematics in Stroke Survivors Walking with Stiff Knee Gait","volume":"50","author":"Tenniglo","year":"2018","journal-title":"J. Rehabil. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.apmr.2007.08.131","article-title":"Effect of Botulinum Toxin Injection in the Rectus Femoris on Stiff-Knee Gait in People with Stroke: A Prospective Observational Study","volume":"89","author":"Stoquart","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.gaitpost.2016.11.032","article-title":"Neurotomy of the Rectus Femoris Nerve: Short-Term Effectiveness for Spastic Stiff Knee Gait","volume":"52","author":"Gross","year":"2017","journal-title":"Gait Posture"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.gaitpost.2019.06.009","article-title":"Impact of Instrumental Analysis of Stiff Knee Gait on Treatment Appropriateness and Associated Costs in Stroke Patients","volume":"72","author":"Merlo","year":"2019","journal-title":"Gait Posture"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1161\/STROKEAHA.110.586917","article-title":"Preswing Knee Flexion Assistance Is Coupled with Hip Abduction in People with Stiff-Knee Gait after Stroke","volume":"41","author":"Sulzer","year":"2010","journal-title":"Stroke"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.gaitpost.2017.07.002","article-title":"Electromyographic Activity of the Vastus Intermedius Muscle in Patients with Stiff-Knee Gait after Stroke. A Retrospective Observational Study","volume":"60","author":"Mazzoli","year":"2018","journal-title":"Gait Posture"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.gaitpost.2008.07.005","article-title":"Relevance of Botulinum Toxin Injection and Nerve Block of Rectus Femoris to Kinematic and Functional Parameters of Stiff Knee Gait in Hemiplegic Adults","volume":"29","author":"Robertson","year":"2009","journal-title":"Gait Posture"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"105035","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105035","article-title":"Pedaling Improves Gait Ability of Hemiparetic Patients with Stiff-Knee Gait: Fall Prevention during Gait","volume":"29","author":"Fujita","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.apmr.2013.11.008","article-title":"Effect of Chemodenervation of the Rectus Femoris Muscle in Adults with a Stiff Knee Gait Due to Spastic Paresis: A Systematic Review with a Meta-Analysis in Patients with Stroke","volume":"95","author":"Tenniglo","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1007\/11811305_33","article-title":"Mining Gait Pattern for Clinical Locomotion Diagnosis Based on Clustering Techniques","volume":"Volume 4093","author":"Li","year":"2006","journal-title":"Advanced Data Mining and Applications"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.gaitpost.2009.05.010","article-title":"Crouch Gait Patterns Defined Using K-Means Cluster Analysis Are Related to Underlying Clinical Pathology","volume":"30","author":"Rozumalski","year":"2009","journal-title":"Gait Posture"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"105248","DOI":"10.1016\/j.clinbiomech.2020.105248","article-title":"Kinematic Cluster Analysis of the Crouch Gait Pattern in Children with Spastic Diplegic Cerebral Palsy Using Sparse K-Means Method","volume":"81","author":"Abbasi","year":"2021","journal-title":"Clin. Biomech."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Kuntze, G., Nettel-Aguirre, A., Ursulak, G., Robu, I., Bowal, N., Goldstein, S., and Emery, C.A. (2018). Multi-Joint Gait Clustering for Children and Youth with Diplegic Cerebral Palsy. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205174"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.gaitpost.2019.04.028","article-title":"Cluster Analysis to Identify Foot Motion Patterns in Children with Flexible Flatfeet Using Gait Analysis. A Statistical Approach to Detect Decompensated Pathology?","volume":"71","author":"Oestreich","year":"2019","journal-title":"Gait Posture"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1177\/193229681000400511","article-title":"A New Classification of Diabetic Gait Pattern Based on Cluster Analysis of Biomechanical Data","volume":"4","author":"Sawacha","year":"2010","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Van Drongelen, S., Stetter, B.J., B\u00f6hm, H., Stief, F., Stein, T., and Meurer, A. (2021). Identification of Patients with Similar Gait Compensating Strategies Due to Unilateral Hip Osteoarthritis and the Effect of Total Hip Replacement: A Secondary Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102167"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3389\/fncom.2019.00031","article-title":"The Application of Unsupervised Clustering Methods to Alzheimer\u2019s Disease","volume":"13","author":"Alashwal","year":"2019","journal-title":"Front. Comput. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.gaitpost.2007.03.008","article-title":"Gait Pattern Categorization of Stroke Participants with Equinus Deformity of the Foot","volume":"27","author":"Kinsella","year":"2008","journal-title":"Gait Posture"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.gaitpost.2009.04.010","article-title":"Gait Classification in Post-Stroke Patients Using Artificial Neural Networks","volume":"30","author":"Kaczmarczyk","year":"2009","journal-title":"Gait Posture"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/S0966-6362(02)00165-0","article-title":"Use of Cluster Analysis for Gait Pattern Classification of Patients in the Early and Late Recovery Phases Following Stroke","volume":"18","author":"Mulroy","year":"2003","journal-title":"Gait Posture"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"939316","DOI":"10.1155\/2014\/939316","article-title":"Gait Patterns in Hemiplegic Patients with Equinus Foot Deformity","volume":"2014","author":"Manca","year":"2014","journal-title":"BioMed. Res. Int"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1038\/s41597-019-0124-4","article-title":"A Multimodal Dataset of Human Gait at Different Walking Speeds Established on Injury-Free Adult Participants","volume":"6","author":"Schreiber","year":"2019","journal-title":"Sci. Data"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/cts.12764","article-title":"Clinical Trial Generalizability Assessment in the Big Data Era: A Review","volume":"13","author":"He","year":"2020","journal-title":"Clin. Transl. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_39","unstructured":"Medical Research Council (1976). Aids to the Investigation of the Peripheral Nervous System, Memorandum No. 45, Pendragon House."},{"key":"ref_40","unstructured":"Van Sint Jan, S. (2007). Color Atlas of Skeletal Landmark Definitions, Churchill Livingstone\/Elsevier."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Dumas, R., and Wojtusch, J. (2017). Estimation of the Body Segment Inertial Parameters for the Rigid Body Biomechanical Models Used in Motion Analysis. Handbook of Human Motion, Springer International Publishing.","DOI":"10.1007\/978-3-319-30808-1_147-1"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/S0021-9290(01)00222-6","article-title":"ISB Recommendation on Definitions of Joint Coordinate System of Various Joints for the Reporting of Human Joint Motion\u2014Part I: Ankle, Hip, and Spine","volume":"35","author":"Wu","year":"2002","journal-title":"J. Biomech."},{"key":"ref_43","first-page":"768","article-title":"Cluster Analysis of Multivariate Data: Efficiency versus Interpretability of Classifications","volume":"21","author":"Forgy","year":"1965","journal-title":"Biometrics"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1109\/TIT.1982.1056489","article-title":"Least Squares Quantization in PCM","volume":"28","author":"Lloyd","year":"1982","journal-title":"IEEE Trans. Inf. Theory"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1109\/TPAMI.1984.4767478","article-title":"K-Means-Type Algorithms: A Generalized Convergence Theorem and Characterization of Local Optimality","volume":"PAMI-6","author":"Selim","year":"1984","journal-title":"IEEE Trans. Pattern Anal. Mach. Intell."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/1467-9868.00293","article-title":"Estimating the Number of Clusters in a Data Set via the Gap Statistic","volume":"63","author":"Tibshirani","year":"2001","journal-title":"J. R. Stat. Soc. Ser. B Stat. Methodol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Chantraine, F., Filipetti, P., Schreiber, C., Remacle, A., Kolanowski, E., and Moissenet, F. (2016). Proposition of a Classification of Adult Patients with Hemiparesis in Chronic Phase. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156726"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/EDE.0000000000000664","article-title":"Generalizing Study Results: A Potential Outcomes Perspective","volume":"28","author":"Lesko","year":"2017","journal-title":"Epidemiology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ijmedinf.2016.12.008","article-title":"Computer-Aided Assessment of the Generalizability of Clinical Trial Results","volume":"99","author":"Cahan","year":"2017","journal-title":"Int. J. Med. Inform."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1161\/STROKEAHA.108.516153","article-title":"Effect of Simultaneous Botulinum Toxin Injections into Several Muscles on Impairment, Activity, Participation, and Quality of Life among Stroke Patients Presenting with a Stiff Knee Gait","volume":"39","author":"Caty","year":"2008","journal-title":"Stroke"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Boudarham, J., Roche, N., Pradon, D., Delouf, E., Bensmail, D., and Zory, R. (2014). Effects of Quadriceps Muscle Fatigue on Stiff-Knee Gait in Patients with Hemiparesis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0094138"},{"key":"ref_52","first-page":"637","article-title":"Does the Duncan-Ely Test Predict Abnormal Activity of the Rectus Femoris in Stroke Survivors with a Stiff Knee Gait?","volume":"54","author":"Tenniglo","year":"2021","journal-title":"J. Rehabil. Med."},{"key":"ref_53","first-page":"10","article-title":"Use of Gait Parameters to Predict the Effectiveness of Botulinum Toxin Injection in the Spastic Rectus Femoris Muscle of Stroke Patients with Stiff Knee Gait","volume":"51","author":"Roche","year":"2015","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Guzik, A., Dru\u017cbicki, M., Wolan-Nieroda, A., Turolla, A., and Kiper, P. (2020). Estimating Minimal Clinically Important Differences for Knee Range of Motion after Stroke. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103305"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/S0966-6362(01)00190-4","article-title":"Mechanisms of Disturbed Motor Control in Ankle Weakness during Gait after Stroke","volume":"15","author":"Lamontagne","year":"2002","journal-title":"Gait Posture"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.aott.2016.03.007","article-title":"Weakening Iliopsoas Muscle in Healthy Adults May Induce Stiff Knee Pattern","volume":"50","author":"Akalan","year":"2016","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"380","DOI":"10.23736\/S1973-9087.17.04722-0","article-title":"Co-Contraction around the Knee and the Ankle Joints during Post-Stroke Gait","volume":"54","author":"Souissi","year":"2018","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1038\/s41598-019-38748-8","article-title":"Explaining the Unique Nature of Individual Gait Patterns with Deep Learning","volume":"9","author":"Horst","year":"2019","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6270\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:02:11Z","timestamp":1760144531000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,25]]},"references-count":58,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jcm11216270"],"URL":"https:\/\/doi.org\/10.3390\/jcm11216270","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,25]]}}}