{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:51:49Z","timestamp":1790596309025,"version":"4.1.0"},"reference-count":55,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background. The best format of exercise training (ET) in the setting of cardiac rehabilitation in patients with chronic heart failure (CHF) is still to be defined. Current guidelines recommend aerobic exercises, such as running and cycling, including some sessions per week of resistance exercise. Aim. The aim of this study was to address the effectiveness of a concurrent exercise training program utilizing a circuit of sequential endurance and resistance exercises on functional capacity and muscular strength in patients with CHF. Methods. Ninety-five consecutive male patients (age 63.1 \u00b1 6 years) with CHF (EF &lt; 40%) in NYHA functional class II\/III, were randomly assigned on 1:1 basis to a 12-week aerobic continuous training (AT) or concurrent CT), aerobic + resistance, training (CT), three times a week, with each session lasting 80 min. We used high quality, specifically designed ergometers, connected with each other and governed by a central console, and managed by a single physiotherapist. Before and after training all patients performed a symptoms-limited exercise test on a treadmill and a 6-min walking test (6MWT). Patients in the CT group also performed resistance exercises of upper and lower body. Results. The 6MWT and exercise duration at ergometric test increased significantly in both AT and CT groups, with the increase being greater in CT group (p &lt; 0.001; ES = 0.13; p &lt; 0.01; ES = 0.07). Muscular strength increased significantly in the CT group, particularly in the lower body muscular districts (p &lt; 0.001). Quality of life improved in both groups, with a significantly greater improvement in the CT group (p &lt; 0.05). No side effects leading to discontinuation of training were observed. Conclusions. These findings indicate that concurrent, within-session training results in larger improvements in functional capacity, in addition to muscle performance, in patients with CHF, in comparison to single-mode aerobic training.<\/jats:p>","DOI":"10.3390\/jcm12030750","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T03:04:44Z","timestamp":1674011084000},"page":"750","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Effects of Concurrent, Within-Session, Aerobic and Resistance Exercise Training on Functional Capacity and Muscle Performance in Elderly Male Patients with Chronic Heart Failure"],"prefix":"10.3390","volume":"12","author":[{"given":"Maurizio","family":"Volterrani","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Cardiology, IRCCS San Raffaele Pisana, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7820-567X","authenticated-orcid":false,"given":"Giuseppe","family":"Caminiti","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Cardiology, IRCCS San Raffaele Pisana, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-2621","authenticated-orcid":false,"given":"Marco Alfonso","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Cerrito","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Cardiology, IRCCS San Raffaele Pisana, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Franchini","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Cardiology, IRCCS San Raffaele Pisana, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0331-5417","authenticated-orcid":false,"given":"Vincenzo","family":"Manzi","sequence":"additional","affiliation":[{"name":"Department of Humanities, Universit\u00e0 Telematica Pegaso, 80132 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8421-5065","authenticated-orcid":false,"given":"Ferdinando","family":"Iellamo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Cardiology, IRCCS San Raffaele Pisana, 00163 Rome, Italy"},{"name":"Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/2047487320913379","article-title":"Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology","volume":"28","author":"Ambrosetti","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/sms.12104","article-title":"Optimizing strength training for running and cycling endurance performance: A review","volume":"24","author":"Mujika","year":"2014","journal-title":"Scand. J. Med. Sci. Sport."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.1111\/j.1600-0838.2010.01283.x","article-title":"Effects of resistance training on endurance capacity and muscle fiber composition in young top-level cyclists","volume":"21","author":"Aagaard","year":"2011","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2165\/00007256-200030060-00001","article-title":"A proposed model for examining the interference phenomenon between concurrent aerobic and strength training","volume":"30","author":"Docherty","year":"2000","journal-title":"Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/BF00421333","article-title":"Interference of strength development by simultaneously training for strength and endurance","volume":"45","author":"Hickson","year":"1980","journal-title":"Eur. J. Appl. Physiol. Occup. Physiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1519\/JSC.0b013e31823a3e2d","article-title":"Concurrent training: A meta-analysis examining interference of aerobic and resistance exercises","volume":"26","author":"Wilson","year":"2012","journal-title":"J. Strength Cond. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.ijcard.2016.07.105","article-title":"Comparing exercise training modalities in heart failure: A systematic review and meta-analysis","volume":"221","author":"Cornelis","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1249\/00005768-198205000-00012","article-title":"Psychophysical bases of perceived exertion","volume":"14","author":"Borg","year":"1982","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_9","first-page":"1","article-title":"The physiology of soccer\u2014With special reference to intense intermittent exercise","volume":"151","author":"Bangsbo","year":"1994","journal-title":"Acta Physiol. Scand."},{"key":"ref_10","unstructured":"Cohen, J. (1977). Statistical Power Analysis for Behavioral Sciences, Academic Press."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1177\/0272989X9701700212","article-title":"An experimental test of a theoretical foundation for rating-scale valuations","volume":"17","author":"Bleichrodt","year":"1997","journal-title":"Med. Decis. Mak."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1093\/eurheartj\/ehn222","article-title":"Combined endurance-resistance training vs. endurance training in patients with chronic heart failure: A prospective randomized study","volume":"29","author":"Beckers","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1097\/00005768-200212000-00002","article-title":"Strength\/endurance training versus endurance training in congestive heart failure","volume":"34","author":"Delagardelle","year":"2002","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1177\/0269215508095362","article-title":"Effects of aerobic or aerobic and resistance training on cardiorespiratory and skeletal muscle function in heart failure: A randomized controlled pilot trial","volume":"23","author":"Mandic","year":"2009","journal-title":"Clin. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1600-0838.2010.01197.x","article-title":"Effects of strength training on endurance capacity in top-level endurance athletes","volume":"20","author":"Aagaard","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1519\/JSC.0b013e3181aeb16a","article-title":"Maximal strength training improves cycling economy in competitive cyclists","volume":"24","author":"Sunde","year":"2010","journal-title":"J. Strength Cond. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"63","DOI":"10.15420\/cfr.2015:26:1","article-title":"Cardiac Rehabilitation in Patients With Heart Failure: New Perspectives in Exercise Training","volume":"2","author":"Volterrani","year":"2016","journal-title":"Card Fail Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1519\/JSC.0000000000001316","article-title":"Effects of strength training on running economy in highly trained runners: A systematic review with meta-analysis of controlled trials","volume":"30","author":"Grivas","year":"2016","journal-title":"J. Strength Cond. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s40279-016-0604-z","article-title":"Explosive training and heavy weight training are effective for improving running economy in endurance athletes: A systematic review and meta-analysis","volume":"47","author":"Denadai","year":"2017","journal-title":"Sports Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/0735-1097(94)00568-B","article-title":"Physical training in patients with stable chronic heart failure: Effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles","volume":"25","author":"Hambrecht","year":"1995","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/S0735-1097(96)00323-3","article-title":"Exercise limitation in chronic heart failure: Central role of the periphery","volume":"28","author":"Clark","year":"1996","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1038\/nrcardio.2009.8","article-title":"Mechanisms by which exercise training benefits patients with heart failure","volume":"6","author":"Crimi","year":"2009","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1016\/j.ijcard.2012.06.057","article-title":"Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure","volume":"167","author":"Iellamo","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3095","DOI":"10.1001\/jama.283.23.3095","article-title":"Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial","volume":"283","author":"Hambrecht","year":"2000","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s10741-007-9053-y","article-title":"Central adaptations to exercise training in patients with chronic heart failure","volume":"13","author":"Mezzani","year":"2008","journal-title":"Heart Fail. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"234","DOI":"10.23736\/S0025-7826.19.03531-2","article-title":"Inflammation, oxidative stress and gene expression: The postprandial approach in professional soccer players to reduce the risk of muscle injuries and early atherosclerosis","volume":"72","author":"Perrone","year":"2019","journal-title":"Med. Sport"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s00421-002-0751-9","article-title":"Neuromuscular adaptations during concurrent strength and endurance versus strength training","volume":"89","author":"Alen","year":"2003","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_28","first-page":"269","article-title":"Development of strength and maximum oxygen uptake during simultaneous training for strength and endurance","volume":"27","author":"Hunter","year":"1987","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1111\/sms.12751","article-title":"Effects of high-intensity interval cycling performed after resistance training on muscle strength and hypertrophy","volume":"27","author":"Tsitkanou","year":"2017","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s40279-017-0812-1","article-title":"Interpreting Adaptation to Concurrent Compared with Single-Mode Exercise Training: Some Methodological Considerations","volume":"48","author":"Fyfe","year":"2017","journal-title":"Sports Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.3389\/fphys.2018.01057","article-title":"The Effects of Concurrent Strength and Endurance Training on Physical Fitness and Athletic Performance in Youth: A Systematic Review and Meta-Analysis","volume":"9","author":"Prieske","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1007\/s00421-016-3369-z","article-title":"Early phase interference between low-intensity running and power training in moderately trained females","volume":"116","author":"Terzis","year":"2016","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1007\/s40279-017-0758-3","article-title":"Implications of Impaired Endurance Performance following Single Bouts of Resistance Training: An Alternate Concurrent Training Perspective","volume":"47","author":"Doma","year":"2017","journal-title":"Sports Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/S0735-1097(97)00015-6","article-title":"Effects of endurance training on mitochondrial ultrastructure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure","volume":"29","author":"Hambrecht","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1161\/01.CIR.93.5.940","article-title":"Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure. Effects of physical training","volume":"93","author":"Piepoli","year":"1996","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1046\/j.1365-201x.2001.00831.x","article-title":"Skeletal muscle training in chronic heart failure","volume":"171","author":"Piepoli","year":"2001","journal-title":"Acta Physiol. Scand."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3390\/jcdd9060181","article-title":"Complementary Role of Combined Indirect and Direct Cardiac Sympathetic (Hyper)Activity Assessment in Patients with Heart Failure by Spectral Analysis of Heart Rate Variability and Nuclear Imaging: Possible Application in the Evaluation of Exercise Training Effects","volume":"9","author":"Iellamo","year":"2022","journal-title":"J. Cardiovasc. Dev. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1007\/s12020-012-9725-9","article-title":"Testosterone and heart failure","volume":"42","author":"Volterrani","year":"2012","journal-title":"Endocrine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"H2867","DOI":"10.1152\/ajpheart.00043.2007","article-title":"Muscle metaboreflex attenuates spontaneous heart rate baroreflex sensitivity during dynamic exercise","volume":"292","author":"Ichinose","year":"2007","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1113\/jphysiol.2005.102426","article-title":"Muscle metaboreflex contribution to cardiovascular regulation during dynamic exercise in microgravity: Insights from mission STS-107 of the space shuttle Columbia","volume":"572","author":"Iellamo","year":"2006","journal-title":"J. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/apha.12174","article-title":"Acute molecular responses in untrained and trained muscle subjected to aerobic and resistance exercise training versus resistance training alone","volume":"209","author":"Lundberg","year":"2013","journal-title":"Acta Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E22","DOI":"10.1152\/ajpendo.00091.2013","article-title":"Resistance exercise induced mTORC1 signaling is not impaired by subsequent endurance exercise in human skeletal muscle","volume":"305","author":"Wang","year":"2013","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1152\/japplphysiol.01082.2013","article-title":"Exercise-induced AMPK activation does not interfere with muscle hypertrophy in response to resistance training in men","volume":"116","author":"Lundberg","year":"2014","journal-title":"J. Appl. Physiol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Kazior, Z., Willis, S.J., Moberg, M., Apr\u00f3, W., Calbet, J.A., Holmberg, H.-C., and Blomstrand, E. (2016). Endurance exercise enhances the effect of strength training on muscle fiber size and protein expression of Akt and mTOR. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149082"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"E470","DOI":"10.1152\/ajpendo.00486.2014","article-title":"Resistance exercise-induced S6K1 kinase activity is not inhibited in human skeletal muscle despite prior activation of AMPK by high-intensity interval cycling","volume":"308","author":"Moberg","year":"2015","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1152\/japplphysiol.00166.2012","article-title":"Concurrent resistance and aerobic exercise stimulates both myofibrillar and mitochondrial protein synthesis in sedentary middle-aged men","volume":"112","author":"Donges","year":"2012","journal-title":"J. Appl. Physiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2165\/11319770-000000000-00000","article-title":"New horizons for the methodology and physiology of training periodization","volume":"40","author":"Issurin","year":"2010","journal-title":"Sports Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1161\/CIRCULATIONAHA.120.051769","article-title":"Pandemic Intensifies Push for Home-Based Cardiac Rehabilitation Options","volume":"142","author":"Kuehn","year":"2020","journal-title":"Circulation"},{"key":"ref_49","first-page":"183","article-title":"Incremental shuttle walk test in the assessment of patients for heart transplantation","volume":"86","author":"Lewis","year":"2001","journal-title":"Heart"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/S0167-5273(00)00393-4","article-title":"Shuttle versus six-minute walk test in the prediction of outcome in chronic heart failure","volume":"76","author":"Morales","year":"2000","journal-title":"Int. J. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1161\/01.CIR.102.13.1591","article-title":"Assessment of functional capacity in clinical and research applications. An advisory from the Committee on Exercise, Rehabilitation and Prevention, Council on Clinical Cardiology, American Heart Association","volume":"102","author":"Fleg","year":"2000","journal-title":"Circulation"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Caminiti, G., Perrone, M.A., Iellamo, F., D\u2019Antoni, V., Catena, M., Franchini, A., and Volterrani, M. (2022). Acute Left Atrial Response to Different Eccentric Resistance Exercise Loads in Patients with Heart Failure with Middle Range Ejection Fraction: A Pilot Study. J. Pers. Med., 12.","DOI":"10.3390\/jpm12050689"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Perrone, M.A., Pomiato, E., Palmieri, R., Di Gi\u00e0, G., Piemonte, F., Porzio, O., and Gagliardi, M.G. (2022). The Effects of Exercise Training on Cardiopulmonary Exercise Testing and Cardiac Biomarkers in Adult Patients with Hypoplastic Left Heart Syndrome and Fontan Circulation. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9060171"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Caminiti, G., Iellamo, F., Perrone, M.A., D\u2019Antoni, V., Catena, M., Manzi, V., Morsella, V., Franchini, A., and Volterrani, M. (2021). Central Hemodynamic Adjustments during Post-Exercise Hypotension in Hypertensive Patients with Ischemic Heart Disease: Concurrent Circuit Exercise versus High-Intensity Interval Exercise. A Preliminary Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10245881"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Gentili, F., Cafiero, G., Perrone, M.A., Bianco, M., Salvati, A., Giordano, U., Silva Kikina, S., Guccione, P., De Zorzi, A., and Galletti, L. (2021). The Effects of Physical Inactivity and Exercise at Home in Young Patients with Congenital Heart Disease during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph181910065"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/750\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:08:36Z","timestamp":1760119716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/750"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12030750"],"URL":"https:\/\/doi.org\/10.3390\/jcm12030750","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,17]]}}}