{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:49:08Z","timestamp":1782712148127,"version":"3.54.5"},"reference-count":69,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:00:00Z","timestamp":1709769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Coloplast A\/S"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Defecation function is negatively impacted in patients with neurogenic bowel dysfunction (NBD), who require effective bowel care for stool evacuation. NBD comprises fecal incontinence and\/or constipation, which can reduce the quality of life and dignity. Transanal irrigation (TAI) is recommended by several clinical guidelines as the second-line treatment after conservative treatment and before surgical options are considered. As the only class in the second-line treatment with an established safety and efficacy profile, the mechanism of action of TAI has not fully been elucidated when administered through a rectal catheter with a balloon. This review examines the current understanding regarding the mechanism of action of TAI, with a focus on the pathophysiology of neurogenic bowel and irregular defecation. By understanding the functional implications of TAI, clinicians may be better able to integrate this modality into bowel care programs, especially for patients with NBD who have significant constipation due to delayed colonic motility and impaired stool emptying with loss of voluntary control of defecation, and those who are unresponsive to conservative treatment, including enemas.<\/jats:p>","DOI":"10.3390\/jcm13061527","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T04:19:02Z","timestamp":1709785142000},"page":"1527","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Functional Implications of Transanal Irrigation: Insights from Pathophysiology and Clinical Studies of Neurogenic Bowel Dysfunction"],"prefix":"10.3390","volume":"13","author":[{"given":"Gianna","family":"Rodriguez","sequence":"first","affiliation":[{"name":"Physical Medicine and Rehabilitation, Spinal Cord Injury Medicine, University of Michigan Health, Ann Arbor, MI 48108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Kirshblum","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ 07103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai","family":"Thao","sequence":"additional","affiliation":[{"name":"Coloplast A\/S, Minneapolis, MN 55411, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"McArthur","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Atrium Health, Charlotte, NC 28204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Camilleri","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/S0140-6736(96)91487-7","article-title":"Bowel dysfunction in spinal-cord-injury patients","volume":"347","author":"Glickman","year":"1996","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/BF02055170","article-title":"Colorectal function in patients with spinal cord lesions","volume":"40","author":"Krogh","year":"1997","journal-title":"Dis. Colon Rectum"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1080\/01952307.1992.11735871","article-title":"Autonomic hyperreflexia with spinal cord injury","volume":"15","author":"Colachis","year":"1992","journal-title":"J. Am. Paraplegia Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1177\/0269215509353253","article-title":"Managing neurogenic bowel dysfunction","volume":"24","author":"Emmanuel","year":"2010","journal-title":"Clin. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1080\/09638280500164685","article-title":"Health problems of persons with spinal cord injury living in the Netherlands","volume":"27","author":"Post","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1038\/sj.sc.3101601","article-title":"Patterns of morbidity and rehospitalisation following spinal cord injury","volume":"42","author":"Middleton","year":"2004","journal-title":"Spinal Cord"},{"key":"ref_7","first-page":"79","article-title":"Neurogenic bowel dysfunction in patients with multiple sclerosis: Prevalence, impact, and management strategies","volume":"8","author":"Preziosi","year":"2018","journal-title":"Degener. Neurol. Neuromuscul. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"209","DOI":"10.7224\/1537-2073.2021-007","article-title":"Neurogenic Bowel Dysfunction Over the Course of Multiple Sclerosis: A Review","volume":"24","author":"Gulick","year":"2022","journal-title":"Int. J. MS Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"745814","DOI":"10.3389\/fneur.2021.745814","article-title":"Health Concerns of Adolescents and Adults With Spina Bifida","volume":"12","author":"Starowicz","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.expneurol.2018.05.006","article-title":"Translating promising strategies for bowel and bladder management in spinal cord injury","volume":"306","author":"Wheeler","year":"2018","journal-title":"Exp. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.pedn.2019.04.002","article-title":"Using a Decision Tree to Guide Bowel Management in Spina Bifida","volume":"47","author":"Beierwaltes","year":"2019","journal-title":"J. Pediatr. Nurs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1038\/s41393-022-00786-x","article-title":"Guideline for the management of neurogenic bowel dysfunction in spinal cord injury\/disease","volume":"60","author":"Kurze","year":"2022","journal-title":"Spinal Cord"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rodriguez, G.M., and Gater, D.R. (2022). Neurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review. J. Pers. Med., 12.","DOI":"10.3390\/jpm12071141"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Magnuson, F.S., Christensen, P., Krassioukov, A., Rodriguez, G., Emmanuel, A., Kirshblum, S., and Krogh, K. (2023). Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis-An Updated and Simplified Treatment Algorithm. J. Clin. Med., 12.","DOI":"10.3390\/jcm12226971"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1080\/10790268.2021.1883385","article-title":"Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury","volume":"44","author":"Johns","year":"2021","journal-title":"J. Spinal Cord Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"53","DOI":"10.46292\/sci21-00008","article-title":"Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury","volume":"27","author":"Dietz","year":"2021","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.46292\/sci2702-1","article-title":"International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019","volume":"27","author":"Rupp","year":"2021","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.46292\/sci2702-23","article-title":"International Standards to document Autonomic Function following SCI (ISAFSCI): Second Edition","volume":"27","author":"Wecht","year":"2021","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3233\/PRM-200724","article-title":"Bowel function and care: Guidelines for the care of people with spina bifida","volume":"13","author":"Beierwaltes","year":"2020","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1038\/sc.2013.86","article-title":"Consensus review of best practice of transanal irrigation in adults","volume":"51","author":"Emmanuel","year":"2013","journal-title":"Spinal Cord"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Verbruggen, S.W. (2018). Mechanobiology in Health and Disease, Academic Press.","DOI":"10.1016\/B978-0-12-812952-4.00006-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"G552","DOI":"10.1152\/ajpgi.00264.2021","article-title":"Interstitial cells of Cajal and human colon motility in health and disease","volume":"321","author":"Huizinga","year":"2021","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e143771","DOI":"10.1172\/JCI143771","article-title":"Gastrointestinal motility disorders in neurologic disease","volume":"131","author":"Camilleri","year":"2021","journal-title":"J. Clin. Investig."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s00428-016-2060-4","article-title":"The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury","volume":"470","author":"Lammens","year":"2017","journal-title":"Virchows Arch."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1002\/cphy.c130045","article-title":"Autonomic consequences of spinal cord injury","volume":"4","author":"Hou","year":"2014","journal-title":"Compr. Physiol."},{"key":"ref_26","unstructured":"Tobias, A., and Sadiq, N.M. (2024). Physiology, Gastrointestinal Nervous Control, StatPearls."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/aja.1001780306","article-title":"Distribution of myelinated nerves in ascending nerves and myenteric plexus of cat colon","volume":"178","author":"Christensen","year":"1987","journal-title":"Am. J. Anat."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1126\/science.1223813","article-title":"Host-gut microbiota metabolic interactions","volume":"336","author":"Nicholson","year":"2012","journal-title":"Science"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/gut.37.5.649","article-title":"Motor activity recorded in the unprepared colon of healthy humans","volume":"37","author":"Lemann","year":"1995","journal-title":"Gut"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"423","DOI":"10.5056\/jnm14092","article-title":"Colonic migrating motor complexes, high amplitude propagating contractions, neural reflexes and the importance of neuronal and mucosal serotonin","volume":"20","author":"Smith","year":"2014","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_31","first-page":"890","article-title":"Periodic rectal motor activity: The intrinsic colonic gatekeeper?","volume":"91","author":"Rao","year":"1996","journal-title":"Am. J. Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"G508","DOI":"10.1152\/ajpgi.00021.2017","article-title":"High-resolution anatomic correlation of cyclic motor patterns in the human colon: Evidence of a rectosigmoid brake","volume":"312","author":"Lin","year":"2017","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e13734","DOI":"10.1111\/nmo.13734","article-title":"Normative values for region-specific colonic and gastrointestinal transit times in 111 healthy volunteers using the 3D-Transit electromagnet tracking system: Influence of age, gender, and body mass index","volume":"32","author":"Nandhra","year":"2020","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_34","first-page":"G856","article-title":"Transit of solids through the human colon: Regional quantification in the unprepared bowel","volume":"258","author":"Proano","year":"1990","journal-title":"Am. J. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/0016-5085(90)90620-G","article-title":"Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation","volume":"99","author":"Sun","year":"1990","journal-title":"Gastroenterology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1172\/JCI104706","article-title":"The internal anal sphincter response: Manometric studies on its normal physiology, neural pathways, and alteration in bowel disorders","volume":"42","author":"Schuster","year":"1963","journal-title":"J. Clin. Investig."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1136\/gutjnl-2011-301181","article-title":"Regional colon transit in patients with dys-synergic defaecation or slow transit in patients with constipation","volume":"61","author":"Nullens","year":"2012","journal-title":"Gut"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s10350-004-6261-6","article-title":"Rectal wall properties in patients with acute and chronic spinal cord lesions","volume":"45","author":"Krogh","year":"2002","journal-title":"Dis. Colon Rectum"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S0079-6123(05)52022-3","article-title":"Colorectal motility and defecation after spinal cord injury in humans","volume":"152","author":"Lynch","year":"2006","journal-title":"Prog. Brain Res."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mosiello, G., Safder, S., Marshall, D., Rolle, U., and Benninga, M.A. (2021). Neurogenic Bowel Dysfunction in Children and Adolescents. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081669"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1038\/sj.sc.3101066","article-title":"Gastrointestinal and segmental colonic transit times in patients with acute and chronic spinal cord lesions","volume":"38","author":"Krogh","year":"2000","journal-title":"Spinal Cord"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1007\/s00384-013-1733-6","article-title":"Colon transit time and anorectal manometry in children and young adults with spina bifida","volume":"28","author":"Velde","year":"2013","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_43","first-page":"535","article-title":"Defecatory disorders in de novo Parkinsonians\u2014colonic transit and electromyogram of the external anal sphincter","volume":"110","author":"Jost","year":"1998","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1002\/mds.20165","article-title":"Colonic transit time, sphincter EMG, and rectoanal videomanometry in multiple system atrophy","volume":"19","author":"Sakakibara","year":"2004","journal-title":"Mov. Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1038\/s41575-021-00487-5","article-title":"Understanding the physiology of human defaecation and disorders of continence and evacuation","volume":"18","author":"Heitmann","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1038\/sj.sc.3101076","article-title":"Anorectal physiology following spinal cord injury","volume":"38","author":"Lynch","year":"2000","journal-title":"Spinal Cord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/014107680409700303","article-title":"Risk factors in acquired faecal incontinence","volume":"97","author":"Lunniss","year":"2004","journal-title":"J. R. Soc. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"393","DOI":"10.12968\/bjon.2020.29.7.393","article-title":"Transanal irrigation: Is it the magic intervention for bowel management in individuals with bowel dysfunction?","volume":"29","author":"Yates","year":"2020","journal-title":"Br. J. Nurs."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Mekhael, M., Kristensen, H.O., Larsen, H.M., Juul, T., Emmanuel, A., Krogh, K., and Christensen, P. (2021). Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040753"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"517","DOI":"10.3109\/00365520903583855","article-title":"Transanal irrigation for disordered defecation: A systematic review","volume":"45","author":"Christensen","year":"2010","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1053\/j.gastro.2006.06.004","article-title":"A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients","volume":"131","author":"Christensen","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1038\/sj.sc.3101887","article-title":"Neurogenic bowel dysfunction score","volume":"44","author":"Krogh","year":"2006","journal-title":"Spinal Cord"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1038\/sc.2012.171","article-title":"Application of transanal irrigation for patients with spinal cord injury in South Korea: A 6-month follow-up study","volume":"51","author":"Kim","year":"2013","journal-title":"Spinal Cord"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1097\/DCR.0b013e3182653bd1","article-title":"Transanal irrigation for bowel symptoms in patients with multiple sclerosis","volume":"55","author":"Preziosi","year":"2012","journal-title":"Dis. Colon. Rectum"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/nau.23904","article-title":"Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches","volume":"38","author":"Brochard","year":"2019","journal-title":"Neurourol. Urodyn."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1111\/codi.16518","article-title":"Transanal irrigation is a better choice for bowel dysfunction in adults with Spina bifida: A randomised controlled trial","volume":"25","author":"Brochard","year":"2023","journal-title":"Colorectal Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"27","DOI":"10.12968\/gasn.2020.18.3.27","article-title":"Transanal irrigation with Peristeen in neurogenic bowel dysfunction: Audit of impact on symptoms and quality of life","volume":"18","author":"McCarthy","year":"2020","journal-title":"Gastrointest. Nurs."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"320","DOI":"10.5056\/jnm19040","article-title":"Transanal Irrigation for Neurogenic Bowel Dysfunction in Multiple Sclerosis: A Retrospective Study","volume":"28","author":"Teng","year":"2022","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1038\/sj.sc.3102167","article-title":"Treatment of neurogenic bowel dysfunction using transanal irrigation: A multicenter Italian study","volume":"46","author":"Mosiello","year":"2008","journal-title":"Spinal Cord"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.rehab.2013.01.005","article-title":"Long-term transanal irrigation\u2019s continuation at home. Preliminary study","volume":"56","author":"Bordes","year":"2013","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/SGA.0000000000000645","article-title":"Transanal Irrigation for People With Neurogenic Bowel Dysfunction: An Integrative Literature Review","volume":"45","author":"Boman","year":"2022","journal-title":"Gastroenterol. Nurs."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s10151-015-1400-8","article-title":"Global audit on bowel perforations related to transanal irrigation","volume":"20","author":"Christensen","year":"2016","journal-title":"Tech. Coloproctol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1038\/sc.2008.159","article-title":"Long-term outcome and safety of transanal colonic irrigation for neurogenic bowel dysfunction","volume":"47","author":"Faaborg","year":"2009","journal-title":"Spinal Cord"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.3748\/wjg.v23.i11.2029","article-title":"Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders","volume":"23","author":"Bildstein","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1080\/10790268.2021.2022371","article-title":"Transanal irrigation bowel routine for people with Cauda Equina Syndrome","volume":"47","author":"Ethans","year":"2022","journal-title":"J. Spinal Cord Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s10350-004-6498-0","article-title":"Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation","volume":"46","author":"Christensen","year":"2003","journal-title":"Dis. Colon Rectum"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"15","DOI":"10.21037\/ales-2022-02","article-title":"New concepts in the pathophysiology of fecal incontinence","volume":"7","author":"Knowles","year":"2022","journal-title":"Ann. Laparosc. Endosc. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/0016-5085(87)90837-7","article-title":"Simplified assessment of segmental colonic transit","volume":"92","author":"Metcalf","year":"1987","journal-title":"Gastroenterology"},{"key":"ref_69","first-page":"20552173221109771","article-title":"Trans-anal irrigation in patients with multiple sclerosis: Efficacy in treating disease-related bowel dysfunctions and impact on the gut microbiota: A monocentric prospective study","volume":"8","author":"Ascanelli","year":"2022","journal-title":"Mult. Scler. J. Exp. Transl. Clin."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/6\/1527\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:10:10Z","timestamp":1760105410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/6\/1527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,7]]},"references-count":69,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["jcm13061527"],"URL":"https:\/\/doi.org\/10.3390\/jcm13061527","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,7]]}}}