{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:48:06Z","timestamp":1792133286661,"version":"4.4.0"},"reference-count":54,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"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>Objectives: Twin pregnancy implies a higher risk of preterm birth and, consequently, higher neonatal morbidity and mortality. In singleton pregnancies, infections of the lower genital tract (LGTIs) and bacterial vaginosis are associated with preterm labor, and their early detection has been proven effective in reducing complications like the preterm premature rupture of membranes (pPROM) and preterm delivery. The same evidence, however, is lacking for twin pregnancies. This study aimed to evaluate whether the early identification and treatment of LGTIs or bacterial vaginosis in asymptomatic women with twin pregnancy could reduce the rate of miscarriages, pPROM, and preterm birth. Methods: This study performed a retrospective comparison of 285 women with a multiple pregnancy submitted for a cervico-vaginal swab only at 20\u201322 weeks (Single Test Group, STG), and 199 women who underwent the swab at 12\u201314 and again at 20\u201322 weeks (Double Test Group, DTG). All women included in the study had a twin pregnancy and were followed up at Sant\u2019Anna Hospital, Turin (Italy), between September 2012 and February 2021. Results: In STG, 21.7% of patients had a positive swab; in DTG, 19.9% had an early positive swab that was immediately treated by targeted antibiotics; and 16.7% had a mid-pregnancy positive swab. The DTG showed a significantly lower incidence of pPROM in univariate analysis (14.4% vs. 23.1%, p = 0.021), which was confirmed by multivariate analysis (OR 0.55, CI 0.33\u20130.93, p = 0.025). Conclusions: Our study suggests that, in asymptomatic women with twin pregnancy, the early screening of LGTIs and bacterial vaginosis by a cervico-vaginal swab at 12\u201314 weeks of gestational age is effective in reducing the risk of pPROM.<\/jats:p>","DOI":"10.3390\/jcm13092673","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T03:57:56Z","timestamp":1714622276000},"page":"2673","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Is the Early Screening of Lower Genital Tract Infections Useful in Preventing Adverse Obstetrical Outcomes in Twin Pregnancy?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1540-4927","authenticated-orcid":false,"given":"Sofia","family":"Roero","sequence":"first","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Benedetto","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1300-4508","authenticated-orcid":false,"given":"Lorena","family":"Charrier","sequence":"additional","affiliation":[{"name":"Departement of Public Health and Pediatrics, A.O.U. Citt\u00e0 della Salute e della Scienza, University of Turin, Via Santena 5, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agata","family":"Ingala","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Ronco","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Fea","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Borgarello","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Bossotti","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Arduino","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5797-3722","authenticated-orcid":false,"given":"Alberto","family":"Revelli","sequence":"additional","affiliation":[{"name":"Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Citt\u00e0 della Salute e della Scienza, Sant\u2019Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.fertnstert.2018.10.025","article-title":"Risk factors for monozygotic twinning after in vitro fertilization: A systematic review and meta-analysis","volume":"112","author":"Busnelli","year":"2019","journal-title":"Fertil. Steril."},{"key":"ref_2","unstructured":"Euro-Peristat Project (2024, April 24). Core Indicators of the Health and Care of Pregnant Women and Babies in Europe from 2015 to 2019. Available online: https:\/\/www.europeristat.com\/images\/Euro-Peristat_Fact_sheets_2022_for_upload.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1111\/aogs.14579","article-title":"Twins vs singletons-Long-term health outcomes","volume":"102","author":"Wainstock","year":"2023","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.siny.2010.06.006","article-title":"Preterm and term labour in multiple pregnancies","volume":"15","author":"Stock","year":"2010","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.ajog.2014.07.047","article-title":"Prediction of preterm birth in twin gestations using biophysical and biochemical tests","volume":"211","author":"Romero","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1111\/1471-0528.16479","article-title":"Association between chorionicity and pretermbirth in twin pregnancies: A systematic reviewinvolving 29 864 twin pregnancies","volume":"128","author":"Marleen","year":"2020","journal-title":"BJOG"},{"key":"ref_7","first-page":"1","article-title":"Births: Final Data for 2014","volume":"64","author":"Hamilton","year":"2015","journal-title":"Natl. Vital Stat. Rep."},{"key":"ref_8","first-page":"899","article-title":"Maternal morbidity and mortality associated with multiple gestations","volume":"95","author":"Lindmark","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_9","first-page":"680","article-title":"Maternal mortality in twin gestations","volume":"42","author":"Blickstein","year":"1997","journal-title":"J. Reprod. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Vogel, J.P., Torloni, M.R., Seuc, A., Betr\u00e1n, A.P., Widmer, M., Souza, J.P., and Merialdi, M. (2013). Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0070549"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.clp.2007.10.001","article-title":"The risks for very low birth weight infants from multiple pregnancies","volume":"34","author":"Shinwell","year":"2007","journal-title":"Clin. Perinatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.clp.2004.04.002","article-title":"Do multiple gestations raise the risk of cerebral palsy?","volume":"31","author":"Blickstein","year":"2004","journal-title":"Clin. Perinatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"578.e1","DOI":"10.1016\/j.ajog.2014.03.003","article-title":"Risk of late-preterm stillbirth and neonatal morbidity for monochorionic and dichorionic twins","volume":"210","author":"Burgess","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.clp.2006.03.017","article-title":"Risk of cerebral palsy in multiple pregnancies","volume":"33","author":"Pharoah","year":"2006","journal-title":"Clin. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1053\/j.semperi.2012.02.005","article-title":"Neurodevelopmental outcomes of twins","volume":"36","author":"Lorenz","year":"2012","journal-title":"Semin. Perinatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/107155760000700601","article-title":"Medical and economic effects of twin gestations","volume":"7","author":"Kinzler","year":"2000","journal-title":"J. Soc. Gynecol. Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.ajog.2004.05.057","article-title":"The cost of twin pregnancy: Maternal and neonatal factors","volume":"192","author":"Luke","year":"2005","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.ajog.2010.04.031","article-title":"Twins: Prevalence, problems, and preterm births","volume":"203","author":"Chauhan","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1053\/j.semperi.2005.08.002","article-title":"Maternal physiology and complications of multiple pregnancy","volume":"29","author":"Norwitz","year":"2005","journal-title":"Semin. Perinatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S149","DOI":"10.1053\/plac.2002.0804","article-title":"Placenta and fetal membranes in human parturition and preterm delivery e a workshop report","volume":"23","author":"Ticconi","year":"2002","journal-title":"Placenta"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.bpobgyn.2022.08.008","article-title":"Screening and prevention of preterm birth in twin pregnancies","volume":"84","author":"Khalil","year":"2022","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1471-0528.2006.01120.x","article-title":"The preterm parturition syndrome","volume":"113","author":"Romero","year":"2006","journal-title":"BJOG"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"214","DOI":"10.36740\/WLek202402105","article-title":"Analysis of cases of premature rupture of membranes and preterm births to identify effective management measures to prevent them","volume":"2","author":"Skrypchenko","year":"2024","journal-title":"Wiad. Lek."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/0002-9378(90)91063-I","article-title":"Infection and labor. VI. Prevalence, microbiology, and clinical significance of intraamniotic infection in twin gestations with preterm labor","volume":"163","author":"Romero","year":"1990","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"624","DOI":"10.3109\/00016349609054686","article-title":"Intraamniotic infection in patients with preterm labor and twin pregnancies","volume":"75","author":"Mazor","year":"1996","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_26","first-page":"CD003767","article-title":"Antibiotics for ureaplasma in the vagina in pregnancy","volume":"2011","author":"Roberts","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_27","first-page":"885","article-title":"Bacterial vaginosis in pregnancy and the risk of prematurity: A meta-analysis","volume":"48","author":"Flynn","year":"1999","journal-title":"J. Fam. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1067\/mob.2003.339","article-title":"Bacterial vaginosis as a risk factor for preterm delivery: A meta-analysis","volume":"189","author":"Leitich","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Prodan-Barbulescu, C., Bratosin, F., Folescu, R., Boeriu, E., Popa, Z.L., Citu, C., Ratiu, A., Rosca, O., and Cosmin Ilie, A. (2024). Analysis of Vaginal Microbiota Variations in the Third Trimester of Pregnancy and Their Correlation with Preterm Birth: A Case-Control Study. Microorganisms, 12.","DOI":"10.3390\/microorganisms12020417"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"356.e1","DOI":"10.1016\/j.ajog.2017.05.030","article-title":"Early pregnancy vaginal microbiome trends and preterm birth","volume":"217","author":"Stout","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/1933719113488838","article-title":"Diversity of the Vaginal Microbiome Correlates With Preterm Birth","volume":"21","author":"Hyman","year":"2014","journal-title":"Reprod. Sci."},{"key":"ref_32","first-page":"100579","article-title":"Cervicovaginal microbiome in twin vs singleton gestations","volume":"4","author":"Lawlor","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.siny.2015.12.010","article-title":"Multiple gestations and preterm birth","volume":"21","author":"Fuchs","year":"2016","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/S0002-9378(96)80051-2","article-title":"The preterm prediction study: Risk factors in twin gestations. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network","volume":"175","author":"Goldenberg","year":"1996","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1111\/j.1471-0528.1997.tb11010.x","article-title":"Fetal fibronectin, endotoxin, bacterial vaginosis and cervical length as predictors of preterm birth and neonatal morbidity in twin pregnancies","volume":"104","author":"Wennerholm","year":"1997","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1177\/0884217504267270","article-title":"The utility of fFN for the prediction of preterm birth in twin gestations","volume":"33","author":"Ruiz","year":"2004","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/uog.15821","article-title":"ISUOG Practice Guidelines: Role of ultrasound in twin pregnancy","volume":"47","author":"Khalil","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e398","DOI":"10.1016\/j.jogc.2017.08.014","article-title":"No. 260\u2014Ultrasound in Twin Pregnancies","volume":"39","author":"Morin","year":"2017","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"ACOG (2021). Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies: ACOG Practice Bulletin, Number 231. Obstet. Gynecol., 137, e145\u2013e162.","DOI":"10.1097\/AOG.0000000000004397"},{"key":"ref_40","unstructured":"NICE (2019, September 04). Twin and Triplet Pregnancy. Available online: www.nice.org.uk\/guidance\/ng137."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/0002-9343(83)91112-9","article-title":"Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations","volume":"74","author":"Amsel","year":"1983","journal-title":"Am. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.ejogrb.2021.04.023","article-title":"Role of progesterone, cerclage and pessary in preventing preterm birth in twin pregnancies: A systematic review and network meta-analysis","volume":"261","author":"Berghella","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100551","DOI":"10.1016\/j.ajogmf.2021.100551","article-title":"Prevention of preterm birth in twin pregnancies","volume":"2","author":"Roman","year":"2022","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1111\/1471-0528.15566","article-title":"Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: An updated systematic review and network meta-analysis","volume":"126","author":"Jarde","year":"2018","journal-title":"BJOG"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/S0140-6736(03)12823-1","article-title":"Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: A randomised controlled trial","volume":"361","author":"Ugwumadu","year":"2003","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ajog.2011.03.047","article-title":"Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: A systematic review and metaanalysis","volume":"205","author":"Lamont","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_47","first-page":"CD000490","article-title":"Antibiotics for asymptomatic bacteriuria in pregnancy","volume":"2","author":"Smaill","year":"2001","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1111\/aogs.14460","article-title":"Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes","volume":"101","author":"Vargas","year":"2022","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/j.1552-6909.2001.tb01521.x","article-title":"Specialized care for twin gestations: Improving newborn outcomes and reducing costs","volume":"30","author":"Ruiz","year":"2001","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_50","unstructured":"French College of Gynaecologists and Obstetricians (2011). Twin pregnancies: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur. J. Obstet. Gynecol. Reprod. Biol., 156, 12\u201317."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.ejogrb.2016.12.035","article-title":"Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF)","volume":"210","author":"Sentilhes","year":"2017","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Khan, W., Zaki, N., Ghenimi, N., Ahmad, A., Bian, J., Masud, M.M., Ali, N., Govender, R., and Ahmed, L.A. (2023). Predicting preterm birth using explainable machine learning in a prospective cohort of nulliparous and multiparous pregnant women. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0293925"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"390.e1","DOI":"10.1016\/j.ajog.2015.05.027","article-title":"The impact of chorionicity on maternal pregnancy outcomes","volume":"213","author":"Carter","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1111\/1471-0528.17013","article-title":"Risk of preterm birth in relation to history of preterm birth: A population-based registry study of 213\u2009335 women in Norway","volume":"129","author":"Tingleff","year":"2022","journal-title":"BJOG"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2673\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:38:35Z","timestamp":1760107115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2673"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,2]]},"references-count":54,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13092673"],"URL":"https:\/\/doi.org\/10.3390\/jcm13092673","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,2]]}}}