{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:41:24Z","timestamp":1792683684125,"version":"4.5.0"},"reference-count":46,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"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>Background\/Objectives: One common musculoskeletal disorder seriously compromising quality of life and burdening healthcare systems is lumbar disk herniation (LDH). LDH affects quality of life, healthcare costs, and occupational productivity, and it is expected to affect 40% of the population, mostly between 30 and 50 years of age. Methods: Over three years, this research assessed treatment results and the effect of comorbidities in a sample of 3074 individuals. Results: Surgical treatments\u2014especially microdiscectomy\u2014have a high success rate; over 90% of patients said their pain and functioning six months after surgery had improved significantly. Comparatively, conservative treatment approaches\u2014physical therapy and epidural steroid injections\u2014showed about 60% success in 70% of patients, indicating a clear need for early surgical assessment since 25% of originally conservatively managed patients needed surgery within one year. Significantly affecting treatment success are demographic variables; patients with preoperative Oswestry Disability Index (ODI) scores above 50 saw a 40-point improvement post-surgery compared to a 20-point gain for those following conservative therapy. High comorbidity rates\u2014including obesity (mean of 148.33) and cardiovascular illnesses (mean of 530.33)\u2014that are associated with extended recovery durations and complications were also seen in this research. Conclusions: Our results support a customized treatment plan, stressing the need of integrating thorough rehabilitation plans with prompt surgical interventions to maximize patient outcomes. This study emphasizes the need for a patient-centered treatment paradigm in controlling LDH, thereby trying to improve recovery and lower the healthcare load.<\/jats:p>","DOI":"10.3390\/jcm14113952","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T11:55:52Z","timestamp":1748951752000},"page":"3952","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Retrospective Study of Lumbar Disk Herniation: An Analysis of Clinical Cases and Treatment Plans"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3092-2324","authenticated-orcid":false,"given":"M\u0103d\u0103lina","family":"Duceac (Covrig)","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"},{"name":"\u201cProf. Dr. Nicolae Oblu\u201d Emergency Clinical Hospital, 2 Ateneului Street, 700309 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5081-3577","authenticated-orcid":false,"given":"Cristian","family":"Gu\u021bu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2710-7284","authenticated-orcid":false,"given":"Alina","family":"Ple\u0219ea-Condratovici","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1652-2618","authenticated-orcid":false,"given":"Leti\u021bia Doina","family":"Duceac","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"},{"name":"\u201cProf. Dr. Nicolae Oblu\u201d Emergency Clinical Hospital, 2 Ateneului Street, 700309 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian","family":"Eva","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"},{"name":"\u201cProf. Dr. Nicolae Oblu\u201d Emergency Clinical Hospital, 2 Ateneului Street, 700309 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3189-2027","authenticated-orcid":false,"given":"Marius Gabriel","family":"Dabija","sequence":"additional","affiliation":[{"name":"\u201cProf. Dr. Nicolae Oblu\u201d Emergency Clinical Hospital, 2 Ateneului Street, 700309 Ia\u0219i, Romania"},{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universit\u0103\u021bii Street, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2094-1089","authenticated-orcid":false,"given":"Eva-Maria","family":"Elkan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina Monica","family":"Miftode","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universit\u0103\u021bii Street, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Stefanache","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universit\u0103\u021bii Street, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad-Andrei","family":"Dabija","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universit\u0103\u021bii Street, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1893-5109","authenticated-orcid":false,"given":"Gabriela","family":"Calin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doina Carina","family":"Voinescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University Gala\u0163i, Al. I. Cuza Street, Nr. 35, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s12178-017-9441-4","article-title":"Lumbar Disc Herniation","volume":"10","author":"Amin","year":"2017","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.amjmed.2023.03.024","article-title":"Lumbar Disc Herniation: Diagnosis and Management","volume":"136","author":"Zhang","year":"2023","journal-title":"Am. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Cioanca, O., Lungu, I.-I., Batir-Marin, D., Lungu, A., Marin, G.-A., Huzum, R., Stefanache, A., Sekeroglu, N., and Hancianu, M. (2025). Modulating Polyphenol Activity with Metal Ions: Insights into Dermatological Applications. Pharmaceutics, 17.","DOI":"10.20944\/preprints202501.1565.v1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"em630","DOI":"10.29333\/ejgm\/15929","article-title":"Diagnostic and Therapeutic Particularities of a Case Admitted for Low Back Pain and Sciatica","volume":"22","author":"Marinescu","year":"2025","journal-title":"Electron. J. Gen. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1056\/NEJMcp1512658","article-title":"Herniated Lumbar Intervertebral Disk","volume":"374","author":"Deyo","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.spinee.2019.06.004","article-title":"Nonsurgical Treatments for Patients with Radicular Pain from Lumbosacral Disc Herniation","volume":"19","author":"Lee","year":"2019","journal-title":"Spine J."},{"key":"ref_7","first-page":"5670303","article-title":"Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis","volume":"2022","author":"Wang","year":"2022","journal-title":"Comput. Math. Methods Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"pzaa231","DOI":"10.1093\/ptj\/pzaa231","article-title":"Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis","volume":"101","author":"Vanti","year":"2021","journal-title":"Phys. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/0269215519872528","article-title":"The Effect of Mechanical Traction on Low Back Pain in Patients with Herniated Intervertebral Disks: A Systemic Review and Meta-Analysis","volume":"34","author":"Cheng","year":"2020","journal-title":"Clin. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e012938","DOI":"10.1136\/bmjopen-2016-012938","article-title":"Surgical versus Conservative Treatment for Lumbar Disc Herniation: A Prospective Cohort Study","volume":"6","author":"Gugliotta","year":"2016","journal-title":"BMJ Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1136\/bjsports-2015-094691","article-title":"Return to Sport after Open and Microdiscectomy Surgery versus Conservative Treatment for Lumbar Disc Herniation: A Systematic Review with Meta-Analysis","volume":"50","author":"Reiman","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s00586-007-0527-3","article-title":"Higher Preoperative Oswestry Disability Index Is Associated with Better Surgical Outcome in Upper Lumbar Disc Herniations","volume":"17","author":"Saberi","year":"2008","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1007\/s00586-017-5185-5","article-title":"Criteria for Failure and Worsening after Surgery for Lumbar Disc Herniation: A Multicenter Observational Study Based on Data from the Norwegian Registry for Spine Surgery","volume":"26","author":"Werner","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1007\/s00586-013-2848-8","article-title":"Systematic Review of Microendoscopic Discectomy for Lumbar Disc Herniation","volume":"22","author":"Smith","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/0269215517719952","article-title":"Surgical versus Non-Operative Treatment for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis","volume":"32","author":"Chen","year":"2018","journal-title":"Clin. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/BRS.0000000000000088","article-title":"Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation: Eight-Year Results for the Spine Patient Outcomes Research Trial","volume":"39","author":"Lurie","year":"2014","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.spinee.2021.02.022","article-title":"Comparison of Interventions for Lumbar Disc Herniation: A Systematic Review with Network Meta-Analysis","volume":"21","author":"Rickers","year":"2021","journal-title":"Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zhao, X., Chen, A., Lou, X., and Zhang, Y. (2022). Comparison of Three Common Intervertebral Disc Discectomies in the Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis Based on Multiple Data. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226604"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E488","DOI":"10.1097\/BRS.0b013e3181cc3f56","article-title":"Conservative Management of Lumbar Disc Herniation with Associated Radiculopathy: A Systematic Review","volume":"35","author":"Hahne","year":"2010","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s00776-010-1457-1","article-title":"Comparison of Early and Late Surgical Intervention for Lumbar Disc Herniation: Is Earlier Better?","volume":"15","author":"Akagi","year":"2010","journal-title":"J. Orthop. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1177\/2192568220936217","article-title":"An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures","volume":"11","author":"Lilly","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"El Melhat, A.M., Youssef, A.S.A., Zebdawi, M.R., Hafez, M.A., Khalil, L.H., and Harrison, D.E. (2024). Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13040974"},{"key":"ref_23","first-page":"93","article-title":"Risk Factors of Recurrent Lumbar Disk Herniation","volume":"8","author":"Shimia","year":"2022","journal-title":"Asian J. Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4184\/asj.2014.8.2.211","article-title":"Risk Factors for Recurrent Lumbar Disc Herniations","volume":"8","author":"Shin","year":"2014","journal-title":"Asian Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1097\/BRS.0000000000002655","article-title":"Clinical Characteristics and Risk Factors of Recurrent Lumbar Disk Herniation: A Retrospective Analysis of Three Hundred Twenty-One Cases","volume":"43","author":"Li","year":"2018","journal-title":"Spine"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Necul\u0103e\u0219, M., Hernandez-Lucas, P., and Lucaci, P. (2024). Implications of Stabilometric Assessment in Determining Functional Deficits in Patients with Severe Knee Osteoarthritis: Observational Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113181"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Duceac, M., Gutu, C., Eva, L., Dabija, M.G., Calin, G., Duceac, L.D., Ciupilan, C., and Voinescu, D.C. (2024). 666 Retrospective Study of Lumbar Disc Herniation in a Hospital in North-Eastern Romania. Balneo PRM Res. J., 15.","DOI":"10.12680\/balneo.2024.666"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"De Simone, M., Choucha, A., Ciaglia, E., Conti, V., Pecoraro, G., Santurro, A., Puca, A.A., Cascella, M., and Iaconetta, G. (2024). Discogenic Low Back Pain: Anatomic and Pathophysiologic Characterization, Clinical Evaluation, Biomarkers, AI, and Treatment Options. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195915"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Scrofani, R., De Simone, M., Migliorini, F., Amoroso, E., Maffulli, N., Narciso, N., and Iaconetta, G. (2024). Spontaneous Resolution of Symptomatic Synovial Cysts of the Lumbar Spine: A Comprehensive Review with Two Illustrative Cases. Medicina, 60.","DOI":"10.3390\/medicina60071115"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"101624","DOI":"10.1016\/j.neuchi.2024.101624","article-title":"The Da Vinci Robot, a Promising yet Underused Minimally Invasive Tool for Spine Surgery: A Scoping Review of Its Current Role and Limits","volume":"71","author":"Choucha","year":"2025","journal-title":"Neurochirurgie"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e14410","DOI":"10.1097\/MD.0000000000014410","article-title":"Comparison of Treatments for Lumbar Disc Herniation: Systematic Review with Network Meta-Analysis","volume":"98","author":"Arts","year":"2019","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1097\/BRS.0000000000002088","article-title":"Reoperation for Recurrent Intervertebral Disc Herniation in the Spine Patient Outcomes Research Trial: Analysis of Rate, Risk Factors, and Outcome","volume":"42","author":"Abdu","year":"2017","journal-title":"Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S187","DOI":"10.1016\/j.otsr.2012.11.005","article-title":"Surgical Discectomy for Lumbar Disc Herniation: Surgical Techniques","volume":"99","author":"Blamoutier","year":"2013","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_34","first-page":"E265","article-title":"Risk Factors of Recurrent Lumbar Disk Herniation: A Single Center Study and Review of the Literature","volume":"28","author":"Miwa","year":"2015","journal-title":"Clin. Spine Surg."},{"key":"ref_35","first-page":"214","article-title":"Efficacy and Tolerability of a Novel Food Supplement (Turbofer (R)) Containing Microencapsulated Iron in Liposomal Form, in Female Iron Deficiency Anaemia","volume":"17","author":"Rosoga","year":"2015","journal-title":"Prog. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.neucir.2016.11.004","article-title":"Lumbar Disc Herniation: Natural History, Role of Physical Examination, Timing of Surgery, Treatment Options and Conflicts of Interests","volume":"28","year":"2017","journal-title":"Neurocirug\u00eda"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"101482","DOI":"10.1016\/j.neuchi.2023.101482","article-title":"Patient-Related Risk Factors and Lifestyle Factors for Lumbar Degenerative Disc Disease: A Systematic Review","volume":"69","author":"Hoffeld","year":"2023","journal-title":"Neurochirurgie"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.2147\/JPR.S132862","article-title":"Incidence and Risk Factors of Persistent Low Back Pain Following Posterior Decompression and Instrumented Fusion for Lumbar Disk Herniation","volume":"10","author":"Wang","year":"2017","journal-title":"J. Pain. Res."},{"key":"ref_39","first-page":"398","article-title":"Obesity, Vascular Disease, and Lumbar Disk Degeneration: Associations of Comorbidities in Low Back Pain","volume":"9","author":"Kendall","year":"2017","journal-title":"PMR"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s00402-021-04194-3","article-title":"Lumbar Spine Intervertebral Disc Desiccation Is Associated with Medical Comorbidities Linked to Systemic Inflammation","volume":"143","author":"Lambrechts","year":"2023","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"204","DOI":"10.3892\/etm.2020.9334","article-title":"Intraocular Pressure Changes during and after Silicone Oil Endotamponade (Review)","volume":"20","author":"Branisteanu","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_42","first-page":"608","article-title":"Stress-Induced Variability in Local Anesthesia Response: Exploring Implications for Dental Anesthetic Management","volume":"16","author":"Grierosu","year":"2024","journal-title":"Rom. J. Oral. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"31","DOI":"10.22603\/ssrr.2021-0035","article-title":"Efficacy and Safety of Condoliase Disc Administration as a New Treatment for Lumbar Disc Herniation","volume":"6","author":"Inoue","year":"2022","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2381462","DOI":"10.1155\/2020\/2381462","article-title":"Efficacy and Safety of Modified Duhuo Jisheng Decoction in the Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis","volume":"2020","author":"Xiong","year":"2020","journal-title":"Evid. Based Complement. Altern. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1080\/15384101.2024.2342703","article-title":"Genetic Predisposition of BMP7 Polymorphisms to Lumbar Disk Herniation in the Chinese Han Population","volume":"23","author":"Sun","year":"2024","journal-title":"Cell Cycle"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1002\/ca.23641","article-title":"Genetic Risk Factors for Lumbar Disc Disease","volume":"34","author":"Doraisamy","year":"2021","journal-title":"Clin. Anat."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3952\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:46:52Z","timestamp":1760032012000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113952"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113952","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]}}}