{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:28:49Z","timestamp":1789698529412,"version":"4.0.1"},"reference-count":53,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"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: MRI FLAIR signal serves as a time surrogate in unknown onset strokes; however, its prognostic value in early known-onset strokes treated with intravenous thrombolysis (IVT) remains unclear. We aim to evaluate whether FLAIR positivity predicts hemorrhagic transformation and less favorable functional outcome following IVT within 4.5 h of symptom onset. Methods: A systematic search of Embase, PubMed, and Cochrane Library was conducted. We included studies reporting 90-day functional outcome and hemorrhagic transformation after intravenous thrombolysis within 4.5 h of symptom onset in relation to the FLAIR signal on pre-treatment MRI. Two reviewers independently extracted data and assessed bias using QUIPS. A random-effects model was used for meta-analysis. The study protocol was registered in PROSPERO (CRD42023486781). Results: Six studies comprising 951 patients were included in the final analysis. Patients with FLAIR-positive lesions (25.86%) had non-significantly higher odds of hemorrhagic transformation (OR, 3.47; 95% CI, 0.51\u201323.57; p = 0.131) and significantly higher odds of unfavorable 90-day outcome (OR, 2.14; 95% CI, 1.01\u20134.55; p = 0.049). The pooled sensitivity and specificity of FLAIR status for predicting hemorrhagic transformation were 41.2% and 82.1%. The pooled sensitivity and specificity of FLAIR status for predicting less favorable outcome were 40.9% and 78.1%, respectively. Conclusions: FLAIR positivity is significantly associated with less favorable 90-day functional outcome and a trend toward a higher rate of hemorrhagic transformation following IVT within 4.5 h of symptom onset. It may aid risk stratification but should not preclude treatment in eligible patients.<\/jats:p>","DOI":"10.3390\/jcm14228031","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:46:22Z","timestamp":1763138782000},"page":"8031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of FLAIR Positivity and Worse Outcomes After Intravenous Thrombolysis in Known-Onset Strokes: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2715-995X","authenticated-orcid":false,"given":"Esra","family":"Zhubi","sequence":"first","affiliation":[{"name":"Department of Neurology, Semmelweis University, 1083 Budapest, Hungary"},{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azamat","family":"Bissenov","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Department of Orthopedics, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3280-4181","authenticated-orcid":false,"given":"Anna S\u00e1ra","family":"Lengyel","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9ka","family":"T\u00f3th","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e1s Attila","family":"Horv\u00e1th","sequence":"additional","affiliation":[{"name":"Neurocognitive Research Center, Ny\u00edr\u0151 Gyula National Institute of Psychiatry and Addictology, 1135 Budapest, Hungary"},{"name":"Research Centre for Natural Sciences, HUN-REN, 1519 Budapest, Hungary"},{"name":"Department of Anatomy, Histology and Embryology, Semmelweis University, 1094 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7638-1741","authenticated-orcid":false,"given":"Szabolcs","family":"K\u00e9ri","sequence":"additional","affiliation":[{"name":"Szt\u00e1rai Institute, University of Tokaj, 3944 S\u00e1rospatak, Hungary"},{"name":"Department of Physiology, Albert Szent-Gy\u00f6rgyi Medical School, University of Szeged, 6720 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4269-5130","authenticated-orcid":false,"given":"Marie Anne","family":"Engh","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Hegyi","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Institute for Translational Medicine, Medical School, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"},{"name":"Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bence","family":"Gunda","sequence":"additional","affiliation":[{"name":"Department of Neurology, Semmelweis University, 1083 Budapest, Hungary"},{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1161\/STROKEAHA.122.042022","article-title":"Burden of Stroke in Europe: An Analysis of the Global Burden of Disease Study Findings From 2010 to 2019","volume":"55","author":"Prendes","year":"2024","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"I\u2013LXII","DOI":"10.1177\/2396987321989865","article-title":"European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke","volume":"6","author":"Berge","year":"2021","journal-title":"Eur. Stroke J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"107426","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107426","article-title":"Continuity and Change in Baseline Stroke Knowledge across the world: Second Wave of FAST Heroes campaign implementation","volume":"32","author":"Tsakpounidou","year":"2023","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"20","author":"Collaborators","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1016\/S0140-6736(14)60584-5","article-title":"Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: A meta-analysis of individual patient data from randomised trials","volume":"384","author":"Emberson","year":"2014","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Spronk, E., Sykes, G., Falcione, S., Munsterman, D., Joy, T., Kamtchum-Tatuene, J., and Jickling, G.C. (2021). Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.661955"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1016\/S0140-6736(10)60491-6","article-title":"Time to treatment with intravenous alteplase and outcome in stroke: An updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials","volume":"375","author":"Lees","year":"2010","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1136\/svn-2018-000141","article-title":"Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous recombinant tissue plasminogen activator: A systematic review and meta-analysis","volume":"3","author":"Guo","year":"2018","journal-title":"Stroke Vasc. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sun, J., Lam, C., Christie, L., Blair, C., Li, X., Werdiger, F., Yang, Q., Bivard, A., Lin, L., and Parsons, M. (2023). Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1079205"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e1444","DOI":"10.1212\/WNL.0000000000206837","article-title":"Age-Related Differences in the Role of Risk Factors for Ischemic Stroke","volume":"100","author":"Howard","year":"2023","journal-title":"Neurology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/S1474-4422(11)70192-2","article-title":"DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4\u00b75 h of symptom onset (PRE-FLAIR): A multicentre observational study","volume":"10","author":"Thomalla","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1056\/NEJMoa1804355","article-title":"MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset","volume":"379","author":"Thomalla","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1177\/23969873211007686","article-title":"Hyperintense acute reperfusion marker associated with hemorrhagic transformation in the WAKE-UP trial","volume":"6","author":"Wouters","year":"2021","journal-title":"Eur. Stroke J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1159\/000517241","article-title":"Fluid-Attenuated Inversion Recovery Hyperintense Ischemic Stroke Predicts Less Favorable 90-Day Outcome after Intravenous Thrombolysis","volume":"50","author":"Kim","year":"2021","journal-title":"Cerebrovasc. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1159\/000331467","article-title":"Fluid-attenuated inversion recovery hyperintensity in acute ischemic stroke may not predict hemorrhagic transformation","volume":"32","author":"Campbell","year":"2011","journal-title":"Cerebrovasc. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3424","DOI":"10.1161\/STROKEAHA.108.516740","article-title":"Focal fluid-attenuated inversion recovery hyperintensity within acute diffusion-weighted imaging lesions is associated with symptomatic intracerebral hemorrhage after thrombolysis","volume":"39","author":"Cho","year":"2008","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Meisterernst, J., Klinger-Gratz, P.P., Leidolt, L., Lang, M.F., Schroth, G., Mordasini, P., Heldner, M.R., Mono, M.L., Kurmann, R., and Buehlmann, M. (2017). Focal T2 and FLAIR hyperintensities within the infarcted area: A suitable marker for patient selection for treatment?. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0185158"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Cumpston, M., Li, T., Page, M.J., Chandler, J., Welch, V.A., Higgins, J.P.T., and Thomas, J. (2019). Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst. Rev., 2019.","DOI":"10.1002\/14651858.ED000142"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1002\/jrsm.1563","article-title":"Citationchaser: A tool for transparent and efficient forward and backward citation chasing in systematic searching","volume":"13","author":"Haddaway","year":"2022","journal-title":"Res. Synth. Methods"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: The kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Neyeloff, J.L., Fuchs, S.C., and Moreira, L.B. (2012). Meta-analyses and Forest plots using a microsoft excel spreadsheet: Step-by-step guide focusing on descriptive data analysis. BMC Res. Notes, 5.","DOI":"10.1186\/1756-0500-5-52"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"280","DOI":"10.7326\/0003-4819-158-4-201302190-00009","article-title":"Assessing bias in studies of prognostic factors","volume":"158","author":"Hayden","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2174\/1874210601206010031","article-title":"Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study","volume":"6","author":"Phi","year":"2012","journal-title":"Open Dent. J."},{"key":"ref_27","first-page":"719","article-title":"Statistical aspects of the analysis of data from retrospective studies of disease","volume":"22","author":"Mantel","year":"1959","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1093\/oxfordjournals.aje.a114447","article-title":"A general estimator for the variance of the Mantel-Haenszel odds ratio","volume":"124","author":"Robins","year":"1986","journal-title":"Am. J. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"377","DOI":"10.6028\/jres.087.022","article-title":"Consensus Values and Weighting Factors","volume":"87","author":"Paule","year":"1982","journal-title":"J. Res. Natl. Bur. Stand."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_31","unstructured":"R Core Team (2023). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_32","unstructured":"Borenstein, M., Egger, M., Higgins, J.P.T., and Smith, G.D. (2022). Meta-Analysis in R. Systematic Reviews in Health Research: Meta-Analysis in Context, John Wiley & Sons. [3rd ed.]."},{"key":"ref_33","unstructured":"Cuijpers, P.F.T., and Ebert, D.D. (2024, April 10). Dmetar: Companion R Package for the Guide Doing Meta-Analysis in R. Available online: https:\/\/dmetar.protectlab.org."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1161\/STROKEAHA.111.632026","article-title":"Fluid-attenuated inversion recovery images and stroke outcome after thrombolysis","volume":"43","author":"Ebinger","year":"2012","journal-title":"Stroke"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"El Nawar, R., Yeung, J., Labreuche, J., Chadenat, M.L., Duong, D.L., De Malherbe, M., Cordoliani, Y.S., Lapergue, B., and Pico, F. (2019). MRI-Based Predictors of Hemorrhagic Transformation in Patients With Stroke Treated by Intravenous Thrombolysis. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00897"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.neurad.2015.04.008","article-title":"Parenchymal FLAIR hyperintensity before thrombolysis is a prognostic factor of ischemic stroke outcome at 3 Tesla","volume":"42","author":"Emeriau","year":"2015","journal-title":"J. Neuroradiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/ane.12272","article-title":"Predicting intracerebral hemorrhage by baseline magnetic resonance imaging in stroke patients undergoing systemic thrombolysis","volume":"130","author":"Hobohm","year":"2014","journal-title":"Acta Neurol. Scand."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/j.1468-1331.2012.03841.x","article-title":"Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis","volume":"20","author":"Kufner","year":"2012","journal-title":"Eur. J. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1161\/STROKEAHA.116.015233","article-title":"Stroke With Unknown Time of Symptom Onset: Baseline Clinical and Magnetic Resonance Imaging Data of the First Thousand Patients in WAKE-UP (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke: A Randomized, Doubleblind, Placebo-Controlled Trial)","volume":"48","author":"Thomalla","year":"2017","journal-title":"Stroke"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1001\/jamaneurol.2020.4123","article-title":"Association of Reperfusion After Thrombolysis With Clinical Outcome Across the 4.5- to 9-Hours and Wake-up Stroke Time Window: A Meta-Analysis of the EXTEND and EPITHET Randomized Clinical Trials","volume":"78","author":"Campbell","year":"2021","journal-title":"JAMA Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1111\/ijs.12011","article-title":"A multicenter, randomized, double-blind, placebo-controlled trial to test efficacy and safety of magnetic resonance imaging-based thrombolysis in wake-up stroke (WAKE-UP)","volume":"9","author":"Thomalla","year":"2014","journal-title":"Int. J. Stroke"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1161\/STROKEAHA.113.004627","article-title":"Fluid-attenuated inversion recovery hyperintensity correlates with matrix metalloproteinase-9 level and hemorrhagic transformation in acute ischemic stroke","volume":"45","author":"Jha","year":"2014","journal-title":"Stroke"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1177\/0284185119887593","article-title":"MRI for prediction of hemorrhagic transformation in acute ischemic stroke: A systematic review and meta-analysis","volume":"61","author":"Suh","year":"2020","journal-title":"Acta Radiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"31","DOI":"10.15441\/ceem.14.043","article-title":"Diffusion-weighted imaging-fluid-attenuated inversion recovery mismatch is associated with better neurologic response to intravenous thrombolytic therapy in acute ischemic stroke patients","volume":"2","author":"Jeong","year":"2015","journal-title":"Clin. Exp. Emerg. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Quan, G., Ban, R., Ren, J.L., Liu, Y., Wang, W., Dai, S., and Yuan, T. (2021). FLAIR and ADC Image-Based Radiomics Features as Predictive Biomarkers of Unfavorable Outcome in Patients With Acute Ischemic Stroke. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.730879"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Xu, Q., Zhu, Y., Zhang, X., Kong, D., Duan, S., Guo, L., Yin, X., Jiang, L., Liu, Z., and Yang, W. (2023). Clinical features and FLAIR radiomics nomogram for predicting functional outcomes after thrombolysis in ischaemic stroke. Front. Neurosci., 17.","DOI":"10.3389\/fnins.2023.1063391"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1148\/radiol.211394","article-title":"Synthetic FLAIR as a Substitute for FLAIR Sequence in Acute Ischemic Stroke","volume":"303","author":"Benzakoun","year":"2022","journal-title":"Radiology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/23969873241263418","article-title":"Multicenter validation of synthetic FLAIR as a substitute for FLAIR sequence in acute ischemic stroke","volume":"10","author":"Hamon","year":"2024","journal-title":"Eur. Stroke J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s12028-014-0060-2","article-title":"Comparison of 8 scores for predicting symptomatic intracerebral hemorrhage after IV thrombolysis","volume":"22","author":"Asuzu","year":"2015","journal-title":"Neurocrit. Care"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1177\/2396987319883461","article-title":"Diagnostic accuracy of computed tomography perfusion in the prediction of haemorrhagic transformation and patient outcome in acute ischaemic stroke: A systematic review and meta-analysis","volume":"5","author":"Adebayo","year":"2020","journal-title":"Eur. Stroke J."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Pensato, U., Rex, N., Kashani, N., Yu, A.Y., Jadhav, A.P., Rha, J.H., Puri, A.S., Burns, P., Demchuk, A.M., and Hill, M.D. (2025). Association between time and severe hypoperfusion with risk of hemorrhagic transformation in stroke patients. Int. J. Stroke, 17474930251360519.","DOI":"10.1177\/17474930251360519"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1038\/s41591-021-01458-8","article-title":"Accelerating the translational medicine cycle: The Academia Europaea pilot","volume":"27","author":"Hegyi","year":"2021","journal-title":"Nat. Med."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Hegyi, P., Petersen, O.H., Holgate, S., Er\u0151ss, B., Garami, A., Szak\u00e1cs, Z., Dobszai, D., Balask\u00f3, M., Kem\u00e9ny, L., and Peng, S. (2020). Academia Europaea Position Paper on Translational Medicine: The Cycle Model for Translating Scientific Results into Community Benefits. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051532"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8031\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:58:05Z","timestamp":1763139485000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":53,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14228031"],"URL":"https:\/\/doi.org\/10.3390\/jcm14228031","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]}}}