{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:36:28Z","timestamp":1765211788124,"version":"3.46.0"},"reference-count":57,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"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>Objective. Limited evidence is available concerning the surgical outcomes of patients with congenital gastrointestinal malformations and perioperative SARS-CoV-2 infection. This study examines the scientific evidence on SARS-CoV-2 infection and congenital gastrointestinal malformations requiring surgery in children. Material and Methods. We performed a systematic review of studies reporting data on children with congenital gastrointestinal malformations and SARS-CoV-2 infection, published in international databases (PubMed and Embase) from pandemic inception up to August 2024. Studies not reporting data on the SARS-CoV-2 infection status on patients with congenital digestive malformation were excluded. We assessed the quality of the included studies according to the Joanna Institute (JBI) appraisal checklist, adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and registered the protocol with the PROSPERO database (CRD42024550744). Results. From the 902 titles retrieved, eight observational studies met the inclusion criteria comprising 29 patients from countries with different socioeconomic statuses. Most patients were neonates (75%) with a median age of 3 days at diagnosis and male to female ratio of 2:1. In total, 18 (62%) presented upper gastrointestinal tract anomalies, including esophageal atresia \u00b1 tracheoesophageal fistula (n = 10, 34.48%), duodenal atresia (n = 3, 10.3%), and congenital hypertrophic pyloric stenosis (n = 5, 17.2%). Lower digestive tract malformations (11, 38%) included anorectal malformations (n = 6, 20.6%), intestinal atresia (n = 3, 10.3%), Hirschsprung disease (n = 1, 3.44%), and Meckel\u2019s diverticulum (n = 1, 3.44%). Surgeries were primarily emergency or urgent procedures and only pyloromyotomy (5\/5) was consistently operated minimally invasively. SARS-CoV-2 infection was identified mainly on routine screening (&gt;95%). Of 29 patients, 85% were discharged home, and no postoperative surgical mortality and significant complications directly associated with COVID-19 were identified, although routine postoperative morbidity not linked to SARS-CoV-2 was observed. Conclusions. Pediatric patients with congenital gastrointestinal malformationsand perioperative SARS-CoV-2 infection typically have mild illness and favorable surgical outcomes. SARS-CoV-2 positivity alone should not delay essential surgery when infection control measures are ensured. Standardized, multicenter studies are needed to clarify perioperative risks to and inform management of this high-risk group.<\/jats:p>","DOI":"10.3390\/jcm14238533","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8533","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Congenital Gastrointestinal Malformation Outcome and Largely Asymptomatic SARS-CoV-2 Infection in Pediatric Patients\u2014A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Iulia","family":"Stratulat-Chiriac","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3018-8011","authenticated-orcid":false,"given":"Elena","family":"\u021aarc\u0103","sequence":"additional","affiliation":[{"name":"Department of Surgery II\u2014Pediatric Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4225-1935","authenticated-orcid":false,"given":"Raluca Ozana","family":"Chistol","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana-Alina","family":"Halip","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4192-3704","authenticated-orcid":false,"given":"Viorel","family":"\u021aarc\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Apollonia University, Strada P\u0103curari nr. 11, 700511 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Furnic\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Morpho-Functional Sciences I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.32074\/1591-951X-553","article-title":"Congenital anomalies of the tubular gastrointestinal tract","volume":"114","author":"Ludwig","year":"2022","journal-title":"Pathologica"},{"key":"ref_2","unstructured":"Bass, L.M., and Wershil, B.K. (2016). Anatomy, histology, embryology, and developmental anomalies of the small and large intestine. Sleisenger and Fordtran\u2019s Gastrointestinal and Liver Disease, Saunders, Elsevier Inc, 1649. [10th ed.]."},{"key":"ref_3","unstructured":"(2024, November 30). Newborn Mortality. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/newborn-mortality."},{"key":"ref_4","unstructured":"GBD 2015 Child Mortality Collaborators (2016) (2016). Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980\u20132015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388, 1725\u20131774."},{"key":"ref_5","unstructured":"European Commision (2024, November 30). Prevalence Charts and Tables. Available online: https:\/\/eu-rd-platform.jrc.ec.europa.eu\/eurocat\/eurocat-data\/prevalence_en."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/0189-6725.150983","article-title":"Epidemiology of congenital abnormalities in West Africa: Results of a descriptive study in teaching hospitals in Abidjan: Cote d\u2019Ivoire","volume":"12","author":"Kouame","year":"2015","journal-title":"Afr. J. Paediatr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"133","DOI":"10.4103\/ajps.AJPS_37_21","article-title":"Congenital Malformations of the Gastrointestinal Tract in Neonates at Aristide Le Dantec University Hospital in Dakar","volume":"19","author":"Camara","year":"2022","journal-title":"Afr. J. Paediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Wang, W., Pan, W., Wu, W., Zhu, D., and Wang, J. (2024). Study of Correlation between Fetal Bowel Dilation and Congenital Gastrointestinal Malformation. Children, 11.","DOI":"10.3390\/children11060670"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1007\/s11605-009-1124-z","article-title":"Congenital Anomalies of the Gastrointestinal Tract Diagnosed in Adulthood\u2014Diagnosis and Management","volume":"14","author":"Vaos","year":"2010","journal-title":"J. Gastrointest. Surg."},{"key":"ref_10","first-page":"97","article-title":"Delayed presentation of duodenal atresia","volume":"20","author":"Tiwari","year":"2023","journal-title":"Afr. J. Paediatr. Surg."},{"key":"ref_11","unstructured":"Global PaedSurg Research Collaboration (2021). Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: A multicentre, international, prospective cohort study. Lancet, 398, 325\u2013339."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e12154","DOI":"10.1097\/MD.0000000000012154","article-title":"Systematic review of epidemiology, presentation, and management of Meckel\u2019s diverticulum in the 21st century","volume":"97","author":"Hansen","year":"2018","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.jpedsurg.2020.04.009","article-title":"From the editors: The COVID-19 crisis and its implications for pediatric surgeons","volume":"55","author":"Davenport","year":"2020","journal-title":"J. Pediatr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e003016","DOI":"10.1136\/bmjgh-2020-003016","article-title":"Mitigating the impact of COVID-19 on children\u2019s surgery in Africa","volume":"5","author":"Mazingi","year":"2020","journal-title":"BMJ Glob. Heal."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1007\/s00383-021-04971-6","article-title":"Children with congenital colorectal malformations during the UK Sars-CoV-2 pandemic lockdown: An assessment of telemedicine and impact on health","volume":"37","author":"Stathopoulos","year":"2021","journal-title":"Pediatr. Surg. Int."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Prato, A.P., Conforti, A., Almstrom, M., Van Gemert, W., Scuderi, M.G., Khen-Dunlop, N., Draghici, I., Mendoza-Sagaon, M., Prades, C.G., and Chiarenza, F. (2020). Management of COVID-19-Positive Pediatric Patients Undergoing Minimally Invasive Surgical Procedures: Systematic Review and Recommendations of the Board of European Society of Pediatric Endoscopic Surgeons. Front. Pediatr., 8.","DOI":"10.3389\/fped.2020.00259"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.12998\/wjcc.v8.i14.2893","article-title":"Recommendations for perinatal and neonatal surgical management during the COVID-19 pandemic","volume":"8","author":"Ma","year":"2020","journal-title":"World J. Clin. Cases"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1089\/lap.2020.0251","article-title":"Letter to the Editor: Robot-Assisted and Minimally Invasive Pediatric Surgery and Urology During the COVID-19 Pandemic: A Short Literature Review","volume":"30","author":"Esposito","year":"2020","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1136\/flgastro-2020-101529","article-title":"Gastrointestinal manifestations of COVID-19 in children: A systematic review and meta-analysis","volume":"12","author":"Akobeng","year":"2020","journal-title":"Front. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/S2352-4642(21)00002-X","article-title":"The ability of the neonatal immune response to handle SARS-CoV-2 infection","volume":"5","author":"Brinkmann","year":"2021","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1111\/pan.13963","article-title":"Implementation and expansion of a preoperative COVID-19 testing process for pediatric surgical patients","volume":"30","author":"Cronin","year":"2020","journal-title":"Pediatr. Anesthesia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.amsu.2020.09.020","article-title":"The Impact of COVID-19 pandemic on pediatric surgery practice: A cross-sectional study","volume":"59","author":"Idham","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101641","DOI":"10.1016\/j.epsc.2020.101641","article-title":"Meckel\u2019s diverticulum perforation in a newborn positive to Sars-Cov-2","volume":"62","author":"Bindi","year":"2020","journal-title":"J. Pediatr. Surg. Case Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2710","DOI":"10.1177\/00031348211067707","article-title":"SARS-CoV-2 Testing of Aerosols Emitted During Pediatric Minimally Invasive Surgery: A Prospective, Case-Controlled Study","volume":"88","author":"Haddadin","year":"2022","journal-title":"Am. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"228","DOI":"10.4103\/ajps.ajps_105_21","article-title":"Surgical Neonates with Coronavirus Infectious Disease-19 Infection","volume":"19","author":"Kadian","year":"2022","journal-title":"Afr. J. Paediatr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1016\/j.jpedsurg.2021.01.033","article-title":"Favorable postoperative outcomes for children with COVID-19 infection undergoing surgical intervention: Experience at a free-standing children\u2019s hospital","volume":"56","author":"Mehl","year":"2021","journal-title":"J. Pediatr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/pan.14156","article-title":"An unexpected COVID-19 diagnosis during emergency surgery in a neonate","volume":"31","author":"Evans","year":"2021","journal-title":"Pediatr. Anesthesia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1213\/ANE.0000000000005606","article-title":"Anesthetic Complications Associated with Severe Acute Respiratory Syndrome Coronavirus 2 in Pediatric Patients","volume":"133","author":"Saynhalath","year":"2021","journal-title":"Anesthesia Analg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e398","DOI":"10.1097\/INF.0000000000002921","article-title":"The Direct and Indirect Impact of SARS-CoV-2 Infections on Neonates","volume":"39","author":"Saha","year":"2020","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"455","DOI":"10.4103\/jiaps.jiaps_142_21","article-title":"Challenges and Changes in Pediatric Surgical Practice during the COVID-19 Pandemic Era","volume":"27","author":"Shah","year":"2022","journal-title":"J. Indian Assoc. Pediatr. Surg."},{"key":"ref_32","first-page":"507","article-title":"Past and present in omphalocele treatment in Romania","volume":"109","author":"Aprodu","year":"2014","journal-title":"Chirurgia"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"\u0162arc\u0103, E., Ro\u0219u, S.T., Cojocaru, E., Trandafir, L., Luca, A.C., Lupu, V.V., Mois\u0103, \u0218.M., Munteanu, V., Butnariu, L.I., and \u0162arc\u0103, V. (2021). Statistical Analysis of the Main Risk Factors of an Unfavorable Evolution in Gastroschisis. J. Pers. Med., 11.","DOI":"10.3390\/jpm11111168"},{"key":"ref_34","unstructured":"World Health Organization (1992). International Statistical Classification of Diseases and Related Health Problems: 10th Revision (ICD-10), World Health Organization. Available online: https:\/\/icd.who.int\/browse10\/2019\/en."},{"key":"ref_35","unstructured":"EUROCAT (2025, October 30). Guide 1.4: Instruction for the Registration and Surveillance of Congenital Anomalies. Ispra, Italy: European Commission, Joint Research Centre. Available online: https:\/\/eu-rd-platform.jrc.ec.europa.eu\/system\/files\/public\/JRC-EUROCAT-Full%20Guide%201%204%20version%2022-Nov-2021.pdf."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/s13052-022-01368-6","article-title":"The incidence of congenital anomalies in newborns before and during the Covid-19 pandemic","volume":"48","author":"Heidarzadeh","year":"2022","journal-title":"Ital. J. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/SLA.0000000000005176","article-title":"COVID-19 Vaccination Associated with Reduced Postoperative SARS-CoV-2 Infection and Morbidity","volume":"275","author":"Prasad","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S577","DOI":"10.1016\/j.ajog.2023.11.1127","article-title":"1100 Major congenital malformation in an experimental mouse model of COVID-19","volume":"230","author":"Paidas","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e079364","DOI":"10.1136\/bmj-2024-079364","article-title":"Covid-19 infection and vaccination during first trimester and risk of congenital anomalies: Nordic registry based study","volume":"386","author":"Magnus","year":"2024","journal-title":"BMJ"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1038\/s41467-022-35771-8","article-title":"A population-based matched cohort study of major congenital anomalies following COVID-19 vaccination and SARS-CoV-2 infection","volume":"14","author":"Calvert","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_41","unstructured":"COVIDSurg Collaborative (2020). Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 396, 10243."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Brandibur, T.E., Kundnani, N.R., Boia, M., Nistor, D., Velimirovici, D.M., Mada, L., Manea, A.M., Boia, E.R., Neagu, M.N., and Popoiu, C.M. (2023). Does COVID-19 Infection during Pregnancy Increase the Appearance of Congenital Gastrointestinal Malformations in Neonates?. Biomedicines, 11.","DOI":"10.3390\/biomedicines11123105"},{"key":"ref_43","unstructured":"(2024, November 30). Covid-19. Available online: https:\/\/www.aap.org\/en\/pages\/2019-novel-coronavirus-covid-19-infections\/children-and-covid-19-state-level-data-report\/."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1038\/s41390-024-03076-9","article-title":"Congenital anomalies and predisposition to severe COVID-19 among pediatric patients in the United States","volume":"96","author":"Goodman","year":"2024","journal-title":"Pediatr. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00540-023-03272-7","article-title":"Postoperative outcomes of pediatric patients with perioperative COVID-19 infection: A systematic review and meta-analysis of observational studies","volume":"38","author":"Gong","year":"2024","journal-title":"J. Anesthesia"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/pan.13889","article-title":"Pediatric anesthetic implications of COVID-19\u2014A review of current literature","volume":"30","year":"2020","journal-title":"Pediatr. Anesthesia"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1001\/jamasurg.2020.2588","article-title":"Incidence of COVID-19 in Pediatric Surgical Patients Among 3 US Children\u2019s Hospitals","volume":"155","author":"Lin","year":"2020","journal-title":"JAMA Surgery"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/ACO.0000000000001000","article-title":"Coronavirus disease 2019 and pediatric anesthesia","volume":"34","author":"Tan","year":"2021","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1111\/anae.15614","article-title":"Peri-operative outcomes of surgery in children with SARS-CoV-2 infection","volume":"77","author":"Glasbey","year":"2022","journal-title":"Anaesthesia"},{"key":"ref_50","first-page":"e644","article-title":"Favourable perioperative outcomes for children with SARS-CoV-2","volume":"107","author":"Nepogodiev","year":"2020","journal-title":"Br. J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e001066","DOI":"10.1136\/bmjpo-2021-001066","article-title":"Changes in children\u2019s surgical services during the COVID-19 pandemic at a tertiary-level government hospital in a lower middle-income country","volume":"5","author":"Kabir","year":"2021","journal-title":"BMJ Paediatr. Open"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.29271\/jcpsp.2021.Supp1.S75","article-title":"Effect of Strict Lockdown on Pediatric Surgical Services and Residency Programme during COVID-19 Pandemic","volume":"31","author":"Zamir","year":"2021","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00595-024-02792-3","article-title":"Impact of the novel coronavirus infection on pediatric surgery: An analysis of data from the National Clinical Database","volume":"54","author":"Ise","year":"2024","journal-title":"Surg. Today"},{"key":"ref_54","unstructured":"(2020). COVIDSurg Collaborative Global guidance for surgical care during the COVID-19 pandemic. Br. J. Surg., 107, 1097\u20131103."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"906","DOI":"10.37358\/RC.19.3.7028","article-title":"Assessment of Bacteria Resistance According to Antibiotic Chemical Structure","volume":"70","author":"Duceac","year":"2019","journal-title":"Rev. de Chim."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Al Namat, R., Duceac, L.D., Chelaru, L., Dimitriu, C., Bazyani, A., Tarus, A., Bacusca, A., Ro\u0219ca, A., Al Namat, D., and Livanu, L.I. (2024). The Impact of COVID-19 Vaccination on Oxidative Stress and Cardiac Fibrosis Biomarkers in Patients with Acute Myocardial Infarction (STEMI), a Single-Center Experience Analysis. Life, 14.","DOI":"10.3390\/life14111350"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"823","DOI":"10.3390\/pediatric16040070","article-title":"Comparison of One-Year Post-Operative Evolution of Children Born of COVID-19-Positive Mothers vs. COVID-19-Negative Pregnancies Having Congenital Gastrointestinal Malformation and Having Received Proper Parenteral Nutrition during Their Hospital Stay","volume":"16","author":"Brandibur","year":"2024","journal-title":"Pediatr. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8533\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:33:09Z","timestamp":1765211589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":57,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238533"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238533","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}