{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:27:43Z","timestamp":1788827263482,"version":"build-2803163510"},"reference-count":58,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Upper-limb rehabilitation is a decisive factor in improving the quality of life for patients who have experienced a stroke. Modern rehabilitation techniques promote the recovery of upper-limb functionality and prehension, contributing to a reduction in disability. Materials and Methods: This retrospective observational study aimed to highlight improvements in prehension through the application of current actual and modern rehabilitation techniques targeting key muscle groups involved in upper-limb recovery. Data from a total of 52 patients were identified and categorized into two groups based on the specific rehabilitation protocols they received during their hospitalization: a study group and a control group. Both groups underwent individualized rehabilitation, differing only in the type of electrotherapy applied: the study group received functional electrical stimulation (FES) and shock wave therapy (RSWT), while the control group received conventional electrical stimulation. Results: After adjusting for baseline differences in severity and time since stroke, patients in the study group demonstrated a significantly greater improvement in functional parameters compared to the control group. The results show us a significant improvement of functionality after RSWT and FES in the study group, with values from 0.28 \u00b1 0.28 to 0.99 \u00b1 0.36 (p-value &lt; 0.001) regarding Hand Grip, suggesting that the treatment effect persists even when initial clinical advantages in the control group are accounted for. Muscle force increased from 0.39 \u00b1 0.54 to 7.67 \u00b1 3.89, p-value &lt; 0.001. Conclusions: The combined application of functional electrical stimulation and shock wave therapy, as modern rehabilitation interventions, provided additional benefits in upper-limb and prehension rehabilitation compared to classical electrical stimulation alone. Our findings suggest that the combined application of RSWT and FES is strongly associated with improved upper-limb recovery, even after adjusting for baseline clinical imbalances. While these results support the integration of these modern techniques into stroke protocols, further prospective randomized controlled trials are needed to confirm the definitive treatment advantage over conventional methods.<\/jats:p>","DOI":"10.3390\/jcm15041560","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:38:39Z","timestamp":1771231119000},"page":"1560","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Modern Upper-Limb Rehabilitation Interventions in Stroke Patients with Spasticity"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5132-2788","authenticated-orcid":false,"given":"Ana Maria","family":"Bumbea","sequence":"first","affiliation":[{"name":"Faculty of Nursing, Medical Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica","family":"Tr\u0103istaru","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Medical Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena-Anca","family":"T\u00e2rtea","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Oltea","family":"Dan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1374-276X","authenticated-orcid":false,"given":"Adina","family":"Turcu-Stiolica","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Matei","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Medical Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"P\u0103tru","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Medical Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Stefan","family":"Bumbea","sequence":"additional","affiliation":[{"name":"Maternity ICU Department, V\u00e2lcea Emergency Hospital, 240284 Ramnicu Valcea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana Octaviana","family":"Daia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/17474930211065917","article-title":"World Stroke Organization (WSO): Global Stroke Fact Sheet 2022","volume":"17","author":"Feigin","year":"2022","journal-title":"Int. J. Stroke"},{"key":"ref_2","unstructured":"World Health Organization (2026, January 18). Stroke, Cerebrovascular Accident. WHO Fact Sheets, Updated 2023. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/stroke."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organ-ization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. J. Stroke"},{"key":"ref_4","first-page":"1477","article-title":"Cervical adenocarcinoma generator of procoagulant status and ischemic stroke","volume":"58","author":"Bumbea","year":"2017","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pino\u0219anu, E.A., Surugiu, R., Burada, E., P\u00eer\u0219coveanu, D., St\u0103nciulescu, C.E., Sandu, R.E., Pisoschi, C., and Albu, C.V. (2023). Oxidative Stress and Antioxidant Defense Mechanisms in Acute Ischemic Stroke Patients with Concurrent COVID-19 Infection. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242316790"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1177\/17474930221150349","article-title":"Antiphospholipid syndrome, antiphospholipid antibodies, and stroke","volume":"18","author":"Mittal","year":"2023","journal-title":"Int. J. Stroke"},{"key":"ref_7","first-page":"1185","article-title":"Study on cognitive decline in patients diagnosed with brain tumors","volume":"58","author":"Bondari","year":"2017","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1177\/0269215520932196","article-title":"The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: A systematic review and meta-analysis","volume":"34","year":"2020","journal-title":"Clin. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/MRR.0000000000000172","article-title":"Differences in motor recovery between upper and lower limbs: Does stroke subtype make the difference?","volume":"39","author":"Paci","year":"2016","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_10","first-page":"KC01","article-title":"Exploring motor recovery differences in paretic upper and lower extremity after stroke: A cross-sectional analytical study","volume":"19","author":"Pulimoot","year":"2025","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gunduz, M.E., Bucak, B., and Keser, Z. (2023). Advances in Stroke Neurorehabilitation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216734"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Cha, K.H., Kang, N.Y., Huh, S., Ko, S.H., Shin, Y.I., and Min, J.H. (2023). The Effects of Autonomic Dysfunction on Functional Outcomes in Patients with Acute Stroke. Brain Sci., 13.","DOI":"10.3390\/brainsci13121694"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.jht.2022.05.001","article-title":"Biofeedback interventions for short term upper limb function following stroke: A systematic review with meta-analysis","volume":"36","author":"Matheus","year":"2023","journal-title":"J. Hand Ther."},{"key":"ref_14","first-page":"480","article-title":"The Effects of Upper Extremity Closed Kinetic Chain Exercise Combined with Biofeedback in Stroke Survivors: A Pilot Study","volume":"56","author":"Kim","year":"2025","journal-title":"NeuroRehabilitation"},{"key":"ref_15","unstructured":"Geeky Medics (2025, February 12). Muscle Power Assessment Scale (MRC Scale). Available online: https:\/\/geekymedics.com\/muscle-power-assessment-mrc-scale\/."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Huerta Ojeda, \u00c1., Fontecilla D\u00edaz, B., Yeomans Cabrera, M.M., and Jerez-Mayorga, D. (2021). Grip power test: A new valid and reliable method for assessing muscle power in healthy adolescents. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0258720"},{"key":"ref_17","unstructured":"PhysioPedia (2025, December 01). Tardieu Scale. Available online: https:\/\/www.physio-pedia.com\/Tardieu_Scale."},{"key":"ref_18","unstructured":"(2025, November 20). Physical Exam of the Hand. Available online: https:\/\/www.orthobullets.com\/hand\/6008\/physical-exam-of-the-hand."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/NPT.0b013e318208efa1","article-title":"Scapular and humeral movement patterns of people with stroke during range-of-motion exercises","volume":"35","author":"Hardwick","year":"2011","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_20","unstructured":"PhysioPedia (2025, January 15). Shoulder Examination. Available online: https:\/\/www.physio-pedia.com\/Shoulder_Examination."},{"key":"ref_21","unstructured":"VA Claims Insider (2025, January 01). The VA Range of Motion Chart Explained. Available online: https:\/\/vaclaimsinsider.com\/va-range-of-motion-chart-explained\/."},{"key":"ref_22","unstructured":"Washington State Department of Social and Health Services (DSHS) (2025, January 20). Range of Joint Motion Evaluation Chart, Form 13-585A (REV. 03\/2014), Available online: https:\/\/www.dshs.wa.gov\/sites\/default\/files\/forms\/pdf\/13-585a.pdf."},{"key":"ref_23","first-page":"e088","article-title":"Validation of Digital Visual Analog Scale Pain Scoring with a Traditional Paper-Based Visual Analog Scale in Adults","volume":"2","author":"Delgado","year":"2018","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"ref_24","unstructured":"Daia, C. (2019). Electroterapie: Principii Practice, Editura Universitar\u0103."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Daia, C., Scheau, C., Toader, C., Bumbea, A.M., Caimac, V.D., Andone, I., Popescu, C., Spanu, A., and Onose, G. (2021). Radial Extracorporeal Shockwave Therapy versus Ultrasound Therapy in Adult Patients with Idiopathic Scoliosis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081701"},{"key":"ref_26","first-page":"S622","article-title":"Role of shockwave therapy in improving joint function in patients with spasticity","volume":"30","author":"Bostina","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Malinaric, R., Mantica, G., Martini, M., Balzarini, F., Mariano, F., Marchi, G., Tognoni, P., Panarello, D., Bottino, P., and Terrone, C. (2023). The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054127"},{"key":"ref_28","unstructured":"International Society for Medical Shockwave Treatment (2025, October 21). Indications. Available online: https:\/\/shockwavetherapy.org\/indications\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.2174\/092986709788682119","article-title":"Extracorporeal shock wave therapy in inflammatory diseases: Molecular mechanism that triggers anti-inflammatory action","volume":"16","author":"Mariotto","year":"2009","journal-title":"Curr. Med. Chem."},{"key":"ref_30","unstructured":"Yoo, J.I., Oh, M.K., Chun, S.W., Lee, S.U., and Lee, C.H. (2020). The effect of extracorporeal shock wave therapy on spasticity: Possible biological mechanisms and clinical implications. Medicina, 56."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0304-3940(01)02320-5","article-title":"Shock wave application to rat skin induces degeneration and reinnervation of sensory nerve fibres","volume":"315","author":"Ohtori","year":"2001","journal-title":"Neurosci. Lett."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1161\/01.STR.0000177880.06663.5c","article-title":"Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke","volume":"36","author":"Manganotti","year":"2005","journal-title":"Stroke"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e19085","DOI":"10.1097\/MD.0000000000019085","article-title":"The effect of focused extracorporeal shock wave therapy on myofascial pain syndrome of trapezius: A systematic review and meta-analysis","volume":"99","author":"Yoo","year":"2020","journal-title":"Medicine"},{"key":"ref_34","first-page":"1672","article-title":"Technological advancements in stroke rehabilitation","volume":"72","author":"Malik","year":"2022","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/S1474-4422(19)30415-6","article-title":"Advances and challenges in stroke rehabilitation","volume":"19","author":"Stinear","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/MRR.0000000000000316","article-title":"Clinical study of combined mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients","volume":"42","author":"Guo","year":"2019","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1749-799X-7-11","article-title":"Extracorporeal shockwave therapy in musculoskeletal disorders","volume":"7","author":"Wang","year":"2012","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Kwon, S., Park, J.H., Kim, W.S., Han, K., Lee, Y., and Paik, N.J. (2018). Health-related quality of life and related factors in stroke survivors: Data from Korea National Health and Nutrition Examination Survey (KNHANES) 2008 to 2014. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195713"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"104591","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104591","article-title":"Long-term Effects of Extracorporeal Shock Wave Therapy on Poststroke Spasticity: A Meta-analysis of Randomized Controlled Trials","volume":"29","author":"Jia","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lee, J.H., and Kim, E.J. (2023). The Effects of Shock Wave Therapy on Spasticity and Walking Ability in People with Stroke: A Comparative Study of Different Application Sites. Brain Sci., 13.","DOI":"10.3390\/brainsci13040687"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/PHM.0000000000002019","article-title":"Effect and Optimal Timing of Extracorporeal Shock-Wave Intervention to Patients with Spasticity After Stroke: A Systematic Review and Meta-analysis","volume":"102","author":"Chen","year":"2023","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1177\/02692155241258740","article-title":"Effects of radial extracorporeal shock wave therapy on flexor spasticity of the upper limb in post-stroke patients: A randomized controlled trial","volume":"38","author":"Fan","year":"2024","journal-title":"Clin. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8064548","DOI":"10.1155\/2022\/8064548","article-title":"Effect of Early Radial Shock Wave Treatment on Spasticity in Subacute Stroke Patients: A Pilot Study","volume":"2022","author":"Brunelli","year":"2022","journal-title":"Biomed. Res. Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1093\/ageing\/afz159","article-title":"Effects of radial extracorporeal shockwave therapy on spasticity of upper-limb agonist\/antagonist muscles in patients affected by stroke: A randomized, single-blind clinical trial","volume":"49","author":"Li","year":"2020","journal-title":"Age Ageing"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e3544","DOI":"10.1097\/MD.0000000000003544","article-title":"Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients with Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial","volume":"95","author":"Li","year":"2016","journal-title":"Medicine"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Starosta, M., Marek, K., Redlicka, J., and Miller, E. (2024). Extracorporeal Shockwave Treatment as Additional Therapy in Patients with Post-Stroke Spasticity of Upper Limb\u2014A Narrative Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13072017"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"518","DOI":"10.23736\/S1973-9087.17.04801-8","article-title":"Comparison of the effect of focused and radial extracorporeal shock waves on spastic equinus in patients with stroke: A randomized controlled trial","volume":"54","author":"Wu","year":"2018","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_48","first-page":"CD003241","article-title":"Electrostimulation for promoting recovery of movement or functional ability after stroke","volume":"2006","author":"Pomeroy","year":"2006","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1177\/0269215519839165","article-title":"Effectiveness of electrical stimulation therapy in improving arm function after stroke: A systematic review and a meta-analysis of randomised controlled trials","volume":"33","author":"Yang","year":"2019","journal-title":"Clin. Rehabil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"5","DOI":"10.17116\/kurort20231000515","article-title":"Primenenie ekzoskeleta s funktsional\u2019noi elektrostimulyatsiei v vosstanovlenii ravnovesiya u patsientov v ostrom i rannem vosstanovitel\u2019nom periodakh ishemicheskogo insul\u2019ta [Application of exoskeleton with functional electrostimulation for rebalancing of patients in acute and early recovery periods of ischemic stroke]","volume":"100","author":"Lutokhin","year":"2023","journal-title":"Vopr. Kurortol. Fizioter. Lech. Fiz. Kult."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1177\/1545968321997769","article-title":"A Robotic System with EMG-Triggered Functional Electrical Stimulation for Restoring Arm Functions in Stroke Survivors","volume":"35","author":"Ambrosini","year":"2021","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1186\/s13063-024-08199-2","article-title":"Effects of robot-assisted upper limb training combined with functional electrical stimulation in stroke patients: Study protocol for a randomized controlled trial","volume":"25","author":"Yang","year":"2024","journal-title":"Trials"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s12984-020-00715-0","article-title":"Systematic review with network meta-analysis of randomized controlled trials of robotic-assisted arm training for improving activities of daily living and upper limb function after stroke","volume":"17","author":"Mehrholz","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Bumbea, A.M., Rogoveanu, O.C., Turcu-Stiolica, A., Pirici, I., Cioroianu, G., Stanca, D.I., Criciotoiu, O., Biciusca, V., Traistaru, R.M., and Caimac, D.V. (2023). Management of Upper-Limb Spasticity Using Modern Rehabilitation Techniques versus Botulinum Toxin Injections Following Stroke. Life, 13.","DOI":"10.3390\/life13112218"},{"key":"ref_55","first-page":"1589","article-title":"Passive mobilisation of the shoulder in subacute stroke patients with persistent arm paresis: A randomised multiple treatment trial","volume":"78","author":"Cools","year":"2022","journal-title":"S. Afr. J. Physiother."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1191\/0269215502cr491oa","article-title":"Shoulder pain after stroke: A review of the evidence base to inform the development of an integrated care pathway","volume":"16","author":"Jackson","year":"2002","journal-title":"Clin. Rehabil."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Gnasso, R., Palermi, S., Picone, A., Tarantino, D., Fusco, G., Messina, M.M., and Sirico, F. (2023). Robotic-Assisted Rehabilitation for Post-Stroke Shoulder Pain: A Systematic Review. Sensors, 23.","DOI":"10.3390\/s23198239"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s12984-023-01285-7","article-title":"Spatial mapping of posture dependent resistance to passive displacement of the hypertonic arm post stroke","volume":"20","author":"Mehta","year":"2023","journal-title":"J. Neuroeng. Rehabil."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1560\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:59:24Z","timestamp":1771232364000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":58,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041560"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041560","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,16]]}}}