{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T19:36:20Z","timestamp":1785267380887,"version":"3.55.0"},"reference-count":70,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"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>Hemophilia is no longer regarded solely as a male disorder; female carriers are increasingly attracting the attention of the scientific community due to the common, albeit overlooked, bleeding tendency associated with their condition. Moreover, women can, in rare cases, experience disease severity comparable to that of hemophilic males. The overall bleeding phenotype in females is complicated by gynecological and obstetric bleedings, which do not always correlate directly to their factor levels. As a patient population, they remain significantly underdiagnosed and inadequately treated due to a range of contributing factors. In genetic terms, a carrier exhibits no clinical or laboratory pathology. In that context, the term \u201chemophilia carrier\u201d has historically led to the presumption of normal hemostasis, thereby impeding the provision of appropriate healthcare services to females in need. Females are not represented in clinical trials and even hemophilia centers lack sufficient experience and appropriate infrastructure to effectively manage and monitor females with hemophilia. Emerging data regarding the needs of this population should be enriched by larger studies, and previously established management practices should be reevaluated, potentially incorporating newer therapeutic options.<\/jats:p>","DOI":"10.3390\/jcm15062155","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:23:03Z","timestamp":1773307383000},"page":"2155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hemophilia\u2019s Overlooked Female Face"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4044-3503","authenticated-orcid":false,"given":"Alkistis","family":"Adramerina","sequence":"first","affiliation":[{"name":"1st Pediatric Department, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Economou","sequence":"additional","affiliation":[{"name":"1st Pediatric Department, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/hae.13891","article-title":"Can we compare haemophilia carriers with clotting factor deficiency to male patients with mild haemophilia?","volume":"26","author":"Raso","year":"2020","journal-title":"Haemophilia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jtha.2024.12.004","article-title":"The history of women and hemophilia: A narrative review of evolving beliefs and testing practices","volume":"23","author":"Chaigneau","year":"2025","journal-title":"J. Thromb. Haemost."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1111\/jth.15397","article-title":"A new hemophilia carrier nomenclature to define hemophilia in women and girls: Communication from the SSC of the ISTH","volume":"19","author":"James","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_4","first-page":"e136","article-title":"Severe and moderate haemophilia A and B in US females","volume":"20","author":"Gibb","year":"2014","journal-title":"Haemophilia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e164","DOI":"10.1111\/hae.14186","article-title":"Genetic causes of haemophilia in women and girls","volume":"27","author":"Miller","year":"2021","journal-title":"Haemophilia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/j.1365-2516.2010.02210.x","article-title":"How many carriers are there?","volume":"16","author":"Kasper","year":"2010","journal-title":"Haemophilia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1038\/s41431-018-0291-3","article-title":"Skewed X-inactivation is common in the general female population","volume":"27","author":"Shvetsova","year":"2019","journal-title":"Eur. J. Hum. Genet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/jth.12854","article-title":"Phenotype\u2013genotype correlations in hemophilia A carriers are consistent with the binary role of the phase between F8 and X-chromosome inactivation","volume":"13","author":"Radic","year":"2015","journal-title":"J. Thromb. Haemost."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1002\/mgg3.378","article-title":"Demonstration of a novel Xp22.2 microdeletion as the cause of familial extreme skewing of X-inactivation utilizing case-parent trio SNP microarray analysis","volume":"6","author":"Mason","year":"2018","journal-title":"Mol. Genet. Genom. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e68","DOI":"10.1111\/hae.13423","article-title":"A novel missense mutation, p.Phe360Cys, in FIX gene results in haemophilia B in a female patient with skewed X-inactivation","volume":"24","author":"Yang","year":"2018","journal-title":"Haemophilia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1002\/ajh.21219","article-title":"Female monozygotic twins discordant for hemophilia A due to nonrandom X-chromosome inactivation","volume":"83","author":"Bennett","year":"2008","journal-title":"Am. J. Hematol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1055\/s-0037-1613833","article-title":"Absence of correlation between X chromosome inactivation pattern and plasma concentration of factor VIII and factor IX in carriers of haemophilia A and B","volume":"83","author":"Orstavik","year":"2000","journal-title":"Thromb. Haemost."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/hae.14379","article-title":"European principles of care for women and girls with inherited bleeding disorders","volume":"27","author":"Lavin","year":"2021","journal-title":"Haemophilia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e426","DOI":"10.1111\/hae.12535","article-title":"Haemophilia A carriers demonstrate pathological and radiological evidence of structural joint changes","volume":"20","author":"Gilbert","year":"2014","journal-title":"Haemophilia"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1111\/jth.12672","article-title":"Definitions in hemophilia: Communication from the SSC of the ISTH","volume":"12","author":"Blanchette","year":"2014","journal-title":"J. Thromb. Haemost."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/hae.14535","article-title":"Health issues in women and girls affected by haemophilia with a focus on nomenclature, heavy menstrual bleeding, and musculoskeletal issues","volume":"28","author":"Weyand","year":"2022","journal-title":"Haemophilia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/hae.14232","article-title":"Women and girls with haemophilia and bleeding tendencies: Outcomes related to menstruation, pregnancy, surgery and other bleeding episodes from a retrospective chart review","volume":"27","author":"Chaudhury","year":"2021","journal-title":"Haemophilia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1002\/rth2.12468","article-title":"Sexism in the management of bleeding disorders","volume":"5","author":"Weyand","year":"2021","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1111\/j.1365-2516.2012.02909.x","article-title":"Guidelines for the management of hemophilia","volume":"19","author":"Srivastava","year":"2013","journal-title":"Haemophilia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1182\/blood.V67.6.1554.1554","article-title":"Carrier detection in hemophilia A: A cooperative international study. I. The carrier phenotype","volume":"67","author":"Graham","year":"1986","journal-title":"Blood"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1111\/hae.14403","article-title":"Women and girls with haemophilia receiving care at specialized haemophilia treatment centres in the United States","volume":"27","author":"Miller","year":"2021","journal-title":"Haemophilia"},{"key":"ref_22","unstructured":"(2026, February 26). Report on the Annual Global Survey 2024. World Federation of Hemophilia. Available online: https:\/\/www1.wfh.org\/publications\/files\/pdf-2588.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5268","DOI":"10.1182\/bloodadvances.2024013866","article-title":"Proactive systematic hemophilia carrier screening: A step toward gender equity in hemophilia care","volume":"8","author":"Krumb","year":"2024","journal-title":"Blood Adv."},{"key":"ref_24","first-page":"163","article-title":"Investigation of a hemophilia family with one female hemophilia A patient and 12 male hemophilia A patients","volume":"4","author":"Wang","year":"2024","journal-title":"Ann. Hematol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/hae.14193","article-title":"Current challenges for men and women with mild-to-moderate haemophilia","volume":"27","author":"Rajpurkar","year":"2021","journal-title":"Haemophilia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e12652","DOI":"10.1002\/rth2.12652","article-title":"The lived experience of women with a bleeding disorder: A systematic review","volume":"6","author":"Sanigorska","year":"2022","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1007\/s10897-017-0112-9","article-title":"\u201cIt was a lot Tougher than I Thought It would be\u201d. A Qualitative Study on the Changing Nature of Being a Hemophilia Carrier","volume":"26","author":"Frich","year":"2017","journal-title":"J. Genet. Couns."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1111\/hae.15090","article-title":"Differences and similarities in patient-reported outcomes among men and women with haemophilia","volume":"30","author":"Kempton","year":"2024","journal-title":"Haemophilia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1111\/jth.14825","article-title":"The experiences and attitudes of hemophilia carriers around pregnancy: A qualitative systematic review","volume":"18","author":"Punt","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/hae.12690","article-title":"Haemophilia A carriers experience reduced health-related quality of life","volume":"21","author":"Gilbert","year":"2015","journal-title":"Haemophilia"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4103\/picr.picr_140_23","article-title":"Designing and validating a research questionnaire-Part 1","volume":"14","author":"Ranganathan","year":"2023","journal-title":"Perspect. Clin. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100826","DOI":"10.1016\/j.blre.2021.100826","article-title":"Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers: A systematic review","volume":"49","author":"Punt","year":"2021","journal-title":"Blood Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1365-2516.2007.01561.x","article-title":"Pregnancy in carriers of haemophilia","volume":"14","author":"Chi","year":"2008","journal-title":"Haemophilia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1111\/j.1365-2516.2004.00946.x","article-title":"Clinical manifestations and management of labor and delivery in women with factor IX deficiency","volume":"10","author":"Yang","year":"2004","journal-title":"Haemophilia"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1016\/S3050-5038(25)00123-2","article-title":"Prevalence of postpartum haemorrhage: A systematic review and meta-analysis","volume":"2","author":"Yunas","year":"2025","journal-title":"Lancet Obstet. Gynaecol. Womens Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/hae.12635","article-title":"Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: A retrospective survey","volume":"21","author":"Stoof","year":"2015","journal-title":"Haemophilia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1182\/blood-2005-09-3879","article-title":"Bleeding in carriers of hemophilia","volume":"108","author":"Plug","year":"2006","journal-title":"Blood"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1111\/hae.13089","article-title":"Evaluation of the utility of the ISTH-BAT in haemophilia carriers: A multinational study","volume":"22","author":"James","year":"2016","journal-title":"Haemophilia"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/j.1365-2516.2010.02426.x","article-title":"Association between phenotype and genotype in carriers of haemophilia A: Bleeding and Gene Mutation in Carriers of Haemophilia A","volume":"17","author":"Miesbach","year":"2011","journal-title":"Haemophilia"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1365-2516.2009.02108.x","article-title":"Determinants of factor VIII plasma levels in carriers of haemophilia A and in control women","volume":"16","author":"Ay","year":"2010","journal-title":"Haemophilia"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/bjh.13423","article-title":"A cross-sectional study of bleeding phenotype in haemophilia A carriers","volume":"170","author":"Paroskie","year":"2015","journal-title":"Br. J. Haematol."},{"key":"ref_42","first-page":"e68636","article-title":"A Comparative Analysis of the Bleeding Profile and Quality of Life Among Women With Hemophilia Genotype Compared to Other Bleeding Disorders","volume":"16","author":"Radhakrishnan","year":"2024","journal-title":"Cureus"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/hae.13889","article-title":"Bleeding assessment in haemophilia carriers\u2014High rates of bleeding after surgical abortion and intrauterine device placement: A multicentre study in China","volume":"26","author":"Li","year":"2020","journal-title":"Haemophilia"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e30644","DOI":"10.1002\/pbc.30644","article-title":"Factor activity levels and bleeding scores in pediatric hemophilia carriers enrolled in the ATHNdataset","volume":"70","author":"Puetz","year":"2023","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/MBC.0000000000000083","article-title":"Clotting factor level is not a good predictor of bleeding in carriers of haemophilia A and B","volume":"25","author":"Olsson","year":"2014","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"E399","DOI":"10.1002\/ajh.27115","article-title":"Trends in dedicated care for females with bleeding disorders within U.S. hemophilia treatment centers","volume":"98","author":"Wheeler","year":"2023","journal-title":"Am. J. Hematol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1111\/hae.70023","article-title":"Comorbidity and Mortality in Men and Women with Haemophilia in Three Nordic Countries\u2013Comparisons to Matched Controls","volume":"31","author":"Astermark","year":"2025","journal-title":"Haemophilia"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1111\/hae.14514","article-title":"The views of women with bleeding disorders: Results from the Cinderella study","volume":"28","author":"Khair","year":"2022","journal-title":"Haemophilia"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1111\/hae.15107","article-title":"Haemophilia testing of young girls in Canada: Describing the current recommendations for factor level and genetic testing and the experiences of Canadian parents","volume":"30","author":"Chaigneau","year":"2024","journal-title":"Haemophilia"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/hae.14094","article-title":"Women and girls with haemophilia: Lessons learned","volume":"27","author":"James","year":"2021","journal-title":"Haemophilia"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/ejh.13625","article-title":"Translation, validation, and usability of the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (Self-ISTH-BAT)","volume":"107","author":"Hansen","year":"2021","journal-title":"Eur. J. Haematol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1111\/hae.15101","article-title":"Women and girls\u2019 participation in haemophilia clinical trials","volume":"30","author":"Fedewa","year":"2024","journal-title":"Haemophilia"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/hae.14046","article-title":"WFH Guidelines for the Management of Hemophilia, 3rd edition","volume":"26","author":"Srivastava","year":"2020","journal-title":"Haemophilia"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/hae.15022","article-title":"Transplacental transfer of emicizumab: Experience with emicizumab in a pregnant female with severe hemophilia A and an inhibitor","volume":"30","author":"Kharel","year":"2024","journal-title":"Haemophilia"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1111\/hae.14821","article-title":"Development of inhibitors in women with mild haemophilia A and concurrent treatment with immune tolerance therapy and emicizumab","volume":"29","author":"Cheong","year":"2023","journal-title":"Haemophilia"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1001\/jamapediatrics.2019.5040","article-title":"Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents","volume":"174","author":"Borzutzky","year":"2020","journal-title":"JAMA Pediatr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/AOG.0000000000005083","article-title":"Von Willebrand Disease, Hemophilia, and Other Inherited Bleeding Disorders in Pregnancy","volume":"141","author":"Pacheco","year":"2023","journal-title":"Obstet. Gynecol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1182\/hematology.2023000475","article-title":"Management of pregnant women who have bleeding disorders","volume":"2023","author":"James","year":"2023","journal-title":"Hematology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"9759","DOI":"10.1080\/14767058.2022.2051699","article-title":"Management and outcomes of mild hemophiliacs and hemophilia carriers during pregnancy and peripartum period: A hemophilia treatment center experience in the United States","volume":"35","author":"Lim","year":"2022","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/hae.14043","article-title":"Clinical management of woman with bleeding disorders: A survey among European haemophilia treatment centres","volume":"26","author":"Lavin","year":"2020","journal-title":"Haemophilia"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1111\/hae.12155","article-title":"The experience of girls and young Women with inherited bleeding disorders","volume":"19","author":"Khair","year":"2013","journal-title":"Haemophilia"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/17474086.2023.2183836","article-title":"Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: Research priorities in health services; diversity, equity, and inclusion; and implementation science","volume":"16","author":"Byams","year":"2023","journal-title":"Expert Rev. Hematol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/hae.14983","article-title":"Women and girls with inherited bleeding disorders: Focus on haemophilia carriers and heavy menstrual bleeding","volume":"30","author":"Hermans","year":"2024","journal-title":"Haemophilia"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.jtha.2023.12.027","article-title":"The underevaluated impacts of the therapeutic revolution of hemophilia on women and girls","volume":"22","author":"Hermans","year":"2024","journal-title":"J. Thromb. Haemost."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1055\/s-0033-1354426","article-title":"Defining Severity of Hemophilia: More than Factor Levels","volume":"39","author":"Pavlova","year":"2013","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1016\/j.jtha.2025.03.013","article-title":"Factor activity levels and bleeding scores in hemophilia carriers: Apparent paradoxes","volume":"23","author":"Puetz","year":"2025","journal-title":"J. Thromb. Haemost."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1016\/j.jtha.2025.02.031","article-title":"Discrepancy between one-stage clotting and chromogenic factor VIII activity in women with hemophilia A and hemophilia A carriers: A retrospective clinical study","volume":"23","author":"Desage","year":"2025","journal-title":"J. Thromb. Haemost."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2656","DOI":"10.1016\/j.jtha.2025.05.003","article-title":"Chromogenic vs one-stage assay to diagnose women and girls with hemophilia A\u2014Mapping global approaches and assessing challenges: Communication from the SSCs of the ISTH","volume":"23","author":"Srivaths","year":"2025","journal-title":"J. Thromb. Haemost."},{"key":"ref_69","unstructured":"(2026, February 26). Annual Report 2024 PedNet Cohort Studies. Available online: https:\/\/pednet.eu\/wp-content\/uploads\/2025\/03\/PedNet-Annual-report-2024_DEF.pdf."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"103203","DOI":"10.1016\/j.rpth.2025.103203","article-title":"Building access to care for Women and Girls+ with Bleeding Disorders: The WGBD Clinic of Excellence Model","volume":"9","author":"Lim","year":"2025","journal-title":"Res. Pract. Thromb. Haemost."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:14:17Z","timestamp":1773310457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":70,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062155"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062155","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}