{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T11:03:08Z","timestamp":1774263788134,"version":"3.50.1"},"reference-count":52,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T00:00:00Z","timestamp":1774137600000},"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: Psoriasis and periodontitis share inflammatory pathways. Current evidence suggests a bidirectional non-causal relation. However, the evidence on the effects of periodontal treatment on psoriasis outcomes (severity, inflammatory markers, quality of life) is limited. This study aims to synthetize the available clinical and preclinical evidence of periodontal treatment effects on psoriasis outcomes, in patients with comorbid psoriasis and periodontitis (CRD420261298145). Methods: Several databases (PubMed, WebOfScience, ScienceDirect, ProQuest and GoogleScholar) were searched for relevant articles, without language or time restrictions. We included randomised and non-randomised clinical studies on humans, and controlled animal experiments. Interventions included periodontal treatment (surgical and non-surgical). Outcomes were the Psoriasis Area and Severity Index and dermatology-specific quality of life scores; secondary outcomes included inflammatory biomarkers and periodontal parameters. Studies were screened in duplicate, data extracted independently and risk of bias was assessed using Cochrane RoB 2, ROBINS I, NOS and SYRCLE. Results: A total of five studies were included in this systematic review (four clinical studies and one preclinical studies). Three studies directly assessed post-treatment psoriasis outcomes, with two studies investigating inflammation mediators as secondary outcomes. Two studies directly assessed PASI (Psoriasis Area and Severity Index) modifications, both studies confirming PASI scores decreasing post-periodontal treatment; one study also reported DLQI (Dermatology Life Quality Index). Typical follow-up durations ranged from 8 to 10 weeks for interventional studies, to 5 years for one cohort study. Conclusions: Although momentarily limited by the small number of available studies, the results of this review suggest that periodontal treatment may be associated with improvements in psoriasis outcomes. Further studies on larger samples, with longer follow-up periods would be necessary to confirm and possibly strengthen the existing results.<\/jats:p>","DOI":"10.3390\/jcm15062434","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T09:48:42Z","timestamp":1774259322000},"page":"2434","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effects of Periodontal Treatment on Psoriasis: A Systematic Review of Limited Clinical and Preclinical Evidence"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6988-5950","authenticated-orcid":false,"given":"Daniela Cornelia","family":"Condor","sequence":"first","affiliation":[{"name":"Periodontology Discipline, Department 3\u2014Oral Rehabilitation, Faculty of Dental Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8368-1259","authenticated-orcid":false,"given":"Ana-Maria","family":"Copaciu-Condor","sequence":"additional","affiliation":[{"name":"Prosthodontics Discipline, Department 4\u2014Prosthodontics and Dental Materials, Faculty of Dental Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"},{"name":"Oral Health Discipline, Department 3\u2014Oral Rehabilitation, Faculty of Dental Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0774-8121","authenticated-orcid":false,"given":"Andreea","family":"Kui","sequence":"additional","affiliation":[{"name":"Prosthodontics Discipline, Department 4\u2014Prosthodontics and Dental Materials, Faculty of Dental Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius","family":"Negucioiu","sequence":"additional","affiliation":[{"name":"Prosthodontics Discipline, Department 4\u2014Prosthodontics and Dental Materials, Faculty of Dental Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4209-9884","authenticated-orcid":false,"given":"Smaranda","family":"Buduru","sequence":"additional","affiliation":[{"name":"Prosthodontics Discipline, Department 4\u2014Prosthodontics and Dental Materials, Faculty of Dental Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ondine Patricia","family":"Lucaciu","sequence":"additional","affiliation":[{"name":"Oral Health Discipline, Department 3\u2014Oral Rehabilitation, Faculty of Dental Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"479","DOI":"10.3390\/epidemiologia5030033","article-title":"Periodontitis in Psoriatic Patients: Epidemiological Insights and Putative Etiopathogenic Links","volume":"5","author":"Rupe","year":"2024","journal-title":"Epidemiologia"},{"key":"ref_2","unstructured":"Gianfredi, V., Casu, G., Bricchi, L., Kacerik, E., Rongioletti, F., and Signorelli, C. (2022). Epidemiology of psoriasis in Italy: Burden, cost, comorbidities and patients\u2019 satisfaction. A systematic review. Acta Bio Medica Atenei Parm., 93."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/jdv.13854","article-title":"A systematic review of worldwide epidemiology of psoriasis","volume":"31","author":"Michalek","year":"2017","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/jcpe.13620","article-title":"Relationship between periodontitis and psoriasis: A two-sample Mendelian randomization study","volume":"49","author":"Baurecht","year":"2022","journal-title":"J. Clin. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/bjd.12670","article-title":"Psoriasis and smoking: A systematic review and meta-analysis","volume":"170","author":"Armstrong","year":"2014","journal-title":"Br. J. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Pisano, M. (2023). Oral Dysbiosis and Systemic Diseases: A Two-Way Relationship?. Medicina, 59.","DOI":"10.3390\/medicina59111933"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1902\/jop.2015.150337","article-title":"Effect of Chronic Periodontitis on Oxidative Status in Patients With Psoriasis and Psoriatic Arthritis","volume":"87","author":"Sezer","year":"2016","journal-title":"J. Periodontol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1111\/j.1468-3083.2012.04615.x","article-title":"Association of chronic plaque psoriasis and severe periodontitis: A hospital based case-control study","volume":"27","author":"Lazaridou","year":"2013","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hashim, N.T., Babiker, R., Padmanabhan, V., Ahmed, A.T., Chaitanya, N.C.S.K., Mohammed, R., Priya, S.P., Ahmed, A., El Bahra, S., and Islam, S. (2025). The Global Burden of Periodontal Disease: A Narrative Review on Unveiling Socioeconomic and Health Challenges. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22040624"},{"key":"ref_10","first-page":"318","article-title":"Association of periodontitis and psoriasis: A systematic review and meta-analysis","volume":"24","author":"Mendes","year":"2022","journal-title":"J. Int. Acad. Periodontol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1111\/jcpe.13506","article-title":"Global, regional, and national burden of severe periodontitis, 1990\u20132019: An analysis of the Global Burden of Disease Study 2019","volume":"48","author":"Chen","year":"2021","journal-title":"J. Clin. Periodontol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/0022034520952401","article-title":"Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-analyses","volume":"100","author":"Romandini","year":"2020","journal-title":"J. Dent. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/jre.13314","article-title":"Treatment of periodontitis ameliorates the severity and extent of psoriasis\u2014A randomized clinical trial","volume":"60","author":"Marruganti","year":"2024","journal-title":"J. Periodontal Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/odi.13617","article-title":"Periodontitis in patients with psoriasis: A systematic review and meta-analysis","volume":"28","author":"Zhang","year":"2020","journal-title":"Oral Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/odi.12271","article-title":"Association of chronic periodontitis and psoriasis: Periodontal status with severity of psoriasis","volume":"21","author":"Sharma","year":"2015","journal-title":"Oral Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1002\/JPER.18-0394","article-title":"Periodontitis as another comorbidity associated with psoriasis: A case-control study","volume":"90","author":"Mendes","year":"2019","journal-title":"J. Periodontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/jdv.13814","article-title":"Risk of periodontitis in patients with psoriasis and psoriatic arthritis","volume":"31","author":"Egeberg","year":"2017","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Qiao, P., Shi, Q., Zhang, R., Lingling, E., Wang, P., Wang, J., and Liu, H. (2019). Psoriasis Patients Suffer From Worse Periodontal Status\u2014A Meta-Analysis. Front. Med., 6.","DOI":"10.3389\/fmed.2019.00212"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1159\/000481544","article-title":"The Prevalence of Periodontitis Is Increased in Psoriasis and Linked to Its Inverse Subtype","volume":"30","author":"Painsi","year":"2018","journal-title":"Ski. Pharmacol. Physiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Zhang, C., Chang, X., Zhang, J., Shu, C., Lin, C., and Hou, J. (2026). Causal association between periodontitis and systemic diseases: A systematic review and meta-analysis of mendelian randomization studies. BMC Oral Health, 26.","DOI":"10.1186\/s12903-026-07725-9"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kim, C.J.H., Baker, M., and Figueredo, C.M.S. (2025). Cytokine Changes in Gingival Crevicular Fluid and Serum After Non-Surgical Periodontal Therapy in Patients with Periodontitis: A Systematic Review and Narrative Synthesis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14238424"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Nijakowski, K., Gruszczy\u0144ski, D., Kolasi\u0144ska, J., Kopa\u0142a, D., and Surdacka, A. (2022). Periodontal Disease in Patients with Psoriasis: A Systematic Review. nt. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191811302"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sterne, J.A.C., Savovi\u0107, J., Page, M.J., Elbers, R.G., Blencowe, N.S., Boutron, I., Cates, C.J., Cheng, H.Y., Corbett, M.S., and Eldridge, S.M. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366.","DOI":"10.1136\/bmj.l4898"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sterne, J.A., Hern\u00e1n, M.A., Reeves, B.C., Savovi\u0107, J., Berkman, N.D., Viswanathan, M., Henry, D., Altman, D.G., Ansari, M.T., and Boutron, I. (2016). ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355.","DOI":"10.1136\/bmj.i4919"},{"key":"ref_26","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Robertson, J., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2014). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses, The Ottawa Hospital."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hooijmans, C.R., Rovers, M.M., De Vries, R.B.M., Leenaars, M., Ritskes-Hoitinga, M., and Langendam, M.W. (2014). SYRCLE\u2019s risk of bias tool for animal studies. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-43"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. Methods"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/jcpe.13205","article-title":"Effects of non-surgical periodontal therapy on inflammatory markers of psoriasis: A randomized controlled trial","volume":"47","author":"Ogrum","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1111\/jcpe.14102","article-title":"The Synergetic Effect of Periodontal Therapy and TNF-\u03b1 Inhibitor for the Treatment of Comorbid Periodontitis and Psoriasis","volume":"52","author":"Marruganti","year":"2025","journal-title":"J. Clin. Periodontol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1111\/j.1365-2133.2012.11126.x","article-title":"The effects of chronic periodontitis and its treatment on the subsequent risk of psoriasis","volume":"167","author":"Keller","year":"2012","journal-title":"Br. J. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1034\/j.1399-302x.2000.150404.x","article-title":"Relationships between the onset of pustulosis palmaris et plantaris, periodontitis and bacterial heat shock proteins","volume":"15","author":"Ishihara","year":"2000","journal-title":"Oral Microbiol. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1111\/jcpe.13996","article-title":"Are periodontitis and psoriasis associated? A pre-clinical murine model","volume":"51","author":"Marruganti","year":"2024","journal-title":"J. Clin. Periodontol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lee, C.T., Li, R., Zhu, L., Tribble, G.D., Zheng, W.J., Ferguson, B., Maddipati, K.R., Angelov, N., and Van Dyke, T.E. (2021). Subgingival Microbiome and Specialized Pro-Resolving Lipid Mediator Pathway Profiles Are Correlated in Periodontal Inflammation. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.691216"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"177521","DOI":"10.1016\/j.ejphar.2025.177521","article-title":"Alterations of gut microbiota for the onset and treatment of psoriasis: A systematic review","volume":"998","author":"Xue","year":"2025","journal-title":"Eur. J. Pharmacol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1007\/s00403-024-03024-x","article-title":"Modulation of the skin and gut microbiome by psoriasis treatment: A comprehensive systematic review","volume":"316","author":"Korneev","year":"2024","journal-title":"Arch. Dermatol. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12903-025-06992-2","article-title":"Causal effects of gut microbiota on periodontitis risk: A meta-analysis of Mendelian randomization studies","volume":"25","author":"Yu","year":"2025","journal-title":"BMC Oral Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"967","DOI":"10.3748\/wjg.v29.i6.967","article-title":"Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis","volume":"29","author":"Kuraji","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1177\/00220345231222800","article-title":"Effect of Periodontitis and Periodontal Therapy on Oral and Gut Microbiota","volume":"103","author":"Baima","year":"2024","journal-title":"J. Dent. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/JPER.21-0078","article-title":"Impact of systemic probiotics as adjuncts to subgingival instrumentation on the oral-gut microbiota associated with periodontitis: A randomized controlled clinical trial","volume":"93","author":"Colombo","year":"2022","journal-title":"J. Periodontol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/s41432-023-00903-6","article-title":"Is periodontitis associated with the risk of immune-mediated systemic conditions?","volume":"24","author":"Moradi","year":"2023","journal-title":"Evid. Based Dent."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/prd.12146","article-title":"Molecular basis for immunohistochemical and inflammatory changes during progression of gingivitis to periodontitis","volume":"76","author":"Kurgan","year":"2017","journal-title":"Periodontology 2000"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Skudutyte-Rysstad, R., Slevolden, E.M., Hansen, B.F., Sandvik, L., and Preus, H.R. (2014). Association between moderate to severe psoriasis and periodontitis in a Scandinavian population. BMC Oral Health, 14.","DOI":"10.1186\/1472-6831-14-139"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1080\/1744666X.2023.2272049","article-title":"Efficacy of biologic agents for palmoplantar psoriasis: A systematic review and network meta-analysis","volume":"19","author":"Tsiogkas","year":"2023","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1111\/1346-8138.15826","article-title":"Similarity and difference between palmoplantar pustulosis and pustular psoriasis","volume":"48","author":"Yamamoto","year":"2021","journal-title":"J. Dermatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1111\/jdv.14386","article-title":"European consensus statement on phenotypes of pustular psoriasis","volume":"31","author":"Navarini","year":"2017","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Kubota, K., Kamijima, Y., Sato, T., Ooba, N., Koide, D., Iizuka, H., and Nakagawa, H. (2015). Epidemiology of psoriasis and palmoplantar pustulosis: A nationwide study using the Japanese national claims database. BMJ Open, 5.","DOI":"10.1136\/bmjopen-2014-006450"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1111\/j.1365-4632.2006.02900.x","article-title":"Regression of pustulosis palmaris et plantaris by periodontal treatment in a subject with severe periodontitis","volume":"45","author":"Akazawa","year":"2006","journal-title":"Int. J. Dermatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e13924","DOI":"10.1111\/dth.13924","article-title":"Palmoplantar pustulosis treated with oral rinse using ozone nanobubble water: A case series","volume":"33","author":"Horiuchi","year":"2020","journal-title":"Dermatol Ther."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jdermsci.2007.12.010","article-title":"Possible involvement of T cell co-stimulation in pustulosis palmaris et plantaris via the induction of inducible co-stimulator in chronic focal infections","volume":"50","author":"Sakiyama","year":"2008","journal-title":"J. Dermatol. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jaad.2023.04.043","article-title":"Comparative efficacy of biologics and oral agents in palmoplantar psoriasis and palmoplantar pustulosis: A systematic review and network meta-analysis of randomized clinical trials","volume":"89","author":"Spencer","year":"2023","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1111\/ijd.17729","article-title":"Diagnostic Performance of GPT-4o and Gemini Flash 2.0 in Acne and Rosacea","volume":"64","author":"Boostani","year":"2025","journal-title":"Int. J. Dermatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2434\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T10:14:21Z","timestamp":1774260861000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2434"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,22]]},"references-count":52,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062434"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062434","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,22]]}}}