{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:17:05Z","timestamp":1774538225294,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["RC2025"],"award-info":[{"award-number":["RC2025"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Novonordisk"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: An appropriate and effective management of haemophilia is currently based on a multidimensional evaluation of treatment adequacy. Current clinical practice however is still lacking standardised tools able to combine clinical, functional, and patient-reported outcomes. In this study a structured Monitoring Tool for haemophilia A and B was developed and validated through a Delphi-based expert consensus process. This study represents an expert consensus-based validation of a monitoring framework, rather than a clinical validation in patient cohorts. The tool is intended for use by haemophilia treaters during routine follow-up visits to support structured treatment reassessment. Score categories reflect the need for clinical re-evaluation or potential treatment optimisation, rather than disease severity. Methods: Italian haemophilia specialists were asked to participate to a panel over a two-round Delphi process. Experts rated the relevance of several predefined clinical domains\u2014pharmacokinetics, bleeding episodes, joint health, adherence and quality of life (QoL)\u2014and the individual items within each domain for patients on prophylactic or on-demand treatment. Consensus was defined by responses within an interquartile range (IQR) &lt; 8. Section and item weights and Likert-based scoring values were used to reach a composite score between 0 and 100. Results: Consensus was achieved for all domains and items across haemophilia types and treatments, prophylaxis and on demand (Haemophilia A: 16 and 12 participants; Haemophilia B: 12 and 9, respectively). With reference to prophylaxis domains, bleeding episodes received the highest domain weight (31\u201332%), followed by joint health (27\u201329%) and adherence\/QoL (21\u201323%) and pharmacokinetics (18\u201319%). For on-demand treatment, pharmacokinetics was excluded; bleeding episodes (38\u201340%) and joint health (35\u201337%) remained dominant. At the item level, dynamic joint health indicators (HJHS and HEAD-US changes) and longitudinal QoL changes consistently received the highest weights. The final scoring system categorised results as Excellent (0\u201325), Suboptimal (26\u201350), Poor (51\u201375), or Critical (76\u2013100). Conclusions: The Delphi-validated Monitoring Tools provide a structured, weighted, and clinically relevant framework for assessing treatment adequacy in haemophilia A and B across prophylactic and on-demand settings. These tools allow multidimensional outcome assessment and may support a more consistent, personalised therapeutic decision-making. A prospective validation of the tool in clinical cohorts is warranted.<\/jats:p>","DOI":"10.3390\/jcm15072533","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:48:41Z","timestamp":1774532921000},"page":"2533","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating Clinical, Functional, and Patient-Reported Outcomes in Haemophilia Care: A Delphi-Based Consensus on a New Monitoring Tool"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8078-8402","authenticated-orcid":false,"given":"Angelo Claudio","family":"Molinari","sequence":"first","affiliation":[{"name":"Thrombosis and Hemostasis Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erminia","family":"Baldacci","sequence":"additional","affiliation":[{"name":"Haematology, Department of Translational and Precision Medicine, \u201cSapienza\u201d University, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0706-8839","authenticated-orcid":false,"given":"Giovanni","family":"Barillari","sequence":"additional","affiliation":[{"name":"Center for Hemorrhagic and Thrombotic Diseases, General and University Hospital S. Maria della Misericordia, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Coluccia","sequence":"additional","affiliation":[{"name":"U.O.C di Medicina Interna, Centro Emofilia e Coagulopatie Rare-Ospedale \u201cI.Veris delli Ponti\u201d, Scorrano-ASL, 73010 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3697-706X","authenticated-orcid":false,"given":"Antonio","family":"Coppola","sequence":"additional","affiliation":[{"name":"Regional Hub Center for Hemophilia and Congenital Bleeding Disorders, University Hospital of Parma, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-7308","authenticated-orcid":false,"given":"Anna Chiara","family":"Giuffrida","sequence":"additional","affiliation":[{"name":"U.O.C Medicina Trasfusionale, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4947-3338","authenticated-orcid":false,"given":"Gaetano","family":"Giuffrida","sequence":"additional","affiliation":[{"name":"U.O.C di Ematologia, A.O.U. Policlinico \u201cVittorio Emanuele\u201d, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Gorio","sequence":"additional","affiliation":[{"name":"Pediatric Onco-Hematology Unit, Children\u2019s Hospital, ASST-Spedali Civili, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5849-7377","authenticated-orcid":false,"given":"Silvia","family":"Linari","sequence":"additional","affiliation":[{"name":"Center for Bleeding Disorders and Coagulation, Department of Heart, Lung and Vessels, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Luciani","sequence":"additional","affiliation":[{"name":"Hemostasis and Thrombosis Center, Onco-Hematology Department, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Catini","sequence":"additional","affiliation":[{"name":"Analisi Statistiche.it, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Nichele","sequence":"additional","affiliation":[{"name":"Centro Malattie Emorragiche e Trombotiche, UOC Ematologia, 36100 Vicenza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7423-9864","authenticated-orcid":false,"given":"Flora","family":"Peyvandi","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy"},{"name":"Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universit\u00e0 Degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berardino","family":"Pollio","sequence":"additional","affiliation":[{"name":"SIMT Immunohematology and Transfusion Medicine Service, Diagnostic Department, A.O. Citt\u00e0 della Salute e della Scienza, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annarita","family":"Tagliaferri","sequence":"additional","affiliation":[{"name":"Regional Hub Center for Hemophilia and Congenital Bleeding Disorders, University Hospital of Parma, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Valeri","sequence":"additional","affiliation":[{"name":"Regional Centre for Hemorrhagic and Thrombotic Diseases, Azienda Ospedaliera Universitaria Citt\u00e0 della Salute e della Scienza,10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5953-0499","authenticated-orcid":false,"given":"Maria Rosaria","family":"Villa","sequence":"additional","affiliation":[{"name":"Hematology Unit, Ospedale Santa Maria di Loreto, 80142 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezio","family":"Zanon","sequence":"additional","affiliation":[{"name":"Haemophilia Centre, First Chair of Internal Medicine, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8934-2936","authenticated-orcid":false,"given":"Mariasanta","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care (PROMISE), Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy"},{"name":"Haematology and Rare Diseases Unit, Hospital \u201cV. Cervello\u201d, 90146 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"542","DOI":"10.7326\/M19-1208","article-title":"Establishing the prevalence and prevalence at birth of hemophilia in males a meta-analytic approach using national registries","volume":"171","author":"Iorio","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-021-00278-x","article-title":"Haemophilia","volume":"7","author":"Berntorp","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/S0140-6736(24)02139-1","article-title":"Haemophilia","volume":"405","author":"Chowdary","year":"2025","journal-title":"Lancet"},{"key":"ref_4","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_5","doi-asserted-by":"crossref","unstructured":"Mancuso, M.E., and Santagostino, E. (2017). Outcome of clinical trials with new extended half-life FVIII\/IX concentrates. J. Clin. Med., 6.","DOI":"10.3390\/jcm6040039"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12929-021-00760-4","article-title":"Advances in the management of haemophilia: Emerging treatments and their mechanisms","volume":"28","author":"Okaygoun","year":"2021","journal-title":"J. Biomed. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1182\/blood-2015-01-528414","article-title":"Optimal treatment strategies for hemophilia: Achievements and limitations of current prophylactic regimens","volume":"125","author":"Oldenburg","year":"2015","journal-title":"Blood"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/MBC.0000000000000885","article-title":"Real-world outcomes associated with standard half-life and extended half-life factor replacement products for treatment of haemophilia A and B","volume":"31","author":"Chhabra","year":"2020","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e12601","DOI":"10.1002\/rth2.12601","article-title":"The impact of extended half-life factor concentrates on patient reported health outcome measures in persons with hemophilia A and hemophilia B","volume":"5","author":"Sun","year":"2021","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ucero-Lozano, R., P\u00e9rez-Llanes, R., Cuesta-Barriuso, R., and Donoso-\u00dabeda, E. (2024). Changes in Quality of Life, Adherence, and Kinesiophobia in Patients with Hemophilia Treated with Extended Half-Life Treatment: Final Results of the LongHest Project. Pharmaceuticals, 17.","DOI":"10.3390\/ph17070835"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Dushimova, Z., Pashimov, M., Kaibullayeva, J., Danyarova, L., Kultanova, E., Abdilova, G., and Mustapayeva, N. (2025). Therapeutic advances in hemophilia: From molecular innovation to patient-centered global care. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1618464"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"10760296251378456","DOI":"10.1177\/10760296251378455","article-title":"Recent Advances in Gene Therapy for Hemophilia","volume":"31","author":"Pang","year":"2025","journal-title":"Clin. Appl. Thromb.\/Hemost."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1002\/rth2.12337","article-title":"Bispecific Antibodies and Advances in Non\u2013Gene Therapy Options in Hemophilia","volume":"4","author":"Shima","year":"2020","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1182\/hematology.2025000764","article-title":"New therapies in hemophilia: Extend the half-life, mimic, or rebalance?","volume":"2025","author":"Reding","year":"2025","journal-title":"Hematology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.blre.2018.01.001","article-title":"Setting the stage for individualized therapy in hemophilia: What role can pharmacokinetics play?","volume":"32","author":"Hazendonk","year":"2018","journal-title":"Blood Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1111\/hae.14861","article-title":"Subclinical synovial proliferation in patients with severe haemophilia A: The value of ultrasound screening and biochemical markers","volume":"29","author":"Foppen","year":"2023","journal-title":"Haemophilia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1111\/bjh.17919","article-title":"Diagnosis and treatment of chronic synovitis in patients with haemophilia: Consensus statements from the Italian Association of Haemophilia Centres","volume":"196","author":"Napolitano","year":"2022","journal-title":"Br. J. Haematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/hae.15153","article-title":"Systematic Literature Review of Outcomes Associated with Adherence to Haemophilia Drug Therapy","volume":"31","author":"Khanji","year":"2025","journal-title":"Haemophilia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1002\/rth2.12331","article-title":"Clinical outcomes in hemophilia: Towards development of a core set of standardized outcome measures for research","volume":"4","author":"Dover","year":"2020","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e12488","DOI":"10.1002\/rth2.12488","article-title":"Patient-relevant health outcomes for hemophilia care: Development of an international standard outcomes set","volume":"5","author":"Cnossen","year":"2021","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/17474086.2024.2365929","article-title":"Outcome measures in hemophilia: Current and future perspectives","volume":"17","author":"Benemei","year":"2024","journal-title":"Expert Rev. Hematol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/hae.13234","article-title":"The outcomes of haemophilia and its treatment: Why we need a core set","volume":"23","author":"Feldman","year":"2017","journal-title":"Haemophilia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.1111\/hae.13504","article-title":"Core outcome set for gene therapy in haemophilia: Results of the coreHEM multistakeholder project","volume":"24","author":"Iorio","year":"2018","journal-title":"Haemophilia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1111\/hae.14943","article-title":"The value-based healthcare approach to haemophilia: Development of outcome measures for the evaluation of care of people with haemophilia","volume":"30","author":"Cortesi","year":"2024","journal-title":"Haemophilia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2040620720966888","DOI":"10.1177\/2040620720966888","article-title":"Pharmacokinetics in routine haemophilia clinical practice: Rationale and modalities\u2014A practical review","volume":"11","author":"Hermans","year":"2020","journal-title":"Ther. Adv. Hematol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/03007995.2019.1662675","article-title":"Assessing bleeding rates, related clinical impact and factor utilization in German hemophilia B patients treated with extended half-life rIX-FP compared to prior drug therapy","volume":"36","author":"Oldenburg","year":"2020","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1111\/hae.13631","article-title":"Measurement of joint health in persons with haemophilia: A systematic review of the measurement properties of haemophilia-specific instruments","volume":"25","author":"Gouw","year":"2019","journal-title":"Haemophilia"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mokhtar, F.M., Rajakumar, S., and Huri, H.Z. (2023). Adherence tool for prophylactic haemophilia treatment in adult and adolescent patients: A systematic review and meta-analysis protocol. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0289815"},{"key":"ref_29","first-page":"100007","article-title":"Patient-reported outcome measures in adults with hemophilia: A scoping review","volume":"1","author":"Bai","year":"2025","journal-title":"Healthc. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s41687-023-00550-6","article-title":"Understanding treatment burden in hemophilia: Development and validation of the Hemophilia Treatment Experience Measure (Hemo-TEM)","volume":"7","author":"Brod","year":"2023","journal-title":"J. Patient Rep. Outcomes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1055\/a-2501-1369","article-title":"Psychometric Validation of the Hemophilia Functional Ability Scoring Tool (Hemo-FAST)","volume":"125","author":"Barbay","year":"2025","journal-title":"Thromb. Haemost."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.3324\/haematol.2019.242735","article-title":"Kreuth V initiative: European consensus proposals for treatment of hemophilia using standard products, extended half-life coagulation factor concentrates and non-replacement therapies","volume":"105","author":"Peyvandi","year":"2020","journal-title":"Haematologica"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1182\/blood-2020-137320","article-title":"Analysis of Hemophilia a Outcomes and Treatment Patterns Using Real-World Data from the Canadian Hemophilia Bleeding Disorder Registry","volume":"136","author":"Lee","year":"2020","journal-title":"Blood"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12955-018-0908-9","article-title":"The impact of severe haemophilia and the presence of target joints on health-related quality-of-life","volume":"16","author":"Walsh","year":"2018","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_35","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_36","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1160\/TH12-11-0874","article-title":"Development and definition of a simplified scanning procedure and scoring method for Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US)","volume":"109","author":"Martinoli","year":"2013","journal-title":"Thromb. Haemost."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e12690","DOI":"10.1002\/rth2.12690","article-title":"The Hemophilia Joint Health Score version 2.1 Validation in Adult Patients Study: A multicenter international study","volume":"6","author":"Abad","year":"2022","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1111\/hae.14018","article-title":"High adherence to prophylaxis regimens in haemophilia B patients receiving rIX-FP: Evidence from clinical trials and real-world practice","volume":"26","author":"Mancuso","year":"2020","journal-title":"Haemophilia"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s11136-020-02688-y","article-title":"Psychometric properties of the EQ-5D-5L: A systematic review of the literature","volume":"30","author":"Feng","year":"2021","journal-title":"Qual. Life Res."},{"key":"ref_40","first-page":"500","article-title":"Development of an index of complexity for outpatient endocrinology and nutrition clinics","volume":"67","year":"2020","journal-title":"Endocrinol. Diabetes Nutr. (Engl. Ed.)"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/hae.14099","article-title":"Outcome measures in Haemophilia: Beyond ABR (Annualized Bleeding Rate)","volume":"27","author":"Warren","year":"2021","journal-title":"Haemophilia"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/hae.14990","article-title":"Outcomes and outcome measures","volume":"30","author":"Castaman","year":"2024","journal-title":"Haemophilia"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.jtha.2024.10.018","article-title":"Intensive FVIII replacement in hemophilia patients with hypertrophic synovium: A randomized study","volume":"23","author":"Calcaterra","year":"2025","journal-title":"J. Thromb. Haemost."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2533\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:21:08Z","timestamp":1774534868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2533"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":43,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072533"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072533","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]}}}