{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T10:52:33Z","timestamp":1776941553836,"version":"3.51.4"},"reference-count":57,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"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: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is a standard procedure with recognized long-term complications that may emerge years after surgery. Informed consent requires disclosure of material risks, but it is unclear whether these long-term sequelae are consistently communicated. This study systematically reviewed publicly available consent materials to assess disclosure of evidence-based long-term complications of PSF for AIS. Methods: Official websites of spine, orthopedic, and neurosurgical societies, along with major hospitals across North America, South America, Europe, and Australia, were searched for publicly available informed consent forms and patient information leaflets related to PSF for AIS. Documents were assessed for explicit mention of predefined long-term complications: chronic pain\/health-related quality of life, pseudoarthrosis, adjacent segment degeneration, future surgery, pulmonary function impact, late infection, local tissue reaction to metal debris, and pregnancy-related issues. Disclosure frequencies were calculated. Results: Thirty-one documents from ten countries were included. Immediate perioperative risks were almost universally reported, whereas long-term complications were inconsistently disclosed. Reporting frequencies were: pseudoarthrosis, 80.6% (n = 25); future surgery, 67.7% (n = 21); adjacent segment degeneration, 51.6% (n = 16); chronic pain, 48.4% (n = 15); local tissue reaction to metal debris, 38.7% (n = 12); late infection, 25.8% (n = 8); pregnancy-related issues, 22.6% (n = 7); and pulmonary impact, 9.7% (n = 3). Conclusions: Publicly available consent materials for AIS surgery incompletely disclose long-term complications compared with the published evidence. However, written information sheets and consent forms represent only one component of the consent process. Consistently with the patient-centered standard articulated in Montgomery v Lanarkshire Health Board, informed consent should include discussion of material risks, benefits, reasonable alternative treatments including standard care, and the option of no treatment, with disclosure tailored to what matters to the patient and family. Updating written materials to better reflect lifelong risks may strengthen one important component of informed consent and shared decision-making for patients and families.<\/jats:p>","DOI":"10.3390\/jcm15093210","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T10:10:17Z","timestamp":1776939017000},"page":"3210","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disclosure of Long-Term Complications in Informed Consent for Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery: A Systematic Review of Online Resources"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6657-7246","authenticated-orcid":false,"given":"Carlos","family":"Barrios","sequence":"first","affiliation":[{"name":"Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, 46001 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jes\u00fas","family":"Burgos","sequence":"additional","affiliation":[{"name":"Vithas Internacional, 28043 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Hevia","sequence":"additional","affiliation":[{"name":"Spine Unit, University of Navarra Clinic, 28027 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicente","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Spine Surgery Section, Araba University Hospital, 01009 Vitoria, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8031-838X","authenticated-orcid":false,"given":"Hashem","family":"Altabbaa","sequence":"additional","affiliation":[{"name":"Al Basheer Hospital, Amman 11118, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5166-198X","authenticated-orcid":false,"given":"Gonzalo","family":"Mariscal","sequence":"additional","affiliation":[{"name":"Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, 46001 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1302\/0301-620X.99B8.BJJ-2016-1351.R1","article-title":"Posterior spinal fusion for adolescent idiopathic scoliosis using a convex pedicle screw technique: A novel concept of deformity correction","volume":"99","author":"Tsirikos","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"591","DOI":"10.2106\/00004623-196244040-00001","article-title":"Treatment of scoliosis. Correction and internal fixation by spine instrumentation","volume":"44","author":"Harrington","year":"1962","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_3","first-page":"885","article-title":"Simultaneous thoracoscopically assisted anterior release in prone position and posterior scoliosis correction: What are the limits?","volume":"44","author":"Shousha","year":"2015","journal-title":"Orthopade"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/foc.2003.14.1.2","article-title":"History of surgery for the correction of spinal deformity","volume":"14","author":"Mohan","year":"2003","journal-title":"Neurosurg. Focus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1001\/archsurg.141.1.86","article-title":"Patient-centered informed consent in surgical practice","volume":"141","author":"Bernat","year":"2006","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1007\/s00268-014-2585-0","article-title":"Informed consent in surgery","volume":"38","author":"Cainzos","year":"2014","journal-title":"World J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1097\/BRS.0000000000003641","article-title":"Parents\u2019\/Patients\u2019 Perception of the Informed Consent Process and Surgeons Accountability in Corrective Surgery for Adolescent Idiopathic Scoliosis: A Prospective Study","volume":"45","author":"Chan","year":"2020","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1007\/s00268-010-0542-0","article-title":"A review of surgical informed consent: Past, present, and future. A quest to help patients make better decisions","volume":"34","author":"Leclercq","year":"2010","journal-title":"World J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/BRS.0000000000001162","article-title":"Surgical Consent of Children and Guardians for the Treatment of Adolescent Idiopathic Scoliosis is Incompletely Informed","volume":"41","author":"Theologis","year":"2016","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Agozzino, E., Borrelli, S., Cancellieri, M., Carfora, F.M., Di Lorenzo, T., and Attena, F. (2019). Does written informed consent adequately inform surgical patients? A cross sectional study. BMC Med. Ethics, 20.","DOI":"10.1186\/s12910-018-0340-z"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13063-020-04969-w","article-title":"The reality of informed consent: Empirical studies on patient comprehension-systematic review","volume":"22","author":"Pietrzykowski","year":"2021","journal-title":"Trials"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1111\/ans.12555","article-title":"Patients\u2019 recollection and understanding of informed consent: A literature review","volume":"84","author":"Sherlock","year":"2014","journal-title":"ANZ J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"10225536241248711","DOI":"10.1177\/10225536241248711","article-title":"Half of the adolescent idiopathic scoliosis patients may have lumbar adjacent segment degeneration following spinal fusion: A systemic review and meta-analysis","volume":"32","author":"Liu","year":"2024","journal-title":"J. Orthop. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1186\/s40001-024-02052-7","article-title":"Long-term outcomes of spinal fusion in adolescent idiopathic scoliosis: A literature review","volume":"29","author":"Pishnamaz","year":"2024","journal-title":"Eur. J. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1097\/BRS.0b013e318236a59f","article-title":"Lumbar curve is stable after selective thoracic fusion for adolescent idiopathic scoliosis: A 20-year follow-up","volume":"37","author":"Larson","year":"2012","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/MOP.0b013e32834ec982","article-title":"Long-term outcomes after posterior spine fusion for adolescent idiopathic scoliosis","volume":"24","author":"Kepler","year":"2012","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E373","DOI":"10.1097\/01.BRS.0000084267.41183.75","article-title":"Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: A case-control study-part II","volume":"28","author":"Danielsson","year":"2003","journal-title":"Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E113","DOI":"10.1097\/BRS.0b013e31827ae3d0","article-title":"Mid- to Long-Term Outcomes in Adolescent Idiopathic Scoliosis After Instrumented Posterior Spinal Fusion: A Meta-Analysis","volume":"38","author":"Lykissas","year":"2013","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Helenius, L., Ahonen, M., Syv\u00e4nen, J., Perokorpi, T., and Helenius, I. (2024). Pulmonary Function at Minimum 10 Years After Segmental Pedicle Screw Instrumentation for Thoracic Adolescent Idiopathic Scoliosis. Spine, Epub ahead of print.","DOI":"10.1097\/BRS.0000000000004996"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s00590-020-02766-4","article-title":"Anchor type at upper instrumented vertebra and postoperative shoulder imbalance in patients with Lenke type 1 adolescent idiopathic scoliosis","volume":"31","author":"Akazawa","year":"2021","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00402-025-06051-z","article-title":"Patient self-reported outcomes 10 years after surgical correction in AIS patients. A systematic review and meta-analysis","volume":"145","author":"Hevia","year":"2025","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2","DOI":"10.21608\/esj.2020.25269.1126","article-title":"Evaluation of Quality of Life (QoL) of Patients with Adolescent Idiopathic Scoliosis (AIS) after Surgical Correction","volume":"33","author":"Abdelaziz","year":"2020","journal-title":"Egypt. Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E922","DOI":"10.1097\/BRS.0000000000000991","article-title":"Minimum 20 Years Long-term Clinical Outcome After Spinal Fusion and Instrumentation for Scoliosis: Comparison of the SRS-22 Patient Questionnaire With That in Nonscoliosis Group","volume":"40","author":"Iida","year":"2015","journal-title":"Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.nec.2018.03.005","article-title":"Preventing Pseudoarthrosis and Proximal Junctional Kyphosis: How to Deal with the Osteoporotic Spine","volume":"29","author":"Karikari","year":"2018","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s11999-009-1026-0","article-title":"Radiographic Classification of Complications of Instrumentation in Adolescent Idiopathic Scoliosis","volume":"468","author":"Flynn","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1097\/00007632-200107010-00024","article-title":"Intraspinal Metallosis Causing Delayed Neurologic Symptoms After Spinal Instrumentation Surgery","volume":"26","author":"Takahashi","year":"2001","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1007\/s43390-024-00858-3","article-title":"A 10-year perspective on the question of whether surgeries for adolescent idiopathic scoliosis are \u201cone and done\u201d?","volume":"12","author":"Gouzoulis","year":"2024","journal-title":"Spine Deform."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1097\/BRS.0b013e3181b3515a","article-title":"Revision surgery after primary spine fusion for idiopathic scoliosis","volume":"34","author":"Luhmann","year":"2009","journal-title":"Spine"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Li, Z., Shen, J., Qiu, G., Yu, H., Wang, Y., Zhang, J., Zhao, H., Zhao, Y., Li, S., and Weng, X. (2014). Unplanned Reoperation within 30 Days of Fusion Surgery for Spinal Deformity. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0087172"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1007\/s43390-021-00284-9","article-title":"Unplanned return to the operating room (UPROR) after surgery for adolescent idiopathic scoliosis","volume":"9","author":"Mehta","year":"2021","journal-title":"Spine Deform."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"494","DOI":"10.5435\/00124635-200908000-00003","article-title":"Pseudarthrosis of the Spine","volume":"17","author":"Raizman","year":"2009","journal-title":"JAAOS\u2014J. Am. Acad. Orthop. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1097\/BRS.0b013e3181ff1ea9","article-title":"Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis","volume":"36","author":"Green","year":"2011","journal-title":"Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1097\/BRS.0000000000001121","article-title":"Comparison of Surgical Outcomes Between Anterior Fusion and Posterior Fusion in Patients With AIS Lenke Type 1 or 2 that Underwent Selective Thoracic Fusion\u2014Long-term Follow-up Study Longer Than 10 Postoperative Years","volume":"40","author":"Nohara","year":"2015","journal-title":"Spine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1007\/s00586-024-08165-1","article-title":"Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: A systematic review and meta-analysis","volume":"33","author":"Burgos","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.jspd.2015.07.001","article-title":"Selective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery","volume":"3","author":"Enercan","year":"2015","journal-title":"Spine Deform."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1177\/2192568218811312","article-title":"Does Posterior Scoliosis Correction Improve Respiratory Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis","volume":"9","author":"Kato","year":"2019","journal-title":"Global. Spine J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00586-012-2533-3","article-title":"Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: Results of 48 patients with minimal 10-year follow-up","volume":"22","author":"Min","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Byun, Y.M., Iida, T., Yamada, K., Abumi, K., Kokabu, T., Iwata, A., Iwasaki, N., and Sudo, H. (2020). Long-term pulmonary function after posterior spinal fusion in main thoracic adolescent idiopathic scoliosis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0235123"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1007\/s00586-025-08831-y","article-title":"Pulmonary function does not improve after 10 years of posterior spinal fusion in adolescent idiopathic scoliosis: A systematic review and meta-analysis","volume":"34","author":"Burgos","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s43390-022-00508-6","article-title":"Complications following surgical treatment of adolescent idiopathic scoliosis: A 10-year prospective follow-up study","volume":"10","author":"Hariharan","year":"2022","journal-title":"Spine Deform."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.2106\/JBJS.16.01331","article-title":"Perioperative and Delayed Major Complications Following Surgical Treatment of Adolescent Idiopathic Scoliosis","volume":"99","author":"Bartley","year":"2017","journal-title":"J. Bone Jt. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e525\u201330","DOI":"10.1097\/BPO.0000000000002440","article-title":"Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal","volume":"43","author":"Benes","year":"2023","journal-title":"J. Pediatr. Orthop."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/s00586-004-0854-6","article-title":"Late implant infections caused by Propionibacterium acnes in scoliosis surgery","volume":"14","author":"Hahn","year":"2005","journal-title":"Eur. Spine J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1097\/00007632-199909150-00008","article-title":"Late-developing infection in instrumented idiopathic scoliosis","volume":"24","author":"Clark","year":"1999","journal-title":"Spine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"E56","DOI":"10.1097\/BRS.0000000000001685","article-title":"Metallosis Presenting as a Progressive Neurologic Deficit Four Years After a Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Case Report","volume":"42","author":"Richman","year":"2017","journal-title":"Spine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1007\/s00586-015-4347-6","article-title":"Spinal metallosis: A systematic review","volume":"25","author":"Goldenberg","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"651","DOI":"10.5312\/wjo.v14.i8.651","article-title":"Metallosis with spinal implant loosening after spinal instrumentation: A case report","volume":"14","author":"Kwan","year":"2023","journal-title":"World J. Orthop."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1007\/s43465-025-01425-2","article-title":"Epidural Metalloma 12 Years After Spinal Fusion for Adolescent Idiopathic Scoliosis: A Case Report","volume":"59","author":"Mohar","year":"2025","journal-title":"Indian J. Orthop."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"301","DOI":"10.3109\/17453674.2011.579518","article-title":"Silent soft tissue pathology is common with a modern metal-on-metal hip arthroplasty: Early detection with routine metal artifact-reduction MRI scanning","volume":"82","author":"Macnair","year":"2011","journal-title":"Acta Orthop."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s00402-005-0802-x","article-title":"Intraspinal metalloma resulting in late paraparesis","volume":"125","author":"Tezer","year":"2005","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s10856-017-6011-7","article-title":"Three cases of metallosis associated with spine instrumentation","volume":"29","author":"Ayers","year":"2017","journal-title":"J. Mater. Sci. Mater. Med."},{"key":"ref_52","first-page":"233","article-title":"Current concepts in orthopaedic biomaterials and implant fixation","volume":"43","author":"Friedman","year":"1994","journal-title":"Instr. Course Lect."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s00586-007-0311-4","article-title":"Metal levels in corrosion of spinal implants","volume":"16","author":"Beguiristain","year":"2007","journal-title":"Eur. Spine J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/j.spinee.2024.02.019","article-title":"Elevated blood metal ion levels in patients undergoing instrumented spinal surgery: A systematic review and meta-analysis","volume":"24","author":"Burgos","year":"2024","journal-title":"Spine J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/j.jos.2019.11.007","article-title":"Health-related quality of life, including marital and reproductive status, of middle-aged Japanese women with posterior spinal fusion using Cotrel-Dubousset instrumentation for adolescent idiopathic scoliosis: Longer than 22-year follow-up","volume":"25","author":"Kino","year":"2020","journal-title":"J. Orthop. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1007\/s00586-025-08734-y","article-title":"Impact of surgical treatment for adolescent idiopathic scoliosis on maternal and obstetric outcomes: A meta-analysis","volume":"34","author":"Hevia","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"363","DOI":"10.21037\/atm.2019.07.44","article-title":"Metal-on-metal (MoM) hip implants and pregnancy: Are MoM implants good for mom?\u2014A systematic review","volume":"11","author":"Samuel","year":"2023","journal-title":"Ann. Transl. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3210\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T10:26:16Z","timestamp":1776939976000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":57,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093210"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093210","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]}}}