{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:24:10Z","timestamp":1786973050756,"version":"build-2736575974"},"reference-count":53,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007414","name":"Qassim University","doi-asserted-by":"publisher","award":["QU-APC-2026"],"award-info":[{"award-number":["QU-APC-2026"]}],"id":[{"id":"10.13039\/501100007414","id-type":"DOI","asserted-by":"publisher"}]},{"award":["QU-APC-2026"],"award-info":[{"award-number":["QU-APC-2026"]}],"id":[{"id":"https:\/\/ror.org\/01wsfe280","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Previous studies hypothesized that significant exposure to lead (Pb) and\/or cadmium (Cd) induces preeclampsia in pregnant women with subsequent unfavorable obstetric outcomes. This study aimed to compare maternal (Pb and Cd) and umbilical cord (Pb and Cd) levels between patients with preeclampsia and healthy control pregnant women and investigate the variables that are associated with preeclampsia. In addition, the possible influences of these heavy metals on birth weight were assessed. Methods: A case\u2013control study involving 60 women in each group was conducted at the Maternity Hospital in Omdurman, Sudan, between January and June 2021, and included pregnant women residing in Omdurman city, Khartoum state, Sudan. A structured questionnaire was used to gather clinical and medical history. Maternal and cord blood concentrations of Pb and Cd were measured using an atomic absorption spectrophotometer. Univariate and multivariate binary logistic regression analyses were conducted to identify variables associated with preeclampsia. Results: The average maternal age in cases was 25.2 (6.1) years, and in the control group, it was 27.7 (7.2) years. All included participants were residing in Omdurman city, Khartoum state. Preeclampsia patients exhibited significantly elevated mean (SD) levels of umbilical cord Pb [14.2 (5.3) vs. 10.2 (4.5) \u00b5g\/L, p &lt; 0.001], and median (25th\u201375th quartile) maternal Cd [3.5 (2.0\u20136.7) vs. 3.0 (2.0\u20134.0) \u00b5g\/L, p = 0.021] and umbilical cord Cd [5.0 (3.0\u20138.1) vs. 2.5 (1.0\u20134.0) \u00b5g\/L, p &lt; 0.001] compared with healthy controls. Mean (SD) of umbilical cord Pb level was lower than maternal Pb [14.2 (5.3) vs. 15.7 (7.8) \u00b5g\/L, p = 0.246), but not reached statistical significance, while median (25th\u201375th quartile) concentration of umbilical cord Cd and maternal Cd remained comparable [5.0 (3.0\u20138.1) vs. 3.5 (2.0\u20136.7) \u00b5g\/L, p = 0.093], in patients with preeclampsia. Levels of umbilical cord Cd correlated inversely with birth weight [Sperman\u2019s correlation coefficient (rho) = \u22120.689, p = 0.013]. Umbilical cord Pb [aOR = 1.29; 1.09 to 1.54; p = 0.003], and Cd [aOR = 1.37; 1.08 to 1.73; p = 0.007], in addition to maternal Cd [aOR = 1.35; 1.06 to 1.72; p = 0.012], were among the variables that are significantly associated with preeclampsia in univariate and multivariate analysis. Conclusions: Umbilical cord Pb, maternal Cd, and umbilical cord Cd concentrations were elevated in pre-eclamptic patients compared with healthy parturient controls and associated with preeclampsia. The preferential higher availability of Cd, but not Pb, in fetal compared with maternal blood might explain why umbilical cord Cd, but not umbilical cord Pb, had a significant negative effect on birthweight.<\/jats:p>","DOI":"10.3390\/jcm15166307","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T15:48:36Z","timestamp":1786722516000},"page":"6307","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal and Umbilical Cord Blood Levels of Lead and Cadmium in Sudanese Women with Preeclampsia"],"prefix":"10.3390","volume":"15","author":[{"given":"Alaeldin","family":"Elhadi","sequence":"first","affiliation":[{"name":"Sudan Academy of Sciences, Khartoum 11111, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal N.","family":"Sharif","sequence":"additional","affiliation":[{"name":"College of Medicine, King Khalid University, Abha 62521, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9269-8239","authenticated-orcid":false,"given":"Hamdan Z.","family":"Hamdan","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5031-7741","authenticated-orcid":false,"given":"Ishag","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0360-8105","authenticated-orcid":false,"given":"Mohamed F.","family":"Lutfi","sequence":"additional","affiliation":[{"name":"Department of Physiology, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e044260","DOI":"10.1161\/JAHA.125.044260","article-title":"Preeclampsia and Eclampsia: A Complex Interplay Between Prepregnancy Obesity, Race, and Ethnicity","volume":"15","author":"Chehab","year":"2026","journal-title":"J. Am. Heart Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"(2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet. Gynecol., 135, 237\u2013260.","DOI":"10.1097\/AOG.0000000000003891"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2454597","DOI":"10.1080\/10641955.2025.2454597","article-title":"Placental Ischemia During Pregnancy Induces Hypertension, Cerebral Inflammation, and Oxidative Stress in Dams Postpartum","volume":"44","author":"Smith","year":"2025","journal-title":"Hypertens. Pregnancy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1161\/CIRCULATIONAHA.125.076218","article-title":"Defective Trophoblast Differentiation, Endothelial Dysfunction, and Immune Dysregulation in Preeclampsia Coalesce on a Placental VGLL3-Centered Gene Network","volume":"153","author":"Plazyo","year":"2026","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s12985-017-0813-6","article-title":"Rubella, Herpes Simplex Virus Type 2 and Preeclampsia","volume":"14","author":"Alshareef","year":"2017","journal-title":"Virol. J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Saad, A., Adam, I., Elzaki, S.E.G., Awooda, H.A., and Hamdan, H.Z. (2020). Leptin Receptor Gene Polymorphisms c.668A>G and c.1968G>C in Sudanese Women with Preeclampsia: A Case-Control Study. BMC Med. Genet., 21.","DOI":"10.1186\/s12881-020-01104-z"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.placenta.2024.12.008","article-title":"Exploring Gene Expression Signatures in Preeclampsia and Identifying Hub Genes through Bioinformatic Analysis","volume":"159","author":"Hamdan","year":"2025","journal-title":"Placenta"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/HJH.0000000000001901","article-title":"Sympathetic Nervous System Control of Vascular Function and Blood Pressure during Pregnancy and Preeclampsia","volume":"37","author":"Spradley","year":"2019","journal-title":"J. Hypertens."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Elmugabil, A., Hamdan, H.Z., Elsheikh, A.E., Rayis, D.A., Adam, I., and Gasim, G.I. (2016). Serum Calcium, Magnesium, Zinc and Copper Levels in Sudanese Women with Preeclampsia. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167495"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1007\/s12011-022-03316-1","article-title":"Association of Selenium Levels with Preeclampsia: A Systematic Review and Meta-Analysis","volume":"201","author":"Hamdan","year":"2023","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"He, J., Pu, Y., Du, Y., Liu, H., Wang, X., He, S., Ai, S., and Dang, Y. (2024). An Exploratory Study on the Association of Multiple Metals in Serum with Preeclampsia. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1336188"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1038\/s41440-025-02122-1","article-title":"Cadmium Levels in Maternal Blood, Placenta, and Cord Blood in Relation to Preeclampsia and Fetal Growth: A Case-Control Study in China","volume":"48","author":"Wu","year":"2025","journal-title":"Hypertens. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vigeh, M., Yokoyama, K., and Sahebi, L. (2025). Prenatal Lead Exposure and Risk of Pregnancy-Induced Hypertension: A Systematic Review and Meta-Analysis. BMC Pregnancy Childbirth, 25.","DOI":"10.1186\/s12884-025-08131-9"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Laine, J.E., Ray, P., Bodnar, W., Cable, P.H., Boggess, K., Offenbacher, S., and Fry, R.C. (2015). Placental Cadmium Levels Are Associated with Increased Preeclampsia Risk. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139341"},{"key":"ref_15","first-page":"332","article-title":"New Data on Toxic Metal Intoxication (Cd, Pb, and Hg in Particular) and Mg Status during Pregnancy","volume":"7","author":"Semczuk","year":"2001","journal-title":"Med. Sci. Monit."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s40557-017-0202-z","article-title":"The Association Between Cadmium and Lead Exposure and Blood Pressure Among Workers of a Smelting Industry: A Cross-Sectional Study","volume":"29","author":"An","year":"2017","journal-title":"Ann. Occup. Environ. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1177\/0748233715576616","article-title":"Blood Pressure and Occupational Exposure to Noise and Lead (Pb): A Cross-Sectional Study","volume":"32","author":"Rapisarda","year":"2016","journal-title":"Toxicol. Ind. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/1477-7827-12-77","article-title":"Preeclampsia Induced by Cadmium in Rats Is Related to Abnormal Local Glucocorticoid Synthesis in Placenta","volume":"12","author":"Wang","year":"2014","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"110052","DOI":"10.1016\/j.envint.2026.110052","article-title":"Gestational Exposure to Metals and Small Vulnerable Newborns: A Systematic Review and Meta-Analysis","volume":"208","author":"Yu","year":"2026","journal-title":"Environ. Int."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ou, Y., Han, J., Wei, Y., and Gao, X. (2025). Meta-Analysis of Maternal Exposure to Heavy Metals (Lead, Cadmium, Mercury, Chromium) and Adverse Pregnancy Outcomes. BMC Pregnancy Childbirth, 26.","DOI":"10.1186\/s12884-025-08507-x"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1038\/s41370-025-00744-8","article-title":"Prenatal Metal(Loid) Exposure and Preterm Birth: A Systematic Review of the Epidemiologic Evidence","volume":"35","author":"Eaves","year":"2025","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1111\/jog.13591","article-title":"Selected Maternal, Fetal and Placental Trace Element and Heavy Metal and Maternal Vitamin Levels in Preterm Deliveries With or Without Preterm Premature Rupture of Membranes","volume":"44","author":"Kucukaydin","year":"2018","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_23","first-page":"312","article-title":"Maternal and Umbilical Cord Blood Level of Lead and Cadmium in an Agricultural Area in Central Sudan","volume":"6","author":"Elmugabil","year":"2016","journal-title":"J. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1779557","DOI":"10.1080\/23311843.2020.1779557","article-title":"Bioaccumulation of Priority Trace Metals in Edible Muscles of West African Lungfish (Protopterus Annectens Owen, 1839) from Nyabarongo River, Rwanda","volume":"6","author":"Nteziyaremye","year":"2020","journal-title":"Cogent Environ. Sci."},{"key":"ref_25","first-page":"402647","article-title":"Heavy Metals in Contaminated Soils: A Review of Sources, Chemistry, Risks and Best Available Strategies for Remediation","volume":"2011","author":"Wuana","year":"2011","journal-title":"Int. Sch. Res. Not."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1002\/ajhb.10220","article-title":"Assessing the Net Effect of Young Maternal Age on Birthweight","volume":"15","author":"Borja","year":"2003","journal-title":"Am. J. Hum. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e72639","DOI":"10.1002\/hsr2.72639","article-title":"Determinants of Low Birth Weight in Ghana: Analysis of the 2022 Demographic and Health Survey","volume":"9","author":"Ofori","year":"2026","journal-title":"Health Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2648184","DOI":"10.1080\/14767058.2026.2648184","article-title":"Prevalence and Related Factors for Low Birth Weight Among Singleton Neonates: A Retrospective Cross-Sectional Study","volume":"39","author":"Nie","year":"2026","journal-title":"J. Matern. Fetal. Neonatal Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s13052-018-0586-6","article-title":"Low Birth Weight and Its Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis","volume":"44","author":"Endalamaw","year":"2018","journal-title":"Ital. J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Agabain, E., Mohamed, H., Elsheikh, A.E., Hamdan, H.Z., and Adam, I. (2017). Maternal Serum Anti-M\u00fcllerian Hormone in Sudanese Women with Preeclampsia. BMC Res. Notes, 10.","DOI":"10.1186\/s13104-017-2544-6"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ahmed, Y.I.B., Yagoub, H.S., Hassan, M.A., Adam, I., and Hamdan, H.Z. (2023). Maternal Serum Iron Status, Hepcidin and Interleukin-6 Levels in Women with Preeclampsia. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1049994"},{"key":"ref_32","first-page":"2593","article-title":"Determinants of Lead Exposure in Children on the Outskirts of Salvador, Brazil","volume":"184","author":"Paes","year":"2011","journal-title":"Environ. Monit. Assess."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.talanta.2007.11.003","article-title":"Biomonitoring Method for the Simultaneous Determination of Cadmium and Lead in Whole Blood by Electrothermal Atomic Absorption Spectrometry for Assessment of Environmental Exposure","volume":"75","author":"Kummrow","year":"2008","journal-title":"Talanta"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.envres.2005.05.005","article-title":"Lead and Other Trace Metals in Preeclampsia: A Case-Control Study in Tehran, Iran","volume":"100","author":"Vigeh","year":"2006","journal-title":"Environ. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"10","DOI":"10.5897\/JTEHS2020.0456","article-title":"Heavy Metal Pollution Status and Risk Assessment on Area with Artisanal Mining Activities","volume":"12","author":"Uzoekwe","year":"2020","journal-title":"J. Toxicol. Environ. Health Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s12011-018-1312-3","article-title":"Maternal Cadmium Levels During Pregnancy and the Relationship with Preeclampsia and Fetal Biometric Parameters","volume":"186","author":"Wang","year":"2018","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1385\/BTER:89:2:97","article-title":"Maternal and Fetal Cadmium and Selenium Status in Normotensive and Hypertensive Pregnancy","volume":"89","author":"Kosanovic","year":"2002","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.2147\/IJWH.S534633","article-title":"Study on the Effects of Cadmium Exposure on Zinc Metabolism and FOXO3a Expression in the Preeclampsia Maternal-Fetal System","volume":"17","author":"Ding","year":"2025","journal-title":"Int. J. Women\u2019s Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"114055","DOI":"10.1016\/j.ecoenv.2022.114055","article-title":"Maternal Cadmium Exposure Impairs Placental Angiogenesis in Preeclampsia through Disturbing Thyroid Hormone Receptor Signaling","volume":"244","author":"Li","year":"2022","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_40","first-page":"3182","article-title":"Al Maternal Serum Lead Levels and Risk of Preeclampsia in Pregnant Women: A Cohort Study in a Maternity Hospital, Riyadh, Saudi Arabia","volume":"7","author":"Jameil","year":"2014","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1289\/ehp.0901561","article-title":"Maternal Low-Level Lead Exposure and Fetal Growth","volume":"118","author":"Zhu","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1136\/oem.59.6.394","article-title":"Effects of Maternal Exposure to Cadmium on Pregnancy Outcome and Breast Milk","volume":"59","author":"Nishijo","year":"2002","journal-title":"Occup. Environ. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.toxlet.2009.04.008","article-title":"Cadmium Exposure during Pregnancy Reduces Birth Weight and Increases Maternal and Foetal Glucocorticoids","volume":"188","author":"Ronco","year":"2009","journal-title":"Toxicol. Lett."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.reprotox.2008.11.057","article-title":"Fetal Growth Restriction Is Related to Placental Levels of Cadmium, Lead and Arsenic but Not with Antioxidant Activities","volume":"27","author":"Llanos","year":"2009","journal-title":"Reprod. Toxicol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1002\/ajim.20313","article-title":"Der Parental Exposure to Lead and Small for Gestational Age Births","volume":"49","author":"Chen","year":"2006","journal-title":"Am. J. Ind. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1002\/ajim.4700260103","article-title":"Prenatal Lead Exposure in Relation to Gestational Age and Birth Weight: A Review of Epidemiologic Studies","volume":"26","author":"Andrews","year":"1994","journal-title":"Am. J. Ind. Med."},{"key":"ref_47","first-page":"1027","article-title":"Effect of Low Lead Exposure on Gestational Age, Birth Weight and Premature Rupture of the Membrane","volume":"60","author":"Mirghani","year":"2010","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_48","unstructured":"(2026, July 27). Lead Poisoning. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/lead-poisoning-and-health?utm_source=chatgpt.com."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"100620","DOI":"10.1016\/j.envadv.2025.100620","article-title":"Heavy Metal and Metalloid Pollution: A Systematic Review of Health Implications for Pregnant Women, Children, and Geriatrics in the East African Region","volume":"19","author":"Udom","year":"2025","journal-title":"Environ. Adv."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Aouache, R., Biquard, L., Vaiman, D., and Miralles, F. (2018). Oxidative Stress in Preeclampsia and Placental Diseases. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19051496"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S9.e1","DOI":"10.1016\/j.ajog.2015.08.003","article-title":"Preeclampsia, Biomarkers, Syncytiotrophoblast Stress, and Placental Capacity","volume":"213","author":"Redman","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.envres.2017.09.014","article-title":"Blood Lead and Preeclampsia: A Meta-Analysis and Review of Implications","volume":"160","author":"Poropat","year":"2018","journal-title":"Environ. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"119391","DOI":"10.1016\/j.envres.2024.119391","article-title":"Environmental Exposure to Metal(Loid)s and Hypertensive Disorders of Pregnancy: A Systematic Review","volume":"257","author":"Marques","year":"2024","journal-title":"Environ. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6307\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:24:59Z","timestamp":1786969499000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":53,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166307"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166307","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}