{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:11:22Z","timestamp":1788862282399,"version":"build-2803163510"},"reference-count":58,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Unilateral cleft lip, alveolus, and palate (UCLAP) is associated with disturbed maxillary and craniofacial growth, and palatal morphology may reflect congenital, growth-related, surgical, and orthodontic influences. This retrospective study used geometric morphometrics to investigate covariation between palatal and craniofacial morphology in children treated for complete UCLAP. Methods: Maxillary dental casts and lateral cephalometric radiographs of 48 non-syndromic patients (33 boys, 15 girls; mean age 9.9 years) were digitized using 239 palatal and 152 craniofacial landmarks and semilandmarks. Covariation was assessed by two-block partial least squares (PLS) analysis with permutation testing. Results: Overall covariation was not statistically significant (RV = 0.254, p = 0.097). PLS1 accounted for 28.9% of total squared covariance and had a block-score correlation of r = 0.658 (p = 0.084). Bootstrap resampling showed only partial reproducibility of the PLS1 directions. Conclusions: Palatal morphology does not appear to reliably reflect the overall craniofacial configuration in children with operated complete UCLAP. Further longitudinal studies using fully three-dimensional assessment are needed to clarify clinically meaningful palate\u2013craniofacial relationships.<\/jats:p>","DOI":"10.3390\/jcm15186939","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:02:24Z","timestamp":1788858144000},"page":"6939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Covariation Between Palatal Shape and Craniofacial Morphology in Complete Unilateral Cleft Lip, Alveolus, and Palate: A Geometric Morphometric Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5731-5977","authenticated-orcid":false,"given":"Marek","family":"Skotarski","sequence":"first","affiliation":[{"name":"Department of Orthodontics, Jagiellonian University Medical College, Montelupich Str. 4, 30-155 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9042-1842","authenticated-orcid":false,"given":"Andrzej","family":"Brudnicki","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Pediatric Surgery Clinic, Institute of Mother and Child, Kasprzaka Str. 17a, 01-211 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8172-0090","authenticated-orcid":false,"given":"Anne Marie","family":"Kuijpers-Jagtman","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, 3010 Bern, Switzerland"},{"name":"Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jakarta 10430, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8777-7434","authenticated-orcid":false,"given":"Piotr S.","family":"Fudalej","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Jagiellonian University Medical College, Montelupich Str. 4, 30-155 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00784-024-05796-y","article-title":"Craniofacial morphological variability in orthodontic patients with non-syndromic orofacial clefts: An approach using geometric morphometrics","volume":"28","author":"Schraad","year":"2024","journal-title":"Clin. Oral Investig."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/ijos.2014.59","article-title":"The impact of cleft lip and palate repair on maxillofacial growth","volume":"7","author":"Shi","year":"2015","journal-title":"Int. J. Oral Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"46","DOI":"10.20517\/2347-9264.2020.97","article-title":"Effects of various surgical protocols on maxillofacial growth in patients with unilateral cleft lip and palate: A systematic review","volume":"7","author":"Corthouts","year":"2020","journal-title":"Plast. Aesthet. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/ocr.12318","article-title":"Palatal morphology in unilateral cleft lip and palate patients: Association with infant cleft dimensions and timing of hard palate repair","volume":"22","author":"Botticelli","year":"2019","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1597\/1545-1569_1998_035_0313_stdopa_2.3.co_2","article-title":"Scar tissue distribution on palates and its relation to maxillary dental arch form","volume":"35","author":"Ishikawa","year":"1998","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1080\/000163598428293","article-title":"Growth sites and growth mechanisms at risk in cleft lip and palate","volume":"56","author":"Friede","year":"1998","journal-title":"Acta Odontol. Scand."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1597\/04-077r.1","article-title":"Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate","volume":"42","author":"Liao","year":"2005","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/jos.jos_173_21","article-title":"The relationship of maxillary arch dimension with vertical facial morphology in proto-Malay race","volume":"11","author":"Lubis","year":"2022","journal-title":"J. Orthod. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1177\/0974909820120605S","article-title":"Relationship between dental arch dimensions and vertical facial morphology in Class I subjects","volume":"46","author":"Khera","year":"2012","journal-title":"J. Ind. Orthod. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1093\/ejo\/cjm113","article-title":"Relationship between dental arch width and vertical facial morphology in untreated adults","volume":"30","author":"Forster","year":"2008","journal-title":"Eur. J. Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/2196-1042-14-43","article-title":"Relationship between vertical facial patterns and dental arch form in Class II malocclusion","volume":"14","author":"Grippaudo","year":"2013","journal-title":"Prog. Orthod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e16031","DOI":"10.7717\/peerj.16031","article-title":"Relationship between vertical facial morphology and dental arch measurements in Class II malocclusion: A retrospective study","volume":"11","author":"Ocak","year":"2023","journal-title":"PeerJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1597\/1545-1569_1996_033_0477_pmatoc_2.3.co_2","article-title":"Palatal morphology and type of clefting","volume":"33","author":"Lammi","year":"1996","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1597\/1545-1569_2001_038_0582_absoca_2.0.co_2","article-title":"Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics","volume":"38","author":"Vendittelli","year":"2001","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ajodo.2010.04.033","article-title":"Initial cleft severity and maxillary growth in patients with complete unilateral cleft lip and palate","volume":"140","author":"Chiu","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/j.ijom.2010.01.024","article-title":"Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth","volume":"39","author":"Liao","year":"2010","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/0002-9416(79)90021-6","article-title":"Occlusion, arch dimensions, and craniofacial morphology after palatal surgery in a group of children with clefts in the secondary palate","volume":"76","author":"Jonsson","year":"1979","journal-title":"Am. J. Orthod."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s11692-009-9055-x","article-title":"Advances in geometric morphometrics","volume":"36","author":"Mitteroecker","year":"2009","journal-title":"Evol. Biol."},{"key":"ref_19","first-page":"15","article-title":"Visualizations in geometric morphometrics: How to read and how to make graphs showing shape changes","volume":"24","author":"Klingenberg","year":"2013","journal-title":"Hystrix"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/ajpa.24531","article-title":"Thirty years of geometric morphometrics: Achievements, challenges, and the ongoing quest for biological meaningfulness","volume":"178","author":"Mitteroecker","year":"2022","journal-title":"Am. J. Biol. Anthropol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.ajodo.2003.05.013","article-title":"Morphometrics for cephalometric diagnosis","volume":"125","author":"Halazonetis","year":"2004","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Paoloni, V., Gastaldi, G., Franchi, L., De Razza, F.C., and Cozza, P. (2020). Evaluation of the morphometric covariation between palatal and craniofacial skeletal morphology in Class III malocclusion growing subjects. BMC Oral Health, 20.","DOI":"10.1186\/s12903-020-01140-4"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/ejo\/cjx014","article-title":"Morphometric covariation between palatal shape and skeletal pattern in Class II growing subjects","volume":"39","author":"Paoloni","year":"2017","journal-title":"Eur. J. Orthod."},{"key":"ref_24","first-page":"377","article-title":"Morphometric covariation between palatal shape and skeletal pattern in children and adolescents: A cross-sectional study","volume":"39","author":"Parcha","year":"2017","journal-title":"Eur. J. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/ocr.12283","article-title":"Analysis of the relationship between the morphology of the palate and facial skeletal patterns in Class III malocclusion using structural equation modelling","volume":"22","author":"Ahn","year":"2019","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1093\/ejo\/cjy055","article-title":"Geometric morphometric analysis of the palatal morphology in growing subjects with skeletal open bite","volume":"41","author":"Paoloni","year":"2019","journal-title":"Eur. J. Orthod."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Latief, B.S., Kuijpers, M.A.R., Stebel, A., Kuijpers-Jagtman, A.M., and Fudalej, P.S. (2020). Pattern of morphological variability in unrepaired unilateral clefts with and without cleft palate may suggest intrinsic growth deficiency. Front. Cell Dev. Biol., 8.","DOI":"10.3389\/fcell.2020.587859"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.ajodo.2014.06.002","article-title":"Morphologic variability of nonsyndromic operated patients affected by cleft lip and palate: A geometric morphometric study","volume":"146","year":"2014","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18837","DOI":"10.1038\/s41598-022-23584-0","article-title":"Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain","volume":"12","author":"Moral","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4103232","DOI":"10.1155\/2018\/4103232","article-title":"Computerized Casts for Orthodontic Purpose Using Powder-Free Intraoral Scanners: Accuracy, Execution Time, and Patient Feedback","volume":"2018","author":"Sfondrini","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Petrova, T., Brudnicki, A., Kotova, M., Urbanova, W., Dubovska, I., Polackova, P., Voborna, I., and Fudalej, P.S. (2023). The Slavcleft: A Three-Center Study of the Outcome of Treatment of Cleft Lip and Palate Considering Palatal Shape. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185985"},{"key":"ref_32","first-page":"103","article-title":"Semilandmarks: A method for quantifying curves and surfaces","volume":"24","author":"Gunz","year":"2013","journal-title":"Hystrix"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"40","DOI":"10.2307\/2992207","article-title":"Extensions of the Procrustes method for the optimal superimposition of landmarks","volume":"39","author":"Rohlf","year":"1990","journal-title":"Syst. Zool."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1080\/106351500750049806","article-title":"Use of two-block partial least-squares to study covariation in shape","volume":"49","author":"Rohlf","year":"2000","journal-title":"Syst. Biol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"751","DOI":"10.2307\/2529140","article-title":"Le traitement des variables vectorielles","volume":"29","author":"Escoufier","year":"1973","journal-title":"Biometrics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23f14933","DOI":"10.4088\/JCP.23f14933","article-title":"How to Understand the 95% Confidence Interval Around the Relative Risk, Odds Ratio, and Hazard Ratio: As Simple as It Gets","volume":"84","author":"Andrade","year":"2023","journal-title":"J. Clin. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/joa.13118","article-title":"Morphological variability in unrepaired bilateral clefts with and without cleft palate evaluated with geometric morphometrics","volume":"236","author":"Latif","year":"2020","journal-title":"J. Anat."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Huang, X., Hu, X., Zhao, Y., Wang, Y., and Gu, Y. (2020). Preliminary comparison of three-dimensional reconstructed palatal morphology in subjects with different sagittal and vertical patterns. BMC Oral Health, 20.","DOI":"10.1186\/s12903-020-1041-9"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s00784-025-06296-3","article-title":"Craniofacial integration and modularity in untreated cleft lip and palate","volume":"29","author":"Sumardi","year":"2025","journal-title":"Clin. Oral Investig."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1601-6343.2009.01448.x","article-title":"Morphological integration of the skull in craniofacial anomalies","volume":"12","author":"Richtsmeier","year":"2009","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_41","first-page":"24","article-title":"Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Maxillary growth at eight years of age","volume":"42","author":"Marcusson","year":"2020","journal-title":"Eur. J. Orthod."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1093\/ejo\/cjab055","article-title":"Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Comparison of dental arch relationships and dental indices at 5, 8, and 10 years","volume":"44","author":"Skaare","year":"2022","journal-title":"Eur. J. Orthod."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.jcms.2017.03.006","article-title":"Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate: A systematic review","volume":"45","author":"Reddy","year":"2017","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1016\/j.jcms.2019.06.017","article-title":"Early or delayed palatoplasty in complete unilateral cleft lip and palate patients? A systematic review of the effects on maxillary growth","volume":"47","author":"Salgado","year":"2019","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"132","DOI":"10.2340\/jphs.v58.13368","article-title":"A systematic review of differences in outcome between one and two stage palate repair in cleft lip and palate","volume":"58","author":"Cornefjord","year":"2023","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1177\/154405910508401002","article-title":"Myofibroblasts in palatal wound healing: Prospects for the reduction of wound contraction after cleft palate repair","volume":"84","author":"Torensma","year":"2005","journal-title":"J. Dent. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1597\/1545-1569_1995_032_0363_whibda_2.3.co_2","article-title":"Wound healing in beagle dogs after palatal repair without denudation of bone","volume":"32","author":"Leenstra","year":"1995","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.ijom.2014.08.004","article-title":"Impact of primary palatoplasty on the maxillomandibular sagittal relationship in patients with unilateral cleft lip and palate: A systematic review and meta-analysis","volume":"44","author":"Bichara","year":"2015","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1177\/1055665618768544","article-title":"Effects of palate repair on cranial base and maxillary morphology in patients with unilateral complete cleft lip and palate","volume":"55","author":"Liu","year":"2018","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1597\/10-043","article-title":"Prevalence of dental anomalies in nonsyndromic individuals with cleft lip and palate: A systematic review and meta-analysis","volume":"49","author":"Tannure","year":"2012","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.archoralbio.2012.12.007","article-title":"Tooth agenesis patterns in unilateral cleft lip and palate in humans","volume":"58","author":"Bartzela","year":"2013","journal-title":"Arch. Oral Biol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Aung, W.P., Pungchanchaikul, P., Pisek, A., Bloch-Zupan, A., and Morkmued, S. (2024). Prevalence of tooth agenesis and supernumerary teeth related to different Thai cleft lip and cleft palate populations. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04719-3"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Oeschger, E.S., Kanavakis, G., Cocos, A., Halazonetis, D.J., and Gkantidis, N. (2022). Number of teeth is related to craniofacial morphology in humans. Biology, 11.","DOI":"10.3390\/biology11040544"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2319\/030122-188.1","article-title":"Rapid maxillary expansion vs slow maxillary expansion in patients with cleft lip and\/or palate: A systematic review and meta-analysis","volume":"93","author":"Luyten","year":"2023","journal-title":"Angle Orthod."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.ajodo.2015.11.022","article-title":"Analysis of the maxillary dental arch after rapid maxillary expansion in patients with unilateral complete cleft lip and palate","volume":"149","author":"Ayub","year":"2016","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"583","DOI":"10.2319\/081018-589.1","article-title":"Cephalometric evaluation of rapid and slow maxillary expansion in patients with BCLP: Secondary data analysis from a randomized clinical trial","volume":"89","author":"Naveda","year":"2019","journal-title":"Angle Orthod."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1093\/ejo\/cjz005","article-title":"Bone-anchored maxillary protraction in unilateral cleft lip and palate: A cephalometric appraisal","volume":"41","author":"Faco","year":"2019","journal-title":"Eur. J. Orthod."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"539","DOI":"10.2319\/091919-598.1","article-title":"Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate: Is maxillary expansion mandatory?","volume":"90","author":"Elabbassy","year":"2020","journal-title":"Angle Orthod."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/6939\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:21:11Z","timestamp":1788859271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/6939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":58,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15186939"],"URL":"https:\/\/doi.org\/10.3390\/jcm15186939","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}