{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:29:43Z","timestamp":1789468183571,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"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: Low anterior resection syndrome (LARS) is a frequent functional complication after sphincter-preserving rectal cancer surgery. Although tumor location and treatment-related factors are established determinants, the contribution of pelvic skeletal anatomy assessed by magnetic resonance imaging (MRI) pelvimetry remains uncertain. This study evaluated whether three conventional MRI-derived skeletal pelvimetry measurements provide incremental predictive information for major LARS beyond a parsimonious preoperative clinical reference model. Methods: This single-center observational cohort study included 168 patients who underwent sphincter-preserving rectal cancer surgery and completed postoperative LARS assessment. MRI pelvimetry included anteroposterior pelvic diameter, interspinous distance, and sacral curvature depth. Associations with LARS score and major LARS were evaluated using correlation analyses, pelvic-tertile comparisons, and multivariable logistic regression. Firth penalized logistic regression was prespecified as a sensitivity analysis. The primary clinical reference model included age, categorical tumor position, and neoadjuvant radiotherapy. Internal validation used stratified five-fold cross-validation repeated 100 times. Incremental model fit was assessed using a likelihood-ratio test. Results: Major LARS occurred in 48 patients (28.6%), and the median postoperative LARS score was 18 (interquartile range 9\u201331). LARS scores and major LARS prevalence were similar across anteroposterior pelvic diameter tertiles. In the parsimonious multivariable model, low tumor position was associated with major LARS (OR 9.51, 95% CI 2.00\u201345.15; p = 0.005), whereas anteroposterior pelvic diameter and interspinous distance were not associated with major LARS. The parsimonious preoperative clinical model achieved a mean repeated five-fold cross-validated AUC of 0.669, compared with 0.671 after addition of MRI pelvimetry (\u0394AUC = +0.002, 95% CI \u22120.052 to 0.054), with no statistically detectable improvement in nested-model fit (likelihood-ratio p = 0.122). Brier scores were 0.187 for both models. Calibration, overall prediction error, and decision-curve performance were similar between models. Conclusions: In this selected retrospective cohort, the three conventional MRI-derived skeletal pelvimetry measurements evaluated did not demonstrate a clear incremental improvement in prediction of major LARS beyond the parsimonious preoperative clinical reference model.<\/jats:p>","DOI":"10.3390\/jcm15187145","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:16:48Z","timestamp":1789460208000},"page":"7145","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incremental Predictive Value of Conventional MRI Pelvimetry for Major Low Anterior Resection Syndrome After Rectal Cancer Surgery"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7767-0975","authenticated-orcid":false,"given":"Stefan","family":"Morarasu","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Gabriel Mihail","family":"Dimofte","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Constantin","family":"Osman","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Wee Liam","family":"Ong","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Tudor","family":"Gramada","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9749-0610","authenticated-orcid":false,"given":"Sorinel","family":"Lunca","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology, 700483 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1002\/bjs5.50312","article-title":"Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: A population-based study","volume":"4","author":"Pieniowski","year":"2020","journal-title":"BJS Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1223","DOI":"10.1097\/SLA.0000000000003806","article-title":"The incidence of low anterior resection syndrome as assessed in an international randomized controlled trial (MRC\/NIHR ROLARR)","volume":"274","author":"Bolton","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s00595-025-03169-w","article-title":"Prevalence of and risk factors for low anterior resection syndrome based on the international consensus definition: A multicenter cross-sectional observational study","volume":"56","author":"Atsumi","year":"2026","journal-title":"Surg. Today"},{"key":"ref_4","first-page":"70","article-title":"Low anterior resection syndrome evaluation and management","volume":"39","author":"Linhares","year":"2025","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/SLA.0000000000005423","article-title":"The longitudinal course of low anterior resection syndrome: An individual patient meta-analysis","volume":"276","author":"Varghese","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Dulskas, A., Kavaliauskas, P., Kulikauskas, E., Smolskas, E., Pumputiene, K., Samalavicius, N.E., and Nunoo-Mensah, J.W. (2022). Low anterior resection syndrome: What have we learned assessing a large population?. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164752"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/DCR.0000000000001583","article-title":"International consensus definition of low anterior resection syndrome","volume":"63","author":"Keane","year":"2020","journal-title":"Dis. Colon Rectum"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1097\/SLA.0b013e31824f1c21","article-title":"Low anterior resection syndrome score: Development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer","volume":"255","author":"Emmertsen","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1097\/SLA.0b013e31828fac0b","article-title":"International validation of the low anterior resection syndrome score","volume":"259","author":"Juul","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"30","DOI":"10.3892\/ol.2023.14163","article-title":"Risk factors for severe low anterior resection syndrome in patients with rectal cancer undergoing sphincter-preserving resection: A systematic review and meta-analysis","volume":"27","author":"Xu","year":"2024","journal-title":"Oncol. Lett."},{"key":"ref_11","first-page":"7249","article-title":"The incidence and risk factors of low anterior resection syndrome after sphincter-preserving surgery for rectal cancer: A systematic review and meta-analysis","volume":"29","author":"Sun","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101691","DOI":"10.1016\/j.suronc.2021.101691","article-title":"Low anterior resection syndrome: Predisposing factors and treatment","volume":"43","author":"Garfinkle","year":"2022","journal-title":"Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.ijsu.2018.06.031","article-title":"A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors","volume":"56","author":"Croese","year":"2018","journal-title":"Int. J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1245\/s10434-018-07096-8","article-title":"Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and quality of life in rectal cancer: Post hoc analysis of a randomized controlled trial (FOWARC)","volume":"26","author":"Sun","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"15330338221105156","DOI":"10.1177\/15330338221105156","article-title":"Effects of preoperative radiotherapy on long-term bowel function in patients with rectal cancer treated with anterior resection: A systematic review and meta-analysis","volume":"21","author":"Liang","year":"2022","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s13304-025-02184-3","article-title":"A systematic review of preoperative radiological factors associated with the development of low anterior resection syndrome","volume":"77","author":"Gravante","year":"2025","journal-title":"Updates Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s10151-020-02274-x","article-title":"The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: A systematic review","volume":"24","author":"Hong","year":"2020","journal-title":"Tech. Coloproctol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s00384-020-03802-9","article-title":"Three-dimensional pelvimetry and biometric measurements: A surgical perspective for colorectal resections","volume":"36","author":"Lorenzon","year":"2021","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1007\/s00384-021-04000-x","article-title":"Can MRI pelvimetry predict the technical difficulty of laparoscopic rectal cancer surgery?","volume":"36","author":"Hong","year":"2021","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s00384-022-04169-9","article-title":"MRI measurements predict major low anterior resection syndrome in rectal cancer patients","volume":"37","author":"Zhang","year":"2022","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e36498","DOI":"10.1016\/j.heliyon.2024.e36498","article-title":"Development and validation of an MRI and clinicopathological factor prediction model for low anterior resection syndrome after anterior resection of middle and low rectal cancer","volume":"10","author":"Wang","year":"2024","journal-title":"Heliyon"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/j.ejso.2015.07.003","article-title":"Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery","volume":"41","author":"Bondeven","year":"2015","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s00595-022-02478-8","article-title":"Prediction of postoperative anorectal dysfunction after low anterior resection for lower rectal cancer by measuring the volume of defecation-related muscles","volume":"52","author":"Mori","year":"2022","journal-title":"Surg. Today"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"529","DOI":"10.4240\/wjgs.v16.i2.529","article-title":"Exploring the pathogenesis of anterior resection syndrome using magnetic resonance imaging rectal defecography","volume":"16","author":"Meng","year":"2024","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lunca, S., Morarasu, S., Osman, C., Shatarat, F.A., Gramada, T., Razniceanu, M., Buzemurga, M., Baltig, E., Zaharia, R., and Ong, W.L. (2025). Predictive risk factors for low anterior resection syndrome in rectal cancer: An observational cohort study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14082831"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/s00384-025-05009-2","article-title":"A 2-year prospective study on the evolution of low anterior resection syndrome following rectal cancer surgery","volume":"40","author":"Lauwereins","year":"2025","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1111\/codi.17181","article-title":"Quality of life and functional outcome of patients with rectal cancer: A prospective cohort study","volume":"26","author":"Pennings","year":"2024","journal-title":"Colorectal Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s10151-025-03136-0","article-title":"Effects of low anterior resection syndrome after colorectal cancer resection on health-related quality of life: A systematic review and meta-analysis","volume":"29","author":"Gorgi","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e17231","DOI":"10.1111\/codi.17231","article-title":"Patient-reported outcomes after treatment for rectal cancer: A prospective nationwide study","volume":"27","author":"Balto","year":"2025","journal-title":"Colorectal Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/DCR.0000000000002107","article-title":"Anterior resection syndrome and quality of life with long-term follow-up after rectal cancer resection","volume":"65","author":"Dilke","year":"2022","journal-title":"Dis. Colon Rectum"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1002\/jso.26729","article-title":"Improvement of low anterior resection syndrome beyond 2 years after total mesorectal excision","volume":"125","author":"He","year":"2022","journal-title":"J. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1089\/lap.2023.0414","article-title":"Low anterior resection syndrome after total mesorectal excision: Risk factors and relationship with quality of life","volume":"34","author":"Zhu","year":"2024","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/codi.15517","article-title":"Management guidelines for low anterior resection syndrome: The MANUEL project","volume":"23","author":"Christensen","year":"2021","journal-title":"Colorectal Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Rosen, H., Sebesta, C.G., and Sebesta, C. (2023). Management of low anterior resection syndrome (LARS) following resection for rectal cancer. Cancers, 15.","DOI":"10.3390\/cancers15030778"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"zrad114","DOI":"10.1093\/bjsopen\/zrad114","article-title":"Tumour-, narrow pelvis-, and surgery-specific factors affecting total mesorectal excision quality and morbidity following rectal cancer resection","volume":"7","author":"Tschann","year":"2023","journal-title":"BJS Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1007\/s12262-021-02745-x","article-title":"Low anterior resection syndrome in adults with rectal cancer in China: A case series analysis","volume":"83","author":"Qiu","year":"2021","journal-title":"Indian J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wang, D.C., Peng, X.F., and Yu, M. (2024). Construction of a prediction model for low anterior resection syndrome after neoadjuvant therapy combined with laparoscopic total mesorectal excision in male patients with mid-low rectal cancer. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1492245"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"6059","DOI":"10.1007\/s00464-021-09002-y","article-title":"Risk factors for low anterior resection syndrome in patients undergoing laparoscopic surgery for rectal cancer","volume":"36","author":"Nicotera","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/DCR.0000000000002168","article-title":"Anastomotic height is a valuable indicator of long-term bowel function following surgery for rectal cancer","volume":"66","author":"Verkuijl","year":"2023","journal-title":"Dis. Colon Rectum"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/ans.15552","article-title":"Impact of temporary ileostomy on long-term quality of life and bowel function: A systematic review and meta-analysis","volume":"90","author":"Keane","year":"2020","journal-title":"ANZ J. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1016\/j.ejso.2022.06.025","article-title":"Defunctioning stoma in rectal cancer surgery: A risk factor for low anterior resection syndrome?","volume":"48","author":"Pieniowski","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"28281","DOI":"10.1038\/s41598-024-79283-5","article-title":"Risk factors for low anterior resection syndrome after ileostomy reversal in patients with rectal cancer","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.asjsur.2021.05.016","article-title":"Risk factors for postoperative low anterior resection syndrome after colorectal cancer surgery: A meta-analysis","volume":"45","author":"Ye","year":"2022","journal-title":"Asian J. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s10151-021-02436-5","article-title":"Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: A systematic review and meta-analysis","volume":"25","author":"Vogel","year":"2021","journal-title":"Tech. Coloproctol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s00423-025-03799-1","article-title":"Impact of anastomotic leakage and radiotherapy on long-term quality of life after sphincter-saving rectal resections","volume":"410","author":"Khalilov","year":"2025","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s13304-025-02111-6","article-title":"Protective ileostomy creation after anterior resection of the rectum (PICARR): A decision-making exploring international survey","volume":"77","author":"Balla","year":"2025","journal-title":"Updates Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1007\/s13304-026-02625-7","article-title":"Prevention and management of anastomotic leakage after colorectal resection: Evolving trends among Italian surgeons. A SICCR survey","volume":"78","author":"Costi","year":"2026","journal-title":"Updates Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2979","DOI":"10.3748\/wjg.v29.i19.2979","article-title":"Machine-learning model for prediction of low anterior resection syndrome following laparoscopic anterior resection of rectal cancer: A multicenter study","volume":"29","author":"Wang","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1002\/cam4.5041","article-title":"Development of a prediction model for low anterior resection syndrome in patients with colorectal cancer after surgery based on machine-learning techniques","volume":"12","author":"Huang","year":"2023","journal-title":"Cancer Med."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Lunca, S., Dimofte, G.M., Musina, A.M., Roata, C.E., Osman, C., Ong, W.L., and Morarasu, S. (2026). Association Between Radiotherapy (\u00b1Chemotherapy) and the Severity of Low Anterior Resection Syndrome After Rectal Cancer Surgery: Does Radiotherapy Separate Risk?. Med. Sci., 14.","DOI":"10.3390\/medsci14020220"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Park, I.J., Lee, J.H., Kye, B.H., Oh, H.K., Cho, Y.B., Kim, Y.T., Kim, J.Y., Sung, N.Y., Kang, S.B., and Seo, J.M. (2020). Effects of probiotics on the symptoms and surgical outcomes after anterior resection of colon cancer (POSTCARE): A randomized, double-blind, placebo-controlled trial. J. Clin. Med., 9.","DOI":"10.3390\/jcm9072181"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"8578","DOI":"10.1038\/s41598-023-34557-2","article-title":"Gut microbiome associated with low anterior resection syndrome after rectal cancer surgery","volume":"13","author":"Kim","year":"2023","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7145\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:56:14Z","timestamp":1789462574000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":52,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187145"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187145","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}