{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:32:37Z","timestamp":1760149957869,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T00:00:00Z","timestamp":1695772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study aimed to examine the function of various inflammation parameters and their interactions in the pathology of Bipolar disorder (BD) and to assess whether they could be biomarkers in the relationship between criminal behavior and BD. Materials and Methods: Overall, 1029 participants, including 343 patients with BD who have committed offenses, 343 nonoffending patients with BD, and 343 healthy controls, were included in this retrospective study. Neutrophil, lymphocyte, monocyte, and platelet counts; high-density lipoprotein (HDL-c) levels; systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), neutrophil to high-density lipoprotein ratio (NHR), lymphocyte to high-density lipoprotein ratio (LHR), monocyte to high-density lipoprotein ratio (MHR), platelet to high-density lipoprotein ratio (PHR) were measured. Results: Significant differences were observed between the groups in terms of SII, SIRI, NHR, LHR, MHR, PHR, neutrophil, and monocyte values (p &lt; 0.001). The lymphocyte counts were significantly higher in the patients with BD who committed offenses (p = 0.04). The platelet counts were significantly lower in the patients with BD who committed offenses compared to nonoffending patients with BD (p = 0.015). The HDL-c levels were significantly lower in the patients with BD who have committed offenses than those of nonoffending patients with BD (p &lt; 0.001). Bipolar disorder, not receiving active psychiatric treatment, having a diagnosis of bipolar manic episodes, and having low platelet and HDL values constitute a risk of involvement in crime. Conclusions: The present study emphasizes the role of systemic inflammation in the pathophysiology of patients with BD with and without criminal offenses and the relationship between inflammation and criminal behavior.<\/jats:p>","DOI":"10.3390\/medicina59101725","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T07:38:46Z","timestamp":1695800326000},"page":"1725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Inflammation Markers in Patients with Bipolar Disorder Who Have Committed Offenses and Their Relationship with Criminal Behavior"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-5790","authenticated-orcid":false,"given":"Burcu","family":"S\u0131rl\u0131er Emir","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Elaz\u0131\u011f Fethi Sekin City Hospital, 23100 Elaz\u0131\u011f, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9951-9093","authenticated-orcid":false,"given":"Sevler","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Elaz\u0131\u011f Fethi Sekin City Hospital, 23100 Elaz\u0131\u011f, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0312-0476","authenticated-orcid":false,"given":"Asl\u0131","family":"Kaz\u011fan K\u0131l\u0131\u00e7aslan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Bozok, 66300 Yozgat, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4164-3611","authenticated-orcid":false,"given":"Osman","family":"Kurt","sequence":"additional","affiliation":[{"name":"Department of Public Health, Ad\u0131yaman Provincial Health Directorate, 23100 Ad\u0131yaman, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3131-6564","authenticated-orcid":false,"given":"Kerim","family":"U\u011fur","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Turgut \u00d6zal, 44900 Malatya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7479-5622","authenticated-orcid":false,"given":"Muhammed Fatih","family":"Tabara","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Elazig Mental Health and Diseases Hospital, 23100 Elaz\u0131\u011f, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6162-3250","authenticated-orcid":false,"given":"S\u00fcleyman","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of F\u0131rat, 23119 Elaz\u0131\u011f, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.ogc.2018.05.002","article-title":"Treatment of peripartum bipolar disorder","volume":"45","author":"Clark","year":"2018","journal-title":"Obstet. Gynecol. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1001\/archgenpsychiatry.2011.12","article-title":"Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative","volume":"68","author":"Merikangas","year":"2011","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3389\/fnmol.2020.00124","article-title":"The P2X7 receptor: Central hub of brain diseases","volume":"13","author":"Andrejew","year":"2020","journal-title":"Front. Mol. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jad.2016.12.059","article-title":"Medical comorbidity in bipolar disorder: The link with metabolic-inflammatory systems","volume":"211","author":"SayuriYamagata","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1038\/s41398-019-0570-y","article-title":"Inflammation-related biomarkers in major psychiatric disorders: A cross-disorder assessment of reproducibility and specificity in 43 meta-analyses","volume":"9","author":"Yuan","year":"2019","journal-title":"Transl. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.rcp.2017.01.004","article-title":"Inflammatory markers in the staging of bipolar disorder: A systematic review of the literature","volume":"47","author":"Duica","year":"2018","journal-title":"Rev. Colomb. Psiquiatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1159\/000444491","article-title":"Thiobarbituric Acid-Reactive Substances: Markers of an Acute Episode and a Late Stage of Bipolar Disorder","volume":"73","author":"Siwek","year":"2016","journal-title":"Neuropsychobiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.psychres.2017.05.022","article-title":"Peripheral zinc and neopterin concentrations are associated with mood severity in bipolar disorder in a gender-specific manner","volume":"255","author":"Millett","year":"2017","journal-title":"Psychiatry Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"\u015awi\u0105dro, M., Ordon, K., Herman, M., Dudek, D., and Wietecha-Pos\u0142uszny, R. (2021). Copper and Zinc as Potential Biomarkers of Mood Disorders and Pandemic Syndrome. Molecules, 27.","DOI":"10.3390\/molecules27010091"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"pyw012","DOI":"10.1093\/ijnp\/pyw012","article-title":"The differential levels of inflammatory cytokines and BDNF among bipolar spectrum disorders","volume":"19","author":"Wang","year":"2016","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3389\/fpsyt.2020.00071","article-title":"Neuroinflammation in Bipolar Depression","volume":"11","author":"Benedetti","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1038\/mp.2016.3","article-title":"A meta-analysis of blood cytokine network alterations in psychiatric patients: Comparisons between schizophrenia, bipolar disorder and depression","volume":"21","author":"Goldsmith","year":"2016","journal-title":"Mol. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1080\/08039488.2017.1340517","article-title":"A comparison of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios in schizophrenia and bipolar disorder patients-a retrospective file review","volume":"71","author":"Sarisoy","year":"2017","journal-title":"Nord. J. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.psychres.2015.05.110","article-title":"Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder","volume":"228","author":"Kalelioglu","year":"2015","journal-title":"Psychiatry Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.genhosppsych.2019.02.003","article-title":"Cross-sectional study of neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios in mood disorders","volume":"58","author":"Mazza","year":"2019","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_16","first-page":"1","article-title":"Systemic immune-inflammation index is a promising noninvasive marker to predict survival of lung cancer","volume":"98","author":"Zhang","year":"2019","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ruta, V.M., Man, A.M., Alexescu, T.G., Motoc, N.S., Tarmure, S., Ungur, R.A., Todea, D.A., Coste, S.C., Valean, D., and Pop, M.C. (2020). Neutrophil-to-lymphocyte ratio and systemic immune-inflammation index-biomarkers in interstitial lung disease. Medicina, 56.","DOI":"10.3390\/medicina56080381"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.intimp.2018.10.002","article-title":"A novel systemic inflammation response index (SIRI) for predicting postoperative survival of patients with esophageal squamous cell carcinoma","volume":"65","author":"Geng","year":"2018","journal-title":"Int. Immunopharmacol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1590\/1806-9282.20210475","article-title":"Gamma-glutamyl transpeptidase-platelet ratio, systemic immune inflammation index, and system inflammation response index in invasive aspergillosis","volume":"67","author":"Cakir","year":"2021","journal-title":"Rev. Assoc. M\u00e9dica Bras."},{"key":"ref_20","first-page":"99","article-title":"Prognostic value of the systemic inflammation response index in human malignancy: A meta-analysis","volume":"11","author":"Wei","year":"2020","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Barker, G., Leeuwenburgh, C., Brusko, T., Moldawer, L., Reddy, S.T., and Guirgis, F.W. (2021). Lipid and lipoprotein dysregulation in sepsis: Clinical and mechanistic insights into chronic critical illness. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081693"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.nbd.2014.07.015","article-title":"HDL and cognition in neurodegenerative disorders","volume":"72","author":"Hottman","year":"2014","journal-title":"Neurobiol. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/S0893-133X(02)00345-7","article-title":"Effects of acute tryptophan depletion on mood and cortisol release in first-degree relatives of type I and type II bipolar patients and healthy matched controls","volume":"27","author":"Sobczak","year":"2002","journal-title":"Neuropsychopharmacology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.jad.2022.01.085","article-title":"Correlates of deliberate self-harm among youth with bipolar disorder","volume":"302","author":"Llamocca","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/15622975.2020.1761033","article-title":"High-lethality of suicide attempts associated with platelet to lymphocyte ratio and mean platelet volume in psychiatric inpatient setting","volume":"22","author":"Aguglia","year":"2021","journal-title":"World J. Biol. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1176\/appi.ps.201400104","article-title":"Individuals with bipolar disorder and their relationship with the criminal justice system: A critical review","volume":"66","author":"Fovet","year":"2015","journal-title":"Psychiatr. Serv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1080\/14789949.2020.1870708","article-title":"Inflammation in bipolar affective disorder patients who committed or did not commit a crime: Neutrophil\/lymphocyte, platelet\/lymphocyte, monocyte\/lymphocyte ratios and mean platelet volume","volume":"32","year":"2021","journal-title":"J. Forensic Psychiatry Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1055\/s-0042-123163","article-title":"Relation between monocyte to high-density lipoprotein cholesterol ratio and presence and severity of erectile dysfunction","volume":"49","author":"Kadihasanoglu","year":"2018","journal-title":"Aktuelle Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12944-021-01462-4","article-title":"Compared with the monocyte to high-density lipoprotein ratio (MHR) and the neutrophil to lymphocyte ratio (NLR), the neutrophil to high-density lipoprotein ratio (NHR) is more valuable for assessing the inflammatory process in Parkinson\u2019s disease","volume":"20","author":"Liu","year":"2021","journal-title":"Lipids Health Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Fusar-Poli, L., Amerio, A., Cimpoesu, P., Grimaldi Filioli, P., Natale, A., Zappa, G., Aguglia, E., Amore, M., Serafini, G., and Aguglia, A. (2021). Gender Differences in Complete Blood Count and Inflammatory Ratios among Patients with Bipolar Disorder. Brain Sci., 11.","DOI":"10.3390\/brainsci11030363"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Fusar-Poli, L., Amerio, A., Cimpoesu, P., Natale, A., Salvi, V., Zappa, G., Serafini, G., Amore, M., Aguglia, E., and Aguglia, A. (2020). Lipid and Glycemic Profiles in Patients with Bipolar Disorder: Cholesterol Levels Are Reduced in Mania. Medicina, 57.","DOI":"10.3390\/medicina57010028"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1177\/1541204012458440","article-title":"Onset, offending trajectories, and crime specialization in violence","volume":"11","author":"Tzoumakis","year":"2013","journal-title":"Youth Violence Juv. Justice"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Dziedzic, E.A., G\u0105sior, J.S., Tuzimek, A., Paleczny, J., Junka, A., D\u0105browski, M., and Jankowski, P. (2022). Investigation of the associations of novel inflammatory biomarkers-systemic inflammatory index (SII) and systemic inflammatory response index (SIRI)\u2014With the severity of coronary artery disease and acute coronary syndrome occurrence. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23179553"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/nyas.13712","article-title":"Inflammation in psychiatric disorders: What comes first?","volume":"1437","author":"Bauer","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s11920-013-0387-y","article-title":"Immunity, inflammation, and bipolar disorder: Diagnostic and therapeutic implications","volume":"15","author":"Hamdani","year":"2013","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4306\/pi.2016.13.1.18","article-title":"Bipolar disorder: Role of inflammation and the development of disease biomarkers","volume":"13","author":"Muneer","year":"2016","journal-title":"Psychiatry Investig."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Jones, G.H., Vecera, C.M., Pinjari, O.F., and Machado-Vieira, R. (2021). Inflammatory signaling mechanisms in bipolar disorder. J. Biomed. Sci., 28.","DOI":"10.1186\/s12929-021-00742-6"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"941728","DOI":"10.3389\/fpsyt.2022.941728","article-title":"Investigation of systemic immune-inflammation index, neutrophil\/high-density lipoprotein ratio, lymphocyte\/high-density lipoprotein ratio, and monocyte\/high-density lipoprotein ratio as indicators of inflammation in patients with schizophrenia and bipolar disorder","volume":"13","author":"Wei","year":"2022","journal-title":"Front. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.jad.2022.04.092","article-title":"Neutrophil\/lymphocyte, platelet\/lymphocyte and monocyte\/lymphocyte ratios in patients with affective disorders","volume":"309","author":"Wei","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"6695796","DOI":"10.1155\/2021\/6695796","article-title":"Connection between the altered HDL antioxidant and anti-inflammatory properties and the risk to develop Alzheimer\u2019s disease: A narrative review","volume":"2021","author":"Zimetti","year":"2021","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1038\/nri3793","article-title":"Cholesterol, inflammation and innate immunity","volume":"15","author":"Tall","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1146\/annurev-pharmtox-010617-052823","article-title":"Inflammatory mediators in mood disorders: Therapeutic opportunities","volume":"58","author":"Pfau","year":"2018","journal-title":"Annu. Rev. Pharmacol. Toxicol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1219151","DOI":"10.3389\/fpsyt.2023.1219151","article-title":"Analysis of complete blood count and derived inflammatory indicators for bipolar disorder patients with different states","volume":"14","author":"Xu","year":"2023","journal-title":"Front. Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"112","DOI":"10.9758\/cpn.2021.19.1.112","article-title":"Elevated monocyte to high-density lipoprotein ratios as an inflammation markers for schizophrenia patients","volume":"19","author":"Sahpolat","year":"2021","journal-title":"Clin. Psychopharmacol. Neurosci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.ejpsy.2022.01.004","article-title":"Impulsive and aggressive traits and increased peripheral inflammatory status as psychobiological substrates of homicide behavior in schizophrenia","volume":"36","author":"Balcioglu","year":"2022","journal-title":"Eur. J. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Dadouli, K., Janho, M.B., Hatziefthimiou, A., Voulgaridi, I., Piaha, K., Anagnostopoulos, L., Ntellas, P., Mouchtouri, V.A., Bonotis, K., and Christodoulou, N. (2022). Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, platelet-to-lymphocyte ratio and systemic immune-inflammatory index in different states of bipolar disorder. Brain Sci., 12.","DOI":"10.3390\/brainsci12081034"},{"key":"ref_47","first-page":"11","article-title":"Evaluation of simple markers of inflammation and systemic immune inflammation index in schizophrenia, bipolar disorder patients and healthy controls","volume":"34","author":"Inaltekin","year":"2023","journal-title":"Turk. J. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jad.2023.07.079","article-title":"Thiol-disulphide homeostasis, ischemia-modified albumin, complete blood count-derived inflammatory markers and C-reactive protein from acute mania to early remission in bipolar disorder","volume":"339","author":"Korkmaz","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1016\/S0140-6736(14)60379-2","article-title":"Antipsychotics, mood stabilisers, and risk of violent crime","volume":"384","author":"Fazel","year":"2014","journal-title":"Lancet"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/1524838015620817","article-title":"Has psychiatric medication reduced crime and delinquency?","volume":"18","author":"Finkelhor","year":"2017","journal-title":"Trauma Violence Abus."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/MED.0000000000000395","article-title":"Low cholesterol, impulsivity and violence revisited","volume":"25","author":"Harro","year":"2018","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1007\/s00213-015-4044-5","article-title":"Effects of psychotropic drugs on inflammation: Consequence or mediator of therapeutic effects in psychiatric treatment?","volume":"233","author":"Baumeister","year":"2016","journal-title":"Psychopharmacology"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Weisburd, D., Savona, E.U., Hasisi, B., and Calderoni, F. (2020). Understanding Recruitment to Organized Crime and Terrorism, Springer International Publishing.","DOI":"10.1007\/978-3-030-36639-1"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1177\/1477370815623566","article-title":"Crime among young Moroccan men in the Netherlands: Does their regional origin matter?","volume":"13","author":"Bovenkerk","year":"2016","journal-title":"Eur. J. Criminol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1725\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:59:25Z","timestamp":1760129965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,27]]},"references-count":54,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["medicina59101725"],"URL":"https:\/\/doi.org\/10.3390\/medicina59101725","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,9,27]]}}}