{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T09:02:04Z","timestamp":1784883724340,"version":"3.55.0"},"reference-count":66,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"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>Traumatic subarachnoid hemorrhage (tSAH) is a common complication of traumatic brain injury (TBI) and represents an important predictor of poor functional outcome. One of the most serious secondary complications is cerebral vasospasm. The pathophysiology of vasospasm is complex, involving the effects of blood breakdown products, inflammatory mediators, and direct mechanical injury to the cerebral vessels. Compared to aneurysmal subarachnoid hemorrhage (aSAH), vasospasm in tSAH typically occurs earlier, lasts for a shorter duration, and presents mostly with a milder clinical course. Due to its atypical clinical presentation and the presence of concurrent injuries, vasospasm is often not recognized in time and may manifest as neurological deterioration or new ischemic lesions on CT imaging. Timely recognition and appropriate management can significantly improve neurological outcomes. This paper presents key characteristics and differences between tSAH and aSAH, available diagnostic approaches, and treatment options, including nimodipine, milrinone, and stellate ganglion block. Owing to the lack of specific clinical guidelines for tSAH, current management strategies often rely on recommendations and experiences from aSAH. Further research is needed to better define risk factors for vasospasm following tSAH, optimize diagnostic pathways, and evaluate targeted treatment strategies.<\/jats:p>","DOI":"10.3390\/medicina62081437","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T07:36:13Z","timestamp":1784878573000},"page":"1437","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebral Vasospasm After Traumatic Subarachnoid Hemorrhage: A Narrative Review"],"prefix":"10.3390","volume":"62","author":[{"given":"Ur\u0161ka","family":"Hr\u017ei\u010d","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, 2000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1161-3577","authenticated-orcid":false,"given":"Andreja","family":"M\u00f6ller Petrun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, 2000 Maribor, Slovenia"},{"name":"Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1179\/016164106X115053","article-title":"Traumatic subarachnoid hemorrhage: Our current understanding and its evolution over the past half century","volume":"28","author":"Armin","year":"2006","journal-title":"Neurol. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E14","DOI":"10.3171\/2017.8.FOCUS17431","article-title":"Traumatic brain injury and intracranial hemorrhage\u2013induced cerebral vasospasm: A systematic review","volume":"43","author":"Amuluru","year":"2017","journal-title":"Neurosurg. Focus"},{"key":"ref_4","first-page":"415813","article-title":"Cerebral Vasospasm in Traumatic Brain Injury","volume":"2013","author":"Kramer","year":"2013","journal-title":"Neurol. Res. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"361","DOI":"10.25259\/SNI_859_2020","article-title":"Cerebral vasospasm and hypoperfusion after traumatic brain injury: Combined CT angiography and CT perfusion imaging study","volume":"12","author":"Maegawa","year":"2021","journal-title":"Surg. Neurol. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/00002727-200504000-00005","article-title":"Cerebral vasospasm after subarachnoid hemorrhage: An update","volume":"28","author":"Kosty","year":"2005","journal-title":"Crit. Care Nurs. Q."},{"key":"ref_7","first-page":"223","article-title":"Morphological presentation of posttraumatic vasospasm","volume":"Volume 76","author":"Zubkov","year":"2000","journal-title":"Acta Neurochirurgica Supplements"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"812","DOI":"10.3171\/jns.2005.103.5.0812","article-title":"Posttraumatic vasospasm: The epidemiology, severity, and time course of an underestimated phenomenon: A prospective study performed in 299 patients","volume":"103","author":"Oertel","year":"2005","journal-title":"J. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1161\/STROKEAHA.108.191395","article-title":"Guidelines for the management of aneurysmal subarachnoid hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association","volume":"40","author":"Bederson","year":"2009","journal-title":"Stroke"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e021845","DOI":"10.1161\/JAHA.121.021845","article-title":"Pathophysiology of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: A Review","volume":"10","author":"Dodd","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"679014","DOI":"10.1155\/2014\/679014","article-title":"Cerebral vasospasm after aneurysmal subarachnoid hemorrhage: Mechanism and therapies","volume":"2014","author":"Lin","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_12","first-page":"86","article-title":"Patofiziologija zapoznele mo\u017eganske ishemije ob subarahnoidni krvavitvi zaradi rupture anevrizme mo\u017eganske arterije","volume":"94","author":"Rowbottom","year":"2025","journal-title":"Slov. Med. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"ECP1","DOI":"10.3171\/foc.2002.12.3.8","article-title":"Molecular mechanisms involved in development of cerebral vasospasm","volume":"12","author":"Tani","year":"2002","journal-title":"Neurosurg. Focus"},{"key":"ref_14","first-page":"15","article-title":"Epidemiology and pathophysiology of cerebral vasospasm following subarachnoid hemorrhage","volume":"42","author":"Pasqualin","year":"1998","journal-title":"J. Neurosurg. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2174\/1570161043476492","article-title":"Continuous elevation of intracellular Ca2+ is essential for the development of cerebral vasospasm","volume":"2","author":"Tani","year":"2004","journal-title":"Curr. Vasc. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/jcbfm.2011.169","article-title":"Delayed cerebral ischemia and spreading depolarization in absence of angiographic vasospasm after subarachnoid hemorrhage","volume":"32","author":"Woitzik","year":"2012","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/S0090-3019(99)00178-0","article-title":"Risk factors for the development of post-traumatic cerebral vasospasm","volume":"53","author":"Zubkov","year":"2000","journal-title":"Surg. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1080\/14737175.2016.1203257","article-title":"Precision medicine of aneurysmal subarachnoid hemorrhage, vasospasm and delayed cerebral ischemia","volume":"16","author":"Burrell","year":"2016","journal-title":"Expert Rev. Neurother."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3171\/jns.1994.81.2.0261","article-title":"The role of hemolysate in the facilitation of oxyhemoglobin-induced contraction in rabbit basilar arteries","volume":"81","author":"Aoki","year":"1994","journal-title":"J. Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1161\/01.RES.0000066663.12256.B2","article-title":"Functional roles of the rho\/rho kinase pathway and protein kinase C in the regulation of cerebrovascular constriction mediated by hemoglobin: Relevance to subarachnoid hemorrhage and vasospasm","volume":"92","author":"Wickman","year":"2003","journal-title":"Circ. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1161\/01.ATV.0000204350.44226.9a","article-title":"Unraveling the reactions of nitric oxide, nitrite, and hemoglobin in physiology and therapeutics","volume":"26","author":"Schechter","year":"2006","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"945","DOI":"10.3171\/JNS-07\/11\/0945","article-title":"Association of an endogenous inhibitor of nitric oxide synthase with cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage","volume":"107","author":"Jung","year":"2007","journal-title":"J. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"648","DOI":"10.3171\/jns.1996.84.4.0648","article-title":"Loss of nitric oxide synthase immunoreactivity in cerebral vasospasm","volume":"84","author":"Pluta","year":"1996","journal-title":"J. Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1161\/CIRCULATIONAHA.105.602532","article-title":"Endothelial nitric oxide synthase in vascular disease: From marvel to menace","volume":"113","year":"2006","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3210","DOI":"10.1172\/JCI90603","article-title":"Understanding the functions and relationships of the glymphatic system and meningeal lymphatics","volume":"127","author":"Louveau","year":"2017","journal-title":"J. Clin. Investig."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jointm.2025.05.004","article-title":"Post-traumatic vasospasm: Epidemiology, specificities, risk factors, and therapeutics","volume":"5","author":"Perrault","year":"2025","journal-title":"J. Intensive Med."},{"key":"ref_27","first-page":"151","article-title":"Vasospasm after head injury studied by transcranial Doppler sonography","volume":"30","author":"Gombi","year":"1989","journal-title":"Radiol. Diagn."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0022-510X(93)90185-2","article-title":"Cerebral vasospasm following post-traumatic subarachnoid hemorrhage evaluated by transcranial Doppler ultrasonography","volume":"119","author":"Sander","year":"1993","journal-title":"J. Neurol. Sci."},{"key":"ref_29","first-page":"697","article-title":"The significance of posttraumatic increase in cerebral blood flow velocity: A transcranial Doppler ultrasound study","volume":"30","author":"Chan","year":"1992","journal-title":"Neurosurgery"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1097\/00006123-199811000-00022","article-title":"Does traumatic subarachnoid hemorrhage caused by diffuse brain injury cause delayed ischemic brain damage? Comparison with subarachnoid hemorrhage caused by ruptured intracranial aneurysms","volume":"43","author":"Fukuda","year":"1998","journal-title":"Neurosurgery"},{"key":"ref_31","first-page":"79","article-title":"Transcranial Doppler monitoring in head injury: Relations between type of injury, flow velocities, vasoreactivity, and outcome","volume":"34","author":"Steiger","year":"1994","journal-title":"Neurosurgery"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1136\/jnnp.59.6.635","article-title":"Prognostic value of the amount of post-traumatic subarachnoid haemorrhage in a six month follow up period","volume":"59","author":"Gaetani","year":"1995","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"762","DOI":"10.3171\/jns.1996.84.5.0762","article-title":"Traumatic subarachnoid hemorrhage as a predictable indicator of delayed ischemic symptoms","volume":"84","author":"Taneda","year":"1996","journal-title":"J. Neurosurg."},{"key":"ref_34","first-page":"e314","article-title":"2023 Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Guideline from the American Heart Association\/American Stroke Association","volume":"54","author":"Hoh","year":"2023","journal-title":"Stroke"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s12028-021-01223-2","article-title":"Application of Near-Infrared Spectroscopy for the Detection of Delayed Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage","volume":"35","author":"Park","year":"2021","journal-title":"Neurocritical Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"49","DOI":"10.32587\/jnic.2023.00633","article-title":"Cerebral Vasospasm After Traumatic Subarachnoid Hemorrhage and Its Risk Factor: Combined Periodic Follow Up of Transcranial Doppler and CT Angiography","volume":"6","author":"Ha","year":"2023","journal-title":"J. Neurointensive Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.31728\/jnn.2022.00115","article-title":"Transcranial Doppler Monitoring in Subarachnoid Hemorrhage","volume":"14","author":"Park","year":"2022","journal-title":"J. Neurosonology Neuroimaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1161\/01.STR.31.9.2168","article-title":"CT angiography for the detection and characterization of carotid artery bifurcation disease","volume":"31","author":"Anderson","year":"2000","journal-title":"Stroke"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00234-011-0876-9","article-title":"CT angiography for evaluation of cerebral vasospasm following acute subarachnoid haemorrhage","volume":"54","author":"Shankar","year":"2012","journal-title":"Neuroradiology"},{"key":"ref_40","first-page":"804","article-title":"Computerized Tomographic Angiography for Detection of Cerebral Vasospasm after Ruptured Intracranial Aneurysm","volume":"98","author":"Namyong","year":"2015","journal-title":"J. Med. Assoc. Thai"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00234-009-0575-y","article-title":"Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage","volume":"51","author":"Dankbaar","year":"2009","journal-title":"Neuroradiology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1161\/STROKEAHA.111.639906","article-title":"Multimodal Monitoring in Subarachnoid Hemorrhage","volume":"43","author":"Sandsmark","year":"2012","journal-title":"Stroke"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1016\/j.clinph.2014.10.215","article-title":"Early prediction of delayed cerebral ischemia in subarachnoid hemorrhage based on quantitative EEG: A prospective study in adults","volume":"126","author":"Gollwitzer","year":"2015","journal-title":"Clin. Neurophysiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/cc11230","article-title":"Quantitative EEG for the detection of brain ischemia","volume":"16","author":"Foreman","year":"2012","journal-title":"Crit. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/WNP.0000000000000754","article-title":"The Utility of Quantitative EEG in Detecting Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage","volume":"39","author":"Baang","year":"2022","journal-title":"J. Clin. Neurophysiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1186\/s13054-025-05701-3","article-title":"Neuromonitoring with near-infrared spectroscopy (NIRS) in aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis","volume":"29","author":"Bensaidane","year":"2025","journal-title":"Crit. Care"},{"key":"ref_47","first-page":"204","article-title":"Brain tissue oxygen monitoring in moderate-to-severe traumatic brain injury: Physiological determinants, clinical interventions and current randomised controlled trial evidence","volume":"26","author":"Jeffcote","year":"2024","journal-title":"Crit. Care Resusc."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s12028-014-0038-0","article-title":"Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring. Monitoring inflammation (including fever) in acute brain injury","volume":"21","author":"Provencio","year":"2014","journal-title":"Neurocrit. Care"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s11910-018-0915-6","article-title":"Cerebral Microdialysis in Neurocritical Care","volume":"18","author":"Zhou","year":"2018","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s12028-022-01492-5","article-title":"Cerebral Microdialysis-Based Interventions Targeting Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage","volume":"37","author":"Winberg","year":"2022","journal-title":"Neurocritical Care"},{"key":"ref_51","first-page":"701","article-title":"Intracerebral microdialysis in clinical practice: Baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery","volume":"47","author":"Reinstrup","year":"2000","journal-title":"Neurosurgery"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00134-015-3930-y","article-title":"Consensus statement from the 2014 International Microdialysis Forum","volume":"41","author":"Hutchinson","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e34789","DOI":"10.1097\/MD.0000000000034789","article-title":"The efficacy of different nimodipine administration route for treating subarachnoid hemorrhage: A network meta-analysis","volume":"102","author":"Lei","year":"2023","journal-title":"Medicine"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"E13","DOI":"10.1093\/neuros\/nyaa430","article-title":"NEWTON-2 Cisternal (Nimodipine Microparticles to Enhance Recovery While Reducing Toxicity After Subarachnoid Hemorrhage): A Phase 2, Multicenter, Randomized, Open-Label Safety Study of Intracisternal EG-1962 in Aneurysmal Subarachnoid Hemorrhage","volume":"88","author":"Macdonald","year":"2020","journal-title":"Neurosurgery"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2174\/1570159X17666190927113021","article-title":"Nimodipine Reappraised: An Old Drug with a Future","volume":"18","author":"Carlson","year":"2020","journal-title":"Curr. Neuropharmacol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.wneu.2012.05.001","article-title":"Intravenous versus enteral nimodipine in aneurysmal subarachnoid hemorrhage: Is there an advantage?","volume":"78","author":"Dumont","year":"2012","journal-title":"World Neurosurg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3892\/mi.2022.63","article-title":"Efficacy of combined intravenous plus intrathecal nimodipine administration in patients with severe cerebral vasospasm post-aneurysmal subarachnoid hemorrhage: A retrospective cohort study","volume":"3","author":"Faropoulos","year":"2023","journal-title":"Med. Int."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"516","DOI":"10.4103\/0970-9185.86598","article-title":"Stellate ganglion block for treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage\u2014A preliminary study","volume":"27","author":"Jain","year":"2011","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"289","DOI":"10.4103\/0028-3886.338735","article-title":"Impact of Stellate Ganglion Block in the Management of Cerebral Vasospasm: A Prospective Interventional Study","volume":"70","author":"Samagh","year":"2022","journal-title":"Neurol. India"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1089\/neu.2015.3967","article-title":"Use of Transcranial Doppler in Patients with Severe Traumatic Brain Injuries","volume":"34","author":"Ziegler","year":"2017","journal-title":"J. Neurotrauma"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/S1474-4422(06)70582-8","article-title":"Effect of nimodipine on outcome in patients with traumatic subarachnoid haemorrhage: A systematic review","volume":"5","author":"Vergouwen","year":"2006","journal-title":"Lancet Neurol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"82","DOI":"10.3171\/jns.1996.85.1.0082","article-title":"Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group","volume":"85","author":"Harders","year":"1996","journal-title":"J. Neurosurg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3109\/02688699009000676","article-title":"A double blind placebo controlled trial of the calcium entry blocking drug, nicardipine, in the treatment of vasospasm following severe head injury","volume":"4","author":"Compton","year":"1990","journal-title":"Br. J. Neurosurg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"401","DOI":"10.33588\/rn.3005.99063","article-title":"Ensayo cl\u00ednico piloto, controlado, doblemente ciego, aleatorizado de nicardipino frente a placebo en pacientes afectos de traumatismo craneal grave o moderado","volume":"30","author":"Robles","year":"2000","journal-title":"Rev. Neurol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"344","DOI":"10.4103\/roaic.roaic_31_22","article-title":"Management of cerebral vascular spasm in posttraumatic subarachnoid hemorrhage using a combination therapy of oral nimodipine and intravenous milrinone: A randomized clinical trial","volume":"9","author":"Fathi","year":"2022","journal-title":"Res. Opin. Anesth. Intensive Care"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.wneu.2023.11.122","article-title":"Stellate Ganglion Block in Subarachnoid Hemorrhage: A Promising Protective Measure Against Vasospasm?","volume":"182","author":"Brenner","year":"2024","journal-title":"World Neurosurg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1437\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T08:11:27Z","timestamp":1784880687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":66,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medicina62081437"],"URL":"https:\/\/doi.org\/10.3390\/medicina62081437","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}