{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:39:42Z","timestamp":1792651182372,"version":"4.5.0"},"reference-count":66,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.<\/jats:p>","DOI":"10.3390\/medsci10020032","type":"journal-article","created":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T03:01:22Z","timestamp":1655348482000},"page":"32","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":238,"title":["Valvular Heart Disease Epidemiology"],"prefix":"10.3390","volume":"10","author":[{"given":"John Sukumar","family":"Aluru","sequence":"first","affiliation":[{"name":"Minneapolis Heart Institute Foundation, Allina Health, Minneapolis, MN 55407, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Barsouk","sequence":"additional","affiliation":[{"name":"Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyan","family":"Saginala","sequence":"additional","affiliation":[{"name":"Plains Regional Medical Group Internal Medicine, Clovis, NM 88101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4361-8498","authenticated-orcid":false,"given":"Prashanth","family":"Rawla","sequence":"additional","affiliation":[{"name":"Parrish Medical Center, Titusville, FL 32796, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Barsouk","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2980","DOI":"10.1016\/j.jacc.2020.11.021","article-title":"The Global Burden of Cardiovascular Diseases and Risks: A Compass for Global Action","volume":"76","author":"Roth","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1016\/j.jacc.2019.10.009","article-title":"The Global Burden of Cardiovascular Diseases and Risk Factors: 2020 and Beyond","volume":"74","author":"Mensah","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1136\/heartjnl-2016-310718","article-title":"Clinical information has low sensitivity for postmortem diagnosis of heart valve disease","volume":"103","author":"Coffey","year":"2017","journal-title":"Heart"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/j.hlc.2019.05.176","article-title":"Echocardiography in Indigenous Populations and Resource Poor Settings","volume":"28","author":"Marangou","year":"2019","journal-title":"Heart Lung Circ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","article-title":"Burden of valvular heart diseases: A population-based study","volume":"368","author":"Nkomo","year":"2006","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1161\/CIRCRESAHA.121.319914","article-title":"Sex Differences and Similarities in Valvular Heart Disease","volume":"130","author":"DesJardin","year":"2022","journal-title":"Circ. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.pop.2017.10.002","article-title":"Valvular Heart Disease","volume":"45","author":"Mrsic","year":"2018","journal-title":"Prim. Care Clin. Off. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1136\/heartjnl-2018-313082","article-title":"Cardiac auscultation poorly predicts the presence of valvular heart disease in symptomatic primary care patients","volume":"104","author":"Gardezi","year":"2018","journal-title":"Heart"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/heartjnl-2012-302265","article-title":"The evolving epidemiology of valvular aortic stenosis. The Troms\u00f8 Study","volume":"99","author":"Eveborn","year":"2013","journal-title":"Heart"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1161\/CIRCULATIONAHA.119.043391","article-title":"Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990\u20132017","volume":"26","author":"Yadgir","year":"2020","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"452","DOI":"10.11622\/smedj.2018103","article-title":"Management of severe aortic stenosis: The Singapore and Asian perspective","volume":"59","author":"Tay","year":"2018","journal-title":"Singap. Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.amjcard.2016.06.039","article-title":"Sex, Race, and Socioeconomic Disparities in Patients With Aortic Stenosis (from a Nationwide Inpatient Sample)","volume":"118","author":"Beydoun","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1016\/j.jacc.2019.08.004","article-title":"Poor Long-Term Survival in Patients With Moderate Aortic Stenosis","volume":"74","author":"Strange","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1111\/echo.13892","article-title":"New classification of geometric ventricular patterns in severe aortic stenosis: Could it be clinically useful?","volume":"35","author":"Cervesato","year":"2018","journal-title":"Echocardiography"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11936-017-0580-0","article-title":"Transcatheter Aortic Valve Replacement: Outcomes, Indications, Complications, and Innovations","volume":"19","author":"Young","year":"2017","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1056\/NEJMoa1910555","article-title":"Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement","volume":"382","author":"Makkar","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/j.echo.2020.04.024","article-title":"Poor Survival with Impaired Valvular Hemodynamics After Aortic Valve Replacement: The National Echo Database Australia Study","volume":"33","author":"Playford","year":"2020","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/CIRCULATIONAHA.120.048048","article-title":"Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis","volume":"143","author":"Vincent","year":"2021","journal-title":"Circulation"},{"key":"ref_19","first-page":"603","article-title":"Familial clustering of bicuspid aortic valve and its relationship with aortic dilation in first-degree relatives","volume":"105","author":"Maldonado","year":"2019","journal-title":"Heart"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2579","DOI":"10.1016\/j.jacc.2017.03.017","article-title":"Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis","volume":"69","author":"Yoon","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.3389\/fphys.2018.01921","article-title":"Bicuspid aortic valve: An update in morphology, genetics, biomarker, complications, imaging diagnosis and treatment","volume":"9","author":"Liu","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1093\/eurheartj\/ehx562","article-title":"Inter-ethnic differences in valve morphology, valvular dysfunction, and aortopathy between Asian and European patients with bicuspid aortic valve","volume":"39","author":"Kong","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e008901","DOI":"10.1161\/CIRCIMAGING.119.008901","article-title":"Impact of cumulative smoking exposure on subclinical degenerative aortic valve disease in apparently healthy male workers","volume":"12","author":"Yamaura","year":"2019","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"6","DOI":"10.2174\/1573402114666180416161326","article-title":"Hypertension and Aortic Stenosis: A Review","volume":"14","author":"Rassa","year":"2018","journal-title":"Curr. Hypertens. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"djv008","DOI":"10.1093\/jnci\/djv008","article-title":"Risk for valvular heart disease after treatment for hodgkin lymphoma","volume":"107","author":"Cutter","year":"2015","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1001\/jamainternmed.2015.1180","article-title":"Cardiovascular Disease After Hodgkin Lymphoma Treatment: 40-Year Disease Risk","volume":"175","author":"Schaapveld","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref_27","first-page":"e2","article-title":"Global Burden of Rheumatic Heart Disease","volume":"378","author":"Watkins","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"305","DOI":"10.21037\/cdt.2019.10.07","article-title":"Rheumatic heart disease: Current status of diagnosis and therapy","volume":"10","author":"Peters","year":"2020","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1056\/NEJMoa1603693","article-title":"Global, Regional, and National Burden of Rheumatic Heart Disease, 1990\u20132015","volume":"377","author":"Watkins","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.5694\/mja2.50853","article-title":"Ending rheumatic heart disease in Australia: The evidence for a new approach","volume":"213","author":"Wyber","year":"2020","journal-title":"Med. J. Aust."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1159\/000174759","article-title":"Heart disease in native americans","volume":"78","author":"Alpert","year":"1991","journal-title":"Cardiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e016851","DOI":"10.1161\/JAHA.120.016851","article-title":"Contemporary incidence and prevalence of rheumatic fever and rheumatic heart disease in australia using linked data: The case for policy change","volume":"9","author":"Katzenellenbogen","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3201\/eid2701.191791","article-title":"Rising ethnic inequalities in acute rheumatic fever and rheumatic heart disease, New Zealand, 2000\u20132018","volume":"27","author":"Bennett","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.amjcard.2012.11.051","article-title":"Prevalence of mitral valve prolapse and congenital bicuspid aortic valves in black and white patients undergoing cardiac valve operations","volume":"111","author":"Novaro","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_35","first-page":"1195","article-title":"Mitral valve prolapse","volume":"63","author":"Sakamoto","year":"2005","journal-title":"Nippon Rinsho Jpn. J. Clin. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/14779072.2019.1553619","article-title":"Mitral valve prolapse","volume":"17","author":"Althunayyan","year":"2019","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2904","DOI":"10.1016\/j.jacc.2018.09.048","article-title":"Arrhythmic Mitral Valve Prolapse: JACC Review Topic of the Week","volume":"72","author":"Miller","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101264","DOI":"10.1016\/j.ppedcard.2020.101264","article-title":"Mitral valve prolapse in adolescent female with hyperthyroidism","volume":"58","author":"Griffith","year":"2020","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1136\/heartjnl-2019-316238","article-title":"Secondary mitral regurgitation: Pathophysiology, proportionality and prognosis","volume":"106","author":"Chehab","year":"2020","journal-title":"Heart"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3515","DOI":"10.1093\/eurheartj\/ehw229","article-title":"Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: The OxVALVE Population Cohort Study","volume":"37","author":"Coffey","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1136\/heartjnl-2016-310894","article-title":"Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study","volume":"103","author":"Andell","year":"2017","journal-title":"Heart"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"27253","DOI":"10.1038\/srep27253","article-title":"Prevalence and correlates of valvular heart diseases in the elderly population in Hubei, China","volume":"6","author":"Shu","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.cpcardiol.2017.10.004","article-title":"Aortic Valve Regurgitation: A Comprehensive Review","volume":"43","author":"Akinseye","year":"2018","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1093\/ehjqcco\/qcaa068","article-title":"Temporal trends and socioeconomic differences in the incidence of left-sided valvular heart disease in Denmark","volume":"7","author":"Gislason","year":"2021","journal-title":"Eur. Heart J. Qual. Care Clin. Outcomes"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.pcad.2020.06.004","article-title":"Sex differences in bicuspid aortic valve disease","volume":"63","author":"Kong","year":"2020","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1177\/2047487320931630","article-title":"Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network","volume":"28","author":"Canciello","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJMcp030912","article-title":"Aortic Regurgitation","volume":"351","author":"Tajik","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Vendramin, I., Lechiancole, A., Piani, D., Sponga, S., Di Nora, C., Muser, D., Bortolotti, U., and Livi, U. (2021). An Integrated Approach for Treatment of Acute Type A Aortic Dissection. Medicina, 57.","DOI":"10.3390\/medicina57111155"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1007\/s00330-016-4590-1","article-title":"Aortic root dimensions are predominantly determined by genetic factors: A classical twin study","volume":"27","author":"Celeng","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s10545-017-0094-7","article-title":"Isolated aortic root dilation in homocystinuria","volume":"41","author":"Lorenzini","year":"2018","journal-title":"J. Inherit. Metab. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1017\/S1047951120003200","article-title":"Aortic root dilation in a child with Marfan syndrome and mosaic Turner syndrome","volume":"30","author":"Groner","year":"2020","journal-title":"Cardiol. Young"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1016\/j.jacc.2008.02.035","article-title":"Aortic Valve Disease in Turner Syndrome","volume":"51","author":"Sachdev","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3574","DOI":"10.1093\/eurheartj\/ehy352","article-title":"Development of significant tricuspid regurgitation over time and prognostic implications: New insights into natural history","volume":"39","author":"Prihadi","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jcmg.2018.06.014","article-title":"Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting","volume":"12","author":"Topilsky","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.amjcard.2020.11.024","article-title":"Ten Years Mortality Trends of Tricuspid Regurgitation in the United States, 2008 to 2018","volume":"140","author":"Shariff","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1007\/s00392-021-01812-3","article-title":"Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation","volume":"110","author":"Riesenhuber","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1136\/hrt.2004.040329","article-title":"Carcinoid heart disease: Presentation, diagnosis, and management","volume":"90","author":"Fox","year":"2004","journal-title":"Heart"},{"key":"ref_58","first-page":"72","article-title":"Ebstein\u2019s anomaly of the tricuspid valve with associated mitral valve prolapse","volume":"28","author":"Khan","year":"2001","journal-title":"Tex. Heart Inst. J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1016\/j.jacc.2015.04.011","article-title":"Functional Tricuspid Regurgitation: A Need to Revise Our Understanding","volume":"65","author":"Dreyfus","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"136","DOI":"10.4250\/jcu.2015.23.3.136","article-title":"Clinical and Echocardiographic Factors Affecting Tricuspid Regurgitation Severity in the Patients with Lone Atrial Fibrillation","volume":"23","author":"Park","year":"2015","journal-title":"J. Cardiovasc. Ultrasound"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Tleyjeh, I.M., and Abdulhak, A.A. (2018). Bin Epidemiology and global burden of infective endocarditis. ESC CardioMed, Oxford University Press.","DOI":"10.1093\/med\/9780198784906.003.0067"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e8392","DOI":"10.1097\/MD.0000000000008392","article-title":"Blood culture-negative endocarditis","volume":"96","author":"Fournier","year":"2017","journal-title":"Medicine"},{"key":"ref_63","unstructured":"Ahmed, S.H. (2022, April 15). Infective Endocarditis Organism-Specific Therapy: Specific Organisms and Therapeutic Regimens. Available online: https:\/\/emedicine.medscape.com\/article\/1976379."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1136\/heartjnl-2019-315204","article-title":"Non-infective endocarditis","volume":"106","author":"Hurrell","year":"2020","journal-title":"Heart"},{"key":"ref_65","first-page":"2091","article-title":"Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: A prospective cohort study","volume":"41","author":"Habib","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"w20473","DOI":"10.4414\/smw.2021.20473","article-title":"Infective endocarditis: Prevention and antibiotic prophylaxis","volume":"151","author":"Sendi","year":"2021","journal-title":"Swiss Med. Wkly."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/10\/2\/32\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:32:01Z","timestamp":1760139121000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/10\/2\/32"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,15]]},"references-count":66,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["medsci10020032"],"URL":"https:\/\/doi.org\/10.3390\/medsci10020032","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,15]]}}}