{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:52:50Z","timestamp":1781765570085,"version":"3.54.5"},"reference-count":48,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MagiCAMP Association"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Malnutrition, encompassing both undernutrition and overnutrition, is a common complication in children with cancer and is associated with impaired treatment tolerance, increased infection risk, altered pharmacokinetics, reduced quality of life, and poorer survival outcomes. Despite its importance, nutritional management in pediatric oncology lacks a unified, systematically organized clinical framework applicable to the full trajectory of the disease. Objective: This study aimed to develop expert consensus recommendations for nutritional intervention in pediatric oncology patients aged 4 to 18 years. Methods: A modified electronic Delphi (e-Delphi) process was conducted with a multidisciplinary expert panel of 22 specialists, including pediatric oncologists, pediatric gastroenterologists, clinical nutrition specialists, radiotherapy specialists, and pediatric surgeons. Statements were rated on a 9-point Likert scale across two anonymous rounds, with consensus predefined as \u226580% agreement. Results: Forty-one consensus recommendations were formulated across nine domains: nutritional screening and assessment, energy and protein requirements, micronutrient supplementation, physical activity, nutritional support escalation, refeeding syndrome prevention, treatment-specific management, survivorship, and palliative care. All recommendations achieved the predefined consensus threshold. Conclusions: This Delphi consensus provides a structured, multidisciplinary, and clinically actionable framework for nutritional management across the full trajectory of childhood cancer and is intended to reduce institutional variability and improve patient outcomes.<\/jats:p>","DOI":"10.3390\/nu18121889","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:52:08Z","timestamp":1781229128000},"page":"1889","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Consensus Recommendations for Nutritional Intervention in Pediatric Oncology (Ages 4\u201318 Years) on Behalf of the Romanian Society of Pediatric Hematology and Oncology and the Romanian Society of Pediatric Gastroenterology, Hepatology and Nutrition"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3253-7341","authenticated-orcid":false,"given":"Irina","family":"Avr\u0103mescu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Pediatrics, and Bone Marrow Transplantation Unit, Fundeni Clinical Institute, 022328 Bucharest, Romania"},{"name":"Romanian Society of Pediatric Hematology and Oncology, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6382-9682","authenticated-orcid":false,"given":"Stelu\u021ba","family":"Boroghin\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Pediatrics, Fundeni Clinical Institute, 022328 Bucharest, Romania"},{"name":"Romanian Society of Pediatric Gastroenterology, Hepatology and Nutrition, 400177 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"P\u00e2rvan","sequence":"additional","affiliation":[{"name":"Romanian Society of Pediatric Gastroenterology, Hepatology and Nutrition, 400177 Cluj-Napoca, Romania"},{"name":"Faculty of Medicine, University of Medicine and Pharmacy Iuliu Ha\u021bieganu, 400012 Cluj-Napoca, Romania"},{"name":"Department of Pediatrics, Emergency Clinical Hospital for Children, 400001 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0815-0025","authenticated-orcid":false,"given":"Laura","family":"B\u0103l\u0103nescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Pediatric Surgery, Grigore Alexandrescu Children\u2019s Emergency Clinical Hospital, 011743 Bucharest, Romania"},{"name":"Romanian Society of Pediatric Surgery, 500058 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Negrei","sequence":"additional","affiliation":[{"name":"Romanian Society of Pediatric Hematology and Oncology, 022328 Bucharest, Romania"},{"name":"MedEuropa, Radiotherapy and Medical Oncology, 022343 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Albu","sequence":"additional","affiliation":[{"name":"Center for Dietetics, Oncology Nutrition, and Integrative Medicine, 013307 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9039-5859","authenticated-orcid":false,"given":"Cristina Georgiana","family":"Jercan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Pediatrics, and Bone Marrow Transplantation Unit, Fundeni Clinical Institute, 022328 Bucharest, Romania"},{"name":"Romanian Society of Pediatric Hematology and Oncology, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3706-6620","authenticated-orcid":false,"given":"Andra Daniela","family":"Marcu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Pediatrics, and Bone Marrow Transplantation Unit, Fundeni Clinical Institute, 022328 Bucharest, Romania"},{"name":"Romanian Society of Pediatric Hematology and Oncology, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hora\u021biu","family":"Albu","sequence":"additional","affiliation":[{"name":"Center for Dietetics, Oncology Nutrition, and Integrative Medicine, 013307 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6031-8190","authenticated-orcid":false,"given":"Anca","family":"Coli\u021b\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania"},{"name":"Department of Pediatrics, and Bone Marrow Transplantation Unit, Fundeni Clinical Institute, 022328 Bucharest, Romania"},{"name":"Romanian Society of Pediatric Hematology and Oncology, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1200\/JCO.2014.55.6571","article-title":"Milestones in the curability of pediatric cancers","volume":"32","author":"Hudson","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Fabozzi, F., Trovato, C.M., Diamanti, A., Mastronuzzi, A., Zecca, M., Tripodi, S.I., Masetti, R., Leardini, D., Muratore, E., and Barat, V. (2022). Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement. Cancers, 14.","DOI":"10.3390\/cancers14143378"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Viani, K., Alves, J., Damasco-Avila, E., Murra, M.S., Schoeman, J., Walters, M., and Ladas, E.J. (2025). Consensus recommendations for the nutritional management of children with cancer in limited resource settings: A report from the International Initiative for Pediatrics and Nutrition. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1605632"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Pedretti, L., Massa, S., Leardini, D., Muratore, E., Rahman, S., Pession, A., Esposito, S., and Masetti, R. (2023). Role of Nutrition in Pediatric Patients with Cancer. Nutrients, 15.","DOI":"10.3390\/nu15030710"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Podpeskar, A., Crazzolara, R., Kropshofer, G., Hetzer, B., Rabensteiner, E., Meister, B., Obexer, P., and Salvador, C. (2023). Recommendations for Nutritional Supplementation in Pediatric Oncology: A Compilation of the Facts. Nutrients, 15.","DOI":"10.3390\/nu15143239"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1002\/pbc.24501","article-title":"Paediatric Oncology in Developing Countries. SIOP PODC: Recommendations for supportive care of children with cancer in a low-income setting","volume":"60","author":"Israels","year":"2013","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1002\/pbc.26016","article-title":"A Framework for Adapted Nutritional Therapy for Children with Cancer in Low- and Middle-Income Countries: A Report from the SIOP PODC Nutrition Working Group","volume":"63","author":"Ladas","year":"2016","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"55","DOI":"10.3945\/ajcn.2010.29201","article-title":"Body composition of children with cancer","volume":"92","author":"Murphy","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_9","unstructured":"World Health Organization (2026, May 26). WHO Child Growth Standards: Methods and Development. Available online: https:\/\/www.who.int\/tools\/child-growth-standards."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","article-title":"GLIM criteria for the diagnosis of malnutrition\u2014A consensus report from the global clinical nutrition community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e28211","DOI":"10.1002\/pbc.28211","article-title":"Assessment of nutritional status in children with cancer: A narrative review","volume":"67","author":"Viani","year":"2020","journal-title":"Pediatr. Blood Cancer."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1002\/jpen.2462","article-title":"Nutrition risk prevalence and screening tools\u2019 validity in pediatric patients: A systematic review","volume":"47","author":"Pereira","year":"2023","journal-title":"J. Parenter. Enteral. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.clnu.2015.02.009","article-title":"Evaluation of the nutrition screening tool for childhood cancer (SCAN)","volume":"35","author":"Murphy","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.clnesp.2024.06.047","article-title":"Prospective validation of the nutrition screening tool for childhood cancer (SCAN)","volume":"63","year":"2024","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: Clinical Nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"European Food Safety Authority (EFSA) (2017). Dietary reference values for nutrients Summary Report. EFSA Support. Publ., 14, 12.","DOI":"10.2903\/sp.efsa.2017.e15121"},{"key":"ref_17","unstructured":"Ortega, R.M., Navia, B., L\u00f3pez-Sobaler, A.M., and Aparicio, A. (2015). Ingestas diarias recomendadas de energia y nutrients para la poblaci\u00f3n espanola. Libro Blanco de la Nutricion Infantil en Espana, Departamento de Nutricion, Faculdad de Farmacia, Universidad Complutense de Madrid."},{"key":"ref_18","unstructured":"Ballabriga, A., and Carrascosa, A. (2006). Nutricion en la adolescencia. Nutricion en la Infancia y Adolescencia, e-Medfarma 2020, S.L.. [3rd ed.]."},{"key":"ref_19","first-page":"423","article-title":"Assessment of Nutritional Status in Children with Cancer and Effectiveness of Oral Nutritional Supplements","volume":"32","author":"Emir","year":"2015","journal-title":"Pediatr. Hematol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1200\/JGO.2016.005587","article-title":"Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review","volume":"3","author":"Diorio","year":"2017","journal-title":"J. Glob. Oncol."},{"key":"ref_21","unstructured":"PAHO (2023). Nutritional Care Guide for Pediatric Cancer, Pan American Health Organization."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e28378","DOI":"10.1002\/pbc.28378","article-title":"The importance of enteral nutrition to prevent or treat undernutrition in children undergoing treatment for cancer","volume":"67","author":"Trehan","year":"2020","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_23","unstructured":"Calderon, V.V., and Aznar, A.L.M. (2015). En Libro Blanco de la Nutricion Infantil en Espana, Prensas de la Universidad de Zaragoza."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2923","DOI":"10.1016\/j.clnu.2021.03.020","article-title":"Micronutrient status influences clinical outcomes of paediatric cancer patients during treatment: A prospective cohort study","volume":"40","author":"Gerasimidis","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"106653","DOI":"10.1016\/j.clnu.2026.106653","article-title":"The association between micronutrient status and clinical outcomes in children with cancer undergoing treatment: A systematic review and meta-analysis","volume":"61","author":"Li","year":"2026","journal-title":"Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e31645","DOI":"10.1002\/pbc.31645","article-title":"Associations of ferritin and folate status with clinical outcomes in childhood cancer patients: A prospective cohort study","volume":"72","author":"Withey","year":"2025","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Alexandru, A., Ivan, C.-S., Tanasescu, S., Oprisoni, L.A., Dragomir, T.-L., Varga, N.-I., Mateescu, D., Diaconu, M., Margan, M.-M., and Boeriu, E. (2024). Are pediatric cancer patients a risk group for vitamin D deficiency? A systematic review. Cancers, 16.","DOI":"10.3390\/cancers16244201"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.clnu.2014.12.023","article-title":"Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients","volume":"35","author":"Rush","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_29","first-page":"CD008796","article-title":"Physical exercise training interventions for children and young adults during and after treatment for childhood cancer","volume":"3","author":"Braam","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Budka-Chrz\u0119szczyk, A., Szlagatys-Sidorkiewicz, A., Bie\u0144, E., Irga-Jaworska, N., Borkowska, A., Krawczyk, M.A., Popi\u0144ska, K., Romanowska, H., Toporowska-Kowalska, E., and \u015awider, M. (2024). Managing Undernutrition in Pediatric Oncology: A Consensus Statement Developed Using the Delphi Method by the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology. Nutrients, 16.","DOI":"10.3390\/nu16091327"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e28324","DOI":"10.1002\/pbc.28324","article-title":"Nutritional traditional and complementary medicine strategies in pediatric cancer: A narrative review","volume":"67","author":"Diorio","year":"2020","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Caccialanza, R., Cereda, E., De Lorenzo, F., Farina, G., Pedrazzoli, P., and on behalf of the AIOM-SINPE-FAVO Working Group (2018). To fast, or not to fast before chemotherapy, that is the question. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4245-5"},{"key":"ref_33","first-page":"144","article-title":"Benefit of oral nutritional supplements for children with acute lymphoblastic leukaemia during remission-induction chemotherapy: A quasi-experimental study","volume":"27","author":"Liang","year":"2018","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/MPG.0b013e3181d336d2","article-title":"Practical approach to paediatric enteral nutrition: A comment by the ESPGHAN committee on nutrition","volume":"51","author":"Braegger","year":"2010","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.clnu.2017.06.017","article-title":"ESPEN expert group recommendations for action against cancer-related malnutrition","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.clnu.2019.04.022","article-title":"ESPEN guideline on home enteral nutrition","volume":"39","author":"Bischoff","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1002\/ncp.10474","article-title":"ASPEN Consensus Recommendations for Refeeding Syndrome","volume":"35","author":"Seres","year":"2020","journal-title":"Nutr. Clin. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Borriello, R., Esposto, G., Ainora, M.E., Podagrosi, G., Ferrone, G., Mignini, I., Galasso, L., Gasbarrini, A., and Zocco, M.A. (2025). Understanding Refeeding Syndrome in Critically III Patients: A Narrative Review. Nutrients, 17.","DOI":"10.3390\/nu17111866"},{"key":"ref_39","unstructured":"National Institute for Health and Clinical Excellence (2026, May 26). Nutrition Support in Adults Clinical Guideline CG32. Available online: www.nice.org.uk\/page.aspx?o=cg032."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1038\/sj.bmt.1705084","article-title":"A double-blind randomized placebo-controlled study of oral glutamine in the prevention of mucositis in children undergoing hematopoietic stem cell transplantation: A pediatric blood and marrow transplant consortium study","volume":"36","author":"Aquino","year":"2005","journal-title":"Bone Marrow Transplant."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S281","DOI":"10.1016\/j.jtct.2025.01.430","article-title":"Prevension of Acute Graft-Versus-Host Disease and Restoration of Gut Microbiome Diversity Via Butyrate Administration in Allogeneic Hematopoietic Stem Cell Transplantation","volume":"31","author":"Kim","year":"2025","journal-title":"Transplant. Cell. Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/SLA.0000000000003256","article-title":"The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review and Meta-analysis","volume":"270","author":"Adiamah","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.clnu.2025.08.029","article-title":"ESPEN guideline on clinical nutrition in surgery\u2014Update 2025","volume":"53","author":"Weimann","year":"2025","journal-title":"Clin. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Mititelu, M., Licu, M., Neac\u0219u, S.M., C\u0103lin, M.F., Matei, S.R., Scafa-Udri\u0219te, A., Stanciu, T.I., Busnatu, \u0218.S., Olteanu, G., and M\u0103ru, N. (2024). An Assessment of Behavioral Risk Factors in Oncology Patients. Nutrients, 16.","DOI":"10.3390\/nu16152527"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s13679-017-0260-0","article-title":"Early Nutrition and Physical Activity Interventions in Childhood Cancer Survivors","volume":"6","author":"Zhang","year":"2017","journal-title":"Curr. Obes. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/j.1365-277X.2010.01047.x","article-title":"Nasogastric tube feeding and percutaneous endoscopic gastrostomy tube feeding in patients with head and neck cancer","volume":"23","author":"Nugent","year":"2010","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4376","DOI":"10.1200\/JCO.2009.27.1916","article-title":"Prognostic factors in patients with advanced cancer: Use of the patient-generated subjective global assessment in survival prediction","volume":"28","author":"Martin","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1200\/JCO.2012.44.6518","article-title":"Parenteral hydration in patients with advanced cancer: A multicenter, double-blind, placebo-controlled randomized trial","volume":"31","author":"Bruera","year":"2013","journal-title":"J. Clin. Oncol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1889\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:03:27Z","timestamp":1781762607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1889"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":48,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18121889"],"URL":"https:\/\/doi.org\/10.3390\/nu18121889","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}