{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:18:38Z","timestamp":1783073918368,"version":"3.54.6"},"reference-count":62,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Projekt DEAL"},{"name":"MED-EL Elektromedizinische Ger\u00e4te GmbH"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Objective fitting measures offer a means to circumvent the subjectivity of cochlear implant programming, with the stapedius reflex representing one robust predictor of the maximum comfortable loudness level. With the present study, it was investigated whether long-term electromyographic measurements of the stapedius muscle using implanted electrodes are feasible. In nine sheep, myoelectrical activities were recorded intraoperatively and synchronized with middle ear admittance as a reference signal. For acoustic stimulation pure tones with different frequencies were used. The electrodes were placed at the stapedius muscle surface after exposing it via the retrofacial approach. EMG-based detection of the stapedius reflex was achievable over six months when electrode integrity and placement were preserved. The treated muscles were subsequently excised, cut and examined histologically. No signs of atrophy were found in the muscles examined. However, the histological section series showed a clear division of the muscle from proximal to distal, the ratio between tendon and muscle fibers being most pronounced in favor of the muscle fibers in the proximal section. The integration of an electromyography-based measurement method for the objective determination of the stapedius reflex threshold and thus, for the long-term adjustment of cochlear implants, appears possible and could potentially enable autonomous fitting of implants.<\/jats:p>","DOI":"10.3390\/s26134224","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:34:11Z","timestamp":1783071251000},"page":"4224","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Electromyographic Monitoring of the Stapedius Reflex via Implanted Electrodes in Sheep: Toward Objective Autonomous Cochlear Implant Fitting"],"prefix":"10.3390","volume":"26","author":[{"given":"Dirk","family":"Arnold","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5125-1999","authenticated-orcid":false,"given":"Jose Luis","family":"Vargas Luna","sequence":"additional","affiliation":[{"name":"MED-EL Medical Electronics, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9671-0784","authenticated-orcid":false,"given":"Orlando","family":"Guntinas-Lichius","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany"},{"name":"Facial-Nerve-Center Jena, Jena University Hospital, 07747 Jena, Germany"},{"name":"Center for Rare Diseases, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1245-6331","authenticated-orcid":false,"given":"Gerd Fabian","family":"Volk","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany"},{"name":"Facial-Nerve-Center Jena, Jena University Hospital, 07747 Jena, Germany"},{"name":"Center for Rare Diseases, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/00003446-198802000-00010","article-title":"Prediction of dynamic range from stapedius reflex in cochlear implant patients","volume":"9","author":"Jerger","year":"1988","journal-title":"Ear Hear."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3109\/00206098809081593","article-title":"Stapedius reflex threshold in cochlear implant patients","volume":"27","author":"Stephan","year":"1988","journal-title":"Audiology"},{"key":"ref_3","first-page":"85","article-title":"Objective measurements and the audiological management of cochlear implant patients","volume":"53","author":"Shallop","year":"1997","journal-title":"Adv. Otorhinolaryngol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/S0378-5955(03)00309-5","article-title":"Further prospective findings with compound action potentials from Nucleus 24 cochlear implants","volume":"188","author":"Polak","year":"2004","journal-title":"Hear. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1080\/00016480510026890","article-title":"Comparisons between neural response imaging thresholds, electrically evoked auditory reflex thresholds and most comfortable loudness levels in CII bionic ear users with HiResolution sound processing strategies","volume":"125","author":"Han","year":"2005","journal-title":"Acta Oto-Laryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1179\/cim.2006.7.3.125","article-title":"Objective methods in postlingually and prelingually deafened adults for programming cochlear implants: ESR and NRT","volume":"7","author":"Polak","year":"2006","journal-title":"Cochlear Implant Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijporl.2017.08.026","article-title":"Postoperative objective detecting techniques for cochlear implant children with inner ear malformation","volume":"102","author":"Qiao","year":"2017","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1080\/14992027.2023.2245141","article-title":"Stapedius reflex thresholds obtained in a free sound field as an indicator for over- and understimulation in cochlear implant listeners","volume":"63","author":"Mattheus","year":"2024","journal-title":"Int. J. Audiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/S0030-6665(20)32539-1","article-title":"The diagnostic role of stapedius reflex estimations","volume":"11","author":"Alberti","year":"1978","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1097\/01.mao.0000178145.14010.25","article-title":"ECAP, ESR and subjective levels for two different nucleus 24 electrode arrays","volume":"26","author":"Polak","year":"2005","journal-title":"Otol. Neurotol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1179\/cim.2008.9.2.70","article-title":"Relationships among objective measures and speech perception in adult users of the HiResolution Bionic Ear","volume":"9","author":"Wolfe","year":"2008","journal-title":"Cochlear Implants Int."},{"key":"ref_12","first-page":"637","article-title":"Optimizing fitting in children using objective measures such as neural response imaging and electrically evoked stapedius reflex threshold","volume":"28","author":"Caner","year":"2007","journal-title":"Otol. Neurotol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1179\/1754762814Y.0000000064","article-title":"A clinical study of electrophysiological correlates of behavioural comfort levels in cochlear implantees","volume":"15","author":"Raghunandhan","year":"2014","journal-title":"Cochlear Implants Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1159\/000535058","article-title":"Patient and device factors contributing to electrically-evoked stapedial reflex thresholds in cochlear implanted adults","volume":"29","author":"Chai","year":"2024","journal-title":"Audiol. Neurotol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1001\/archotol.127.8.963","article-title":"Measurement of comfort levels by means of electrical stapedial reflex in children","volume":"127","author":"Bresnihan","year":"2001","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3109\/01050399009070761","article-title":"Dynamic range of the contralateral stapedius reflex in cochlear implant patients","volume":"19","author":"Stephan","year":"1990","journal-title":"Scand. Audiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1177\/00034894991080S413","article-title":"Using electrically evoked auditory reflex thresholds to fit the CLARION cochlear implant","volume":"177","author":"Hodges","year":"1999","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5935\/1808-8694.20140014","article-title":"The importance of electrically evoked stapedial reflex in cochlear implant","volume":"80","author":"Andrade","year":"2014","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4103\/1012-5574.175848","article-title":"The relationship between the electrical stapedial muscle reflex threshold and electrical and behavioral measures in cochlear implant patients","volume":"32","author":"Asal","year":"2016","journal-title":"Egypt. J. Otolaryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"68","DOI":"10.3109\/00016489.2015.1086022","article-title":"Objective and subjective evaluations of the Nurotron Venus cochlear implant system via animal experiments and clinical trials","volume":"136","author":"Gao","year":"2016","journal-title":"Acta Otolaryngol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"292","DOI":"10.3766\/jaaa.16117","article-title":"The Value of Electrically Evoked Stapedius Reflex in Determining the Maximum Comfort Level of a Cochlear Implant","volume":"29","author":"Muniz","year":"2018","journal-title":"J. Am. Acad. Audiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1080\/14670100.2017.1416759","article-title":"Comparing eSRT and eCAP measurements in pediatric MED-EL cochlear implant users","volume":"19","author":"Kosaner","year":"2018","journal-title":"Cochlear Implants Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1080\/14992027.2020.1866780","article-title":"Stapedius reflex evoked in free sound field in cochlear implant users compared to normal-hearing listeners","volume":"60","author":"Mattheus","year":"2021","journal-title":"Int. J. Audiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e667","DOI":"10.1097\/MAO.0000000000003988","article-title":"Cochlear Implant Upper Stimulation Levels: eSRT vs. Loudness Scaling","volume":"44","author":"Holder","year":"2023","journal-title":"Otol. Neurotol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1114\/1.1454132","article-title":"Measuring the electrical stapedius reflex with stapedius muscle electromyogram recordings","volume":"30","author":"Clement","year":"2002","journal-title":"Ann. Biomed. Eng."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1097\/00003446-199010000-00008","article-title":"Electrically elicited stapedius reflex in cochlear implant patients","volume":"11","author":"Battmer","year":"1990","journal-title":"Ear Hear."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MAO.0b013e31818a0898","article-title":"Electromyographical recording of the electrically elicited stapedius reflex via a bipolar hook electrode","volume":"30","author":"Pau","year":"2009","journal-title":"Otol. Neurotol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3109\/00206090009073067","article-title":"Objective intraoperative method to record averaged electromyographic stapedius muscle reflexes in cochlear implant patients","volume":"39","author":"Almqvist","year":"2000","journal-title":"Audiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"108290","DOI":"10.1016\/j.heares.2021.108290","article-title":"Intraoperative recordings of electromyogenic responses from the human stapedius muscle","volume":"408","author":"Zarowski","year":"2021","journal-title":"Hear. Res."},{"key":"ref_30","first-page":"e66526","article-title":"Electrically Evoked Stapedius Reflex Measurements in Cochlear Implantation and its Application in the Postoperative Fitting Process","volume":"208","author":"Mair","year":"2024","journal-title":"J. Vis. Exp."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"501738","DOI":"10.1155\/2014\/501738","article-title":"Cochlear implant programming: A global survey on the state of the art","volume":"2014","author":"Vaerenberg","year":"2014","journal-title":"Sci. World J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/00003446-199404000-00008","article-title":"The relationship between electrical acoustic reflex thresholds and behavioral comfort levels in children and adult cochlear implant patients","volume":"15","author":"Spivak","year":"1994","journal-title":"Ear Hear."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1179\/1754762810Y.0000000001","article-title":"Multicentre investigation on electrically evoked compound action potential and stapedius reflex: How do these objective measures relate to implant programming parameters?","volume":"13","author":"Akin","year":"2012","journal-title":"Cochlear Implants Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3109\/14992020209090399","article-title":"Relationship of intraoperative electrically evoked stapedius reflex thresholds to maximum comfortable loudness levels of children with cochlear implants","volume":"41","author":"Allum","year":"2002","journal-title":"Int. J. Audiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/01.aud.0000146178.84065.b3","article-title":"Toward a battery of behavioral and objective measures to achieve optimal cochlear implant stimulation levels in children","volume":"25","author":"Gordon","year":"2004","journal-title":"Ear Hear."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1121\/1.4835715","article-title":"Plasticity and modified loudness following short-term unilateral deprivation: Evidence of multiple gain mechanisms within the auditory system","volume":"135","author":"Munro","year":"2014","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ijporl.2015.12.027","article-title":"Electrically evoked compound action potential (ECAP) in cochlear implant children: Changes in auditory nerve response in first year of cochlear implant use","volume":"82","author":"Telmesani","year":"2016","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.heares.2017.01.009","article-title":"Using acoustic reflex threshold, auditory brainstem response and loudness judgments to investigate changes in neural gain following acute unilateral deprivation in normal hearing adults","volume":"345","author":"Brotherton","year":"2017","journal-title":"Hear. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1080\/14670100.2023.2221048","article-title":"The effect of cochlear implant age and duration of intervention on ESRT in children with cochlear implant","volume":"24","author":"Tyagi","year":"2023","journal-title":"Cochlear Implants Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1097\/MAO.0000000000004374","article-title":"The Relationship Between the Electrically Evoked Stapedius Reflex Threshold and Stimulus Burst Duration in Pediatric Cochlear Implant Users: Preliminary Data","volume":"46","author":"Walkowiak","year":"2025","journal-title":"Otol. Neurotol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4861","DOI":"10.1007\/s00405-025-09532-4","article-title":"Longitudinal changes in electrical stapedius reflex thresholds (eSRT) in children with cochlear implants","volume":"282","author":"Muigg","year":"2025","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1097\/MAO.0000000000002964","article-title":"The Long-Term Stability of the Electrical Stapedial Reflex Threshold","volume":"42","author":"Pitt","year":"2021","journal-title":"Otol. Neurotol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8","DOI":"10.5152\/iao.2019.6589","article-title":"The Relationship between Electrical Stapedius Reflex Thresholds and Behaviorally Most Comfortable Levels in Experienced Cochlear Implant Users","volume":"16","year":"2020","journal-title":"J. Int. Adv. Otol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1179\/146701010X12671177204822","article-title":"Influence of non-optimal levels of electrical stimulation in cochlear implantees on hearing benefits","volume":"11","author":"Wasowski","year":"2010","journal-title":"Cochlear Implants Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1055\/s-0029-1224158","article-title":"The temporal bone of lamb and pig as an alternative in ENT-education","volume":"89","author":"Gurr","year":"2010","journal-title":"Laryngorhinootologie"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e174","DOI":"10.1097\/MAO.0000000000003413","article-title":"Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study","volume":"43","author":"Arnold","year":"2022","journal-title":"Otol. Neurotol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Guntinas-Lichius, O., Arnold, D., Volk, G.F., Korth, D., Aschenbach, R., Hempel, J.M., Schneider, F., Schade-Mann, T., Gamerdinger, P., and Tropitzsch, A. (2022). Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0272943"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1080\/14992027.2016.1227480","article-title":"Tympanometric measurements in conscious sheep\u2014A diagnostic tool for pre-clinical middle ear implant studies","volume":"56","author":"Pohl","year":"2017","journal-title":"Int. J. Audiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1159\/000326892","article-title":"Evoked stapedius reflex and compound action potential thresholds versus most comfortable loudness level: Assessment of their relation for charge-based fitting strategies in implant users","volume":"73","author":"Walkowiak","year":"2011","journal-title":"ORL J. Otorhinolaryngol. Relat. Spec."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.otoeng.2024.01.004","article-title":"Variation of electrical impedance over 5 years post-implantation and relationship with the maximum comfort level (MCL) in adults with cochlear implants","volume":"75","year":"2024","journal-title":"Acta Otorrinolaringol. (Engl. Ed.)"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00405-023-08076-9","article-title":"Early fitting in cochlear implant surgery: Preliminary results","volume":"281","author":"Soncini","year":"2024","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3109\/00206090009073049","article-title":"Post-operative stapedius reflex tests with simultaneous loudness scaling in patients supplied with cochlear implants","volume":"39","author":"Stephan","year":"2000","journal-title":"Audiology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/joa.13861","article-title":"Unique fiber phenotype composition and metabolic properties of the stapedius and tensor tympani muscles in the human middle ear","volume":"243","author":"Thornell","year":"2023","journal-title":"J. Anat."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"10440","DOI":"10.1038\/s41598-024-60875-0","article-title":"Long-term stimulation by implanted pacemaker enables non-atrophic treatment of bilateral vocal fold paresis in a human-like animal model","volume":"14","author":"Walluks","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e70178","DOI":"10.1002\/rcs.70178","article-title":"Feasibility of Minimally Invasive Robot-Assisted Retrofacial Access to the Stapedius Muscle for Applications in Objective Cochlear Implant Fitting: A Cadaveric Study","volume":"22","author":"Arnold","year":"2026","journal-title":"Int. J. Med. Robot."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S1042-3680(18)30755-1","article-title":"Peripheral nerve regeneration","volume":"2","author":"Liuzzi","year":"1991","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1007\/BF01611989","article-title":"Survival and subsequent regeneration of olfactory neurons after a distal axonal lesion","volume":"16","author":"Cancalon","year":"1987","journal-title":"J. Neurocytol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s004050000234","article-title":"Influence of volatile and intravenous anesthetics on the threshold of the acoustically evoked stapedius reflex","volume":"257","author":"Bissinger","year":"2000","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1002\/hbm.26199","article-title":"Responsiveness variability during anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks","volume":"44","author":"Deng","year":"2023","journal-title":"Hum. Brain Mapp."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1213\/ane.0b013e31819bdfd5","article-title":"Dose-dependent suppression of the electrically elicited stapedius reflex by general anesthetics in children undergoing cochlear implant surgery","volume":"108","author":"Crawford","year":"2009","journal-title":"Anesth. Analg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1055\/s-2007-997095","article-title":"Effect of anesthesia on the intraoperative elicited stapedius reflex","volume":"73","author":"Gnadeberg","year":"1994","journal-title":"Laryngorhinootologie"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"15065","DOI":"10.1038\/s41598-026-53093-3","article-title":"Electromyography of the stapedius muscle via a retrofacial approach and electrically evoked stapedius reflex during cochlear implant surgery: A prospective bicentric study","volume":"16","author":"Arnold","year":"2026","journal-title":"Sci. Rep."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/13\/4224\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:44:06Z","timestamp":1783071846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/13\/4224"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":62,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["s26134224"],"URL":"https:\/\/doi.org\/10.3390\/s26134224","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}