{"id":"https://openalex.org/W4414915596","doi":"https://doi.org/10.1093/asjof/ojaf128","title":"Association Between Breast Microbiota and Capsular Contracture: A Systematic Review","display_name":"Association Between Breast Microbiota and Capsular Contracture: A Systematic Review","publication_year":2025,"publication_date":"2025-01-01","ids":{"openalex":"https://openalex.org/W4414915596","doi":"https://doi.org/10.1093/asjof/ojaf128","pmid":"https://pubmed.ncbi.nlm.nih.gov/41235296","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/12611302"},"language":"en","primary_location":{"id":"doi:10.1093/asjof/ojaf128","doi":"https://doi.org/10.1093/asjof/ojaf128","is_oa":true,"landing_page_url":"https://doi.org/10.1093/asjof/ojaf128","pdf_url":"https://academic.oup.com/asjopenforum/advance-article-pdf/doi/10.1093/asjof/ojaf128/64528483/ojaf128.pdf","source":{"id":"https://openalex.org/S4210168700","display_name":"Aesthetic Surgery Journal Open Forum","issn_l":"2631-4797","issn":["2631-4797"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Aesthetic Surgery Journal Open Forum","raw_type":"journal-article"},"volume":null,"type":"review","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://academic.oup.com/asjopenforum/advance-article-pdf/doi/10.1093/asjof/ojaf128/64528483/ojaf128.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5119884595","display_name":"Hassan Aden","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4387156423","display_name":"Mogadishu Somali Turkish Training and Research Hospital","ror":"https://ror.org/00fadqs53","country_code":"SO","type":"healthcare","lineage":["https://openalex.org/I4387156423"]},{"id":"https://openalex.org/I45129253","display_name":"University College London","ror":"https://ror.org/02jx3x895","country_code":"GB","type":"education","lineage":["https://openalex.org/I124357947","https://openalex.org/I45129253"]}],"countries":["GB","SO"],"is_corresponding":false,"raw_author_name":"Hassan Aden","raw_affiliation_strings":["Department of General Surgery , Mogadishu Somali Turkiye Training and Research Hospital , Mogadishu , Somalia","University College London, London, United Kingdom"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of General Surgery , Mogadishu Somali Turkiye Training and Research Hospital , Mogadishu , Somalia","institution_ids":["https://openalex.org/I4387156423"]},{"raw_affiliation_string":"University College London, London, United Kingdom","institution_ids":["https://openalex.org/I45129253"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5018644861","display_name":"Abdirahman Ahmed Mohamud","orcid":"https://orcid.org/0000-0001-7889-7231","observed_orcids":["https://orcid.org/0000-0001-7889-7231"]},"institutions":[{"id":"https://openalex.org/I4387156423","display_name":"Mogadishu Somali Turkish Training and Research Hospital","ror":"https://ror.org/00fadqs53","country_code":"SO","type":"healthcare","lineage":["https://openalex.org/I4387156423"]}],"countries":["SO"],"is_corresponding":false,"raw_author_name":"Abdirahman Ahmed Mohamud","raw_affiliation_strings":["Department of General Surgery, Mogadishu Somali Turkiye Training and Research Hospital , Mogadishu, Somalia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of General Surgery, Mogadishu Somali Turkiye Training and Research Hospital , Mogadishu, Somalia","institution_ids":["https://openalex.org/I4387156423"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5109595450","display_name":"Ammara Hassan","orcid":"https://orcid.org/0009-0008-0596-1106","observed_orcids":["https://orcid.org/0009-0008-0596-1106"]},"institutions":[{"id":"https://openalex.org/I4210157195","display_name":"Jamhuriya University of Science and Technology","ror":"https://ror.org/05brr5h08","country_code":"SO","type":"education","lineage":["https://openalex.org/I4210157195"]}],"countries":["SO"],"is_corresponding":false,"raw_author_name":"Abdisalam Ismail Hassan","raw_affiliation_strings":["Faculty of Medicine and Health Science, Jamhuriya University of Science and Technology , Mogadishu, Somalia"],"raw_orcid":"https://orcid.org/0009-0008-0596-1106","affiliations":[{"raw_affiliation_string":"Faculty of Medicine and Health Science, Jamhuriya University of Science and Technology , Mogadishu, Somalia","institution_ids":["https://openalex.org/I4210157195"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5076325376","display_name":"Osman Abubakar Fiidow","orcid":"https://orcid.org/0000-0002-0177-6690","observed_orcids":["https://orcid.org/0000-0002-0177-6690"]},"institutions":[{"id":"https://openalex.org/I4387154936","display_name":"Salaam University","ror":"https://ror.org/05g7ez988","country_code":"SO","type":"education","lineage":["https://openalex.org/I4387154936"]}],"countries":["SO"],"is_corresponding":false,"raw_author_name":"Osman Abubakar Fiidow","raw_affiliation_strings":["Faculty of Medicine and Surgery, Salaam University , Mogadishu, Somalia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Faculty of Medicine and Surgery, Salaam University , Mogadishu, Somalia","institution_ids":["https://openalex.org/I4387154936"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5007051644","display_name":"Ahmed Muhammad Bashir","orcid":"https://orcid.org/0000-0002-7992-506X","observed_orcids":["https://orcid.org/0000-0002-7992-506X"]},"institutions":[{"id":"https://openalex.org/I4387156423","display_name":"Mogadishu Somali Turkish Training and Research Hospital","ror":"https://ror.org/00fadqs53","country_code":"SO","type":"healthcare","lineage":["https://openalex.org/I4387156423"]}],"countries":["SO"],"is_corresponding":true,"raw_author_name":"Ahmed Muhammad Bashir","raw_affiliation_strings":["Corresponding Author: Dr Ahmed Muhammad Bashir, Department of Internal Medicine, Mogadishu Somali Turkiye Training and Research Hospital, Mogadishu, Somalia","Department of Internal Medicine, Mogadishu Somali Turkiye Training and Research Hospital , Mogadishu, Somalia"],"raw_orcid":"https://orcid.org/0000-0002-7992-506X","affiliations":[{"raw_affiliation_string":"Corresponding Author: Dr Ahmed Muhammad Bashir, Department of Internal Medicine, Mogadishu Somali Turkiye Training and Research Hospital, Mogadishu, Somalia","institution_ids":["https://openalex.org/I4387156423"]},{"raw_affiliation_string":"Department of Internal Medicine, Mogadishu Somali Turkiye Training and Research Hospital , Mogadishu, Somalia","institution_ids":["https://openalex.org/I4387156423"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5007051644"],"corresponding_institution_ids":["https://openalex.org/I4387156423"],"apc_list":{"value":3051,"currency":"USD","value_usd":3051},"apc_paid":{"value":3051,"currency":"USD","value_usd":3051},"fwci":0.6967,"has_fulltext":true,"cited_by_count":4,"citation_normalized_percentile":{"value":0.54506196,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":97,"max":98},"biblio":{"volume":"7","issue":null,"first_page":"ojaf128","last_page":"ojaf128"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11258","display_name":"Breast Implant and Reconstruction","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11258","display_name":"Breast Implant and Reconstruction","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11293","display_name":"Orthopedic Infections and Treatments","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10359","display_name":"Dental Implant Techniques and Outcomes","score":0.0,"subfield":{"id":"https://openalex.org/subfields/3504","display_name":"Oral Surgery"},"field":{"id":"https://openalex.org/fields/35","display_name":"Dentistry"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/capsular-contracture","display_name":"capsular contracture","score":0.9800000190734863},{"id":"https://openalex.org/keywords/breast-implants","display_name":"breast implants","score":0.9390000104904175},{"id":"https://openalex.org/keywords/bacterial-biofilms","display_name":"bacterial biofilms","score":0.8299999833106995},{"id":"https://openalex.org/keywords/staphylococcus-epidermidis","display_name":"Staphylococcus epidermidis","score":0.9929999709129333},{"id":"https://openalex.org/keywords/cutibacterium-acnes","display_name":"Propionibacterium acnes","score":0.9990000128746033},{"id":"https://openalex.org/keywords/streptococcus","display_name":"Streptococcus","score":0.9990000128746033},{"id":"https://openalex.org/keywords/breast-augmentation","display_name":"breast augmentation","score":0.7870000004768372},{"id":"https://openalex.org/keywords/breast-reconstruction","display_name":"breast reconstruction","score":0.7950000166893005}],"concepts":[{"id":"https://openalex.org/C2775951664","wikidata":"https://www.wikidata.org/wiki/Q524677","display_name":"Capsular contracture","level":5,"score":0.7972999811172485},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7735000252723694},{"id":"https://openalex.org/C2778187792","wikidata":"https://www.wikidata.org/wiki/Q749053","display_name":"Breast implant","level":3,"score":0.6075000166893005},{"id":"https://openalex.org/C113280763","wikidata":"https://www.wikidata.org/wiki/Q2326546","display_name":"Subclinical infection","level":2,"score":0.5019000172615051},{"id":"https://openalex.org/C2780440149","wikidata":"https://www.wikidata.org/wiki/Q3851652","display_name":"Breast augmentation","level":3,"score":0.47699999809265137},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.4478999972343445},{"id":"https://openalex.org/C530470458","wikidata":"https://www.wikidata.org/wiki/Q128581","display_name":"Breast cancer","level":3,"score":0.4415999948978424},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.41429999470710754},{"id":"https://openalex.org/C2777704003","wikidata":"https://www.wikidata.org/wiki/Q4959802","display_name":"Breast surgery","level":4,"score":0.3869999945163727},{"id":"https://openalex.org/C189708586","wikidata":"https://www.wikidata.org/wiki/Q1504425","display_name":"Systematic review","level":3,"score":0.3781000077724457},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.36489999294281006},{"id":"https://openalex.org/C143998085","wikidata":"https://www.wikidata.org/wiki/Q162555","display_name":"Oncology","level":1,"score":0.3528999984264374},{"id":"https://openalex.org/C2777757722","wikidata":"https://www.wikidata.org/wiki/Q848318","display_name":"Mastectomy","level":4,"score":0.32339999079704285},{"id":"https://openalex.org/C16005928","wikidata":"https://www.wikidata.org/wiki/Q171171","display_name":"Dermatology","level":1,"score":0.3165999948978424},{"id":"https://openalex.org/C29456083","wikidata":"https://www.wikidata.org/wiki/Q1221899","display_name":"Gynecology","level":1,"score":0.3043000102043152},{"id":"https://openalex.org/C2779880527","wikidata":"https://www.wikidata.org/wiki/Q4959796","display_name":"Breast disease","level":4,"score":0.29649999737739563},{"id":"https://openalex.org/C2781037480","wikidata":"https://www.wikidata.org/wiki/Q11002196","display_name":"Mammaplasty","level":2,"score":0.2962999939918518},{"id":"https://openalex.org/C2992397963","wikidata":"https://www.wikidata.org/wiki/Q189790","display_name":"Anaerobic bacteria","level":3,"score":0.29019999504089355},{"id":"https://openalex.org/C81182388","wikidata":"https://www.wikidata.org/wiki/Q353963","display_name":"Complication","level":2,"score":0.2808000147342682},{"id":"https://openalex.org/C2910302809","wikidata":"https://www.wikidata.org/wiki/Q7193","display_name":"Microbiological Techniques","level":2,"score":0.2653999924659729},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.2581000030040741},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.2554999887943268},{"id":"https://openalex.org/C523546767","wikidata":"https://www.wikidata.org/wiki/Q10876","display_name":"Bacteria","level":2,"score":0.2526000142097473},{"id":"https://openalex.org/C60644358","wikidata":"https://www.wikidata.org/wiki/Q128570","display_name":"Bioinformatics","level":1,"score":0.2515000104904175}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1093/asjof/ojaf128","doi":"https://doi.org/10.1093/asjof/ojaf128","is_oa":true,"landing_page_url":"https://doi.org/10.1093/asjof/ojaf128","pdf_url":"https://academic.oup.com/asjopenforum/advance-article-pdf/doi/10.1093/asjof/ojaf128/64528483/ojaf128.pdf","source":{"id":"https://openalex.org/S4210168700","display_name":"Aesthetic Surgery Journal Open Forum","issn_l":"2631-4797","issn":["2631-4797"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Aesthetic Surgery Journal Open Forum","raw_type":"journal-article"},{"id":"pmh:oai:europepmc.org:11416081","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12611302","pdf_url":null,"source":{"id":"https://openalex.org/S4306400806","display_name":"Europe PMC (PubMed Central)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1303153112","host_organization_name":"European Bioinformatics Institute","host_organization_lineage":["https://openalex.org/I1303153112"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":null,"raw_type":"Text"},{"id":"pmid:41235296","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41235296","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Aesthetic surgery journal. Open forum","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:12611302","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12611302/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Aesthet Surg J Open Forum","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1093/asjof/ojaf128","doi":"https://doi.org/10.1093/asjof/ojaf128","is_oa":true,"landing_page_url":"https://doi.org/10.1093/asjof/ojaf128","pdf_url":"https://academic.oup.com/asjopenforum/advance-article-pdf/doi/10.1093/asjof/ojaf128/64528483/ojaf128.pdf","source":{"id":"https://openalex.org/S4210168700","display_name":"Aesthetic Surgery Journal Open Forum","issn_l":"2631-4797","issn":["2631-4797"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj"],"host_organization":"https://openalex.org/P4310311648","host_organization_name":"Oxford University Press","host_organization_lineage":["https://openalex.org/P4310311648","https://openalex.org/P4310311647"],"host_organization_lineage_names":["Oxford University Press","University of Oxford"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Aesthetic Surgery Journal Open Forum","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9940000176429749,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Systematic Review","id":"https://openalex.org/study-designs/systematic-review"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4414915596.pdf","grobid_xml":"https://content.openalex.org/works/W4414915596.grobid-xml"},"referenced_works_count":14,"referenced_works":["https://openalex.org/W2004201763","https://openalex.org/W2017084535","https://openalex.org/W2039914303","https://openalex.org/W2084925518","https://openalex.org/W2116015046","https://openalex.org/W2268075413","https://openalex.org/W2296908670","https://openalex.org/W2315976320","https://openalex.org/W2888680688","https://openalex.org/W2954285250","https://openalex.org/W2959098174","https://openalex.org/W3135728833","https://openalex.org/W3142485202","https://openalex.org/W4211163608"],"related_works":["https://openalex.org/W2486013019","https://openalex.org/W4396800891","https://openalex.org/W2146524741","https://openalex.org/W3134914773","https://openalex.org/W2268075413","https://openalex.org/W2771248333","https://openalex.org/W2778218966","https://openalex.org/W2039914303","https://openalex.org/W4411856735","https://openalex.org/W4410640652"],"abstract_inverted_index":{"Abstract":[0],"Capsular":[1],"contracture":[2],"(CC),":[3],"a":[4,22,231],"common":[5],"complication":[6],"of":[7,39,61,132,177,204,241],"breast":[8,43,71,83,121,182,236],"implants,":[9],"has":[10],"an":[11,129],"unclear":[12],"etiology.":[13],"Subclinical":[14],"infection":[15],"around":[16],"the":[17,36,42,68,194],"implant":[18,140],"is":[19],"widely":[20],"considered":[21],"potential":[23],"cause.":[24],"Microorganisms,":[25],"such":[26],"as":[27],"Staphylococcus":[28],"epidermidis,":[29,168,187,223],"have":[30,54],"been":[31],"associated":[32],"with":[33,128,155,180,214],"CC,":[34],"but":[35],"specific":[37,235],"role":[38],"bacteria":[40,165],"from":[41,88],"capsule,":[44],"glandular":[45],"tissue,":[46],"or":[47,81,142,150,209],"skin":[48],"remains":[49],"unclear.":[50],"No":[51],"molecular":[52],"studies":[53,89,135,205],"definitively":[55],"investigated":[56],"this":[57,62],"association.":[58],"The":[59,115,145,202],"authors":[60],"systematic":[63,175],"review":[64,116,176],"aim":[65],"to":[66,125],"evaluate":[67],"relationship":[69],"between":[70,234],"microbiota,":[72],"bacterial":[73],"biofilms,":[74],"and":[75,97,105,171,190,238],"CC":[76,200],"in":[77,199,227],"patients":[78],"undergoing":[79],"cosmetic":[80],"reconstructive":[82],"augmentation.":[84],"Data":[85],"were":[86,113,193],"extracted":[87],"identified":[90,164],"through":[91],"different":[92],"search":[93],"engines,":[94],"including":[95],"Medline":[96],"Embase.":[98],"Inclusion":[99],"criteria":[100],"focused":[101],"on":[102,139],"patient,":[103],"surgical,":[104],"implant-related":[106],"factors":[107],"influencing":[108],"CC.":[109,239],"Only":[110],"English-language":[111],"articles":[112],"considered.":[114],"included":[117,166],"428":[118,178],"women":[119,179],"(453":[120],"implants)":[122],"aged":[123],"27":[124],"53":[126],"years,":[127],"average":[130],"age":[131],"31.":[133],"Most":[134],"lacked":[136],"detailed":[137],"reporting":[138],"characteristics":[141],"surgical":[143],"techniques.":[144],"majority":[146,203],"employed":[147],"cell":[148,207],"culture":[149,208],"pathology":[151,210],"for":[152,211],"microbiota":[153,212,237],"assessment,":[154,213],"1":[156,215],"study":[157],"using":[158],"polymerase":[159],"chain":[160],"reaction":[161],"(PCR).":[162],"Frequently":[163],"S.":[167,186,222],"Propionibacterium":[169],"acnes,":[170,189],"Streptococcus":[172,191],"spp.":[173,192],"This":[174],"453":[181],"implants":[183],"found":[184],"that":[185],"P.":[188],"most":[195],"frequently":[196],"isolated":[197],"microorganisms":[198],"cases.":[201],"used":[206],"employing":[216],"PCR.":[217],"Bacterial":[218],"biofilm,":[219],"particularly":[220],"involving":[221],"was":[224],"consistently":[225],"reported":[226],"contracted":[228],"capsules,":[229],"suggesting":[230],"strong":[232],"association":[233],"Level":[240],"Evidence:":[242],"2":[243],"(Risk)":[244]},"counts_by_year":[{"year":2026,"cited_by_count":4}],"updated_date":"2026-11-13T13:42:25.865203","created_date":"2025-10-10T00:00:00"}