Biomedica : revista del Instituto Nacional de Salud最新文献

{"title":"Diabetes mellitus in patients with heart failure and effect modification of risk factors for short-term mortality: An observational study from the Registro Colombiano de Falla Cardíaca (RECOLFACA).","authors":"Luis Eduardo Echeverría, Clara Saldarriaga, Sebastián Campbell-Quintero, Lisbeth Natalia Morales-Rodríguez, Juan David López-Ponce de León, Andrés Felipe Buitrago, Erika Martínez-Carreño, Jorge Alberto Sandoval-Luna, Alexis Llamas, Gustavo Adolfo Moreno-Silgado, Julián Vanegas-Eljach, Nelson Eduardo Murillo-Benítez, Ricardo Gómez-Paláu, Alex Arnulfo Rivera-Toquica, Juan Esteban Gómez-Mesa, Recolfaca Research Group","doi":"10.7705/biomedica.6951","DOIUrl":"10.7705/biomedica.6951","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure and type 2 diabetes mellitus are critical public health issues.</p><p><strong>Objective: </strong>To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors.</p><p><strong>Materials and methods: </strong>Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models.</p><p><strong>Results: </strong>A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed.</p><p><strong>Conclusions: </strong>Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"182-197"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic and radiological aspects of pediatric renal cystic disease: A case series","authors":"Rafael Adrián Pacheco-Orozco, Jessica María Forero-Delgadillo, Vanessa Ochoa, Juan Sebastián Toro, Harry Pachajoa, Jaime Manuel Restrepo","doi":"10.7705/biomedica.7110","DOIUrl":"10.7705/biomedica.7110","url":null,"abstract":"<p><p>Renal cystic diseases are common conditions whose etiology can be highly heterogeneous.\u0000They require a correct approach for adequate diagnosis and management. We aimed to illustrate part of the spectrum of renal cystic diseases through some clinical cases managed in our service.\u0000We describe 11 clinical cases including clinical entities such as renal multicystic dysplasia, and autosomal dominant and autosomal recessive polycystic renal disease, among other pathologies.\u0000Renal cystic diseases are heterogeneous in their clinical presentation, natural history, radiological findings, and genetic and pathophysiological basis. An integral clinical approach is needed to get a clear etiological diagnosis and offer adequate individualized care and follow-up for patients.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"27-41"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11357701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of quality and duration of sleep with arterial hypertension in a Colombian population","authors":"Ludwing Ricardo Marín, Lina María Vera, Boris Eduardo Vesga, Mabelyn Solany Marín","doi":"10.7705/biomedica.7012","DOIUrl":"10.7705/biomedica.7012","url":null,"abstract":"<p><p>Introduction. Alterations in the quality and duration of sleep are risk factors for the development of arterial hypertension in Eastern countries. However, in Latin America there are few studies researching this association.\u0000Objective. To analyze the association between the quality and duration of sleep and the rate of arterial hypertension in a Colombian population.\u0000Materials and methods. An observational, longitudinal, prospective and analytical study nested in the INEFAC population-based cohort, was conducted with participants over 18 years of age from Bucaramanga (Colombia). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Sleep duration was assessed using standardized questions. Multivariate analysis was performed with logistic regression models adjusted for possible confounding variables.\u0000Results. A total of 1,306 non-hypertensive participants with a mean age of 40 ± 12 years were included. In this population, 92.8% had one or more sleep issues. 45.15% slept 6 hours or less and 28.6% slept 8 hours or more. Multivariate analysis showed a higher risk of hypertension in participants with diabetes (OR = 5.27; 95% CI: 2.27-12.26), obesity (OR = 2.81; 95% CI: 1.11-7.13), active smoking (OR = 2.02; 95% CI: 1.01-4.04) and higher socioeconomic level (OR = 4.94; 95% CI: 1.59-15.38 for level 4), but no higher risk was found in participants with poor sleep quality or short sleep duration.\u0000Conclusions. No association was found between the duration or quality of sleep and the rate of arterial hypertension in the Colombian population. More studies are required in this population to reach definitive conclusions.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"47-62"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a web application to evaluate spirometric curve and clinical variables to support COPD diagnosis in primary care.","authors":"Adriana Maldonado-Franco, Luis F Giraldo-Cadavid, Eduardo Tuta-Quintero, Alirio R Bastidas, Angélica Moreno-Giraldo, Daniel A Botero-Rosas","doi":"10.7705/biomedica.7142","DOIUrl":"10.7705/biomedica.7142","url":null,"abstract":"<p><strong>Introduction: </strong>Choric obstructive pulmonary disease (COPD) is the third mortality cause in the world, and the development of useful diagnostic tools is necessary to improve timely diagnostic rates in primary care settings.</p><p><strong>Objective: </strong>To develop a web application displaying spirometric and clinical information - including respiratory symptoms and risk factors- to facilitate a COPD diagnosis.</p><p><strong>Materials and methods: </strong>In this cross-sectional study, an expert consensus was carried out with three specialists using the Delphi method to choose the relevant variables for COPD diagnosis. We developed a Python-based web application to diagnose COPD, displaying the clinical variables deemed relevant by the experts along the spirometric curve.</p><p><strong>Results: </strong>Twenty-six clinical variables were included in the web application for the diagnosis of COPD. A fourth expert used the web application to classify a cohort of 695 patients who had undergone spirometry in a third-level centre and had answered at least one of five questionnaires for COPD screening. Out of the 695 subjects, 34% had COPD, according to the expert that diagnosed them using the web application. Only 42% of the patients in the COPD group had received a previous COPD diagnosis and 19% of the patients in the no COPD group had been misdiagnosed with the disease.</p><p><strong>Conclusion: </strong>We developed a web application that displays demographic and clinical information, as well as spirometric data, to facilitate the process of diagnosing COPD in primary care settings.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"160-170"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac disease discrimination from 3D-convolutional kinematic patterns on cine-MRI sequences.","authors":"Alejandra Moreno Tarazona, Lola Xiomara Bautista, Fabio Martínez","doi":"10.7705/biomedica.7115","DOIUrl":"10.7705/biomedica.7115","url":null,"abstract":"<p><strong>Introduction: </strong>Cine-MRI (cine-magnetic resonance imaging) sequences are a key diagnostic tool to visualize anatomical information, allowing experts to localize and determine suspicious pathologies. Nonetheless, such analysis remains subjective and prone to diagnosis errors.</p><p><strong>Objective: </strong>To develop a binary and multi-class classification considering various cardiac conditions using a spatiotemporal model that highlights kinematic movements to characterize each disease.</p><p><strong>Materials and methods: </strong>This research focuses on a 3D convolutional representation to characterize cardiac kinematic patterns during the cardiac cycle, which may be associated with pathologies. The kinematic maps are obtained from the apparent velocity maps computed from a dense optical flow strategy. Then, a 3D convolutional scheme learns to differentiate pathologies from kinematic maps.</p><p><strong>Results: </strong>The proposed strategy was validated with respect to the capability to discriminate among myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy, abnormal right ventricle, and normal cardiac sequences. The proposed method achieves an average accuracy of 78.00% and a F1 score of 75.55%. Likewise, the approach achieved 92.31% accuracy for binary classification between pathologies and control cases.</p><p><strong>Conclusion: </strong>The proposed method can support the identification of kinematically abnormal patterns associated with a pathological condition. The resultant descriptor, learned from the 3D convolutional net, preserves detailed spatiotemporal correlations and could emerge as possible digital biomarkers of cardiac diseases.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"89-100"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Following the roadmap outlined by the World health Organization: Innovation for the control of chronic noncommunicable diseases","authors":"Ricardo A Peña-Silva, Juan Sebastián Reyes-González","doi":"10.7705/biomedica.7603","DOIUrl":"10.7705/biomedica.7603","url":null,"abstract":"","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"5-10"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loneliness as a predictor of mortality in cancer patients, a cohort study","authors":"Adriana Valdelamar, Fernando De La Hoz, Ricardo Sánchez","doi":"10.7705/biomedica.7150","DOIUrl":"10.7705/biomedica.7150","url":null,"abstract":"<p><p>Introduction. Some studies have indicated that loneliness may be associated with an increased risk of mortality in cancer patients, as it can weaken treatment response and the immune system, and promote harmful behaviors, worsening the prognosis and increasing the likelihood of death. Addressing loneliness in public health is essential to provide social support and improve outcomes in cancer patients.\u0000Objective. To obtain an estimator of the unwanted loneliness-mortality association.\u0000Materials and methods. We followed a prospective cohort of 400 patients for two years (exposure=loneliness levels; outcome=mortality; sociodemographic and clinical control variables were included). A parametric survival model (log normal) was used.\u0000Results. The cohort had a median survival of 20.2 months and a mortality rate of 3.2 deaths/100 patient-months (95% CI: 2.8 to 3.7). The survival model found the following time ratios (TR): moderate level/low level: TR=0.55; 95% CI: 0.39 to 0.77; moderately high level/low level: TR=0.62; 95% CI: 0.41 to 0.93; high level/low level: TR=1.17; 95% CI: 0.31 to 4.42.\u0000Conclusion. Compared to patients with low levels of loneliness, patients with moderate or moderately high levels reach death more quickly (statistically significant TRs, adjusted for the effect of other variables in the model); this highlights the need for interventions to mitigate loneliness and promote social support in patients having cancer.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"119-138"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined hyperglycemic crises in adult patients already exist in Latin America","authors":"Guillermo Edinson Guzmán, Veline Martínez, Sebastián Romero, María Mercedes Cardozo, María Angélica Guerra, Oriana Arias","doi":"10.7705/biomedica.6912","DOIUrl":"10.7705/biomedica.6912","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus is one of the most common diseases worldwide, with a high morbidity and mortality rate. Its prevalence has been increasing, as well as its acute complications, such as hyperglycemic crises. Hyperglycemic crises can present with combined features of diabetic ketoacidosis and hyperosmolar state. However, their implications are not fully understood.</p><p><strong>Objective: </strong>To describe the characteristics, outcomes, and complications of the diabetic population with hyperglycemic crises and to value the combined state in the Latin American population.</p><p><strong>Materials and methods: </strong>Retrospective observational study of all hyperglycemic crises treated in the intensive care unit of the Fundación Valle del Lili between January 1, 2015, and December 31, 2020. Descriptive analysis and prevalence ratio estimation for deaths were performed using the robust Poisson regression method.</p><p><strong>Results: </strong>There were 317 patients with confirmed hyperglycemic crises, 43 (13.56%) with diabetic ketoacidosis, 9 (2.83%) in hyperosmolar state, and 265 (83.59%) with combined diabetic ketoacidosis and hyperosmolar state. Infection was the most frequent triggering cause (52.52%). Fatalities due to ketoacidosis occurred in four patients (9.30%) and combined diabetic ketoacidosis/hyperosmolar state in 22 patients (8.30%); no patient had a hyperosmolar state. Mechanical ventilation was associated with death occurrence (adjusted PR = 1.15; 95 % CI 95 = 1.06 - 1.24).</p><p><strong>Conclusions: </strong>The combined state was the most prevalent presentation of the hyperglycemic crisis, with a mortality rate similar to diabetic ketoacidosis. Invasive mechanical ventilation was associated with a higher occurrence of death.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"110-118"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection","authors":"Karen M Fériz-Bonelo, María B Iriarte-Durán, Oscar Giraldo, Luis G Parra-Lara, Veline Martínez, María A Urbano, Guillermo Guzmán","doi":"10.7705/biomedica.7095","DOIUrl":"10.7705/biomedica.7095","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease.</p><p><strong>Objective: </strong>To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed.</p><p><strong>Results: </strong>A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia).</p><p><strong>Conclusions: </strong>Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"73-88"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating zinc levels and cardiometabolic risk-related variables in adults","authors":"Milton Fabián Suárez-Ortegón, Alejandra Arbeláez, José Guillermo Ortega-Ávila, Mildrey Mosquera","doi":"10.7705/biomedica.6882","DOIUrl":"10.7705/biomedica.6882","url":null,"abstract":"<p><p>Introduction. Altered serum zinc levels, lower and higher than values in healthy controls, have been observed in individuals affected by non-communicable chronic diseases. However, to date, studies describing potential determinants of zinc levels in general populations free of chronic diseases appear to be limited.\u0000Objective. To evaluate whether nutrient intake, biochemical and clinical measures, lifestyle, and family history of cardio-metabolic diseases are independently associated with zinc levels in apparently healthy individuals.\u0000Materials and methods. We evaluated 239 healthy subjects. Serum zinc was measured via flame atomic absorption spectrometry, and the remaining biochemical markers were assessed using enzymatic colorimetric methods. Standard techniques were employed to quantify waist circumference, height, and weight. Body fat was measured via bioimpedance, and blood pressure was measured using digital sphygmomanometers. We applied a survey to record the personal and family history of non-communicable chronic diseases, and nutrient intake was estimated using the 24-hour recall method.\u0000Results. Women had lower serum zinc levels than men. In multivariate analyzes, total fat intake (β = -0.15; standard error = 0.03; p < 0.001), plasma log-triglycerides (β = -10.18; standard error = 3.9; p = 0.010), and female gender (β = -6.81; standard error = 3.3; p = 0.043) were significant predictors for serum zinc levels. Zinc intake was not significantly related to serum zinc in univariate and multivariate analyses.\u0000Conclusions. Variables related to cardiometabolic risk, such as plasma triglyceride levels and total fat intake, were associated with serum zinc levels in individuals without a diagnosis of chronic or infectious/inflammatory diseases. Further studies are required to confirm our findings and to evaluate possible biological mechanisms for these relationships.</p>","PeriodicalId":101322,"journal":{"name":"Biomedica : revista del Instituto Nacional de Salud","volume":"44 Sp. 1","pages":"63-72"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}