Clinical Obesity最新文献

{"title":"Classification of Obesity Based on Weight History: Perceptions of People With Obesity","authors":"Bruno Halpern,&nbsp;Simone van de Sande-Lee,&nbsp;Maria Edna de Melo,&nbsp;Rodrigo N. Lamounier,&nbsp;Cintia Cercato,&nbsp;Paulo Augusto Carvalho Miranda,&nbsp;Rodrigo O. Moreira,&nbsp;Mario Kehdi Carra,&nbsp;Cesar Luiz Boguszewski,&nbsp;Marcio C. Mancini","doi":"10.1111/cob.70068","DOIUrl":"10.1111/cob.70068","url":null,"abstract":"<p>Two Brazilian medical societies have proposed a new classification of obesity based on the maximum weight attained in an individual's lifetime, to be used in the clinical evaluation of individuals undergoing obesity treatment. This classification, which applies to adults aged 18 to 65 years, categorises people with obesity (PwO) who lose a certain percentage of their weight as having either ‘reduced’ or ‘controlled’ obesity. While the classification aims to improve patient care, there is limited data on PwO perceptions. To explore this, a cross-sectional online survey was conducted with 500 PwO, including an explanation and clinical case of the new classification. The survey revealed that 64% of participants had never been asked by a healthcare professional (HCP) about their maximum weight. After knowing the new classification, 82% found it useful for changing perceptions about obesity treatment; 66% felt it would encourage them to seek treatment; 63% believed it would help with treatment maintenance; and 74% indicated they would feel better achieving ‘controlled obesity,’ even if the weight loss fell short of their goals. A majority agreed that the classification could help establish realistic goals (77%) and reduce biases from HCPs (69%). Overall, PwO perceived the classification as beneficial for encouraging treatment and reducing stigma.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12803873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984406","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":"Treatment Approaches for Obesity in Children With Heterozygous MC4R Variants","authors":"Mostafa Salama,&nbsp;Leslie Saba,&nbsp;Lourdes Valdez,&nbsp;Aida Lteif,&nbsp;Seema Kumar","doi":"10.1111/cob.70069","DOIUrl":"10.1111/cob.70069","url":null,"abstract":"<div>\u0000 \u0000 <p>Melanocortin-4 receptor (MC4R) deficiency is the most common cause of monogenic obesity; yet treatment options for children with MC4R mutations are limited. We describe significant improvement in weight in three patients with pathogenic or likely pathogenic MC4R mutations; two adolescents treated with semaglutide, and a younger child treated with metformin and topiramate. These findings indicate GLP-1 receptor agonists, topiramate and metformin can be helpful in managing obesity associated with MC4R deficiency.</p>\u0000 </div>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoedema and Bariatric and Metabolic Surgery: A Systematic Review","authors":"Qamil Pajaziti,&nbsp;Georgios Geropoulos,&nbsp;Emma MacVicar,&nbsp;Nicola Colucci,&nbsp;James Lucocq,&nbsp;Peter J. Lamb,&nbsp;Andrew G. Robertson","doi":"10.1111/cob.70062","DOIUrl":"10.1111/cob.70062","url":null,"abstract":"<div>\u0000 \u0000 <p>Lipoedema is a chronic, progressive condition characterised by disproportionate fat accumulation in the lower extremities, often misdiagnosed due to symptom overlap with obesity. Weight management is a key component of lipoedema treatment, yet the role of bariatric surgery remains unclear. This systematic review evaluates the impact of bariatric and metabolic surgery (BMS) on lipoedema symptoms, weight loss outcomes, and the need for further interventions. A systematic search of PubMed, Scopus and the Cochrane Library was conducted up to January 2025 following PRISMA guidelines. Studies reporting on patients with lipoedema (or equivalent diagnoses) who underwent BMS were included. Quality was assessed using the Joanna Briggs Institute (JBI) checklist for case reports and the National Heart, Lung and Blood Institute (NHLBI) tool for case series. Seven studies met the inclusion criteria (five case reports, two cohort studies), comprising 51 patients. All underwent BMS, primarily sleeve gastrectomy or Roux-en-Y gastric bypass. One study (<i>n</i> = 31) reported a significant reduction in thigh volume and weight loss comparable to controls. The remaining studies found persistent or worsened lower body disproportionality and no improvement in pain. Postoperative lipoedema diagnoses were common, raising concerns over diagnostic accuracy. Overall weight loss averaged 33.9% total weight loss. Bariatric and metabolic surgery achieves meaningful weight reduction in patients with lipoedema and obesity but does not consistently improve core lipoedema symptoms. Its role remains adjunctive rather than primary. Preoperative identification and documentation of lipoedema features are recommended, with a postoperative plan for adjunct conservative therapies and selective consideration of lymph-sparing liposuction where symptoms persist. Larger prospective studies using standardised definitions and outcome measures are needed to clarify its therapeutic value in this population.</p>\u0000 </div>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Impact of Weight on Quality of Life and Willingness to Pay for Obesity Management in the APAC Region","authors":"Hae-Jin Ko,&nbsp;Nitin Kapoor,&nbsp;Mariana Mercado Garcia,&nbsp;Sungeun Grace Jung,&nbsp;Jack Garcia Uranga Romano,&nbsp;Samantha L. Hocking","doi":"10.1111/cob.70066","DOIUrl":"10.1111/cob.70066","url":null,"abstract":"<p>Overweight and obesity are estimated to affect more than 40% of adults in the Asia-Pacific (APAC) region. This study used a cross-sectional online survey to assess the impact of obesity on health-related quality of life (HRQOL) using the Impact of Weight on Quality of Life (IWQOL)-Lite instrument and willingness to pay for obesity management among adults with body mass index (BMI) ≥ 18 kg/m² in Australia, India and South Korea. A total of 2952 adults completed the survey. Most respondents (82%) were concerned with their weight, increasing with obesity class. Rated on a scale of 0–100 (worst to best quality of life), the mean (SD) overall IWQOL-Lite score was 61 (30) with no differences by gender. The mean lowest score was in the self-esteem domain, with female respondents reporting greater impairment than male respondents (47 vs. 53, <i>p</i> &lt; 0.05). Total IWQOL-Lite and domain scores declined with increasing weight class (mean of 81 for individuals with normal weight to 35 for those with Obesity Class III). Of the 1752 individuals living with obesity, 80% would be willing to pay USD $25 per month for a weight loss method requiring minimal/moderate changes to diet, exercise and lifestyle that would enable them to achieve weight loss in 1 year; nearly half were willing to pay USD $225 per month. Our study highlights the negative impact of weight on the HRQOL of individuals in three APAC countries and the willingness to pay to achieve weight loss.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12717460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793435","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":"Changes in Eating Behaviour During Treatment With Obesity Medications","authors":"Ming Chuen Chong,&nbsp;Tak Ying Louise Ko,&nbsp;Philippus L. le Roux,&nbsp;Carel W. le Roux","doi":"10.1111/cob.70065","DOIUrl":"10.1111/cob.70065","url":null,"abstract":"<p>Obesity is a chronic, relapsing disease influenced by biological, environmental and behavioural factors. Pharmacological therapies have demonstrated substantial effects in weight loss, appetite suppression and modulation of food-related thoughts; however, the long-term effects of medications and eating behaviours across treatment phases throughout time remain poorly understood. This qualitative study involves 31 semi-structured interviews exploring patients in the dynamic and stable phase of weight loss. The interviews were conducted, transcribed, then analysed thematically. The five main themes that emerged were hunger, fullness, thoughts of food, portion size and palatability. The dynamic phase reported profound appetite suppression, early fullness, reduced ‘food noise’ with diminished cravings and smaller portion size. Portion control remained a persistent behavioural change across both phases. Long-term goals shifted from weight loss in the dynamic phase to weight maintenance in the stable phase. This transition is best described as a spectrum of change rather than a strict dichotomy. With a perceived loss of efficacy, some also report consideration of switching medications, especially in the stable phase. Overall, this cross sectional, patient-centred qualitative study may change practice of prescribers, policymakers, and the focus of future research.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12717437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793458","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":"Patient Perspectives on the Course of Alcohol Use After Metabolic and Bariatric Surgery: Implications for Prevention, Intervention, and Future Research","authors":"Erin N. Haley,&nbsp;Alyssa M. Vanderziel,&nbsp;Jordan M. Braciszewski,&nbsp;Heidi Westerman,&nbsp;Roland S. Moore,&nbsp;Kristina M. Jackson,&nbsp;Aaron Hamann,&nbsp;Arthur M. Carlin,&nbsp;Lisa R. Miller-Matero","doi":"10.1111/cob.70061","DOIUrl":"10.1111/cob.70061","url":null,"abstract":"<p>Despite substantial benefits of metabolic and bariatric surgery (MBS), up to 1 in 5 patients develop an alcohol use disorder (AUD) within 5 years post-operatively. Cognitive-behavioural processes that are relevant to the reinitiation and escalation of alcohol use post-MBS are not well understood. Through content analysis of 20 patient interviews, we explored the course of alcohol use among individuals 6 months to 5 years post-MBS and examined potential differences by level of use. Over half (55%) of the participants reported high alcohol use, most described a gradual reintroduction to alcohol post-MBS, and escalation to misuse was thought to occur at an accelerated pace (i.e., potentially within months). Pre-operative intentions, attitudes/beliefs about post-MBS alcohol use, social factors, mood, visual cues, and post-MBS biological changes were reported to influence the course of post-MBS alcohol use. Although most features did not differ widely between those with higher versus lower alcohol consumption, reinitiating alcohol less than 12 months post-operatively and certain attitudinal factors (i.e., minimising the risks) may relate to greater alcohol use post-MBS. Findings illustrate the importance of early and long-term monitoring of post-MBS alcohol use. Several implications for early intervention and future research are discussed.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773814","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":"Relation Between Adiposity Measures and the Risk of a Composite of Cardiovascular Events, Diabetes, and Cancer in Patients With Cardiovascular Disease","authors":"Ritobrata Bhattacharya,&nbsp;Frank L. J. Visseren,&nbsp;Manon G. van der Meer,&nbsp;Martin Teraa,&nbsp;Jannick A. N. Dorresteijn,&nbsp;Ynte M. Ruigrok,&nbsp;Thomas T. van Sloten,&nbsp;the UCC-Smart Study Group","doi":"10.1111/cob.70064","DOIUrl":"10.1111/cob.70064","url":null,"abstract":"<p>Adiposity contributes to multiple non-communicable diseases. To guide prevention of morbidity, this study aimed to quantify the relation between waist circumference (WC), body mass index (BMI), waist to height ratio (WtHR), abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) and the risk of a composite outcome including recurrent cardiovascular events, incident type 2 diabetes and incident cancer, as well as each individual disease and all-cause mortality. Data were used from the UCC-SMART cohort study from 6138 patients with cardiovascular disease. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for adiposity measures, modelled as quartiles and per 1 SD increase, in relation to disease outcomes. All adiposity measures, except SAT, were related to higher risk of the composite outcome. WC and VAT showed the strongest relation (HR 1.62, 95% CI: 1.43, 1.83 and 1.62, 95% CI: 1.44, 1.83, respectively). Only WC and VAT were related to all-cause mortality (HRs 1.17, 95% CI: 1.01, 1.37 and 1.26, 95% CI: 1.08, 1.46, respectively). In patients with cardiovascular disease, WC and VAT are most strongly related to the risk of the composite outcome and to all-cause mortality. Monitoring adiposity with WC and VAT may help identify high-risk patients and could guide earlier interventions.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773767","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":"Evaluation of Skinfolds Based Predictive Equations for Estimating Body Fat Percentage in Older Adults: A Comparison Using Digital Adipometer (Lipowise) and Dual-Energy X-Ray Absorptiometry (DXA)","authors":"Gabriela Benatti de Oliveira,&nbsp;Lara Vilar Fernandes,&nbsp;Teresa F. Amaral,&nbsp;Ana Carolina Junqueira Vasques,&nbsp;Ligiana Pires Corona","doi":"10.1111/cob.70063","DOIUrl":"https://doi.org/10.1111/cob.70063","url":null,"abstract":"<p>Accurate assessment of body fat percentage (%BF) is essential for predicting health risks in older adults, as age-related changes affect fat distribution and measurement accuracy. While dual-energy x-ray absorptiometry (DXA) is a standard reference, it is costly and less accessible. This pilot study evaluated the validity of four skinfold equations using a digital calliper, with DXA as the reference to estimate %BF in older adults. A cross-sectional study included 149 participants (28 men and 121 women) aged 60 to 86 years. The Lean, Durnin-Womersley, and Visser equations (using 2 and 4 skinfolds) were analysed to estimate %BF. Statistical analyses were performed using SPSS (v.29), including Student's t-test, Mann–Whitney, Cohen's Kappa, and Bland–Altman. Skinfold equations differed significantly from DXA-derived %BF. In women, DXA values were lower than Lean but higher than Durnin-Womersley; in men, DXA showed lower %BF than Lean and higher than others. Agreement with DXA was moderate (Kappa 0.54–0.59). Durnin-Womersley underestimated %BF, especially in men (11.5%); Lean slightly overestimated (1.3%). Visser showed minimal bias—slight overestimation in women (0.3%, 0.4%) and underestimation in men (3.7%, 4.3%). Age-related physiological factors may impact equation accuracy. Discrepancies between DXA and skinfold equations highlight the need for age-specific prediction models for older adults.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cob.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145719441","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":"Association of Weight Loss Composition Following Metabolic-Bariatric Surgery With Incident Major Adverse Cardiovascular Events and All-Cause Mortality","authors":"Malou A. H. Nuijten,&nbsp;Bente M. de Roos,&nbsp;Jan H. M. Karregat,&nbsp;Eric J. Hazebroek,&nbsp;Valerie M. Monpellier,&nbsp;Ignace M. C. Janssen,&nbsp;Maria T. E. Hopman,&nbsp;Esmée A. Bakker,&nbsp;Thijs M. H. Eijsvogels","doi":"10.1111/cob.70054","DOIUrl":"10.1111/cob.70054","url":null,"abstract":"<p>Severe obesity is associated with an increased cardiovascular risk. Metabolic-bariatric surgery (MBS) can reduce the risk of cardiovascular events and mortality, potentially depending on weight loss composition. This study assessed the association between post-MBS weight loss composition and major adverse cardiovascular events (MACE) and all-cause mortality. This retrospective, single-center study included patients who underwent MBS between 2012 and 2020. Twelve-month total weight loss (TWL), fat mass loss (FML), fat-free mass loss (FFML), and proportion of FFML within weight loss (FFML/WL) were assessed. The primary endpoint was a composite of MACE and all-cause mortality. The event rate was compared across weight composition tertiles, while adjusting for cardiometabolic medication, age, sex, preoperative weight and surgery type. In total, 5889 patients (21% men; 44.3 ± 11.1 years) were included. During a follow-up of 4.9 ± 2.2 years, a total of 106 patients (1.8%) reached the primary endpoint. TWL, FFML, FML and FFML/WL were not associated with the composite endpoint after adjustment for confounders. Nevertheless, stratified analysis revealed that older patients (≥ 45 years) with a high TWL (HR = 1.68 [95% CI, 1.03–2.75]) and high FFML/WL (HR = 1.78 [95% CI, 1.12–2.85]) had a higher risk of MACE and all-cause mortality. Weight loss composition was not related to MACE and mortality in the total population, but higher TWL and FFML/WL ≥ 30% at 12 months post-MBS were associated with a worse prognosis among patients aged ≥ 45 years. The harm associated with excessive TWL and FFML post-MBS, along with potential countermeasures, should be further investigated to optimise clinical outcomes.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548496","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 Between Sleep Duration and Overweight/Obesity: A Comprehensive Overview of Meta-Analyses","authors":"Mateus Assis Benfica,&nbsp;Tamiles Costa Ribeiro,&nbsp;Kallyane Santos Oliveira Silva,&nbsp;Marcelle Reis Nascimento Oliveira,&nbsp;Ericka Luanny Machado Maia,&nbsp;Eduardo Koji Tamura,&nbsp;David Ohara,&nbsp;Eduardo da Silva Alves","doi":"10.1111/cob.70051","DOIUrl":"10.1111/cob.70051","url":null,"abstract":"<div>\u0000 \u0000 <p>Overweight and obesity are increasing globally and have an important impact on individuals' health and healthcare costs. Several factors contribute to this growth, and changes in normal sleep duration (SD) have been recognised. This relationship has given rise to numerous systematic reviews with meta-analyses (SRMAs) over the last years. Thus, synthesising these studies could help researchers and clinicians offering the highest level of evidence synthesis. Therefore, we aimed to provide a comprehensive overview of SRMAs that explored the relationship between SD and overweight/obesity. Searches were conducted in PubMed, Web of Science, Embase and Scopus. The quality of the reviews was evaluated using the Risk Of Bias In Systematic reviews (ROBIS) tool. The inverse variance heterogeneity model (IVhet) was adopted to assess the pooled relative risks (RR) and 95% confidence intervals (CIs) of SRMAs. After the selection process, 18 SRMAs were included in the synthesis. Short SD increased the risk of being overweight/obese in younger children (RR = 1.39; 95% CI: 1.27–153), older children (RR = 2.21; 95% CI: 1.59–3.07), adolescents (RR = 1.36; 95% CI: 1.22–1.51) and adults (RR = 1.30; 95% CI: 1.17–1.44). Long SD increases the risk in adults (RR = 1.05; 95% CI: 1.02–1.08), but has a protective effect in children (RR = 0.86; 95% CI: 0.78–0.95). These findings reinforce the role of SD as a significant and modifiable risk factor for overweight and obesity.</p>\u0000 </div>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"16 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}