Zachary Bergman, Taariq Mohammed, Lisa Schocket, Rachid Aouchiche, Mary A Johnson
{"title":"Autoimmune retinopathy in a patient with smoldering multiple myeloma: a case report.","authors":"Zachary Bergman, Taariq Mohammed, Lisa Schocket, Rachid Aouchiche, Mary A Johnson","doi":"10.1007/s10633-024-09965-y","DOIUrl":"10.1007/s10633-024-09965-y","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple myeloma (MM) is a plasma cell dyscrasia leading to proliferation of monoclonal plasma cells. Ocular involvement in multiple myeloma is uncommon but can occur. The ocular manifestations of MM may include the cornea, uvea, and retinal vasculature. We present a rare case of autoimmune retinopathy associated with smoldering MM.</p><p><strong>Case: </strong>A 76-year-old female with no significant past medical or ocular history presented with four months of worsening vision, difficulty with night driving, and loss of peripheral vision. Examination was notable for pallor of the optic nerves and vascular attenuation. Visual field testing demonstrated significant and progressive field loss in both eyes. An electroretinogram was extinguished under all conditions. Serum protein electrophoresis showed a significant elevation of IgG with an M-spike, and a subsequent bone marrow biopsy was performed showing 12.5% plasma cells, consistent with the diagnosis of MM. CAR antibody testing was positive for anti-enolase, anti-GAPDH, and anti-Rab6 antibodies, consistent with autoimmune retinopathy.</p><p><strong>Discussion: </strong>Autoimmune retinopathy associated with MM is exceedingly rare. Management of this condition is challenging, as treatment of the underlying disease does not often lead to improvement in visual symptoms. Ultimately, visual prognosis is very poor, and both patients and clinicians should be aware of the guarded visual potential.</p><p><strong>Conclusion: </strong>The association of autoimmune retinopathy with multiple myeloma is rare. It is crucial for physicians to be aware of such manifestations to ensure timely and appropriate diagnosis and management for patients.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":" ","pages":"167-171"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139740617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Kiraly, Maja Šuštar Habjan, Jaka Smrekar, Polona Jaki Mekjavić
{"title":"Morphological and Functional Correlations in Acute Central Serous Chorioretinopathy.","authors":"Peter Kiraly, Maja Šuštar Habjan, Jaka Smrekar, Polona Jaki Mekjavić","doi":"10.1007/s10633-024-09969-8","DOIUrl":"10.1007/s10633-024-09969-8","url":null,"abstract":"<p><strong>Purpose: </strong>We evaluate morphological and functional correlations in patients with acute central serous chorioretinopathy (CSC).</p><p><strong>Methods: </strong>A prospective study was conducted on 50 patients with an acute CSC episode lasting less than 3 months. At baseline, assessments included optical coherence tomography (OCT), best-corrected visual acuity (BCVA), contrast sensitivity (CS), microperimetry (MP), and multifocal electroretinography (mfERG). A correlation analysis between OCT morphological parameters (maximal subretinal fluid height (SRF), central retinal thickness (CRT), and macular volume (MV)) and functional parameters was conducted on the affected eye for each patient.</p><p><strong>Results: </strong>Among the morphological parameters, SRF showed the strongest correlations with functional parameters (r absolute value range = 0.10-0.70). Weak correlations were observed between BCVA and morphological parameters (r absolute value range = 0.14-0.26). Average retinal sensitivity (MP-A) was the functional parameter displaying the most robust negative correlation with morphological parameters (r absolute value range = 0.61-0.70). In contrast, average contrast sensitivity (CS-A) and mfERG average amplitude density in the first (mfERG-A1) and second (mfERG-A2) ring showed weak to moderate (r absolute value range = 0.35-0.56) yet statistically significantly nonzero correlations.</p><p><strong>Conclusions: </strong>SRF and CRT could serve as the most representative morphological proxies for visual function deficit in acute CSC patients. Retinal sensitivity, as measured by MP, may be superior to BCVA in clinical research studies or when an in-depth visual function evaluation is needed.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":" ","pages":"145-153"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11096228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mirella T S Barboni, Maja Sustar Habjan, Sanja Petrovic Pajic, Marko Hawlina
{"title":"Electroretinographic oscillatory potentials in Leber hereditary optic neuropathy.","authors":"Mirella T S Barboni, Maja Sustar Habjan, Sanja Petrovic Pajic, Marko Hawlina","doi":"10.1007/s10633-024-09968-9","DOIUrl":"10.1007/s10633-024-09968-9","url":null,"abstract":"<p><strong>Purpose: </strong>Leber hereditary optic neuropathy (LHON) affects retinal ganglion cells causing severe vision loss. Pattern electroretinogram and photopic negative response (PhNR) of the light-adapted (LA) full-field electroretinogram (ERG) are typically affected in LHON. In the present study, we evaluated dark-adapted (DA) and LA oscillatory potentials (OPs) of the flash ERG in genetically characterized LHON patients to dissociate slow from fast components of the response.</p><p><strong>Methods: </strong>Seven adult patients (mean age = 28.4 ± 5.6) in whom genetic diagnosis confirmed LHON with mtDNA or nuclear DNAJC30 (arLHON) pathogenic variants were compared to 12 healthy volunteers (mean age = 35.0 ± 12.1). Full-field ERGs were recorded from both eyes. Offline digital filters at 50, 75 and 100 Hz low cutoff frequencies were applied to isolate high-frequency components from the original ERG signals.</p><p><strong>Results: </strong>ERG a-waves and b-waves were comparable between LHON patients and controls, while PhNR was significantly reduced (p = 0.009) in LHON patients compared to controls, as expected. OPs derived from DA signals (75 Hz low cutoff frequency) showed reduced peak amplitude for OP2 (p = 0.019). LA OP differences between LHON and controls became significant (OP2: p = 0.047, OP3: p = 0.039 and OP4: p = 0.013) when the 100 Hz low-cutoff frequency filter was applied.</p><p><strong>Conclusions: </strong>Reduced OPs in LHON patients may represent disturbed neuronal interactions in the inner retina with preserved photoreceptoral (a-wave) to bipolar cell (b-wave) activation. Reduced DA OP2 and high-cutoff LA OP alterations may be further explored as functional measures to characterize LHON status and progression.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":" ","pages":"133-143"},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11096212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical course of two siblings with potassium voltage-gated channel modifier subfamily V member 2 (KCNV2)-associated retinopathy","authors":"Tomoko Sato, Kazuki Kuniyoshi, Takaaki Hayashi, Hirokazu Nishiwaki, Kei Mizobuchi, Shunji Kusaka","doi":"10.1007/s10633-024-09971-0","DOIUrl":"https://doi.org/10.1007/s10633-024-09971-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p><i>KCNV2</i>-associated retinopathy causes a phenotype reported as “cone dystrophy with nyctalopia and supernormal rod responses (CDSRR; OMIM# 610356),” featuring pathognomonic findings on electroretinography (ERG). Here, we report the clinical courses of two siblings with CDSRR.</p><h3 data-test=\"abstract-sub-heading\">Case reports</h3><p><b>Patient 1:</b> A 3-year-old boy with intermittent exophoria was referred to our hospital. The patient’s decimal best-corrected visual acuity (BCVA) at age 6 was 0.7 and 0.7 in the right and left eyes, respectively. Photophobia and night blindness were also observed. Because the ERG showed a delayed and supernormal b-wave with a “squaring (trough-flattened)” a-wave in the DA-30 ERG, and CDSRR was diagnosed. The patient’s vision gradually worsened, and faint bilateral bull’s eye maculopathy was observed at the age of 27 years, although the fundi were initially unremarkable. Genetic examination revealed a homozygous missense variant, c.529T > C (p.Cys177Arg), in the <i>KCNV2</i> gene.</p><p><b>Patient 2:</b> The second patient was Patient 1’s younger sister, who was brought to our hospital at 3 years of age. The patient presented with exotropia, mild nystagmus, photophobia, night blindness, and color vision abnormalities. The patients’ decimal BCVA at age 13 was 0.6 and 0.4 in the right and left eyes, respectively, and BCVA gradually decreased until the age of 24 years. The fundi were unremarkable. The siblings had similar ERG findings and the same homozygous missense variant in the <i>KCNV2</i> gene.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The siblings had clinical findings typical of CDSRR. High-intense flash ERG is recommended for identifying pathognomonic “squaring” a-waves in patients with CDSRR.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jana Szanyi, Jan Kremlacek, Zuzana Kubova, Miroslav Kuba, Frantisek Vit, Jana Langrova, Pavel Gebousky, Juraj Szanyi
{"title":"Optic nerve involvement in patients with Lyme neuroborreliosis: an electrophysiological study","authors":"Jana Szanyi, Jan Kremlacek, Zuzana Kubova, Miroslav Kuba, Frantisek Vit, Jana Langrova, Pavel Gebousky, Juraj Szanyi","doi":"10.1007/s10633-024-09975-w","DOIUrl":"https://doi.org/10.1007/s10633-024-09975-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The aim of this neurophysiological study was to retrospectively analyze visual evoked potentials (VEPs) acquired during an examination for diagnosing optic nerve involvement in patients with Lyme neuroborreliosis (LNB). Attention was focused on LNB patients with peripheral facial palsy (PFP) and optic nerve involvement.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A total of 241 Czech patients were classified as having probable/definite LNB (193/48); of these, 57 were younger than 40 years, with a median age of 26.3 years, and 184 were older than 40 years, with a median age of 58.8 years. All patients underwent pattern-reversal (PVEP) and motion-onset (MVEP) VEP examinations.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Abnormal VEP results were observed in 150/241 patients and were noted more often in patients over 40 years (<i>p</i> = 0.008). Muscle/joint problems and paresthesia were observed to be significantly more common in patients older than 40 years (<i>p</i> = 0.002, <i>p</i> = 0.030), in contrast to headache and decreased visual acuity, which were seen more often in patients younger than 40 years (<i>p</i> = 0.001, <i>p</i> = 0.033). Peripheral facial palsy was diagnosed in 26/241 LNB patients. Among patients with PFP, VEP peak times above the laboratory limit was observed in 22 (84.6%) individuals. Monitoring of patients with PFP and pathological VEP showed that the adjustment of visual system function occurred in half of the patients in one to more years, in contrast to faster recovery from peripheral facial palsy within months in most patients.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In LNB patients, VEP helps to increase sensitivity of an early diagnostic process.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":"49 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Slope between positive and negative ERG components in patients with open-angle glaucoma","authors":"Maja Sustar Habjan, Barbara Cvenkel","doi":"10.1007/s10633-024-09972-z","DOIUrl":"https://doi.org/10.1007/s10633-024-09972-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To evaluate ERG morphology, in particular the slope between P50 and N95 components of the PERG, as well as between the b-wave and the photopic negative response (PhNR) of the light-adapted (LA) ERG in patients with retinal ganglion cell (RGC) dysfunction due to open-angle glaucoma.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The PERG and LA-ERG traces of 16 glaucoma patients and 21 age-similar controls were retrospectively analysed. The ERG signal between the peak of the positive component (P50 and b-wave) towards the negative component (N95 and PhNR) was described by a linear regression <i>y</i> = <i>a</i> + <i>bx</i>, where the parameter <i>b</i> indicated the steepness of the P50-N95 and b-PhNR slope.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The P50-N95 slope was less steep in glaucoma patients (−0.079 ± 0.034 vs. −0.166 ± 0.050 in controls, <i>p</i> < 0.001), while the b-PhNR slope was not affected (−4.2 ± 2.1 vs. −4.4 ± 1.2, <i>p</i> = NS). The P50-N95 slope showed strong correlation with PhNR and N95 amplitude (<i>r</i> = −0.68 and −0.92, respectively; <i>p</i> < 0.001), while the b-PhNR slope correlated only with b-wave amplitude (<i>r</i> = −0.66, <i>p</i> < 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The P50-N95 slope is a sensitive indicator of RGC dysfunction in patients with open-angle glaucoma. A similar component of LA-ERG, the b-PhNR slope, is less affected by glaucomatous RGC dysfunction and probably originates from similar retinal mechanisms as the b-wave.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":"10 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140569972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jit Kai Tan, Gavin Arno, Dragana Josifova, Moin D Mohamed, Omar A Mahroo
{"title":"Unusual OCT findings in a patient with CABP4-associated cone-rod synaptic disorder.","authors":"Jit Kai Tan, Gavin Arno, Dragana Josifova, Moin D Mohamed, Omar A Mahroo","doi":"10.1007/s10633-023-09961-8","DOIUrl":"10.1007/s10633-023-09961-8","url":null,"abstract":"<p><strong>Purpose: </strong>Bi-allelic variants in CABP4 are associated with congenital cone-rod synaptic disorder, which has also been classified, electrophysiologically, as incomplete congenital stationary night blindness (iCSNB). We describe clinical findings in a patient who demonstrated an unusual macular optical coherence tomography (OCT) phenotype, not previously reported in this condition.</p><p><strong>Methods: </strong>Our patient underwent multimodal retinal imaging, international standard full-field ERG testing and whole genome sequencing.</p><p><strong>Results: </strong>The patient was a 60-year-old woman with non-progressive visual impairment since birth, nystagmus and preference for dim lighting. Clinical fundus examination was unremarkable. OCT imaging revealed a hypo-reflective zone under an elevated fovea in both eyes. ERGs showed an electronegative DA10 response, with severely abnormal light-adapted responses. Whole genome sequencing revealed homozygosity for a known pathogenic variant in CABP4. No variants were found in other genes that could explain the patient's phenotype.</p><p><strong>Conclusions: </strong>OCT findings of foveal elevation and an underlying hypo-reflective zone are novel in this condition. Whilst the clinical history was similar to achromatopsia and other cone dysfunction syndromes, ERG findings suggested disease associated with CACNA1F or CABP4. As CACNA1F is X-linked, CABP4 was more likely, and confirmed on genetic testing. The patient saw better in dim light, confirming that night blindness is not a feature of CABP4-associated disease. Our case highlights the value of ERGs in discriminating between causes of cone dysfunction, and extends the range of retinal imaging phenotypes reported in this disorder.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":" ","pages":"115-120"},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10954985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sofia A Mironets, Marina A Shurupova, Alexander F Karelin
{"title":"Videoocular assessment of eye movement activity in an ataxia-telangiectasia: a case study.","authors":"Sofia A Mironets, Marina A Shurupova, Alexander F Karelin","doi":"10.1007/s10633-024-09964-z","DOIUrl":"10.1007/s10633-024-09964-z","url":null,"abstract":"<p><strong>Purpose: </strong>Ataxia-telangiectasia (A-T) is an autosomal recessive disorder characterized by progressive neurological deficits, including prominent oculomotor dysfunction. We report 5 cases of eye movement assessment in children 9-15 years old with A-T.</p><p><strong>Methods: </strong>Three different oculomotor tasks (gaze holding, visually guided saccades and visual search) were used, and video-oculography was performed. Additionally, the scale for the assessment and rating of ataxia (SARA) score was used to assess severity of the cerebellar ataxia.</p><p><strong>Results: </strong>Unstable gaze holding, nystagmus and saccadic intrusions were found. In addition to psychophysiological assessment results, we provide quantitative analysis of oculomotor activity, revealing a specific abnormal oculomotor pattern, consisting of (i) marked saccade hypermetria, (ii) unstable gaze holding, and (iii) gaze-evoked nystagmus.</p><p><strong>Conclusion: </strong>Our study opens the prospect to evaluate efficacy and safety of alternative methods for supporting the patient and improving his/her life quality.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":" ","pages":"107-114"},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139729240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asma Hermas, Catherine Tsilfidis, Rustum Karanjia, Garfield Miller, Ange-Lynca Kantungane, Amanda El-Salibi, Irfan N Kherani, Shveta Bali, Stuart Coupland
{"title":"Sensitivity and specificity of the uniform field electroretinogram in glaucoma detection in comparison to the pattern electroretinogram.","authors":"Asma Hermas, Catherine Tsilfidis, Rustum Karanjia, Garfield Miller, Ange-Lynca Kantungane, Amanda El-Salibi, Irfan N Kherani, Shveta Bali, Stuart Coupland","doi":"10.1007/s10633-023-09960-9","DOIUrl":"10.1007/s10633-023-09960-9","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the ability of the photopic negative response (PhNR) of the uniform field electroretinogram (UF-ERG) to identify early glaucomatous changes in comparison to the checkerboard and bar stimuli of the pattern electroretinogram (PERG).</p><p><strong>Methods: </strong>Forty-nine glaucoma patients were classified into two groups: glaucoma-suspect (23 eyes) and early to moderate glaucoma (30 eyes), based on their clinical examination and the results of standard automated perimetry. Thirty patients (30 eyes) with intraocular pressures (IOP) of 21 mmHg or less, with no history of reported high IOP, were included as controls. PERG and UF-ERG recordings were obtained on a Diagnosys D-341 Attaché-Envoy System. Visual field testing was done only for glaucoma-suspect and glaucoma patients.</p><p><strong>Results: </strong>All three tests (PERG bar stimulus, PERG checkerboard stimulus and PhNR) displayed significantly prolonged peak times for glaucoma and glaucoma-suspect patients, with delays ranging from 7.8 to 14.8%, depending on the test. The PERG bar stimulus also showed a significantly lower N95 amplitude for both glaucoma groups (with reductions of 26.0% and 33.0% for glaucoma-suspect and glaucoma groups, respectively). The PERG checkerboard N95 amplitude component had high sensitivity for detecting glaucoma patients but a low specificity (97% and 37%, respectively; AUC = 0.61). Overall, the PhNR peak time showed the highest sensitivity and specificity (77% and 90%, respectively; AUC = 0.87).</p><p><strong>Conclusions: </strong>PERG bar stimuli and the PhNR of the UF-ERG can be used in the clinical setting to detect glaucoma-related changes in glaucoma-suspect and glaucoma patients. However, our data confirm that the PhNR peak time has the best combined sensitivity and specificity.</p>","PeriodicalId":11207,"journal":{"name":"Documenta Ophthalmologica","volume":" ","pages":"97-106"},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139502374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}