Dysphagia最新文献

{"title":"A Letter to the Editor on Presbyphagia: A Conceptual Analysis of Contemporary Proposals and their Influences on Clinical Diagnosis.","authors":"Francelise Pivetta Roque, Ana Beatriz Ferreira Monteiro, Patrick Alexander Wachholz, Roberta Gonçalves da Silva","doi":"10.1007/s00455-025-10825-3","DOIUrl":"https://doi.org/10.1007/s00455-025-10825-3","url":null,"abstract":"<p><p>The author identified three main operational definitions of presbyphagia in the specialized literature: (1) changes in healthy older people's swallowing, (2) a swallowing disorder compensated by physiological reserves, and (3) a synonym of dysphagia. As the author stated in the conclusion, presbyphagia should be considered an etiology of oropharyngeal dysphagia (OD). However, significant methodological flaws were found, including selecting only one person to screen and analyze articles in the systematic review, not using any keywords or MeSH terms in the search, not presenting a search strategy, limiting the search term to \"presbyphagia\", and omitting details about screening, inclusion, and exclusion criteria. The operational definitions describe that aging inherently causes swallowing impairment. However, they disregard age-related changes without significant functional impact, as found by a previous study, reviewed in the current research, but analyzed inconsistently by the author. This recent study showed that presbyphagia is the opposite of OD, framing both the \"negative\" aspects of swallowing and the \"compensatory positives\" as natural consequences of aging, consistent with the World Health Organization's concept of intrinsic capacity. This perspective positions aging as an adaptive process-not a disease or cause of disease-, although it may increase vulnerability due to cumulative factors. Since OD is a symptom, attributing it to aging frames aging itself as a disease, contradicting current geriatrics and gerontology paradigms.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance.","authors":"Erin Kamarunas, Kelsey Murray, Teresa Drulia, Sarah Szynkiewicz, Lindsay Griffin, Rachel Mulheren","doi":"10.1007/s00455-024-10751-w","DOIUrl":"10.1007/s00455-024-10751-w","url":null,"abstract":"<p><p>Rehabilitative exercises require precise movement coordination and target accuracy for optimal effectiveness. This paper explores the impact of tongue strength exercises (TSE) performance accuracy on exercise outcomes, adherence, and participant confidence and motivation. An 8-week randomized clinical trial included 84 typically aging participants divided into four groups defined by access to biofeedback (present/absent) and TSE intensity dosing (maximal/submaximal) during a home exercise program (HEP). Retention, training, and HEP accuracy were tracked at biweekly visits and during HEP for participants with access to a biofeedback device. Associations with tongue strength outcomes, participant factors, biofeedback, and intensity dosing were analyzed. Exercise accuracy measures did not contribute to tongue strength outcomes at the end of 8 weeks. Increased training accuracy (less practice required to achieve competency) was associated with higher participant confidence and better adherence to the HEP. The presence of biofeedback was associated with reduced adherence but better retention accuracy, while maximal intensity was associated with improvements in all accuracy measures compared to submaximal intensity exercise. These findings in typically aging participants suggest the need for tailored approaches in swallowing-related exercise programs, given the effects of biofeedback and exercise intensity on motor learning and exercise retention. Accuracy performance and its effect on clinical outcomes warrants study in clinical populations with dysphagia and with various rehabilitative approaches.Trial Registration Clincialtrials.gov: NCT04809558.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"489-500"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.","authors":"Leen Van den Steen, Edwig Goossens, Martijn van Gemst, Geertrui Vlaemynck, Bart Geurden, Gwen Van Nuffelen","doi":"10.1007/s00455-024-10752-9","DOIUrl":"10.1007/s00455-024-10752-9","url":null,"abstract":"<p><p>The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"501-509"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortical Activation during Swallowing Exercise Tasks: an fNIRS Pilot Study.","authors":"Denise Mae N Chua, Karen Man-Kei Chan","doi":"10.1007/s00455-024-10730-1","DOIUrl":"10.1007/s00455-024-10730-1","url":null,"abstract":"<p><p>This pilot study used functional near-infrared spectroscopy (fNIRS) to examine brain activity in selected regions of the left motor and sensory cortex while doing swallowing-related tasks. Specifically, differences in cortical activation during normal saliva swallows, effortful swallows, and tongue pressing were investigated. Nine healthy, right-handed adults (5 female, 4 male; Age: 22-30 years) were recruited. The tasks included were (1) normal saliva swallowing, (2) effortful saliva swallowing, and (3) lingual pressing against the palate. Each task was completed three times in a block, for a total of five blocks. Blocks were randomized and presented with set time intervals using PsychoPy. Motor activity was highest during effortful swallows, followed by normal swallows, and lingual presses. Activation in the sensory region was not significantly different across tasks; however, effortful swallows elicited the highest mean peak activation. Our findings suggest that fNIRS can be a viable imaging method used to examine differences in cortical activity in the context of swallowing. Its applicability in future dysphagia research should be explored.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"327-335"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Statistical Practices for Longitudinal Group Comparison of the Penetration-Aspiration Scale on Power and Effect Size Estimation: A Monte Carlo Simulation Study.","authors":"James C Borders, Alessandro A Grande, Carly E A Barbon, Katherine A Hutcheson, Michelle S Troche","doi":"10.1007/s00455-024-10738-7","DOIUrl":"10.1007/s00455-024-10738-7","url":null,"abstract":"<p><p>Multiple bolus trials are administered during clinical and research swallowing assessments to comprehensively capture an individual's swallowing function. Despite valuable information obtained from these boluses, it remains common practice to use a single bolus (e.g., the worst score) to describe the degree of dysfunction. Researchers also often collapse continuous or ordinal swallowing measures into categories, potentially exacerbating information loss. These practices may adversely affect statistical power to detect and estimate smaller, yet potentially meaningful, treatment effects. This study sought to examine the impact of aggregating and categorizing penetration-aspiration scale (PAS) scores on statistical power and effect size estimates. We used a Monte Carlo approach to simulate three hypothetical within-subject treatment studies in Parkinson's disease and head and neck cancer across a range of data characteristics (e.g., sample size, number of bolus trials, variability). Different statistical models (aggregated or multilevel) as well as various PAS reduction approaches (i.e., types of categorizations) were performed to examine their impact on power and the accuracy of effect size estimates. Across all scenarios, multilevel models demonstrated higher statistical power to detect group-level longitudinal change and more accurate estimates compared to aggregated (worst score) models. Categorizing PAS scores also reduced power and biased effect size estimates compared to an ordinal approach, though this depended on the type of categorization and baseline PAS distribution. Multilevel models should be considered as a more robust approach for the statistical analysis of multiple boluses administered in standardized swallowing protocols due to its high sensitivity and accuracy to compare group-level changes in swallowing function. Importantly, this finding appears to be consistent across patient populations with distinct pathophysiology (i.e., PD and HNC) and patterns of airway invasion. The decision to categorize a continuous or ordinal outcome should be grounded in the clinical or research question with recognition that scale reduction may negatively affect the quality of statistical inferences in certain scenarios.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"388-398"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and Confidence of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Rating Among Research and Clinical Speech Pathologists Before and After Implementation of a Training Manual: A Multi-site Study.","authors":"C E A Barbon, C L Warneke, B Ledger, N Rogus-Pulia, L Cunningham, J L Coyle, C Levesque-Boissonneault, C Alvarez, D Valencia, K A Hutcheson","doi":"10.1007/s00455-024-10733-y","DOIUrl":"10.1007/s00455-024-10733-y","url":null,"abstract":"<p><p>DIGEST is a validated, open-source method to grade the severity of pharyngeal dysphagia from the modified barium swallow (MBS) study. Dissemination and implementation of DIGEST is rising, making it critical to understand reliability and facilitators of accurate implementation among users. The aim was to assess reliability of the tool among speech-language pathology (SLP) raters practicing at multiple sites before and after review of a DIGEST training manual and evaluate confidence of DIGEST use pre-and post-training. Thirty-two SLPs from 5 sites participated in a blinded longitudinal DIGEST rating study. Raters were provided a standardized training set of MBS (n = 19). Initial SLP ratings (round 1, R1) were followed by a 2-4 week break before raters rated a re-keyed MBS set (round 2, R2). A minimum 4-8 week wash-out period then preceded self-study of the DIGEST training manual which was followed by a final rating (round 3, R3) and a post-manual survey afterwards. Baseline reliability (R1) of overall DIGEST was on average k = 0.70, reflecting agreement in the substantial range. Seventy-five percent of raters (24/32) demonstrated reliability ≥ 0.61 in the substantial to almost perfect range prior to training. Inter-rater reliability significantly improved from R1 to R3 after review of the DIGEST manual, with the largest change in DIGEST-Efficiency (mean change: DIGEST k = .04, p = .009, DIGEST-Safety k = .07, p = 0.03, and DIGEST-Efficiency k = .14, p = 0.009). Although DIGEST reliability at baseline was adequate in the majority of raters, self-study of the DIGEST training manual significantly improved inter-rater reliability and rater confidence using the DIGEST method, particularly when assigning DIGEST-Efficiency grade. These early data show promise that provider training may be useful to aid in fidelity of DIGEST implementation among SLP clinical users with varying DIGEST experience.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"353-362"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Visual Biofeedback Using the Iowa Oral Performance Instrument and Auditory Feedback on Floor-of-the-Mouth Muscle Activation and Oral Pressure During Effortful Swallowing in Healthy Older Adults.","authors":"Jong-Chi Oh","doi":"10.1007/s00455-025-10824-4","DOIUrl":"https://doi.org/10.1007/s00455-025-10824-4","url":null,"abstract":"<p><p>Effortful swallowing (ES) is a promising exercise option for patients with dysphagia due to reduced tongue base retraction. However, studies confirming how exercise physiology changes when performing ES continuously over multiple sets in clinical practice are limited. This study aimed to determine the effect of visual biofeedback using the Iowa Oral Performance Instrument (IOPI) on the muscle activity of the floor-of-the-mouth (FOM) and oral swallowing pressure during ES exercise. Forty-five healthy older adults (mean age 76.1 ± 4.48y) participated in this randomized crossover study with two conditions. In the visual biofeedback condition using the IOPI, the participants were presented with a value corresponding to 80% of the maximum isometric pressure of the posterior oral tongue measured at baseline and asked to exceed the target value while performing ES. In the no-feedback condition, the IOPI screen was blocked to ensure that information regarding the swallowing pressure during ES was not provided. In the biofeedback condition, participants showed a significantly higher oral swallowing pressure from Sets 3-8 compared with the no-feedback condition (p < 0.05). In the no feedback condition, FOM muscle activity was significantly lower in Set 4 than in the Set 1 (p < 0.05). To improve the strength of the tongue and FOM muscles through ES exercise, providing biofeedback using the IOPI may be beneficial for maintaining a consistently high level of exercise intensity. Further research is required to enable the application of this study's finding to patients with dysphagia.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the European Portuguese Version of the Yale Pharyngeal Severity Rating Scale.","authors":"Isabel Silva-Carvalho, Adriana Martins, Susana Vaz Freitas, Laetitia Teixeira, Luís Meireles, Isabel Pedroto","doi":"10.1007/s00455-024-10731-0","DOIUrl":"10.1007/s00455-024-10731-0","url":null,"abstract":"<p><p>This study aimed to validate the Yale Pharyngeal Residue Severity Rating Scale's European Portuguese version and investigate the impact of rater experience. The scale measures the severity of residue in the vallecula and pyriform sinus. Ninety Fiberoptic Endoscopic Evaluation of Swallowing images were selected after consensus and proposed to 13 raters who were asked to assess the severity of pharyngeal residue (PR) in each image in two moments with an interval of two weeks. The raters were divided by years of experience conducting the Fiberoptic Endoscopic Evaluation of Swallowing and in experience using severity scales for residues. Construct validity, inter-rater, and intra-rater reliability were assessed by kappa statistics. The original English scale was translated into European Portuguese using a forward-backward method for validation. The scale reliability was strong, with an elevated intra-rater internal consistency for vallecula (Cronbach's alpha = 0.982) and pyriform sinus (Cronbach's alpha = 0.922). Inter-rater reliability for raters was equally significant and high for vallecula (0.613 for first assessment and 0.604 for second assessment) and pyriform sinus (0.558 for first assessment and 0.509 for second assessment) or for raters with experience using Yale Pharyngeal Severity Rating Scale (vallecula with 0.832 for first assessment and 0.717 for second assessment and pyriform sinus with 0.856 for first assessment and 0.714 for second assessment).The European Portuguese version of the Yale Pharyngeal Severity Rating Scale is a valid, reliable instrument for scoring the location and severity of pharyngeal residue in the context of fiberoptic endoscopic evaluation of swallowing.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"336-342"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telesimulation for Training in Infant Feeding: A Randomized Controlled Trial.","authors":"Jeanne Marshall, Charis Shiu, Madeline Raatz, Adriana Penman, Kelly Beak, Sally Clarke, Elizabeth C Ward","doi":"10.1007/s00455-024-10746-7","DOIUrl":"10.1007/s00455-024-10746-7","url":null,"abstract":"<p><p>Simulation is an education modality known to support clinical skill development. Unfortunately, access to simulation has been challenging, both prior to and during the pandemic. Simulation via telepractice, i.e., \"telesimulation\", has emerged, but little is known about whether outcomes are comparable to in-person simulation. This study compared in-person versus telesimulation learner outcomes in an infant feeding scenario. The secondary aim was to compare outcomes between novice and experienced participants.This pragmatic randomized controlled trial included speech pathologists who could attend if randomized to the in-person modality. Block randomization matched participants with < 6 months' infant feeding experience to those with > 6 months experience (2:1 ratio) into telesimulation or in-person simulation. Measures of clinical reasoning, confidence/anxiety, and satisfaction were collected, pre-, post-, and 4-weeks post-simulation.Overall, 39 clinicians completed either in-person simulation (n = 17) or telesimulation training (n = 22), including 16 experienced and 23 novice learners. Both in-person and telesimulation groups achieved significant improvements across time in clinical reasoning, self-reported confidence, and anxiety. The extent of change in clinical reasoning, confidence and anxiety was comparable between the telesimulation and in-person simulation groups. Comparing by experience, novice-level participants reported significantly greater changes in confidence and anxiety than experienced participants. Satisfaction levels were high regardless of simulation modality or experience.Participants in telesimulation and in-person simulation achieved similar improvements in the primary outcome measure of clinical reasoning, had comparable improvements in self-perceived confidence and anxiety, and demonstrated high satisfaction levels. Telesimulation is a promising means to improve clinician access to simulation training in infant feeding.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"443-453"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Rest Interval Length on Oral Swallowing Pressure During Effortful Swallowing Exercises in Healthy Adults: A Crossover Design.","authors":"Jong-Chi Oh, Min-Sook Shin, Mo-A Son, Hyeon-Ji Kim","doi":"10.1007/s00455-024-10749-4","DOIUrl":"10.1007/s00455-024-10749-4","url":null,"abstract":"<p><p>Evidence supporting the prescription of effortful swallowing (ES) as a rehabilitation exercise remains lacking. This study aimed to evaluate the effect of rest interval length between sets on oral swallowing pressure during ES exercises in healthy adults. This study was a randomized trial of participants using a crossover design. Forty-three healthy adults (25.0 ± 3.7 years; 32 women and 11 men) without swallowing difficulties were recruited and participated in all four conditions (rest intervals between sets: 0-, 1-, 3-, and 5-min intervals) in a random order. The exercise constituted five sets, each comprising 10 ES repetitions. ES was performed with saliva swallows. The rest interval between each repetition was fixed at 10 s, and the oral swallowing pressure during ES was measured using a tongue pressure measuring device. Oral swallowing pressures were significantly lower in the fifth set than in the first set at the 0-min rest condition. In the comparison by condition, oral swallowing pressures were significantly higher in the 5-min than in the 0-min rest conditions in the fourth set and in the 3- and 5-min rest conditions than in the 0-min rest condition in the fifth set. A rest interval of appropriate length between sets during ES exercises may consistently maintain the targeted high swallowing pressures during the exercises. Further studies using more diverse equipment and targeting older patients and those with dysphagia are required to determine the effect of the rest interval length between sets on the degree of exercise intensity to improve the swallowing-related muscle strength.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":"464-475"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}