Endocrine journal最新文献

{"title":"A questionnaire-based survey on hyperphagia in individuals with Prader-Willi syndrome in Japan.","authors":"Makiko Tachibana, Yuji Oto, Kenichi Kashimada, Tomohiro Ishii, Yutaka Takahashi, Koji Muroya, Yoko Aoki, Kenji Kurosawa, Tsutomu Ogata, Masanobu Kawai","doi":"10.1507/endocrj.EJ25-0039","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0039","url":null,"abstract":"<p><p>Prader-Willi syndrome (PWS) is associated with increased mortality, primarily due to complications from hyperphagia-associated obesity. Clinical trials investigating anti-hyperphagic medications are currently underway. The Hyperphagia Questionnaire for Clinical Trials (HQ-CT) is designed to assess hyperphagia in PWS, with scores ranging from 0 to 36, where higher scores indicate greater severity. However, HQ-CT scores have not yet been evaluated in Japan. Therefore, we conducted a questionnaire-based survey among patient association members. Of 605 members, the score was available in 266. Their median age was 13 years (range: 0-48). Of these, 160 were children (<18 years), and 106 were adults (≥18 years). Obesity was observed in 11% and 40% of the pediatric and adult participants, respectively. The genetic subtypes included deletions (56%) and uniparental disomies (26%). The median HQ-CT score was 5 (range: 0-30), with no significant differences observed by sex or genetic subtype. The adult participants had significantly higher scores than pediatric participants (8 vs. 4). The HQ-CT score was lower than that reported in studies conducted overseas. Among adult participants, the score was significantly higher in obese individuals than in non-obese individuals, and multivariate analysis demonstrated a positive association between the score and body mass index, after adjusting for age, sex, genotype, and growth hormone treatment during childhood (β = 0.38, p = 0.0001). However, no such association was observed in pediatric participants. These findings provide valuable insights into the hyperphagic status of PWS in Japan and implicate that hyperphagia imposes a disease burden, particularly during adulthood.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706734","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":"Novel germline likely pathogenic frameshift variant of the MEN1 gene contributes to multiple endocrine neoplasia type 1: a case report with review of literature.","authors":"Masanori Yamazaki, Tomomi Kojima, Yusuke Shibata, Tomoki Kosho, Mitsuhisa Komatsu","doi":"10.1507/endocrj.EJ25-0110","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0110","url":null,"abstract":"<p><p>A 46-year-old man with a family history of multiple endocrine neoplasia type 1 (MEN1) presented with recurrent hypoglycemic episodes and was referred to our hospital. Based on hypoglycemia, endogenous hyperinsulinemia, and imaging findings revealing masses in the head, body, and tail of the pancreas, insulin-producing neuroendocrine neoplasms (NENs) or insulinomas were strongly suspected. A selective arterial calcium stimulation test supported this diagnosis. Additional biochemical and imaging studies suggested the presence of normocalcemic primary hyperparathyroidism (PHPT), a thymic NEN, and a prolactinoma. The patient subsequently underwent distal pancreatectomy for the pancreatic body and tail masses, enucleation of the pancreatic head mass, extended thymectomy, and subtotal parathyroidectomy. Histopathological evaluation confirmed the diagnoses of insulinoma, thymic NEN, and normocalcemic PHPT. He continued medical treatment with the dopamine receptor agonist cabergoline for the prolactinoma. Genetic testing revealed a novel heterozygous likely pathogenic frameshift MEN1 variant, c.1078del (p.Ile360Serfs*8). Based on a previous study, this variant (located within the JunD-interacting domain of the transcript Menin) has been proposed to impair the repression of JunD-mediated transcription and may contribute to aggressive tumors such as thymic NENs, which have high recurrence rates, metastatic potential, and high mortality risk. Although the specific pathological significance of this variant in tumorigenesis remains unclear, this case suggests a need for increased awareness and cautious surveillance of aggressive manifestations, including thymic lesions, in individuals harboring this variant.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648856","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":"Potentially fatal crisis after ¹⁷⁷Lu-DOTATATE therapy for paraganglioma: a case report with review of literature.","authors":"Aoki Tobimatsu, Kosuke Mukai, Yoshinari Obata, Kayako Isohashi, Kazuyuki Miyashita, Atsunori Fukuhara, Hiroki Kato, Iichiro Shimomura","doi":"10.1507/endocrj.EJ24-0713","DOIUrl":"https://doi.org/10.1507/endocrj.EJ24-0713","url":null,"abstract":"<p><p>Pheochromocytoma/paraganglioma (PPGL) is a rare neuroendocrine tumor with metastatic potential. Peptide receptor radionuclide therapy with ¹⁷⁷Lu-DOTATATE, a radiolabeled somatostatin analog, has been used for the treatment of somatostatin receptor-positive PPGLs and has shown promising efficacy and generally mild toxicity. However, rare instances of fatal crises following treatment have been reported. A 50-year-old man with pheochromocytoma was admitted for ¹⁷⁷Lu-DOTATATE therapy. At the age of 49, he received ¹³¹I-MIBG therapy for the recurrence of pheochromocytoma with bone metastasis. He rejected additional radionuclide treatment because of work commitments. However, the patient's plasma normetanephrine levels increased to >7,200 pg/mL, which worsened his pain from bone metastasis. Therefore, the patient resumed radionuclide treatment. Because his markedly elevated catecholamine levels might have induced a hypertensive crisis, ¹⁷⁷Lu-DOTATATE therapy was applied to reduce staff radiation exposure in an emergency. He developed a fever and tachycardia approximately 30 hours after ¹⁷⁷Lu-DOTATATE administration followed by cardiopulmonary arrest with hemoptysis approximately 35 hours after the administration. He was not revived. Postmortem imaging suggested alveolar hemorrhage. ¹⁷⁷Lu-DOTATATE administration might induce a fatal crisis, alveolar hemorrhage, and subsequent death. This is the first detailed report of a patient with PPGL who died shortly after ¹⁷⁷Lu-DOTATATE therapy. A review of five reported cases of fatal crises after ¹⁷⁷Lu-DOTATATE treatment suggests that high catecholamine levels are associated with a risk of crisis. In conclusion, while ¹⁷⁷Lu-DOTATATE therapy is generally considered safe, our findings underscore the potential risks of fatal crisis after therapy. Careful monitoring of patients with PPGL should be performed after treatment.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599739","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":"Autoantibodies to the TSH Receptor-from discovery to understanding the mechanisms of action and to new therapeutics.","authors":"Bernard Rees Smith","doi":"10.1507/endocrj.EJ25-0127","DOIUrl":"https://doi.org/10.1507/endocrj.EJ25-0127","url":null,"abstract":"<p><p>Prior to 1956, Graves' hyperthyroidism was thought to be due to high levels of TSH but in that year Adams & Purves demonstrated the presence of a thyroid stimulator in Graves' sera with a prolonged time course of action (long-acting thyroid stimulator, LATS) quite distinct from TSH. LATS was only present in the serum IgG fraction suggesting it was a thyroid stimulating autoantibody. In 1974 Graves' IgG was shown to compete with ¹²⁵I-labelled TSH for the TSH receptor providing good evidence that Graves' hyperthyroidism was caused by TSH receptor autoantibodies. Further breakthroughs occurred in 1989 (TSHR cloning) and 2003 (monoclonal thyroid stimulating autoantibody M22^TM). Subsequently atomic level detail of how TSHR stimulating (2007) and blocking (2011) autoantibodies interact with the TSHR became available. Cryo-EM studies followed (2022-2025) and provide a detailed understanding of how TSHR autoantibodies with different properties function. The human monoclonal autoantibody K1-70^TM with powerful TSH receptor blocking activity is now in clinical trials. It has the expected beneficial effects on Graves' hyperthyroidism and Graves' ophthalmopathy and is an exciting new TSHR specific drug.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575079","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":"Enteric capsuled protein reduced food intake and inhibited high-fat diet-induced weight gain in mice.","authors":"Keitaro Kawada, Shunbun Kita, Shiro Fukuda, Hirofumi Nagao, Yuya Fujishima, Hitoshi Nishizawa, Iichiro Shimomura","doi":"10.1507/endocrj.EJ24-0679","DOIUrl":"https://doi.org/10.1507/endocrj.EJ24-0679","url":null,"abstract":"<p><p>To understand the mechanisms of food intake reduction after metabolic bariatric surgery, we investigated the potential antiobesity effects of undigested proteins delivered to the small intestine using enteric capsules. We utilized EUDRAGIT-coated capsules (enteric capsules) to deliver contents not into the stomach but into the small intestine. Wild-type mice were administered various proteins (soy, pea, chicken, or whey) in the enteric capsules, and the amount of food intake and weight gain by the high-fat diet were evaluated. Protein aggregation by heat treatment and vagal nerve ablation by capsaicin treatment were conducted to determine whether they affect food intake. We found that: (1) Single administration of less than 4 milligrams of soy protein in enteric capsules significantly reduced food intake. Similar effects were observed with other proteins. (2) Heat treatment increased the food intake reduction effect of whey protein with increasing levels of the enteric hormone PYY. Vagal nerve ablation by capsaicin abolished the effects of such food intake reduction. (3) Multiple administrations of soy protein in enteric capsules reduced body weight gain and liver triglyceride accumulation under high-fat diet conditions. We concluded that proteins delivered to the small intestine via enteric capsules reduced food intake and inhibited high-fat diet-induced weight gain in mice. The aggregation of protein and the capsaicin-sensitive vagal afferent nerve might play a role in this effect.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552678","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":"Children with idiopathic short stature and growth hormone deficiency exhibit similar changes in gut microbiota.","authors":"Jing Han, Congfu Huang, Lingjuan Meng, Hui Wu, Dongming Meng","doi":"10.1507/endocrj.EJ24-0615","DOIUrl":"10.1507/endocrj.EJ24-0615","url":null,"abstract":"<p><p>Children with idiopathic short stature (ISS) and growth hormone deficiency (GHD) exhibit imbalances in gut microbiota (GM), and the latter is related to endocrine hormones (such as insulin-like growth factor 1 (IGF-1)). The current study investigated the compositional and functional variations in GM between children with ISS and GHD, employing 16S rRNA sequencing technology. Sequencing results from 15 children with ISS and 18 children with GHD indicated no significant differences in GM alpha diversity or phylum-level diversity between the ISS and GHD groups. At the genus level, the abundance of Terrisporobacter was significantly greater in the ISS group compared to the GHD group, whereas the abundance of Acidovorax was reduced. The abundance of Prevotella stercorea and uncultured Sutterella sp. at the species level was significantly lower in the ISS group compared to the GHD group. The third level (L3) of the Kyoto Encyclopedia of Genes and Genomes (KEGG) database revealed functional variations in GM, with children in the ISS group having higher levels of intestinal bacteria Mobility Proteins and Background Chemotaxis. Despite these differences, the overall composition and function of GM between ISS and GHD children were not significantly different, indicating that the mechanisms by which GM influences the growth and development of children in both groups may be similar. This study was registered with the Medical Research Registration and Record System with the registration number MR-44-24-045472.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"791-799"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794968","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":"Severe obesity with hypo-leptinemia.","authors":"Masanori Kita, Shuhei Morita, Hiroyuki Ariyasu, Tomoya Tsuji, Shinsuke Uraki, Ken Takeshima, Hiroshi Iwakura, Taka-Aki Matsuoka","doi":"10.1507/endocrj.EJ24-0568","DOIUrl":"10.1507/endocrj.EJ24-0568","url":null,"abstract":"<p><p>Some cases of obesity are thought to be associated with hypo-leptinemia. This may cause decreased appetite suppression resulting in increased appetite, leading to weight gain. Replacement therapy with leptin might be theoretically useful, but verification by reporting more cases is required. Here, we first investigated the serum leptin levels and their correlation with body mass index (BMI) in 107 patients with obesity to identify the subjects with hypo-leptinemia. Among them, one patient with congenital hypopituitarism was further investigated by comparison of his clinical and pathological characteristics with those of control subjects. This 40-year-old Japanese man, who was large from birth, consistently showed obesity of more than 2SD during his growth period. He had 41.5 kg/m² at BMI with central hypogonadism, central diabetes insipidus and severe growth hormone deficiency, cognitive impairment, and abnormal eating behavior, which led to suspicion of the involvement of hypothalamic factors. Genetic analysis revealed no definite mutations regarding metabolic and nutritional systems or adipocytes including leptin-related genes. Electron microscopic images of subcutaneous adipose tissue demonstrated relatively smaller adipocytes compared with a BMI-matched patient. The patient suffered from his abnormal eating behavior, began dialysis at the age of 41 years, and died of bacterial pneumonia at 49 years of age. Among patients with severe obesity with hypo-leptinemia, there could be patients with disturbance of healthy expansion in adipocyte, probably due to unknown dysfunction. Even with the lack of abnormality of leptin-related genes, indication of leptin-replacement may be considered for severely obese patients with hypo-leptinemia.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"801-811"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699933","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":"Early postoperative levothyroxine initiation after total thyroidectomy for Graves' disease.","authors":"Yuji Nagayama, Seigo Tachibana, Takashi Fukuda, Kento Katsuyama, Daisuke Tatsushima, Yusuke Mori, Hisakazu Shindo, Hiroshi Takahashi, Misa Okamura, Atsushi Yamaoka, Shinya Sato, Hiroyuki Yamashita","doi":"10.1507/endocrj.EJ25-0009","DOIUrl":"10.1507/endocrj.EJ25-0009","url":null,"abstract":"<p><p>No evidence-based standards exist regarding levothyroxine (LT4) replacement therapy initiation timing in patients with hyperthyroid Graves' disease undergoing total thyroidectomy. Although LT4 replacement from the first postoperative day has been the standard of care at our hospital, its clinical validity has not been thoroughly examined. This study investigated the perioperative kinetics of thyroid hormones to assess the safety and efficacy of early LT4 initiation. Thirty patients with Graves' disease (18 hyperthyroid and 12 euthyroid) and 12 with thyroid nodules who underwent total thyroidectomy were included. Blood samples were collected from each patient for thyroid hormone measurement on the day before surgery (D-1), 15 min after surgery (D0), at 8:00 am on days 1 (D1) and 3 (D3), and 3 weeks (W3) and 3 months (M3) after surgery. In 18 patients with hyperthyroid Graves' disease, serum free triiodothyronine (FT3) levels significantly decreased immediately after surgery and were within the normal range by D1. Although LT4 was started on D1, FT3 levels continued to decline by D3 and remained low at W3 and M3. Serum FT4 levels followed a slower decline but remained within the normal range for M3. In patients with euthyroid Graves' disease and those with thyroid nodules, hormone levels stayed within or around the reference range throughout the observation period. In conclusion, initiating LT4 on the day after surgery is safe and effective for maintaining thyroid function in patients with hyperthyroid Graves' disease undergoing total thyroidectomy. These results could inform future guidelines, supporting earlier postoperative LT4 initiation.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"813-818"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729422","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":"Physiology and clinical applications of GIP.","authors":"Shunsuke Yamane, Norio Harada, Nobuya Inagaki","doi":"10.1507/endocrj.EJ25-0087","DOIUrl":"10.1507/endocrj.EJ25-0087","url":null,"abstract":"<p><p>Glucose-dependent insulinotropic polypeptide (GIP) is secreted by enteroendocrine K cells, primarily located in the upper small intestine, in response to food intake and plays a significant role in the postprandial regulation of nutrient metabolism. Although the importance of GIP in metabolic regulation has long been recognized, progress in developing GIP as a therapeutic target has been limited. However, the GIP/GIP receptor (GIPR) axis has garnered increasing attention in recent years. Emerging evidence suggests that dual GIP/GLP-1 receptor agonists and triple GIP/GLP-1/glucagon receptor agonists provide beneficial metabolic effects in individuals with type 2 diabetes and obesity. In this review, we outline the physiological roles of GIP, detailing the mechanisms of GIP secretion from K cells in response to macronutrients, its actions on key target organs involved in metabolic regulation, and ongoing developments in its therapeutic applications.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"751-764"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771171","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":"Status of temozolomide use without insurance coverage in patients with aggressive pituitary neuroendocrine tumors.","authors":"Atsushi Ishida, Naoko Inoshita, Noriaki Tanabe, Koji Takano, Hideki Shiramizu, Haruko Yoshimoto, Masataka Kato, Go Matsuoka, Shozo Yamada","doi":"10.1507/endocrj.EJ24-0727","DOIUrl":"10.1507/endocrj.EJ24-0727","url":null,"abstract":"<p><p>The 2017 World Health Organization classification described aggressive pituitary neuroendocrine tumor (PitNET) as \"a tumor with strong invasiveness and rapid growth, which is difficult to treat with surgery, radiation therapy, or drug therapy,\" which remains a challenge in the treatment of pituitary tumors. Currently, temozolomide (TMZ) is the first-line treatment for aggressive PitNET. However, it is not yet covered by insurance in Japan. Additionally, O6-Methylguanine-DNA Methyltransferase (MGMT) expression can lead to treatment resistance, further complicating treatment selection. We previously demonstrated the effectiveness of combination therapy with capecitabine (CAPTEM) in several cases of aggressive PitNETs. The present study described our experiences with TMZ in 13 patients with aggressive PitNETs (including four patients administered CAPTEM). Pathological examination revealed eight corticotroph, four lactotroph, and one somatotroph tumors. Of these, seven patients are still receiving treatment, and six patients have terminated treatment. The reasons for discontinuation were poor efficacy (three patients), financial reasons (two patients), and patient preference (one patient). No patients required treatment discontinuation owing to adverse events. Furthermore, one case of a lactotroph tumor, which achieved remission with CAPTEM but was discontinued after three years for financial reasons, remains in remission on imaging and maintained normal PRL levels for 15 months after discontinuation. The most significant issue is off-label use. Concern exists that financial constraints may prevent future patients from using TMZ.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"781-789"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613504","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}