European Respiratory Review最新文献

{"title":"Rural <i>versus</i> urban living and COPD: a systematic review.","authors":"Samit Patel, Joseph Marchant, Surya P Bhatt, John R Hurst","doi":"10.1183/16000617.0290-2025","DOIUrl":"10.1183/16000617.0290-2025","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. Emerging evidence suggests disparities in COPD outcomes between rural and urban populations, but no prior review has synthesised these differences globally. Five databases (Medline, Embase, Emcare, CINAHL and Cochrane Central) were searched in May 2025. Eligible peer-reviewed studies directly compared rural and urban populations in at least one of four measures of COPD burden: prevalence, symptom burden, exacerbations or mortality. Study quality was assessed and narrative synthesis was conducted due to heterogeneity in outcome measures. Of 1339 screened studies, 32 met inclusion criteria, spanning 13 countries. COPD prevalence was higher rurally in 83% (15/18) of studies, with 11/15 demonstrating statistical significance. This pattern was consistent across geographical distributions. Total exacerbation rates were higher rurally in 60% (3/5) of studies, although hospitalisations varied significantly. 50% (6/12) of studies reported higher hospitalisation rates in urban areas and 5/12 studies reporting higher rates in rural areas. 86% (6/7) of studies demonstrated higher mortality rurally and symptom burden was higher amongst rural residents in 67% (4/6) of studies; however, the majority of these were conducted in the USA. This review highlights consistent rural-urban inequalities in COPD prevalence and outcomes, reflecting the impact of healthcare inequities, socioeconomic deprivation and environmental exposures on COPD burden in rural areas. Targeted interventions promoting equitable healthcare access, health education, transition to cleaner fuels and rural access to smoking cessation and pulmonary rehabilitation services are essential to mitigate these disparities and improve outcomes in rural populations.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Considerations of emerging diaphragmatic ultrasound techniques for clinical practice: potential pitfalls and future challenges.","authors":"Ivo Neto Silva, Karim Bendjelid","doi":"10.1183/16000617.0064-2026","DOIUrl":"10.1183/16000617.0064-2026","url":null,"abstract":"","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating the start of an exacerbation from day-to-day variation in people with COPD: a systematic review.","authors":"Shaogi Syam, Arafa Aboelhassan, Malik A Althobiani, Ömer Faruk Uysal, Naif Sulaiman, Amar J Shah, Swapna Mandal, Ali R Mani, Joanna C Porter, John R Hurst","doi":"10.1183/16000617.0212-2025","DOIUrl":"10.1183/16000617.0212-2025","url":null,"abstract":"<p><strong>Introduction: </strong>COPD symptoms occur with day-to-day variation. An exacerbation of COPD is a symptom worsening that exceeds these fluctuations and requires systemic treatment. Differentiating the start of an exacerbation from day-to-day disease variation is an unmet research need. We sought to examine the evidence that monitoring daily variation in COPD can differentiate this from the onset of an exacerbation.</p><p><strong>Methods: </strong>A systematic review was conducted across MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, Institute of Electrical and Electronics Engineers and Cochrane databases, as well as a citation search, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies focused on monitoring daily symptoms and/or physiological parameters in stable COPD. Quality assessments were conducted using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Findings were qualitatively synthesised, considering essential components.</p><p><strong>Results: </strong>22 studies were included in the review. The definitions of exacerbation were diverse across studies. 14 (64%) of the included studies demonstrated that day-to-day variation in symptoms (<i>e.g.</i> Chronic Airways Assessment Test score), vital signs (heart rate, respiratory rate and peripheral oxygen saturation) and lung function (peak expiratory flow, forced oscillatory technique), alone and in combination, showed promise in differentiating the onset of exacerbations. Daily monitoring provided earlier detection of exacerbation, up to 7 days before the day of onset. Baseline and threshold settings were identified as crucial factors. Continuous monitoring was more effective than once-daily assessments.</p><p><strong>Conclusion: </strong>This review summarises evidence on how day-to-day variation differs from the start of an exacerbation in COPD. The combination of continuous monitoring, reliable measurement tools and a refined algorithm, with personalised baseline and threshold values, yields promising results.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oscillometry for the diagnosis of asthma in children: a systematic review.","authors":"Senali Y Seneviratne, Saxon Law-Gleen, Jonathan Broomfield, Pip Divall, Pooja Devani, Francine M Ducharme, Erol A Gaillard","doi":"10.1183/16000617.0293-2025","DOIUrl":"10.1183/16000617.0293-2025","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing asthma in children and young people (CYP) remains challenging. Oscillometry is a promising tool and is feasible from 2 years of age. European Respiratory Society (ERS) technical standards and bronchodilator response (BDR) oscillometry thresholds have been published, but diagnostic accuracy is not established.</p><p><strong>Methods: </strong>We systematically reviewed studies comparing oscillometry and spirometry in CYP under investigation for asthma. Reference standards were positive BDR or positive methacholine challenge test (MCT). Primary aims were to investigate the sensitivity and specificity of current ERS oscillometry thresholds (>40% decrease in resistance at 5 Hz (<i>R</i> ₅), >50% increase in reactance at 5 Hz (<i>X</i> ₅) or >80% decrease in the area under the reactance curve); secondary aims were to identify oscillometry threshold values optimising both sensitivity and specificity.</p><p><strong>Results: </strong>11 studies were included; six (n=992 CYP) utilised BDR and five (n=531 CYP) MCT as reference standard. Meta-analysis was not possible due to heterogeneity of results reported. In two studies using current ERS BDR thresholds, zero sensitivity and high specificity (>85%) were observed. In weighted regression analyses of BDR studies, a 17.0% decrease in resistance at 5-6 Hz had sensitivity and specificity of 71.6% (95% CI 69.7-73.7%); a 20.2% increase in <i>X</i> ₅ had sensitivity and specificity of 68.6% (95% CI 66.6-70.8%). Similarly, 27.7% increase in <i>R</i> ₅ had sensitivity and specificity of 73.6% (95% CI 71.9-75.3%) for MCT.</p><p><strong>Conclusion: </strong>Currently recommended ERS thresholds for oscillometry BDR have low sensitivity. Proposed thresholds for defining positive BDR and MCT by oscillometry require prospective validation and adoption of standards for measuring and reporting oscillometry parameters in future diagnostic comparative studies.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of mechanical power in lung ventilation for the prevention of ventilator-induced lung injury: a narrative review.","authors":"Raman Pasledni, Tomasz Urbankowski, Marek Darowski","doi":"10.1183/16000617.0283-2025","DOIUrl":"10.1183/16000617.0283-2025","url":null,"abstract":"<p><p>Ventilator-induced lung injury continues to limit outcomes in patients with acute respiratory failure despite established lung-protective strategies.Mechanical power, the rate of energy transfer from the ventilator to the respiratory system, has emerged as an integrative index of ventilator-induced stress. Experimental studies indicate that cumulative and dissipated energy, rather than isolated pressures or volumes, drive lung injury. Observational and registry data consistently link higher mechanical power with increased mortality in acute respiratory distress syndrome and mixed intensive care unit populations, with thresholds of ∼16-18 J·min^-1 associated with increased risk. Normalised indices (<i>e.g.</i> mechanical power per predicted body weight or per compliance) often outperform absolute mechanical power as predictors of outcome. Strategies to minimise mechanical power include individualised positive end-expiratory pressure titration, driving pressure limitation, and an optimised respiratory rate. Complementing traditional physiological analysis, this review highlights the emerging role of technological integration, specifically closed-loop ventilation and artificial intelligence-driven prediction models, as essential tools to bridge the gap between theoretical mechanical power concepts and bedside application.Mechanical power provides a unifying physiological framework that integrates volume, pressure, flow and frequency into a single descriptive measure of ventilatory load. While higher mechanical power is consistently associated with worse outcomes, current evidence does not support titrating ventilation to pre-defined numerical power thresholds, and prospective randomised trials are required to determine whether mechanical power-informed strategies improve patient-centred outcomes. Mechanical power should therefore be regarded as a contextual physiological descriptor rather than a standalone therapeutic target.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations of emerging diaphragmatic ultrasound techniques for clinical practice: potential pitfalls and future challenges.","authors":"Haotian Zhao, Yaru Yan, Yi Liu, Li Li, Heling Zhao","doi":"10.1183/16000617.0277-2025","DOIUrl":"10.1183/16000617.0277-2025","url":null,"abstract":"","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchopulmonary dysplasia and extremely preterm birth: time for a broader perspective on long-term outcomes.","authors":"Luca Bonadies, Lorenzo Zanetto, Valentina Agnese Ferraro, Laura Moschino, Alberto Papi, Eugenio Baraldi","doi":"10.1183/16000617.0304-2025","DOIUrl":"10.1183/16000617.0304-2025","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia is a hallmark respiratory complication of prematurity and remains a major health determinant of individuals born very preterm. Its impact, however, extends far beyond the neonatal period and far beyond the lungs. Children, adolescents and adults born very preterm often follow diverse developmental trajectories that diverge from typical postnatal growth. These trajectories often display early airflow limitation, as well as features of increased cardiovascular vulnerability and altered multisystemic profiles. Although common respiratory labels such as asthma are often applied to these patients, evidence highlights distinct pathobiological mechanisms rooted in arrested alveolar and vascular growth, with a possible contribution from persistent airway inflammation and oxidative stress. Extrapulmonary involvement, including cardiovascular, neurodevelopmental, neurosensory, renal and metabolic domains, further shapes long-term outcomes and should be systematically integrated into long-term monitoring. Yet, despite improving survival and growing recognition of this multisystemic burden, current evidence remains insufficient to design a dedicated, holistic, multidisciplinary follow-up programme tailored to the diverse subgroups of preterm-born individuals. Increasing awareness among healthcare professionals of the long-term implications of prematurity is essential to ensure that these patients receive appropriate and coordinated attention. Emerging lines of research, spanning new preventive and therapeutic options, advanced imaging, mechanistic studies, and long-term cohort designs, hold promise in elucidating the biological determinants of disease. Integrating these insights into clinical pathways, together with sustained implementation of family-centred care models, will be crucial to optimise organ function trajectories, delay deterioration and ultimately improve the quality of life of the growing population of survivors of prematurity.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of respiratory viruses in stable and acute asthma: a systematic review and meta-analysis.","authors":"Sachin Ananth, Gioulinta S Alimani, Cristina Boccabella, Ekaterina Khaleva, Jan Hansel, Ran Wang, Graham Roberts, Chris Kosmidis, Apostolos Bossios, Jørgen Vestbo, Effie Papageorgiou, Nikolaos G Papadopoulos, Apostolos Beloukas, Alexander G Mathioudakis","doi":"10.1183/16000617.0179-2025","DOIUrl":"10.1183/16000617.0179-2025","url":null,"abstract":"<p><strong>Background: </strong>Respiratory viruses, frequently detected in asthma, are associated with worse outcomes. This meta-analysis systematically quantifies the prevalence of respiratory viruses in stable and acute asthma, across children and adults, and explores factors associated with increased viral burden through meta-regression.</p><p><strong>Methods: </strong>This prospectively registered meta-analysis (PROSPERO-CRD42023375108) included studies employing molecular techniques to assess respiratory virus prevalence in asthma. Three databases were searched in August 2024. Risk of bias and certainty of evidence were assessed. We performed random-effects meta-analysis of proportions.</p><p><strong>Results: </strong>We included 111 eligible studies. Moderate-certainty evidence indicated a pooled prevalence of any respiratory virus of 33.9% (95% confidence interval 24.8-43.7%) in children and 23.0% (12.9-35.0%) in adults with stable asthma. In acute asthma, prevalence increased to 58.8% (52.5-65.0%) in children and 49.9% (41.2-58.5%) in adults (moderate certainty). Rhinovirus was the most frequently identified virus, especially in acute asthma (45.0% in children <i>versus</i> 21.2% in adults). Respiratory syncytial virus and bocavirus were more common in younger children, while coronavirus and influenza were more frequently detected in adults; respiratory syncytial virus peaked in older adults too. A higher prevalence of influenza virus B and adenovirus in children, and of influenza virus A and parainfluenza 2 in adults with severe <i>versus</i> non-severe acute asthma suggests a potential association with more severe acute attacks.</p><p><strong>Conclusion: </strong>Respiratory viruses are common in both stable and acute asthma. This suggests that the diagnostic value of a positive viral test during acute episodes may be limited and could benefit from complementary biomarkers to improve interpretation.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between inhaled corticosteroids and risk of cardiovascular mortality in patients with COPD: a systematic review and meta-analysis.","authors":"Ming-Jin Yang, Yan Zhang, Hai-Yun Dai, Wei He, Xue-Mei Ying, Xing-Xing Jin, Shu-Liang Guo, Don D Sin","doi":"10.1183/16000617.0254-2025","DOIUrl":"10.1183/16000617.0254-2025","url":null,"abstract":"<p><strong>Background: </strong>COPD frequently coexists with cardiovascular diseases. Cardiovascular death is also a major contributor to mortality in COPD patients. Inhaled corticosteroids (ICS), as the most commonly prescribed inhaled anti-inflammatory medications, have been widely used for management of COPD patients who experience frequent exacerbations. However, whether ICS have a cardiovascular protective effect remains unclear. The purpose of this work was to comprehensively ascertain the risks of cardiovascular deaths related to ICS in COPD patients.</p><p><strong>Methods: </strong>PubMed, the Cochrane Library and Embase were searched to screen qualifying articles from September to November 2022. An updated search was conducted in October 2025. We identified trials of any ICS for treatment of COPD and reported on cardiovascular deaths. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. The primary end-point was cardiovascular mortality.</p><p><strong>Findings: </strong>35 randomised controlled trials enrolling 74 004 subjects were analysed. Inhaled formulations containing ICS significantly reduced the risk of cardiovascular deaths compared with inhaled formulations without ICS (risk ratio 0.84, 95% CI 0.74-0.95). ICS/long-acting muscarinic antagonist (LAMA)/long-acting β₂-agonist (LABA) significantly reduced the risk of cardiovascular deaths compared with dual LAMA/LABA therapy (risk ratio 0.56, 95% CI 0.37-0.86). ICS monotherapy also significantly reduced the risk of cardiovascular deaths compared with placebo (risk ratio 0.81, 95% CI 0.66-0.99). However, ICS/LABA did not significantly reduce the risk of cardiovascular deaths compared to LABA monotherapy (risk ratio 0.98, 95% CI 0.80-1.20).</p><p><strong>Conclusions: </strong>Inhaled formulations containing ICS are associated with a reduced risk of cardiovascular deaths in patients with COPD.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunological mechanisms and therapeutic approaches in pulmonary fibrosis.","authors":"Laurine M Nell, Rudi W Hendriks, Marlies S Wijsenbeek, Odilia B J Corneth, Thomas Koudstaal","doi":"10.1183/16000617.0227-2025","DOIUrl":"10.1183/16000617.0227-2025","url":null,"abstract":"<p><p>Pulmonary fibrosis (PF), the irreversible scarring of the lungs in many interstitial lung diseases, remains fatal despite currently approved antifibrotic therapy. Converging evidence shows that dysregulated innate and adaptive immunity orchestrates every stage of the fibrotic cascade. Roughly 20% of PF susceptibility loci map to immune regulatory genes, including Toll-interacting protein, interleukin (IL)-1 receptor antagonist, Toll-like receptor-3, complement receptor-1 and tumour necrosis factor-α (TNF-α), indicating that genetically primed host defence pathways predispose to maladaptive repair. Recurrent epithelial injury triggers a type 1 inflammatory response that gradually shifts toward type 2-skewed wound healing; the resulting cytokine milieu rich in transforming growth factor-β, IL-13, IL-6 and platelet-derived growth factor reprogrammes fibroblasts into collagen-secreting myofibroblasts. Spatial-omic profiling of PF lungs corroborates this model, revealing niches where profibrotic macrophages, T-helper cells and inflammatory fibroblasts colocalise within a stiff, collagen-rich matrix. Beyond their direct antimesenchymal actions, the current therapeutics pirfenidone and nintedanib also temper innate and adaptive immune signalling. Proof of concept for sharper immunomodulation now comes from recent phase III trials of nerandomilast, a highly selective phosphodiesterase-4B inhibitor that preserved forced vital capacity and downregulated TNF-α, IL-6 and IL-17 networks. These results demonstrate that immune pathway modulation can complement existing antifibrotics and invigorate efforts to align mechanism-based therapies with patient-specific immune endotypes, steered by genetics, cellular phenotypes and circulating biomarkers. This review synthesises current understanding of how immunity initiates, amplifies and perpetuates PF, linking genetic and mechanistic insights to emerging therapeutic opportunities. A deeper grasp of immune-epithelial-fibroblast crosstalk is essential for transforming disease-slowing care into genuinely disease-modifying intervention.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"35 180","pages":""},"PeriodicalIF":10.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}