Indian Journal of Endocrinology and Metabolism最新文献

{"title":"Comparison of the Clinical and Biochemical Parameters Between Cystic and Non-Cystic Pheochromocytoma.","authors":"Somdatta Giri, Aravind Prasad, Bandna Kumari, Kodakkattil S Sreerag, Sidhartha Kalra, G Ramkumar, Nandini Pandit, Jayaprakash Sahoo, Sadish K Kamalanathan, Dukhabandhu Naik, Samim A Mondal","doi":"10.4103/ijem.ijem_114_26","DOIUrl":"10.4103/ijem.ijem_114_26","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited literature studies and awareness regarding the clinical and biochemical characteristics specific to cystic pheochromocytomas. This study aims to comprehensively assess clinical and biochemical characteristics of cystic pheochromocytomas and compare them with non-cystic counterparts.</p><p><strong>Methods: </strong>Based on pre-operative computed tomography (CT) imaging, patients were divided into two groups. Group 1 comprised patients with predominantly cystic pheochromocytoma, defined by the presence of >50% cystic component within the tumour volume. Group 2 included patients with non-cystic pheochromocytoma.</p><p><strong>Results: </strong>A total of 46 patients with histopathologically confirmed pheochromocytoma were analysed, of which 8 (17.4%) were cystic and 38 (82.6%) were non-cystic. There were no differences in demographic and clinical parameters between the two groups. However, patients with cystic tumours had significantly lower prevalence of elevated plasma normetanephrine levels (37.5% vs. 85.7%, <i>P</i> = 0.005), suggesting a lower catecholamine secretory burden. Cystic pheochromocytoma more frequently occurred on the left side (85.7% vs. 29.4%, <i>P</i> = 0.03) and had lower baseline CT attenuation than non-cystic pheochromocytoma (31.3 ± 8.2 vs. 39.25 ± 7.6, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>Cystic pheochromocytomas may represent a distinct subtype with lower biochemical activity. Their identification requires careful radiological assessment, especially in biochemically negative patients. Enhanced awareness of their characteristics may improve diagnosis and optimise surgical outcomes.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"346-351"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Health and Psychological Wellbeing in Turner Syndrome: A Tertiary Healthcare Centre Experience from North India.","authors":"Umesh K Sah, Siddhnath Sudhanshu, Amita Moirangthem, Preeti Dabadghao, Vijayalakshmi Bhatia","doi":"10.4103/ijem.ijem_872_25","DOIUrl":"10.4103/ijem.ijem_872_25","url":null,"abstract":"<p><strong>Introduction: </strong>There is a paucity of data in literature on assessment of bone health and psychological health among Turner syndrome (TS) from India and worldwide. Delayed detection and management may have long-term adverse effects on bone and psychological health in TS.</p><p><strong>Methods: </strong>Karyotype proven TS (n: 67) attending the endocrinology outpatient department were included. Bone mineral density was performed by DXA scan. Psychological assessment using GAD7 (Anxiety) and PHQ9 (Depression) questionnaire was done and compared with healthy and type 1 diabetes controls.</p><p><strong>Results: </strong>Height-age unadjusted low areal bone mineral density (aBMD; Z score ≤-2.0) was found in 61% of all TS subjects. Height-age adjustment for aBMD in subjects with age ≤20 years reduced low aBMD Z-score frequency from 52% to 12%. The patients with menarche or oestrogen replacement for >2 years had a significantly higher bone mineral apparent density (BMAD) compared to prepubertal or patients with hormone replacement therapy for less than 2 years [mean (sd) at spine; 0.243 (0.03) <i>vs</i>. 0.21 (0.02) gm/cm³; <i>P</i> = 0.03]. Mild to severe anxiety and depression in TS subjects was significantly higher than that in healthy controls (<i>P</i> = 0.038 and <i>P</i> = 0.007) but not different than that in type 1 diabetic controls.</p><p><strong>Conclusion: </strong>Low bone mineral density is a frequent finding in TS, especially with advancing age. Height-age adjustment for aBMD Z-score should be done for younger patients. Timely and appropriate oestrogen therapy can maintain appropriate bone health. Anxiety and depression were often unnoticed but were present in a significant number of patients.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"352-356"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Dapagliflozin vs. Saroglitazar on Hepatic Steatosis and Fibrosis in Patients of Type 2 Diabetes Mellitus and Metabolic-Associated Steatotic Liver Disease (MASLD).","authors":"Bijay K Das, Sambit Das, Dayanidhi Meher, Arun K Choudhury, Sourav Padhee, Sandeep K Sahu, Devadarshini Sahoo, Binod Prusty, Vishal Agarwal","doi":"10.4103/ijem.ijem_848_25","DOIUrl":"10.4103/ijem.ijem_848_25","url":null,"abstract":"<p><strong>Introduction: </strong>There is a rising prevalence of metabolic-associated steatotic liver disease (MASLD), particularly in patients with type 2 diabetes mellitus, which needs early detection and treatment to prevent the grave outcomes. Dapagliflozin and Saroglitazar are known to improve metabolic and liver health in patients with type 2 diabetes mellitus.</p><p><strong>Methods: </strong>Our study was a randomised, controlled, open-label, parallel trial of 101 patients with T2DM and MASLD. Patients were randomly assigned to receive Dapagliflozin 10 mg or Saroglitazar 4 mg on top of standard diabetes care. The primary endpoints were changes in hepatic steatosis and fibrosis (FIB) as estimated by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) using FibroScan, respectively. The secondary endpoints were changes in anthropometric parameters, glycemic parameters, lipid profiles, transaminases, and FIB scores, which were monitored at baseline, 3 months, and 6 months.</p><p><strong>Results: </strong>At the end of 6 months of study, both cohorts resulted in significant clinical benefits. Comparison between the two cohorts revealed no significant statistical difference between the two groups regarding their impact on the primary endpoints (CAP and LSM). Minimal but statistically significant intergroup differences were noted only for BMI (<i>P</i> = 0.033) and LDL cholesterol (<i>P</i> = 0.020) in the Dapagliflozin cohort and alanine transaminase levels (<i>P</i> = 0.037) in the Saroglitazar cohort.</p><p><strong>Conclusion: </strong>Both Dapagliflozin and Saroglitazar are potent therapeutic options in patients with type 2 diabetes mellitus who also have MASLD.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"306-312"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Cell-Free DNA as Predictor of Progression of Kidney Disease in Diabetes: A Single-Center Prospective Study.","authors":"Jatin K Majhi, Padala R Kumar, Deepak K Dash, Debasish Patro, Bhabani S Dhal, Bandana Dash, Pradosh K Sahu","doi":"10.4103/ijem.ijem_250_25","DOIUrl":"10.4103/ijem.ijem_250_25","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease with significant variability in progression among individuals. Identifying reliable biomarkers to predict DKD progression remains a critical unmet need. This study aimed to evaluate the role of cell-free DNA (cfDNA) as a biomarker for predicting the progression of DKD in patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>In this prospective study, T2DM patients aged 18-80 years with DKD (estimated glomerular filtration rate [eGFR] 20-60 ml/min/1.73 m² and/or urinary albumin-to-creatinine ratio (UACR) 30-300 mg/gm) were recruited and were followed every 6 months for 18 months. Progression was defined as a ≥20% decline in eGFR and/or UACR > 300 mg/gm. Baseline cfDNA was retrospectively analyzed for progression of DKD. Multiple logistic regression analysis was performed to explore the association between cfDNA and the progression of DKD by adjusting in different models.</p><p><strong>Results: </strong>Out of 154 T2DM patients with DKD, 140 participants completed the study and progression was found to be in 63 (45%) of patients. Median baseline cfDNA levels were significantly higher in the progressive group than in the nonprogressive group (197.23 ng/ml vs. 138.79 ng/ml, <i>P</i> = 0.008). cfDNA was found to be an independent predictor of DKD progression (odds ratio 1.004; 95% confidence interval: 1.001-1.006; <i>P</i> = 0.005). The optimal cfDNA cut-off (247.27 ng/ml) showed 44.4% sensitivity and 85.7% specificity for predicting progression of DKD.</p><p><strong>Conclusion: </strong>cfDNA independently predicts DKD progression in T2DM patients. However, future large-scale, long-term studies are necessary to validate these findings for clinical application.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"328-334"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of First-Year Growth Velocity Response to Growth Hormone Therapy in Patients with Growth Hormone Deficiency.","authors":"Ravindranath K Reddy, Manasvini Bhatt, Vanshja Pandit, Aashima D Gupta, Rahul Gupta, Viveka P Jyotsna, Rajesh Khadgawat","doi":"10.4103/ijem.ijem_1005_25","DOIUrl":"10.4103/ijem.ijem_1005_25","url":null,"abstract":"<p><strong>Introduction: </strong>First-year growth response to biosynthetic growth hormone (GH) largely varies between populations. We aimed to predict first-year growth response to growth hormone replacement therapy (GHRT) in children with growth hormone deficiency (GHD).</p><p><strong>Methods: </strong>Growth response during the first year of GHRT was determined for both prepubertal and peripubertal children with congenital isolated GHD. The diagnosis of GHD was made using a standard work-up plan. Subjects with acquired causes of GHD were excluded. GHRT was started as per standard treatment guidelines. A predictive growth model based on these variables was derived from the analysis for the first-year growth response.</p><p><strong>Results: </strong>A total of 107 children with congenital GHD were studied (70 prepubertal; 37 peripubertal). The age at initiation of GHRT was 11.36 ± 3.83 years. In the prepubertal group, age at baseline and differences between mid-parental height (MPH; MPH-standard deviation score [SDS] and height-SDS) were significant predictors of first-year growth velocity response. The first-year height velocity was 11.12 ± 3.62 cm. Prediction formula for prepubertal group is as follows: first-year growth velocity = 10.24 + 1.27*(difference between MPH-SDS and height-SDS) -0.27* Age. In peripubertal children with GHD, gender, mother's height, and the difference between MPH-SDS and height-SDS were important predictors of first-year growth velocity. The first-year height velocity was 8.85 ± 2.84 cm. Prediction formula for the peripubertal group is as follows: 14.09 + 0.69*(difference between MPH-SDS and height-SDS) + 0.16*Mother height-2.51*gender.</p><p><strong>Conclusion: </strong>This model is an accurate and practicable tool to predict first-year growth response in GHD children in the Indian subcontinent.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"335-339"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Age in Endocrinology - Part 1: Methods of Bone Age Assessment.","authors":"Kiran K Golla, Eram Nahid, Rajesh Khadgawat","doi":"10.4103/ijem.ijem_653_25","DOIUrl":"10.4103/ijem.ijem_653_25","url":null,"abstract":"<p><p>Bone age assessment is an essential competency for endocrinology residents, guiding the diagnosis and management of growth disorders, pubertal abnormalities and endocrine conditions. This review is presented in two parts: Part 1 focuses on the methods of bone age assessment, while Part 2 addresses its clinical utility and applications. The Greulich and Pyle (G&P) atlas is widely used for its simplicity, while the Tanner-Whitehouse (TW) method offers a more detailed, scoring-based approach but requires more time. In younger children, proximal ossification centres are more informative, whereas distal centres are more informative in older adolescents. TW3 generally estimates slightly younger ages than TW2, and G&P tends to score younger than TW2. Emerging tools-such as automated image analysis, content-based image retrieval and ultrasonography-promise efficiency gains but face challenges of operator dependence and variable reliability. Advances like BoneXpert have improved standardization and reproducibility, yet traditional G&P and TW methods remain central in endocrine practice due to their accessibility, validated references and widespread familiarity.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"274-279"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusion of Pharmacologists as Authors in Clinical Guidelines and/or Consensus Statements.","authors":"Anant Patil","doi":"10.4103/ijem.ijem_516_26","DOIUrl":"10.4103/ijem.ijem_516_26","url":null,"abstract":"","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"369-370"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity and Osteoporotic Fractures: Solving the Paradox.","authors":"Khushboo Agarwal, Shinjan Patra","doi":"10.4103/ijem.ijem_818_25","DOIUrl":"10.4103/ijem.ijem_818_25","url":null,"abstract":"<p><p>Obesity is a global health issue linked to conditions like metabolic syndrome and heart disease, but its relationship with fracture risk is complex. While higher body mass index (BMI) is associated with increased bone mineral density (BMD) due to mechanical loading, it does not uniformly protect against fractures. Obese individuals face higher risks of proximal humerus and ankle fractures, along with propensity for increased falls and sarcopenic obesity. Higher fat mass, particularly visceral adiposity, correlates with lower bone quality and increased fracture risk, independent of BMD. Obesity triggers inflammatory pathways (e.g., TNF-α, Monocyte Chemotactic Protein-1 [MCP-1]) and adipokine imbalances (e.g., adiponectin, leptin), impairing bone formation and resorption. Vitamin D deficiency and secondary hyperparathyroidism further exacerbate cortical bone loss. Diagnostic challenges arise as dual-energy X-ray absorptiometry and FRAX tools may underestimate fracture risk in obesity. Preventive strategies emphasize lifestyle interventions, including moderate weight loss targeting subcutaneous fat, resistance training, and optimal dairy intake to enhance BMD.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"297-301"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin Resistance and Beta Cell Function in Hepatogenous Diabetes.","authors":"Kirandeep Kaur, Anand Sharma, Gourab Bhaduri, Ch Jagapathi Babu, Aneesa A Mirza, Yogesh Bahurupi, Kalyani Sridharan","doi":"10.4103/ijem.ijem_863_25","DOIUrl":"10.4103/ijem.ijem_863_25","url":null,"abstract":"<p><strong>Introduction: </strong>The present study aimed to examine the change in beta cell function and insulin resistance (IR) over 6 months in patients with liver cirrhosis (LC) and hepatogenous diabetes (HD) and to assess their correlation with liver disease severity.</p><p><strong>Methods: </strong>One hundred and seventy-three patients with LC without a prior history/risk factors of type 2 diabetes mellitus and with non-diabetic fasting blood glucose and glycated haemoglobin were subjected to a 75-g oral glucose tolerance test (OGTT). Those with 2-h plasma glucose ≥140 mg/dl were categorised as having HD. Plasma insulin and glucose were analysed during OGTT. Indices for IR and beta cell function, such as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), oral glucose sensitivity index - 3 h (OGIS-3h) and insulinogenic index (IGI) were examined at baseline and repeated after a 6-month follow-up.</p><p><strong>Results: </strong>HD was detected in 65.8% (114/173) of the study cohort. Eighty-nine patients were recruited to the study, and 40 were available for follow-up. The majority (89.8%) were males with a mean body mass index of 23 ± 4.1 kg/m². Alcohol was the most common cause of LC (76.4%), and most (84.3%) belonged to Child-Turcot-Pugh (CTP) classes B and C. Plasma fasting insulin and HOMA-IR values were significantly higher in higher CTP classes and worsened at the 6-month follow-up. Peripheral insulin sensitivity measured by OGIS-3h was significantly worse in patients with a worse Model for End-Stage Liver Disease value at baseline but did not change during follow-up. Beta cell function measured by IGI was neither different across CTP classes at baseline nor changed during follow-up.</p><p><strong>Conclusion: </strong>Peripheral hyperinsulinaemia and IR, rather than beta cell dysfunction, predominate in patients with LC and glucose abnormalities on OGTT and worsen with worsening liver dysfunction.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"320-327"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth Outcomes and Safety of Recombinant Growth Hormone in Noonan Syndrome: A Systematic Review and Meta-Analysis.","authors":"Sweekruti Jena, Deep Dutta, Brijesh Krishnappa, Pooja Tiwari, Radhika Jindal","doi":"10.4103/ijem.ijem_49_26","DOIUrl":"10.4103/ijem.ijem_49_26","url":null,"abstract":"<p><p>Noonan syndrome (NS), a RASopathy marked by partial resistance within the GH-IGF-1 axis, is characterised by short stature. Although growth hormone is commonly prescribed, there is a gap in data on long-term efficacy and safety profile. The objective of this study was to assess the long-term growth response and safety profile of recombinant human growth hormone (rhGH) therapy in children with NS. Randomised and observational studies reporting height outcomes in children with NS treated with rhGH were included. Thirty-nine studies, including 3167 patients, were analysed. At baseline, children had marked growth impairment [mean height standard deviation score (SDS) -2.95]. After 1 year of therapy, height SDS increased significantly (mean change +1.16). rhGH therapy leads to meaningful and sustained improvements in linear growth in children with NS without major safety concerns. Early initiation and continuation of therapy, alongside regular cardiac monitoring, should be considered in clinical practice.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"30 4","pages":"280-288"},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}