Indian Journal of Endocrinology and Metabolism最新文献

{"title":"ESI Clinical Practice Guidelines for the Evaluation and Management of Obesity in India - An Update (2025).","authors":"Sri Venkata Madhu, Nitin Kapoor, Sambit Das, Nishant Raizada, Sanjay Kalra","doi":"10.4103/ijem.ijem_680_25","DOIUrl":"10.4103/ijem.ijem_680_25","url":null,"abstract":"","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"355-365"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015045","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":"Inherited, Non-CAH Primary Adrenal Insufficiency in Children: A Genetic and Clinical Profile from a Tertiary Care Centre.","authors":"Anand Sheya, Gogineni S Namratha, Shriraam Mahadevan, Adlyne R Ashirvatham, Asha Ranjan","doi":"10.4103/ijem.ijem_22_25","DOIUrl":"10.4103/ijem.ijem_22_25","url":null,"abstract":"<p><strong>Introduction: </strong>Primary adrenal insufficiency (PAI) results from inadequate adrenal hormone production due to adrenal cortex dysfunction. While congenital adrenal hyperplasia (CAH) is the most common cause in children, non-CAH causes are rare and often associated with specific genetic mutations. This study aims to explore the genetic, clinical, and biochemical spectrum of non-CAH PAI in South Indian children.</p><p><strong>Methods: </strong>This retrospective study reviewed records of children under 18 years diagnosed with PAI at a tertiary care centre between January 2016 and December 2023. Data on clinical presentation, biochemical parameters, genetic findings, and treatment responses were analysed.</p><p><strong>Results: </strong>Twelve patients (11 index) (7 males, 5 females) with non-CAH PAI were identified, with a median age of 2.5 years at diagnosis. Common symptoms included hyperpigmentation (100%), recurrent infections, gastrointestinal issues, and growth delays. Genetic analysis identified seven distinct mutations: <i>AAAS, MC2R, ABCD1, CYP11A1, NNT, NROB1, and TXNRD2</i>. All 12 patients were initiated on glucocorticoids, and six were also initiated on fludrocortisone.</p><p><strong>Conclusion: </strong>This study highlights the genetic and clinical spectrum of non-CAH PAI in South India, emphasising the importance of early diagnosis and genetic profiling. The findings suggest a high prevalence of consanguinity and specific mutations, underscoring the need for genetic testing in resource-limited settings. Future research should focus on expanding genetic databases and evaluating long-term outcomes to refine treatment strategies and improve patient care.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"440-445"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015031","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":"Assessment of Cardiovascular Risks by CT-Derived Calcium Scoring and FGF-23 in Patients with Renal Hyperparathyroidism Undergoing Near-Total Parathyroidectomy and Cinacalcet Therapy: A Prospective Pilot Study.","authors":"Anirudh J Shetty, Manphool Singhal, Raja Ramachandran, Kathirvel Soundappan, Sanjay K Bhadada, Anand Sudhayakumar","doi":"10.4103/ijem.ijem_502_24","DOIUrl":"10.4103/ijem.ijem_502_24","url":null,"abstract":"<p><strong>Introduction: </strong>Near-total parathyroidectomy (NPTX) could provide persistent improvements in dysregulated mineral metabolism, leading to a reduction in all-cause and cardiovascular (CV) mortality by reducing coronary artery calcium score (CACS) in refractory secondary hyperparathyroidism (SHPT). In this study, we have attempted to compare the effect of NPTX and cinacalcet therapy in patients with refractory SHPT on dialysis, with regard to their effects on CACS and FGF-23.</p><p><strong>Methods: </strong>A total of 14 patients with refractory SHPT were followed prospectively. Five patients were enrolled in the NPTX arm and nine in the cinacalcet arm. Demographics, CACS, biochemical, and hormonal analysis were performed at baseline with a planned follow-up of 1 year.</p><p><strong>Results: </strong>The NPTX group showed a more favourable change in total calcification score over 1 year compared to the cinacalcet group, with a mean difference of 625.6 units. After NPTX, CACS was stable or reduced (<15% per year increase in CACS) in four of five (80%) patients. In the cinacalcet group, for those with a very severe baseline CACS (>400), there was a progression in the CACS. In the NPTX group, iPTH and FGF 23 reduced significantly after 1 year with an iPTH of 58.00 (8.5-76) pg/mL (<i>P</i> < 0.001) and FGF 23 of 5.4 (5.4-7.9) pg/mL (<i>P</i> < 0.04), respectively.</p><p><strong>Conclusion: </strong>NTPTX resulted in amelioration of dysregulated mineral metabolism, leading to reduction or stabilization of CACS. There was also a marked reduction in FGF-23 levels following NPTX, which may be the principal factor in preventing the progression of CACS.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"446-452"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015102","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":"Endocrine Adverse Events of Immune Checkpoint Inhibitors: A Comprehensive Review.","authors":"Remya Rajan, Devika Nandakumar","doi":"10.4103/ijem.ijem_47_25","DOIUrl":"10.4103/ijem.ijem_47_25","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy by enhancing T-cell-mediated tumour eradication. However, their use is associated with immune-related adverse events, with endocrinopathies being the most common. Thyroid dysfunction, hypophysitis, primary adrenal insufficiency (PAI), and insulin-dependent diabetes mellitus are well-documented complications. Thyroid dysfunction typically follows a biphasic course, with transient thyrotoxicosis progressing to hypothyroidism. Hypophysitis primarily affects the anterior pituitary, often leading to isolated adrenocorticotropic hormone deficiency. ICI-induced diabetes mellitus results from autoimmune β-cell destruction, frequently presenting as diabetic ketoacidosis. Primary adrenal insufficiency is rare but requires prompt recognition. Despite these endocrine toxicities, the benefits of ICIs outweigh their risks, and treatment is usually continued with appropriate hormone replacement. Early recognition and management of these endocrinopathies are crucial for optimising patient outcomes. This review summarises the incidence, pathophysiology, diagnosis, and management of ICI-associated endocrine disorders, providing essential insights for oncologists and endocrinologists.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"408-413"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015096","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":"Assessment of the Relationship of Cationic Trypsinogen (PRSS1) Gene Polymorphism with Prediabetes and Type 2 Diabetes in the Bangladeshi Population.","authors":"Ramendu Parial, Ayesha Siddika, Md Maruf H Chowdhury, Manisha Das","doi":"10.4103/ijem.ijem_546_24","DOIUrl":"10.4103/ijem.ijem_546_24","url":null,"abstract":"<p><strong>Introduction: </strong>Cationic trypsinogen (<i>PRSS1</i>) gene mutation is responsible for hereditary pancreatitis (HP) with clinical outcomes like abdominal pain, diabetes mellitus and pancreatic cancer. The present study aims to screen <i>PRSS1</i> (<i>A16V, R122C and R122H</i>) gene polymorphism in the Bangladeshi population, categorized as normal glucose tolerant (NGT), prediabetes (PD) and type 2 diabetes (T2D).</p><p><strong>Methods: </strong>Blood was collected from the study subjects with overnight fasting (8-10 h), and 2 h after 75 g glucose intake orally. Serum was used for biochemical analyses, and whole blood for genetic analysis. Biochemical parameters were measured following a standard procedure. Anthropometric, clinical and biochemical abnormalities were defined and classified as per World Health Organization (WHO) guidelines for the population from Asia. Genetic analysis was done following the polymerase chain reaction-restriction fragment length polymorphism method standardized in our laboratory. Data were analyzed with the SPSS Software (version 22), IBM Corporation, USA.</p><p><strong>Results: </strong>For the <i>PRSS1</i> genotype, a total of 559 subjects were screened. R122H and R122C variant genotypes were absent in all subjects' categories. However, three heterozygous variant genotypes A16V (1.3%) in the trypsinogen gene were found in the NGT subjects group. Abdominal pain in the subjects was significantly higher in the A16V variant genotype compared to subjects with no abdominal pain (Fisher's exact/<i>P</i>, 7.256/0.027). A significant positive correlation was observed with the <i>A16V</i> genotype for the abdominal pain (<i>P</i> = 0.008) and DBP (<i>P</i> = 0.026) of the study subjects.</p><p><strong>Conclusion: </strong><i>PRSS1 A16V, R122C</i> and <i>R122H</i> variants have no relationship with prediabetic and/or type 2 diabetic subjects of Bangladesh. However, abdominal pain was significantly related to the <i>PRSS1</i> A16V variant.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"472-477"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015019","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":"Role of T3 in Management of Hypothyroidism.","authors":"Sanjay Kalra, Ambrish Mithal, Subhash K Wangnoo, Krishna Seshadri, Mala Dharmalingnam","doi":"10.4103/ijem.ijem_294_24","DOIUrl":"10.4103/ijem.ijem_294_24","url":null,"abstract":"<p><p>The management of hypothyroidism is based on the assumption that levothyroxine monotherapy normalizes thyroid hormone homeostasis, rendering patients clinically and biochemically euthyroid. However, a subset of patients treated with levothyroxine (LT4) are dissatisfied as they continue to have symptoms such as fatigue, weight gain, and difficulty in concentration. Some patients do not achieve normalization of thyroid-stimulating hormone despite adherence to adequate LT4 dosing. It has been proposed that liothyronine (LT3) may benefit such patients. This review addresses the specific role of LT3 in the management of hypothyroidism with an emphasis on practical considerations and a focus on appropriate patient selection. It identifies clinical challenges where patient outcomes are improved by adding LT3 to LT4 therapy, including myxedema coma, preoperative management, and situations where swift resolution of hypothyroidism is warranted. Further, it addresses the challenges faced in dose titration of LT4 and LT3 and the importance of monitoring therapy with LT3.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"402-407"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015038","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":"Deciphering Bone Microarchitecture in Diabetic Charcot Neuroarthropathy of Foot: A Case Control Study.","authors":"Raveena Singh, Ashu Rastogi, Subashini H Kumar, Uttam C Saini, Srinivas Seshabhattaru, Rajesh Kesavan, Uma N Saikia","doi":"10.4103/ijem.ijem_51_25","DOIUrl":"10.4103/ijem.ijem_51_25","url":null,"abstract":"<p><strong>Introduction: </strong>Charcot neuroarthropathy (CNO) of foot characterised by an increased bone turnover denoted by serological markers of bone resorption. However, histological characteristics of foot bones in people with CNO are not well elucidated.</p><p><strong>Methods: </strong>The foot bone samples were collected from patients who had either surgical reconstruction or below-knee amputations for chronic CNO foot (<i>n</i> = 10, Group A), unsalvageable diabetic foot ulcer (<i>n</i> = 16, Group B), and non-diabetic healthy controls following road traffic accident (<i>n</i> = 16, group C). Calcaneum bones retrieved were processed and sections (Haemotoxylin and Eosin, Masson-Goldner stain) evaluated for quantitative histopathological parameters including bony trabeculae number, trabeculae thinning, osteoclast number, Howship's lacunae, and Haversian canal.</p><p><strong>Results: </strong>The mean age of participants in the CNO group was 61.6 ± 5.0 and 62.9 ± 6.5 years in diabetic neuropathy group with duration of diabetes 13.1 ± 6.8 and 14.1 ± 9.1 years with HbA1c of 7.6 ± 1.8% and 8.7 ± 2.6 in group A and B, respectively. We observed that normal bone trabeculae were 15% (10-37.5) in group A and 60% (47.5-82.5) in group B as compared to controls (<i>P</i> = <0.001). Thin bone trabeculae (%) were observed in 10% (3.5-77.5) and 7.5% (0-30), <i>P</i> =<0.001), with increased Howship's lacunae number (1.5 [0.25-2] and 1 [0-2.25] (<i>P</i> = <0.001)) and increased osteoclast number in group A and B as compared to healthy controls.</p><p><strong>Conclusions: </strong>There is an increased bone resorption in CNO causing thinning of bone trabeculae secondary to increased osteoclast numbers and Howship's lacunae in CNO of foot. Anti-resorptive therapies that target osteoclast activity may be an appealing treatment option for diabetic CNO of foot.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"465-471"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015070","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":"Clinical Profile and Treatment Outcomes of Tumour-Induced Osteomalacia - A Single-Centre Experience.","authors":"Prashiddha Dhakal, Alpesh Goyal, Viveka P Jyotsna, Ashutosh K Arya, Devasenathipathy Kandasamy, Shipra Agarwal, Madhvi Tripathi, Mani Kalaivani, Rajesh Khadgawat, Nikhil Tandon","doi":"10.4103/ijem.ijem_43_25","DOIUrl":"10.4103/ijem.ijem_43_25","url":null,"abstract":"<p><strong>Introduction: </strong>Tumour-induced osteomalacia (TIO) is rare. At our referral centre, we see a substantial number of TIO. Therefore, we planned to study their profile and treatment outcomes to provide insight in management.</p><p><strong>Methods: </strong>This ambispective study evaluated 43 patients with TIO treated at our centre (2014-2024). Patients were grouped into (a) Localised TIO (<i>n</i> = 31; histopathology suggesting phosphaturic mesenchymal tumour or disease remission and (b) Unlocalised TIO (<i>n</i> = 12; occult tumour and negative genetic testing for hereditory hypophosphatemic disorders).</p><p><strong>Results: </strong>The mean age of participants was 40.9 ± 13.4 years. The median diagnostic delay was 3 years from symptom onset. Bone pain, muscle weakness, fractures, teeth loss, and palpable lump were presenting features. Two had intact fibroblast growth factor 23 (iFGF23) in normal range. No significant clinical bias existed between tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) calculated using second void urine and 24-h urine samples. The most common location was lower limbs (41.9%), followed by head and neck (32.3%). Tracer avid lesions on Ga-68-DOTANOC-positron emission tomography/computed tomography (PET/CT) were noted in 30/43 (69.8%) patients. Of the 13 patients negative on somatostatin receptor-based imaging, only one showed tracer avid lesion on F-18-fluorodeoxyglucose-PET/CT scan. Disease remission was documented in 19/24 (79.2%) patients undergoing surgical excision and 1/5 (20%) treated with radiofrequency ablation. After successful intervention, plasma iFGF23 levels normalised by Day-3, tubular reabsorption of phosphate and TmP/GFR by Day-4, and serum phosphate by Day-7. No patient with remission experienced relapse at a median follow-up of 4.25 years.</p><p><strong>Conclusion: </strong>Ga-68-DOTANOC-PET/CT picked up maximum lesions, F-18-FDG-PET/CT picked up one additional lesion. Surgery was curative in most. Post successful intervention, iFGF23 normalised in all by the third day.</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"414-422"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015098","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":"The Prediabetes Wake-Up Call: Time for Proactive Endocrine Care.","authors":"Ganapathi Bantwal, Manasa Mudalagiri","doi":"10.4103/ijem.ijem_780_25","DOIUrl":"10.4103/ijem.ijem_780_25","url":null,"abstract":"","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"351-354"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015012","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":"Trimester-Specific Reference Range for Thyroid Function Tests (TFTs) in Normal Pregnant Women at a Tertiary Care Centre.","authors":"Deepak K Dash, Padala R Kumar, Radhakrishna Telagareddy, Debasish Patro, Mahija Sahu","doi":"10.4103/ijem.ijem_78_25","DOIUrl":"10.4103/ijem.ijem_78_25","url":null,"abstract":"<p><strong>Introduction: </strong>Gestational age, ethnicity, assay method, thyroid autoimmunity and iodine status of the community affect thyroid hormone levels in pregnancy, and there is a need to establish trimester-specific reference ranges for thyroid hormones across different regions of the world. There was no previous study regarding this from this part of the country. The aim of this study was to establish trimester-specific reference range for thyroid hormones during pregnancy in a tertiary care centre in Southern Odisha.</p><p><strong>Methods: </strong>In this cross-sectional study a total of 676 (n = 180, 244 and 342 for first, second and third trimester, respectively) healthy pregnant women (18-40 years) carrying a singleton pregnancy were recruited after excluding women with history of chronic medical illness, personal or family history thyroid disorder, recurrent abortion, oligo/polyhydramnios, hyperemesis gravidarum, goitre, intake of drugs affecting thyroid hormones, anti-TPO antibody positivity (>60 IU/ml) and low maternal spot urinary iodine concentration (<150 μg/L). Serum free tri-iodothyronine (FT3), free tetra-iodothyronine (FT4) and thyroid stimulating hormone (TSH) were estimated for each trimester by chemiluminescence (CLIA) method and reference interval was expressed as 2.5^th and 97.5^th percentile.</p><p><strong>Results: </strong>The reference interval for TSH was 0.12-4.10 μIU/ml, 0.55-3.97 μIU/ml and 0.46-4.31 μIU/ml for first, second and third trimester, respectively. The reference intervals for FT3 were 1.93-3.78 pg/ml, 2.06-3.55 pg/ml, 1.77-3.25 pg/ml and for FT4 were 0.78-1.50 ng/dl, 0.72-1.34 ng/dl, 0.70-1.31 ng/dl in the first, second and third trimester respectively.</p><p><strong>Conclusion: </strong>The upper reference limit of TSH obtained from our study corroborates with that proposed by American Thyroid Association (2017).</p>","PeriodicalId":13353,"journal":{"name":"Indian Journal of Endocrinology and Metabolism","volume":"29 4","pages":"453-457"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015028","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}