Internal and Emergency Medicine最新文献

{"title":"Impact of antithrombotic therapy on management and prognosis of patients hospitalized for upper gastrointestinal bleeding: a multicenter retrospective cohort study.","authors":"Mathilde De Caluwe, Manon Fainelli, Agathe Beauvais, Sarah Harzo, Clément Prebin, Florent Noel, Youri Yordanov, Judith Leblanc, Pierre-Clément Thiebaud","doi":"10.1007/s11739-026-04555-z","DOIUrl":"https://doi.org/10.1007/s11739-026-04555-z","url":null,"abstract":"<p><strong>Background: </strong>Antithrombotic agents are frequently implicated in upper gastrointestinal bleeding (UGIB), yet their impact on prognosis and management remains unclear. The aim of this study was to assess the impact of pre-existing antithrombotic therapy on the management and prognosis of patients hospitalized for UGIB.</p><p><strong>Methods: </strong>This study used data from a retrospective, multicenter cohort of adult patients hospitalized for UGIB between January 2019 and December 2020 in Greater Paris University Hospitals. Patients were categorized into four groups according to their pre-existing antithrombotic treatment: antiplatelet therapy, anticoagulant therapy, both, or none. The primary outcome was thirty-day mortality. Secondary outcomes included endoscopy, endoscopic hemostasis, and blood transfusion within 7 days, and intensive care unit admission. Associations were assessed using multivariable logistic regression and reported as adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs).</p><p><strong>Results: </strong>Among 928 patients, 226 (24%) were on antiplatelet therapy alone, 154 (17%) on anticoagulant therapy alone, 61 (7%) on combined therapy, and 487 (52%) received no antithrombotic treatment. Thirty-day mortality was 6.9%: 8.4% in the no-antithrombotic group, 6.2% in the antiplatelet group, 4.5% in the anticoagulant group, and 3.3% in the combined therapy group. Compared with the no-antithrombotic group, anticoagulant therapy alone was associated with lower mortality (aOR=0.28, 95% CI 0.10-0.83), while antiplatelet therapy alone or combined therapy were not significantly associated (aOR=0.47, 95% CI 0.19-1.14 and aOR=0.12, 95% CI 0.01-1.11, respectively). Neither anticoagulant nor antiplatelet therapy was associated with secondary outcomes.</p><p><strong>Conclusions: </strong>Antithrombotic therapy had no negative impact on the management or prognosis of patients hospitalized for UGIB.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apixaban vs rivaroxaban for venous thromboembolism: a systematic review and meta-analysis.","authors":"Bassel Alrabadi, Omar Alomari, Alwaleed Emad Alshakhshir, Shahad S Abdelwahab, Natalie Bandak","doi":"10.1007/s11739-026-04556-y","DOIUrl":"https://doi.org/10.1007/s11739-026-04556-y","url":null,"abstract":"<p><p>Direct oral anticoagulants are first-line therapy for venous thromboembolism (VTE), yet comparative evidence between apixaban and rivaroxaban remains limited. This systematic review and meta-analysis aimed to compare the efficacy and safety of apixaban versus rivaroxaban in patients with VTE. A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted from inception through March 2026. Studies directly comparing apixaban and rivaroxaban in adult VTE patients were included. Outcomes, including recurrent VTE, major bleeding, all-cause mortality, and net clinical harm, were pooled using a random-effects model. Thirteen studies comprising more than 220,000 patients were included. Apixaban was associated with a significantly lower risk of recurrent VTE compared to rivaroxaban (RR 0.85; 95% CI 0.74-0.98), with moderate heterogeneity. Apixaban was also associated with a significant 28% reduction in major bleeding risk (RR 0.72; 95% CI 0.65-0.81), with low heterogeneity, indicating consistent findings across studies. When efficacy and safety outcomes were combined, apixaban demonstrated a significantly lower risk of net clinical harm (RR 0.76; 95% CI 0.68-0.86). In contrast, no statistically significant difference was observed in all-cause mortality (RR 0.95; 95% CI 0.80-1.12), with substantial heterogeneity across studies. Sensitivity analyses confirmed the robustness of these findings, with no single study significantly altering the overall estimates. Overall, apixaban demonstrated a more favorable efficacy and safety profile compared with rivaroxaban in VTE management, with reduced recurrence and bleeding risk, while mortality remained comparable. These findings suggest that apixaban may be associated with a more favorable efficacy and safety profile than rivaroxaban; however, the results should be interpreted cautiously given the predominance of observational evidence.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance and timeliness of ultrasound-guided core needle biopsy for peripheral lymphadenopathy in Internal Medicine: a multicenter real-world study.","authors":"Francisco Javier Teigell-Muñoz, Juan Delgado-Cuesta, Javier Camarón, José Tomás Algado-Rabasa, Laura Porcel, Amy Galán-Gómez, Cristina Escorial-Moya, Isabel Ribes, Lorena Delgado-Bazán, José M Porcel","doi":"10.1007/s11739-026-04552-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04552-2","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided core needle biopsy (CNB) is increasingly used for evaluating peripheral lymphadenopathy, but evidence regarding its implementation in Internal Medicine remains limited. We assessed its diagnostic performance, safety, and diagnostic timeliness in routine clinical practice.</p><p><strong>Methods: </strong>This retrospective multicenter study included consecutive patients undergoing ultrasound-guided CNB of peripheral lymphadenopathy in five Internal Medicine departments between February 2021 and March 2026. The primary outcome was diagnostic performance. Secondary outcomes included safety, diagnostic timeliness, performance in lymphoma patients, and factors associated with obtaining a definitive diagnosis.</p><p><strong>Results: </strong>A total of 413 patients were included (median age 62 years; 41.3% women). Lymphoma and carcinoma accounted for 44.1% and 23.7% of final diagnoses, respectively. The first CNB provided a definitive diagnosis in 85.7% of patients and a suggestive diagnosis in 8.0%, yielding an overall diagnostic yield of 93.7%. No major complications occurred. Median time from biopsy request to procedure was 1 day (IQR 0-2), and median time to definitive diagnosis was 10 days (IQR 6-16). Surgical biopsy was required in 9.4% of patients and was associated with longer diagnostic delays (42 vs 9 days; p < 0.001). Among 182 patients with lymphoma, overall diagnostic yield was 93.4%. Lower operator experience and hospital size < 500 beds were independently associated with a lower likelihood of obtaining a definitive diagnosis.</p><p><strong>Conclusions: </strong>Ultrasound-guided CNB of peripheral lymphadenopathy performed by internists demonstrated high diagnostic yield, excellent safety, and short diagnostic timelines in a large multicenter real-world cohort. Operator experience and institutional context may influence diagnostic performance.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Evaluation of pre-endoscopy risk scores and base deficit for prediction adverse clinical outcomes in patients with upper gastrointestinal bleeding.","authors":"Çağrı Safa Buyurgan, Akif Yarkaç, Seyran Bozkurt, Ataman Köse, Buğrahan Güldür, Gülhan Orekici Temel","doi":"10.1007/s11739-026-04542-4","DOIUrl":"https://doi.org/10.1007/s11739-026-04542-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life-course hygiene exposures and disorders of gut-brain interaction: a multinational cross-sectional study.","authors":"Keren Hod, Giovanni Marasco, Luigi Colecchia, Ami David Sperber, Olafur Steinn Palsson, Shrikant Ishver Bangdiwala, Giovanni Barbara","doi":"10.1007/s11739-026-04546-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04546-0","url":null,"abstract":"<p><p>Despite growing interest in its role in immune-mediated diseases, the relevance of the hygiene hypothesis to disorders of gut-brain interaction (DGBI) remains unclear. We aimed to examine the associations between childhood and adulthood hygiene-related exposures and DGBI prevalence, and to assess whether these associations persist after adjustment for sociodemographic and national development indicators. This cross-sectional study included 54,127 adults from 26 countries. DGBI were defined using Rome IV criteria. Childhood (≤ 7 years) and adulthood hygiene-related exposures included farm residence and access to running water, electricity, and rural residence. Country-level development was assessed using the Human Development Index (HDI). After adjustment for sociodemographic factors and psychological distress, several individual exposures showed independent associations with DGBI. Childhood farm exposure was independently associated with higher odds of DGBI (OR=1.11, 95% CI 1.03-1.19), irritable bowel syndrome (OR=1.21, 95% CI 1.03-1.42), and functional dyspepsia (OR=1.22, 95% CI 1.08-1.38). In contrast, rural residence (OR=0.88, 95% CI 0.82-0.95) and absence of running water (OR=0.83, 95% CI 0.77-0.90) or electricity (OR=0.86, 95% CI 0.77-0.97) in adulthood were associated with lower odds of DGBI. These associations remained statistically significant after additional adjustment for HDI. Several individual hygiene-related environmental exposures were associated with DGBI, suggesting that environmental conditions may be associated with global variation in DGBI burden.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory function, functional capacity, dyspnea, and sleep quality in young adults using the IQOS heated tobacco product: a matched cross-sectional study.","authors":"Rıdvan Aktan, Görkem Çetin, Göknil Tekinöz, Emre Halden","doi":"10.1007/s11739-026-04554-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04554-0","url":null,"abstract":"<p><p>This matched cross-sectional study compared respiratory function, respiratory muscle strength, functional exercise capacity, dyspnea, and sleep quality between young IQOS users and matched control subjects. This study involved 31 young adult IQOS users and 31 age/sex/body mass index-matched never-tobacco users who underwent a standardized testing protocol during a single visit. Spirometry, maximal inspiratory pressure (MIP), 6-min walk test (6MWT), modified Medical Research Council (mMRC) dyspnea scale, modified Borg Scale (mBorg), and Pittsburgh Sleep Quality Index (PSQI) scores were compared. While mean resting lung functions were similar between groups (all p > 0.05), IQOS users had shorter 6MWT distances (591.1 [580.2 - 638.4] meters vs. 626.0 [600.5 - 683.8] meters, p = 0.003, r = 0.53) and higher mMRC dyspnea scores (median mMRC Grade = 1 (0-1) in IQOS users vs 0 (0-0) in controls, p < 0.001, r = 0.62), higher mBorg dyspnea scores at the end of the 6MWT (median end-6MWT mBorg rating scale 1 [0-2] vs 0 [0-1], p = 0.001, r = 0.57), and poor sleep quality (PSQI global score 6.32 ± 2.63 vs 4.58 ± 1.61, p = 0.012, r = 0.45). Additionally, while MIP values tended toward being lower in IQOS users, these differences were statistically nonsignificant (p = 0.090). In conclusion, young exclusive IQOS users showed lower functional exercise capacity, greater dyspnea, and poorer sleep quality than matched never-users despite comparable resting spirometry, and these hypothesis-generating findings warrant longitudinal evaluation with biochemical exposure verification.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary sodium density as a potential nutritional marker of HSI-defined hepatic steatosis in Korean adults: a nationwide cross-sectional study with a dose-response analysis.","authors":"Misuk Oh, Yun-Hwan Oh, Woo-Young Shin","doi":"10.1007/s11739-026-04551-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04551-3","url":null,"abstract":"<p><strong>Background: </strong>The association between energy-adjusted dietary sodium density and non-invasively assessed hepatic steatosis remains poorly defined in population-based studies.</p><p><strong>Aim: </strong>We investigated the association and dose-response relationship between dietary sodium density and HSI-defined hepatic steatosis in Korean adults.</p><p><strong>Methods: </strong>We analyzed 14,445 adults (aged ≥20 years) from the 2021-2023 KNHANES. Sodium intake from a 24-h recall was calculated as sodium density (mg/1,000 kcal). HSI ≥36 defined hepatic steatosis; descriptive analyses compared HSI <36 versus ≥36, whereas regression analyses used HSI <30 as the reference, with HSI 30.0-35.9 treated separately.</p><p><strong>Results: </strong>Compared with HSI <30, each 100 mg/1,000 kcal increase in sodium density was associated with higher odds of HSI-defined hepatic steatosis across all models: Unadjusted OR 1.058 (95% CI 1.032-1.085; P<0.001), Age/Sex-adjusted OR 1.051 (95% CI 1.024-1.079; P<0.001), Lifestyle-adjusted OR 1.048 (95% CI 1.020-1.077; P=0.001), and Fully adjusted OR 1.054 (95% CI 1.020-1.089; P=0.002). Participants in the highest sodium density quartile (Q4) exhibited 36.2% higher odds of HSI-defined hepatic steatosis than those in the lowest quartile (Q1) (adjusted OR 1.362; 95% CI 1.144-1.621; P=0.0004; P for trend = 0.001). The association remained robust after adjusting for potassium density (OR 1.042; 95% CI 1.012-1.072; P=0.005). RCS analysis showed an approximately linear increase in odds across the observed range, without evidence of non-linearity (P=0.738).</p><p><strong>Conclusions: </strong>Elevated sodium density was associated with higher odds of HSI-defined hepatic steatosis and may serve as a nutritional marker of metabolic liver health.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of multimorbidity and in-hospital kidney function decline in older adults: a latent class analysis of three acute-care cohorts.","authors":"Maria Serena Iuorio, Luca Soraci, Antonio De Vincentis, Pier Mannuccio Mannucci, Alessandro Nobili, Mauro Tettamanti, Sara Ratti, Filippo Aucella, Francesco Aucella, Maria Nardella, Mara Volpentesta, Andrea Corsonello, Raffaele Antonelli Incalzi","doi":"10.1007/s11739-026-04527-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04527-3","url":null,"abstract":"<p><p>Multimorbidity is associated with an increased risk of renal function decline in older individuals. In this study, we aimed to evaluate whether multimorbidity patterns differently contributed to this risk in three different hospital settings. We conducted a comparative cohort study of patients aged ≥ 65 years admitted to acute-care hospitals in Italy. Data were drawn from the retrospective SIN-SIGG study (geriatric units, n = 1600; nephrology units, n = 560) and the prospective REPOSI registry (internal medicine units, n = 4595). Quantitative multimorbidity was defined as the number of chronic conditions with prevalence ≥ 5% per cohort; qualitative multimorbidity was derived through latent class analysis of disease combinations. The primary outcome was change in estimated glomerular filtration rate (eGFR) from admission to discharge, calculated using the Berlin Initiative Study 1 (BIS1) equation. A relative decline was defined as ≥ 20% reduction from baseline. Multivariable models were adjusted for age, sex, baseline eGFR, acute diagnoses, and number of medications. Among 6,755 patients (mean age 80.6 years; 47% women), multimorbidity prevalence ranged from 87 to 93%. Quantitative multimorbidity showed modest and inconsistent associations with renal decline. In contrast, qualitative multimorbidity consistently predicted eGFR deterioration. Across all cohorts, the cardiorespiratory and renal cluster was associated with higher odds of in-hospital eGFR decline compared with neurogeriatric and mixed patterns (geriatrics OR 2.24 [95% CI 1.16-4.70]; internal medicine OR 1.72 [95% CI 1.22-2.45]; nephrology OR 2.11 [95% CI 1.01-4.56]). Disease-pattern-based multimorbidity better stratifies short-term renal risk than disease counts, identifying high-risk patients for targeted nephroprotective care during hospitalization.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not all diverticulosis are colonic - jejunal diverticulitis.","authors":"Schattner Ami, Shechtman Yitzhak, Yair Glick","doi":"10.1007/s11739-026-04550-4","DOIUrl":"https://doi.org/10.1007/s11739-026-04550-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual congestion and urinary sodium and chloride trajectories in acute heart failure.","authors":"Amelia Campos-Sáenz de Santamaría, Laura-Karla Esterellas-Sánchez, Marc Gómez-Godos, Silvia Crespo-Aznarez, Marta Sánchez-Marteles, Vanesa Garcés-Horna, Ignacio Giménez-López, Joan Carles Trullas, Jorge Rubio-Gracia","doi":"10.1007/s11739-026-04543-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04543-3","url":null,"abstract":"<p><p>Residual congestion remains frequent after initial treatment for acute heart failure (AHF), and its presence may not be adequately identified using individual clinical or biochemical markers. We investigated residual congestion using a multimodal approach and examined its relationship with changes in urinary sodium and chloride during the first 72 h of hospitalization. We prospectively included consecutive patients hospitalized for AHF who underwent congestion assessment at admission and 72 h. Clinical evaluation, NT-proBNP, and venous Doppler ultrasound (VExUS) were integrated to assess congestion. Residual multimodal congestion was defined by the presence of at least two of three criteria: VExUS score ≥ 1, < 30% reduction in NT-proBNP, and clinical congestion score ≥ 3. Urinary sodium and chloride were measured at admission and 72 h, and their changes over time were evaluated using linear mixed-effects models. Baseline estimated glomerular filtration rate (eGFR), worsening renal function, and urinary albumin-to-creatinine ratio were additionally characterized. Among 146 patients, 67 (45.9%) had residual multimodal congestion at 72 h. Urinary sodium and chloride concentrations were lower in patients with residual congestion. Both electrolytes decreased during the first 72 h (p < 0.001 for both), but their changes differed according to residual congestion status, with significant time-by-group interactions for sodium (p = 0.013) and chloride (p = 0.001). Patients with residual congestion also showed a trend toward poorer 180-day event-free survival, although this difference did not reach statistical significance (log-rank p = 0.078). Patients with residual congestion showed different early patterns of urinary sodium and chloride during treatment for AHF. Serial measurement of these electrolytes may complement clinical, biochemical, and venous ultrasound assessment when evaluating the response to decongestive therapy. These findings support their potential role in characterizing different decongestive profiles, although their clinical and prognostic value requires further evaluation.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}