Intestinal Research最新文献

{"title":"Prevalence and risk factors of gallstone disease in Korean patients with ulcerative colitis.","authors":"Kwangwoo Nam, Jae Yong Lee, Sang Hyoung Park, Ha Won Hwang, Ho-Su Lee, Kyunghwan Oh, Hee Seung Hong, Kyuwon Kim, Jin Hwa Park, Seung Wook Hong, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang","doi":"10.5217/ir.2024.00070","DOIUrl":"https://doi.org/10.5217/ir.2024.00070","url":null,"abstract":"<p><strong>Background/aims: </strong>The prevalence of gallstone disease in patients with ulcerative colitis (UC) is higher than in the general population. However, risk factors of gallstone disease in these patients remain unclear. Thus, we investigated the prevalence and risk factors of gallstone disease in Korean patients with UC.</p><p><strong>Methods: </strong>Patients diagnosed with UC who underwent abdominal imaging studies between 1997 and 2020 were investigated using a well-established referral center-based large volume inflammatory bowel disease cohort. The prevalence and clinical characteristics of patients with gallstone disease were evaluated and compared with those without gallstone disease.</p><p><strong>Results: </strong>Overall, 2,811 patients with UC were enrolled. During the follow-up period (mean, 5.7 years), 198 patients (7.0%) were diagnosed with gallstone disease and compared with those without gallstone disease (n = 2,613). The proportion of extensive colitis at maximum extent, primary sclerosing cholangitis (PSC), history of cytomegalovirus, corticosteroid use, immunomodulatory use, colectomy, and appendectomy were significantly higher in the gallstone group (all P< 0.05). In multivariate analyses, age ≥ 60 years at gallstone evaluation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002-1.052; P= 0.033), PSC (OR, 6.304; 95% CI, 3.162-12.565; P< 0.001), and history of colectomy (OR, 2.494; 95% CI, 1.222-5.087; P= 0.012) were significant risk factors for gallstone disease in patients with UC.</p><p><strong>Conclusions: </strong>The prevalence of gallstone disease in Korean patients with UC was 7.0%, and age ≥ 60 years at gallstone evaluation, PSC, and history of colectomy were significant risk factors for UC patients with gallstone disease.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy.","authors":"Ryoya Sakakibara, Shinya Sugimoto, Kaoru Takabayashi, Hiroki Kiyohara, Yusuke Wakisaka, Yuta Kaieda, Miho Kawaida, Yusuke Yoshimatsu, Tomohisa Sujino, Naoki Hosoe, Motohiko Kato, Masayuki Shimoda, Yohei Mikami, Yasushi Iwao, Takanori Kanai","doi":"10.5217/ir.2024.00006","DOIUrl":"10.5217/ir.2024.00006","url":null,"abstract":"<p><strong>Background/aims: </strong>Poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma (por/sig/muc), which are considered to be histologic subtypes with a poor prognosis, occur more frequently with colitis-associated cancer than with sporadic tumors. However, their invasiveness and manifestations are unclear. This study aimed to determine the prevalence of the por/sig/muc component in ulcerative colitis-associated neoplasms (UCANs) and its association with invasiveness and to clarify its clinicohistologic and endoscopic features.</p><p><strong>Methods: </strong>This retrospective observational study included patients diagnosed with ulcerative colitis-associated high-grade dysplasia or adenocarcinoma from 1997 to 2022 who were divided according to the presence or absence of a por/sig/muc component.</p><p><strong>Results: </strong>Thirty-five patients had UCAN with a por/sig/muc component and 66 had UCAN without this component. The 5-year survival rate was significantly lower in the por/sig/muc group than in the tub group (67% vs. 96%, P= 0.001), which was attributed to disease above stage III and depth to below the subserosa. Biopsy-based diagnosis before resection detected a por/sig/muc component in only 40% of lesions (14/35). Lesions with a por/sig/muc component were prevalent even in the early stages: stage 0 (4/36, 11%), I (8/20, 40%), II (7/12, 58%), III (10/14, 71%), and IV (6/8, 75%).</p><p><strong>Conclusions: </strong>This is the first investigation that shows UCANs with a por/sig/muc component tended to be deeply invasive and were often not recognized preoperatively. Endoscopists should be aware that UCAN often has a por/sig/muc component that is not always recognized on biopsy, and the optimal treatment strategy needs to be carefully considered.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"428-438"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857048","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 evolving understanding of histology as an endpoint in ulcerative colitis.","authors":"Shintaro Akiyama, Yusuke Miyatani, David T Rubin","doi":"10.5217/ir.2023.00120","DOIUrl":"10.5217/ir.2023.00120","url":null,"abstract":"<p><p>A therapeutic goal for patients with ulcerative colitis (UC) is deep remission including clinical remission and mucosal healing. Mucosal healing was previously defined by endoscopic appearance, but recent studies demonstrate that histological improvements can minimize the risks of experiencing clinical relapse after achieving endoscopic remission, and there is growing interest in the value and feasibility of histological targets of treatment in inflammatory bowel disease, and specifically UC. In this review article, we identify remaining challenges and discuss an evolving role of histology in the management of UC.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"389-396"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140110272","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":"What to do when traditional rescue therapies fail in acute severe ulcerative colitis.","authors":"Christopher F D Li Wai Suen, Matthew C Choy, Peter De Cruz","doi":"10.5217/ir.2024.00003","DOIUrl":"10.5217/ir.2024.00003","url":null,"abstract":"<p><p>Acute severe ulcerative colitis (ASUC) is a medical emergency that affects approximately 25% of patients with ulcerative colitis at some point in time in their lives. Outcomes of ASUC are highly variable. Approximately 30% of patients do not respond to corticosteroids and up to 50% of patients do not respond to rescue therapy (infliximab or cyclosporin) and require emergency colectomy. Data are emerging on infliximab dosing strategies, use of cyclosporin as a bridge to slower acting biologic agents and Janus kinase inhibition as primary and sequential therapy. In this review, we outline contemporary approaches to clinical management of ASUC in the setting of failure to respond to traditional rescue therapies.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"397-413"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944613","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 serum leucine-rich alpha-2 glycoprotein in predicting findings of Crohn's disease small bowel lesion in capsule endoscopy.","authors":"Teppei Omori, Miki Koroku, Shun Murasugi, Ayumi Ito, Maria Yonezawa, Shinichi Nakamura, Katsutoshi Tokushige","doi":"10.5217/ir.2023.00139","DOIUrl":"10.5217/ir.2023.00139","url":null,"abstract":"<p><strong>Background/aims: </strong>Small bowel capsule endoscopy (SBCE) is an evaluation method for small bowel (SB) lesions in Crohn's disease (CD). However, the relationship between SBCE findings and the serological biomarker leucine-rich alpha-2 glycoprotein (LRG) remains unclear. We aimed to establish appropriate cutoff values of LRG to predict the presence of SB lesions in CD through SBCE.</p><p><strong>Methods: </strong>Patients with CD with SB lesions who had undergone SBCE and LRG measurements 1 month before and after the SBCE were included. The LRG values for ulcers ≥0.5 cm and other inflammatory lesions noted in SBCE were determined using the Youden Index, and the sensitivity and specificity were calculated. Additionally, the correlation between the SBCE scores (CD Activity in Capsule Endoscopy) and LRG values was evaluated.</p><p><strong>Results: </strong>Forty patients without active colorectal lesions were included in the study. When the cutoff value of LRG for SB ulcers ≥ 0.5 cm was set at 14 μg/mL, the sensitivity was 92.3%, specificity was 81.5%, positive predictive value (PPV) was 70.6%, and negative predictive value (NPV) was 95.7%. In contrast, an LRG cutoff value of 12 μg/mL without inflammatory findings had a sensitivity of 91.7%, specificity of 82.1%, PPV of 68.8%, and NPV of 95.8%. CD Activity in Capsule Endoscopy correlated well with LRG values (Spearman's rank correlation coefficient ρ = 0.681, P< 0.001).</p><p><strong>Conclusions: </strong>An LRG cutoff value of 14 μg/mL may be useful in predicting the presence of SB ulcers ≥ 0.5 cm, and an LRG cutoff value of 12 μg/mL may be useful in predicting the absence of SB inflammatory findings.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"464-472"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857354","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":"Perianal fistulizing lesions of Crohn's disease are associated with long-term behavior and its transition: a Chinese cohort study.","authors":"Wei Zhan, Xiaoyin Bai, Hong Yang, Jiaming Qian","doi":"10.5217/ir.2024.00021","DOIUrl":"10.5217/ir.2024.00021","url":null,"abstract":"<p><strong>Background/aims: </strong>Crohn's disease (CD) has a progressive nature and commonly perianal involvement. The aim of this study is to assess the prevalence, surgical treatment, and outcome of perianal fistulizing CD with associated risk factors in a large Chinese cohort.</p><p><strong>Methods: </strong>Hospitalized patients diagnosed with CD in our center were consecutively enrolled between January 2000 and December 2018. Transition of disease behavior was classified according to the presence or absence of penetrating behavior (B3 in the Montreal classification) at diagnosis and at a median follow-up of 102 months.</p><p><strong>Results: </strong>A total of 504 patients were included, of whom 207 (41.1%) were classified as B3 and 348 (69.0%) as L2/3 at follow-up. Transition of behavior to B3 was observed in 86 patients (17.1%). The incidence of perianal fistulizing lesions was 10.9% at 10 years with a final prevalence of 27.0% (n = 136) at the end of follow-up. Multivariate Cox regression identified independent risks of perianal fistulizing lesions for persistent B3 (hazard ratio, 4.72; 95% confidence interval, 1.91-11.66) and behavior transition of progressed to B3 (hazard ratio, 9.90; 95% confidence interval, 4.60-21.33). Perianal surgical treatments were performed in 104 patients (20.6%). Thirty-six cases (7.1%) were refractory, and it is independently associated with behavior of persistent B3 (P= 0.011).</p><p><strong>Conclusions: </strong>Perianal fistulizing lesions occurred frequently in Chinese CD patients. Its incidence and refractory outcome were closely associated with the penetrating CD behavior. An additional risk of perianal fistulizing lesions was indicated for CD patients with behavior of progressing to B3, suggesting further attention.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"484-495"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616394","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":"Defining management strategies for acute severe ulcerative colitis using predictive models: a simulation-modeling study.","authors":"Danny Con, Peter De Cruz","doi":"10.5217/ir.2023.00175","DOIUrl":"10.5217/ir.2023.00175","url":null,"abstract":"<p><strong>Background/aims: </strong>Robust management algorithms are required to reduce the residual risk of colectomy in acute severe ulcerative colitis (ASUC) refractory to standard infliximab salvage therapy. The aim of this study was to evaluate the performance and benefits of alternative ASUC management strategies using simulated prediction models of varying accuracy.</p><p><strong>Methods: </strong>This was a simulation-based modeling study using a hypothetical cohort of 5,000 steroid-refractory ASUC patients receiving standard infliximab induction. Simulated predictive models were used to risk-stratify patients and escalate treatment in patients at high risk of failing standard infliximab induction. The main outcome of interest was colectomy by 3 months.</p><p><strong>Results: </strong>The 3-month colectomy rate in the base scenario where all 5,000 patients received standard infliximab induction was 23%. The best-performing management strategy assigned high-risk patients to sequential Janus kinase inhibitor inhibition and mediumrisk patients to accelerated infliximab induction. Using a 90% area under the curve (AUC) prediction model and optimistic treatment efficacy assumptions, this strategy reduced the 3-month colectomy rate to 8% (65% residual risk reduction). Using an 80% AUC prediction model with only modest treatment efficacy assumptions, the 3-month colectomy rate was reduced to 15% (35% residual risk reduction). Overall management strategy efficacy was highly dependent on predictive model accuracy and underlying treatment efficacy assumptions.</p><p><strong>Conclusions: </strong>This is the first study to simulate predictive model-based management strategies in steroid-refractory ASUC and evaluate their effect on short-term colectomy rates. Future studies on predictive model development should incorporate simulation studies to better understand their expected benefit.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"439-452"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863817","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":"Early change in serum leucine-rich α-2-glycoprotein predicts clinical and endoscopic response in ulcerative colitis.","authors":"Ryo Karashima, Shintaro Sagami, Yoko Yamana, Masa Maeda, Aya Hojo, Yusuke Miyatani, Masaru Nakano, Takahisa Matsuda, Toshifumi Hibi, Taku Kobayashi","doi":"10.5217/ir.2023.00135","DOIUrl":"10.5217/ir.2023.00135","url":null,"abstract":"<p><strong>Background/aims: </strong>Leucine-rich α-2-glycoprotein (LRG) is a new serum biomarker reflecting the disease activity of ulcerative colitis (UC), but its change during the acute phase has not been enough investigated.</p><p><strong>Methods: </strong>Patients with UC who initiated the induction therapy with steroid or advanced therapy (biologics or Janus kinase inhibitors) were prospectively enrolled. Associations of LRG, C-reactive protein (CRP) and fecal calprotectin (FC) at baseline, week 1, and week 8 with clinical remission at week 8 and subsequent endoscopic improvement within 1 year (Mayo endoscopic subscore of 0 or 1) were assessed.</p><p><strong>Results: </strong>A total of 143 patients with UC were included. LRG and CRP at week 1 were significantly lower in the clinical remission group than in the non-remission group (LRG, 20.6 μg/mL vs. 28.4 μg/mL, P< 0.001; CRP, 0.9 mg/dL vs. 2.3 mg/dL, P< 0.001) while FC demonstrated the difference between groups only at week 8. The area under the curves of week 1 LRG, CRP, and FC for week 8 clinical remission using the receiver operating characteristic curves analysis were 0.68, 0.71, and 0.57, respectively. Furthermore, LRG and CRP predicted subsequent endoscopic improvement as early as week 1, while FC was predictive only at week 8.</p><p><strong>Conclusions: </strong>LRG can be an early-phase biomarker predicting subsequent clinical and endoscopic response to induction therapy.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"473-483"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247482","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":"Predictors of histologic remission in patients with biologic-naïve, moderate-to-severe ulcerative colitis treated with first-line biologic agents and small-molecule drugs: a single-center, retrospective cohort study.","authors":"Kijae Jo, Kwang Woo Kim, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim, Seong-Joon Koh","doi":"10.5217/ir.2024.00044","DOIUrl":"10.5217/ir.2024.00044","url":null,"abstract":"<p><strong>Background/aims: </strong>The prevalence and incidence of ulcerative colitis (UC) in Korea is increasing. Each patient has a different disease course and treatment response. Recently, with the development of biologic agents, histological remission has become a treatment goal. In this study, we aimed to identify the predictors of histological remission after first-line biologic agent treatment in patients with biologic agent-naïve UC.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical records of 92 patients who had been diagnosed with UC and treated with first-line biologic agent treatment at our center, between 2015 and 2022. The clinical characteristics, laboratory test results, and endoscopic and biopsy findings were analyzed. Histological remission was defined as the absence of cryptitis, crypt abscesses, and inflammatory cells on histology. Univariate and multivariate logistic regression analyses were performed to identify the predictors of histological remission after first-line treatment.</p><p><strong>Results: </strong>Of the total 92 patients, 25 (27.2%) achieved histological remission. Each cohort had a varied body mass index (BMI) distribution, with a statistically significant overweight ratio, as defined by the Asian-Pacific BMI category of 23-25 kg/m2, of 48.0% in the histological remission cohort (P= 0.026). A causal correlation between the overweight category and histological remission was confirmed (odds ratio, 3.883; 95% confidence interval, 1.141-13.212; P= 0.030).</p><p><strong>Conclusions: </strong>We confirmed that the overweight category was a predictor of histological remission after first-line treatment with a biological agent. However, as BMI does not account for skeletal muscle mass, future studies are required to confirm the correlation between skeletal muscle mass and histological remission.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"453-463"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075936","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":"Complex dichotomous links of nonalcoholic fatty liver disease and inflammatory bowel disease: exploring risks, mechanisms, and management modalities.","authors":"Kanishk Aggarwal, Bhupinder Singh, Abhishek Goel, Durgesh Kumar Agrawal, Sourav Bansal, Sai Gautham Kanagala, Fnu Anamika, Aachal Gupta, Rohit Jain","doi":"10.5217/ir.2024.00001","DOIUrl":"10.5217/ir.2024.00001","url":null,"abstract":"<p><p>Nonalcoholic fatty liver disease (NAFLD) has been shown to be linked to inflammatory bowel disease (IBD) due to established risk factors such as obesity, age, and type 2 diabetes in numerous studies. However, alternative research suggests that factors related to IBD, such as disease activity, duration, and drug-induced toxicity, can contribute to NAFLD. Recent research findings suggest IBD relapses are correlated with dysbiosis, mucosal damage, and an increase in cytokines. In contrast, remission periods are characterized by reduced metabolic risk factors. There is a dichotomy evident in the associations between NAFLD and IBD during relapses and remissions. This warrants a nuanced understanding of the diverse influences on disease manifestation and progression. It is possible to provide a holistic approach to care for patients with IBD by emphasizing the interdependence between metabolic and inflammatory disorders.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":"414-427"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247479","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}