JAMA Network Open最新文献

{"title":"Accuracy of Artificial Intelligence for Gatekeeping in Referrals to Specialized Care.","authors":"Piter Oliveira Vergara, Jeronimo de Conto Oliveira, Rita Mattiello, Alfredo Montelongo, Rudi Roman, Natan Katz, Leandro Krug Wives, Dimitris Varvaki Rados","doi":"10.1001/jamanetworkopen.2025.13285","DOIUrl":"10.1001/jamanetworkopen.2025.13285","url":null,"abstract":"<p><strong>Importance: </strong>Integrating artificial intelligence (AI) technologies into gatekeeping holds significant potential, as it efficiently handles repetitive tasks and can process large amounts of information quickly.</p><p><strong>Objective: </strong>To develop and assess the accuracy of an AI model that enhances the gatekeeping process for referrals to specialized care.</p><p><strong>Design, setting, and participants: </strong>This diagnostic study comprised referrals from primary care to endocrinology, gastroenterology, proctology, rheumatology, and urology from a retrospective administrative database of patients in Brazil between June 2016 and April 2019. Analysis was performed between December 2022 and July 2024.</p><p><strong>Main outcomes and measures: </strong>The algorithm's development and testing comprised 2 stages. Multiple AI models were initially evaluated to train and test the algorithm for categorizing referrals as authorizing or requiring additional information. Subsequently, the model's performance was assessed against an independent set of referrals. Additionally, the current (human) evaluations of gatekeepers were evaluated against the standard. The reference standard was the consensus of 2 physicians with extensive experience. Accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC) were assessed.</p><p><strong>Results: </strong>The electronic system retrieved 45 039 eligible referrals for the development stage (mean [SD] patient age, 51.9 [15.8] years; 25 458 women [56.5%]). An algorithm utilizing word embeddings and a neural network proved the most effective. In the second phase, 1750 referrals (350 for each specialty) showed a 32% authorization rate according to the reference standard. The AI model achieved an overall accuracy of 0.716 (95% IC, 0.694-0.737), with a sensitivity of 0.542 (95% CI, 0.501 to 0.582) and specificity of 0.801 (95% CI, 0.777 to 0.822). Regarding individual specialties, rheumatology exhibited the highest accuracy (0.811; 95% IC, 0.767-0.849), while proctology had the lowest (0.649; 95% IC, 0.597-0.697). The overall AUC-ROC was 0.765 (95% IC, 0.742-0.788). When compared against the consensus standard, the AI model had higher accuracy and specificity and lower sensitivity than the current approach.</p><p><strong>Conclusions and relevance: </strong>In this diagnostic study of referral data, a novel AI model effectively distinguished between referrals that warranted immediate authorization and those that required further information with moderate accuracy; it had higher specificity and lower sensitivity than gatekeepers decisions. Implementing this AI model in the gatekeeping process should combine human judgment and AI support to optimize the referral process.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513285"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Household Firearm Access Among Adolescents-Opportunities for Firearm Injury Prevention.","authors":"Ali Rowhani-Rahbar","doi":"10.1001/jamanetworkopen.2025.14449","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.14449","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514449"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in Complete Blood Count Reports Across US Hospitals.","authors":"Lewis T Go, Lucas T Go, Madugodaralalage D S K Gunaratne, Jithma P Abeykoon","doi":"10.1001/jamanetworkopen.2025.14050","DOIUrl":"10.1001/jamanetworkopen.2025.14050","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514050"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home-Based Transcranial Direct Current Stimulation vs Placebo for Fibromyalgia: A Randomized Clinical Trial.","authors":"Wolnei Caumo, Barbara Regina Franca, Roman Orzechowski, Graziele Bueno, Arthur França, Jéssica Vebber Dos Santos da Silva, Paulo R S Sanches, Danton P Da Silva, Iraci L S Torres, Vania Naomi Hirakata, Kevin Pacheco-Barrio, Felipe Fregni","doi":"10.1001/jamanetworkopen.2025.14262","DOIUrl":"10.1001/jamanetworkopen.2025.14262","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Previous trials with smaller samples and shorter follow-up periods showed that multiple-session home-based anodal transcranial direct current stimulation (A-tDCS) on the left dorsolateral prefrontal cortex (DLPFC) improved fibromyalgia symptoms. However, the duration of the effect, the influence of exercise and pain neuroscience education (PNE), and the role of placebo remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether A-tDCS targeting the left DLPFC, combined with exercise and PNE, is more effective than sham tDCS in reducing pain and disability, based on placebo-test responses (responders vs nonresponders).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This double-blind, sham-controlled randomized clinical trial enrolled women aged 18 to 65 years with fibromyalgia. Participants were randomized to receive A-tDCS or sham tDCS between April 2022 and April 2024. They were treated at home and at the outpatient Clinical Research Center of Hospital de Clínicas de Porto Alegre in Porto Alegre, Brazil. Exclusion criteria included tDCS contraindications and uncontrolled clinical conditions. Intention-to-treat analyses were conducted from July to December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Home-based tDCS (2 mA; 20 minutes daily) or sham tDCS (2 mA; 30 seconds at the start, then 10 minutes, and then 20 minutes, with a 20-second ramp-up and ramp-down) for 4 weeks with anodal-left and cathodal-right prefrontal stimulation (35 cm2 electrodes), combined with exercise and PNE via videos and remote supervision following in-person training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Change in Multidimensional Pain Interference Index (MPII) at treatment end and 3-month follow-up. MPII was measured by the Brief Pain Inventory, a 7-item scale that assesses the impact of pain on daily activities, emotional well-being, and social interactions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 112 female patients (mean [SD] age, 49.04 [9.71] years) were included and randomized to either A-tDCS (n = 56 placebo nonresponders) or sham tDCS (n = 56 placebo responders). In the intention-to-treat analysis, linear mixed-effects models showed reduced MPII by 38.76% (95% CI, -41.90% to -30.92%) for the A-tDCS group vs 16.08% (95% CI, -21.42% to -10.41%) for sham tDCS (mean difference [MD], 22.68%; 95% CI, 12.79%-40.00%; Cohen d = 0.73). A significant treatment-by-time interaction favored A-tDCS across 5 assessments, with no interaction by placebo response. In placebo responders, MPII was reduced by 34.21% (95% CI, -46.88% to -28.29%) for A-tDCS vs 18.13% (95% CI, -24.90% to 3.34%) for sham tDCS (MD, 24.23%; 95% CI, 15.80%-32.67%). Among placebo nonresponders, MPII decreases were 35.49% (95% CI, -41.21% to -29.53%) for A-tDCS vs 25.96% (95% CI, -34.31% to -20.42%) for sham tDCS (MD, 9.52%; 95% CI, 2.79%-19.78%). Improvement in MPII of 50% or more was achieved by 62.5% of participants (n = 35) in the A-tDCS","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514262"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusive Cancer Clinical Trial Participation-A Recipe for New Treatment Advances.","authors":"Joseph M Unger","doi":"10.1001/jamanetworkopen.2025.15210","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.15210","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2515210"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectionality of Sexual Orientation, Race, and Ethnicity in Medical School Attrition.","authors":"Mytien Nguyen, Dowin Boatright, John Paul Sánchez, Alexandra M Hajduk, Shruthi Venkataraman, Meghan O'Connell, Allison Aviles, Pradeep Rajbhandari, Sarwat I Chaudhry","doi":"10.1001/jamanetworkopen.2025.14515","DOIUrl":"10.1001/jamanetworkopen.2025.14515","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514515"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oseltamivir Treatment vs Supportive Care for Seasonal Influenza Requiring Hospitalization.","authors":"Anthony D Bai, Siddhartha Srivastava, Thuwiba Al Baluki, Fahad Razak, Amol A Verma","doi":"10.1001/jamanetworkopen.2025.14508","DOIUrl":"10.1001/jamanetworkopen.2025.14508","url":null,"abstract":"<p><strong>Importance: </strong>Current guidelines recommend oseltamivir treatment for all patients hospitalized with influenza, but this guidance is based on suboptimal evidence.</p><p><strong>Objective: </strong>To evaluate outcomes associated with oseltamivir treatment when compared with supportive care for severe seasonal influenza requiring hospitalization.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study using target trial emulation included adult patients admitted to hospital with influenza from 30 hospitals in Ontario, Canada, from January 2015 to June 2023. Data were analyzed from November 2024 to March 2025.</p><p><strong>Exposure: </strong>Oseltamivir treatment on hospital day 0 or 1 vs supportive care without oseltamivir.</p><p><strong>Main outcome and measures: </strong>The primary outcome was in-hospital mortality. Secondary outcomes included time to being discharged alive and readmission within 30 days. Overlap weighting of propensity scores was used to balance covariates, and a competing risk model was used to compare time to being discharged alive.</p><p><strong>Results: </strong>Of 11 073 patients (mean [SD] age, 72.6 [16.8] years; 5793 female [52.3%]), there were 7632 patients (68.9%) and 3441 patients (31.1%) in the oseltamivir and supportive care groups, respectively. In hospital, 268 patients (3.5%) and 168 patients (4.9%) in the oseltamivir and supportive care groups died, respectively, with an adjusted risk difference of -1.8% (95% CI, -2.8% to -0.9%; P < .001). The oseltamivir treatment group was more likely to be discharged alive (adjusted subdistribution hazard ratio, 1.20; 95% CI, 1.15 to 1.25; P < .001). After discharge, 645 patients (8.5%) and 336 patients (9.8%) were readmitted in the oseltamivir and supportive care groups, respectively, with an adjusted risk difference of -1.5% (95% CI, -2.8% to -0.2%; P = .02).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients hospitalized with influenza, oseltamivir treatment was associated with a lower in-hospital mortality risk, earlier discharge, and lower readmission rate, supporting evidence for the current guideline recommendation of oseltamivir treatment for severe influenza. Clinical trials are needed to definitively answer this question.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514508"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant Zoster Vaccination and Risk of Postherpetic Neuralgia or Zoster Ophthalmicus.","authors":"Ousseny Zerbo, Joan Bartlett, Bruce Fireman, Kristin Goddard, Jonathan Duffy, Jason Glanz, Allison L Naleway, James G Donahue, Tara C Anderson, Nicola P Klein","doi":"10.1001/jamanetworkopen.2025.14615","DOIUrl":"10.1001/jamanetworkopen.2025.14615","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514615"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Transdiagnostic Emotion Regulation Treatment for Adolescents With Mental Health Problems: A Randomized Clinical Trial.","authors":"Katja Sjöblom, Katri Frankenstein, Lars Klintwall, Jannike Nilbrink, Maria Zetterqvist, Hugo Hesser, Erik Hedman-Lagerlöf, James J Gross, Clara Hellner, Martin Bellander, Johan Bjureberg","doi":"10.1001/jamanetworkopen.2025.14871","DOIUrl":"10.1001/jamanetworkopen.2025.14871","url":null,"abstract":"<p><strong>Importance: </strong>Mental health problems are common during adolescence, but access to effective treatments is limited. Transdiagnostic treatments could address this treatment gap, but their feasibility, acceptability, and effectiveness remain unknown.</p><p><strong>Objective: </strong>To test the feasibility and acceptability of an online emotion regulation treatment for adolescents with mental health problems and investigate the preliminary effects on clinical outcomes and the target mechanism, emotion regulation.</p><p><strong>Design, setting, and participants: </strong>This single-blind randomized clinical trial was conducted between October 16, 2022, and July 28, 2023, in a primary care setting in Sweden. Participants in the intention-to-treat analysis were adolescents aged 12 to 17 years with mental health problems and their parents.</p><p><strong>Intervention: </strong>Participants were randomized 1:1 to 6 weeks of therapist-guided online transdiagnostic emotion regulation treatment or an active control condition consisting of 6 weeks of online supportive treatment.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were feasibility and acceptability measures, including consent rate, completion of assessments, adherence, credibility and expectancy ratings (Credibility/Expectancy Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire), immediately after treatment. Clinical outcomes, rated by blinded assessor, included global symptom severity and improvement, symptoms of depression and anxiety, global functioning, and emotion regulation.</p><p><strong>Results: </strong>A total of 30 adolescents (mean [SD] age, 14.2 [1.48] years; 28 females [93%]) were randomized to experimental treatment (n = 15) or active control treatment (n = 15). The consent rate (30 of 37 eligible participants [81%]) and rate of assessment completion immediately after treatment (28 [93%]) were high. Adherence, credibility, expectancy, and satisfaction in both groups were adequate. Participation in the experimental condition, but not the control condition, was associated with large within-group reductions in symptom severity (effect size, 1.30; 95% CI, 0.73-1.86) and symptoms of anxiety and depression (Cohen d, 1.07; 95% CI, 0.37-1.84), improved global functioning (Cohen d, 1.26; 95% CI, 0.66-1.85), and reductions in maladaptive cognitive coping (Cohen d, 1.10; 95% CI, 0.52-1.70) immediately after treatment.</p><p><strong>Conclusion and relevance: </strong>In this randomized clinical trial, a brief online transdiagnostic emotion regulation treatment targeting adolescents with mental health problems was found to be feasible, acceptable, and potentially efficacious in primary care and may increase treatment outreach and accessibility for this population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05032547.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514871"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Trial Discussion and Participation in a Breast Cancer Cohort by Race and Ethnicity.","authors":"Nan Chen, Jincong Q Freeman, Fangyuan Zhao, Leah Goldberg, Sudha R Yarlagadda, Elizabeth Terman, Dezheng Huo, Rita Nanda","doi":"10.1001/jamanetworkopen.2025.15205","DOIUrl":"10.1001/jamanetworkopen.2025.15205","url":null,"abstract":"<p><strong>Importance: </strong>Racial and ethnic disparities in breast cancer clinical trial participation pose a significant barrier to providing equitable care. Black and Hispanic patients are underrepresented in clinical trials, and an improved understanding of barriers to enrollment is needed.</p><p><strong>Objective: </strong>To examine patterns of clinical trial discussion and participation and patient attitudes toward clinical trial participation in a diverse cohort of patients with breast cancer.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used survey data from patients enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Patients were queried about clinical trial discussion and subsequent enrollment in a therapeutic clinical trial. Barriers to trial enrollment were also assessed. Surveys were conducted from July to September 2022, and data were analyzed from February to October 2024.</p><p><strong>Exposure: </strong>Self-reported race and ethnicity, including Asian, Black, Hispanic, and White.</p><p><strong>Main outcomes and measures: </strong>Outcomes of interest were discussing participation in a breast cancer clinical trial with a health care practitioner, participating in a clinical trial, and barriers to trial enrollment.</p><p><strong>Results: </strong>Of 1150 respondents (mean [SD] age, 53.7 [11.9] years), 51 (4.4%) were Asian, 224 (19.5%) were Black, 35 (3.1%) were Hispanic, and 838 (73.0%) were White. A total of 447 respondents (38.9%) reported discussing trial participation with a health care practitioner. There were no differences in trial discussion between White patients and other racial groups (Asian: adjusted odds ratio [AOR], 0.75; 95% CI, 0.31-1.82; Black: AOR, 1.31; 95% CI, 0.78-2.21; Hispanic: AOR, 0.73; 95% CI, 0.26-2.08). Among 443 patients offered a trial, 285 (64.3%) participated. While there were differences in trial participation across racial and ethnic groups, these differences were not significant after adjusting for sociodemographic and clinical factors. Among 158 patients who did not enroll in the trial offered, 37 (23.4%) reported ineligibility, 17 (10.8%) were worried about the possibility of getting a placebo, 16 (10.1%) were worried about extra time required, and 14 (8.9%) were worried about possible adverse effects.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study demonstrated that when offered, patients across racial and ethnic groups were equally likely to participate in clinical trials. In addition to ineligibility, time toxicity was a significant barrier to enrollment. These data provide valuable insights that can serve as a roadmap for how to expand access to trials for all patients, regardless of racial, ethnic, and socioeconomic background.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2515205"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}