Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia最新文献

{"title":"Economic analysis of hemodialysis and urgent-start peritoneal dialysis therapies.","authors":"Alexandre Minetto Brabo, Dayana Bitencourt Dias, Everton Nunes da Silva, Daniela Ponce","doi":"10.1590/2175-8239-JBN-2024-0051en","DOIUrl":"10.1590/2175-8239-JBN-2024-0051en","url":null,"abstract":"<p><strong>Introduction: </strong>Unplanned initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is a common situation worldwide. In this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD; however, the literature lacks such analyses when initiation is urgent.</p><p><strong>Objective: </strong>To clinically and economically evaluate, from the perspective of the Unified Health System (SUS, Sistema Único de Saúde), the strategy of initiating unplanned RRT using HD or PD in patients during their first year of therapy.</p><p><strong>Methodology: </strong>Quasi-experimental study with cost-effectiveness analysis based on primary data from incident patients on RRT, over a twelve-month follow-up period, using the intention-to-treat approach. Data collection occurred prospectively, directly from medical records, computing data on the use of dialysis therapy, high-cost medications, procedures in dialysis accesses and recorded events. Costs were estimated using the amounts reimbursed by the SUS. In the economic analysis, the application of the bootstrap method and the construction of graphical representations were proposed.</p><p><strong>Results: </strong>At the end of one year, there were no differences between costs and effectiveness when initiating unplanned RRT using either PD or HD.</p><p><strong>Conclusion: </strong>Starting RRT with PD is a similar option to starting with HD in patients requiring unplanned methods. The minimal initial investment required to establish PD slots makes it a strong option as a public health policy for expanding RRT in developing countries.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240051"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962239","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":"Multicenter research in dialysis centers in Brazil: recruitment and implementation of the SARC-HD study.","authors":"Marvery P Duarte, Otávio T Nóbrega, Barbara P Vogt, Fábio A Vieira, Dário R Mondini, Maryanne Z C Silva, Henrique S Disessa, Rodrigo R Krug, Bruna R M Sant'Helena, Daiana C Bundchen, Maristela Bohlke, Angélica N Adamoli, Marco C Uchida, Carla M Avesani, Maycon M Reboredo, Heitor S Ribeiro","doi":"10.1590/2175-8239-JBN-2024-0009en","DOIUrl":"10.1590/2175-8239-JBN-2024-0009en","url":null,"abstract":"<p><strong>Introduction: </strong>Multicenter research initiatives in Brazilian dialysis centers are scarce. We described the recruitment and implementation phases of the SARC-HD study, aimed at investigating sarcopenia and its impact on adverse clinical outcomes.</p><p><strong>Methods: </strong>The SARC-HD is a cohort study being conducted with patients on hemodialysis in Brazil. The recruitment phase was defined as the period from the invitation to the center until the start of patient enrollment, whereas the implementation phase lasted from then until the completion of enrollment and baseline data collection. Upon implementation, a structured questionnaire was distributed to collect feedback from principal investigators.</p><p><strong>Results: </strong>21 centers from three Brazilian regions consented to participate, with two dropping out. Ten principal investigators oversaw the 19 sites. Nine centers (47%) were funded entirely by health insurance companies. A total of 1525 patients were screened for eligibility and 1008 were enrolled, with a 66.1% recruitment rate. Recruitment and baseline data collection took 12 [interquartile range: 5-15] weeks. Qualitative content analysis identified barriers such as a lack of infrastructure and logistics for research. Facilitators included the management and organization of the steering committee. Data collection challenges were mainly reported with the subjective 7-point global assessment and the international physical activity questionnaire. The main challenge for the ongoing maintenance phase will be the lack of standardized information in electronic health records.</p><p><strong>Conclusions: </strong>The recruitment and implementation phases of the multicenter SARC-HD study were feasible. Barriers and facilitators identified by principal investigators may help future multicenter initiatives to integrate research-related tasks into clinical routine, facilitating successful experiences.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240009"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949093","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":"Presence of Cryptosporidium spp and other enteroparasites with pathogenic potential in hemodialysis patients: an open controlled study.","authors":"Yara Leite Adami, Nycole Abreu Gama, Flavia de Souza Cunha, Regina Helena Saramago Peralta, Jocemir Ronaldo Lugon","doi":"10.1590/2175-8239-JBN-2024-0015en","DOIUrl":"10.1590/2175-8239-JBN-2024-0015en","url":null,"abstract":"<p><strong>Introduction: </strong>The World Health Organization (WHO) points out that infection by enteroparasites can affect ~3.5 billion people around the world. Hemodialysis (HD) patients may be more susceptible to infections by opportunistic pathogens due to impaired immune function. We evaluated enteroparasite infection in a sample of HD-patients from two dialysis centers and in a control group.</p><p><strong>Methods: </strong>Fecal samples were processed using the Hoffmann-Pons-Janner, Ritchie, Willis, and Rugai techniques. Patients with kidney failure from two dialysis centers undergoing HD for more than 3 months were included. The control group consisted of relatives of the patients without overt CKD. The TaqMan PCR and multiplex real-time PCR were carried out for detection of Cryptosporidium spp. and C. parvum and to differentiate the Entamoeba (E.) histolytica/E. dispar complex, respectively.</p><p><strong>Results: </strong>A total of 97 HD patients and 42 controls were enrolled in the study. Fifty (51.5%) fecal samples from the HD group were positive for enteroparasites, as were 26 (61.9%) from the control group (P = 0.260). S. stercoralis was the single helminth detected and was only present in HD-patients. Coproscopy detected seven positive samples for the E. histolytica/E. dispar complex, three from HD patients and four from controls: by PCR, all samples were positive for the non-pathogenic E. dispar. Safranin-stained fecal smear slides were all negative for Cryptosporidium spp. However, by PCR, amplification for Crypstosporidium spp. was seen in six samples, all from the HD patients. Two of the species were classified as C. hominis by PCR-RFLP.</p><p><strong>Conclusions: </strong>Enteroparasite infection as detected by traditional techniques were not more prevalent in HD patients, but S. stercoralis was only found in these patients. It is noteworthy that Cryptosporidium spp. infection, also affecting only HD patients, could only be detected by molecular biology techniques.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240015"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949131","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":"Phosphate binder in dialysis: a cross-sectional study of patients' adherence and pill burden.","authors":"Brunelle Bruna Scavello Coelho Ferezin, Luiza Karla Ramos Pereira de Araújo, Carolina Marquez Lima, Hugo Abensur, Benedito Jorge Pereira, Maria Aparecida Dalboni, Rosa Maria Affonso Moyses, Rosilene Motta Elias","doi":"10.1590/2175-8239-JBN-2024-0075en","DOIUrl":"10.1590/2175-8239-JBN-2024-0075en","url":null,"abstract":"<p><strong>Introduction: </strong>Phosphate (P) binders are among the most common medications prescribed to control P levels in patients with chronic kidney disease on dialysis. There is still a paucity of data on adherence to P binders with no comparison between dialysis modalities.</p><p><strong>Methods: </strong>We accessed factors associated with P binder adherence among patients on dialysis in an academic hospital. Adherence was calculated as the ratio between the number of pills taken per day as reported and the prescribed number of pills. Patients were considered non-adherent if adherence was at least 20% less or 30% more than prescribed.</p><p><strong>Results: </strong>Patients (N = 137) were young, mostly women, and on dialysis for a median time of 53 months. Sevelamer and calcium carbonate were prescribed as P binders to 70.8% and 10.2% of patients, respectively, with no difference across dialysis modalities (p = 0.839). P correlated with the number of pills prescribed (r = 0.368, p = 0.001) and the number of pills taken per day (r = 0.275, p = 0.001). Hyperphosphatemia was found in 52 patients (36.4%). Adherence to Ca carbonate and sevelamer was 100% and 68.4%, respectively. Non-adherent patients were women, younger, with higher serum albumin and urea, and lower serum calcium. Logistic regression showed that female sex (HR 3.30, 95% CI: 1.39-7.84, p = 0.007) and hemodialysis vs. peritoneal dialysis (HR 4.55, 95%, CI: 1.26-16.39, p = 0.021) remained independently associated with a non-adherence behavior.</p><p><strong>Conclusions: </strong>The current study suggests that strategies to increase adherence should be implemented. Whether phosphate binder adherence is associated with better outcomes deserves further investigation.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240075"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005502","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":"Onconephrology: a new frontier in medicine.","authors":"Carolina Maria Pozzi, Juliana El Ghoz Leme","doi":"10.1590/2175-8239-JBN-2025-E004en","DOIUrl":"10.1590/2175-8239-JBN-2025-E004en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e2025E004"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573033","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":"Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss.","authors":"Adrieli Barros Bessa, Marina Pontello Cristelli, Claudia Rosso Felipe, Renato Demarchi Foresto, Marcelo Cunio Machado Fonseca, Jose Medina Pestana, Helio Tedesco-Silva","doi":"10.1590/2175-8239-JBN-2024-0060en","DOIUrl":"10.1590/2175-8239-JBN-2024-0060en","url":null,"abstract":"<p><strong>Background: </strong>A new induction therapy strategy of a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG) showed a lower incidence of acute rejection.</p><p><strong>Methods: </strong>The objective of this study was to use real-world data to determine the incremental cost-effectiveness ratio (ICER) of r-ATG induction for the prevention of acute rejection (AR) in the first year following kidney transplantation and for kidney graft survival over 1, 4, and 10 years of post-transplantation from the perspective of the national public healthcare system. A Markov state transition model was developed utilizing real-world data extracted from medical invoices from a single center. The study population consisted of adults at low immunological risk undergoing their initial transplantation and received kidneys from either living or deceased donors. The intervention of r-ATG induction was compared to no induction. The clinical outcomes considered for this analysis were acute rejection, cytomegalovirus infection/disease, death, graft loss, and retransplantation.</p><p><strong>Results: </strong>The cost-effectiveness analysis in the first year revealed that the r-ATG group was more cost-effective, with an ICER of US$ 399.96 per avoided AR episode, an effectiveness gain of 0.01 year in graft survival and a total incremental cost of US$ 147.50. The 4- and 10-year analyses revealed an effectiveness gain of 0.06 and 0.16 years in graft survival in the r-ATG induction group, and a total incremental cost of US$ -321.68 and US$ -2,440.62, respectively.</p><p><strong>Conclusion: </strong>The single 3 mg/kg dose of r-ATG is cost-effective in preventing acute rejection episodes and dominant in the long term of transplantation, conferring survival gain.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240060"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949134","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":"Renal long COVID-19: an ongoing debate requiring robust evidence.","authors":"Heitor S Ribeiro, Emmanuel A Burdmann, Luis Yu","doi":"10.1590/2175-8239-JBN-2025-E001en","DOIUrl":"10.1590/2175-8239-JBN-2025-E001en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e2025E001"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515703","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":"Should a low-protein diet and ketoanalogue supplementation be part of the management of advanced chronic kidney disease?","authors":"Yoko Narasaki, Hyung-Ah Jo, Connie M Rhee","doi":"10.1590/2175-8239-JBN-2024-0237en","DOIUrl":"10.1590/2175-8239-JBN-2024-0237en","url":null,"abstract":"<p><p>The vast majority of patients with advanced chronic kidney disease (CKD) who transition to end-stage kidney disease (ESKD) are treated with dialysis. Given that dialysis does not always have the intended effects of increasing longevity and/or improving health, particularly in those with high comorbidity burden and/or older age groups, there has been increasing emphasis on interventions that delay or avert the need for renal replacement therapy. Among the multi-disciplinary approaches used to reduce CKD progression, dietary interventions are a major cornerstone. Current guidelines support the role of a low-protein diet in patients with moderate to advanced CKD who are metabolically stable. In addition to dietary protein amount, there is evidence that dietary protein sources as well as nutrients in plant-based foods have an important impact on kidney health outcomes. Clinical practice guidelines, including the 2020 National Kidney Foundation and Academy of Nutrition and Dietetics Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in CKD, recommend a low protein diet for patients with moderate to advanced non-dialysis dependent (NDD)-CKD who are metabolically stable to reduce risk of ESKD and death. In addition to recommending lower protein intake, the recent 2024 Kidney Disease Improving Global Outcomes CKD Guidelines include a Practice Point advising that people with CKD eat more plant-based foods than animal-based foods. Increasing data also show that plant-based diets are associated with lower risk of progression of CKD and its complications including cardiovascular disease (cardio-kidney-metabolic syndrome), acid-base balance disorders, mineral bone disease, and dysglycemia.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240237"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604851","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":"Delving into the complexities of the interplay between acute kidney injury and diabetic kidney disease: A focus on glycemic control and outcomes.","authors":"Érika Bevilaqua Rangel","doi":"10.1590/2175-8239-JBN-2024-0074en","DOIUrl":"10.1590/2175-8239-JBN-2024-0074en","url":null,"abstract":"<p><p>Patients with diabetic kidney disease (DKD) face an elevated risk of experiencing acute kidney injury (AKI), exacerbating the progression of DKD. This article offers a comprehensive review of the literature and knowledge of the primary pathophysiologic mechanisms underlying kidney damage, as well as the biological implications of maladaptive kidney repair in the context of DKD complicated by AKI. Additionally, we examine in detail the findings of clinical trials evaluating the efficacy and safety of intensive insulin treatment for hyperglycemic patients in intensive care units, alongside the potential risks of hypoglycemia and mortality. Furthermore, through critical analysis of clinical trial results, opportunities for personalized safety-based approaches to mitigate side effects are identified. It is imperative to conduct randomized-controlled studies to assess the impact of intensive insulin treatment on diabetic patients with DKD, and to validate AKI biomarkers in this patient population. Such studies will help to tailor treatment strategies to improve patient outcomes and preserve kidney function.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240074"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828562","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":"Feasibility of the Hemomindful Program: a mindfulness-based program performed during hemodialysis.","authors":"Angélica Nickel Adamoli, Bruno Nunes Razzera, Raphaele Nonnenmacher Colferai, Maitê Freitas Ranheiri, Wagner de Lara Machado, Ana Maria Pandolfo Feoli, Ana Regina Noto, Margareth da Silva Oliveira","doi":"10.1590/2175-8239-JBN-2024-0068en","DOIUrl":"10.1590/2175-8239-JBN-2024-0068en","url":null,"abstract":"<p><strong>Introduction: </strong>Recent evidence indicates that mindfulness-based programs (MBPs) improve overall well-being and the ability to cope with kidney failure and hemodialysis stressors. However, intradialytic MBPs are poorly investigated.</p><p><strong>Objective: </strong>The aim of this study was to describe the study protocol, evaluate the feasibility and perceived effects of the Hemomindful Program.</p><p><strong>Methods: </strong>The results presented are from a mixed-methods randomized controlled trial. Thirty-two adults with kidney failure were randomized into the Hemomindful Program, which consisting of 8 weekly individual sessions of 1 hour delivered at chairside during hemodialysis combined with the treatment as usual (TAU), or TAU alone. Feasibility was assessed based on retention of the study protocol, adherence to the Hemomindful Program, its safety, and participant satisfaction. Semi-structured interviews were conducted with participants in the intervention arm immediately following treatment. Data were analyzed using descriptive statistics and discursive textual analysis.</p><p><strong>Results: </strong>The overall rate of adherence to the study protocol was 84.38%. Among the participants in the Hemomindful Program (n = 16), 15 had four or more sessions (93.7%) and 12 completed the protocol (75%). Degree of importance attributed to the intervention was 8.58 (SD = 2.06) and intention to maintain the formal and informal mindfulness practices after the intervention was 6.67 (SD = 2.93) and 8.5 (SD = 2.31). The qualitative analysis indicated satisfaction with the perceived changes (greater awareness in daily activities, less reactivity, management of pain and discomfort) and the structure of the program.</p><p><strong>Conclusion: </strong>The Hemomindful Program showed positive indicators of feasibility, with good retention, acceptability and safety.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"47 1","pages":"e20240068"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828564","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}