Journal of Clinical and Experimental Hepatology最新文献

{"title":"Glycerol-3-Phosphate Dehydrogenase 1 Deficiency and Steatotic Liver Disease in Children: Our Cases and Review of Literature","authors":"Ankit Agrawal ,&nbsp;Anshu Srivastava ,&nbsp;Amita Moirangthem ,&nbsp;Suzena M. Singh ,&nbsp;Dhriti Kodethoor ,&nbsp;Srinivas S. Vadlapudi ,&nbsp;Moinak S. Sarma ,&nbsp;Ujjal Poddar","doi":"10.1016/j.jceh.2024.102484","DOIUrl":"10.1016/j.jceh.2024.102484","url":null,"abstract":"<div><h3>Introduction</h3><div>Glycerol-3-phosphate dehydrogenase 1 (GPD1) deficiency is an autosomal recessive disorder causing hypertriglyceridemia, hepatomegaly, fatty liver, and hepatic fibrosis in infancy. It is an under-recognized cause of pediatric steatotic liver disease (SLD) with only 36 cases reported worldwide.</div></div><div><h3>Method</h3><div>We analyzed the clinical profile of our five cases diagnosed by exome sequencing (ES) and reviewed the published cases till December 2023 using PubMed search.</div></div><div><h3>Results</h3><div>Five unrelated boys (6–24months) presented with hepatomegaly, hypertriglyceridemia, transaminase elevation, and fatty liver. ES revealed compound heterozygous mutations in two and homozygous mutation in three including two novel mutations (c.917T &gt;C, c.905C &gt; G). All received supportive therapy, and fenofibrate was successfully used in one case for progressive hypertriglyceridemia. Globally, 36 cases (age at diagnosis: 6 [1–164 months]) have been reported. Majority had hepatomegaly (94.4%), 22.2% each had splenomegaly and growth failure. Hypertriglyceridemia (97.2%) was nearly universal, 100% had fatty liver, and hypoglycaemia (11.2%) was uncommon. Liver biopsy (n = 18) demonstrated steatosis in all, fibrosis in 94.4%, and cirrhosis in 22.2%. During follow-up (11–376 months), hepatomegaly resolved in 35.2%, triglycerides, and transaminases normalized in 29.1% and 31.5%, respectively. No pancreatitis, cardiac events, or liver decompensation was reported.</div></div><div><h3>Conclusion</h3><div>GPD1 is an uncommon cause of SLD, raised transaminases and hypertriglyceridemia in young children. Diagnosis is confirmed by genetic testing. Supportive therapy, parental counseling about the disease nature and close follow-up is recommended.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102484"},"PeriodicalIF":3.3,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006176","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":"Successful Liver Transplantation from a Deceased Donor With Gilbert's Syndrome","authors":"Sunil Shenvi,&nbsp;Prashantha S. Rao,&nbsp;Ameya Panchwagh,&nbsp;Mitul Shah,&nbsp;Shaesta N. Zaidi,&nbsp;Ravi Mohanka","doi":"10.1016/j.jceh.2024.102470","DOIUrl":"10.1016/j.jceh.2024.102470","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102470"},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006204","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":"“Post-Kasai Portoenterostomy Cholangitis: What Have We Learnt So Far?”","authors":"Arghya Samanta,&nbsp;Moinak S. Sarma","doi":"10.1016/j.jceh.2024.102471","DOIUrl":"10.1016/j.jceh.2024.102471","url":null,"abstract":"<div><div>Post-Kasai portoenterostomy (KPE) cholangitis is one of the most common complications that has a negative impact on liver function and native liver survival. Early diagnosis and judicious empiric antimicrobial management are, therefore, important to prevent further liver damage and decompensation. However, there is no consensus regarding the standard definition of post-KPE cholangitis, and established guidelines on evaluation and management are also lacking. Metagenomic next-generation sequencing, a new molecular diagnostic technique, has the potential for detecting broader spectrum of pathogens, especially in blood culture-negative patients. Antibiotic prophylaxis to prevent cholangitis has been widely used, but questions over the choice of antibiotics, route of administration, and optimal duration remain unsettled. The available evidence on the efficacy of antibiotic prophylaxis in preventing cholangitis has shown conflicting results. This review offers a summary of the current research on advances in diagnostic approaches, including molecular techniques, and therapeutic challenges in managing intractable cholangitis.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102471"},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006084","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":"Liver Organoids From Hepatocytes of Healthy Humans and Non-alcoholic Fatty Liver Disease (NAFLD) Patients Display Multilineage Architecture and can be Used to Develop an In Vitro Model of Steatohepatitis","authors":"Yamini Goswami ,&nbsp;Akash Baghel ,&nbsp;Ghanshyam Sharma ,&nbsp;Phulwanti K. Sharma ,&nbsp;Sagnik Biswas ,&nbsp;Rajni Yadav ,&nbsp;Pramod K. Garg ,&nbsp;Shalimar ,&nbsp;Ruchi Tandon","doi":"10.1016/j.jceh.2024.102463","DOIUrl":"10.1016/j.jceh.2024.102463","url":null,"abstract":"<div><h3>Background/Aim</h3><div>Non-alcoholic fatty liver disease (NAFLD) is a global health concern with limited treatment options. The paucity of predictive <em>i</em><em>n</em> <em>v</em><em>itro</em> models in preclinical settings seems to be one of the limitations of identifying effective medicines. We therefore aimed to develop an <em>i</em><em>n</em> <em>v</em><em>itro</em> model that can display the key hallmarks of NAFLD, such as steatosis, inflammation, and fibrosis.</div></div><div><h3>Methods</h3><div>An <em>in vitro</em> model of steatohepatitis was developed using organoids prepared from hepatocytes of healthy individuals from a commercial source (HLOs) and the liver tissues collected from needle biopsies of NAFLD patients (HLO_NAFLD) using defined culture conditions. HLOs were treated with palmitic acid for 72 h to develop an <em>i</em><em>n</em> <em>v</em><em>itro</em> model of steatohepatitis, while HLO_NAFLD served as a natural model of steatohepatitis. Metformin and saroglitazar were used to validate the liver organoid model of steatohepatitis. Saroglitazar was also evaluated in the high-fat, high-fructose (HF-HF) diet-induced model of NAFLD using C57BL/6 mice to validate the findings from the <em>i</em><em>n</em> <em>v</em><em>itro</em> model.</div></div><div><h3>Results</h3><div>HLOs and HLO_NAFLD exhibited bipotent properties, showing the expression of markers of hepatocytes, ductal cells, and also stem cells. Furthermore, they demonstrated the expression of nonparenchymal cell markers such as stellate cells (CD166) and Kupffer-like cells (CD68 and EMR1). The steatohepatitis models developed using these organoids displayed markers associated with steatosis, inflammation and fibrosis, which were decreased by metformin and saroglitazar.</div></div><div><h3>Conclusion</h3><div>The <em>in vitro</em> models developed in our lab employing HLOs and HLO_NAFLD display all three key hallmarks of NAFLD: steatosis, inflammation, and fibrosis without the necessity for coculture with other nonparenchymal cells. The implementation of the HLO_NAFLD-based model is also expected to provide a more realistic assessment of test substances to develop therapeutics for NAFLD.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102463"},"PeriodicalIF":3.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052641","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":"Bleeding From Unintentional Portal Vein Stenting During Endoscopic Retrograde Cholangiopancreatography Managed With Portal Vein Stent Graft Placement—A Case Report With a Detailed Review of the Literature","authors":"Prayas Vats ,&nbsp;Pradeep K. Jain ,&nbsp;Sanjay Khanna ,&nbsp;Amol Srivastava ,&nbsp;Ranjan K. Patel","doi":"10.1016/j.jceh.2024.102468","DOIUrl":"10.1016/j.jceh.2024.102468","url":null,"abstract":"<div><div>Suspicion of vascular injury during endoscopic retrograde cholangiopancreatography (ERCP) should be raised in the event of intraprocedural bleeding, persistent hyperbilirubinemia, and sepsis despite biliary stenting. Most inadvertent portal vein (PV) cannulations during ERCP are innocuous, and mere withdrawal of guidewire and catheter suffices. However, unintentional PV stenting, particularly with larger metallic stents, increases the likelihood of significant bleeding. Thus, endoscopic removal of a malpositioned stent from the PV should be carried out in the interventional radiology suite so that PV stent grafting can be performed in case of unexpected bleeding. Here, we describe a case of bleeding from a malpositioned 10-French plastic stent within the PV during ERCP in a 79-year-old male. The bleeding was effectively controlled by inserting a 16-mm covered stent into the PV via a transjugular route.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102468"},"PeriodicalIF":3.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971046","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":"Safety and Outcomes of an On-Demand Transfusion Strategy Versus Prophylactic Transfusion of Platelets in Patients With Liver Cirrhosis and Severe Thrombocytopenia Undergoing High-Risk Procedures: A Post Hoc Analysis of Two Randomized Controlled Trials","authors":"Sagnik Biswas ,&nbsp;Sanchita Gupta ,&nbsp;Shubham Mehta ,&nbsp;Shekhar Swaroop ,&nbsp;Arnav Aggarwal ,&nbsp;Ayush Agarwal ,&nbsp;Sarthak Saxena ,&nbsp;Tushar Sehgal ,&nbsp;Samagra Aggarwal ,&nbsp;Deepak Gunjan ,&nbsp;Baibaswata Nayak ,&nbsp;Shivanand Gamanagatti ,&nbsp;Shalimar","doi":"10.1016/j.jceh.2024.102467","DOIUrl":"10.1016/j.jceh.2024.102467","url":null,"abstract":"<div><h3>Background</h3><div>There are limited studies assessing whether prophylactic platelet transfusions prior to high-risk procedures reduce the risk of bleeding in patients with liver cirrhosis.</div></div><div><h3>Methods</h3><div>We performed a <em>post hoc</em> analysis of two prior randomized clinical trials (CTRI/2017/12/010822 and CTRI/2021/05/033464), which compared thromboelastography-guided prophylactic platelet transfusion to standard-of-care (empirical prophylactic transfusion for all patients prior to the procedure) or on-demand transfusion (no prophylactic transfusions). We aimed to assess the risk of major procedure-related bleeding or mortality among patients who had received prophylactic platelet transfusions versus those who did not (on-demand transfusions).</div></div><div><h3>Results</h3><div>A total of 118 patients were included in the analysis, with baseline demographics well matched between groups. The leading etiologies of cirrhosis were cryptogenic (42, 35.6%) and autoimmune liver disease (30, 25.4%). The most common procedures performed were percutaneous liver biopsy (73, 61.8%), followed by transjugular intrahepatic portosystemic shunt (14, 11.9%) and transarterial chemoembolization (14, 11.9%). No episode of major bleeding or procedure-related mortality occurred in either group, though minor bleeding occurred in 5 patients. A significantly lower number of patients in the on-demand group required platelet transfusions than those receiving empirical transfusions as part of standard care.</div></div><div><h3>Conclusion</h3><div>Procedure-related bleeding rates were not significantly higher among patients with liver cirrhosis undergoing high-risk procedures without prophylactic platelet transfusions than in those who received them. Larger randomized trials are required to validate these findings from our <em>post hoc</em> analysis.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102467"},"PeriodicalIF":3.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006161","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":"Prevalence of Transaminitis and Metabolic Dysfunction-Associated Steatotic Liver Disease Among Young Indian Adults—A Population-Based Study","authors":"Abilash Nair ,&nbsp;Jabbar Puthiyaveettil Khadar ,&nbsp;Archana Mohan Preetha ,&nbsp;Jayakumari Chellamma ,&nbsp;Krishnadas Devadas ,&nbsp;Tanvir Kaur Gandhi ,&nbsp;Bipin K. Gopal ,&nbsp;Sreejith Babu U.S. ,&nbsp;Amal Kingsley ,&nbsp;Anish Thekkumkara Surendran Nair ,&nbsp;Ramesh Gomez ,&nbsp;Praveen G ,&nbsp;Ajosh Thambi T.S. ,&nbsp;Sumitha N.","doi":"10.1016/j.jceh.2024.102466","DOIUrl":"10.1016/j.jceh.2024.102466","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) with onset in youth may be more consequential for adverse outcomes than that detected later in adulthood. Transaminitis in the general population is a marker of the prevalence of MASLD. There are no previous community-based studies in Indian youth assessing the prevalence of transaminitis. The purpose of this study was to find out the prevalence of transaminitis, MASLD and elevated Fibrosis-4 (FIB-4) index among young South Indian adults.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study done over a period of 1 year from January 2022 among adults aged 18–30 years. Multistage sampling was used to recruit participants with body mass index (BMI) &lt; 30 kg/m² and without moderate to heavy alcohol consumption from four different sociogeographic regions. Detailed history, physical examination and investigations including liver enzymes (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), platelet count, and metabolic workup were carried out. FIB-4 index and Nonalcoholic fatty liver disease-liver fat score (NAFLD-LFS) were calculated. LFS ≥ −0.64 was used to rule in MASLD.</div></div><div><h3>Results</h3><div>A total of 2373 (1170 males) participants with a mean age of 24 ± 3.5 years were included. Transaminitis (AST or ALT≥35 IU/L) was seen in 25.9% of the cohort. MASLD by NAFLD-LFS was present in 27.4% of the population. FIB-4 index ≥1.3 was found in 54 (2.27%) participants. Neck circumference and Trivandrum Medical College adiposity index were associated with transaminitis, MASLD, and elevated FIB-4. Blood pressure, triglycerides, and low-density lipoprotein cholesterol were higher, and high-density lipoprotein cholesterol was lower among participants with transaminitis, but they were not different among those with elevated FIB-4 index. BMI and waist-hip ratio were not different among participants with and those without transaminitis or MASLD.</div></div><div><h3>Conclusion</h3><div>There is a high prevalence of transaminitis and MASLD in community-dwelling young adult Indians. We recommend screening all young adult Indians for MASLD and transaminitis.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102466"},"PeriodicalIF":3.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047004","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":"Liver Explantation in Difficult Scenarios","authors":"Rajesh Dey,&nbsp;Shaleen Agarwal,&nbsp;Subash Gupta","doi":"10.1016/j.jceh.2024.102461","DOIUrl":"10.1016/j.jceh.2024.102461","url":null,"abstract":"<div><div>Recipient hepatectomy is considered as the most difficult part of a liver transplant operation. This article describes techniques to deal with scenarios like massive caudate lobe, a recipient with a transjugular intrahepatic portosystemic shunt (TIPS) shunt <em>in situ</em>, a recipient with hepatocellular carcinoma, acute liver failure and a history of previous abdominal surgery.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102461"},"PeriodicalIF":3.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971040","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":"Tofacitinib-induced Hepatitis and Tuberculosis: A Case of Two Rare Adverse Events in a Single Patient","authors":"Kamlesh Taori,&nbsp;Sanjay Kumar,&nbsp;Mayankbhushan Pateriya,&nbsp;Naveen TMU","doi":"10.1016/j.jceh.2024.102457","DOIUrl":"10.1016/j.jceh.2024.102457","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102457"},"PeriodicalIF":3.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931945","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":"Body Composition in Cholangiocarcinoma Affects Immune Cell Populations in the Tumor and Normal Liver Parenchyma","authors":"Guanwu Wang ,&nbsp;Dong Liu ,&nbsp;Tarick M. Al-Masri ,&nbsp;Carlos C. Otto ,&nbsp;Jens Siveke ,&nbsp;Sven A. Lang ,&nbsp;Tom F. Ulmer ,&nbsp;Steven WM Olde Damink ,&nbsp;Tom Luedde ,&nbsp;Edgar Dahl ,&nbsp;Ulf P. Neumann ,&nbsp;Lara R. Heij ,&nbsp;Jan Bednarsch","doi":"10.1016/j.jceh.2024.102460","DOIUrl":"10.1016/j.jceh.2024.102460","url":null,"abstract":"<div><h3>Background</h3><div>Due to malnutrition and tumor cachexia, body composition (BC) is frequently altered and known to adversely affect short- and long-term results in patients with cholangiocarcinoma (CCA). Here, we explored immune cell populations in the tumor and liver of CCA patients with respect to BC.</div></div><div><h3>Methods</h3><div>A cohort of 96 patients who underwent surgery for CCA was investigated by multiplexed immunofluorescence (MIF) techniques with computer-based analysis on whole-tissue slide scans to quantify and characterize immune cells in normal liver and tumor regions. BC was characterized by obesity, sarcopenia, myosteatosis, visceral obesity and sarcopenic obesity. Associations between BC and immune cell populations were determined by univariate and multivariable binary logistic regressions.</div></div><div><h3>Results</h3><div>BC was frequently altered in intrahepatic CCA (iCCA, n = 48), with 47.9% of the patients showing obesity, 70.8% sarcopenia, 18.8% sarcopenic obesity, 58.3% myosteatosis and 54.2% visceral obesity as well as in perihilar CCA (pCCA, n = 48) with 45.8% of the patients showing obesity, 54.0 sarcopenia, 14.6% sarcopenic obesity, 47.9% myosteatosis and 56.3% visceral obesity. From an immune cell perspective, independent associations within the tumor compartment were observed for iCCA (myosteatosis: TIM-3+CD8+cells; obesity: PD-1+TIM-3+CD4+cells) and for pCCA (myosteatosis: PD-L2+CD68-cells and CD4+cells). Further, independent associations were observed within the normal liver parenchyma for iCCA (visceral obesity: PD-1+PD-L1+PD-L2+CD68+cells) and for pCCA (sarcopenia: CD68+cells and TIM-3+CD8+cells; visceral obesity: ICOS+-TIGIT+CD8+cells and sarcopenic obesity: PD-1+PD-L1+PD-L2+CD8+cells).</div></div><div><h3>Conclusion</h3><div>This is the first systematic analysis of the association of BC and immune cells in cholangiocarcinoma showing a strong association between BC and distinct immune cell populations within the tumor itself as well as within the normal parenchyma.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 2","pages":"Article 102460"},"PeriodicalIF":3.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931861","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}