Journal of Infection and Chemotherapy最新文献

{"title":"Comparative Efficacy and Safety of Oral Versus Intravaginal Metronidazole for the Treatment of Bacterial Vaginosis: A Systematic Review and Meta-Analysis.","authors":"Jun Hirai, Yu Arakawa, Hideo Kato, Tomonori Takano, Yuka Yamagishi, Hiroyuki Kunishima, Hiroshige Mikamo","doi":"10.1016/j.jiac.2025.102826","DOIUrl":"https://doi.org/10.1016/j.jiac.2025.102826","url":null,"abstract":"<p><strong>Background: </strong>Although oral and intravaginal metronidazole (MNZ) are recommended as the standard treatments for bacterial vaginosis (BV), the optimal route of administration remains controversial. Oral MNZ is effective but often leads to gastrointestinal side effects and thus reduces patient adherence. Intravaginal MNZ may offer similar efficacy with improved tolerability; however, comprehensive evidence is needed to guide treatment choices. This study aimed to compare oral and intravaginal MNZ for BV treatment.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis of randomized controlled trials (RCTs), the primary outcomes were the clinical and microbiological cure rates, and the secondary outcome was the incidence of adverse gastrointestinal events. Relevant studies published until March 2025 were identified through database searches (PubMed, Web of Science, Scopus, and Ichushi). Data were synthesized using risk ratios (RRs) and 95% confidence intervals (CIs) with random-effects models.</p><p><strong>Results: </strong>Seven RCTs, including 697 patients, were analyzed. Clinical cure rates were equivalent between oral and intravaginal MNZ groups (pooled RR, 1.00; 95% CI 0.94-1.06; p=0.90). Microbiological cure rates also showed no significant difference (RR=0.95; 95% CI 0.75-1.71; p=0.66). Gastrointestinal side effects were significantly more frequent in the oral MNZ group than in the intravaginal MNZ group (RR=2.29; 95% CI 1.57-3.35; p<0.001). Intravaginal MNZ was associated with better tolerability than oral MNZ.</p><p><strong>Conclusion: </strong>Oral and intravaginal MNZ offer similar efficacies for BV treatment; however, intravaginal administration reduces systemic side effects and may improve adherence. Treatment should be individualized on the basis of patient preferences, side effect profiles, and accessibility.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102826"},"PeriodicalIF":1.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features of pediatric invasive Escherichia coli disease: A study at seven facilities in Chiba prefecture in Japan.","authors":"Tadashi Hoshino, Noriko Takeuchi, Hiroshi Okada, Ken Takahashi, Shoko Hirose, Koo Nagasawa, Katsuhiko Kitazawa, Toru Igarashi, Takeshi Asano, Kaoru Obinata, Naruhiko Ishiwada","doi":"10.1016/j.jiac.2025.102825","DOIUrl":"10.1016/j.jiac.2025.102825","url":null,"abstract":"<p><strong>Background: </strong>Escherichia coli is a major pathogen of pediatric invasive diseases; infection with multidrug-resistant strains needs immediate attention. The incidence and clinical characteristics of invasive E. coli disease (IED) in Japanese pediatric populations remain unclear. We aimed to investigate clinical and epidemiological characteristics of pediatric IED.</p><p><strong>Methods: </strong>We retrospectively studied hospitalized patients aged ≤15 years diagnosed with IED between 2009 and 2022 at seven medical facilities in Chiba Prefecture, Japan. IED was defined as E. coli isolated from sterile sites, excluding cases with urine as the sole isolation site. Clinical data, antimicrobial susceptibility, outcomes, and estimated incidence rates were analyzed.</p><p><strong>Results: </strong>A total of 172 IED episodes were identified in 162 patients, 86 % of which were in children aged <5 years, and 65 % had comorbidities. Urinary tract infections (UTIs) with bacteremia were the most common diagnoses. However, trends varied by age, with UTIs accompanied by bacteremia being the most common in patients aged <5 years, whereas bacteremia alone was the most common diagnosis in those aged ≥5 years. Death or other sequalae were observed in 21 (12.2 %) patients. Extended-spectrum β-lactamase (ESBL)-producing strains caused 12.2 % of infections, mostly affecting infants. Recurrence occurred in six patients, with five having comorbidities. Female sex was an independent risk factor for poor outcomes (odds ratio 3.115, p = 0.039).</p><p><strong>Conclusions: </strong>Pediatric IEDs are more frequent in children with comorbidities, and they vary in clinical features according to the age group. ESBL-producing strains should be considered in empiric therapy, particularly in infants.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102825"},"PeriodicalIF":1.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical considerations of the safety and efficacy of clofazimine in the treatment of nontuberculous mycobacterial disease","authors":"Fumiya Watanabe","doi":"10.1016/j.jiac.2025.102823","DOIUrl":"10.1016/j.jiac.2025.102823","url":null,"abstract":"<div><div>Clofazimine (CFZ) has been shown to exhibit synergism with amikacin and clarithromycin against nontuberculous mycobacteria (NTM), and is thus being repositioned to treat associated infections. However, clinical evidence supporting its efficacy and optimal dosage remains limited. Nonetheless, <em>in vitro</em> and retrospective studies have suggested its potential utility in treating NTM pulmonary disease. Moreover, CFZ pharmacokinetics and CFZ-induced side effects, such as pigmentation, heart rate corrected QT interval prolongation, and gastrointestinal disorders, are well characterized. This study aims to outline the pharmacokinetics of CFZ, as well as its efficacy and side effects, to inform its optimal use in the treatment of NTM pulmonary disease.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 11","pages":"Article 102823"},"PeriodicalIF":1.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the necessity of two-point sampling for vancomycin area under the curve in follow-up therapeutic drug monitoring.","authors":"Ayako Suzuki, Hisato Fujihara, Fumihiro Yamaguchi, Hiroaki Yoshida, Hiroaki Tanaka, Yusuke Yagi, Takumi Maruyama, Yukihiro Hamada, Tomoyuki Ishigo, Satoshi Fujii, Fumio Nagumo, Masaru Samura, Hiroaki Chiba, Fumiya Ebihara, Akitoshi Takuma, Toshiaki Komatsu, Atsushi Tomizawa, Yoshifumi Nishi, Yuki Igarashi, Yuki Enoki, Kazuaki Matsumoto","doi":"10.1016/j.jiac.2025.102821","DOIUrl":"10.1016/j.jiac.2025.102821","url":null,"abstract":"<p><strong>Objective: </strong>While both peak and trough (two-point) sampling are recommended to estimate the area under the concentration-time curve (AUC) for vancomycin, one-point sampling may reduce clinical burden. This study aimed to identify patient populations requiring two-point sampling by examining risk factors associated with AUC discrepancies between one- and two-point sampling during follow-up therapeutic drug monitoring (TDM).</p><p><strong>Method: </strong>This multicenter retrospective observational study included adult patients who received vancomycin from September 2020 to December 2023 and underwent two-point sampling at both initial and follow-up TDM. AUC was estimated using the Practical Antimicrobial TDM (PAT) version 4.0, and creatinine clearance (CLcr) was calculated using the Cockcroft-Gault equation. One- and two-point follow-up AUCs were compared using previously entered two-point concentrations from initial TDM. Patients were divided into a discrepancy group (AUC difference ≥10 %) and a non-discrepancy group. Risk factors were identified by univariate and multivariate analysis.</p><p><strong>Results: </strong>AUC values from one- and two-point sampling in 256 cases were highly correlated (r² = 0.965, p < 0.001). Seventeen cases (6.6 %) showed discrepancies ≥10 %. Multivariate analysis identified BMI ≥25 kg/m² (OR = 6.946, p = 0.001), CLcr <50 mL/min (OR = 5.863, p = 0.002), and ΔCLcr ≥10 mL/min (OR = 4.444, p = 0.012) as significant risk factors.</p><p><strong>Conclusion: </strong>Although one- and two-point AUCs showed strong correlation, discrepancies ≥10 % were more likely in patients with elevated BMI or impaired/unstable renal function. This suggests that two-point sampling may be essential for these patients to ensure accurate dosing of vancomycin during follow-up TDM.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102821"},"PeriodicalIF":1.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular epidemiology and pathogenicity analysis of community-acquired MRSA in Japanese children with a severe or recurrent infection.","authors":"Atsushi Miyake, Kenji Gotoh, Hiroyuki Miyazaki, Kiyohito Okumiya, Yuhei Tanaka, Tatsuki Mizuochi, Hiroshi Watanabe","doi":"10.1016/j.jiac.2025.102824","DOIUrl":"https://doi.org/10.1016/j.jiac.2025.102824","url":null,"abstract":"<p><p>Reports of severe infections caused by Panton-Valentine leukocidin (PVL)-positive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasing. Pediatric infections caused by CA-MRSA, including in children without known risk factors, are on the rise worldwide. In recent years, PVL-producing USA300-related clones and ST22-PT clones producing both PVL and toxic shock syndrome toxin-1 (TSST-1) have been identified, which suggests an emerging threat. We treated 10 pediatric patients with severe or recurrent MRSA infections between 2021 and 2024. These included four cases of recurrent subcutaneous abscesses, two cases of necrotizing pneumonia, and one case each of bacteremia, suppurative osteomyelitis, cellulitis, and infective endocarditis. Four patients had underlying medical conditions. Molecular analysis revealed that all of the isolates carried SCCmec type IV, 50% were PVL-positive, and 30% produced TSST-1. Multilocus sequence typing showed that 60% of isolates belonged to sequence type (ST) 8 clones suspected to be USA300-related variants. Furthermore, one isolate belonged to the ST22-PT clone. These findings revealed that CA-MRSA accounts for the majority of MRSA infections even in pediatric patients, with severe cases caused by PVL or TSST-1 positive strains. CA-MRSA has also spread within healthcare settings and could pose a significant risk to pediatric patients with underlying conditions. Furthermore, the results suggest that severe infections caused by USA300-related clone and ST22-PT could increase in the future. Ongoing molecular surveillance is essential to guide effective treatment and infection-control strategies.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102824"},"PeriodicalIF":1.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of community-acquired respiratory virus infections and impact on cancer treatment at a tertiary care cancer center in Japan.","authors":"Takahiro Fujita, Takeharu Iida","doi":"10.1016/j.jiac.2025.102822","DOIUrl":"10.1016/j.jiac.2025.102822","url":null,"abstract":"<p><strong>Aim: </strong>To clarify the burden of community-acquired respiratory virus (CRV) other than SARS-CoV-2 infections in adult patients with cancer and their impact on cancer treatment.</p><p><strong>Patients and methods: </strong>We retrospectively examined positive cases using multiplex respiratory polymerase chain reaction panel tests at a Japanese tertiary-care cancer center. From April 2023 to March 2024, a total of 1629 tests were performed on 1068 patients.</p><p><strong>Results: </strong>CRV other than SARS-CoV-2 were identified in 128 cases. These include rhinovirus/enterovirus (47 cases), parainfluenza virus (22 cases), human coronavirus (18 cases), Respiratory syncytial virus (15 cases), influenza A (14 cases), and human metapneumovirus (10 cases). Pneumonia was observed in 19 (15.7 %) patients. In 38 patients (31.4 %), cancer treatment was postponed due to CRV other than SARS-CoV-2 infection.</p><p><strong>Conclusion: </strong>CRV other than SARS-CoV-2infections contribute to delays in cancer treatment and are frequently associated with pneumonia. To ensure the safe continuation of cancer treatment, it is imperative to provide patients with appropriate infection control guidance and perform respiratory panel tests for an accurate diagnosis.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102822"},"PeriodicalIF":1.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Hydrogen Peroxide Vaporizing Against Methicillin-Resistant Staphylococcus aureus, Extended-Spectrum β-Lactamase-Producing Bacteria, and Clostridioides difficile.","authors":"Narimi Miyazaki, Ai Kurumiya, Mina Takayama, Yuzuka Kawamoto, Daisuke Sakanashi, Tomoko Ohno, Atsuko Yamada, Akiko Nakamura, Hirotoshi Ota, Yuichi Shibata, Nobuhiro Asai, Yuka Yamagishi, Hiroshige Mikamo","doi":"10.1016/j.jiac.2025.102820","DOIUrl":"https://doi.org/10.1016/j.jiac.2025.102820","url":null,"abstract":"<p><strong>Background: </strong>Environmental contamination with drug-resistant bacteria and spore-forming organisms such as Clostridioides difficile poses a significant risk of healthcare-associated infections (HAIs). While manual disinfection using disinfectant-impregnated cloths is standard practice, it is susceptible to human error and may leave residual contamination by pathogens.</p><p><strong>Methods: </strong>We evaluated the bactericidal efficacy of hydrogen peroxide vaporizing using a compact device (NOCOSPRAY2) in a simulated hospital room (28.8 m³). Surfaces were inoculated with methicillin-resistant Staphylococcus aureus (MRSA, ATCC43300), ESBL-producing Escherichia coli (NCTC13353), or C. difficile (ATCC9689), followed by drying. Vaporizing was performed at three different settings: 2-minute spray + 60-minute contact (1×), 6-minute spray + 90-minute contact (3×), and 9-minute spray + 90-minute contact (5×). Viable bacterial counts were determined post-vaporizing to calculate log reduction values.</p><p><strong>Results: </strong>For MRSA, a significant bactericidal effect of ≥5 logs was observed after 6 minutes of vaporization. For ESBL-producing E. coli, a significant bactericidal effect of ≥5 logs was observed after 2 minutes of vaporization. For C. difficile, a significant sporicidal effect of ≥3 logs was observed after 2 minutes of vaporization. Hydrogen peroxide concentrations outside the room remained below safety thresholds throughout all tests.</p><p><strong>Conclusion: </strong>Hydrogen peroxide vaporizing demonstrated broad-spectrum efficacy against drug-resistant and spore-forming organisms, including C. difficile, including high-touch surfaces commonly found in hospital settings. This no-touch disinfection method may serve as a valuable adjunct or alternative to manual cleaning for environmental decontamination in healthcare settings.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102820"},"PeriodicalIF":1.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The iron-infection axis revisited: From mechanistic insights to therapeutic frontiers","authors":"Hiroshi Moro","doi":"10.1016/j.jiac.2025.102818","DOIUrl":"10.1016/j.jiac.2025.102818","url":null,"abstract":"<div><div>Iron is an essential element for both the host and the invading pathogens since its chemically reactive nature makes it favorable for its nutritional value during infection. Pathogens employ high-affinity siderophores to acquire iron. Meanwhile the host sequestrates iron by binding proteins and a suite of regulatory factors including hepcidin, lipocalin-2, and natural resistance-associated macrophage protein 1. These natural immune responses by the host are intimately linked with the inflammatory mechanisms to control infection by restricting access to iron to the pathogen. In the era of increasing antimicrobial resistance, this interplay presents an attractive target for novel drug development, which has led to the clinical use of siderophore-conjugated antimicrobials. This comprehensive overview of the host-pathogen iron interplay, highlighting the dynamics of Iron-infection Axis offers a new paradigm for understanding disease pathogenesis. A deeper appreciation of this axis is expected to accelerate the development of future diagnostic and therapeutic strategies.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 11","pages":"Article 102818"},"PeriodicalIF":1.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent pneumococcal OPSI after splenectomy: The need for optimized vaccination and prophylaxis.","authors":"Masashi Nishiyama, Kyoko Yokota, Akihito Matsuoka, Tatsuya Fujikawa","doi":"10.1016/j.jiac.2025.102819","DOIUrl":"10.1016/j.jiac.2025.102819","url":null,"abstract":"<p><p>Patients are known to be at an increased risk of sepsis post-splenectomy due to encapsulated organisms, such as Streptococcus pneumoniae. This is clinically important, as overwhelming post-splenectomy infection (OPSI) is very serious. Prevention, including vaccination, is recommended. Herein, we describe the case of a patient who survived a second attack of OPSI due to S. pneumoniae, serotype 34, that occurred 8 years after acute pericarditis related to S. pneumoniae-associated OPSI. The patient underwent a splenectomy due to malignant lymphoma and had been vaccinated with PPSV 23, but had not received any additional vaccinations since then. Serotype 34 is not covered by either PPSV23 or PCV13. This case highlights the importance of providing patients who have undergone splenectomy with more optimized vaccines, prophylaxis, and education to prevent OPSI, tailored to their immunocompromised status.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102819"},"PeriodicalIF":1.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial stewardship among Japanese obstetricians and gynecologists: A nationwide questionnaire-based survey of knowledge, awareness, and practice","authors":"Nobuaki Mori ,&nbsp;Hiroaki Miyazaki ,&nbsp;Yasuyuki Noguchi ,&nbsp;Kaori Iino ,&nbsp;Hiroshige Mikamo ,&nbsp;Tsuyoshi Higuchi","doi":"10.1016/j.jiac.2025.102817","DOIUrl":"10.1016/j.jiac.2025.102817","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) is a global threat; however, data on stewardship awareness and practices among Japanese obstetricians and gynecologists are limited. The aim of this study was to establish a baseline understanding of AMR-related knowledge, attitudes, and practices to identify challenges and guide future interventions in this specialty.</div></div><div><h3>Methods</h3><div>A cross-sectional anonymous questionnaire survey was conducted among members of the Japan Society of Obstetrics and Gynecology in early 2025. The survey assessed awareness of the national AMR Action Plan, knowledge of antibiotic properties, and self-reported clinical practices, including pretreatment culturing and de-escalation.</div></div><div><h3>Results</h3><div>In total, 442 physicians responded to the questionnaire. A significant gap between awareness and practice was identified: although 72 % of the respondents reported high awareness of stewardship, only 27.6 % were aware of the high bioavailability of first-generation cephalosporins, and only 19.0 % regularly performed de-escalation. Furthermore, a widespread lack of familiarity with support systems was evident. Only 23.3 % of physicians understood the national AMR Action Plan and only 25.1 % confirmed the presence of an antimicrobial stewardship team (AST) at their institution.</div></div><div><h3>Conclusion</h3><div>Japanese obstetricians and gynecologists demonstrated a critical disconnect between stewardship awareness and the practical knowledge required for its application, alongside low recognition of national and institutional guidelines. Targeted educational interventions and improved integration with local ASTs are essential to address these gaps.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 11","pages":"Article 102817"},"PeriodicalIF":1.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}