Journal of investigative medicine high impact case reports最新文献

{"title":"Sugammadex-Associated Delayed Laryngeal and Upper Airway Edema: A Novel Adverse Effect.","authors":"Ruba Habib, Rouba Isshak, Rayan Sabouh, Hala Moussa, Hasan Munshi, Ivan Mercado, Aqsa Sorathia, Arham Hazari, Ruth Lamm","doi":"10.1177/23247096261451464","DOIUrl":"10.1177/23247096261451464","url":null,"abstract":"<p><p>Sugammadex is a new drug that gained FDA approval in 2015 for rapid reversal of aminosteroid neuromuscular blockade as it showed faster action than the traditional drugs, neostigmine and is generally well tolerated. However, hypersensitivity reactions, including anaphylaxis, have been increasingly recognized. These reactions typically occur within minutes of administration and often involve multisystem manifestations. Isolated upper airway edema with delayed onset has not been previously described. We present an 87-year-old woman was admitted for abdominal wall cellulitis complicated by abscess requiring incision and drainage under general anesthesia. She received propofol, rocuronium, and sugammadex without immediate complications and was extubated successfully. Approximately 2.5 hours later, she developed acute tongue and lip swelling, respiratory distress, and stridor. Vital signs showed hypoxia, hypertension and tachycardia without hypotension. She was treated with epinephrine, corticosteroids, and antihistamines but required emergent intubation due to severe airway edema. Laryngoscopy revealed significant glottic swelling. She improved with supportive care in the intensive care unit and was successfully extubated after 2 days. Laboratory evaluation demonstrated normal C1 esterase inhibitor levels and complement levels, excluding hereditary and acquired C1 inhibitor deficiency. Medication review identified sugammadex as the only new exposure. The delayed onset, isolated airway involvement, and absence of systemic features distinguish this case from typical sugammadex hypersensitivity and suggest a possible alternative mechanism, including bradykinin-mediated pathways. This case expands the spectrum of sugammadex-related adverse effects and highlights the need for awareness of delayed, atypical presentations to guide perioperative monitoring and future anesthetic management.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261451464"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874246","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":"Integrating Physiology Into Hyponatremia Algorithms: Moving Beyond Volume Status.","authors":"Jodie Mogensen, Livia Frost, Bryan Tucker, L Parker Gregg, Maulin K Shah","doi":"10.1177/23247096261474690","DOIUrl":"10.1177/23247096261474690","url":null,"abstract":"<p><p>Hyponatremia is a prevalent electrolyte disorder with a broad differential diagnosis, which can pose a challenge for determining the underlying etiology. Academic resources teach two diagnostic frameworks designed to guide a physician to the underlying etiology. One approach uses volume status and serum osmolality as earlier branch points, with later consideration of urine osmolality and urine sodium for diagnosis within certain pathways in the branching logic. The other uses serum osmolality, urine osmolality, and spot urine sodium to guide the entire diagnostic reasoning process. These two approaches can ultimately guide clinicians to different diagnoses for the same patient. In this case series, we present an adapted physiology-based (European) algorithm and describe three patients who illustrate key shortcomings of the volume status-based approach to identifying the etiology of hyponatremia. The first case emphasizes that understanding the relationship between osmolality and tonicity adds important nuance to the interpretation of measured serum osmolality. The second case demonstrates how the inherent limitations of the physical examination for volume status contribute to imprecision and inter-individual variation in volume status assessment and underscores the importance of interpreting laboratory values with nuance rather than relying rigidly on strict cutoff values as branch points in clinical reasoning. The third case illustrates that more complex presentations may not fit neatly within any single algorithm and require more nuanced clinical judgment. Together, these cases demonstrate how a diagnostic approach to hyponatremia rooted in physiology provides learners with greater insight into the underlying pathophysiology and may improve diagnostic accuracy.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261474690"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620369","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":"Fulminant Seronegative Systemic Lupus Erythematosus With Class IV/V Lupus Nephritis and Multisystem Involvement.","authors":"Luisa Montoya, Abdel Martinez, Krystal Simono, Luis Alvarez, Jean Luis Cabrera, Brandon Cantazaro, Fatimah Bello","doi":"10.1177/23247096261501840","DOIUrl":"https://doi.org/10.1177/23247096261501840","url":null,"abstract":"<p><p>Seronegative systemic lupus erythematosus (SLE) poses a diagnostic challenge, particularly when patients develop organ-threatening disease despite negative traditional serologies. We report a fulminant case in a 24-year-old woman with congenital atrioventricular (AV) block, chronic pancytopenia, chronic kidney disease (CKD), and morbid obesity, who presented with progressive anasarca, dyspnea, dizziness, and cough. Laboratory evaluation revealed severe pancytopenia, nephrotic-range proteinuria 11-13 g/day (reference range: 0-150 mg/24 hours), and acute kidney injury. Renal biopsy demonstrated Class IV proliferative and Class V membranous lupus nephritis, despite negative antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA) antibodies, anti-Smith (anti-Sm) antibodies, anti-Sjögren's-syndrome-related antigen A (SSA) and antigen B (SSB) antibodies, and normal complement levels. Within 24 hours, she developed hypoxia, hemoglobin drop, and a right subcapsular renal hematoma. Echocardiography revealed dilated cardiomyopathy, severe aortic insufficiency with valvular vegetation, and suspected pacing-induced cardiomyopathy, progressing to cardiogenic shock requiring inotropes. She developed necrotizing mucocutaneous lesions, vasculitic purpura, pseudomembranous colitis secondary to Clostridioides difficile (C. difficile), and microangiopathic hemolysis. Despite high-dose steroids and mycophenolate, her condition deteriorated, necessitating transfer for plasmapheresis and rituximab. Seronegative SLE represents up to 5% of cases and is often associated with severe, multisystem involvement. Seronegativity may reflect low antibody titers, immune complex sequestration, or assay variability. This case underscores that negative serologies do not exclude SLE, and early recognition through clinical suspicion and tissue biopsy is critical. Aggressive immunosuppression and multidisciplinary care are essential in managing fulminant seronegative lupus with severe nephritis, vasculopathy, and systemic complications.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261501840"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220502","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":"Subacute Coronary Stent Thrombosis as the Initial Presentation of Acute Myeloid Leukemia: A Case Report and Literature Review.","authors":"Tasneem Manasrah, Abdallah Dwayat, Alhareth M Amro, Malak Hroub, Areej Abumazen, Rand Abusnineh, Anas Manasrah","doi":"10.1177/23247096261457129","DOIUrl":"10.1177/23247096261457129","url":null,"abstract":"<p><p>Subacute stent thrombosis is an uncommon but life-threatening complication of percutaneous coronary intervention (PCI). While mechanical and antiplatelet-related factors are most frequently implicated, systemic hypercoagulable conditions are increasingly recognized as important contributors. Acute myeloid leukemia (AML) is associated with complex hemostatic abnormalities that may predispose to both venous and arterial thrombosis, particularly in the presence of hyperleukocytosis. We report the case of a 33-year-old male with minimal cardiovascular risk factors who presented with ST-segment elevation myocardial infarction and was found to have a large thrombus burden in the proximal left anterior descending artery. Despite pharmacologic reperfusion and subsequent drug-eluting stent implantation, he re-presented ten days after discharge with subacute stent thrombosis and additional thrombotic involvement of multiple coronary vessels, leading to hemodynamic instability. Although he reported adherence to dual antiplatelet therapy, laboratory evaluation revealed rapidly progressive leukocytosis accompanied by anemia and thrombocytopenia. Further hematologic workup confirmed a diagnosis of acute myeloid leukemia with profound hyperleukocytosis. Cytoreductive therapy was initiated, but the course was complicated by tumor lysis syndrome and acute kidney injury, necessitating renal replacement therapy prior to transfer for definitive oncologic management. This case highlights AML-associated hypercoagulability and hyperleukocytosis as potential contributors to early and recurrent coronary thrombosis following PCI. Leukostasis, endothelial activation, and blast-mediated procoagulant activity likely acted synergistically with stent-related endothelial injury to promote thrombosis despite standard antiplatelet therapy. Early or recurrent stent thrombosis, particularly in younger patients or in the presence of unexplained hematologic abnormalities, should prompt evaluation for underlying malignancy. Recognition of AML in this context is critical, as it may influence revascularization strategy, antithrombotic management, and overall prognosis.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261457129"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148101533","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":"Pulmonary Embolism Presenting as Backache After Appendectomy: An Atypical Presentation of a Common Diagnosis.","authors":"Songjun Shao, Yujun Wang, Xiaoju Tang, Fengming Luo","doi":"10.1177/23247096261429177","DOIUrl":"10.1177/23247096261429177","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is a disease with diverse clinical manifestations, which lacks specificity but may be life-threatening. We describe a 39-year-old male who presented with acute PE complicated by pulmonary infarction, confirmed by computed tomography pulmonary angiography 2 weeks following laparoscopic appendectomy. His initial symptom was right lower-back pain. This case underscores the diagnostic challenge posed by an atypical presentation of PE, in which isolated back pain was the sole initial manifestation. Furthermore, we delineate the pathophysiologic mechanisms that may account for PE presenting initially as isolated back pain, knowledge that could expedite early recognition and guideline-directed anticoagulation.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261429177"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317273","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":"Co-occurrence of Griscelli Syndrome Type 2 and Systemic Juvenile Idiopathic Arthritis in a Pediatric Patient: A Case Report.","authors":"Ali Falah Zbala, Haneen Sedqi Al Fhrnawie, Diyar Sedqi Al Fhrnawie, Sajjad Ghanim Al-Badri, Ibrahim Khalil","doi":"10.1177/23247096261428870","DOIUrl":"10.1177/23247096261428870","url":null,"abstract":"<p><p>Griscelli syndrome type 2 (GS2) is a rare autosomal recessive immunodeficiency disorder characterized by silver-colored hair, fair skin, and an increased risk of developing hemophagocytic lymphohistiocytosis (HLH). Systemic juvenile idiopathic arthritis (sJIA) is an autoinflammatory condition distinguished by daily fevers, transient rash, and arthritis, with macrophage activation syndrome being a known complication. We present a case involving an 18-month-old female with persistent fever, rash, and joint inflammation. Laboratory findings revealed elevated inflammatory markers and hyperferritinemia, prompting concern for HLH, though full diagnostic criteria were not satisfied. A unique clinical sign led to extended evaluation, and genetic testing confirmed the presence of GS2. Concurrent clinical features also met the requirements for sJIA. To the best of our knowledge, this is the first reported instance of GS2 co-occurring with sJIA. This case highlights a potential shared susceptibility to immune dysregulation and raises the possibility that immunodeficiency may reveal or influence the manifestation of autoinflammatory diseases. Prompt recognition is essential in managing atypical and treatment-resistant inflammatory presentations.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261428870"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376039","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":"Unmasking Diffuse Large B-Cell Lymphoma: A Challenging Case of Acute Cardiac Tamponade in the Setting of Right-Sided Heart Mass Invasion.","authors":"Rouba Isshak, Aqsa Sorathia, Hasan Munshi, Alaa Musallam, Nagihan Orhun, Abraam Rezkalla, Sacide S Ozgur, Abdullah Sultan Ahmad, Yezin F Shamoon, Fayez Shamoon","doi":"10.1177/23247096261419226","DOIUrl":"10.1177/23247096261419226","url":null,"abstract":"<p><p>Cardiac metastases, particularly those originating from non-Hodgkin lymphoma, are often underdiagnosed and represent a rare but critical manifestation of advanced cancer. This case report discusses a 57-year-old female with a history of hypertension who initially presented with symptoms of cardiac tamponade, leading to the discovery of a large cardiac mass, ultimately diagnosed as diffuse large B-cell lymphoma following a cytological examination of the pericardial fluid and lymph node biopsy. Further imaging, including echocardiography and computed tomography scans, showed extensive metastasis to the pericardium, mediastinum, and other areas, such as the thyroid and peritoneum. Despite the prompt initiation of management, the patient suffered a massive pulmonary embolism, highlighting the poor prognosis associated with metastatic cardiac lymphoma. This case underscores the importance of bedside echocardiography as a rapid initial method for identifying cardiac tamponade, as well as maintaining a high index of suspicion for hematologic malignancies in patients presenting with unexplained pericardial effusions. It emphasizes the need for comprehensive diagnostic approaches and multidisciplinary management to improve patient outcomes in this rare and challenging clinical scenario.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261419226"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12932876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276200","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":"Testosterone and DHEA-S Secreting Adrenal Cortical Adenoma in a Postmenopausal Woman: A Rare Functional Incidentaloma.","authors":"Crystal M Acosta, Ugur Deniz Ayar, Neeta J Erinjeri, Ron T Varghese","doi":"10.1177/23247096261498515","DOIUrl":"https://doi.org/10.1177/23247096261498515","url":null,"abstract":"<p><p>Postmenopausal hyperandrogenism is uncommon and should prompt evaluation for an underlying androgen-secreting source. Although ovarian causes are more frequent, adrenal tumors remain an important consideration and may occasionally be malignant. We report a 53-year-old postmenopausal woman who presented with progressive hirsutism, scalp hair loss, and mild clitoromegaly. Laboratory evaluation showed markedly elevated total testosterone and dehydroepiandrosterone sulfate levels with suppressed gonadotropins. Pelvic ultrasonography showed no ovarian mass. CT demonstrated a 3.5 × 2.4 cm left adrenal mass with precontrast attenuation of 31 Hounsfield units and an enhancement washout pattern not typical of an adrenal adenoma. MRI showed a 3.6 × 2.1 cm left adrenal lesion with arterial hyperenhancement, restricted diffusion, and no signal drop on out-of-phase imaging. Biochemical testing excluded pheochromocytoma, primary aldosteronism, and clinically significant cortisol co-secretion. The patient underwent laparoscopic adrenalectomy, and pathology confirmed a 3.6 cm adrenal cortical adenoma with negative margins, positive inhibin, Melan-A, and steroidogenic factor-1 staining, and Ki-67 <3%. Postoperative androgen levels normalized, and adrenal insufficiency was excluded by cosyntropin stimulation testing. This case highlights the importance of integrating clinical presentation, biochemical localization, adrenal imaging, differential diagnosis, and pathology when evaluating severe postmenopausal hyperandrogenism.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261498515"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172274","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":"Localized Laryngeal Amyloidosis Treated With Systemic Therapy: Case Series and Literature Review.","authors":"Kareem Latif, Priya Darshini Krishna, Mojtaba Akhtari","doi":"10.1177/23247096261497007","DOIUrl":"https://doi.org/10.1177/23247096261497007","url":null,"abstract":"<p><p>Localized laryngeal amyloidosis is a localized plasma cell-mediated process characterized by extracellular amyloid deposition confined to the larynx. Surgical excision has traditionally been the mainstay of treatment; however, complete resection may be anatomically difficult, and some patients experience persistent or progressive disease. Evidence supporting systemic therapy in localized disease remains limited. We report two adult female patients with biopsy-proven localized laryngeal amyloidosis without evidence of systemic involvement who were treated with plasma cell-directed immunochemotherapy in collaboration with ENT and head and neck surgery teams. Both patients presented with worsening dysphonia. One had persistent symptoms following partial surgical resection, while the other had multifocal unresectable supraglottic disease. Given limited surgical options, treatment with daratumumab, cyclophosphamide, bortezomib, and dexamethasone (Dara-CyBorD) was initiated. Therapy was well tolerated overall, with only mild neuropathy and mild leukopenia reported. After 6-14 cycles, both patients experienced marked improvement in voice quality and functional status, with no radiographic or clinical evidence of progression. Neither patient required additional surgical intervention, and both achieved durable symptom control during follow-up. These cases highlight a potential role for systemic plasma cell-targeted therapy in selected patients with localized laryngeal amyloidosis when surgery is noncurative or not feasible. Although local resection alone remains curative for many patients, multidisciplinary collaboration is essential in complex cases. Further study is needed to clarify patient selection, optimal treatment duration, and long-term outcomes of systemic immunochemotherapy in this rare disorder.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261497007"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127817","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":"Functional Recovery Following Intensive Upfront Therapy in Multiple Myeloma Patients With Poor Performance Status: A Case Series.","authors":"Kareem Latif, Jerry Qi, Pranati Shah, Mojtaba Akhtari","doi":"10.1177/23247096261446475","DOIUrl":"10.1177/23247096261446475","url":null,"abstract":"<p><p>Patients with newly diagnosed multiple myeloma (MM) may present with profound functional impairment due to high disease burden, and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 4 is often viewed as a barrier to intensive therapy despite potential reversibility. We report six newly diagnosed, bedbound MM patients (ECOG 4) treated with individualized multi-agent regimens incorporating proteasome inhibitors, immunomodulatory agents, and anti-CD38 monoclonal antibodies when feasible. Advanced features included extensive skeletal disease, renal dysfunction, hyperviscosity, and high-risk cytogenetics. All patients demonstrated rapid biochemical response, with a median M-protein reduction of approximately 75%; five of six achieved a very good partial response or better, including one complete response. Functional recovery paralleled depth of response, with a median time to meaningful improvement of 10 weeks. All patients improved to ECOG 2 or better, regaining ambulation and independence in activities of daily living. One patient proceeded to autologous stem cell transplantation and another completed stem cell mobilization. No irreversible treatment-limiting toxicities were observed. These findings suggest that severe functional impairment at presentation often reflects reversible disease burden and that aggressive, individualized therapy can result in substantial clinical and functional recovery in patients initially considered too debilitated for intensive treatment.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261446475"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773795","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}