Journal of Neurogastroenterology and Motility最新文献

{"title":"The Association Between Usual Diet and Bowel Disorders of Gut-Brain Interaction: Analyses From the Rome Foundation Global Epidemiology Study.","authors":"Daniel Bushyhead, Rutaba Khatun, Shrikant I Bangdiwala, Olafur Palsson, Ami D Sperber, Eamonn M M Quigley","doi":"10.5056/jnm25137","DOIUrl":"10.5056/jnm25137","url":null,"abstract":"<p><strong>Background/aims: </strong>: Food is thought to play a central role in the pathophysiology of disorders of gut-brain interaction (DGBI). Data on these associations come largely from Western countries. We evaluated associations between diet and common bowel DGBI using the database of the Rome Foundation Global Epidemiology Study (RFGES).</p><p><strong>Methods: </strong>: The RFGES database contains data collected via the Internet, personal interviews, or both from 33 countries, providing prevalence rates for common DGBI. Logistic regressions were used to analyze associations between DGBI and vegan, vegetarian, lactose-free and bread-, pasta-, and rice-predominant diets.</p><p><strong>Results: </strong>: 54 127 internet and 20 973 household survey subjects were included. Rates of adherence to a vegan or vegetarian diet were low in both surveys (0.4% to 9.8%) and differences in dietary preference were also noted between surveys with lactose-free and rice-predominant diets being more common among household survey respondents. While discrepancies between results from the 2 surveys limited the interpretation of the data, some trends were evident with a lactose-free diet linked to an increased prevalence and bread- and rice-predominant diets to lower prevalence rates of several bowel DGBI.</p><p><strong>Conclusions: </strong>: Though complicated by variations in results between the 2 survey populations, this global survey has revealed dietary factors that may impact, in the general population, on reported prevalence rates for DGBI.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"429-437"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Understanding Calcium Sensitization in Gastrointestinal Smooth Muscles: Pathways, Interstitial Cells, and Disease.","authors":"Brian A Perrino, Ji Yeon Lee, Sang Don Koh","doi":"10.5056/jnm25251","DOIUrl":"10.5056/jnm25251","url":null,"abstract":"<p><p>Contractile activity of gastrointestinal smooth muscles is triggered by increased intracellular Ca²⁺, which activates myosin light chain kinase (MLCK) and leads to phosphorylation of myosin regulatory light chain (RLC), enabling contraction. Myosin light chain phosphatase (MLCP) dephosphorylates RLC for relaxation. The balance between MLCK and MLCP determines the relationship between calcium levels and contractile force. Shifting the balance between MLCK and MLCP in favor of MLCK by inhibiting MLCP allows MLCK to phosphorylate more RLC and generate increased force at any given Ca²⁺ concentration. Thus, when MLCP is inhibited, the myofilaments are more sensitive to calcium, allowing greater force at any given Ca²⁺ concentration. Major mechanisms for calcium sensitization in GI smooth muscle include protein kinase C-mediated phosphorylation of protein phosphatase 1 regulatory subunit 14A (CPI-17) and Rho-associated coiled-coil kinase 2 (ROCK2)-mediated phosphorylation of myosin phosphatase targeting subunit 1. Calcium sensitization is crucial for sphincter tone, sustained contraction, peristalsis, energy conservation, and coordinated motility. Smooth muscle cells, interstitial cells of Cajal, and platelet-derived growth factor alpha positive (PDGFRα⁺) cells form the SIP syncytium, which regulates excitability and calcium sensitization. This review updates our current understanding of the regulatory mechanisms of calcium sensitization with the recent findings from genetically engineered mice with deficiencies in protein kinase C and ROCK2 calcium sensitization pathways, and the involvement of interstitial cells in regulating GI smooth muscle cell excitability. Dysregulated calcium sensitization pathways in motility disorders are summarized, to potentially aid in the development of new pharmacological strategies to prevent and treat GI motility disorders.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"310-325"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroesophageal Reflux Disease and Reflux-like Phenotypes: Using Lyon Consensus 2.0 to Guide Clinical Approach.","authors":"Matthew K Schroeder, C Prakash Gyawali","doi":"10.5056/jnm26021","DOIUrl":"10.5056/jnm26021","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) is common worldwide, but troublesome symptoms alone are not sufficient for a conclusive diagnosis. The Montreal Consensus introduced a symptom-based definition of GERD and defined mucosal injury phenotypes of the disease. The Lyon Consensus adapted mucosal injury findings as well as defined abnormal reflux burden criteria for the diagnosis of conclusive GERD. The diagnosis of esophageal disorders of gut-brain interaction (E-DGBI) using Rome V criteria requires exclusion of GERD, which is also described in the Lyon Consensus 2.0 criteria. Collectively utilizing these various criteria, distinct phenotypes can be identified in patients with troublesome reflux-like symptoms. The mucosal injury phenotype, initially defined by the Montreal Consensus, requires reflux management for healing of esophagitis to improve symptoms, and surveillance to identify and prevent GERD complications including Barrett's esophagus and esophageal adenocarcinoma. The abnormal reflux burden phenotype requires reflux management for symptom improvement. The E-DGBI phenotype requires specific management of each of the functional disorders for symptom relief. Hypervigilance and symptom-specific anxiety can overlap with all the phenotypes, and E-DGBI can coexist with conclusive GERD. Therefore, there are intricate interrelationships between Montreal, Lyon and Rome criteria that aid evaluation of troublesome symptoms, and concepts from each of these contribute to accurate phenotyping and optimal management of patients.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"326-336"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possible Mechanisms Underlying the Effects of Fecal Microbiota Transplantation in Patients With Irritable Bowel Syndrome.","authors":"Magdy El-Salhy, Tora Skarvatun, Dag Arne Lihaug Hoff, Johan Lunding, Elisabeth Kjelsvik Steinsvik, Odd Helge Gilja, Jan Gunnar Hatlebakk","doi":"10.5056/jnm26028","DOIUrl":"10.5056/jnm26028","url":null,"abstract":"<p><strong>Background/aims: </strong>: This study aims to identify the mechanisms underlying the effects of fecal microbiota transplantation (FMT).</p><p><strong>Methods: </strong>: This study investigated 93 patients included in our previous clinical trial: 24 received 30 g of their own feces (placebo group), while 47 and 22 received 30 g and 60 g of donor feces, respectively. The patients underwent sigmoidoscopy with biopsies, provided fecal samples, and completed questionnaires to assess irritable bowel syndrome (IBS) symptoms, fatigue, and quality of life at the baseline and at 1 month following FMT. The biopsy samples were immunostained for Musashi-1, neurogenin-3, and enteroendocrine and immune cells. The cell densities were quantified by computerized image analysis. Fecal short-chain fatty acids (SCFAs) were measured by gas chromatography, and fecal bacteria were measured by 16S ribosomal RNA polymerase chain reaction DNA amplification.</p><p><strong>Results: </strong>: The densities of stem cells, enteroendocrine cell progenitors, serotonin, glucagon-like peptide 1, and peptide YY (PYY) cells increased following FMT in the 30-g and 60-g treated groups but not in the placebo group, and they were inversely correlated with both IBS symptoms and fatigue. The densities of submucosal immune cells and mast cells decreased following FMT in the 30-g and 60-g treated groups but not in the placebo group, and they were correlated with IBS symptoms and fatigue. The fecal level of butyric acid increased in patients treated with donor feces, and this was inversely correlated with IBS symptoms and fatigue.</p><p><strong>Conclusions: </strong>: Stem cells, enteroendocrine progenitors, serotonin, and glucagon-like peptide 1 as well as low-grade inflammation may play roles in IBS symptom manifestations. The effects of FMT are probably due to the amelioration of these abnormalities.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"449-463"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ineffective Esophageal Motility and Its Predictors in Gastroesophageal Reflux Disease Patients with Pathologic Acid Exposure Time.","authors":"Ayça Eroğlu Haktanır, Altay Çelebi","doi":"10.5056/jnm25209","DOIUrl":"10.5056/jnm25209","url":null,"abstract":"<p><strong>Background/aims: </strong>: Although gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM) often coexist, the directionality of their relationship remains uncertain. Clarifying physiological predictors of IEM in GERD patients with objectively verified pathological acid exposure may facilitate more personalized treatment strategies.</p><p><strong>Methods: </strong>: This retrospective analysis included 289 patients with typical reflux symptoms and abnormal acid exposure (acid exposure time > 6%) confirmed by 24-hour pH-impedance monitoring. Esophageal motility was assessed using high-resolution manometry, while mucosal integrity was evaluated through distal mean nocturnal baseline impedance (MNBI). Patients were categorized into normal motility and IEM groups. Clinical, endoscopic, manometric, and impedance parameters were compared between the groups.</p><p><strong>Results: </strong>: IEM was identified in 41.5% of patients. Compared with those showing normal motility, the IEM group was older (median 51.5 vs 44 years, <i>P</i> < 0.001), had reduced lower esophageal sphincter (LES) pressure (15 vs 19 mmHg, <i>P</i> = 0.006), and exhibited decreased distal MNBI (1300 vs 1780 Ω, <i>P</i> = 0.005). Multivariate regression revealed prolonged upright bolus exposure, reduced LES pressure, delayed supine distal latency, and MNBI < 1500 Ω as independent predictors of IEM. No significant associations were observed with diabetes or <i>Helicobacter pylori</i> infection.</p><p><strong>Conclusions: </strong>: In GERD patients with confirmed pathological acid exposure, IEM is common and associated with weakened LES pressure, delayed peristalsis, and reduced mucosal integrity. The link between low MNBI and IEM suggests an interaction between epithelial barrier dysfunction and esophageal motility, emphasizing the need for comprehensive functional evaluation in GERD management.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"417-428"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potassium-competitive Acid Blockers in Gastroesophageal Reflux Disease and Functional Dyspepsia: A Korean Expert Review With Original Meta-analyses.","authors":"Seung In Seo, Sang Pyo Lee, Cheol Min Shin, Yu Kyung Cho, Jeong Hwan Kim, Jung-Hwan Oh, Moo In Park","doi":"10.5056/jnm26007","DOIUrl":"10.5056/jnm26007","url":null,"abstract":"<p><p>Potassium-competitive acid blockers (P-CABs) have emerged as a potent alternative to proton pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease and functional dyspepsia (FD). This narrative review incorporating original meta-analyses summarizes the latest evidence from randomized controlled trials and meta-analyses, emphasizing the efficacy, safety, and clinical applications of P-CABs such as vonoprazan, tegoprazan, fexuprazan, keverprazan, and zastaprazan. P-CABs demonstrate rapid onset, sustained acid suppression, and superior healing rates in erosive esophagitis (EE), particularly in severe EE (grade C/D). Maintenance therapy in healed EE with P-CABs also yields higher endoscopic remission rates compared to PPIs. In non-erosive reflux disease, P-CABs offer rapid and sustained symptom control compared with placebo. Their pharmacologic profiles, including flexible dosing and rapid action, support on-demand therapy, potentially enhancing patient satisfaction. In addition, P-CABs may help overcome unmet needs from suboptimal efficacy of PPIs in nocturnal heartburn and extraesophageal symptoms. Emerging economic evaluation suggests P-CABs may be cost-effective in Asian healthcare systems. In FD, tegoprazan offers effective symptom relief without delaying gastric emptying, distinguishing it from PPIs. Limited clinical and real-world data indicate that second-generation P-CABs do not exhibit significant hepatotoxicity, however, long-term hypergastrinemia and mucosal changes warrant further surveillance. This review highlights the evolving role of P-CABs in gastroesophageal reflux disease and FD and emphasizes the need for further research to refine their clinical positioning, optimize therapeutic strategies, and evaluate long-term safety outcomes.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"337-349"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinterpreting Amitriptyline in Extra-esophageal Gastroesophageal Reflux Disease Through the GABAergic Inhibitory Axis.","authors":"Qing Xiao, Ziwei Li, Anlong Yuan, Jun Xiao","doi":"10.5056/jnm26018","DOIUrl":"10.5056/jnm26018","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"468-469"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Clustering Identifies Achalasia-Spectrum Phenotypes in Distal Esophageal Spasm.","authors":"Ofer Z Fass, John E Pandolfino, Dustin A Carlson","doi":"10.5056/jnm25171","DOIUrl":"10.5056/jnm25171","url":null,"abstract":"<p><strong>Background/aims: </strong>: Distal esophageal spasm (DES) is a rare, heterogeneous esophageal motility disorder with variable treatment responses. Machine learning methods are well suited to distinguish DES phenotypes that could inform therapeutic decisions and outcomes. This exploratory study aims to identify and characterize unique DES phenotypes using unsupervised machine learning clustering.</p><p><strong>Methods: </strong>: Adults undergoing high-resolution esophageal manometry (HRM) for esophageal symptoms between 2005-2025 were included. Uniform manifold approximation and projection (UMAP) was used for dimensionality reduction of HRM metrics. DES patients were classified as within-cluster or outside-cluster according to density contours. Patient characteristics, manometric parameters, functional lumen imaging probe findings, and treatment outcomes were compared between clusters.</p><p><strong>Results: </strong>: Among 5360 patients, 42 (0.8%) had DES, 2400 (45%) normal motility, and 107 (2.0%) type III achalasia. UMAP identified 33 DES patients clustering alongside type III achalasia patients, while 9 DES patients remained outside this cluster. The primary differentiating characteristic between clusters was premature supine contraction frequency (median 8 vs 0, <i>P</i> < 0.001). Within-cluster patients demonstrated higher Esophageal Hypervigilance and Anxiety Scale scores (30 vs 20.5, <i>P</i> = 0.010). All 3 within-cluster patients who underwent peroral endoscopic myotomy achieved symptom resolution, compared to partial response in outside-cluster patients.</p><p><strong>Conclusions: </strong>: Machine learning clustering successfully identified a DES phenotype characterized by high premature contraction frequency that clusters with type III achalasia. Premature contraction frequency may serve as a clinical marker for selecting DES patients for lower esophageal sphincter-directed therapies. Given the rarity of DES, larger validation studies are needed to confirm these findings.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"387-395"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confocal Laser Endomicroscopy With Duodenal Food Challenge Does Not Predict Triggering Food Items in Eosinophilic Esophagitis: Results From a Pilot Trial.","authors":"Karlien Raymenants, Lukas M Balsiger, Jolien Schol, Cedric Van de Bruaene, Joran Tóth, Daphne Dufour, Gert De Hertogh, Ricard Farré, Kristin Verbeke, Walburga Dieterich, Yurdagül Zopf, Matthias Ceulemans, Astrid Verbiest, Joris Arts, Lucas Wauters, Tim Vanuytsel, Jan Tack","doi":"10.5056/jnm25132","DOIUrl":"10.5056/jnm25132","url":null,"abstract":"<p><strong>Background/aims: </strong>: Targeted elimination of triggering food items is an attractive treatment option in eosinophilic esophagitis (EoE). However, no reliable biomarkers exist to identify culprit foods. In a previous uncontrolled study, 6/9 responded to duodenal food challenge (DFC), visualized by confocal laser endomicroscopy (CLE). This study aims to assess efficacy of a targeted elimination diet based on identification of nutrients that trigger acute mucosal alterations in the duodenum compared to a sham diet.</p><p><strong>Methods: </strong>: Randomized double-blind cross-over study in EoE. After baseline endoscopy, patients with peak eosinophil count of > 15 eosinophils/high power field underwent CLE. Following baseline assessment, a solution of foods (grains/milk/egg/soy/fish/nuts) was sprayed on the duodenal mucosa, with repeat imaging thereafter. Mucosa was judged as altered in case of fluorescein leakage and particle shedding. Based on the results, patients underwent a blinded randomized 6-week cross-over elimination diet with follow-up endoscopy. Exploratory measurements were done for small intestinal permeability, eosinophil- and mast cell activation.</p><p><strong>Results: </strong>: Seven patients completed the study. At CLE, 1 patient displayed baseline alterations, 5 reacted to 1 to 2 nutrients in 2 sessions (milk = 4, grains = 2, nuts = 2, fish = 1). There was no association between CLE results, and presence of food-specific IgE (<i>P</i> > 0.999). Both dietary arms resulted in a similar histological response (<i>P</i> > 0.999), with histological remission in only 1 patient (excluding gluten-containing grains). Permeability, eosinophil or mast cell activation were not different between arms.</p><p><strong>Conclusions: </strong>: In this pilot blinded cross-over trial, a targeted elimination diet based on the results of CLE with DFC did not generate a superior response compared to a sham diet.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"350-361"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Dysbiosis Restoration: Does the Success of Fecal Microbiota Transplantation for Irritable Bowel Syndrome Lie in Repairing the Intestinal Stem Cell Niche?","authors":"Yong Sung Kim, Suck Chei Choi","doi":"10.5056/jnm26132","DOIUrl":"10.5056/jnm26132","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"307-309"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}