Journal of Neurology最新文献

{"title":"Myasthenia gravis in 2025: five new things and four hopes for the future.","authors":"S N M Binks, I M Morse, Mohammad Ashraghi, A Vincent, Patrick Waters, M Isabel Leite","doi":"10.1007/s00415-025-12922-7","DOIUrl":"10.1007/s00415-025-12922-7","url":null,"abstract":"<p><p>The last 10 years has brought transformative developments in the effective treatment of myasthenia gravis (MG). Beginning with the randomized trial of thymectomy in myasthenia gravis that demonstrated efficacy of thymectomy in nonthymomatous MG, several new treatment approaches have completed successful clinical trials and regulatory launch. These modalities, including B cell depletion, complement inhibition, and blockade of the neonatal Fc receptor, are now in use, offering prospects of sustained remission and neuromuscular protection in what is a long-term disease. In this review, we update our clinico-immunological review of 2016 with these important advances, examine their role in treatment algorithms, and focus attention on key issues of biomarkers for prognostication and the growing cohort of older patients, both those with long-term disease, and late-onset MG ('LOMG'). We close by expressing our four hopes for the next 5-10 years: improvements in laboratory medicine to facilitate rapid diagnosis, effective strategies for neuromuscular protection, more research into and better understanding of pathophysiology and treatment response in older individuals, and the potentially transformative role of therapies aimed at delivering a durable response such as chimeric antigen receptor (CAR) T cells. Our postscript summarizes some emerging themes in the field of serological and online biomarkers, which may develop greater stature in the next epoch.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"226"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone-based gait analysis in the assessment of fatigue and fatigability in people with multiple sclerosis: a supervised cohort study.","authors":"Carolin Schönherr, Julian Ziegler, Ton Zentek, Asarnush Rashid, Sebastian Strauss, Alexander Tallner, Matthias Grothe","doi":"10.1007/s00415-025-12906-7","DOIUrl":"10.1007/s00415-025-12906-7","url":null,"abstract":"<p><strong>Background: </strong>Gait impairments and fatigue are the most common and disabling symptoms in people with multiple sclerosis (PwMS). Objective 6-min walk test (6MWT) gait testing can be improved through body-worn accelerometers, but its association to subjective fatigue and objective fatigability is contradictory. This study aims to validate an algorithm using smartphone sensor data for spatial-temporal gait parameters in PwMS and healthy controls, and evaluate its accuracy in detecting fatigability, and quantify its association with fatigue in PwMS.</p><p><strong>Methods: </strong>We recruited PwMS with mild to moderate disability (EDSS 0.0-6.5) and healthy controls in a supervised, lab-based cohort study. All participants performed the 6MWT while wearing a smartphone at the hip, which collected acceleration data of step count, cadence and walking speed. Algorithm validation included the mean absolute percentage error (MAPE) and Bland-Altman analysis. Fatigability and fatigue were measured in PwMS, with fatigability defined as a 10% decline in gait performance, and fatigue using the fatigue scale for motor and cognitive functions (FSMC). Further, correlations between gait parameters and FSMC were assessed.</p><p><strong>Results: </strong>A total of 38 PwMS and 24 healthy controls were included. The algorithm demonstrated high validity for step count (MAPE < 3%) and cadence (MAPE < 10%). Gait analyses revealed fatigability in between 2.6 and 15.8% of PwMS, with large differences between the gait parameter assessed. Significant correlations were found especially between FSMC motor fatigue scores and step count (r = - 0.50), cadence (r = 0.51) and walking speed (r = 0.50).</p><p><strong>Conclusion: </strong>Smartphone-based gait analysis provides an accessible and valid method for detecting steps and cadence. There are major differences in the assessment of fatigability, but an allover association to subjective motor fatigue.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"217"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A disproportionality analysis of surgical site infections across multiple sclerosis disease modifying therapies.","authors":"Alexandra Balshi, John Dempsey, Nova Manning, Grace Leuenberger, Ursela Baber, Jacob A Sloane","doi":"10.1007/s00415-025-12980-x","DOIUrl":"10.1007/s00415-025-12980-x","url":null,"abstract":"<p><strong>Background and objective: </strong>People with multiple sclerosis (PwMS) may be at an increased risk of surgical site infections (SSIs). However, the role of specific MS disease-modifying therapies (DMTs) in modulating this risk remains underexplored.</p><p><strong>Methods: </strong>The FDA Adverse Event Reporting System (FAERS) was used to investigate if MS DMTs are associated with disproportionally higher SSI reporting compared to other FAERS medications for individuals of all ages and those over the age of 50.</p><p><strong>Results: </strong>We identified 769 reports of SSIs across MS DMTs (352 in PwMS aged 50 or older) and 21 SSI-associated deaths. A pooled analysis of all DMTs revealed increased risks of SSIs (reporting odds ratio [ROR] of 1.95, 95% confidence interval [CI] 1.80-2.12) for all age groups and for those 50 or older (ROR of 2.58, 95% CI 2.27-2.92). For both age groups, ocrelizumab and interferon beta-1a met Evan's threshold for disproportionally high SSI reporting compared to all other FAERS medications.</p><p><strong>Conclusion: </strong>MS DMTs are collectively associated with disproportionately high SSI reporting, especially for PwMS over the age of 50, with ocrelizumab and interferon beta-1a increasing SSI reporting risk in both age groups. These findings reveal a need to take extra precautions when caring for PwMS in a surgical setting, such as engaging wound care teams to minimize SSI risk.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"223"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of CT perfusion in posterior circulation stroke: evaluation of perfusion abnormalities and associated clinical signs.","authors":"Giovanni Furlanis, Edoardo Ricci, Miloš Ajčević, Filippo Spigariol, Emanuele Vincis, Gabriele Prandin, Laura Mancinelli, Federica Palacino, Magda Quagliotto, Paola Caruso, Maja Ukmar, Marcello Naccarato, Paolo Manganotti","doi":"10.1007/s00415-025-12933-4","DOIUrl":"10.1007/s00415-025-12933-4","url":null,"abstract":"<p><strong>Purpose: </strong>Acute posterior circulation stroke (PCS) is characterized by often non-specific clinical signs, with neuroimaging playing a pivotal role in assessment in the emergency setting. The aim of this study was to investigate the effectiveness of CT Perfusion (CTP) maps in detecting acute PCS and to identify clinical factors associated with perfusion abnormalities.</p><p><strong>Methods: </strong>We retrospectively analyzed clinical and radiological data of consecutive patients with acute PCS admitted to our Stroke Unit that underwent CTP. Follow-up NECT or MRI was performed to confirm the diagnosis of PCS. The effectiveness of CTP to identify PCS was evaluated as the ratio of the CTP in which perfusion abnormalities, compatible with an ischemic event, were present in at least one CTP map among MTT, CBF, TTP, and CBV. Multivariate logistic regression analysis was conducted to identify clinical factors associated with perfusion abnormalities.</p><p><strong>Results: </strong>CTP showed alterations in 69 of 107 PCS (64.5%) included in final analysis and MTT proved to be the most sensitive. Multivariate analysis showed that atrial fibrillation (OR = 8.571, CI 95% 2.224-33.037, p = 0.002), dyslipidemia (OR = 0.285, CI 95% 0.100-0.814, p = 0.019), visual field deficits (OR = 3.372, CI 95% 1.020-11.150, p = 0.046), and higher neurological deficit (NIHSS > 5) (OR = 4.054, CI 95% 1.147-14.331, p = 0.030) were significantly associated with perfusion abnormalities on CTP.</p><p><strong>Conclusion: </strong>CT perfusion can be a valuable resource for detecting acute PCS showing a moderately high positivity rate, higher than that of NECT alone or CTA. These findings contribute to the growing body of evidence supporting the use of perfusion imaging in acute posterior circulation stroke.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"225"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive therapies for Parkinson's disease: an adapted excerpt from the guidelines of the German Society of Neurology.","authors":"René Reese, Thomas Koeglsperger, Christoph Schrader, Lars Tönges, Günther Deuschl, Andrea A Kühn, Paul Krack, Alfons Schnitzler, Alexander Storch, Claudia Trenkwalder, Günter U Höglinger","doi":"10.1007/s00415-025-12915-6","DOIUrl":"10.1007/s00415-025-12915-6","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) is characterized by hypokinetic motor symptoms, tremor, and various non-motor symptoms with frequent fluctuations of symptoms in advanced disease stages. Invasive therapies, such as deep brain stimulation (DBS), ablative therapies, and continuous subcutaneous or intrajejunal delivery of dopaminergic drugs via pump therapies are available for the management of this complex motor symptomatology and may also impact non-motor symptoms. The recent update of the clinical guideline on PD by the German Neurological Society (Deutsche Gesellschaft für Neurologie e.V.; DGN) offers clear guidance on the indications and applications of these treatment options.</p><p><strong>Methods: </strong>The guideline committee formulated diagnostic questions for invasive therapies and structured them according to the PICOS framework (Population-Intervention-Comparisons-Outcome-Studies). A systematic literature review was conducted. Questions were addressed using the findings from the literature review and consented by the guideline committee.</p><p><strong>Results: </strong>Specific recommendations are given regarding (i) the optimal timing for starting invasive therapies, (ii) the application of DBS, (iii) the use of pump therapies in advanced PD, (iv) the indications for ablative procedures, and (iv) selecting the most appropriate therapy according to individual patient characteristics.</p><p><strong>Conclusion: </strong>This review is an adapted excerpt of the chapters on the use of invasive therapies in PD of the novel German guideline on PD. Clear recommendations on the use of treatment options for advanced PD are provided.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"219"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Richard Caton (1842-1926).","authors":"Andrew J Larner","doi":"10.1007/s00415-025-12935-2","DOIUrl":"10.1007/s00415-025-12935-2","url":null,"abstract":"","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"221"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specific contribution of cognitive and motor impairments with functional capacity and dependence in Huntington's disease.","authors":"Andres Gil-Salcedo, Marine Lunven, Charlotte Jacquemot, Renaud Massart, Anne-Catherine Bachoud-Levi","doi":"10.1007/s00415-025-12982-9","DOIUrl":"10.1007/s00415-025-12982-9","url":null,"abstract":"<p><strong>Background: </strong>Huntington's disease (HD) leads to increasing dependence. Unlike psychiatric disorders, motor and cognitive deficits evolve progressively over time. Understanding their specific impact on daily activities is crucial for preserving autonomy. However, because cognitive tasks in HD rely on motor functions, and motor tasks demand cognitive processing, disentangling their specific impact remains a challenge.</p><p><strong>Objective: </strong>To identify the specific contribution of cognitive and motor impairments on global functional capacity, basic and instrumental activities of daily living (ADL/IADL), and work-related activities (WRA) in HD.</p><p><strong>Methods: </strong>158 HD mutation carriers, enrolled in the BioHD (NCT01412125) and RepairHD (NCT03119246) studies, were evaluated with the Unified Huntington's Disease Rating Scale and the SelfCog. The SelfCog assesses motor processing separately from memory, language, executive functions and visuospatial processing. Linear regressions were fitted to assess how functional capacity declined with motor and cognition impairments. Odds of dependence in ADLs, IADLs and WRAs were estimated using logistic regressions.</p><p><strong>Results: </strong>Cognitive and motor performance were independently associated with functional capacities, though motor performance showed a stronger association than cognitive performance. Decline of all SelfCog cognitive domains contributed to functional decline, with stronger association with global and executive scores compared to language, visuospatial, and memory domains. Higher global and executive deficits were associated with an increased risk of dependence in ADLs, IADLs, and WRAs.</p><p><strong>Conclusion: </strong>The independent contributions of motor, followed by cognitive-mainly executive-functions to functional decline suggest targeted interventions to preserve autonomy and quality of life in HD.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"224"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure freedom and therapy discontinuation in patients with idiopathic generalized epilepsy: retrospective cohort study from a tertiary epilepsy outpatient service.","authors":"Davide G Curti, Anna Bellini, Marco Cursi, Jacopo Lanzone, Fabio Minicucci, Giovanna F Fanelli, Federica Agosta, Massimo Filippi","doi":"10.1007/s00415-025-12890-y","DOIUrl":"10.1007/s00415-025-12890-y","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic generalized epilepsy (IGE) affects young individuals and is typically successfully managed with anti-seizure medications (ASMs). Discontinuing therapy in IGE patients is a critical decision due to the risk of seizure recurrence. This study aims to identify factors influencing seizure freedom (SF) or relapse after ASM discontinuation.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of patients seen at our clinic between 2002 and 2024. Collected data included demographics, disease history, seizure types, ASMs used, EEG findings, outcomes related to SF and ASM withdrawal.</p><p><strong>Results: </strong>We identified 322 records, with a mean age of 30 ± 12.4 years and an age at onset of 16 ± 5.9 years. On average, patients tried 1.9 ASMs, 23% on polytherapy. The main seizure types were generalized tonic-clonic seizures (GTCS) in 53.1%, myoclonic seizures in 31.7%, absences in 15.2%. SF was achieved by 76.6%. Patients with GTCS as main seizure type or presenting with GTCS in the first year of disease experienced a delayed achievement of SF. ASM discontinuation was attempted in 64 patients. Predictors of relapse after discontinuation were myoclonic and generalized seizures as principal seizure type and higher seizure frequency. Early SF and lower seizure frequency were associated with successful discontinuation. EEG predictors of discontinuation failure included worsening during treatment tapering and specific abnormalities, such as spike waves, photosensitivity, and hyperpnoea sensitivity.</p><p><strong>Conclusions: </strong>This study provides long-term follow-up data on IGE patients, highlighting key predictors of seizure control, including GTCS or myoclonic seizures and a rapid initial ASM response. EEG emerges as a valuable tool for the longitudinal monitoring of patients undergoing ASM discontinuation.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"218"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic therapies for movement disorders - current status.","authors":"J Sartorelli, J Ng, A A Rahim, S N Waddington, M A Kurian","doi":"10.1007/s00415-025-12940-5","DOIUrl":"10.1007/s00415-025-12940-5","url":null,"abstract":"<p><p>Movement disorders are a group of heterogeneous neurological conditions associated with alterations of tone, posture and voluntary movement. They may either occur in isolation or as part of a multisystemic condition. More recently, the advent of next generation sequencing technologies has facilitated better understanding of the underlying causative genes and molecular pathways, thereby identifying targets for genetic therapy. In this review, we summarize the advances in genetic therapy approaches for both hyperkinetic and hypokinetic movement disorders, including Parkinson's Disease, Huntington's Disease and rarer monogenic conditions of childhood onset. While there have been significant advances in the field, multiple challenges remain, related to safety, toxicity, efficacy and brain biodistribution, which will need to be addressed by the next generation of genetic therapies.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"220"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GAD antibodies in neurological disease: a critical evaluation of the utility and treatment implications of GAD antibodies in clinical practice.","authors":"Rachel L Brown, Gilbert Thomas-Black, Hector Garcia-Moreno, Michael Chou, Zofia Fleszar, Michael S Zandi, Miles Chapman, Andrew J Church, Melanie Hart, Paola Giunti, Angela Vincent, Michael P Lunn","doi":"10.1007/s00415-025-12926-3","DOIUrl":"10.1007/s00415-025-12926-3","url":null,"abstract":"<p><strong>Background: </strong>The interpretation of antibodies to glutamic acid decarboxylase 65 (GAD-Abs) in neurological practice is challenging. GAD-Abs are not considered directly pathogenic and immunotherapy guidelines are lacking.</p><p><strong>Methods: </strong>We undertook a single-center retrospective service evaluation of GAD-Abs, documenting clinical features, immunotherapy responses, and outcomes of 335 patients with positive GAD-Abs measured by indirect ELISA between 2012 and 2020. The serum:CSF ratio of GAD-Ab values was used as a surrogate for intrathecal synthesis.</p><p><strong>Results: </strong>168 (50%) patients had diagnosed neurological disorders (GAD-ND). Ninety-six had neurological disorders often or sometimes associated with GAD-Abs, i.e., stiff person syndrome spectrum disorders (SPS-SD, n = 26), cerebellar ataxia (n = 21), epilepsy (n = 19), encephalitis (n = 18), or any combination of these (\"mixed\", n = 12). Seventy-two had other neurological disorders (ONDs) not typically associated with GAD-Abs. We defined a cut-off of 10,000 IU/mL a priori and a posteriori for GAD-Ab associated NDs, but identified values > 10,000 IU/mL in 21% and 11% of patients with ONDs or diabetes respectively, and < 10,000 IU/mL in 39% patients with classical GAD-Ab syndromes, indicating low assay specificity and sensitivity. Low serum: CSF GAD-Ab ratios were consistent with intrathecal synthesis in 12/19 tested; 25/54 patients had oligoclonal bands. 30/50 patients given adequate immunotherapies had partial (n = 17) or good (n = 13) responses, particularly those with SPS-SD or limbic encephalitis. Within the limitations of small subgroups and routine laboratory titrations, patients with GAD-Ab values > 10,000 IU/mL, intrathecal synthesis of GAD-Abs, or oligoclonal bands, were not more likely to improve with immunotherapies than those with GAD-Ab values < 10,000 IU/mL and a non-inflammatory CSF. Rather, treatment response correlated with disease group, principally SPS-SD and encephalitis.</p><p><strong>Conclusions: </strong>These results suggest caution in over-interpreting GAD-Abs values. Better biomarkers for identifying patients with immunotherapy responsive GAD-Ab disease are needed.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 3","pages":"222"},"PeriodicalIF":4.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}