Journal of Occupational Health最新文献

{"title":"Increased risk of proximal tubular dysfunction due to occupational cadmium exposure: a survival analysis study.","authors":"Kento Hoshino, Satoko Iwasawa, Noriyuki Yoshioka, Satoko Suzuki, Itsumi Hashimoto, Shoko Ukita, Genta Toshima, Kengo Nagashima, Toru Takebayashi, Masashi Tsunoda","doi":"10.1093/joccuh/uiaf016","DOIUrl":"10.1093/joccuh/uiaf016","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of the current study was to elucidate the relationship between blood cadmium (Cd-B) levels and proximal tubular dysfunction using urinary β2-microglobulin (B2M-U) as an indicator among workers in nickel-cadmium battery plants in Japan.</p><p><strong>Methods: </strong>Medical check-up data from 338 workers exposed to cadmium at 2 plants were collected from 1997 through 2020. Workers with at least 2 check-ups were included, excluding those with other renal dysfunctions. Proximal tubular dysfunction was defined as a B2M-U of 300 μg/g creatinine or higher in 2 or more consecutive check-ups. A multivariable Cox proportional-hazards regression model with time-dependent covariates was performed to analyze the relationship between Cd-B levels and the time to onset of proximal tubular dysfunction, adjusting for age, sex, and smoking history.</p><p><strong>Results: </strong>Of the 338 workers, 238 met the study eligibility criteria for the analyses. The geometric mean of Cd-B was 1.97 μg/L. The Cox proportional hazards analysis demonstrated that higher time-dependent Cd-B levels were significantly associated with an increased risk of proximal tubular dysfunction, with a hazard ratio of 1.17 (95% CI: 1.06-1.29).</p><p><strong>Conclusions: </strong>Higher Cd-B levels are associated with an increased risk of proximal tubular dysfunction in workers exposed to cadmium, indicating an increased risk of renal disease under the current industrial health management in Japan. Continuous monitoring and improved management of cadmium exposure are necessary to protect workers' health even in developed countries such as Japan.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational health topics series on the effects of chemicals: epidemiological and toxicological risk assessments of ortho-toluidine for bladder cancer.","authors":"Makiko Nakano, Min Gi, Tatsushi Toyooka, Shugo Suzuki, Hideki Wanibuchi, Toru Takebayashi","doi":"10.1093/joccuh/uiaf005","DOIUrl":"10.1093/joccuh/uiaf005","url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to report integrative evidence for the health risk assessment of ortho-toluidine (OT) in bladder cancer in a mini-review of the recent studies of humans, experimental animals, and OT skin permeability.</p><p><strong>Methods: </strong>Bladder cancer cases were identified in workers in Japan who were occupationally exposed in 2014-2017 to aromatic amines, primarily to the human carcinogen OT.</p><p><strong>Results: </strong>A key epidemiological study of 98 aromatic amine-exposed workers in Japan showed a clear OT exposure-response relationship with a standardized incidence ratio. A rat model experimental study also indicated that OT and acetoaceto-o-toluidine are potent bladder carcinogens. Multiple mechanisms of OT-related bladder cancer have been proposed: metabolic activation to reactive metabolites that bind DNA and proteins, mutagenicity, oxidative DNA damage, chromosomal damage, and cytotoxicity by OT. Recent comprehensive analyses of DNA adducts in rats identified a number of common oxidative DNA adducts, including 8-OHdG, in the rat urothelium and indicated that oxidative stress may play a crucial role in the development of urinary cancer caused by OT. The skin permeability of 6 aromatic amines (o-toluidine, aniline, p-toluidine, o-anisidine, 2,4-dimethylaniline, and o-chloroaniline) was examined with the use of a 3-dimensional (3D) reconstructed human skin model; ~70%-80% of the 6 aromatic amines had permeated through the 3D skin within 8 hours. Genotoxic potency testing in a human urothelial cell line using γ-H2AX, a marker of DNA damage, suggested that OT exhibited strong γ-H2AX generation.</p><p><strong>Conclusions: </strong>Prolonged dermal exposure to OT along with other genotoxic aromatic amines over many years may contribute to the development of bladder cancer.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11858003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of perceived workplace health support on absenteeism and presenteeism among Japanese workers: a prospective cohort study.","authors":"Kazushirou Kurogi, Kazunori Ikegami, Hajime Ando, Akira Ogami","doi":"10.1093/joccuh/uiaf018","DOIUrl":"10.1093/joccuh/uiaf018","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate the impact of perceived workplace health support (PWHS) on absenteeism and presenteeism among Japanese workers to determine the significance of health and productivity management in improving labor productivity.</p><p><strong>Methods: </strong>This prospective cohort study, using data from the Work Systems & Health Internet Research (WSHIR) study, involved 1879 Japanese workers aged 20-69 years. The intensity of PWHS was assessed using self-administered questionnaires. The participants were followed up from October 2021 to October 2022 to evaluate the incidence of absenteeism and presenteeism based on the level of PWHS.</p><p><strong>Results: </strong>The study findings revealed that higher PWHS significantly correlated with lower presenteeism, indicating better work productivity. Conversely, the relationship between PWHS and absenteeism was less clear, with no consistent trend observed across different levels of PWHS intensity.</p><p><strong>Conclusions: </strong>Enhanced PWHS was associated with reduced presenteeism among Japanese workers, underscoring the importance of workplace health support for improving employee productivity. This finding emphasizes the need for companies to focus on health promotion activities and recognize the potential of PWHS as a performance indicator in corporate health management.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Associations of physical activity and sedentary time with psychological distress among Japan self-defense forces personnel dispatched overseas: a prospective cohort study.","authors":"","doi":"10.1093/joccuh/uiaf011","DOIUrl":"https://doi.org/10.1093/joccuh/uiaf011","url":null,"abstract":"","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":"67 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between health literacy and behaviors among shift workers: an observational cross-sectional study with mediation analysis.","authors":"Yuko Morikawa, Keiko Teranishi, Masaru Sakurai, Masao Ishizaki, Teruhiko Kido, Hideaki Nakagawa","doi":"10.1093/joccuh/uiae070","DOIUrl":"10.1093/joccuh/uiae070","url":null,"abstract":"<p><strong>Objectives: </strong>Previous research has indicated that shift workers exhibit fewer healthy behaviors than those working regular daytime hours. Although health literacy influences health behaviors, studies comparing health literacy levels between shift and fixed-day workers and investigating whether differences in health behaviors between these 2 groups are mediated by health literacy are lacking.</p><p><strong>Methods: </strong>This cross-sectional study used a self-administered questionnaire in a large-scale manufacturing company. Overall, 2152 manual workers aged 18-64 years were enrolled in this study (961 and 1191 fixed-day and shift workers, respectively). Logistic regression structural equation models were used for analyzing the mediating role of health literacy in the relationship between shift work and health behaviors.</p><p><strong>Results: </strong>Shift and fixed-day workers did not show differences in age-adjusted health literacy. Compared with fixed-day workers, the odds ratios of shift workers for leisure time exercise, not currently smoking, having breakfast, brushing their teeth, and eating green and yellow vegetables were 0.85 (95% CI, 0.70-1.02), 0.68 (95% CI, 0.56-0.80), 0.63 (95% CI, 0.52-0.76), 0.79 (95% CI, 0.65-0.95), and 0.58 (95% CI, 0.48-0.70), respectively. Mediation analysis showed that the odds ratios of the direct effects of shift work on favorable habits were almost the same as the total effect.</p><p><strong>Conclusions: </strong>This study observed that health literacy did not mediate health behavior and shift work. Further research is needed to clarify the causes of these differences.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":"67 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic occupational paronychia secondary to digital pilonidal sinus from dog grooming.","authors":"Mikko P Räisänen, Heidi Furu, Aleksi Reito, Randy R Bindra","doi":"10.1093/joccuh/uiae076","DOIUrl":"10.1093/joccuh/uiae076","url":null,"abstract":"<p><p>Pilonidal sinus is a recognized occupational condition sometimes seen in barbers and pet groomers, and it involves most commonly interdigital spaces. We present a previously unreported case of chronic paronychia with 2 separate digital pilonidal sinuses resulting from multiple embedded hair fragments in the eponychium of a dog groomer, who had been repeatedly treated with antibiotics with no success and ended up having surgical treatment. The objective of this study is to remind readers of this rare but possible occupational disease, particularly among employees working with hair, and to emphasize the importance of preventive measures to prevent its occurrence. Intraoperatively, a crescent of eponychial skin parallel to the proximal nail fold was excised, which incorporated the sinuses. Additionally, the nail plate was removed, and multiple hair fragments were retrieved from the nail folds. At the follow-up, the infection had resolved, and nail growth had resumed. Additional animal hair was found in the nail folds, as the patient continued to work without protective gloves. This case highlights the importance of considering embedded hair as a potential cause for chronic paronychia in individuals with occupations involving hair cutting and grooming. Chronic hand infection poses a risk of infection contaminating clients or patients; for example, a veterinarian should not operate with an infected hand. The costs of sickness absences are considerable for all the stakeholders. The use of protective gloves, hand hygiene, skin care, and thorough removal of loose hair fragments should be emphasized for workers in professions dealing with animal or human hair.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between fear of future workplace violence and burnout among pediatricians in China with psychological resilience as a moderator.","authors":"Yuntian Shi, Fangxiang Mao, Xuan Zhang","doi":"10.1093/joccuh/uiaf029","DOIUrl":"10.1093/joccuh/uiaf029","url":null,"abstract":"<p><strong>Objectives: </strong>This study explored the relationship between fear of future workplace violence (FFWV) and burnout, and the moderating effect of psychological resilience on this relationship.</p><p><strong>Methods: </strong>We recruited 413 pediatricians from 26 specialized and general hospitals in China's Shandong provinces and Ningxia Hui Autonomous Region from August 2021 to April 2022. Fear of future workplace violence was measured using the Fear of Future Violence at Work Scale. Burnout was assessed using the Maslach Burnout Inventory. Psychological resilience was measured using the 10-item Connor-Davidson Resilience Scale. A multiple linear regression analysis was used to investigate the relationship between FFWV and burnout. The SPSS PROCESS macro was used to examine the moderating effect of psychological resilience on this relationship.</p><p><strong>Results: </strong>About 85.7% of pediatricians experienced a medium or high level of fear. Fear of future workplace violence was significantly and positively associated with emotional exhaustion, depersonalization, and personal accomplishment (B = 0.23, SE = 0.39, P < .001; B = 0.06, SE = 0.13, P < .001; B = 0.17, SE = 0.03, P < .001, respectively, where B denotes the unstandardized regression coefficient). The interaction effects of FFWV and psychological resilience on emotional exhaustion (B = -0.008; 95% CI, -0.01 to -0.004) and depersonalization (B = -0.003; 95% CI, -0.005 to -0.001) were statistically significant. The protective effect conforms to the \"protective-stabilizing\" model.</p><p><strong>Conclusions: </strong>Psychological resilience training may be beneficial for pediatricians in preventing high levels of emotional exhaustion and cynicism resulting from FFWV.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between days of work and presenteeism, and mediation of this relationship by fatigue among disaster responders.","authors":"Inn-Kynn Khaing, Odgerel Chimed-Ochir, Emma M Rath, Seiichiro Tateishi, Nahoko Enokida, Koji Mori, Yoshihisa Fujino, Tatsuhiro Nagata, Ogawa Hanako, Akihiro Taji, Noriyuki Shiroma, Ami Fukunaga, Yui Yumiya, Tatsuhiko Kubo","doi":"10.1093/joccuh/uiaf019","DOIUrl":"10.1093/joccuh/uiaf019","url":null,"abstract":"<p><strong>Objectives: </strong>Occupational health studies have identified positive associations between work duration and presenteeism, but there is limited understanding of this relationship in disaster responders. We examined the relationship between the number of work days and presenteeism and the mediating effect of fatigue in disaster responders deployed after the Noto Peninsula earthquake.</p><p><strong>Methods: </strong>This cross-sectional study examined disaster responders deployed after the Noto Peninsula earthquake (Japan, 2024). Data were collected using the health management version of the app for Japanese Surveillance in Post-extreme Emergencies and Disasters, and included days of work, fatigue score, and presenteeism. Structural equation modeling (SEM) was employed to examine the direct and indirect effects of the number of work days on presenteeism, with fatigue as a potential mediator. Sensitivity analysis was also performed.</p><p><strong>Results: </strong>We analyzed 4656 disaster responders who were deployed after the Noto Peninsula earthquake. Presenteeism increased with the number of work days, and ranged from 3.4% (1 day) to 16.9% (>7 days). However, fatigue decreased as the number of work days increased. SEM demonstrated a significant direct effect of the number of work days on presenteeism, and that fatigue slightly decreased this effect for work durations of 4 to 7 days and more than 7 days. Sensitivity analyses supported these findings.</p><p><strong>Conclusions: </strong>Working more days led to increased presenteeism in disaster responders, but fatigue decreased as the number of work days increased. Future longitudinal studies should examine additional factors that may affect presenteeism in disaster responders and other individuals exposed to stressful environments.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How many truck drivers have sleep disorders? Investigation of the effects of lifestyle and stress on insomnia among Japanese male truck drivers.","authors":"Ryoya Aoki, Takashi Miyachi, Yuta Sugano, Choichiro Kanke, Teiichiro Yamazaki, Kazuo Mishima, Kyoko Nomura","doi":"10.1093/joccuh/uiaf012","DOIUrl":"10.1093/joccuh/uiaf012","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate how many male truck drivers have sleep disorders and what factors are most associated with chronic insomnia symptoms.</p><p><strong>Methods: </strong>A cross-sectional study of 505 truck drivers in Akita prefecture was conducted using a self-administered questionnaire and health checkup data. We defined insomnia based on the International Classification of Sleep Disorders, third edition, sleep apnea syndrome (SAS) with a simple 4-variable screening tool, and restless legs syndrome (RLS) with RLS/Willis-Ekbom disease diagnostic criteria. Investigated factors included sleep duration, driving characteristics, caffeine types (foods and beverage) and amounts, caffeine intake timing, State-Trait Anxiety Inventory (STAI), individual stress, and other covariates.</p><p><strong>Results: </strong>The prevalence of suspected SAS was 23.2% (n = 154), and that of RLS was 0.8% (n = 5). After excluding those, chronic insomnia symptoms were present in 36/505 drivers (7.1%). After adjusting for covariates, a logistic model demonstrated that drinking habits [odds ratio (OR), 6.21; 95% CI, 1.07-35.8], caffeine intake before sleep (OR, 2.65; 95% CI, 1.09-6.45), sleep duration on days off (OR, 1.44; 95% CI, 1.01-2.05), and STAI score (OR, 12.8; 95% CI, 2.53-64.2) were significantly associated with chronic insomnia symptoms. STAI was significantly positively correlated with individual stress, such as family worries (r = 0.22), relationships with non-partners (r = 0.28), and health (r = 0.23).</p><p><strong>Conclusions: </strong>Our study revealed that one-fourth of male truck drivers had sleep disorders that require further medical evaluation. For male truck drivers, lifestyle modification and stress relief may be key to address insomnia.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on health emergency and disaster risk management systems: a scoping review of mental health support provided to health care workers.","authors":"Jargalmaa Amarsanaa, Oyundari Batsaikhan, Badamtsetseg Jargalsaikhan, Tatsuhiko Kubo, Nader Ghotbi, Ryoma Kayano, Odgerel Chimed-Ochir","doi":"10.1093/joccuh/uiaf020","DOIUrl":"10.1093/joccuh/uiaf020","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic scoping review examined the strategies used by different countries and institutions to support the mental health of health care workers (HCWs) during the COVID-19 pandemic, to identify effective practices and the lessons learned in dealing with the associated challenges.</p><p><strong>Methods: </strong>Of 1330 retrieved articles from PubMed, Scopus, and the Web of Science, 34 articles were ultimately included in the final analysis.</p><p><strong>Results: </strong>The analysis revealed that mental health consultation services, especially telephone support lines, online interventions, and apps, played a critical role in addressing the psychological burden experienced by HCWs. Group activities and peer support strategies offered personalized support, and educational programs offered crucial information regarding stress management. Improvements in the work environment, such as the addition of dedicated rest areas, enhanced the well-being of HCWs. However, many interventions suffered from low participation and a lack of tailored content, despite their apparent effectiveness.</p><p><strong>Conclusions: </strong>Many interventions have focused on psychological support and resilience-building for HCWs, but they often overlook systemic issues. Comprehensive mental health support must address these systemic factors, such as adequate staffing, training, and resource allocation. Future strategies should emphasize leadership commitment to tackling root causes and actively involve HCWs in program design to ensure relevance and effectiveness. Educational resources and wellness interventions, although reported as effective, need to be tailored and adapted to specific emergencies. Additionally, research gaps, especially in low-resource settings, highlight the need for further studies to enhance preparedness for future crises.</p>","PeriodicalId":16632,"journal":{"name":"Journal of Occupational Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}