Journal of Pediatric Gastroenterology and Nutrition最新文献

{"title":"Short, not skinny: The distinct sarcopenia phenotype of pediatric primary sclerosing cholangitis-inflammatory bowel disease.","authors":"Ghaida Dahlwi, Toshifumi Yodoshi, Jonathan E M O'Donnell, Fatemeh Hadian, Anne M Griffiths, Peter C Church, Amanda Ricciuto","doi":"10.1002/jpn3.70499","DOIUrl":"10.1002/jpn3.70499","url":null,"abstract":"<p><strong>Objectives: </strong>Sarcopenia is prevalent in pediatric liver disease and inflammatory bowel disease (IBD) and predicts adverse outcomes. We aimed to compare sarcopenia prevalence in pediatric primary sclerosing cholangitis (PSC)-colitis versus non-PSC colitis, characterize longitudinal anthropometric trajectories, and examine the association between sarcopenia and liver outcomes.</p><p><strong>Methods: </strong>This retrospective study compared children with PSC-colitis to matched non-PSC colitis controls. Total psoas muscle area (tPMA) was measured on magnetic resonance enterography. Sarcopenia was defined as tPMA <3rd percentile. Logistic regression examined the PSC-sarcopenia association adjusting for IBD factors. Anthropometric and gamma-glutamyl transferase (GGT) trajectories were analyzed using linear mixed-effects models.</p><p><strong>Results: </strong>Of 85 patients (31 PSC-colitis, 54 non-PSC colitis), sarcopenia prevalence was 42% versus 26%. After adjustment, PSC-colitis patients had nearly fivefold higher odds of sarcopenia (adjusted odds ratio [aOR] 4.81, 95% confidence interval [CI] 1.33-17.36, p = 0.016). However, height-corrected tPMA was similar between groups (p = 0.97), and the PSC-sarcopenia association attenuated when adjusting for height (aOR 3.16, p = 0.085). Sarcopenic PSC-colitis patients demonstrated weight recovery yet persistent height deficits. Sarcopenic non-PSC colitis patients had persistent weight deficits without height impairment. GGT trajectories in PSC-colitis did not differ by sarcopenia status.</p><p><strong>Conclusions: </strong>Sarcopenia in PSC-colitis may reflect proportionate growth impairment, \"short but not skinny,\" rather than catabolic wasting. This phenotype, characterized by persistent height deficits despite weight recovery and mild colitis, may suggest hepatobiliary or other mechanisms distinct from the gut inflammation-driven sarcopenia in non-PSC colitis and the cachexia of end-stage liver disease.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"606-615"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination in pediatric transplantation-General recommendations. A position paper by the European Reference Network TransplantChild.","authors":"Valeria Casotti, Francesco Saglio, Adriana Balduzzi, Peter Barany, Vibeke Brix Christensen, Simona Buelli, Daniele Donà, Maja Klaudel-Dreszler, Sara Mosca, Andrea Pietrobattista, Michele Pinon, Giusy Ranucci, Lars Wennberg, Lorenzo D'Antiga","doi":"10.1002/jpn3.70523","DOIUrl":"10.1002/jpn3.70523","url":null,"abstract":"<p><p>Infectious diseases remain a leading cause of morbidity and mortality among pediatric transplant recipients, despite significant advances in transplantation management. Vaccination is the most effective strategy to prevent infections; however, its efficacy is hindered in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, due to altered immune responses. Pediatric SOT candidates often have incomplete vaccination status prior to transplantation and reduced vaccine efficacy post-transplant due to immunosuppressive therapy. They are also at greater risk of vaccine-preventable infections compared to adults, leading to higher rates of hospitalization, graft loss, and death. In HSCT recipients, immune ablation and reconstitution result in the loss of immunologic memory, rendering both pre- and post-transplant vaccine strategies particularly challenging. Factors such as graft-versus-host disease, immunoglobulin therapy, and ongoing immunosuppression further complicate timing and effectiveness of vaccinations. Despite established guidelines emphasizing timely immunization, several studies report low vaccination coverage and inadequate protective immunity in both groups. Barriers include intercurrent illness, variation in national immunization schedules, vaccine hesitancy, and uncertainties regarding optimal vaccination timing. In this position statement, the European Reference Network (ERN) TransplantChild Working Group conducted a comprehensive literature review on the most relevant studies on vaccinations in pediatric transplant candidates and recipients, with the aim of developing evidence-based recommendations tailored to pediatric SOT and HSCT recipients. This position paper outlines current challenges, summarizes existing evidence, and proposes recommendations to improve immunization practices in this high-risk population.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"624-636"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685058","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":"Dyssynergic defecation in adolescents with constipation: Anorectal manometry findings.","authors":"Mustafa Sadek, Alaa Almallouhi, Olla Darwish, Kristin Cole, Mhd Louai Manini, Yamen Ezaizi","doi":"10.1002/jpn3.70513","DOIUrl":"10.1002/jpn3.70513","url":null,"abstract":"<p><strong>Objectives: </strong>To describe and compare anorectal manometry findings in constipated adolescents with and without dyssynergic defecation (DD).</p><p><strong>Methods: </strong>We retrospectively reviewed adolescents ≤18 years who underwent anorectal manometry (ARM) and/or balloon expulsion testing (BET) between 2015 and 2022. Patients with prior pelvic floor therapy, inflammatory bowel disease, or colon surgery were excluded. DD was defined by abnormal ARM (paradoxical anal contraction or inadequate anal relaxation ≤20% during simulated evacuation) and/or abnormal BET (>60 s). Manometric parameters were compared between patients with and without DD and between those with abnormal versus normal BET. Diagnostic performance of rectoanal pressure gradient cutoffs were assessed.</p><p><strong>Results: </strong>A total of 170 adolescents were included; 69 (40.6%) met criteria for DD. Median age was 17 years (interquartile range [IQR] 16-18), and 80.7% were female. Gastrointestinal symptoms did not differ between groups. Patients with DD demonstrated significantly more negative rectoanal pressure gradients compared with those without DD (median [IQR]: -49.0 mmHg [-73.9 to -31.4] vs. -25.2 mmHg [-40.2 to -9.8]; p < 0.001). Rectal sensory thresholds did not differ significantly between groups. A rectoanal pressure gradient cutoff of -45 mmHg demonstrated the best balance of sensitivity (58%) and specificity (86%) for identifying DD. Depression was more prevalent among adolescents with DD (p = 0.007).</p><p><strong>Conclusions: </strong>Rectoanal pressure gradient is a useful manometric parameter for identifying DD in constipated adolescents, particularly when BET is unavailable. Psychological factors such as depression may be more prevalent in this population.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"652-657"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The illusion of competence: Evaluating the clinical reasoning of large language models in pediatric gastroenterology.","authors":"Yasin Maruf Ergen, Selçuk Teke, Edibe Gözde Başaran, Necati Balamtekin","doi":"10.1002/jpn3.70502","DOIUrl":"10.1002/jpn3.70502","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic accuracy and clinical reasoning of three frontier large language models (LLMs) across standardized pediatric gastroenterology, hepatology, and nutrition (PGHN) clinical vignettes.</p><p><strong>Methods: </strong>In this cross-sectional study, 25 fictional PGHN vignettes were developed by one board-certified pediatric gastroenterologist and evaluated using three LLMs: Gemini 3.1 Pro, ChatGPT 5.4 Thinking, and Claude Sonnet 4.6 Extended. A conditional two-step prompting protocol was applied. Three blinded, PGHN-certified co-authors independently scored responses using a structured instrument covering four domains (diagnostic accuracy, management, patient safety, reference quality; 0-2 each) and a global quality of clinical reasoning (QCR) score (1-5 Likert scale). Interobserver reliability was assessed using the intraclass correlation coefficient (ICC). Group differences were analyzed using the Kruskal-Wallis H test with Dunn post-hoc correction.</p><p><strong>Results: </strong>Interobserver reliability was excellent (ICC: 0.98 for domains; 0.87 for QCR). All three models achieved perfect diagnostic accuracy (median 2.00, interquartile range: 2.00-2.00). Statistically significant intermodel differences were identified in reference quality (p = 0.048) and QCR (p = 0.049). Claude achieved significantly higher QCR scores than ChatGPT (p = 0.043) and demonstrated the highest overall reference quality. Qualitative analysis revealed critical pharmacological dosing errors, contextual blindness, temporal obsolescence, and a high frequency of fabricated citations.</p><p><strong>Conclusion: </strong>While current LLMs demonstrate good diagnostic pattern recognition in PGHN, reproducible and potentially life-threatening failures in pharmacological reasoning and reference accuracy create a dangerous illusion of competence. These findings suggest that LLMs may support differential diagnosis brainstorming in PGHN but do not establish their safety in real-world clinical scenarios.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"644-651"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of rifaximin in reducing central line-associated bloodstream infections in pediatric intestinal failure.","authors":"Emma Johnson, Claire Konicek, Nathan Lamb, Joseph Fishbein, Ravi Jhaveri, Valeria Cohran","doi":"10.1002/jpn3.70522","DOIUrl":"10.1002/jpn3.70522","url":null,"abstract":"<p><strong>Objectives: </strong>Due to their dependence on parenteral nutrition, patients with intestinal failure (IF) are at an increased risk of central line-associated blood stream infections (CLABSIs). Ethanol lock therapies (ELTs) reduce the incidence of CLABSIs, but ELTs work locally in the line and have limited availability in the United States. Rifaximin is a non-absorbed, enteral antibiotic used to manage small intestinal bacterial overgrowth (SIBO). Our primary objective was to evaluate the effectiveness of rifaximin to prevent CLABSIs in pediatric IF patients.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with IF managed at a single pediatric center between January 2010 and December 2022. Patients in the cohort had at least 1 CLABSI prior to initiation of rifaximin. Data were collected for 12 months pre- and post-rifaximin initiation. CLABSI incidences were compared using Poisson regression with a log transformation.</p><p><strong>Results: </strong>Thirty-three patients were included. The observed incidence of CLABSI for all patients in our sample, before and after rifaximin initiation, was 10.2 (8.2, 12.7) and 7.3 (5.8, 9.2) per 1000 central line days, respectively, p = 0.03. Subgroup analysis showed patients who received rifaximin without ELT had signification reduction in CLABSIs, 8.3 versus 3.0 (p < 0.001). There were no statistically significant differences in the proportion of gram-positive or gram-negative bacteria or yeast isolated before and after rifaximin.</p><p><strong>Conclusions: </strong>Children with IF who were treated with rifaximin experienced fewer CLABSI events, suggesting that rifaximin is a viable option for CLABSI prophylaxis in pediatric IF patients.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"675-680"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-like peptide-1 receptor agonists in pediatrics: The pancreatology perspective.","authors":"Rosara Bass, Chinenye R Dike, Jennifer M Ladd, Jefferson N Brownell","doi":"10.1002/jpn3.70512","DOIUrl":"10.1002/jpn3.70512","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"587-590"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of professional practise on Helicobacter pylori in paediatrics: A pan-European study.","authors":"Marta Tavares, Angelika Kindermann, Claudio Romano, Anatoly Kavkin, Yasar Dogan, Camille Jung, Antal Dezsőfi-Gottl, Vaidotas Urbonas, Amit Assa, Alexandru Pirvan, Staffan K Berglund, Matjaž Homan","doi":"10.1002/jpn3.70515","DOIUrl":"10.1002/jpn3.70515","url":null,"abstract":"<p><strong>Objectives: </strong>Recent guidelines provide insightful information on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection. The knowledge of the latest guidelines for European paediatric gastroenterologists is currently being discussed. This study aimed to evaluate the current knowledge regarding paediatric H. pylori management.</p><p><strong>Methods: </strong>Members from the National Societies of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were invited to complete an online questionnaire. Descriptive and statistical analyses were conducted using SPSS®.</p><p><strong>Results: </strong>A questionnaire was completed by 508 paediatric healthcare professionals from 32 countries (60% were specialists, 82% worked in hospitals and 49% in university hospitals). Of these, 360 (71%) had a background in paediatric gastroenterology. In 30% of cases, the local prevalence of H. pylori was unknown. Primary testing indications included duodenal or gastric erosions (85%), oral iron-refractory anaemia (59%) and a positive family history of gastric cancer (41%), 7.5% complied with the guidelines. Fifty-seven per cent requested invasive diagnostic tests, including culture (66%) and molecular tests (34%). The test-and-treat strategy was considered by 43% of clinicians, and more than half of respondents would include probiotics in eradication. Amoxicillin-based therapies represented 77% of prescriptions, with 54% opting for clarithromycin for empirical treatment. Additionally, the eradication regimens varied significantly across different European regions, with limited/small differences by clinician category.</p><p><strong>Conclusions: </strong>This study among healthcare professionals revealed that H. pylori infection management does not entirely follow the guidelines regarding indications, testing and treatment regimens. There is a need for education in Europe to increase literacy and clinical updates.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"665-674"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impacts of energy and protein provision on anthropometric changes in infants with critical congenital heart disease.","authors":"Colin R Tang-Whitmore, Cydney Coleman, Brittany Faanes, Laura Gearman, Brian F Joy, Stacie Knutson, Benjamin W Langworthy, Katie M Pfister, Catherine Larson-Nath","doi":"10.1002/jpn3.70514","DOIUrl":"10.1002/jpn3.70514","url":null,"abstract":"<p><strong>Objectives: </strong>Malnutrition in patients with critical congenital heart disease (CCHD) is associated with worse outcomes, however, feeding challenges, and changes in metabolic demands obscure the relationship between nutrient intake and growth in this patient population. We examined the relationship between nutrition provision (caloric and protein intake) and anthropometric indices (weight-for-age z-score [WAZ], length-for-age z-score [LAZ], and occipital-frontal-circumference-for-age [OAZ]).</p><p><strong>Methods: </strong>A single-center prospective cohort study of infants admitted to cardiac intensive care at a tertiary care children's hospital with CCHD between January 2020 and August 2023. Changes in weekly anthropometric measures were modeled with weekly protein and energy intake using a generalized estimating equation model, controlling for relevant factors. The effects of meeting protein (at least 2 g/kg/day) and energy (at least 120 kcal/kg/day) goals on anthropometric z-scores were also assessed, with a significance threshold of p < 0.05 and no corrections for multiple comparisons.</p><p><strong>Results: </strong>Thirty-six patients were enrolled (18 male), including eight with single ventricle and 28 with biventricular physiology. Increased energy and protein intake were associated with greater expected improvements in growth parameters. Among patients who met the daily caloric goal of at least 120 kcal/kg, there was a significant increase in change in LAZ. Meeting the protein goal of at least 2 g/kg was not associated with changes in WAZ, LAZ, and OAZ.</p><p><strong>Conclusion: </strong>Increased energy and protein provision is associated with greater change in all anthropometric indices in neonates with CCHD demonstrating the importance of nutrition provision in this population.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"737-743"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562275","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":"Gut microbiome in pediatric acute pancreatitis and Crohn's disease versus irritable bowel syndrome and healthy controls.","authors":"Neha R Santucci, Chinenye R Dike, Jenny Hellmann, Nicholas J Ollberding, Qing Duan, Philip Minar, Lee A Denson, David B Haslam, Daniel Castillo, Maisam Abu-El-Haija","doi":"10.1002/jpn3.70504","DOIUrl":"10.1002/jpn3.70504","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric acute pancreatitis (AP), Crohn's disease (CD), and irritable bowel syndrome (IBS) are associated with gut dysbiosis, but differences and similarities between conditions are unknown. We hypothesized that gut microbial ecology would differ across these disorders.</p><p><strong>Methods: </strong>Stool was collected from 120 subjects (AP [n = 30], CD [n = 29], IBS Rome IV [n = 27], and healthy controls [HC, n = 34]). Shotgun metagenomic sequencing was performed on extracted DNA and taxonomic and functional profiles obtained using sylph and HUMAnN3 with default parameters.</p><p><strong>Results: </strong>Age interquartile range for all participants was 8.1-17.7 years. Shannon diversity was decreased in AP compared to IBS or HC (p < 0.0001) and similar to CD (p = 0.97). CD differed from IBS (p = 0.001) and HC (p < 0.0001) while IBS and HC were similar (p = 0.61). Ordination of the first two principal coordinate analyses axes showed sample clustering by condition (R² = 0.12, p < 0.001), and differences between all conditions in pairwise comparisons (p < 0.001). Escherichia coli, Ruminococcus gnavus, Staphylococcus aureus, and Thomasciavelia ramosa remained enriched when all conditions (AP, CD, and IBS) were compared as a single group to HC. Using a random forest machine learning algorithm for species relative abundance, the ability to classify a sample to each condition versus all others was highest for CD (area under the receiver operative characteristic curve, AUC = 0.97), followed by AP (AUC = 0.92), HC (AUC = 0.88), and IBS (AUC = 0.83).</p><p><strong>Conclusion: </strong>Organic disorders (AP and CD) are associated with significant gut dysbiosis than IBS which appears more like HC. Interventions targeting shifts in commensals in AP and CD may be helpful in improving outcomes in both disorders.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"728-736"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436895","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":"Should Europe have a European infant feeding policy?","authors":"Stewart Forsyth","doi":"10.1002/jpn3.70493","DOIUrl":"10.1002/jpn3.70493","url":null,"abstract":"","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"577-579"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329800","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}