Journal of the Canadian Association of Gastroenterology最新文献

{"title":"Practice patterns for eosinophilic esophagitis vary widely among Canadian gastroenterologists: a nationwide survey.","authors":"Andrew Fetz, Alexander R Hemy, Hyun Jae Kim, Sarvee Moosavi","doi":"10.1093/jcag/gwae033","DOIUrl":"10.1093/jcag/gwae033","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilic esophagitis (EoE) is a chronic allergic, type 2, immune-mediated condition of the oesophagus, resulting in dysmotility and oesophageal stricturing. This study aims to identify practice variation among Canadian gastroenterologists treating adults with EoE.</p><p><strong>Methods: </strong>A cross-sectional, web-based survey was distributed to Canadian gastroenterologists through the Canadian Association of Gastroenterology and administrations of Canadian universities.</p><p><strong>Results: </strong>Seventy gastroenterologists completed the survey, with 59% working in academic practice or research. Overall, 90% of gastroenterologists require histological evidence of EoE to establish a diagnosis of EoE, while 50% require clinical symptoms of oesophageal dysfunction; 39% of gastroenterologists take less than 5 biopsies when assessing for EoE, with variability in biopsy location. Only 51% of respondents took biopsies in every case presenting with acute food bolus. Proton pump inhibitors were the initial therapy of 70% of gastroenterologists, with 11% using topical steroids. The preferred dietary approach was the 6-food elimination diet in 36%, followed by the 2-food elimination diet in 26%. Overall, 27% of participants did not use histologic improvement and 63% did not use endoscopic improvement to evaluate treatment response. Use of EoE Endoscopic Reference Score (EREFS) is low, with 56% being either unaware of what EREFS is or never using it. Most respondents feel Canadian guidelines would be helpful in their practice.</p><p><strong>Conclusions: </strong>Eosinophilic esophagitis practice patterns among Canadian gastroenterologists are variable and differ from consensus guidelines. The development of Canadian guidelines and continuing medical education content can be considered to improve the management of EoE in Canada.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 1","pages":"13-20"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid to prevent bleeding after endoscopic resection of large colorectal polyps: a pilot project.","authors":"Mandip Rai, Mary Sedarous, Connie Taylor, Jackie McKay, Lawrence Hookey, Robert Bechara","doi":"10.1093/jcag/gwae038","DOIUrl":"10.1093/jcag/gwae038","url":null,"abstract":"<p><strong>Background and aims: </strong>Delayed post-polypectomy bleeding (DPPB) can occur up to a month following the procedure but is typically seen within the first week. Tranexamic acid (TXA) is a member of a class of drugs called antifibrinolytic agents. It reduces fibrinolysis by slowing down the conversion of plasminogen to plasmin, which may prevent bleeding. The goal of this pilot study is to assess the feasibility of using tranexamic acid after endoscopic mucosal resection (EMR) of large (≥2 cm) non-pedunculated colorectal polyps (LNPCPs) to prevent DPPB.</p><p><strong>Methods: </strong>This was a single centre feasibility study conducted at the Kingston Health Sciences Centre in 2021. After the polypectomy was completed, IV tranexamic acid was given [1 gram of TXA in 100 mL of normal saline] and infused over a 10-min interval. The participants received tranexamic acid 1 gram PO TID to be taken for 5 days.</p><p><strong>Results: </strong>A total of 25 patients were enrolled with a mean polyp size of 3 cm. Intraprocedural bleeding occurred in 7 patients (28%) and all of these were treated with soft coagulation. Two patients had clipping for suspected muscle injury. All 25 patients received IV TXA post-procedure. Sixteen patients (64%) took every dose of the prescribed pills. One patient presented with post-polypectomy bleeding. All patients completed the day 30 follow-up phone call. There were no major adverse events.</p><p><strong>Conclusions: </strong>TXA to prevent delayed post-polypectomy bleeding (DPPB) was feasible to use with no major adverse events reported. A randomized controlled study will be needed to see if TXA can significantly reduce DPPB.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 1","pages":"39-43"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response from the Canadian Children Inflammatory Bowel Disease Network to the US Food and Drug Administration Draft Guidance for Industry on pediatric inflammatory bowel disease: developing drugs for treatment.","authors":"Eytan Wine, Jennifer deBruyn, Eileen Crowley, Anne M Griffiths","doi":"10.1093/jcag/gwae034","DOIUrl":"10.1093/jcag/gwae034","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"397-398"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Year in Review: JCAG's Inaugural Editorial Fellowship.","authors":"Jeffery M Venner","doi":"10.1093/jcag/gwae037","DOIUrl":"10.1093/jcag/gwae037","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"396"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features, management, and complications of paediatric button battery ingestions in Canada: an active surveillance study using surveys of Canadian paediatricians and paediatric subspecialists.","authors":"Alexandra S Hudson, Matthew W Carroll","doi":"10.1093/jcag/gwae032","DOIUrl":"10.1093/jcag/gwae032","url":null,"abstract":"<p><strong>Background: </strong>Button battery ingestions pose a serious threat to paediatric health and are on the rise worldwide. Little is known about Canadian data. This study described the type of button battery ingestions Canadian paediatric physicians have observed, including treatment and complications.</p><p><strong>Methods: </strong>A Canadian Paediatric Surveillance Program (CPSP) survey was sent to paediatricians and paediatric subspecialists. The questions were developed through a literature review and consultation with 19 CPSP members, before piloting with 5 paediatric physicians. Descriptive analyses were conducted.</p><p><strong>Results: </strong>The response rate was 39% (<i>n</i> = 1067/2716). Few were aware of treatment options with honey (<i>n</i> = 189/1067, 18%) and sucralfate (<i>n</i> = 118/1067, 11%). Two hundred and ninety-nine physicians (28%) had been involved in a case in the past 1 year (<i>n</i> = 132 case details). Children < 3 years were most affected (<i>n</i> = 67/132, 51%). In unwitnessed ingestions (<i>n</i> = 41/132, 31%), the most common symptoms were dysphagia (<i>n</i> = 14/41, 34%) and coughing (<i>n</i> = 10/41, 24%). When it was known where the child found the battery, it was most commonly loose in the environment (<i>n</i> = 34/132, 26%). Seventy per cent of patients (<i>n</i> = 92/132) presented within 6 h following the ingestion. Six per cent (<i>n</i> = 8/132) reported the battery eroding into important adjacent structures (eg, aorta and trachea).</p><p><strong>Interpretation: </strong>A high degree of suspicion for button battery ingestion is needed in young children presenting with dysphagia and coughing. Prevention efforts should be aimed at battery disposal and security. There is a need for dissemination of guidelines to physicians caring for paediatric patients, since modifiable patient factors, such as honey and/or sucralfate administration while awaiting definitive treatment, can improve outcomes.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"416-422"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian female perspectives on training in the boys club: advanced therapeutic endoscopy.","authors":"Avni Jain, Madeleine Barker, Jennifer Telford","doi":"10.1093/jcag/gwae035","DOIUrl":"10.1093/jcag/gwae035","url":null,"abstract":"<p><strong>Introduction: </strong>Unequal female representation in the field of advanced therapeutic endoscopy (ATE) has been recently highlighted in the United States. Previous attempts to determine the barriers to entry into the career have reported a lack of mentorship, patriarchy, inflexible hours/calls and exposure to fluoroscopy. Canadian trainee exposure to ATE and differences in experience between men and women is unknown.</p><p><strong>Objectives: </strong>We sought to determine the barriers to pursuing a career in ATE, specifically focussing on the perspectives of Canadian female gastroenterology fellows.</p><p><strong>Methods: </strong>An online survey was developed and distributed to Canadian gastroenterology fellows enrolled in Royal College-accredited programs in 2021-2022.</p><p><strong>Results: </strong>Responses were received from gastroenterology fellows at 12 of the 14 Canadian programs. The response rate was 46% (<i>n</i> = 42, 16 female respondents and 26 male respondents). An equal proportion of male (42%, <i>n</i> = 11) and female (38%, <i>n</i> = 6) trainees indicated interest in a career in ATE. Thirty-eight per cent (<i>n</i> = 6) of female trainees felt that they had inadequate mentorship opportunities/role models within ATE, in comparison to 4% (<i>n</i> = 1) of males (<i>P</i> = .004). Furthermore, 19% (<i>n</i> = 3) of females felt that this lack of mentorship/role models was a primary deterrent from pursuing ATE as a career, in comparison to 0% of males (<i>P</i> = .02). There was equal self-perceived competency surrounding ATE knowledge between both men and women.</p><p><strong>Conclusions: </strong>Female gastroenterology fellows in Canada lack mentorship and role models in ATE, which seems to be a primary deterrent from pursuing it as a career when compared to their male counterparts. Recognizing and addressing the lack of female leadership and visibility is necessary to improve parity and encourage women to train in the male-dominated field of ATE.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"399-402"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability, feasibility, and impact of the MyGut digital health platform in the monitoring and management of inflammatory bowel disease.","authors":"Jamie Zhen, Maude Simoneau, Pooja Sharma, Pascale Germain, Pascale Watier-Levesque, Abdulrahman Othman, John K Marshall, Waqqas Afif, Neeraj Narula","doi":"10.1093/jcag/gwae029","DOIUrl":"10.1093/jcag/gwae029","url":null,"abstract":"<p><strong>Background: </strong>Digital health monitoring may help facilitate self-management strategies when caring for patients with inflammatory bowel disease (IBD).</p><p><strong>Aims: </strong>This study investigated the feasibility of implementing the MyGut health application when caring for patients with IBD and evaluated whether its use improved health outcomes.</p><p><strong>Methods: </strong>We conducted a prospective trial in 2 Canadian hospitals from 2020 to 2023. Patients with IBD were recruited from gastroenterology clinics, and the MyGut application was installed onto their mobile devices. Metrics such as acceptability, satisfaction, feasibility, quality-of-life scores (measured through the short IBD questionnaire [SIBDQ]), and resource utilization were collected throughout the 1-year follow-up period.</p><p><strong>Results: </strong>Of the 84 patients enrolled, 58 patients (69%) continued to use the app until the study completion. At recruitment, all 84 patients (100%) were willing to use the MyGut application after a brief tutorial. There was a significant improvement in the SIBDQ scores after 1 year of MyGut use (mean = 56.0, SD 8.85 vs 52.0, SD 9.84) (<i>P</i> = .012). However, only 42.9% (21/49) of the patients were willing to continue using the application after 1 year, a significant decrease compared with the 71.4% (35/49) who were willing to continue after 2 months (<i>P</i> = .001). No differences were observed in the number of emergency room visits/hospitalizations (<i>P</i> = .78) before and after 1 year of MyGut use.</p><p><strong>Conclusions: </strong>This study demonstrates that patients are willing to use digital health monitoring platforms and this may lead to improved quality of life. However, sustained efforts must be made to optimize its long-term feasibility.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"423-430"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of endoscopic retrograde cholangiopancreatography performed in the AM versus PM: does procedural timing matter?","authors":"Nasruddin Sabrie, Nikko Gimpaya, Kareem Khalaf, Maya Deeb, Wedad Mhalawi, Michael Meleka, Daniel C Tham, Ahmed H Mokhtar, Caleb Na, Sophia P Abal, Sharan B Malipatil, Sarang Gupta, Sechiv Jugnundan, Deiya Chopra, Rishad Khan, Natalia C Calo, Christopher W Teshima, Gary R May, Jeffrey D Mosko, Samir C Grover","doi":"10.1093/jcag/gwae028","DOIUrl":"10.1093/jcag/gwae028","url":null,"abstract":"<p><strong>Background: </strong>ERCP is a technically demanding procedure that carries a high cumulative adverse event (AE) rate of >10%. Identifying risk factors for adverse events is paramount. Procedure timing, as a surrogate for endoscopist fatigue, has been shown to influence key quality metrics in colonoscopy, but data on this relationship in ERCP is sparse.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of ERCP procedures performed by 5 experienced staff endoscopists, with or without advanced endoscopy fellow (AEF) involvement, from January 1, 2010 to December 1, 2020 at St Michael's Hospital, Toronto, Ontario, a regional referral center for therapeutic endoscopy. The primary outcome was the difference in rate of selective deep, duct canulation between AM and PM procedures.</p><p><strong>Results: </strong>A total of 5672 ERCP procedures were eligible for inclusion. 2793 (49.2%) procedures were performed in the AM and 2879 procedures (50.8%) were performed in the PM. We found no significant difference in the rate of selective ductal cannulation between AM and PM procedures in the unadjusted (82.8% AM vs. 83.1% <i>P</i>-value = .79) or adjusted (OR = 0.98, 95% CI, 0.85-1.12, <i>P</i>-value = .72) analyses. We found no significant difference in the mean procedural duration or rate of perforation between AM and PM procedures. The rate of immediate bleeding was slightly higher in the AM cohort.</p><p><strong>Conclusion: </strong>In our single-center retrospective study, ERCP quality, including selective cannulation rates and immediate adverse events were not significantly different in procedures performed in the morning compared to those performed in the afternoon.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"411-415"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The circadian rhythm as therapeutic target in inflammatory bowel disease.","authors":"Zoë Post, Netanel F Zilberstein, Ali Keshavarzian","doi":"10.1093/jcag/gwae027","DOIUrl":"10.1093/jcag/gwae027","url":null,"abstract":"<p><p>The primary objectives of the management of patients with inflammatory bowel disease (IBD) are to prevent IBD flares, prevent/delay disease progression and improve patients' quality of life. To this end, one needs to identify risk factor(s) associated with flare-ups and disease progression. We posit that disruption of circadian rhythms is one of the key factors that is associated with risk of flare-up and disease progression. This hypothesis is based on published studies that show: (1) The circadian rhythm regulates many biological processes including multiple IBD-relevant biological processes that are critical in inflammatory/immune processes such as environment/microbe interaction, microbe/host interaction, intestinal barrier integrity and mucosal immunity-all central in the pathogenesis of IBD, and (2) Circadian machinery is the primary tool for the host to interact with the environment. Circadian misalignment results in a loss of preparedness of the host to respond and adjust to the environmental changes that could make the host more vulnerable to IBD flare-ups. In this review, we first provide an overview of circadian rhythms and its role in healthy and disease states. Then we present data to support our hypothesis that: (1) IBD patients have disrupted circadian rhythms (\"social jet lag\") and (2) circadian misalignment and associated disrupted sleep decreases the resiliency of IBD patients resulting in microbiota dysbiosis, more disrupted intestinal barrier integrity and a more aggressive disease phenotype. We also show that circadian-directed interventions have a potential to mitigate the deleterious impact of disrupted circadian and improve IBD disease course.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 Suppl 2","pages":"S27-S35"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivations behind complementary and alternative medicine use in patients with Crohn's disease and ulcerative colitis.","authors":"Natasha Klemm, Roberto Trasolini, Brian Bressler, Gregory Rosenfeld, Gina Almasan, Yvette Leung","doi":"10.1093/jcag/gwae020","DOIUrl":"https://doi.org/10.1093/jcag/gwae020","url":null,"abstract":"<p><strong>Background: </strong>Complementary and alternative medicine (CAM) use is common in inflammatory bowel disease (IBD) patients and impacts compliance with conventional treatment. Gastroenterologists should understand the motivational factors of CAM use-factors that <i>push</i> patients away from standard therapy or <i>pull</i> towards CAM. Our study describes the motivations behind CAM use for IBD and evaluates differences between Crohn's disease (CD) and ulcerative colitis (UC) patients.</p><p><strong>Methods: </strong>Retrospective cohort survey of patients over 18 years old with IBD, evaluated by gastroenterologists at a tertiary care referral centre from January 1 to December 31, 2019. Only patients who reported CAM use were included. Chi-square and independent <i>t</i>-tests were performed and <i>P</i>-value <0.05 was significant.</p><p><strong>Results: </strong>Of the 230 completed surveys, 193 reported CAM use (CD: 57.5% vs UC: 42.5%). Demographics, disease duration, and hospitalizations were similar, but CD patients had lower SIBDQ scores (CD: 48.1 vs UC: 53.5, <i>P</i> < 0.001). Both groups were largely influenced by their social network to use CAM (CD: 33% vs UC: 31.3%) and did not feel well informed about CAM (87.4%). CD and UC patients had similar push and pull factors. Push factors included lack of improvement (39%) and side effects (20%) with conventional treatment. Pull factors included the desire for a holistic approach (21%) and to improve mood (35%). UC patients wanted a natural approach to treat their IBD, which nearly reached significance (<i>P</i> = 0.049). Most patients hoped fatigue 62.7%, and diarrhoea 61.7% would improve with CAM, but more CD patients wanted to improve their appetite (<i>P</i> = 0.043).</p><p><strong>Conclusion: </strong>Despite differences in QoL, push and pull motivations for CAM use did not differ between CD and UC patients. Most users do not feel well informed of CAM and ongoing dialogue is important for patient-centred care.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 5","pages":"376-383"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}