Menopause: The Journal of The North American Menopause Society最新文献

{"title":"The impact of 3,3'-diindolylmethane on estradiol and estrogen metabolism in postmenopausal women using a transdermal estradiol patch.","authors":"Mark S Newman, Jaclyn Smeaton","doi":"10.1097/GME.0000000000002542","DOIUrl":"10.1097/GME.0000000000002542","url":null,"abstract":"<p><strong>Objectives: </strong>3,3'-diindolylmethane (DIM) is a supplement, investigational drug, and the primary in vivo product of indole-3-carbinol. DIM is sometimes recommended to postmenopausal women by functional or integrative medicine providers. Some of these women may be concurrently receiving menopausal hormone therapy (MHT), and since DIM's mechanism of action involves the alteration of estrogen metabolism, it is possible that a drug-supplement interaction exists. The objective of this study was to examine the effect of DIM on the estrogen profiles of postmenopausal women receiving MHT in the form of a transdermal estradiol (E2) patch.</p><p><strong>Methods: </strong>This was a retrospective, observational cohort study for which data were collected from a database containing laboratory results for patients processed between January 1, 2016 and December 9, 2019. Laboratory measurements included urinary E2 and 9 other estrogen metabolites. From this database, we identified 1,458 results that were from postmenopausal women using a transdermal E2 patch. Of these 1,458 women, 108 indicated they were concurrently taking a DIM supplement. Wilcoxon rank sum tests were used to assess differences between groups. Multivariable linear regression models were created to confirm the effect of DIM on individual estrogen metabolites.</p><p><strong>Results: </strong>When compared with postmenopausal women using a transdermal E2 patch alone, postmenopausal women using a patch and concurrently taking DIM had statistically significant alterations in their urinary estrogen profiles ( P < 0.001 for all metabolites with differences). Multivariable linear regression models indicated that DIM had a significant effect on 6 of the 10 estrogen metabolites measured, including estrone, estriol, 2-OHE1, 2-OHE2, 4-OHE2, and 16-OHE1, as well as the 2-OHE1/16-OHE1 ratio.</p><p><strong>Conclusions: </strong>Postmenopausal women who are prescribed transdermal E2 patch therapy who choose to concurrently use a DIM supplement may have unexpected changes in their urinary estrogen profiles. Further research is needed to assess whether these changes are clinically significant, as there is a possibility that they may decrease the overall estrogenic impact of MHT on key clinical endpoints such as symptom improvement and bone mineral density. The presence and magnitude of these changes suggest that providers treating postmenopausal women with MHT should ask their patients if they are taking a DIM supplement and, if so, consider the potential implications of drug-supplement interactions for MHT dose management and effectiveness.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"630-639"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011779","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":"The clinical performance of different cervical cancer screening strategies in premenopausal and postmenopausal women.","authors":"Qiang Zhou, Tingyuan Li, Lingling Zhu, Yining Chang, Jingjing Yang, Wen Chen, Ying Yang, Yong He, Chanjuan He, Jingchang Du, Xiaoli Peng, Yuqian Zhao","doi":"10.1097/GME.0000000000002546","DOIUrl":"10.1097/GME.0000000000002546","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates the clinical performance of high-risk human papillomavirus (HR-HPV) testing, liquid-based cytology (LBC), and HR-HPV and LBC co-testing for detecting cervical intraepithelial neoplasia (CIN) in premenopausal and postmenopausal women.</p><p><strong>Methods: </strong>A total of 6,085 premenopausal and 4,766 postmenopausal women were recruited for cervical cancer screening using LBC and HR-HPV testing. Following screening, colposcopy and biopsy for pathology were performed according to established protocols. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for detecting CIN2/3 or worse (CIN2/3+).</p><p><strong>Results: </strong>The sensitivity of LBC for detecting CIN2+ was 73.4% (95% CI=60.7%-83.3%) in premenopausal women and 58.8% (95% CI=44.2%-72.1%) in postmenopausal women. In contrast, significantly higher sensitivities were observed for HR-HPV testing and HR-HPV and LBC co-testing, both of which showed sensitivities of 96.9% (95% CI=88.2%-99.5%) in premenopausal women and 98.0% (95% CI=88.2%-99.9%) in postmenopausal women. While HR-HPV and LBC co-testing demonstrated superior specificity compared with HR-HPV testing alone [95.8% (95% CI=95.2%-96.3%) vs. 86.3% (95% CI=85.4%-87.1%) in premenopausal women; 93.7% (95% CI=92.9%-94.3%) vs. 80.6% (95% CI=79.5%-81.7%) in postmenopausal women], it also exhibited the highest PPV for CIN2+ prediction [19.6% (95% CI=15.4%-24.4%) in premenopausal women; 14.5% (95% CI=10.9%-18.6%) in postmenopausal women] compared with LBC or HR-HPV testing alone.</p><p><strong>Conclusions: </strong>HR-HPV and LBC co-testing demonstrates comparable high clinical accuracy for detecting CIN2+ in both premenopausal and postmenopausal women, with a preference for its use in postmenopausal screening.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"640-647"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016459","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":"Association of menopausal status and hormone use with bladder health and lower urinary tract symptoms in US women: results from the RISE FOR HEALTH study.","authors":"Camille P Vaughan, Alayne D Markland, Gerald McGwin, Emily S Lukacz, Sonya S Brady, Yvette D Lacoursiere, Jean F Wyman, Siobhan Sutcliffe, Ariana L Smith, Kimberly Kenton, Ann Stapleton, Linda Brubaker, Bernard L Harlow","doi":"10.1097/GME.0000000000002541","DOIUrl":"10.1097/GME.0000000000002541","url":null,"abstract":"<p><strong>Objectives: </strong>Most previous studies of genitourinary symptoms associated with menopause focus on comparisons of postmenopausal to premenopausal women and less is known about bladder health during menopause. We evaluated associations of menopause status and hormone use with bladder health and lower urinary tract symptoms (LUTS).</p><p><strong>Methods: </strong>Data were collected from May 2022 to December 2023 from a regionally representative cohort of community-dwelling adult women in the United States. Bladder health and LUTS were measured using validated questionnaires. Analyses included multivariable linear and logistic regression models.</p><p><strong>Results: </strong>Of 3,423 eligible participants, 3,126 responded to menopause and hormone use questions. Of these, 1,226 were premenopausal, 260 perimenopausal, and 1,640 postmenopausal. Premenopausal women reported hormone use more often than perimenopausal or postmenopausal women (38.3% vs. 21.5% and 13.2%). Across multiple bladder health scales (BHS, range 0-100) and bladder function indices (BFI, range 0-100), perimenopause and postmenopause status were associated with worse scores compared with premenopause status. Perimenopausal women were more likely to report urgency UI [OR 2.27, (95% CI: 1.49-3.46)] and other LUTS compared to premenopausal women. Hormone use was associated with worse bladder health in postmenopausal women [postmenopause/hormone -6.0 Overall BHS, (95% CI: -9.8 to -2.2)] and BFI [postmenopause/hormone BFI -4.8, (95% CI: -7.4 to -2.2)].</p><p><strong>Conclusions: </strong>Promotion of bladder health and LUTS prevention is important as women approach the menopause transition. Hormone use was infrequently reported in perimenopausal and postmenopausal women and was associated with worse bladder health postmenopause.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"583-591"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006914","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":"Letters to the Editor.","authors":"Sarah Glynne","doi":"10.1097/GME.0000000000002582","DOIUrl":"10.1097/GME.0000000000002582","url":null,"abstract":"","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"667-669"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032222","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":"Oncofertility and female fertility preservation: a clinical update.","authors":"Mindy S Christianson","doi":"10.1097/GME.0000000000002558","DOIUrl":"10.1097/GME.0000000000002558","url":null,"abstract":"<p><p>Certain cancer and medical treatments can be harmful to fertility by depleting the egg supply. The risk to fertility is dependent on the patient's age, ovarian reserve before treatment, specific medication, or treatment and dosage. For women at risk of developing ovarian insufficiency because of gonadotoxic treatment, fertility preservation options include embryo, oocyte, and ovarian-tissue cryopreservation. Surgical procedures that can protect fertility for patients facing pelvic radiation therapy include ovarian transposition and uterine transposition. This Practice Pearl will focus on fertility preservation options for women facing medical treatment, a core component of oncofertility.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":"32 7","pages":"655-657"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528684","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":"Anger, aging, and reproductive aging: observations from the Seattle Midlife Women's Health Study.","authors":"Nancy Fugate Woods, Ken Pike, Ellen Sullivan Mitchell","doi":"10.1097/GME.0000000000002587","DOIUrl":"https://doi.org/10.1097/GME.0000000000002587","url":null,"abstract":"<p><strong>Objectives: </strong>Although investigators have devoted significant effort to understanding women's experiences of depressed mood and clinical depression during the menopausal transition and early postmenopause, they have focused less on women's perimenopausal experiences of emotional arousal, including anger. The purpose of these analyses was to examine the influence of aging and reproductive aging stages on women's reports of anger.</p><p><strong>Methods: </strong>Participants aged 35-55 years from the Seattle Midlife Women's Health Study population-based cohort (N=501 at baseline) completed an annual health report. Participants completed the State-Trait Anger Inventory (STAXI) (State Anger, Trait Anger, Anger Temperament, Anger Reaction, Anger-in, and Anger Control subscales) and the SCL90 Hostility scale on up to five occasions during the course of the study. Reproductive aging stages were assessed using menstrual calendars and questionnaire data. Menstrual calendars were used to identify menopausal transition stages using the Mitchell (2000) criteria for stages of reproductive aging: late reproductive stages (LRS1 and LRS2), early menopausal transition stage (EMT), late menopausal transition stage (LMT), and postmenopause (PM). Multilevel modeling with Mixed Models Analysis of Linear Models (SPSS 28) was used to examine the effects of age and reproductive aging stages on the repeated measures of anger and hostility using the STAXI Scales and SCL-90 Hostility Subscale.</p><p><strong>Results: </strong>Age was significantly related to most anger measures, with State and Trait Anger and Anger Control increasing with age. Anger Temperament, Anger Reaction, Anger Expressed Aggressively, and Hostility each decreased significantly with age. Only Anger Suppressed was not related to age. When accounting for age effects, Reproductive Aging Stages significantly affected State and Trait Anger and Anger Temperament: each decreased after the late reproductive stages with women's progression through further reproductive aging stages.</p><p><strong>Conclusions: </strong>Aging was significantly related to anger, with anger expression indicators decreasing with age, suggesting emotion regulation may occur during midlife. When aging was taken into account, reproductive aging was associated with decreasing levels of State and Trait Anger and Anger Temperament Scale scores. Both chronological aging and reproductive aging had important effects on dimensions of anger, warranting further attention during midlife and the menopausal transition and early postmenopause.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540769","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":"Correlation between equol production and intestinal microbiota after treatment with isoflavone, isoflavone plus probiotic and hormonal therapy in postmenopausal women: a pilot study.","authors":"Ana Elisa Ribeiro, Naice Eleidiane Santana Monteiro, Lucia Helena Simões da Costa Paiva, Adriana Orcesi Pedro","doi":"10.1097/GME.0000000000002544","DOIUrl":"10.1097/GME.0000000000002544","url":null,"abstract":"<p><strong>Objectives: </strong>To correlate the urinary excretion of equol with intestinal microbiota in response to isoflavone supplementation alone or in combination with probiotics, and to compare these results with those of hormone therapy in postmenopausal women.</p><p><strong>Methods: </strong>A pilot study was conducted on 47 postmenopausal women aged 40-60 years. Participants were randomly assigned to one of three groups: (A) oral isoflavone (150 mg dry extract of Glycine max); (B) isoflavone plus probiotic (Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis); or (C) hormone therapy (1 mg estradiol/0.5 mg norethisterone acetate). Fecal samples were collected to extract bacterial DNA, and equol and its intermediates were measured using gas chromatography coupled with mass spectrometry at baseline and after 16 weeks of treatment.</p><p><strong>Results: </strong>In the isoflavone alone and isoflavone plus probiotic groups, no statistically significant correlations were found between bacterial phyla or genera and the urinary excretion of equol or its intermediate after 16 weeks of treatment. In the hormone therapy group, directly proportional correlation between Bacteroidetes (Spearman R=0.83, Pa=0.01), Cyanobacteria (Spearman R=0.89, Pa=0.002), Alistipes (Spearman R=0.81, Pa=0.04), Catenibacterium (Spearman R=0.81, Pa=0.04), Clostridium (Spearman R=0.84, Pa=0.02), Barnesiella (Spearman R=0.84, Pa=0.02), and the urinary excretion of the equol intermediate were observed.</p><p><strong>Conclusions: </strong>Only the hormone therapy group showed a significant increase in bacterial abundance involved in isoflavone metabolism.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":"32 7","pages":"610-620"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528682","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":"Letters to the Editor.","authors":"Susan R Davis, Rodney Baber, Paula Briggs, Haitham Hamoda, Martha Hickey, Rossella E Nappi, Tommaso Simoncini","doi":"10.1097/GME.0000000000002581","DOIUrl":"10.1097/GME.0000000000002581","url":null,"abstract":"","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"665-667"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022219","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":"Palpitations in midlife women: the Menopause Racing Heart Pilot Study.","authors":"Janet S Carpenter, Heather A Jaynes, Mofareh A Alzahrani, Peng-Sheng Chen, Richard J Kovacs, James E Tisdale","doi":"10.1097/GME.0000000000002538","DOIUrl":"10.1097/GME.0000000000002538","url":null,"abstract":"<p><strong>Objective: </strong>Although palpitations are common in midlife women and may have long-term effects on cardiovascular health and longevity, little is known about underlying electrocardiogram findings, real-time palpitations reporting, or correlates. This hypothesis-generating pilot study compared midlife perimenopausal and postmenopausal women with and without palpitations on electrocardiogram findings, real-time palpitations reporting, and potential correlates.</p><p><strong>Methods: </strong>In this prospective, longitudinal, descriptive, comparative pilot study, 15 midlife women with and 15 without palpitations provided data. They wore an ambulatory electrocardiogram patch for 14-28 days, prospectively recorded palpitations via event button presses and daily diaries, recorded vasomotor symptoms in daily diaries, provided blood samples, and completed questionnaires.</p><p><strong>Results: </strong>There were no group differences in age [Md (IQR) = 56 (50, 59) vs. 55 (53, 57) with an age range of 46 to 62 in both groups] or menopausal status. The palpitations group had significantly lower heart rate variability and longer runs of atrial tachycardia. Button press data indicated that 50% of the palpitations group experienced palpitations (1) one third or more of all nights on the study, (2) nearly half of all days on the study, or (3) once or more per 24 hours on the study. Symptoms occurred during altered rhythms and normal sinus rhythm, though the latter seemed more common at night. Palpitations reporting was not related to demographics, clinical variables, biomarkers, anxiety, or somatosensory awareness but was related to having vasomotor symptoms and diabetes.</p><p><strong>Conclusion: </strong>The pilot study findings revealed some important hypothesis-generating differences that are worthy of further investigation in a larger study.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"571-582"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484986","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":"Associations between reproductive health factors and sociodemographic characteristics and the severity of moderate to severe postmenopausal depression: a secondary analysis of randomized controlled trial data.","authors":"Xiao Wang, Qinge Zhang, Gang Wang, Jingjing Zhou","doi":"10.1097/GME.0000000000002543","DOIUrl":"10.1097/GME.0000000000002543","url":null,"abstract":"<p><strong>Objectives: </strong>The cessation of the menstrual cycle is associated with numerous physiological changes and symptoms, with depression being common during perimenopause and postmenopause, causing significant impacts on one's life. The objective of this study was to explore the relationship between the severity of moderate to severe postmenopausal depression and reproductive health factors, as well as sociodemographic characteristics.</p><p><strong>Methods: </strong>This secondary analysis is based on data from a randomized controlled trial conducted at both a psychiatric hospital (Beijing Anding Hospital) and a general hospital (Beijing Chaoyang Hospital) between April 2013 and September 2017. The original randomized controlled trial employed a multicenter, randomized design over an 8-week period to evaluate depression and associated clinical characteristics. Of the 189 women screened, 5 did not meet the inclusion criteria, leaving 184 eligible for this secondary analysis. The study group consisted of 184 postmenopausal women. Depression was the primary outcome, measured by a 24-item Hamilton Depression Rating Scale observer-rated scale. Quick Inventory of Depressive Symptomatology-Self-Report was used for sensitivity analysis and was considered a secondary outcome. The visual analog scale (VAS) primarily assesses physical pain symptoms. The patient's basic sociodemographic characteristics and reproductive-related information are considered secondary indicators.</p><p><strong>Results: </strong>Linear regression analysis revealed that a lower age at menopause (β = -0.380; P < 0.001), married/partnered (β = -3.028; P = 0.001), higher body mass index (BMI) (β = 0.744; P < 0.001), higher VAS (β = 0.126; P < 0.001), and have chronic physical diseases (β = 2.335; P = 0.015) are significantly associated with more severe depressive symptoms in moderate to severe postmenopausal depression. Logistic regression analysis revealed that BMI [odds ratio (OR) = 1.156; 95% CI: 1.012-1.32], VAS (OR = 1.04; 95% CI: 1.017-1.063), and being single (OR = 3.658; 95% CI: 1.618-8.27) were significantly associated with an increased risk of severe depressive symptoms in postmenopausal participants, while age at menopause (OR = 0.857; 95% CI: 0.765-0.96) emerged as a protective factor.</p><p><strong>Conclusions: </strong>Our findings indicate that an earlier age at menopause, being single, the presence of concomitant physical illnesses, a higher BMI, and more severe pain symptoms are associated with increased severity of moderate to severe postmenopausal depression. These results contribute to raising awareness of moderate to severe depression among postmenopausal women and underscore the importance of early diagnosis through targeted screening efforts.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"621-629"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216303","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}