Neurology最新文献

{"title":"Preventive Neurology and Brain Health: The Path to a Pound of Cure.","authors":"Philip B Gorelick, Farzaneh A Sorond","doi":"10.1212/WNL.0000000000213859","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213859","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213859"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-Diagnosed Traumatic Head Injury and Associated Risk of Developing ALS: A Nationwide Population-Based Case-Control Study.","authors":"Lotte Levison, Peter Jepsen, Jakob Udby Blicher, Henning Andersen","doi":"10.1212/WNL.0000000000213809","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213809","url":null,"abstract":"<p><strong>Background and objectives: </strong>Previous studies have suggested that traumatic head injury (THI) may be a risk factor of amyotrophic lateral sclerosis (ALS) development, yet the association remains unclear. We aimed to determine whether hospital-diagnosed THI is an important ALS risk factor, and we investigated the magnitude and duration of associated ALS risk.</p><p><strong>Methods: </strong>In this population-based case-control study, we used individual-level data linkage across nationwide health registers from 1980 to 2021 to identify patients with hospital-diagnosed ALS. Each patient was matched 1:10 with individuals from the general population by age, sex, and diagnostic index date. We used conditional logistic regression to examine the relative risk of ALS associated with having previous hospital-diagnosed THI. To avoid the effect of reverse causation, we investigated ALS risk within several time windows and repeated all analyses after restricting THI exposures to more than 3 years before the date of ALS diagnosis.</p><p><strong>Results: </strong>THI was observed in 4.7% of 5,943 ALS cases vs 3.7% of 59,426 controls, with a matched odds ratio (OR) of 1.3 (95% CI 1.1-1.4). However, the risk of ALS declined considerably with increasing time since head injury, with a high OR of 4.5 (95% CI 2.8-7.3) observed within the 6 months before ALS diagnosis. If head injury was suffered 6-12 months before ALS diagnosis, the OR was 2.4 (95% CI 1.4-4.0). Restricting the analysis to THI suffered more than 3 years before ALS diagnosis, we found no association with an OR of 1.1 (95% CI 1.0-1.3).</p><p><strong>Discussion: </strong>Although a strong association of ALS with THI experienced ≤1 year before ALS diagnosis was evident, our results suggest that this is due to reverse causation. When restricting the analysis to a period deemed relevant for causative events leading to ALS development, no association was observed. Consequently, we do not consider THI an important ALS risk factor. This study was limited by the inability to consider minor THIs not receiving hospital attendance. Future research should explore alternative models to unfold this possible ALS risk factor.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213809"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Ischemic Stroke Risk Following Cardiac Interventions in the United States From 2016 to 2021.","authors":"Andrew B Koo, Lily Zhou, Irbaz Hameed, Cyprien A Rivier, Santiago Clocchiatti-Tuozzo, Hooman Kamel, Guido J Falcone, John Ney, Richa Sharma, Charles Matouk, Shadi Yaghi, Kevin Navin Sheth, Adam de Havenon","doi":"10.1212/WNL.0000000000213766","DOIUrl":"10.1212/WNL.0000000000213766","url":null,"abstract":"<p><strong>Background and objectives: </strong>Ischemic stroke following cardiac intervention is a serious complication. However, there are limited data comparing stroke risk and severity among patients undergoing different types of cardiac interventions. We examined the incidence of ischemic stroke among patients undergoing cardiac interventions and identified variables associated with risk and severity of ischemic stroke.</p><p><strong>Methods: </strong>We included cardiac intervention hospitalizations for adults within the United States from 2016 to 2021 in the National Inpatient Sample. We constructed a cross-sectional cohort of cardiac intervention hospitalizations comprising all hospitalizations within a Centers for Medicare & Medicaid Services-defined \"Cardiac Surgery\" Diagnosis-Related Group. The exposure was category of cardiac intervention, and primary outcome was ischemic stroke in any coding position. After survey weighting, we examined the frequency and factors associated with ischemic stroke, stroke severity, and inpatient mortality. A secondary analysis was performed in a subset of patients with documented NIH Stroke Scale (NIHSS).</p><p><strong>Results: </strong>After survey weighting, among 6,083,899 cardiac intervention hospitalizations (mean age: 67.8 years, 34.5% female), ischemic stroke was diagnosed in 75,280 (1.24%). A higher risk of stroke was associated with female sex (vs male, adjusted odds ratio [OR] 1.25, 95% CI 1.20-1.29), age 75 or older (vs 18-54, OR 1.33, 95% CI 1.23-1.42), and non-Hispanic Black ethnicity (vs White, OR 1.32, 95% CI 1.24-1.39). Compared with percutaneous interventions, open cardiac surgery was associated with higher incidence of stroke (adjusted OR 2.47, 95% CI 2.39-2.55) and the strokes were significantly more severe (NIHSS median: 5 vs 3, mean 8.7 vs 5.6, respectively, <i>p</i> < 0.001). Among patients undergoing a cardiac intervention, the rate of ischemic stroke increased from 1.10% in 2016 to 1.33% in 2021 (<i>p</i> < 0.001) and ischemic stroke increased the risk of in-hospital death 5-fold (OR 5.07, 95% CI 4.77-5.39).</p><p><strong>Discussion: </strong>Ischemic stroke during hospitalizations for cardiac interventions in the United States varies by type of intervention and shows an increasing trend from 2016 to 2021. Cardiac intervention patients sustaining an ischemic stroke are 5 times as likely to have in-hospital death as those without stroke. Further research is needed to identify high-risk populations that could benefit from specific postoperative monitoring strategies and/or specific therapeutic interventions.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213766"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Combined Aerobic Exercise and Coaching on Physical Fitness in People With Neuromuscular Diseases: A Randomized Clinical Trial.","authors":"Sander Oorschot, Merel-Anne Brehm, Annerieke C van Groenestijn, Tim Veneman, Jos Twisk, Camiel Verhamme, Filip Eftimov, Judith G M Jelsma, Vibeke Valkenburg, Esther Kruitwagen, Patrice Tomassen, Heleen van der Wielen, Nicole B M Voet, Nicol Cornelia Voermans, Frans Nollet, Eric L Voorn","doi":"10.1212/WNL.0000000000213781","DOIUrl":"10.1212/WNL.0000000000213781","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;The quality of evidence for improving physical fitness in people with neuromuscular diseases (NMDs) through aerobic exercise is low. The aim of this study was to evaluate the efficacy of combined personalized home-based aerobic exercise and coaching on physical fitness in people with NMD, compared with usual care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In a multicenter, assessor-blinded, randomized controlled trial, participants with different types of NMD were randomized (1:1 ratio) to a 6-month intervention (personalized home-based aerobic exercise and coaching) or usual care. Assessments were performed at baseline, directly after intervention, and at 6 and 12 months after intervention. The primary outcome was physical fitness, measured as peak oxygen uptake (VO&lt;sub&gt;2peak&lt;/sub&gt;) directly after intervention. Secondary outcomes included daily physical activity, quality of life, physical functioning, metabolic syndrome markers, and creatine kinase level. We conducted intention-to-treat linear mixed-model analyses for all outcomes, with the baseline value of the particular outcome as covariate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ninety-one participants (median age = 64.0, 60% female) were randomized to the intervention (n = 44) or usual care (n = 47) group. The mean group difference in VO&lt;sub&gt;2peak&lt;/sub&gt; directly after intervention was 2.2 mL/min/kg (95% CI 0.2-4.1, &lt;i&gt;p&lt;/i&gt; = 0.028) and 1.7 mL/min/kg (95% CI 0.1-3.4, &lt;i&gt;p&lt;/i&gt; = 0.039) on average over time, in favor of the intervention group. There were no significant between-group differences in the secondary outcomes. Twenty-five and 22 adverse events were reported in the intervention and usual care groups, respectively. Creatine kinase levels remained unchanged.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This study provides evidence that combined personalized home-based aerobic exercise and coaching is safe and improves physical fitness in people with NMD, but without evidence of improved physical functioning, daily physical activity, quality of life, or metabolic syndrome markers. This home-based approach has good potential for wider implementation. Future research should explore the association between changes in VO&lt;sub&gt;2peak&lt;/sub&gt; and functional outcomes and strategies to counteract the slightly diminishing long-term intervention effect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration information: &lt;/strong&gt;The study was registered in the Netherlands Trial Register (ID: NL7344) on November 5, 2018. The first participant enrolled on September 19, 2018. However, the Ethics Review Committee of the Amsterdam Medical Center approved the study protocol on November 7, 2017. No adjustments were made to the approved study protocol, and the register corresponds one on one with the approved study protocol.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Classification of evidence: &lt;/strong&gt;This study provides Class II evidence that a 6-month personalized aerobic exercise program combined with coaching improves maximal aerob","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213781"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lamotrigine and Cardiac Arrhythmias: A Target Trial Approach.","authors":"Samuel W Terman, Colin Bruce Josephson, Parag Goyal, Arturo Gonzalez-Izquierdo, Jean Morrison, Spiros Denaxas, Samuel Wiebe","doi":"10.1212/WNL.0000000000213640","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213640","url":null,"abstract":"<p><strong>Background and objectives: </strong>While lamotrigine is an effective, well-tolerated antiseizure medication (ASM), a recent warning raised the possibility of ventricular arrhythmias. We compared arrhythmia incidence between patients newly treated for seizures with lamotrigine and those with levetiracetam (presumed cardiac-inert control).</p><p><strong>Methods: </strong>We included patients whose first ASM prescription fill was after the first seizure or epilepsy ICD code in the study period, with no ASM in the previous year. We conducted retrospective cohort studies to emulate a target trial using 2 datasets: (1) 2009-2018 Medicare claims (United States) and (2) Clinical Practice Research Datalink (CPRD), a population-based cohort (United Kingdom). We examined cumulative incidence curves for ventricular tachycardia or fibrillation (VT/VF) from Cox proportional hazard models.</p><p><strong>Results: </strong>We included 40,554 patients (lamotrigine: 3,038; levetiracetam: 37,516) from Medicare and 13,098 (lamotrigine: 8,694; levetiracetam: 4,404) from CPRD. In Medicare, the median (interquartile range) age was 61 (44-74) years and 60% were female in the lamotrigine group vs 74 (65-82) years and 57% female in the levetiracetam group. In CPRD, the median (interquartile range) age was 34 (23-53) years and 63% were female in the lamotrigine group vs 48 (29-66) years and 50% female in the levetiracetam group. After adjusting for demographics, comorbidities, and medication use, the hazard ratio for VT/VF comparing patients whose first ASM was lamotrigine vs levetiracetam was 0.73 (95% CI 0.50-1.08) for Medicare and 0.75 (95% CI 0.35-1.59) for CPRD, with a 2-year cumulative incidence of 1.7% (95% CI 1.0%-2.3%) vs 2.3% (95% CI 2.1%-2.4%) for Medicare and 0.2% (95% CI 0.1%-0.4%) vs 0.3% (95% CI 0.2%-0.6%) for CPRD. In both datasets, lamotrigine showed a slightly but nonsignificantly lower 2-year absolute difference in cumulative incidence of VT/VF compared with levetiracetam (Medicare: -0.6%, 95% CI -1.2% to 0.0%; CPRD: -0.1%, 95% CI -0.3% to 0.1%). Numerous sensitivity analyses modifying the outcome (atrial arrhythmias or any arrhythmias), censorship procedure (further censoring patients on discontinuing their initial ASM akin to a \"per-protocol\" analysis), or population (patients with existing cardiovascular diagnoses) found similar results.</p><p><strong>Discussion: </strong>These data do not support concerns regarding lamotrigine increasing arrhythmias. Limitations include possible residual confounding and lack of generalizability to other populations.</p><p><strong>Classification of evidence: </strong>This study provides Class III evidence that lamotrigine compared with levetiracetam did not significantly increase the 2-year cumulative incidence of VT/VF in adult patients with epilepsy.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213640"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching NeuroImage: Vasculitic Neuropathy With Cutaneous Polyarteritis Nodosa.","authors":"Emily A Howell,Mary Megan Higginson,Emily Jernigan Elliott","doi":"10.1212/wnl.0000000000213875","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213875","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"41 1","pages":"e213875"},"PeriodicalIF":9.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Disability Equity in Neurology: An AAN Position Statement.","authors":"Bhooma Rajagopalan Aravamuthan,Luke Moretti,Diana Cejas,Divya Singhal,Roy H Hamilton,Nimish A Mohile,Lisa I Iezzoni,","doi":"10.1212/wnl.0000000000213873","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213873","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"283 1","pages":"e213873"},"PeriodicalIF":9.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching NeuroImage: Neuroradiological Aspects of Cerebral Proliferative Angiopathy.","authors":"Maria Júnia Lira E Silva, Isabella Mesquita Venancio, Jordana Gaudie Gurian, Beatriz Sarno Ramos, Ingrid Pereira Marques, Heitor Nunes de Oliveira Sento-Sé Neto, Eva Carolina Rocha, Gisele Sampaio Silva","doi":"10.1212/WNL.0000000000213788","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213788","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213788"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Plasma Phosphorylated Tau 217 With Clinical Deterioration Across Alzheimer Disease Stages.","authors":"Judit Selma-Gonzalez, Sara Rubio-Guerra, Jesús García-Castro, Elena Vera-Campuzano, Isabel Sala, María Belén Sánchez-Saudinós, Nuole Zhu, Javier Arranz, José Enrique Arriola-Infante, Íñigo Rodríguez-Baz, Lucía Maure-Blesa, Oriol Dols-Icardo, Laura Videla, Sílvia Valldeneu, Isabel Barroeta, Miguel Santos-Santos, Maria Carmona-Iragui, Lídia Vaqué-Alcázar, Esther Alvarez-Sanchez, Oriol Lorente, Mireia Carreras, Olivia Belbin, Burak Arslan, Nicholas J Ashton, Henrik Zetterberg, Kaj Blennow, Laia Montoliu-Gaya, Alexandre Bejanin, Alberto Lleó, Juan Fortea, Daniel Alcolea, Ignacio Illan-Gala","doi":"10.1212/WNL.0000000000213769","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213769","url":null,"abstract":"<p><strong>Background and objectives: </strong>Phosphorylated tau at threonine 217 (p-tau217) is a highly sensitive blood-based biomarker for Alzheimer disease (AD) pathology, showing high diagnostic accuracy. However, its prognostic value across different clinical stages of AD remains unclear. The aim of this study was to assess the prognostic utility of plasma p-tau217, measured using a commercially available immunoassay, regarding clinical and functional decline across the clinical stages of AD in a cohort with up to 10 years of follow-up.</p><p><strong>Methods: </strong>We conducted a retrospective longitudinal cohort study using data from the Sant Pau Initiative on Neurodegeneration, a research project performed at the Sant Pau Memory Unit between 2011 and 2022. Participants were classified into clinical stages 1-6 based on AD pathology status in CSF, determined by the p-tau181/Aβ1-42 ratio. The primary outcomes were cognitive decline, measured by changes in the Mini-Mental State Examination (MMSE), and progression to dementia. Plasma p-tau217 and CSF p-tau181 levels were assessed, and statistical analysis was performed using linear mixed-effects models for longitudinal changes in MMSE scores and Cox proportional hazard regression was used to examine progression to dementia.</p><p><strong>Results: </strong>A total of 731 participants (mean age 71.5 ± 10.1 years; 60% female) were included. Plasma p-tau217 levels showed a significant increase across advancing AD stages, with all between-group comparisons remaining significant after false discovery rate adjustment (<i>p</i> < 0.05). Longitudinal analysis showed a significant increase in plasma p-tau217 (β = 7.7, 95% CI 3.0-12.5, <i>p</i> = 0.002) and CSF p-tau181 (β = 3.2, 95% CI 1.4-5.0, <i>p</i> = 0.001). Baseline plasma p-tau217 levels were associated with faster MMSE decline (β = -0.08, 95% CI -0.11 to -0.05, <i>p</i> < 0.001) and progression to dementia (hazard ratio 1.03, 95% CI 1.01-1.05, <i>p</i> < 0.001), independent of clinical stage.</p><p><strong>Discussion: </strong>Plasma p-tau217 was significantly associated with cognitive and functional decline in AD. These findings support the potential use of plasma p-tau217 as a prognostic marker for monitoring AD progression in clinical practice. Future studies should validate these results across diverse cohorts and explore their utility in early-stage detection and monitoring.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213769"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Reasoning: A 64-Year-Old Man With Confusion, Nausea, Seizure, and Fever.","authors":"Zhimin Xu, Subhan Khan, Ahya Ali, Terry Park, Fang Yu, Jon Rosenberg, Fawaz Al-Mufti","doi":"10.1212/WNL.0000000000213659","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213659","url":null,"abstract":"<p><p>Evaluating patients with encephalitis is common, but it can be complicated in immunocompromised patients. In this case, a 64-year-old man with a medical history of multiple myeloma and previous Lyme disease presented with acute onset of confusion, nausea, and fever; developed generalized tonic-clonic seizures; and subsequently became comatose. This case highlights the importance of thinking broadly beyond common viral and bacterial encephalitides and developing a comprehensive differential diagnosis.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213659"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}