Pediatric Pulmonology最新文献

{"title":"Spirometry Assessments in Children With Sickle Cell Disease in Ghana.","authors":"Baah Agyeiwah Birgit, Ntim Amankwa Emmanuel, Osei Eugenia, Paintsil Vivian, Marfo Joseph, Marozva Nicola, Osei Akoto Alex, Ansong Daniel, Gray Diane, Kwarteng-Owusu Sandra","doi":"10.1002/ppul.71655","DOIUrl":"https://doi.org/10.1002/ppul.71655","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary disease in children with SCD is common and heterogeneous and includes pulmonary function impairment. This study aimed to investigate spirometry patterns in Ghanaian children with SCD and factors that contribute to low lung function.</p><p><strong>Methods: </strong>A case-control study involving children aged 6-16 years with and without SCD was carried out at the Komfo Anokye Teaching Hospital. Demographic, socio-economic, and clinical information were collected. Spirometry was performed for both cases and controls at enrolment and interpreted based on the GLI-Black reference equation. Logistic and linear regression analyses were performed.</p><p><strong>Results: </strong>A total of 115 cases and 115 controls were recruited for the study. Children with SCD had significantly lower anthropometric measurements, lower lung volumes compared to the controls: median (IQR) BMI z-scores; cases vs controls, -0.5 (-1.3 to 0.3); versus -0.2 (-0.9 to 0.8) p = 0.01, mean z- scores for forced expiratory volume in 1 s (FEV₁₎, cases vs controls, -1.0 (SD1.2) vs -0.4 (SD 1.2) z-score, (p < 0.001), mean z-scores for forced vital capacity (FVC z-scores), cases versus controls, -0.8 (SD1.2) z score vs -0.3 (SD 1.3) z-score, (p < 0.001). Abnormal lung function was significantly more common in cases than controls, 42% (n = 48) and 17.4% (n = 20) respectively. The lung function abnormalities noted were as follows: restrictive pattern, cases versus controls [24.3% (n = 28) vs 12.2% (n = 14)] (p < 0.001), obstructive pattern [14.8% (n = 17) versus 5.2% (n = 6)] (p < 0.001), mixed pattern [2.6% (n = 3) versus 0 (p < 0.001). Being female and having higher BMI z-scores were associated with significantly lower odds of having a restrictive lung function pattern compared to normal lung function, OR 0.31 (95% CI 0.16, 0.58) (p < 0.001).</p><p><strong>Conclusion: </strong>This study has demonstrated a predominance of low anthropometric measurements and restrictive abnormality on spirometry in children with SCD in Ghana. Females and those with higher BMI z-scores had significantly lower odds of having a restrictive lung function pattern compared to normal lung function.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71655"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840663","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":"Function and Structure Relationships With Inflammation Differ in Two Chronic Suppurative Lung Diseases.","authors":"Teresa Fuchs, Jacqueline Donovan, Andrew Ives, Samantha Irving, Gwyneth Davies, Claire Hogg, Eric Alton, Gemma Wilson, Andrew Bush, Jane C Davies","doi":"10.1002/ppul.71659","DOIUrl":"https://doi.org/10.1002/ppul.71659","url":null,"abstract":"<p><strong>Rationale: </strong>Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are characterized by neutrophilic airway inflammation but differ in clinical features.</p><p><strong>Objectives: </strong>We investigated relationships of pulmonary and systemic inflammatory markers with functional and structural lung disease.</p><p><strong>Methods: </strong>Systemic (CRP, IgG, IL-6, and IL-8) and sputum (calprotectin, IL-6, and IL-8) markers were measured at baseline. Relationships were explored with spirometry, lung clearance index and lung computed tomography (CT) scores at baseline and with spirometry 10 years later.</p><p><strong>Results: </strong>42 patients (21 CF, 21 PCD) of similar age (median CF 27 y [12-59], PCD 27 y [11-62]) and lung function (median ppFEV₁CF 59% [40-99], PCD 67% [30-101]) were enrolled in 2009. Systemic inflammation was significantly higher in CF (Neutrophils, p < 0.05, IL-6 and 8, p < 0.01). Conversely, sputum IL-6 and 8 were higher in PCD (p < 0.01). In CF, sputum IL-6 counter-intuitively correlated with better CT scores (r = -0.51/p < 0.05) at baseline and with better spirometry (r = 0.58, p < 0.05) 10 years later. Conversely, high sputum IL-6 at baseline was associated with worse lung function in PCD (r = 0.81/p = 0.001) after 10 years.</p><p><strong>Conclusion: </strong>This study emphasizes the differences of functional and structural aspects in both diseases. Markers that predict long-term outcome in PCD and in CF were identified. The most striking and unanticipated finding was that sputum IL-6 correlated with better CT scores and lung function in CF. This paradox merits further research but challenges whether sputum IL-6 in CF is always a bad prognostic indicator.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71659"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841540","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":"Improved Respiratory Outcomes Following Multidisciplinary Aerodigestive Care in Medically Complex Children: A Longitudinal Single-Center Study.","authors":"Füsun Ünal, Gözde Cavıldak Karaaslan, Pınar Yamaç Dilaver, Haticenur Kırar, Fatma Nerse, Hakan Yazan, Tolga Kandoğan, Ömer Faruk Çalım, Gökhan Baysoy, Sedat Öktem","doi":"10.1002/ppul.71646","DOIUrl":"https://doi.org/10.1002/ppul.71646","url":null,"abstract":"<p><strong>Introduction: </strong>Children with medical complexity are at risk of pulmonary injury due to chronic pulmonary aspiration. Our study aimed to determine the effect of multidisciplinary evaluation and periodic follow-up of aerodigestive disorders on the final status of the respiratory conditions.</p><p><strong>Materials and methods: </strong>Children followed for at least 1 year by the Medipol University Aerodigestive Clinic between March 2019 and August 2024 were included. Demographic data, underlying diagnoses, respiratory and nutritional status at admission, hospitalization frequency and duration, and home ventilation requirements were analyzed. Swallowing dysfunction and/or aspiration were assessed using clinical and instrumental methods. All children received tailored swallowing and nutritional therapy.</p><p><strong>Results: </strong>Of 89 children, 72 of them were followed for at least 1 year (12 died, 5 lost follow-up). The median follow-up period was 30 months (18-46 months). The median age during that time of admission was 30 months (11-62 months). The most common underlying conditions were neuromuscular disorders (43%), bronchopulmonary dysplasia (14%), and congenital heart disease (13%). Dysphagia was confirmed instrumentally in 61% of patients. Among tracheostomized children, 13 of 22 (60%) were successfully decannulated. Respiratory support was reduced or discontinued in 14 of 31 (45%) children. Oral feeding was achieved in 21 (29%) previously tube-fed children. Hospitalizations decreased in all but one child, and 45 (62.5%) required no hospitalization in the year following aerodigestive clinic evaluation.</p><p><strong>Conclusions: </strong>A multidisciplinary aerodigestive approach improves respiratory outcomes in children with medical complexity by reducing the need for respiratory support, facilitating decannulation, and decreasing hospitalizations.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71646"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840290","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":"Waiting List Survival Trends in Pediatric Lung Transplantation: A National Cohort Study.","authors":"Elijah Roberts, Maya Sela, Chase Robinson, Zhi Mei Sonia He, Garrett Wortham, Kiran Thirukonda, Rodrigo Zea-Vera, Abbas Rana, David S Moreno McNeill","doi":"10.1002/ppul.71656","DOIUrl":"https://doi.org/10.1002/ppul.71656","url":null,"abstract":"<p><strong>Background: </strong>Advancements in pediatric lung transplantation, including support devices, the Lung Allocation Score (LAS), and the subsequent Composite Allocation Score (CAS), have led to significant improvements in survival on the waiting list. Policy changes, like the removal of the Donation Service Area in 2017, aimed to further improve outcomes, but their impact in more recent years remains unclear. Our study examines recent waiting list survival trends and key factors affecting outcomes for pediatric lung transplant candidates.</p><p><strong>Methods: </strong>Pediatric patients (n = 535) listed for lung transplantation in the OPTN Database were categorized into four eras based on year of listing: 2014-2017 (n = 182), 2017-2020 (n = 174), 2020-March 2023 (n = 134), and March 2023 onward (n = 45). Our primary outcome was death on the waiting list. Predictors of waitlist mortality were identified with multivariable logistic regression. Kaplan-Meier curves with a log-rank test were used to evaluate outcomes across eras. The Fine and Gray method was used to account for competing outcomes, including transplantation and removal from the waitlist due to clinical improvement.</p><p><strong>Results: </strong>Poor functional status, ventilation at time of listing, African American ethnicity, and listing in region 1 were associated with increased waitlist mortality. One-year survival increased from 2014-2017 to 2020-2023 (p < 0.05). When accounting for competing risks, Fine and Gray showed a declining incidence of waitlist mortality with each successive era.</p><p><strong>Conclusion: </strong>Waiting list survival for pediatric lung transplant candidates has improved since 2014, with notable progress in the 2020-2023 era. The reasons for these improvements are likely multifactorial, and further studies are needed to evaluate their impact.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71656"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841142","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":"When a Seizure Affects the Lungs: Recurrent Postictal Neurogenic Pulmonary Edema in an Adolescent-A Case Report.","authors":"Elif Duygu Kutbe, Huseyin Per, Mehmet Kose","doi":"10.1002/ppul.71639","DOIUrl":"https://doi.org/10.1002/ppul.71639","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71639"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778128","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":"Viral Infection-Associated Plastic Bronchitis Demonstrating Eosinophil Extracellular Trap Formation.","authors":"Yusuke Iwata, Hidehito Ota, Takahito Koba, Takaya Hanawa, Natsuho Adachi, Tomomi Fujimura, Ayumi Kunikata, Tomosato Yamagata, Hisataka Nozawa, Hironori Ebishima, Masako Ikemura, Keinosuke Hizuka, Shigeharu Ueki, Hikoro Matsui","doi":"10.1002/ppul.71642","DOIUrl":"https://doi.org/10.1002/ppul.71642","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71642"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819444","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":"Evolution of the New York State Cystic Fibrosis Newborn Screening Algorithm: Two Decades of Experience.","authors":"Elinor Langfelder-Schwind, Denise M Kay, Maria Berdella, Joan K DeCelie-Germana, Zafer N Soultan, Danielle M Goetz, Christopher N Fortner, John J Welter, Robert Giusti, Karen Voter, Robert Kaslovsky, Carlos A Saavedra-Matiz, Norma P Tavakoli, Michele Caggana, Hossein Sadeghi, Catherine Kier","doi":"10.1002/ppul.71650","DOIUrl":"https://doi.org/10.1002/ppul.71650","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71650"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819427","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":"Real-World Effectiveness of Universal Nirsevimab on Bronchiolitis Incidence: A Regional Hub-Spoke Surveillance Analysis in Liguria, Italy.","authors":"Marcello Mariani, Giacomo Brisca, Marina Francesca Strati, Silvia Buratti, Marta Ferretti, Alberto Gaiero, Valeria Musso, Andrea Gazzolo, Francesca Ginocchio, Katiuscia Zerbini, Diego Minghetti, Maria Franca Corona, Laura De Hoffer, Daniela Pirlo, Emanuela Piccotti, Luca Antonio Ramenghi, Marisa Alberti, Raffaele Spiazzi, Elio Castagnola, Andrea Moscatelli","doi":"10.1002/ppul.71653","DOIUrl":"https://doi.org/10.1002/ppul.71653","url":null,"abstract":"<p><strong>Background: </strong>Bronchiolitis represents a major cause of infant hospitalization, predominantly due to respiratory syncytial virus (RSV). Nirsevimab, a long-acting monoclonal antibody targeting the prefusion RSV F protein, has recently been introduced to provide season-long protection against RSV-related lower respiratory tract infection.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective, population-based study across the Liguria Region (Northwest Italy) to assess the impact and effectiveness of the 2024-2025 nirsevimab immunization campaign. All infants under 2 years of age hospitalized with acute bronchiolitis between October 2023 and March 2025 were identified through the regional pediatric Hub-and-Spoke network. Data were compared between the pre-nirsevimab (2023-2024) and post-nirsevimab (2024-2025) seasons. Nirsevimab effectiveness (VE) against RSV-positive hospitalization was estimated using a test-negative design.</p><p><strong>Results: </strong>A total of 858 infants were hospitalized with bronchiolitis across the two seasons. Following the introduction of nirsevimab, bronchiolitis hospitalizations decreased from 41.7 to 17.3 per 1000 admissions (Incidence Rate Ratio 0.4; 95% CI: 0.4-0.5; p < 0.001), corresponding to a 60% reduction. Estimated nirsevimab effectiveness was 65.0% (95% CI: 39.2%-79.8%) against RSV-positive hospitalization. No high-risk infants-those previously eligible for palivizumab-developed severe RSV infection requiring PICU admission. Breakthrough infections occurred in a minority of immunized infants but showed a similar clinical course to non-immunized cases.</p><p><strong>Conclusions: </strong>The introduction of universal nirsevimab immunization in Liguria was associated with a marked reduction in RSV-related hospitalizations, confirming its strong real-world epidemiological impact. These findings support nirsevimab as an effective and feasible public health intervention to substantially reduce the burden of RSV bronchiolitis in infants.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71653"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840693","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":"Considerations for the Role and Implementation of Reproductive Health Shared Decision-Making Interventions for Cystic Fibrosis: A Qualitative Investigation of Perspectives From Clinicians and Females With Cystic Fibrosis.","authors":"Sarah Brown, Denitza Williams, Jamie Duckers, Traci M Kazmerski, Olivia M Stransky, Caitlin Mason, Alexis Bennett, Jennifer Ward, David Taylor-Robinson, Oluwaseun B Esan, Shantini Paranjothy, Daniela Schlüeter, Rhiannon Phillips","doi":"10.1002/ppul.71643","DOIUrl":"https://doi.org/10.1002/ppul.71643","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in cystic fibrosis (CF) treatment have seen more people with CF starting a family. Females with CF (FwCF) have expressed a need for improved reproductive health-related shared decision-making (SDM) with health care providers. This study explored perspectives of FwCF and clinicians on the role and implementation of SDM tools in CF reproductive health care.</p><p><strong>Methods: </strong>We conducted qualitative semi-structured interviews with FwCF and clinicians. We recruited clinicians through professional networks and FwCF via a previous study and social media. Interviews explored experiences of SDM related to reproductive health. Participants were given examples of SDM tools and asked to consider their utility within CF care. We analyzed interview transcripts using an inductive approach, identifying key themes.</p><p><strong>Results: </strong>Six FwCF and 23 clinicians participated. Four themes were identified: Perceived usefulness of an SDM approach for CF reproductive health, Role of tools in facilitating SDM, Considerations for SDM tool development, and Implementation of SDM in routine CF care. Participants saw information provision as key to SDM, enhancing patient confidence to initiate and engage in conversations. Participants considered SDM tools helpful at three stages: preparing for consultations, facilitating in-consultation communication, and supporting post-consultation reflection and discussion. Trustworthy content was key to engagement. Participants felt reproductive health conversations should start in adolescence and recur throughout the life course. Clinicians highlighted the need for a service-wide culture supporting SDM.</p><p><strong>Conclusions: </strong>Both groups supported early and ongoing reproductive health-related SDM. Further research should evaluate CF-specific reproductive health SDM interventions that build confidence, skills, and foster a health-service culture supportive of SDM.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71643"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841536","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":"Clinical Outcomes Associated With Long-Acting Beta Agonist Escalation in Preschool Children With Severe Asthma: A Retrospective Hospital Based Clinic Cohort Study.","authors":"Adi Meridor Eizner, Avigdor Mandelberg, Adi Ovadia, Keren Armoni Domany","doi":"10.1002/ppul.71654","DOIUrl":"https://doi.org/10.1002/ppul.71654","url":null,"abstract":"<p><strong>Background: </strong>We define adherent, difficult-to-treat asthma as 'true severe asthma.' In preschool children, evidence for add-on long-acting beta-agonists (LABA) to inhaled corticosteroids (ICS) in those with persistent uncontrolled disease despite high-dose ICS remains limited. We evaluated clinical outcomes of ICS-LABA therapy in this population.</p><p><strong>Methods: </strong>This retrospective observational study (2021-2024) included children aged 6-72 months with severe, uncontrolled asthma despite medium- to high-dose ICS and verified adherence, who were initiated on LABA therapy. Primary outcomes were severe exacerbations (systemic corticosteroid use, hospitalizations, and uncontrolled symptoms). Secondary outcomes included PICU admissions and spontaneously reported adverse events. Outcomes 6 months before and after LABA initiation were compared using generalized estimating equations (GEE), adjusting for seasonality, age, sex, and atopy.</p><p><strong>Results: </strong>Fifty-three children were included (mean age 38.8 ± 17.6 months, 41.5% male, atopy 49.1%). LABA initiation was associated with a substantial reduction in clinical burden: hospitalizations declined from 41.5% to 3.8% (p < 0.001), systemic corticosteroid use from 86.8% to 52.8% (p < 0.001), and daily symptoms from 86.8% to 37.7% (p < 0.001). PICU admissions decreased from 9.4% to 0%. These associations remained significant after adjustment for covariates (p < 0.001). No adverse events were spontaneously reported by patients or caregivers during the follow-up period; however, systematic adverse event surveillance was not conducted.</p><p><strong>Conclusion: </strong>In adherent preschool children with true severe asthma, LABA initiation was associated with observed improvements in clinical outcomes. Still, prospective controlled studies with systematic safety surveillance are warranted.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 5","pages":"e71654"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841512","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}