Restorative neurology and neuroscience最新文献

{"title":"Hematopoietic Endothelial Progenitor cells enhance motor function and cortical motor map integrity following cerebral ischemia","authors":"Aqeela Afzal, Nagheme Thomas, Zuha Warraich, Scott Barbay, J. Mocco","doi":"10.3233/rnn-231378","DOIUrl":"https://doi.org/10.3233/rnn-231378","url":null,"abstract":"Hematopoietic stem cells (HSC) are recruited to ischemic areas in the brain and contribute to improved functional outcome in animals. However, little is known regarding the mechanisms of improvement following HSC administration post cerebral ischemia. To better understand how HSC effect post-strokeimprovement, we examined the effect of HSC in ameliorating motor impairment and cortical dysfunction following cerebral ischemia. Methods:Baseline motor performance of male adult rats was established on validated motor tests. Animals were assigned to one of three experimental cohorts: control, stroke, stroke + HSC. One, three and five weeks following a unilateral stroke all animals were tested on motor skills after which intracortical microstimulation was used to derive maps of forelimb movement representations within the motor cortex ipsilateral to the ischemic injury. Results:Stroke + HSC animals significantly outperformed stroke animals on single pellet reaching at weeks 3 and 5 (28±3% and 33±3% versus 11±4% and 17±3%, respectively, p < 0.05 at both time points). Control animals scored 44±1% and 47±1%, respectively. Sunflower seed opening task was significantly improved in the stroke + HSC cohort versus the stroke cohort at week five-post stroke (79±4 and 48±5, respectively, p < 0.05). Furthermore, Stroke + HSC animals had significantly larger forelimb motor maps than animals in the stroke cohort. Overall infarct size did not significantly differ between the two stroked cohorts. Conclusion:These data suggest that post stroke treatment of HSC enhances the functional integrity of residual cortical tissue, which in turn supports improved behavioral outcome, despite no observed reduction in infarct size.","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":"48 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141166386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticospinal excitability during motor preparation of upper extremity reaches reflects flexor muscle synergies: A novel principal component-based motor evoked potential analyses","authors":"Thomas E. Augenstein, Seonga Oh, Trevor A. Norris, Joshua Mekler, Amit Sethi, Chandramouli Krishnan","doi":"10.3233/rnn-231367","DOIUrl":"https://doi.org/10.3233/rnn-231367","url":null,"abstract":"Background:\u0000Previous research has shown that noninvasive brain stimulation can be used to study how the central nervous system (CNS) prepares the execution of a motor task. However, these previous studies have been limited to a single muscle or single degree of freedom movements (e.g., wrist flexion). It is currently unclear if the findings of these studies generalize to multi-joint movements involving multiple muscles, which may be influenced by kinematic redundancy and muscle synergies. Objective:\u0000The objective of this study was to characterize corticospinal excitability during motor preparation in the cortex prior to functional upper extremity reaches. Methods:\u000020 participants without neurological impairments volunteered for this study. During the experiment, the participants reached for a cup in response to a visual “Go Cue”. Prior to movement onset, we used transcranial magnetic stimulation (TMS) to stimulate the motor cortex and measured the changes in motor evoked potentials (MEPs) in several upper extremity muscles. We varied each participant’s initial arm posture and used a novel synergy-based MEP analysis to examine the effect of muscle coordination on MEPs. Additionally, we varied the timing of the stimulation between the Go Cue and movement onset to examine the time course of motor preparation. Results:\u0000We found that synergies with strong proximal muscle (shoulder and elbow) components emerged as the stimulation was delivered closer to movement onset, regardless of arm posture, but MEPs in the distal (wrist and finger) muscles were not facilitated. We also found that synergies varied with arm posture in a manner that reflected the muscle coordination of the reach. Conclusions:\u0000We believe that these findings provide useful insight into the way the CNS plans motor skills.","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":"43 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial random noise stimulation to augment hand function in individuals with moderate-to-severe stroke: A pilot randomized clinical trial","authors":"Amit Sethi, Alvaro Pascual-Leone, Emiliano Santarnecchi, Ghaleb Almalki, Chandramouli Krishnan","doi":"10.3233/rnn-231314","DOIUrl":"https://doi.org/10.3233/rnn-231314","url":null,"abstract":"Background:Interventions to recover upper extremity (UE) function after moderate-to-severe stroke are limited. Transcranial random noise stimulation (tRNS) is an emerging non-invasive technique to improve neuronal plasticity and may potentially augment functional outcomes when combined with existing interventions, such as functional electrical stimulation (FES). Objective:The objective of this study was to investigate the feasibility and preliminary efficacy of combined tRNS and FES-facilitated task practice to improve UE impairment and function after moderate-to-severe stroke. Methods:Fourteen individuals with UE weakness were randomized into one of two groups: 1) tRNS with FES-facilitated task practice, or 2) sham-tRNS with FES-facilitated task practice. Both groups involved 18 intervention sessions (3 per week for 6 weeks). tRNS was delivered at 2 mA current between 100–500 Hz for the first 30 minutes of FES-facilitated task practice. We evaluated the number of sessions completed, adverse effects, participant satisfaction, and intervention fidelity between the two therapists. UE impairment (Fugl-Meyer Upper Extremity, FMUE), function (Wolf Motor Function Test, WMFT), participation (Stroke Impact Scale hand score, SIS-H), and grip strength were assessed at baseline, within 1 week and 3 months after completing the intervention. Results:All participants completed the 18 intervention sessions. Participants reported minimal adverse effects (mild tingling in head). The two trained therapists demonstrated 93% adherence and 96% competency with the intervention protocol. FMUE and SIS-H improved significantly more in the tRNS group than in the sham-tRNS group at both timepoints (p≤0.05), and the differences observed exceeded the clinically meaningful differences for these scores. The WMFT and paretic hand grip strength improved in both groups after the intervention (p≤0.05), with no significant between group differences. Conclusion:Our findings show for the first time that combining tRNS and FES-facilitated task practice is a feasible and promising approach to improve UE impairment and function after moderate-to-severe stroke.","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":"85 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139584179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of plasma exchange versus intravenous immunoglobulin for the treatment of Guillain-Barré Syndrome: A double-blind, randomized clinical trial","authors":"Nourelhoda A. Haridy, Mohamed M. Shehab, Eman M. Khedr","doi":"10.3233/rnn-231369","DOIUrl":"https://doi.org/10.3233/rnn-231369","url":null,"abstract":"Background:\u0000Most previous studies comparing the effectiveness of Plasma Exchange (PE) or intravenous immunoglobulin (IVIG) in treating Guillain-Barre syndrome (GBS) have focused on the short-term outcome at around 1 month. Objective:\u0000To compare the long-term efficacy of PE and IVIG at one year in adult patients with GBS. Methods:\u0000Eighty-one adult patients with acute GBS were randomized into two groups with a ratio of 2 : 1: PE (N = 54) and IVIG (N = 27). Patients were assessed with the Medical Research Council sum score (MRC sum score), GBS Disability Scale (GDS), and Functional assessment of acute inflammatory neuropathy (FAAIN) at baseline, ten days, one month, three months, and one year. Neurophysiological examinations were performed at baseline and three months following treatment. Results:\u0000There were no significant differences between groups in demographic, clinical, and laboratory data. Both treatments produced a significant improvement in all clinical rating scales in both groups that continued up to one year. There were significant differences in the time course of recovery in the MRC and FAAIN scales, with significantly more improvement in the IVIG group at 1 and 3 months, although there was no significant difference in outcome at one year. However the effect size showed measurable differences between the PE and IVIG groups across the different measures at one-year. Electrophysiological studies showed equal improvement in most measures in both groups at three months, with a slightly greater effect in the IVIG group. Conclusion:\u0000long term outcomes of IVIG and PE were equivalent. However the effect size showed measurable differences between the PE and IVIG groups across the different measures at one-year follow-up that indicate the superiorty of IVIG. There was also a tendency for improvement to be slightly faster in the IVIG group.","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":"8 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139460525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shock waves modulate corticospinal excitability: A proof of concept for further rehabilitation purposes?","authors":"Matteo Guidetti, Anisa Naci, Andrea Cerri, Rossella Pagani, Antonino Michele Previtera, Alberto Priori, Tommaso Bocci","doi":"10.3233/rnn-231371","DOIUrl":"https://doi.org/10.3233/rnn-231371","url":null,"abstract":"Background:Focal extracorporeal shock wave therapy (fESWT) is a physical therapy vastly studied and used for various musculoskeletal disorders. However, the effect of fESWT on central nervous system is still to be determined. Objective:To elucidate spinal and supra-spinal mechanisms of fESWT in healthy subjects, in order to widen the spectrum of its clinical applications. Methods:In this quasi-experimental, unblinded, proof-of-concept clinical study, 10 voluntary healthy subjects underwent fESWT and were assessed immediately before (T0), immediately after (T1) and seven days after (T2) the intervention. As neurophysiological outcomes, motor evoked potentials (resting motor threshold, maximal motor evoked potential and maximal compound muscle action potential ratio, cortical silent period, total conduction motor time, direct and indirect central motor conduction time), F-waves (minimal and mean latency, persistence and temporal dispersion) and H-reflex (threshold, amplitude, maximal H reflex and maximal compound muscle action potential ratio, latency) were considered. Results:Resting motor threshold and F-waves temporal dispersion significantly decreased, respectively, from T1 and T2 and from T0 and T2 (for both, p < 0.05). H-reflex threshold increase between T0 and T1. Analysis disclosed a strong negative correlation between Δ3 cortical silent period (i.e., T2 –T1 recordings) and Δ1 Hr threshold (i.e., T1 –T0 recordings) (r = –0.66, p < 0.05), and a positive strong relationship between Δ3 cortical silent period and Δ3 Hr threshold (r = 0.63, p < 0.05). Conclusions:fESWT modulates corticospinal tract excitability in healthy volunteers, possibly inducing an early inhibition followed by a later facilitation after one week.","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":"121 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139412823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal ganglion cell and microvascular density loss in hereditary spastic paraplegia","authors":"Gabrielle N. Turski, Christopher A. Turski, Marcus Grobe-Einsler, Xenia Kobeleva, Jennifer S. Turski, Frank G. Holz, Robert P. Finger, Thomas Klockgether","doi":"10.3233/rnn-231380","DOIUrl":"https://doi.org/10.3233/rnn-231380","url":null,"abstract":"<h4><span>Abstract</span></h4><h3><span></span>Background:</h3><p>Hereditary spastic paraplegia (HSP) is characterized by progressive degeneration of distal axons in the long corticospinal tracts. Loss of retinal cells and microvascular networks has neither been suspected nor investigated. We concurrently examined the retinal microvasculature and retinal layer morphology in patients with HSP to assess whether retinal features may portray disease and its progression.</p><h3><span></span>Methods:</h3><p>Fifteen patients with HSP and 30 healthy controls were included in this cross-sectional case-control study. Disease severity was assessed with the Spastic Paraplegia Rating Scale (SPRS). Severity of ataxia was determined by the Scale for the Assessment and Rating of Ataxia (SARA). Retinal microvasculature was measured by means of optical coherence tomography angiography (OCT-A) and morphology of retinal layers using structural OCT. Mixed-effects models were applied for data analysis.</p><h3><span></span>Results:</h3><p>HSP patients showed significantly reduced vessel density of the superficial vascular plexus (SVP), reduced ganglion cell layer (GCL) volume, reduced inner plexiform layer (IPL) volume and reduced temporal-inferior peripapillary retinal nerve fiber layer (pRNFL) thickness versus healthy controls. GCL volume reduction correlated significantly with the worsening of visual acuity and higher SARA scores.</p><h3><span></span>Conclusions:</h3><p>These findings demonstrate that, in HSP both cells and vascular networks of the retina are compromised. Assessment of the retinal GCL, IPL and SVP may aid in diagnosis and monitoring of disease progression as well as provide novel structural outcome measures for clinical trials.</p>","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":"23 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139412707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate effects of insoles applied to the sound side lower extremity of patients with chronic hemiplegia during walking.","authors":"Chaeyoo Park, Youngkeun Woo, Jongim Won, Sujin Kim","doi":"10.3233/RNN-241389","DOIUrl":"10.3233/RNN-241389","url":null,"abstract":"<p><strong>Background: </strong>Asymmetric gait patterns are mostly observed in hemiplegic stroke patients. These abnormal gait patterns resulting in abnormal speed, and decreased ability in daily of activity living.</p><p><strong>Objective: </strong>This study aimed to determine the immediate changes in gait parameters and plantar pressure during elevation by wearing an insole on the sound side lower extremity of patients with hemiplegia.</p><p><strong>Methods: </strong>Thirty-six participants were recruited, comprising those with a post-stroke follow-up of ≥3 months and a functional ambulation category score of ≥2. The participants were asked to walk with and without a 1 cm insole in the shoe of their sound side, and the order of wearing or not wearing the insole was randomized. Gait parameters, bilateral gait parameters, and dynamic plantar pressure were measured using the GAITRite Walkway System.</p><p><strong>Results: </strong>Paired t-test was used to examine immediate changes in gait parameters and plantar pressure with and without insoles during walking in the same group. Overall, gait velocity and step length significantly decreased (p < 0.05), whereas step time significantly increased (p < 0.05). The swing phase of the affected sidelower extremities significantly increased (p < 0.05), and the stance phase significantly decreased (p < 0.05). Double-support unloading phase (pre-swing phase) significantly increased (p < 0.05). The changes in plantar pressure were significantly increased in some lateral zones and significantly decreased in the medial zone of the mid-hindfoot, both in terms of pressure per time and peak pressure (p < 0.05).</p><p><strong>Conclusion: </strong>Although this study did not show immediate positive effects on gait parameters and gait cycle, it is expected that sensory input from the sole of the foot through changes in plantar pressure may help improve gait asymmetry and regulate postural symmetry.</p>","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":" ","pages":"167-177"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Announcement: Appointment of New Editor-in-Chief Lechoslaw (Les) Turski, MD, PhD.","authors":"","doi":"10.3233/RNN-249001","DOIUrl":"10.3233/RNN-249001","url":null,"abstract":"","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":" ","pages":"91-92"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential effects of exercise and hormone treatment on spinal cord injury-induced changes in micturition and morphology of external urethral sphincter motoneurons.","authors":"Emily A Hibbard, Xiaolong Du, Yihong Zhang, Xiao-Ming Xu, Lingxiao Deng, Dale R Sengelaub","doi":"10.3233/RNN-241385","DOIUrl":"10.3233/RNN-241385","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) results in lesions that destroy tissue and spinal tracts, leading to deficits in locomotor and autonomic function. We have previously shown that after SCI, surviving motoneurons innervating hindlimb muscles exhibit extensive dendritic atrophy, which can be attenuated by treadmill training or treatment with gonadal hormones post-injury. We have also shown that following SCI, both exercise and treatment with gonadal hormones improve urinary function. Animals exercised with forced running wheel training show improved urinary function as measured by bladder cystometry and sphincter electromyography, and treatment with gonadal hormones improves voiding patterns as measured by metabolic cage testing.</p><p><strong>Objective: </strong>The objective of the current study was to examine the potential protective effects of exercise or hormone treatment on the structure and function of motoneurons innervating the external urethral sphincter (EUS) after contusive SCI.</p><p><strong>Methods: </strong>Gonadally intact young adult male rats received either a sham or a thoracic contusion injury. Immediately after injury, one cohort of animals was implanted with subcutaneous Silastic capsules filled with estradiol (E) and dihydrotestosterone (D) or left blank; continuous hormone treatment occurred for 4 weeks post-injury. A separate cohort of SCI-animals received either 12 weeks of forced wheel running exercise or no exercise treatment starting two weeks after injury. At the end of treatment, urinary void volume was measured using metabolic cages and EUS motoneurons were labeled with cholera toxin-conjugated horseradish peroxidase, allowing for assessment of dendritic morphology in three dimensions.</p><p><strong>Results: </strong>Locomotor performance was improved in exercised animals after SCI. Void volumes increased after SCI in all animals; void volume was unaffected by treatment with exercise, but was dramatically improved by treatment with E + D. Similar to what we have previously reported for hindlimb motoneurons after SCI, dendritic length of EUS motoneurons was significantly decreased after SCI compared to sham animals. Exercise did not reverse injury-induced atrophy, however E + D treatment significantly protected dendritic length.</p><p><strong>Conclusions: </strong>These results suggest that some aspects of urinary dysfunction after SCI can be improved through treatment with gonadal hormones, potentially through their effects on EUS motoneurons. Moreover, a more comprehensive treatment regime that addresses multiple SCI-induced sequelae, i.e., locomotor and voiding deficits, would include both hormones and exercise.</p>","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":" ","pages":"151-165"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensory augmentation for a rapid motor task in a multisensory environment.","authors":"James Negen, Heather Slater, Marko Nardini","doi":"10.3233/RNN-221279","DOIUrl":"10.3233/RNN-221279","url":null,"abstract":"<p><strong>Background: </strong>Sensory substitution and augmentation systems (SSASy) seek to either replace or enhance existing sensory skills by providing a new route to access information about the world. Tests of such systems have largely been limited to untimed, unisensory tasks.</p><p><strong>Objective: </strong>To test the use of a SSASy for rapid, ballistic motor actions in a multisensory environment.</p><p><strong>Methods: </strong>Participants played a stripped-down version of air hockey in virtual reality with motion controls (Oculus Touch). They were trained to use a simple SASSy (novel audio cue) for the puck's location. They were tested on ability to strike an oncoming puck with the SASSy, degraded vision, or both.</p><p><strong>Results: </strong>Participants coordinated vision and the SSASy to strike the target with their hand more consistently than with the best single cue alone, t(13) = 9.16, p <.001, Cohen's d = 2.448.</p><p><strong>Conclusions: </strong>People can adapt flexibly to using a SSASy in tasks that require tightly timed, precise, and rapid body movements. SSASys can augment and coordinate with existing sensorimotor skills rather than being limited to replacement use cases - in particular, there is potential scope for treating moderate vision loss. These findings point to the potential for augmenting human abilities, not only for static perceptual judgments, but in rapid and demanding perceptual-motor tasks.</p>","PeriodicalId":21130,"journal":{"name":"Restorative neurology and neuroscience","volume":" ","pages":"113-120"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}