Rheumatology Advances in Practice最新文献

{"title":"Bone marrow oedema of the sacroiliac joint without spondyloarthritis: a retrospective study of 34 cases of osteitis condensans ilii.","authors":"Sabine Guehery, Julian Plenard, François Lafourcade, Franck Lapegue, Laurent Zabraniecki, Arnaud Constantin, Nicolas Sans, Adeline Ruyssen Witrand, Marie Faruch Bilfeld","doi":"10.1093/rap/rkaf108","DOIUrl":"10.1093/rap/rkaf108","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of bone marrow oedema (BME) in osteitis condensans ilii (OCI) on MRI of the sacroiliac joint (SIJ). Secondary objectives include comparisons of socio-demographic characteristics, prevalence of other imaging features (MRI, CT scan), and low back pain in patients with OCI with those in a sex- and age-matched control group.</p><p><strong>Methods: </strong>A total of 34 patients with OCI, including 29 with MRI, were recruited for retrospective analysis. The SIJ MRIs were retrospectively analysed by two readers. A sex- and age-matched control group of patients without SIJ disorders was included. In both groups, the presence of structural bone abnormalities was assessed by CT scan analysis, and socio-demographic data were obtained by telephone questionnaire. A longitudinal analysis was conducted on patients who had undergone multiple imaging examinations.</p><p><strong>Results: </strong>All patients were female with a mean age of 34 years. BME was observed in 66% (19/29) of OCI patients. BME in OCI was mainly located in the anterior-middle quadrant (43.48%). OCI patients had significantly more than one delivery (<i>P</i> = 0.0094, McNemar test), even if OCI was found in four nulliparous patients (15%). OCI patients experienced significantly more pain (<i>P</i> = 0.0026, McNemar test).</p><p><strong>Conclusion: </strong>OCI is an entity found in both pregnant and non-pregnant young women. SIJ BME was found in two-thirds of OCI patients. OCI is a significant cause of BME and should be carefully considered by clinicians when dealing with a patient with low back pain in order to avoid misdiagnosing spondyloarthritis in the presence of BME of the SIJ.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 4","pages":"rkaf108"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HandScan criteria versus ACR/EULAR Boolean remission as treatment target in early rheumatoid arthritis: results of a randomized controlled trial.","authors":"Matthijs S van der Leeuw, Paco M J Welsing, Janneke Tekstra, Antonius A A Westgeest, Ruth Klaasen, Mihaela Gamala, Johannes W G Jacobs, Maxime M A Verhoeven, Jacob M van Laar","doi":"10.1093/rap/rkaf106","DOIUrl":"10.1093/rap/rkaf106","url":null,"abstract":"<p><strong>Objectives: </strong>The HandScan is a novel method to quickly and objectively quantify RA disease activity using optical spectral transmission in hands and wrists. The aim of this study was to investigate whether treat-to-target (T2T) in early RA patients aimed at 'HandScan' remission is non-inferior to that aimed at ACR/EULAR 2011 'Boolean' remission.</p><p><strong>Methods: </strong>We performed a multicentre randomized double-blind, non-inferiority trial. Newly diagnosed RA patients naive to DMARDs were randomized 1:1 to targeting HandScan remission or Boolean remission. At monthly visits, treatment was intensified/continued/deescalated according to the respective target following a predefined treatment schedule. Primary outcome was the HAQ score at 18 months, and non-inferiority was tested using a non-inferiority margin of 0.2 with a one-sided alpha of 0.05.</p><p><strong>Results: </strong>Of the 56 patients included per arm, a remarkably high number was not able to follow the T2T protocol (HandScan: 95%, Boolean: 80%, <i>P</i> = 0.01). The main reason was that patients and/or rheumatologists felt there was overtreatment (43%, 32%). HAQ at 18 months was 0.21 (95% CI: 0.01-0.40) units lower (i.e. better) in the Boolean arm. Thus, non-inferiority was absent for the HandScan target. Sensitivity analyses confirmed this conclusion. The HandScan target required more intensive treatment than the Boolean target, indicating overtreatment.</p><p><strong>Conclusion: </strong>Current HandScan remission criteria are not suitable for a T2T strategy in early RA since they may lead to overtreatment and inferior clinical outcomes. Additionally, both treatment targets lead to extraordinarily high non-adherence rates predominantly based on the feeling of overtreatment.</p><p><strong>Trial registration: </strong>International Clinical Trials Registry Platform, www.trialsearch.who.int, NTR6388.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 4","pages":"rkaf106"},"PeriodicalIF":2.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early onset neutropenia in rituximab treated rheumatoid arthritis patients: a case series.","authors":"Chung Mun Alice Lin, Alice R Lorenzi, John D Isaacs, Faye A H Cooles","doi":"10.1093/rap/rkaf105","DOIUrl":"10.1093/rap/rkaf105","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 4","pages":"rkaf105"},"PeriodicalIF":2.1,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Let's ask the patient: disease prediction based on patients' symptom descriptions in free text.","authors":"Inés Pérez-Sancristóbal, Nils Steinz, Ling Qin, Tjardo Maarseveen, Floor Zegers, Barbara Bislawska Axnäs, Luis Rodríguez-Rodríguez, Rachel Knevel","doi":"10.1093/rap/rkaf103","DOIUrl":"10.1093/rap/rkaf103","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the value self-reported free-text symptom descriptions for supporting diagnostic decisions in osteoarthritis (OA), fibromyalgia (FM) and immune-mediated rheumatic diseases (imRD) using natural language processing (NLP) and machine learning (ML).</p><p><strong>Methods: </strong>Free-text descriptions from 8454 patients were processed using a word-weighting method (TF-IDF vectorization) that reflects how relevant each word is across the dataset, and then classified with support vector machine (SVM) models. OA and FM models were optimized for specificity and the imRD model for sensitivity based on disease context and validated against an independent dataset. Model explainability was explored using SHapley Additive exPlanations (SHAP) values.</p><p><strong>Results: </strong>The SVM models demonstrated moderate diagnostic support potential with Area under the Receiver Operating Characteristic Curve (AUC-ROC) values of 0.68 for OA, 0.75 for FM and 0.69 for imRD. When optimized for clinical utility, the models achieved high specificity of 0.82 for OA and 0.92 for FM, effectively reducing unnecessary referrals with misdiagnosis rates of only 17% and 8%, respectively. For imRD, the model achieved a sensitivity of 0.92 and negative predictive value (NPV) of 0.77, ensuring minimal missed diagnoses of these potentially serious conditions. Decision curve analysis confirmed clinical utility across varying threshold preferences. SHAP analysis revealed that key linguistic patterns in patient descriptions aligned with clinical reasoning, enhancing the models' interpretability.</p><p><strong>Conclusion: </strong>Our results highlight the value of patient-reported data in augmenting rheumatology decision-making and sets the stage for further development in AI-assisted diagnostics. While not a standalone diagnostic tool, the integration of NLP-driven analysis of free-text symptom descriptions shows promise in reducing diagnostic ambiguity.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 4","pages":"rkaf103"},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guselkumab effectiveness in real-world settings: observations from an Italian multicentre study.","authors":"Andrea Becciolini, Antonio Marchesoni, Simone Parisi, Alberto Lo Gullo, Olga Addimanda, Eleonora Celletti, Luca Idolazzi, Romina Andracco, Marino Paroli, Patrizia Del Medico, Antonella Farina, Palma Scolieri, Aurora Ianniello, Federica Lumetti, Cecilia Giampietro, Camilla Mazzanti, Alessandra Bezzi, Elisa Visalli, Elena Bravi, Alessandro Volpe, Rosetta Vitetta, Marta Priora, Viviana Ravagnani, Bernd Raffeiner, Aldo Biagio Molica Colella, Maddalena Larosa, Francesco Girelli, Veronica Franchina, Giulio Ferrero, Francesca Ometto, Valeria Nucera, Francesca Serale, Rosalba Caccavale, Mirco Magnani, Natalia Mansueto, Gianluca Smerilli, Maria Chiara Ditto, Riccardo Bixio, Maria Cristina Focherini, Fabio Mascella, Myriam Di Penta, Emanuela Sabatini, Alessia Fiorenza, Davide Murgia, Guido Rovera, Claudio Angrisani, Massimiliano De Simone, Giuditta Adorni, Eleonora Di Donato, Daniele Santilli, Roberta Foti, Ylenia Dal Bosco, Francesco De Lucia, Giorgio Amato, Francesco Molica Colella, Ilaria Platè, Vincenzo Bruzzese, Gerolamo Bianchi, Simone Bernardi, Antonio Marchetta, Rosario Foti, Gianluca Santoboni, Dario Camellino, Francesco Cipollone, Enrico Fusaro, Eugenio Arrigoni, Gianluca Lucchini, Gilda Sandri, Dilia Giuggioli, Massimo Reta, Alarico Ariani","doi":"10.1093/rap/rkaf094","DOIUrl":"10.1093/rap/rkaf094","url":null,"abstract":"<p><strong>Objectives: </strong>Guselkumab is a biologic disease-modifying antirheumatic drug (bDMARD) with proven efficacy for psoriatic arthritis (PsA) in randomized controlled trials. Evidence of its effectiveness from clinical practice remains limited. We evaluated the real-world effectiveness of guselkumab for PsA (primary objective) and identified factors influencing clinical outcomes.</p><p><strong>Methods: </strong>This retrospective, observational, multicentre study enrolled consecutive patients with PsA prescribed guselkumab for joint involvement at 26 Italian rheumatology referral centres. Baseline data included patient history, PsA subtype, treatment history and disease activity. Treatment effectiveness was assessed with Kaplan-Meier curves; Cox proportional hazards analysis identified factors associated with treatment persistence.</p><p><strong>Results: </strong>The study included 278 patients (median age: 57 years [interquartile range, IQR: 50-63]; 64.4% female); median observation 10.7 months (IQR: 5.3-15.9; total: 3332.6 patient-months). Retention rates at 6, 12 and 24 months were 90.4%, 80.0% and 67.8%, respectively. Reasons for discontinuation included primary inefficacy (48% of 54 cases), secondary inefficacy (41%) and skin/mucosal intolerance (4%). Statistically significant factors (<i>P </i>< 0.05) influencing treatment persistence included sex, smoking, concurrent conventional synthetic DMARDs (csDMARDs), corticosteroid use, year of prescription and axial or enthesitic involvement.</p><p><strong>Conclusions: </strong>Approximately two-thirds of PsA patients treated with guselkumab remained on therapy after 2 years. Adverse events motivated <10% of discontinuations. Effectiveness was higher in patients with enthesitic or axial PsA and in those without concurrent corticosteroids or csDMARDs, confirming the effectiveness and safety of guselkumab as an optimal choice for monotherapy, particularly in PsA patients with enthesitis, with or without joint impairment, and/or axial involvement.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 4","pages":"rkaf094"},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between gout, hyperuricaemia and Parkinson's disease risk: a cohort study in western Sweden (2001-2017).","authors":"Mats Dehlin, Filip Bergquist, Panagiota Drivelegka, Tatiana Zverkowa Sandström, Lennart T H Jacobsson","doi":"10.1093/rap/rkaf102","DOIUrl":"10.1093/rap/rkaf102","url":null,"abstract":"<p><strong>Objectives: </strong>Neurodegenerative diseases including Parkinson's disease (PD) have been found to be associated with gout and hyperuricaemia in multiple studies but with conflicting results. We set out to determine the incidence and relative risk of PD in all gout individuals in western Sweden from 2001 to 2016 compared with controls. Blood urate levels in gout patients with and without incident PD were compared.</p><p><strong>Methods: </strong>All individuals with a gout diagnosis between 2001 and 2016 were identified and matched to population non-gout controls; individuals with prevalent PD were excluded. PD incidence rates were compared between cases and controls. The effect of gout on the risk of PD was calculated using Cox regression. The plasma urate level was identified for all gout cases.</p><p><strong>Results: </strong>In the 42 260 gout cases (67% male) and 174 747 controls (65% male) the incidence rate for PD was 1.38 per 1000 person-years in gout cases compared with 1.73 in controls, producing a significant decreased incidence rate ratio of 0.80 (95% CI 0.72, 0.90; <i>P</i> < 0.0001). Cox regression also showed a significant decreased risk for PD in the gout patients [hazard ratio 0.77 (95% CI 0.69, 0.86), <i>P</i> < 0.0001]. Gout patients with incident PD had significantly lower plasma levels of urate compared with gout patients without incident PD.</p><p><strong>Conclusion: </strong>The findings in this study show that gout is inversely associated with PD and in gout patients urate levels were inversely associated with the risk of PD. If future research proves this association to be causal it would have clinical implications in lowering urate in gout subjects at high risk of PD.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 4","pages":"rkaf102"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetically proxied tumour necrosis factor inhibition and pregnancy-related maternal and foetal outcomes in the general population: a Mendelian randomization study.","authors":"Sizheng Steven Zhao, Benjamin Woolf, Tormod Rogne, Dipender Gill","doi":"10.1093/rap/rkaf100","DOIUrl":"10.1093/rap/rkaf100","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence on the safety of TNF inhibitors (TNFi) for pregnancy-related maternal and foetal outcomes remains limited. While some studies report increased rates of preterm delivery, others have suggested a possible protective role for gestational diabetes. We used population-level data to examine the effect of genetically proxied TNFi on these outcomes.</p><p><strong>Methods: </strong>We proxied TNFi using rs1800693, a splicing variant within the <i>TNFRSF1A</i> gene, which is strongly associated with CRP in a genome-wide association study of 575 531 individuals of European ancestry. CRP was selected as the biomarker because TNFi is recognized to suppression CRP. Genetic association data for pregnancy-related outcomes were taken from FinnGen and UK Biobank, including the outcomes of spontaneous abortion, ectopic pregnancy, hyperemesis gravidarum, gestational diabetes, pre-eclampsia or eclampsia, preterm birth and offspring birthweight. Colocalization analysis was used to examine genetic confounding.</p><p><strong>Results: </strong>We found no strong association between genetically proxied TNFi and any adverse pregnancy-related outcome, including spontaneous abortion (odds ratio [OR] 1.07, 95% CI: 0.41, 2.81), preterm birth (OR 0.48, 95% CI 0.14, 1.60), hyperemesis gravidarum (OR 0.20, 95% CI 0.02, 2.57), pre-eclampsia or eclampsia (OR 0.59, 95% CI 0.13, 2.65). Genetically proxied TNFi was associated with lower risk of gestational diabetes (OR 0.16, 95% CI 0.05, 0.52). There was no statistical evidence to suggest genetic confounding through linkage disequilibrium.</p><p><strong>Conclusion: </strong>This genetic investigation found no evidence linking TNFi to adverse pregnancy-related outcomes. The suggestive association with a reduced risk of gestational diabetes warrants further research and may support its consideration for at-risk pregnant women.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf100"},"PeriodicalIF":2.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and caregiver perspectives of an early integrated systemic sclerosis palliative care clinic: a qualitative study.","authors":"Carolyn Wicks, Julie McDonald, Laura Ross","doi":"10.1093/rap/rkaf098","DOIUrl":"10.1093/rap/rkaf098","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals with systemic sclerosis (SSc) and their caregivers have unmet palliative care needs, yet the role of palliative medicine in SSc is unclear. In this study we aimed to explore patient and caregiver perspectives of a newly developed early, integrated SSc-specific palliative care clinic.</p><p><strong>Methods: </strong>All patients and caregivers who attended the SSc Palliative Care Clinic within the first 6 months of its implementation were invited to participate in a semi-structured phone interview. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Six patient interviews, three caregiver interviews and three patient-caregiver dyad interviews were performed. The SSc Palliative Care Clinic was valued and accepted by patients and caregivers. The experience of living with and caring for SSc was described in all interviews. Four further themes were identified, describing the experience of attending the SSc Palliative Care Clinic: the valued integrated structure of the clinic, including the value of interdisciplinary care; respectful communication style of the physician that patients found non-judgemental, supportive and empathetic; the dichotomy of receiving palliative care that included the relief of discussing symptom burden and hope arising from active symptom management; and diverging views of future care discussions.</p><p><strong>Conclusion: </strong>The SSc Palliative Care Clinic was both accepted and valued by patients and caregivers. Findings highlighted the need for palliative care delivery to be sensitive and person-centred, with such care being observed to foster hope and optimism for both patients and their caregivers.</p>","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 4","pages":"rkaf098"},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain intensity levels and their associations in people with rheumatic diseases in the UK: observational study using British Society for Rheumatology ePROMs data.","authors":"Kolawole Adeniran, Mumina Akthar, Ram Bajpai, James Galloway, Samantha L Hider, Richard Partington, Sara Muller, Ian C Scott","doi":"10.1093/rap/rkaf097","DOIUrl":"10.1093/rap/rkaf097","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf097"},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse fasciitis with restrictive ventilatory impairment and type 2 respiratory failure: a rare case report.","authors":"Rinko Katsuda, Akiko Kitagawa, Yoshihiro Seri, Misuzu Fujimori, Tetsuji Kawamura","doi":"10.1093/rap/rkaf096","DOIUrl":"10.1093/rap/rkaf096","url":null,"abstract":"","PeriodicalId":21350,"journal":{"name":"Rheumatology Advances in Practice","volume":"9 3","pages":"rkaf096"},"PeriodicalIF":2.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}