The Journal of the Association of Physicians of India最新文献

{"title":"A Study of the Clinicoetiological Profile of Hyponatremia in Patients in a Tertiary Care Hospital.","authors":"Somyata Somendra, Raman Sharma","doi":"10.59556/japi.74.1512","DOIUrl":"https://doi.org/10.59556/japi.74.1512","url":null,"abstract":"<p><strong>Background: </strong>Hyponatremia is a common and important electrolyte imbalance seen both in isolation and more commonly, as a complication of other medical illnesses. With a wide spectrum of presentations, the prognostic implications are grave and far-reaching if not addressed meticulously. Despite the knowledge of hyponatremia since the mid-20th century, data on the prevalence and clinical profile of hyponatremia are scarce, to say the least, from the Indian subcontinent. We took up this hospital-based observational study to explore the clinicoetiological profile of hyponatremia.</p><p><strong>Results: </strong>Mean serum sodium level was 122.24 ± 6.10. Most of the patients had severe hyponatremia (63.3%). The most common cause of hyponatremia, as well as severe and euvolemic hyponatremia, was syndrome of inappropriate antidiuretic hormone secretion (SIADH) (21.9%). Most patients with SIADH had tubercular meningitis (TBM). The most common type of hyponatremia was hypovolemic hyponatremia (42.4%), of which sepsis was the most common cause.</p><p><strong>Conclusion: </strong>Further prospective studies are required as hyponatremia remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, its causation by multiple etiologies with differing pathophysiological mechanisms, and marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of hyponatremia; also, optimal treatment strategies have not been well defined for these reasons.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6E","pages":"e6-e8"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Curious Case of Emphysema and Fibrosis.","authors":"Sanket Joshi, Dipti Gothi","doi":"10.59556/japi.74.1586","DOIUrl":"https://doi.org/10.59556/japi.74.1586","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a systemic autoimmune disease with frequent extra-articular manifestations, of which pulmonary involvement is the most common and clinically significant. Combined pulmonary fibrosis and emphysema (CPFE) is a distinct clinic-radiological syndrome characterized by the coexistence of upper-lobe emphysema and lower-lobe fibrosis and is increasingly recognized in patients with connective tissue diseases, including RA. We describe the case of a 50-year-old nonsmoking woman who presented with a 3-year history of progressive exertional dyspnea and chronic dry cough, preceding the onset of inflammatory polyarthritis by nearly 2 years. She later developed symmetrical involvement of small and large joints with prolonged morning stiffness, along with constitutional symptoms including low-grade fever and weight loss. Physical examination revealed grade IV digital clubbing and bibasilar inspiratory crackles. Laboratory evaluation showed elevated inflammatory markers with negative rheumatoid factor and anticyclic citrullinated peptide antibodies, consistent with seronegative RA. High-resolution computed tomography of the thorax showed upper lobe emphysema and lower lobe honeycombing, confirming the diagnosis of CPFE. Pulmonary function testing showed relatively preserved airflow with mildly reduced diffusion capacity, along with severe exercise-induced desaturation. Echocardiography revealed mild pulmonary hypertension. This case highlights an uncommon presentation of rheumatoid arthritis-associated combined pulmonary fibrosis and emphysema (RA-CPFE), where pulmonary manifestations preceded articular disease, emphasizing the need for a high index of suspicion. Early recognition through high-resolution computed tomography (HRCT) and comprehensive pulmonary evaluation is crucial, as RA-CPFE is associated with significant morbidity, pulmonary hypertension, and poor prognosis. Multidisciplinary management incorporating immunosuppressive therapy, consideration of antifibrotics in progressive disease, and supportive care remains essential. Further studies are required to better define optimal treatment strategies and prognostic markers in RA-CPFE.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6S","pages":"13-16"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ask-Upmark Kidney: A Rare Cause of Hypertension in Young Patients.","authors":"Jyoti Prakash, Pooja Kumari","doi":"10.59556/japi.74.1535","DOIUrl":"https://doi.org/10.59556/japi.74.1535","url":null,"abstract":"<p><p>Ask-Upmark kidney was originally described as a congenital segmental hypoplasia of the kidney, but recent data suggest it to be a sequela of vesicoureteral reflux or pyelonephritis in early age. This segmental hypoplasia leads to hypertension in young people. This hypertension is treatable with a partial nephrectomy. This reported patient presented with hypertensive urgency in the OPD. On evaluation, he was found to have Ask-Upmark kidney. The patient was managed conservatively. In case of severe and progressive renal damage, surgical resection with or without transplant can be considered. If the disease is nonprogressive with normal kidney function, the patient can be managed with antihypertensive treatment alone. This is one of the rare causes of hypertension in young that should be kept in mind while evaluating such cases.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6S","pages":"45-46"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When It's Not Just \"That Time of the Month\": Identifying Thoracic Endometriosis in the Context of Recurrent Pleural Effusion.","authors":"Anjali Kamath, Jairaj P Nair, Tanay Sinha, Mrinal Mallya, Swapnil M Thorve, Harshita Mishra, Amol Shenurkar","doi":"10.59556/japi.74.1018","DOIUrl":"https://doi.org/10.59556/japi.74.1018","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Recurrent hemorrhagic pleural effusion presents as a challenge for both the clinician and the patient, with common causes being tuberculosis, malignancy, and collagen vascular diseases. Among uncommon causes of recurrent hemorrhagic effusion is catamenial hemothorax, which is a part of thoracic endometriosis syndrome (TES). Endometriosis is the extrauterine growth of endometrial glands and stroma. It is relatively common among women of reproductive age-group, with reported incidence of around 11%. Although rare, the thorax is the most common extraabdominal site for endometriosis. Here we present a rare case of recurrent hemorrhagic pleural effusion due to thoracic endometriosis in a young female with infertility. A 33-year-old female housewife presented with dyspnea on exertion modified Medical Research Council (mMRC) grade 2 and dry cough occasionally for 6 months. She had a history of tubercular cervical lymphadenopathy for which she was on treatment. Therapeutic thoracocentesis was performed thrice in 4 months. Routine microscopy showed predominantly lymphocytes, mesothelial cells, and numerous foamy histiocytes, some pigment laden. There were no malignant cells or acid-fast bacilli (AFB) detected in the fluid. Pleural fluid amylase and lipase were normal. Contrast-enhanced computed tomography (CT) thorax showed moderate right-sided pleural effusion without any evident parenchymal lesions, pleural lesions, or mediastinal lymphadenopathy. Ultrasonography (USG) abdomen and pelvis showed mild ascites which was nontappable. As we had not reached a definitive diagnosis, medical thoracoscopy was performed. It showed moderate hemorrhagic pleural fluid in the pleural cavity and a small raised erythematous glandular tissue on the parietal pleural surface from which biopsy was taken. Histopathology showed an island of endometrial stroma with a single gland. Immunohistochemistry was performed on this section, which was PAX8 and CD10 positive, confirming the diagnosis of thoracic endometriosis. Pleurodesis with talc slurry was done to prevent further refilling of the effusion. Gynecology opinion was sought, and patient was started on monthly subcutaneous injections of gonadotropin-releasing hormone (GnRH) analogue for 3 months. Chest X-ray after 3 months showed no refilling of pleural effusion. Catamenial hemothorax is the second commonest manifestation of TES, occurring in approximately 14% of cases. It affects the right side in about 80% of the cases. Diagnosis is based on high degree of suspicion and is often delayed. Video-assisted thoracic surgery (VATS) remains the gold standard for diagnosis and management of TES. Medical thoracoscopy is a viable alternative in resource-poor settings or when diagnosis is not confirmed. On histology, diagnosis is confirmed by the presence of endometriotic glands or stroma, which may also show stromal arterioles, erythrocytes, and pigmented histiocytes. In difficult-to-diagnose cases, CD10 immunohistochemical s","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6S","pages":"17-19"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osmotic Demyelination Syndrome Secondary to Hypernatremia and Hypokalemia: A Case Report of Complete Recovery.","authors":"Keerthana Manoharan, T Geetha, K Sivakumar","doi":"10.59556/japi.74.1552","DOIUrl":"https://doi.org/10.59556/japi.74.1552","url":null,"abstract":"<p><strong>Background: </strong>Osmotic demyelination syndrome (ODS) presents as quadriplegia with pseudobulbar palsy, and most cases occur with rapid correction of hyponatremia. It is due to demyelination of the pons without any inflammation. Other causes include chronic malnutrition, alcoholism, and underlying medical illnesses such as post-liver transplant. Here, we present a case report of a patient with hypernatremia and hypokalemia leading to ODS, whose early diagnosis and effective treatment resulted in complete recovery of the patient.</p><p><strong>Case description: </strong>A 33-year-old female patient presented with vomiting followed by confusion and weakness of all four limbs. On admission, the patient was drowsy, obeying oral commands, mildly dyspneic, dehydrated, weakness of all four limbs. Deep tendon reflexes were present, and the bilateral plantar reflex showed no response. Her vitals were stable. On evaluation, arterial blood gas (ABG) showed hyperchloremic normal anion gap metabolic acidosis. Serum potassium level was very low, and serum sodium level was significantly high. MRI brain T2-FLAIR image showed hyperintensity in the central pons with peripheral sparing. Pons appeared swollen and edematous, suggestive of ODS. On further evaluation, she was found to have distal renal tubular acidosis. With this presentation and in the background of renal tubular acidosis, autoimmune disease was considered. It was negative in our case. In view of hypernatremia, after calculating the water deficit, she was given IV 5% dextrose and free water through the nasogastric tube, along with potassium supplements. She was also given steroids and other supportive measures. The patient recovered completely.</p><p><strong>Conclusion: </strong>There was no evidence of hyponatremia during admission. Here, we consider that the osmotic demyelination could have occurred due to hypernatremia. The cause for hypernatremia in this case would have been hypokalemia. Moreover, hypokalemia leads to hypernatremia through a combination of increased sodium reabsorption in the kidneys, aldosterone-mediated effects, impaired renal concentrating ability, cellular electrolyte shifts, and associated volume depletion and dehydration. These mechanisms explain the complex relationship between sodium and potassium. Early diagnosis with MRI brain imaging and treatment allowed our patient to recover completely.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6S","pages":"47-48"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden Trends and Future Projections of Acute Glomerulonephritis in India till 2040: An Analysis from the Global Burden of Disease Study.","authors":"Hari S Meshram, Sanshriti Chauhan, Saurabh Puri, Sourabh Sharma, Narinder P Singh","doi":"10.59556/japi.74.1550","DOIUrl":"https://doi.org/10.59556/japi.74.1550","url":null,"abstract":"<p><strong>Background: </strong>Glomerulonephritis (GN) remains a significant cause of kidney-related morbidity and mortality in low- and middle-income countries (LMICs). Despite advances in acute renal care in India, the national epidemiological trajectory and future burden of GN have not been comprehensively characterized.</p><p><strong>Materials and methods: </strong>This study utilized Global Burden of Disease (GBD) 2023 data to estimate incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to GN in India from 1990 to 2023. Age-standardized rates (ASRs) were calculated per 100,000 population. Temporal trends were assessed using estimated annual percentage change (EAPC) from log-linear regression models. Future projections to 2040 were modeled using historical EAPC and population forecasts from the Institute for Health Metrics and Evaluation.</p><p><strong>Results: </strong>From 1990 to 2023, India achieved a 75% reduction in age-standardized death rates (0.091-0.023 per 100,000; EAPC -4.42%, <i>p</i> < 0.001), while incidence remained stable (3.09 per 100,000; EAPC -0.05%, <i>p</i> = 0.123). DALYs declined 77% (2.49-0.58 per 100,000), driven by YLLs rather than disability (YLDs). Males experienced a 1.5-fold higher burden across all metrics. Marked geographic disparities emerged, with eastern states (Jharkhand, Chhattisgarh, Bihar) demonstrating 2-4-fold higher mortality than the national average despite similar incidence. By 2040, age-standardized death rates are projected to decline 52% further, but absolute incident cases will increase 18% (41,200-48,720) due to population growth.</p><p><strong>Conclusion: </strong>India has achieved major reductions in GN mortality, yet stable incidence and persistent disability indicate that primary prevention and early detection remain inadequate. Without policy intervention, rising case numbers will place increasing demand on renal services. GN should be prioritized within national and subnational kidney health strategies as a sentinel indicator of health system preparedness in LMICs.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6","pages":"50-55"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple Central Nervous System Pathogen Infections and Vascular Events in Advanced Human Immunodeficiency Virus-Implications for Early Diagnosis and Multidisciplinary Management: A Case Series from Two Tertiary Centers.","authors":"Sakshi Puri, Rupak Chatterjee, Insha Aleena, Sarbajit Das","doi":"10.59556/japi.74.1595","DOIUrl":"https://doi.org/10.59556/japi.74.1595","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system (CNS) infections remain a major cause of morbidity and mortality in people living with HIV (PLHIV), particularly in the setting of advanced immunosuppression and recent initiation of antiretroviral therapy (ART). While individual opportunistic CNS infections are well-documented, simultaneous infections with multiple pathogens are rare and diagnostically challenging.</p><p><strong>Methods: </strong>We report a case series of 11 HIV-positive individuals aged 25-50 years, presenting within 3 months of ART initiation to two tertiary centers over a 2-year period. All patients exhibited clinical features of meningitis and underwent cerebrospinal fluid (CSF) analysis, PCR testing, neuroimaging, and comprehensive microbiological workup.</p><p><strong>Results: </strong>All 11 patients were diagnosed with triple-pathogen CNS infections. The most common combination was <i>Mycobacterium tuberculosis,</i> <i>Cryptococcus neoformans,</i> and herpes simplex virus type 1 (HSV-1). Additional pathogens included <i>Toxoplasma gondii,</i> <i>Treponema pallidum,</i> and CMV. Median CD4 count was <70 cells/µL. Coinfections were frequently unmasked shortly after ART initiation, suggestive of immune reconstitution inflammatory syndrome (IRIS). Despite aggressive treatment, mortality was 45%. One complex case included CNS vasculitis, ischemic stroke, pulmonary embolism, and multiple systemic infections.</p><p><strong>Conclusion: </strong>This series underscores the diagnostic and therapeutic complexities of managing CNS coinfections in PLHIV, especially in the context of IRIS. A high index of suspicion, early multiplex diagnostic testing, and multidisciplinary management are crucial. Furthermore, the presence of noninfectious complications such as stroke and thromboembolism highlights the broader spectrum of HIV-related neurological disease. Early recognition and targeted treatment can improve outcomes in this high-risk population.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6S","pages":"74-78"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial Imaging and Burnout Transition of Extramedullary Hematopoiesis in Sickle Beta-thalassemia: A Two-year Case Study.","authors":"Nivedita Sharma, Samanyu Handa, Abhishek Gupta, Sonal Saran","doi":"10.59556/japi.74.1555","DOIUrl":"https://doi.org/10.59556/japi.74.1555","url":null,"abstract":"<p><p>The synthesis of blood cells, initiated during fetal development, transitions from the yolk sac to the liver and spleen, and finally to the bone marrow by 18 weeks of gestation, continuing throughout adulthood. Postnatally, hematopoiesis occurs exclusively in the bone marrow, but can be taken over by other organs in various hematological disorders. Extramedullary hematopoiesis (EMH) can involve numerous organs and lead to conditions such as hepatomegaly, splenomegaly, and paraspinal masses. Rarely, EMH occurs in atypical sites such as the gastrointestinal tract, lungs, or central nervous system, especially in patients with conditions such as thalassemias, myelofibrosis, hemolytic anemias, and hematological malignancies. This report describes a 26-year-old man with sickle beta-thalassemia and EMH, observed through serial imaging over 2 years. Initial imaging showed paravertebral masses and diffuse skeletal sclerosis on radiography and CT, with MRI revealing lobulated lesions without spinal canal extension. Treatment included radiotherapy and hydroxyurea, leading to fatty replacement in EMH masses, evidenced by changes in MRI characteristics over time. The case provides a longitudinal perspective on EMH. The observed transition from active EMH to fatty replacement underscores the dynamic response to treatment and highlights the importance of serial imaging in managing EMH. This case emphasizes the need for further studies to optimize treatment strategies and improve understanding of EMH progression in hematological disorders.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6S","pages":"49-52"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Tuberculosis in Renal Insufficiency.","authors":"Nikhil Gupta, Harshita Rani, Rishabh Kacker, Rajendra Prasad, Rishikesh Balasaheb Deshmukh","doi":"10.59556/japi.74.1527","DOIUrl":"https://doi.org/10.59556/japi.74.1527","url":null,"abstract":"<p><p>Tuberculosis (TB) is a significant global health challenge, particularly in patients with renal insufficiency, where both the disease and its treatment are complicated by altered pharmacokinetics, immunosuppression, and increased risk of drug toxicity. Management of TB in patients with renal insufficiency is complex and necessitates an individualized, multidisciplinary approach. Careful dose adjustments, regimen selection, management of comorbid conditions, regular monitoring, and adherence to current guidelines can optimize outcomes while minimizing adverse effects. This article reviews current strategies and evidence-based approaches for the treatment of TB in patients with renal insufficiency, with a focus on drug selection, dose adjustment, and monitoring for toxicity and efficacy.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6","pages":"85-87"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JAPI: Its Journey towards the Platinum Peak.","authors":"Nandini Chatterjee","doi":"10.59556/japi.74.1539","DOIUrl":"https://doi.org/10.59556/japi.74.1539","url":null,"abstract":"<p><p>The Journal of the Association of Physicians of India, the erstwhile \"MEDICINE\", has come a long way since its inception on a busy morning in 1952. The association had been founded in 1944 by a band of visionaries who felt that physicians needed a platform for academic exchange and enrichment. It took another eight years to conceptualize and bring out the Journal of API, then named simply \"MEDICINE\". It was a treatise that would be the mouthpiece of the physicians of India, the medium of dissemination of new information, research, and the wisdom of the times.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 6","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}