Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

{"title":"Cutaneous leishmaniasis: a neglected clinical manifestation among the tribal population in Nilambur, Kerala, India.","authors":"P A Fathima, Harish Kumar Shah, R S Aiswarya, P M Ajithlal, T V Shailaja, C Shubin, K J Reena, Prasanta Saini","doi":"10.1093/trstmh/trae102","DOIUrl":"10.1093/trstmh/trae102","url":null,"abstract":"<p><strong>Background: </strong>Different clinical manifestations of leishmaniasis (cutaneous and visceral) caused by Leishmania donovani have been reported from Kerala, India. Leishmania donovani causing cutaneous leishmaniasis (CL) (also called atypical CL [ACL]) is one of the major health concerns in the Western Ghats belt of the state.</p><p><strong>Methods: </strong>Skin biopsies of 20 patients with suspected CL from Nilambur, Kerala, were processed for CL diagnosis during the period 2022-2023. Parasite species were characterized using Leishmania-specific Internal Transcribed Spacer-Ⅰ (ITS-Ⅰ) PCR and ITS-Ⅰ RFLP analysis.</p><p><strong>Result: </strong>A total of 18 cases were confirmed to be CL and the parasite was identified as L. donovani.</p><p><strong>Conclusion: </strong>These indigenous ACL (CL due to L. donovani) reports from the small foci of Nilambur reveal an emerging endemic zone of leishmaniasis in the Western Ghats.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"393-395"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668037","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":"First report on the enzootic maintenance of Dirofilaria sp. hongkongensis in the canine hosts and mosquito vector Armigeres subalbatus (Coquillet) in Puducherry.","authors":"Jagatheesh Manikannan, Uma Sambath, Krishan Kumar Sihag, Waseema Arif, Srikanth Srirama, Abiramy Prabavathy A, Kumar Raja, Manju Rahi, Mathivanan Ashokkumar, Panneer Devaraju","doi":"10.1093/trstmh/traf037","DOIUrl":"https://doi.org/10.1093/trstmh/traf037","url":null,"abstract":"<p><strong>Background: </strong>Dirofilariasis is a re-emerging zoonosis caused by the nematode Dirofilaria spp., parasitizing canines, felines and humans and transmitted by mosquito vectors of the Culicidae family. Currently, reports of human dirofilariasis are increasing in India and thus we explored the occurrence of Dirofilaria infection among dogs and mosquitoes in Puducherry, India.</p><p><strong>Methods: </strong>Two millilitres of blood collected from 293 dogs from Puducherry was subjected to microscopy and Dirofilaria screening polymerase chain reaction (PCR) targeting the ITS2 gene. Mosquitoes trapped from areas with filaria-positive dogs were also subjected to PCR and representative samples were dissected for microscopy. The partially amplified ITS1, COX1 and 12s recombinant RNA genes from positive samples were sequenced for phylogeny.</p><p><strong>Results: </strong>Only 4 among the 293 dogs tested positive for Dirofilaria by microscopy and PCR and the parasite was identified as Dirofilaria sp. hongkongensis. None of the mosquito pools (n=39) tested positive by PCR. However, the presence of microfilaria and larvae was evident in Armigeres subalbatus (n=2) mosquitoes.</p><p><strong>Conclusions: </strong>The abundance of the vectors, susceptible dog population and ecosystem in Puducherry confers a congenial niche for the parasite and poses a risk for human transmission. Implementation of one health-based control measure would help to curtail the infection.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754774","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":"Knowledge, attitudes and practices of the general population towards Marburg virus disease in sub-Saharan African countries: a cross-sectional study.","authors":"Mohamed Fakhry Hussein, Assem Gebreal, Marina Saleeb, Eyerusalem Amossa Tessema, Debra Okeh, Gori Gaitano, Marc Nathanson, Nthabiseng Tsoeu, Eshun Gilbert, Khadija Swalehe Ally, Ahmed Elsayed Said Noureldin, Mai Hussein, Ramy Mohamed Ghazy","doi":"10.1093/trstmh/trae122","DOIUrl":"10.1093/trstmh/trae122","url":null,"abstract":"<p><strong>Background: </strong>Marburg virus disease (MVD) is categorized among viral hemorrhagic fevers. MVD is associated with high rates of morbidity and mortality. This study aimed to identify factors affecting MVD knowledge, attitudes and practices in sub-Saharan African countries.</p><p><strong>Methods: </strong>Using a validated questionnaire, a cross-sectional survey was conducted from 21 April to 23 May 2023 in eight English-speaking sub-Saharan African countries (Ethiopia, Ghana, Kenya, Lesotho, Nigeria, Senegal, South Africa and Tanzania).</p><p><strong>Results: </strong>Of 3142 participants, 51% were males, 66.0% were aged 18-29 y, 74.4% were living in urban areas, 47.9% completed their university education and 21.7% were healthcare workers (HCWs). Tanzanians had the highest good knowledge (89%), while Kenyans had the lowest (26%). Tanzanians had the highest positive attitude (82%), while Nigerians had the highest negative attitude (95%). The best practices exhibited were by Ethiopians (70%), and the poorest practices exhibited were by Ghanaians (94%). The predictors of good knowledge were marital status (adjusted OR [aOR]=0.75; 95% CI 0.59 to 0.94; p=0.013), knowing the correct mode of transmission (aOR=18.31; 95% CI 13.31 to 25.66; p<0.001), whether the participant has heard before about MVD (aOR=2.24; 95% CI 1.82 to 2.75; p<0.001), whether they modified their working habits (aOR=2.79; 95% CI 2.12 to 3.67; p<0.001), nationality (p<0.001) and being a HCW (aOR=2.71; 95% CI 2.01 to 3.67; p<0.001). The predictors of good attitude were being female (aOR=0.71; 95% CI 0.60 to 0.85; p<0.001), age (aOR=0.99; 95% CI 0.98 to 0.99; p=0.01), place of residence (aOR=3.13; 95% CI 2.46 to 3.99; p<0.001), level of education (aOR=1.67; 95% CI 1.37 to 2.04; p<0.001), knowing the correct mode of transmission (aOR=1.59; 95% CI 1.28 to 1.98; p<0.001), modification of working habits (aOR=1.30; 95% CI 1.01 to 1.68; p=0.039) and nationality (p<0.001). The predictors of practice were being female (aOR=1.17; 95% CI 1.01 to 1.37; p=0.042), place of residence (aOR=1.23; 95% CI 1.02 to 1.48; p=0.033), marital status (aOR=0.65; 95% CI 0.55 to 0.78; p<0.001), knowing the correct mode of transmission (aOR=0.46; 95% CI 0.38 to 0.56; p<0.001), modification of working habits (aOR=0.40; 95% CI 0.32 to 0.49; p<0.001) and occupation (aOR=0.37; 95% CI 0.30 to 0.46; p<0.001).</p><p><strong>Conclusions: </strong>Different modifiable and non-modifiable risk factors can be targeted to improve population perspectives towards MVD.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"354-366"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855454","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":"Investigating outcomes of female genital schistosomiasis in communities in Ogun State, Nigeria: a pilot cross-sectional study.","authors":"Vincent P Gyang, Hameedat O Abdulssalam, Aminat O Ahmed, Oluwatomilola V Tokun, Timothy N Ejike, Joseph Jonathan, Adedotun A Bayegun, Taiwo O Adubi, Maryam N Patrobas, Jacob B Ajayi, Pheabian O Akinwale","doi":"10.1093/trstmh/traf006","DOIUrl":"10.1093/trstmh/traf006","url":null,"abstract":"<p><strong>Background: </strong>Female genital schistosomiasis (FGS) is still a relatively new area of study in Nigeria, although the knowledge has improved since the Female Genital Schistosomiasis Society of Nigeria was launched in 2022, but gaps exist in evaluating the consequences of this disease. This pilot study investigated outcomes of FGS in two communities in Ogun State, Nigeria.</p><p><strong>Methods: </strong>Women <65 y of age from two communities in Ogun State were investigated. Of 126 women screened by urine microscopy, only 47 participants further consented for colposcopy to investigate FGS, guided by the World Health Organization FGS pocket atlas. Samples from the cervix and vagina were also subjected to a Pap test. Questionnaires were also used.</p><p><strong>Results: </strong>Among the 47 participants, 23.4% had egg-patent urogenital schistosomiasis, with younger women being significantly more infected (p<0.05): age group 16-25 y (30.8%) and 26-35 y (35.7%). Investigation by colposcopy showed that 18 (38.3%) women had signs that could be considered as FGS, including grainy sandy patches (12.8%), yellow sandy patches (38.3%), abnormal blood vessels (17%) and rubbery papules (4.3%). Pap smear results showed cervical atypia in all samples, with two having Schistosoma ova.</p><p><strong>Conclusions: </strong>The results of this pilot study reaffirm the reason why more attention to FGS from the Federal Ministry of Health is required, and we strongly recommend the need for more studies with larger sample sizes to gather more information.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"367-374"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123123","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":"Spatiotemporal analysis of visceral leishmaniasis in Belo Horizonte, Brazil: a historical perspective (1994-2018).","authors":"Carla M D Lopes, Diogo T Cardoso, Juliana M T Bezerra, Giovanna R de Araújo, Mariângela Carneiro, Maria H F Morais, David S Barbosa","doi":"10.1093/trstmh/trae143","DOIUrl":"10.1093/trstmh/trae143","url":null,"abstract":"<p><strong>Background: </strong>In the Americas, visceral leishmaniasis (VL) results from the zoonotic transmission of Leishmania infantum. VL has a high occurrence rate in the Metropolitan Region of Belo Horizonte (BH), Minas Gerais, Brazil, and has rapidly spread throughout the municipality since it was first recorded in 1994. This research analysed a historical perspective over 25 y of human VL occurrence in BH.</p><p><strong>Methods: </strong>An ecological study of reported human VL occurrence from January 1994 to December 2018 in BH was performed. Epidemiological indicators and changes in the spatiotemporal transmission patterns of human VL were analysed throughout the study period.</p><p><strong>Results: </strong>The average annual incidence of human VL was 3.20 cases per 100 000 inhabitants over the study period. The case fatality rate ranged from 7% to 21%. The proportion of VL/human immunodeficiency virus coinfection was >20% in the years 2012, 2015 and 2018. Human VL was introduced into BH through the East and Northeast regions, expanding to other areas. The coverage areas of the São Miguel Arcanjo and Cafezal health centres (both in the Centro-Sul region of the city) as well as other areas in the Northeast, Northwest, Pampulha, Venda Nova, North, and East regions of the city presented higher relative risks for human VL occurrence.</p><p><strong>Conclusions: </strong>The study contributes to a better understanding of the disease's epidemiological profile and identifies priority areas for developing control and monitoring actions.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"384-392"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068054","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":"Uniting against the snakebite challenge: are we there yet?","authors":"Maya Gopalakrishnan, Frank-Leonel Tianyi, Thomas Pinfield","doi":"10.1093/trstmh/traf025","DOIUrl":"10.1093/trstmh/traf025","url":null,"abstract":"","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"398-399"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574122","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":"Genetic variability in snake venom and its implications for antivenom development in sub-Saharan Africa.","authors":"Innocent Ayesiga, Lenz N Okoro, Chirigo Taremba, Michael O Yeboah, Justine T M Naab, Ruphline M Anyango, John Adekeye, Ivan Kahwa","doi":"10.1093/trstmh/trae070","DOIUrl":"10.1093/trstmh/trae070","url":null,"abstract":"<p><p>Snake venom, a complex mixture of proteins, has attracted human attention for centuries due to its associated mortality, morbidity and other therapeutic properties. In sub-Saharan Africa (SSA), where snakebites pose a significant health risk, understanding the genetic variability of snake venoms is crucial for developing effective antivenoms. The wide geographic distribution of venomous snake species in SSA countries demonstrates the need to develop specific and broad antivenoms. However, the development of broad antivenoms has been hindered by different factors, such as antivenom cross-reactivity and polygenic paratopes. While specific antivenoms have been hindered by the numerous snake species across the SSA region, current antivenoms, such as SAIMR polyvalent and Premium Serums & Vaccines, exhibit varying degrees of cross-reactivity. Such ability to cross-react enables the antivenoms to target multiple components from the different snake species. The advent of biotechnological innovations, including recombinant antibodies, small-molecule drugs, monoclonal antibodies and synthetic antivenoms, presents options for eliminating limitations associated with traditional plasma-derived antivenoms. However, challenges still persist, especially in SSA, in addressing genetic variability, as evidenced by inadequate testing capacity and limited genomic research facilities. This comprehensive review explores the genetic variability of snake venoms in SSA, emphasizing the venom composition of various snake species and their interactions. This information is critical in developing multiple strategies during antivenom development. Finally, it offers information concerning the need for extensive collaborative engagements, technological advancements and comprehensive genomic evaluations to produce targeted and effective antivenoms.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"400-406"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923395","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":"Effects of heparin on venom-induced consumption coagulopathy: a meta-analysis of randomized controlled trials.","authors":"Yu-Ning Huang, Wei-Chuan Chang, Yun-Kuan Lin","doi":"10.1093/trstmh/trae103","DOIUrl":"10.1093/trstmh/trae103","url":null,"abstract":"<p><p>Venom-induced consumption coagulopathy (VICC) is a serious complication of snakebites, potentially leading to life-threatening bleeding. Despite efforts to determine effective treatments other than antivenom, such as heparin, the evidence supporting their use remains insufficient. Therefore, this study aimed to perform a systematic review, meta-analysis and trial sequential analysis (TSA) to examine the effects of heparin on VICC. On 11 August 2024, a systematic search for randomized controlled trials (RCTs) investigating the effects of heparin on VICC was conducted using eight online databases. Six RCTs were included in this study. The meta-analysis revealed that heparin did not significantly reduce the mortality rate (risk ratio, 0.65; 95% CI 0.39 to 1.10). Additionally, the meta-analysis showed no significant differences in various clinical outcomes between the heparin group and control group. The TSA indicated insufficient evidence to conclude the effects of heparin on VICC mortality, and a sample size of 741 patients may be needed for further RCTs. In conclusion, our findings indicate that heparin may not significantly affect VICC outcomes. Although the current evidence is inconclusive because of the limited sample size, it highlights the need for future trials to provide more precise insights.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"407-417"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923331","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":"Knowledge, perceptions and healthcare practices of communities for management of snakebites in Kamuli District, Eastern Uganda.","authors":"Joan Tusabe, Michael Muhoozi, Dan Kajungu, Aggrey Mukose, Simon Kasasa, Simon Peter Sebina Kibira","doi":"10.1093/trstmh/trae105","DOIUrl":"10.1093/trstmh/trae105","url":null,"abstract":"<p><strong>Background: </strong>Snakebite is one of the neglected tropical diseases in Uganda affecting rural areas, especially during the rainy season. Households mainly rely on traditional remedies for management, which are not always effective, leading to disability and sometimes death. We explored the knowledge, perceptions and healthcare practices related to snakebites in Kamuli District.</p><p><strong>Methods: </strong>We used the participatory research appraisal (PRA) method to conduct the study. Six PRA sessions were carried out in five purposively selected villages of Wankole subcounty, Kamuli District, as they reported a high number of snakebites. In addition, we conducted 15 in-depth interviews with current and past snakebite victims and 10 key informant interviews with professional healthcare providers and traditional healers. Audio files were transcribed and translated verbatim and data were analysed to identify themes. Analysis was conducted using ATLAS.ti version 8.0.</p><p><strong>Results: </strong>Overall, the community considered snakebites a big problem that worsens during rainy seasons. Knowledge of snakebite management was inadequate. Perceptions about snakes and snakebites included snakes are related to traditions, ancestral spirits and witchcraft. Practices following snakebites included applying a tourniquet and the use of herbs, paraffin and a 500-shilling coin. Snakebites were associated with out-of-pocket expenditures and limited capacity to manage.</p><p><strong>Conclusions: </strong>The study calls for policy changes to improve snakebite management in Eastern Uganda, highlighting gaps in knowledge and harmful practices. It emphasizes the need for health education and financial support for affected households. Collaboration between healthcare providers, traditional healers and the community is crucial for effective prevention and management.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"418-431"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921573","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":"Snakebites, a neglected public health concern: an analysis of distribution, trends and incidence of snakebite cases reported to health facilities in the Volta Region of Ghana, 2018-2023.","authors":"Samuel Adolf Bosoka, Joseph Yaw Jerela, Amatus Nambagyira, Emmanuel Yaw Bonsu, Felix Kwame Korang, Senanu Kwesi Djokoto, Chrysantus Kubio","doi":"10.1093/trstmh/trae113","DOIUrl":"10.1093/trstmh/trae113","url":null,"abstract":"<p><strong>Background: </strong>Snakebite affects 5.4 million people annually, causing up to 2.7 million envenoming cases and 137 880 deaths. Its rise has been linked to flooding. This study examines the distribution, trends and incidence of snakebite cases in the Volta Region and identifies snakebite outbreaks in flood-affected districts.</p><p><strong>Methods: </strong>We undertook a descriptive secondary data analysis of 2018-2023 snakebite cases from the District Health Information and Management Systems II database for the Volta Region. Cumulative Sum was used to identify missed outbreaks. The results are presented in tables, graphs and maps.</p><p><strong>Results: </strong>A total of 1637 snakebite cases were reported across the 6-y study period, with an overall incidence rate of 15.8 cases per 100 000 population and a case fatality rate of 0.4% (7/1637). Case patients aged 20-34 y were the most affected (26.7%; 437/1637). Most of the cases peaked in March during the rainy season. The incidence of snakebites decreased from 18 cases per 100 000 population in 2018 to 15.8 cases per 100 000 population in 2023. Each of the flood-affected districts reported snakebite outbreaks before the flooding event. No new outbreaks were detected during or after the floods as of December 2023.</p><p><strong>Conclusions: </strong>While snakebite incidence has decreased overall in the Volta Region, the burden remains alarmingly high in Ketu North. Young adults are particularly vulnerable. Urgent efforts are needed to enhance education, emphasising the importance of protective attire during the wet season for community safety.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"443-452"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923158","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}