Thorax最新文献

{"title":"Clinical benefit of chronic non-invasive ventilation in severe stable COPD: a matter of persistent hypercapnia improvement","authors":"Tim Raveling, Renzo Boersma, Peter J Wijkstra, Marieke L Duiverman","doi":"10.1136/thorax-2024-221899","DOIUrl":"https://doi.org/10.1136/thorax-2024-221899","url":null,"abstract":"Purpose In patients with chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV), the relation between improvements in nocturnal transcutaneous partial pressure of CO2 (PtcCO2) and daytime arterial partial pressure of CO2 (PaCO2) remains uncertain. Also, to what extent improvements in nocturnal PtcCO2 result in better health-related quality of life (HRQL), exercise capacity, lung function and survival has not been investigated. Patients and methods Patients with COPD who were initiated on chronic NIV were prospectively followed for 6 months. Daytime PaCO2 and nocturnal PtcCO2 were measured before NIV initiation. NIV targeted normocapnia (PaCO2/mean PtcCO2<6.0 kPa) or to reduce baseline values >20%. HRQL was measured with the Severe Respiratory Insufficiency questionnaire (SRI) and exercise capacity with the 6-min walk test (6MWT). Patients were divided into three groups: group 1: neither PtcCO2 nor PaCO2 reductions reached the target; group 2: both PtcCO2 and PaCO2 targets were reached; group 3: only PtcCO2 target was reached. Results 177 participants were included with both transcutaneous and daytime gas exchange data. In total, 66% reached nocturnal gas exchange targets. However, in only 17%, this also resulted in substantial daytime PaCO2 reduction (group 2). Compared with group 1, these patients had higher baseline PtcCO2 (7.4±0.7 vs 8.2±1.9 kPa, p=0.012) and better NIV usage (6.2±2.8 vs 8.3±2.4 hours, p=0.010). Despite comparable NIV settings, the forced expiratory volume in 1 s and 6MWT improved only in group 2, and only these participants reached a clinically relevant improvement on the SRI and experienced improved survival. Conclusion Patients with COPD who can maintain improved ventilation by nocturnal NIV during daytime spontaneous breathing are most likely to experience relevant benefits on HRQL, exercise capacity, lung function and survival. No data are available. The data used for this analysis were obtained from two clinical trials ([NCT02652559][1] and [NCT03053973][2]). Request for data sharing should be directed to the principal investigators of those trials. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02652559&atom=%2Fthoraxjnl%2Fearly%2F2025%2F01%2F01%2Fthorax-2024-221899.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03053973&atom=%2Fthoraxjnl%2Fearly%2F2025%2F01%2F01%2Fthorax-2024-221899.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"17 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal club","authors":"Alexandra Hodge","doi":"10.1136/thorax-2024-222742","DOIUrl":"https://doi.org/10.1136/thorax-2024-222742","url":null,"abstract":"There are no licensed pharmacological treatments for obstructive sleep apnoea (OSA). Obesity is a modifiable risk factor for OSA with existing pharmacological interventions. One such treatment is tirzepatide which is a long-acting glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide-1 (GLP-1) receptor agonist. Malhotra et al . (N Engl J Med 2024;391:1193–1205) reported the SURMONT-OSA phase three trials which evaluated the safety and efficacy of tirzepatide for the treatment of OSA in obese adults. SURMONT-OSA comprised of two multi-centre, international, double-blind, randomised, controlled trials conducted over 52 weeks. All participants had moderate-severe OSA. Participants were randomised to placebo or tirzepatide treatment arms. Trial one included participants unable or unwilling to use positive airway pressure (PAP) therapy (n=234) and trial two included participants using and continuing PAP therapy (n=235). The primary end-point was the change in apnoea-hypopnea index (AHI) from baseline. In trial one the mean change in AHI at week 52 was −25.3 events/hour (95% CI, −29.3 to −21.2) with tirzepatide and −5.3 events/hour (95% CI, −9.4 to −1.1) with placebo. In trial 2, after withdrawing PAP therapy, the mean change in AHI at week 52 with tirzepatide was −29.3 events/hour (95% CI, −33.2 to −25.4, p<0.001) and …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"36 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: What’s hot that the other lot got","authors":"BMJ Publishing Group Ltd and British Thoracic Society","doi":"10.1136/thoraxjnl-2015-207694corr1","DOIUrl":"https://doi.org/10.1136/thoraxjnl-2015-207694corr1","url":null,"abstract":"Higginson J. What’s hot that the other lot got. Thorax 2015;70:1010. This Journal club article was originally published with 2 citations missing. The relevant citations have been added to the text below. The editors would like to apologise for any inconvenience caused. Zhou et al (J Clin Oncol 2015 Jul 1;33(19):2197–204) have performed a randomised, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"11 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142874038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABCA3-related interstitial lung disease in a young woman","authors":"Simone Petrarulo, Claudia Ravaglia, Maria Giulia Disanto, Sara Piciucchi, Venerino Poletti","doi":"10.1136/thorax-2024-222120","DOIUrl":"https://doi.org/10.1136/thorax-2024-222120","url":null,"abstract":"A 25-year-old non-smoking caucasian woman, with no family history of interstitial lung disease (ILD) or consanguinity, presented with a 6-month history of progressive exertional dyspnoea, chest pain and episodes of mild haemoptysis. Her medical history was unremarkable. Physical examination revealed bibasilar crackles and digital clubbing. Blood tests showed neutrophilic leucocytosis (WBC 12 040/mm³ with neutrophils 9860/mm³) and CRP 3.8 mg/L. An autoimmunity panel and specific IgG tests for mould and avian antigens were all negative. Spirometry indicated a restrictive ventilatory defect with severe impairment of DLCO (FVC 57% predicted and DLCO 35% predicted). A high resolution CT revealed ground-glass attenuation in the peripheral regions of both lungs, with small cysts in the anterior segments of both upper lobes (figure 1). A bronchoalveolar lavage performed in the lingula showed 99% macrophages and 1% lymphocytes, and microbiology cultures for bacterial, fungal and viral pathogens were negative. After a multidisciplinary discussion, a transbronchial …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"87 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do inhaled corticosteroids decrease the risk of cardiovascular outcomes in patients with chronic obstructive pulmonary disease?","authors":"David M Mannino","doi":"10.1136/thorax-2024-222606","DOIUrl":"https://doi.org/10.1136/thorax-2024-222606","url":null,"abstract":"Polymorbidity is an important component of chronic obstructive pulmonary disease (COPD), with cardiovascular diseases being among the most important comorbidities.1 The development of both incident and recurrent cardiovascular events is related to the degree of lung function impairment in COPD.2 Acute exacerbations of COPD (AECOPD) are associated with a higher risk of developing an acute cardiovascular event, particularly in the first 6 months following the AECOPD.3 4 Therapies that include inhaled corticosteroids (ICS) decrease the risk of exacerbations.5 6 Thus, it would follow that therapies that decrease exacerbations, such as those include ICS, would decrease cardiovascular events. This was the topic for the Study to Understand Mortality and Morbidity in COPD trial, a 3-year trial of over 16 000 patients randomised into four groups (placebo, fluticasone furoate, vilanterol and fluticasone/vilanterol).7 The ICS-containing groups had fewer exacerbations and less lung function decline but did not significantly decrease mortality or cardiovascular events. Cardiopulmonary events are the focus for ‘A Randomised, Double-Blind, Parallel Group, Multicentre, Phase III Study to Assess the Efficacy of Budesonide, Glycopyrronium and Formoterol Fumarate Metered Dose Inhaler Relative to Glycopyrronium and Formoterol Fumarate MDI on Cardiopulmonary Outcomes in COPD (THARROS)’, which is currently recruiting up to 5000 patients with an estimated completion in 2028.8 The …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"71 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroid therapy for treating acute exacerbation of interstitial lung diseases: a systematic review","authors":"Narat Srivali, Federica De Giacomi, Teng Moua, Jay H Ryu","doi":"10.1136/thorax-2024-222636","DOIUrl":"https://doi.org/10.1136/thorax-2024-222636","url":null,"abstract":"Introduction Acute exacerbation of interstitial lung disease (AE-ILD) often results in death and poses significant challenges in clinical management. While corticosteroids are frequently employed, the optimal regimen and their clinical efficacy remain uncertain. To address this knowledge gap, we undertook a systematic review to evaluate the impact of steroid therapy on clinical outcomes in patients experiencing AE-ILD. Method Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched multiple databases, identifying 12 454 articles. After removing duplicates and screening titles and abstracts, 447 articles were selected for full-text review. Ultimately, nine studies met inclusion criteria, comparing high-dose corticosteroids with low-dose or non-steroidal interventions in treating AE-ILD. Key outcomes included in-hospital and long-term mortality, as well as AE recurrence. Results Analysis of nine studies (total n=18 509) revealed differential treatment effects based on the ILD subtype. In non-idiopathic pulmonary fibrosis (IPF) ILD, high-dose corticosteroid therapy (>1.0 mg/kg prednisolone) demonstrated improved survival (adjusted HR 0.221, 95% CI 0.102 to 0.480, p<0.001) and reduced 90-day mortality. Early tapering of high-dose corticosteroids (>10% reduction within 2 weeks) reduced in-hospital mortality (adjusted HR 0.37, 95% CI 0.14 to 0.99). Higher cumulative doses in the first 30 days (5185±2414 mg/month vs 3133±1990 mg/month) were associated with lower recurrence rates (adjusted HR 0.61, 95% CI 0.41 to 0.90, p=0.02). In IPF patients, however, high-dose therapy showed inconsistent benefits, with some studies reporting increased mortality risk (OR 1.075, 95% CI 1.044 to 1.107, p<0.001). Conclusion This review emphasises the potential benefits of individualised treatment approaches for AE-ILD but highlights the need for caution in making definitive recommendations. Although high-dose corticosteroids may show promise, particularly in non-IPF cases, the current evidence is inconsistent, and the lack of robust supporting literature makes it difficult to draw firm conclusions. Further research through randomised controlled trials is necessary to refine and optimise therapeutic strategies for AE-ILD. Data sharing not applicable as no datasets generated and/or analysed for this study.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"8 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled corticosteroids and major cardiovascular events in people with chronic obstructive pulmonary disease","authors":"Anne E Ioannides, Constantinos Kallis, Hannah R Whittaker, Jennifer K Quint","doi":"10.1136/thorax-2024-222113","DOIUrl":"https://doi.org/10.1136/thorax-2024-222113","url":null,"abstract":"Background Whether inhaled corticosteroids (ICSs) reduce major adverse cardiovascular events (MACEs) in people with chronic obstructive pulmonary disease (COPD) is debated. Objectives To establish, within people with COPD, (1) whether ICS reduced MACE rates (acute coronary syndrome (ACS), heart failure (HF), ischaemic strokes or cardiovascular-specific death) compared with long-acting bronchodilators; and (2) whether drug class, incident usership or patient cardiovascular history influenced the ICS-MACE relationship. Methods We conducted a cohort study including patients with COPD in England, using Clinical Practice Research Datalink Aurum data, linked with Hospital Episode Statistics and Office of National Statistics death data, between 1 January 2010 and 31 December 2019. We implemented Cox proportional hazard regressions, adjusting for time interactions or using propensity score-adjusted models, as necessary. Our exposures included prescriptions of any ICS (vs any long-acting bronchodilators) and triple therapy (vs combination long-acting bronchodilators), determined during the year prior to follow-up. The outcomes of interest were MACE collectively and individual MACE subtypes. Measurements and main results Among 113 353 people with COPD (mean age 67.9 years old, 53.3% male), ICS prescription was not associated with MACE (adjusted HR (95% CI)=0.98 (0.95, 1.02), p=0.41) but was associated with reduced HF, specifically, until year 6 of follow-up (average adjusted HR (95% CI)=0.91 (0.86, 0.96), p<0.001). HF reduction was driven by the ICS group containing mometasone furoate, beclomethasone, budesonide or ciclesonide (HR (95% CI)=0.89 (0.84, 0.94), p<0.001). Incident ICS use was associated with increased ACS (HR (95% CI)=1.27 (1.09, 1.47), p<0.001) but was not sustained beyond incident use. There was no association between triple therapy and MACE. Results did not differ by cardiovascular history. Conclusions ICS did not reduce MACE, except HF, likely by reducing misclassified COPD exacerbations. Data may be obtained from a third party and are not publicly available. Data sets generated and/or analysed in this study are not publicly available, however, data are available on request from the CPRD. Their provision requires the purchase of a license and this license does not permit the authors to make them publicly available to all. This work used data from the version collected in May 2022 and has clearly specified the data selected in the Methods section. To allow identical data to be obtained by others, via the purchase of a license, the code lists will be provided upon request. Licenses are available from the CPRD (<http://www.cprd.com>): The Clinical Practice Research Datalink Group, The Medicines and Healthcare products Regulatory Agency, 10 South Colonnade, Canary Wharf, London E14 4PU.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"41 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endobronchial obstruction of the left middle lobe","authors":"Hardeep Singh Kalsi, Rimsha Khan, Reena Khiroya, Neal Navani, Ricky Thakrar","doi":"10.1136/thorax-2024-221955","DOIUrl":"https://doi.org/10.1136/thorax-2024-221955","url":null,"abstract":"A 48-year-old woman reported a 1-year history of breathlessness, persistent cough and recurrent chest infections. She was a former smoker with a medical history of nasal polyps and asthma since childhood. She was managed as a case of worsening bronchial asthma, until a CT scan was performed to investigate anaemia, incidentally identified an obstructing lesion in her left main bronchus (figure 1). She was referred to our specialist interventional bronchoscopy unit for further investigation and management. A review of her imaging disclosed a pedunculated soft tissue lesion obstructing the distal left main bronchus and presence of left-to-right axis switching of the aorta and inferior vena cava with polysplenia (figure 1). All abdominal organs were normally sited. Figure 1 (A) Chest x-ray showing dextrocardia and partial left lower lobe collapse (B) CT chest with contrast demonstrating left hilar lesion on axial view (see arrow & red circle) (C) Coronal view showing lesion in distal …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"25 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular phenotypes of critical illness confer prognostic and biological enrichment in sub-Saharan Africa: a prospective cohort study from Uganda","authors":"Matthew J Cummings, Julius J Lutwama, Alin S Tomoiaga, Nicholas Owor, Xuan Lu, Jesse E Ross, Moses Muwanga, Christopher Nsereko, Irene Nayiga, Kai Nie, John Kayiwa, Xiaoyu Che, Misaki Wayengera, Seunghee Kim-Schulze, W Ian Lipkin, Max R O’Donnell, Barnabas Bakamutumaho","doi":"10.1136/thorax-2024-222412","DOIUrl":"https://doi.org/10.1136/thorax-2024-222412","url":null,"abstract":"The generalisability of critical illness molecular phenotypes to low- and middle-income countries (LMICs) is unknown. We show that molecular phenotypes derived in high-income countries (hyperinflammatory and hypoinflammatory, reactive and uninflamed) stratify sepsis patients in Uganda by physiological severity, mortality risk and dysregulation of key pathobiological domains. A classifier model including data available at the LMIC bedside modestly discriminated phenotype assignment (area under the receiver operating characteristic curve (AUROC) 0.80, 95% CI 0.71 to 0.90 for hyperinflammatory vs hypoinflammatory; AUROC 0.74, 95% CI 0.65 to 0.83 for reactive vs uninflamed). Our findings highlight the potential for a globally relevant, clinicomolecular classification of critical illness and may support the inclusion of diverse populations in phenotype-targeted critical care trials. Improved laboratory capacity and access to rapid biomarker assays are likely necessary to optimise phenotype stratification in LMIC settings.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"11 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative estimate of glucose-lowering therapies on risk of incident pneumonia and severe sepsis: an analysis of real-world cohort data.","authors":"Alex E Henney, David R Riley, Theresa J Hydes, Matthew Anson, Gema H Ibarburu, Frederick Frost, Uazman Alam, Daniel J Cuthbertson","doi":"10.1136/thorax-2024-221906","DOIUrl":"10.1136/thorax-2024-221906","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are treatments for type 2 diabetes (T2D). Beyond glucose-lowering and cardiorenal protection, these drugs may protect against pneumonia and sepsis.</p><p><strong>Aims: </strong>This study assesses the impact of SGLT2i and GLP-1 RAs on the risk of incident pneumonia and severe sepsis.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using anonymised electronic medical records from TriNetX, a global federated database. Two intention-to-treat analyses were performed, each with two cohorts of adult T2D patients. The first analysis compared individuals prescribed SGLT2i, and the second individuals prescribed GLP-1 RAs, with those prescribed dipeptidyl peptidase-4 inhibitors (DPP-4i). An active comparator new user design was used, with outcomes defined as time-to-incident pneumonia and severe sepsis. Propensity score matching (1:1) was applied to control for potential confounders, and patients were followed for 12 months. Secondary analyses compared SGLT2i and GLP-1 RAs against other glucose-lowering therapies.</p><p><strong>Results: </strong>After propensity score matching, 352 687 patients were included in the SGLT2i versus DPP-4i comparison. SGLT2i treatment was associated with a risk reduction in incident pneumonia (HR 0.75 (95% CI 0.73, 0.78)) and severe sepsis (0.75 (0.73, 0.77)). In the GLP-1 RA versus DPP-4i comparison, 331 863 patients were included. GLP-1 RA treatment was associated with a risk reduction in incident pneumonia (0.60 (0.58, 0.62)) and severe sepsis (0.61 (0.59, 0.63)).</p><p><strong>Conclusion: </strong>SGLT2i and GLP-1 RAs are associated with a reduced risk of incident pneumonia and severe sepsis in patients with T2D. Further research and focused randomised controlled trials are warranted to explore the broader clinical implications of these treatments.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"32-41"},"PeriodicalIF":9.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}