World Journal of Hepatology最新文献

{"title":"Response rates, survival status and adverse events of placebo in randomized control trials for hepatocellular carcinoma: A meta-analysis.","authors":"Wei-Yu Chen, Qing Chen, Chen-Chen Wang, Chen-Yue Zhang, Si-Kun Chen, Zhi-Qiang Meng, Ping Han, Shu Dong, Qi-Wen Chen","doi":"10.4254/wjh.v17.i8.108533","DOIUrl":"10.4254/wjh.v17.i8.108533","url":null,"abstract":"<p><strong>Background: </strong>In randomized controlled trials (RCTs), the placebo arm has often been ignored as the attention tends to be focused on the treatment arm. We undertook a meta-analysis based on the data from the placebo arm in RCTs of hepatocellular carcinoma (HCC), the response rates and survival status, and adverse events (AEs) were summarized and evaluated.</p><p><strong>Aim: </strong>To systematically evaluate the response rates, survival status and AEs in the placebo arms of RCTs for HCC.</p><p><strong>Methods: </strong>A systematic search was performed on PubMed, Ovid MEDLINE, Embase and Cochrane Library to identify relevant trials evaluating the efficacy of drugs for the treatment of HCC, published until December 31, 2023. Statistical analysis was performed using R statistical software (version 4.3.2).</p><p><strong>Results: </strong>A total of 18 RCTs, involving 2390 patients, met the criteria for inclusion in the meta-analysis. The pooled overall disease control rate and objective response rate in the placebo group were 38% [95% confidence interval (CI): 33%-42%] and 1% (95%CI: 1%-2%), respectively. Overall survival and progression-free survival in the placebo group were 7.9 months (95%CI: 7.6-8.31 months) and 1.9 months (95%CI: 1.6-2.1 months), respectively. The incidence of grade 3 or 4 AEs was 37% (95%CI: 30%-43%). Additionally, the incidence of interruptions or dose reductions due to AEs was 20% (95%CI: 13%-27%), while the incidence of treatment discontinuation due to AEs was 9% (95%CI: 6%-12%).</p><p><strong>Conclusion: </strong>Over one-third of advanced HCC patients exhibit therapy-free disease control, with placebo-arm AEs observed. These findings guide single-arm trials design and enhance patient acceptance of anticancer therapies.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 8","pages":"108533"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993244","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":"Iron metabolism and sepsis-associated liver injury: Methodological considerations and clinical perspectives.","authors":"Gokhan Koker","doi":"10.4254/wjh.v17.i8.108474","DOIUrl":"10.4254/wjh.v17.i8.108474","url":null,"abstract":"<p><p>This letter offered commentary on the recently published article by Wang <i>et al</i> that investigated the relationship between iron metabolism disorders and sepsis-associated liver injury (SALI). The original study identified serum iron and total iron-binding capacity as potential predictive markers of SALI, contributing important insights to critical care hepatology. In this correspondence several methodological considerations that may influence the interpretation and generalizability of the findings were discussed. These include the limitations of a single-center design, the lack of serial biomarker measurements, the omission of hepcidin (a central iron regulatory hormone) as a measured variable, and the exclusive reliance on biochemical criteria for diagnosing liver injury. The potential value of incorporating imaging modalities and additional iron-related markers such as ferritin and transferrin saturation were also highlighted. The aim was to reinforce the importance of a comprehensive approach to iron metabolism in sepsis and to suggest future directions for clinical research that may enhance the diagnostic and prognostic utility of iron-related biomarkers in SALI.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 8","pages":"108474"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993599","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":"Biparametric magnetic resonance imaging-based radiomic and deep learning models for predicting Ki-67 risk stratification in hepatocellular carcinoma.","authors":"Xue-Yong Zuo, Hai-Feng Liu","doi":"10.4254/wjh.v17.i8.109530","DOIUrl":"10.4254/wjh.v17.i8.109530","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is a prevalent and life-threatening cancer with increasing incidence worldwide. High Ki-67 risk stratification is closely associated with higher recurrence rates and worse outcomes following curative therapies in patients with HCC. However, the performance of radiomic and deep transfer learning (DTL) models derived from biparametric magnetic resonance imaging (bpMRI) in predicting Ki-67 risk stratification and recurrence-free survival (RFS) in patients with HCC remains limited.</p><p><strong>Aim: </strong>To develop a nomogram model integrating bpMRI-based radiomic and DTL signatures for predicting Ki-67 risk stratification and RFS in patients with HCC.</p><p><strong>Methods: </strong>This study included 198 patients with histopathologically confirmed HCC who underwent preoperative bpMRI. Ki-67 risk stratification was categorized as high (> 20%) or low (≤ 20%) according to immunohistochemical staining. Radiomic and DTL signatures were extracted from the T2-weighted and arterial-phase images and combined through a random forest algorithm to establish radiomic and DTL models, respectively. Multivariate regression analysis identified clinical risk factors for high Ki-67 risk stratification, and a predictive nomogram model was developed.</p><p><strong>Results: </strong>A nonsmooth margin and the absence of an enhanced capsule were independent factors for high Ki-67 risk stratification. The area under the curve (AUC) of the clinical model was 0.77, while those of the radiomic and DTL models were 0.81 and 0.87, respectively, for the prediction of high Ki-67 risk stratification, and the nomogram model achieved a better AUC of 0.92. The median RFS times for patients with high and low Ki-67 risk stratification were 33.00 months and 66.73 months, respectively (<i>P</i> < 0.001). Additionally, patients who were predicted to have high Ki-67 risk stratification by the nomogram model had a lower median RFS than those who were predicted to have low Ki-67 risk stratification (33.53 <i>vs</i> 66.74 months, <i>P</i> = 0.007).</p><p><strong>Conclusion: </strong>Our developed nomogram model demonstrated good performance in predicting Ki-67 risk stratification and predicting survival outcomes in patients with HCC.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 8","pages":"109530"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993648","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":"Liver regeneration after partial hepatectomy: Triggers and mechanisms.","authors":"Bakari Korchilava, Tamar Khachidze, Nino Megrelishvili, Lika Svanadze, Manana Kakabadze, Keti Tsomaia, Memed Jintcharadze, Dimitri Kordzaia","doi":"10.4254/wjh.v17.i7.107378","DOIUrl":"10.4254/wjh.v17.i7.107378","url":null,"abstract":"<p><p>Liver regeneration (LR) following partial hepatectomy (PH) is a unique and complex physiological response that restores hepatic mass and function through tightly orchestrated cellular and molecular events. Traditionally viewed as a proliferation-driven process, LR is now understood to involve both hepatocyte hyperplasia and hypertrophy, triggered primarily by hemodynamic alterations such as increased portal pressure and shear stress. These promote LR through endothelial-hepatocyte communication <i>via</i> activation of Piezo1 - a mechanosensitive ion channel highly expressed in vascular endothelial cells. This channel is considered one of the potential upstream activators of molecular cascades including the interleukin (IL)-6/signal transducer and activator of transcription 3, tumour necrosis factor-alpha/nuclear factor-kappa B, Wnt/β-catenin, Hippo/ YAP, transforming growth factor-beta, and Notch pathways, which contribute variably to the proliferation, differentiation, or suppression of hepatic cells. Novel insights into the IL-22 and IL-33 signaling axes, bile acid and glutamine metabolism, and the role of intestinal microbiota are also presented as promising emerging targets. This review synthesizes current insights into the interplay between mechanical cues, key signaling pathways, and metabolic reprogramming that govern early regenerative responses. We explore the mechanisms dictating the balance between hyperplasia and hypertrophy, noting that hypertrophy predominates after minor resections, while proliferation is dominant in larger resections. Polyploidization emerges as a significant adaptive mechanism, contributing to hepatocyte survival and tissue remodeling. The importance of ductular reactions, microvascular adjustments, and extracellular matrix dynamics in lobular architecture remodeling is also highlighted. The study explores the occurrence of ductular reactions in both minor and major resections, particularly within the granulation tissue near dissection areas. The paper also examines structural remodeling in regenerated liver tissue, demonstrating ongoing transformations in hepatocyte morphology and sinusoidal architecture even months after PH, and emphasizing that the termination of liver mass regrowth does not equate to the cessation of LR.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 7","pages":"107378"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761525","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":"New hope in treating progressive familial intrahepatic cholestasis in children.","authors":"Lama Ebrahim Mkarem, Mohammed Ali Hosny Batika, Rana Bitar","doi":"10.4254/wjh.v17.i7.108253","DOIUrl":"10.4254/wjh.v17.i7.108253","url":null,"abstract":"<p><p>Progressive familial intrahepatic cholestasis (PFIC) is a group of rare, inherited cholestatic liver disorders presenting in infants and children and are associated with impaired bile flow (<i>i.e.</i>, cholestasis), pruritus and progressive liver disease. Historically there has been no effective or approved pharmacologic treatments for these disorders and standard medical treatment has only been supportive. The impaired bile flow within the liver, leads to accumulation in the liver and inflammation. Historically there has been no effective or approved pharmacologic treatments for these disorders and standard medical treatment has only been supportive. A potential for reducing pathologic bile accumulation in the liver is surgical biliary diversion, with an aim to interrupt the enterohepatic circulation. These procedures have demonstrated a positive effect in PFIC by normalizing serum bile acids, reducing pruritus and liver injury and improving the patient quality of life. Nonsurgical approach to interrupting the enterohepatic circulation is inhibition of the ileal bile acid transporter (IBAT). IBAT inhibition has demonstrated efficacy in reducing serum bile acids and pruritus. We aim to present the 13 types of PFIC and the current evidence on the use of IBAT inhibitors in treating children with PFIC.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 7","pages":"108253"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761529","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":"Role of mac-2 binding protein glycosylation isomer in predicting fibrosis in patients with metabolic dysfunction-associated steatotic liver disease.","authors":"Thuy Thi Thu Pham, Dat Tan Ho, Chanh Pham, Hoan Phan, Bieu Phu, Toan Nguyen, Dang Nguyen, Hai Thanh Phan, Khue Minh Nguyen","doi":"10.4254/wjh.v17.i7.106991","DOIUrl":"10.4254/wjh.v17.i7.106991","url":null,"abstract":"<p><strong>Background: </strong>Mac-2 binding protein glycosylation isomer (M2BPGi) serves as a marker of activated hepatic stellate cells and as such holds potential as a biomarker for liver fibrosis. In Viet Nam, metabolic dysfunction-associated steatotic liver disease (MASLD) is rising in prevalence and there is an urgent need for better clinical management, particularly in early detection methods that will improve overall prognosis.</p><p><strong>Aim: </strong>To examine M2BPGi cut-off values for staging liver fibrosis in patients with MASLD and risk factors associated with disease progression.</p><p><strong>Methods: </strong>A total of 301 individuals with ultrasound-confirmed or FibroScan-confirmed diagnosis of fatty liver were enrolled in the study. The participants were stratified according to fibrosis stage, measured <i>via</i> magnetic resonance elastography. M2BPGi, Fibrosis-4 (FIB-4) Index score, and routine parameters of liver function were assessed to statistically investigate the correlation of M2BPGi levels in various fibrosis stages and to identify risk factors associated with fibrosis severity.</p><p><strong>Results: </strong>M2BPGi levels positively correlated with fibrosis stages, with cut-off indexes of 0.57 for F0-1, 0.68 for F2-3, and 0.78 for F4. M2BPGi levels in the F0-1 group were significantly different from those in both the F2-3 group (<i>P</i> = 0.038) and the F4 group (<i>P</i> = 0.0051); the F2-3 and F4 groups did not show a significant difference (<i>P</i> = 0.39). Females exhibited significantly higher M2BPGi levels than males for all fibrosis stages, particularly in the F2-3 group (<i>P</i> = 0.01) and F4 group (<i>P</i> = 0.0006). In the F4 (cirrhosis) group, individuals with diabetes had significantly higher M2BPGi levels than those without. M2BPGi, hemoglobin A1c, and FIB-4 score were identified as independent risk factors for greater fibrosis and cirrhosis.</p><p><strong>Conclusion: </strong>M2BPGi levels varied significantly throughout fibrosis progression, from early MASLD to cirrhosis, with sex correlation. M2BPGi holds promise as an early biomarker for fibrosis characterization in MASLD adult patient populations.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 7","pages":"106991"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761530","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":"Link between type 2 diabetes mellitus and hepatocellular carcinoma.","authors":"Somdatta Giri, Alpana Mukhuty, Samim A Mondal, Jayaprakash Sahoo, Ayan Roy, Sadishkumar Kamalanathan, Dukhabandhu Naik","doi":"10.4254/wjh.v17.i7.107675","DOIUrl":"10.4254/wjh.v17.i7.107675","url":null,"abstract":"<p><p>Type 2 diabetes mellitus (T2DM) and hepatocellular carcinoma (HCC) have a strong bidirectional relationship. T2DM increases the risk of developing HCC, mainly through the nonalcoholic steatohepatitis pathway, but a significant proportion of patients develop HCC without developing cirrhosis. The identification of HCC in T2DM patients is difficult considering the low incidence of HCC and the high prevalence of T2DM. However, considering the alarming increase in the incidence of diabetes mellitus in the global population, effective strategies are urgently needed to identify patients at high risk. Nonetheless, various classes of drugs, such as sodium-glucose cotransporter-2 inhibitors and incretin analogs, may be promising for reducing the risk of nonalcoholic steatohepatitis and HCC development in T2DM patients in the future. In this review, we discuss all these facets of the relationship between HCC and T2DM, and we summarize future directions.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 7","pages":"107675"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761522","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":"Are we standing on the shifting sands of post-transplant metabolic-associated steatotic liver disease?","authors":"Renata Zatta, Luana S da Silva, Guilherme Felga, Carolina Fmg Pimentel","doi":"10.4254/wjh.v17.i7.107837","DOIUrl":"10.4254/wjh.v17.i7.107837","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the predominant global cause of chronic liver disease and represents a major indication for liver transplantation. Post-transplant MASLD manifests as recurrent disease in nearly all recipients by five years post-transplantation, while de novo MASLD shows variable incidence (18%-78%). Although histologically similar, recurrent MASLD follows a more aggressive trajectory, with accelerated fibrosis and cirrhosis. Metabolic disturbances, immunosuppression regimens, donor-related factors, and chronic inflammation synergistically contribute to disease pathogenesis. The disorder not only compromises graft function but is also associated with elevated cardiovascular and overall morbidity, and malignancy risk. Despite advancements in noninvasive diagnostics, histopathology remains essential for definitive diagnosis and prognostic stratification. Management should prioritize metabolic optimization, lifestyle intervention, and tailored immunosuppressive regimens. Glucagon-like peptide-1 receptor agonists represent a promising therapeutic avenue. However, the absence of standardized, transplant-specific guidelines is a significant limitation. Further research is necessary to define diagnostic criteria, risk stratification, and targeted therapy to improve graft survival and patient outcomes.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 7","pages":"107837"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761476","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":"Systemic treatment of liver cancer: Current status and future perspectives.","authors":"Chun-Bo Li, Yu-Ting Ning, Nai-Ying Shen, Ben Wang, Han Xiao, Gang Luo","doi":"10.4254/wjh.v17.i7.107520","DOIUrl":"10.4254/wjh.v17.i7.107520","url":null,"abstract":"<p><p>Primary liver cancer, a common malignant tumor of the digestive tract, ranks fifth in global cancer incidence and shows high morbidity and mortality. Liver cancer patients who are diagnosed early have the option of surgical resection, which offers the possibility of a radical cure. However, due to the insidious disease onset, most patients are diagnosed in the intermediate or advanced stages, and surgery is no longer a viable option. Therefore, systemic treatment options play an essential role in the management of advanced liver cancer. These treatments aim to suppress disease progression, prolong survival, and improve quality of life. This article reviews the latest research in the field of systemic therapy of liver cancer, including molecular targeted therapy, immunotherapy, and their combination strategies. At first, the application and efficacy of first-line molecularly targeted drugs are discussed. Next, the revolutionary advances in immune checkpoint blockers are presented. Subsequently, the clinical effects of the combination of molecularly targeted therapy and immunotherapy are analyzed. Finally, this article summarizes the current challenges faced by the systemic treatment of liver cancer and introduces the prospect of future treatment trends.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 7","pages":"107520"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761532","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":"Toward non-invasive assessment strategies in autoimmune hepatitis.","authors":"David Jerez Diaz, Patrick Twohig","doi":"10.4254/wjh.v17.i7.107881","DOIUrl":"10.4254/wjh.v17.i7.107881","url":null,"abstract":"<p><p>In this article, we comment on the article by Peta <i>et al</i>. This study evaluates the diagnostic performance of FibroTest-Actitest, transient elastography, and the fibrosis-4 index against a histological reference. Using the Obuchowski measure, the authors demonstrate that FibroTest and vibration-controlled transient elastography outperform the fibrosis-4 index in detecting fibrosis. Additionally, Actitest offers superior estimation of inflammatory activity compared to conventional biomarkers. Assessing liver fibrosis is crucial for managing autoimmune hepatitis (AIH), yet reliance on invasive liver biopsy remains higher than in other liver diseases. This is partly due to more complex diagnostic criteria for AIH, the lack of standardized scoring for non-invasive testing, and the presence of inflammation, which can lead to falsely elevated results with non-invasive tests. A Bayesian latent class model further supports the reliability of these non-invasive tests, highlighting their potential to complement biopsy, particularly for long-term disease monitoring. These findings underscore the importance of non-invasive diagnostics in optimizing AIH management.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 7","pages":"107881"},"PeriodicalIF":2.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761534","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}