Clinical Parkinsonism Related Disorders最新文献

{"title":"Pathophysiology of dystonia: Through the lens of Mark Hallett","authors":"Anna Latorre ,&nbsp;Lorenzo Rocchi ,&nbsp;Kailash P. Bhatia","doi":"10.1016/j.prdoa.2026.100454","DOIUrl":"10.1016/j.prdoa.2026.100454","url":null,"abstract":"<div><div>Dystonia was originally framed as a basal ganglia disorder, yet the mechanisms linking abnormal basal ganglia output to its defining clinical features have remained uncertain. Over four decades, Mark Hallett approached this problem by posing deceptively simple mechanistic questions and addressing them through careful physiological investigation, progressively reshaping the conceptual understanding of dystonia. Across these investigations, the concept of dystonia evolved from abnormalities of muscle activation toward broader concepts of motor control and network dysfunction. Emerging evidence suggested that dystonia reflects abnormal regulation within distributed sensorimotor networks, where impaired inhibition, abnormal premotor influences, altered sensory modulation, and dysregulated plasticity interact across cortical and subcortical circuits. In this framework, dystonia is not simply excessive movement, but a failure of the mechanisms that normally refine and shape motor behaviour. At the same time, Hallett consistently emphasized the heterogeneity of dystonia and cautioned against overgeneralization. By considering individual dystonic entities on their own terms, his work provides more than a catalogue of physiological findings: it offers a coherent framework for understanding how abnormal physiological processes may become acquired and stabilized within motor networks. The persistence of dystonia despite diverse treatments suggests that the decisive factor may lie not in outward phenomenology, but in the durability of network modification itself. Understanding how such pathological motor memories are maintained—and how they might be safely reversed—remains central to future therapeutic progress.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100454"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177650","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":"Sexual dysfunction in movement disorders: prevalence, clinical features, associated factors and management","authors":"Vincent Leclercq","doi":"10.1016/j.prdoa.2026.100452","DOIUrl":"10.1016/j.prdoa.2026.100452","url":null,"abstract":"<div><div>Sexual dysfunction is a common but insufficiently addressed non-motor symptom in movement disorders. While Parkinson’s disease (PD) is the condition most frequently investigated, sexual dysfunction is also reported in Huntington’s disease, dystonia, and other movement disorders. Clinical presentations are heterogeneous, encompassing reduced desire, erectile dysfunction, ejaculatory and orgasmic disorders, lubrication difficulties, dyspareunia, and hypersexuality. In PD, prevalence estimates vary widely across studies, largely because of differences in disease stage, cultural context, and assessment methodology. The most consistent associated factors include depression, anxiety, age, autonomic dysfunction, and motor disability. Dopaminergic treatment has a bidirectional influence, with potential benefit on hypoactive sexual symptoms but an increased risk of hypersexuality, especially with dopamine agonists. Evidence for treatment remains limited, with the strongest support for phosphodiesterase-5 inhibitors in erectile dysfunction and dopaminergic treatment adjustment in hypersexuality. Sexual dysfunction remains underrecognized in routine practice despite its major impact on quality of life and intimate relationships. Routine screening and multidisciplinary management should be encouraged in the care of patients with movement disorders.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100452"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147951146","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":"Chronic lead encephalopathy in an adult: A case report and literature review","authors":"Tourby Rim,&nbsp;Sikkal Asmaa,&nbsp;Khattab Hajar,&nbsp;Haddouali Kamal,&nbsp;Bellakhdar Salma,&nbsp;El Moutawakil Bouchra,&nbsp;Rafai M.A.,&nbsp;El Otmani Hicham","doi":"10.1016/j.prdoa.2026.100450","DOIUrl":"10.1016/j.prdoa.2026.100450","url":null,"abstract":"<div><div>We report the case of a 51-year-old man with lead encephalopathy due to chronic occupational exposure in fishing net manufacturing. Over three years, he developed cognitive decline, cerebellar ataxia, parkinsonism, and myoclonus. MRI showed bilateral hyperintensities T2/FLAIR sequences in deep brain structures, and elevated blood lead levels confirmed the diagnosis [2]. Chelation therapy led to slight improvement in motor symptoms, but cognitive deficits persisted [3]. This case highlights the importance of early recognition and management of lead neurotoxicity to prevent irreversible brain damage.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"15 ","pages":"Article 100450"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214693","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":"Improving access to care through transportation and internet use for patients with atypical parkinsonism: A pilot study","authors":"Maria Schmidt,&nbsp;Kyurim Kang,&nbsp;Hannah Jackson,&nbsp;Claudia Waddell,&nbsp;Anna Hall,&nbsp;Alexander Pantelyat","doi":"10.1016/j.prdoa.2026.100431","DOIUrl":"10.1016/j.prdoa.2026.100431","url":null,"abstract":"<div><h3>Introduction</h3><div>This quality improvement study aimed to assess whether arrangement of transportation and/or distribution of internet-enabled tablets could improve access to care in a multi-disciplinary Atypical Parkinsonism clinic for patients with Progressive Supranuclear Palsy (PSP), corticobasal syndrome (CBS), and multiple system atrophy (MSA) who 1) lack the ability to arrange transportation to our clinics; 2) lack reliable Internet access/devices for telehealth, or 3) both 1) and 2).</div></div><div><h3>Methods</h3><div>Patients and care partners completed digitally distributed surveys and were given the option to complete hard copy surveys. The primary outcome variable was change in patient-reported Accessibility survey responses at 6 months, and secondary outcome variables included change in patient-reported assessments (PSP-QoL, CBFS, MSA-QoL) and Zarit Caregiver Burden Scale scores at 6 months.</div></div><div><h3>Results</h3><div>While limited access to resources was a less frequently reported factor at 6-month follow-up, there was an increase in factors contributing to worse quality of life (QoL) for PSP patients. There was no effect on transportation barriers at 6-month follow-up.</div></div><div><h3>Conclusions</h3><div>Integrating transportation support into routine care processes can help improve access to care for patients with PSP, CBS, and MSA.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100431"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327440","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 systematic review of the clinical correlates of delusions in Parkinson's disease.","authors":"Tarini Sharma,&nbsp;Abhishek Lenka,&nbsp;Emma McLachlan,&nbsp;Jennifer Foley,&nbsp;Suzanne Reeves","doi":"10.1016/j.prdoa.2026.100493","DOIUrl":"10.1016/j.prdoa.2026.100493","url":null,"abstract":"<div><h3>Introduction</h3><div>Research within Parkinson's disease (PD) psychosis has mostly focused on hallucinations due to their higher prevalence, limiting our understanding of the clinical correlates of delusions. This review aims to systematically review the content and clinical correlates of delusions in PD, including demographic, motor and non-motor symptoms and medication.</div></div><div><h3>Method</h3><div>Following PRISMA Guidelines, a search on Ovid Medline, PsycINFO, Web of Science and Embase was performed to include English language studies evaluating delusions in PD. Data extraction included study and patient characteristics, clinical factors, outcome measures and cognitive correlates. Risk of bias was assessed for each study.</div></div><div><h3>Results</h3><div>Seven studies were eligible. Persecutory delusions were most commonly reported; and one study focused solely on delusional misidentification. Delusional jealousy was associated with younger age and shorter disease duration, and a single study reported a higher prevalence in men. Delusions were associated with motor symptoms but less strongly than hallucinations, neither were delusions associated with cognitive deficits, apart from delusional misidentification, which was associated with deficits in verbal memory and language. A diagnosis of depression and the severity of anxiety symptoms predicted the presence and number of delusional types. Dopamine agonists were commonly prescribed, but there was no association with prescribed dose.</div></div><div><h3>Conclusion</h3><div>The small number and heterogeneity of the included studies limited interpretation and generalizability of our findings and emphasize the need for further investigation of the intersection of age, sex and dopamine agonist use in delusional jealousy, neuropsychological correlates of delusional misidentification and affective and psychological correlates of delusions.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"15 ","pages":"Article 100493"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921081","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":"Clopidogrel use is associated with an increased prevalence of Parkinson’s disease, particularly among US adults with diabetes","authors":"Jinbang Zhan ,&nbsp;Wenfeng Zhang ,&nbsp;Yanan Liu ,&nbsp;Shuhua Guan,&nbsp;Xiaofen Lin,&nbsp;Jinli Yang,&nbsp;WeiHua Yuan,&nbsp;Longyu Zhou,&nbsp;Gan Huang","doi":"10.1016/j.prdoa.2026.100430","DOIUrl":"10.1016/j.prdoa.2026.100430","url":null,"abstract":"<div><h3>Background</h3><div>Antiplatelet drugs have been hypothesized to be involved in the pathological process of Parkinson’s disease (PD) by affecting neuroinflammation and vascular function. However, their association with PD prevalence at the population level remains unclear. This study aimed to investigate the relationship between antiplatelet drug use and PD prevalence among American adults.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 21,288 participants aged 40 years and older from the 1999–2018 National Health and Nutrition Examination Survey (NHANES). Antiplatelet drug use was assessed through prescription records, and PD diagnosis was based on the use of typical anti-PD medications. The association between antiplatelet drug use and PD prevalence was analyzed using weighted multivariate logistic regression models.</div></div><div><h3>Results</h3><div>After adjusting for multiple confounders, antiplatelet drug use was associated with a higher prevalence of PD (OR = 1.66, 95% CI: 1.08–2.56). Specifically, clopidogrel use was significantly associated with increased prevalence (OR = 1.75, 95% CI: 1.01–3.01), whereas aspirin showed no significant association. Stratified and interaction analyses further revealed that the association with clopidogrel was statistically significant only in diabetic patients (OR = 3.80, 95% CI: 1.68–8.60), whereas no significant association was observed in non-diabetic patients.</div></div><div><h3>Conclusion</h3><div>Antiplatelet drug use, particularly clopidogrel, is associated with increased PD prevalence, with this association being particularly pronounced in diabetic patients. However, as a cross-sectional analysis, this study cannot infer causality; furthermore, the medication-based definition of PD may involve diagnostic misclassification. Therefore, these findings should be interpreted with caution. Consideration could be given to enhanced monitoring of neurological symptoms for diabetic patients on long-term clopidogrel therapy. Prospective studies are needed to further explore potential mechanisms and temporal relationships.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100430"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327449","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":"Identification of responsive motor symptom assessment items reflecting plasma levodopa changes in individuals with Parkinson’s disease","authors":"Yuki Kondo ,&nbsp;Kota Furukawa ,&nbsp;Ippei Suzuki ,&nbsp;Yosuke Ariake ,&nbsp;Yasuo Takata ,&nbsp;Takatoshi Hara ,&nbsp;Yohei Mukai ,&nbsp;Yuji Takahashi","doi":"10.1016/j.prdoa.2026.100449","DOIUrl":"10.1016/j.prdoa.2026.100449","url":null,"abstract":"<div><h3>Introduction</h3><div>Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms, including tremors, rigidity, and bradykinesia. Although levodopa remains the gold standard treatment, clinical practice highly depends on subjective patient reporting to assess medication effectiveness, which can be unreliable owing to cognitive decline and motivational factors. We aimed to identify motor symptom assessment variables within the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) framework that reliably reflect plasma levodopa concentration changes in individuals with PD.</div></div><div><h3>Methods</h3><div>Forty-seven participants with PD underwent standardized levodopa challenge testing with concurrent plasma concentration monitoring. Motor symptoms were evaluated using a simplified assessment protocol based on selected MDS-UPDRS variables.</div></div><div><h3>Results</h3><div>Subgroup analysis by baseline tremor status revealed that rigidity demonstrated the most consistent responsiveness across all patient groups, showing large effect sizes (ES) regardless of baseline characteristics (overall ES: 0.65, 57.4% improvement; baseline tremor-absent ES: 0.66, 56.8% improvement; baseline tremor-present ES: 0.62, 60.0% improvement), whereas tremor and bradykinesia effectiveness varied considerably by subgroup.</div></div><div><h3>Conclusion</h3><div>Rigidity assessment within the MDS-UPDRS framework may serve as a robust clinical indicator for monitoring dopaminergic responsiveness, and thereby provide a practical tool to complement subjective patient reporting to enable individualized PD management.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100449"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849426","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":"Emerging neurotechnological approaches to management of sleep disturbances in Parkinson’s disease","authors":"Mason Dallegge ,&nbsp;Sanjana Murthy ,&nbsp;Don M. Tucker ,&nbsp;Emmanuel During ,&nbsp;Shannon O’Neill ,&nbsp;Rachel Fremont ,&nbsp;Joohi Jimenez-Shahed ,&nbsp;Allison C. Waters","doi":"10.1016/j.prdoa.2025.100413","DOIUrl":"10.1016/j.prdoa.2025.100413","url":null,"abstract":"<div><div>Among non-motor symptoms of Parkinson’s disease (PD), sleep disruption is highly prevalent and may be a target for emerging neurotechnological approaches to treatment. Neuroanatomical and chemical changes in PD significantly impact sleep regulation, affecting both REM and non-REM sleep stages. These disturbances contribute to cognitive decline and disease progression, underscoring the critical need for effective management strategies. Sleep-focused neurotechnological advancements offer promising avenues for enhancing treatment of PD. Cognitive Behavioral Therapy for Insomnia (CBT-I) successfully addresses maladaptive sleep behaviors exacerbated by PD and may be further enhanced with the use of sleep tracking technologies. At-home EEG-based monitoring complements CBT-I by facilitating real-time adjustments and optimizations and provides insights into personalized sleep management strategies. Additionally, neuromodulation techniques using direct stimulation aim to restore deep sleep (N3) by targeting specific brain regions affected by PD-related neurodegeneration. This article reviews the presentation of sleep disturbances in PD, explores the potential role for physiological tracking and neuromodulation in treatment of PD, and explores the use of consumer technologies to support personalized sleep management for patients and clinicians.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100413"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927598","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":"Tremor pathophysiology","authors":"Rodger J. Elble","doi":"10.1016/j.prdoa.2026.100455","DOIUrl":"10.1016/j.prdoa.2026.100455","url":null,"abstract":"<div><div>Tremor syndromes arise from diverse combinations of neuronal oscillation, resonance, and entrainment within interconnected cerebellar, thalamocortical, basal ganglia, and sensorimotor loops. This review synthesizes anatomical, physiological, pathological, clinical, and computational evidence to identify the most likely network mechanisms of common and uncommon tremor syndromes. Mechanical-reflex tremor reflects underdamped musculoskeletal resonance and reflex loop dynamics, whereas central neurogenic tremors arise from intrinsic membrane conductances, electrical coupling, and recurrent inhibitory and excitatory loops that support oscillation, frequency-selective resonance, and entrainment. Acute cerebellar lesions produce intention tremor through impaired dentate-mediated motor planning and interpositus-dependent predictive motor control, causing hypermetria and abnormal transcortical mechanical-reflex oscillation. Delayed tremor after a cerebellothalamic pathway injury reflects maladaptive plasticity, likely within the thalamocortical loop, and similar delayed maladaptive change plus abnormal basal ganglia oscillation produces Holmes tremor. Essential tremor probably originates from oscillatory cerebellar cortical circuits with thalamocortical amplification, shaped by heterogeneous genetic vulnerabilities. Parkinson tremor is produced by increased pallidal and subthalamic oscillation combined with thalamocortical resonance in response to a loss of dopaminergic modulation. Dystonic tremor arises from abnormal oscillation within interacting basal ganglia and cerebellar circuits. Cortical tremor stems from cortical hyperexcitability and reverberation. The properties of orthostatic tremor are most consistent with oscillation originating in the fastigium and associated cerebellar cortex with resonant amplification primarily in the pontobulbar reticular formation and secondarily in the thalamocortical loop. Neuropathic tremors appear to begin as disturbances of physiological mechanical-reflex and central neurogenic pathways but may evolve into disabling oscillation in the cerebellothalamocortical pathway. Tremor in sarcomeric myopathies probably emerges from unexplored central mechanisms of tremorogenesis. Future progress in tremor pathophysiology will require additional animal models and computational network models that can experimentally test proposed oscillatory mechanisms, distinguish causal oscillators from entrained amplifiers, and guide mechanism-based therapies.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"14 ","pages":"Article 100455"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177696","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":"Hyperkinetic manifestations in sporadic parkinsonism: An exploratory case series with APOE and NOS3 variants","authors":"Sara Varanese,&nbsp;Rossella Ferrante,&nbsp;Maria Pia Buongarzone,&nbsp;Stefano Viola,&nbsp;Luisa Fiorelli,&nbsp;Daniela Travaglini,&nbsp;Paola Ajdinaj,&nbsp;Rino Speranza,&nbsp;Laura Bonanni","doi":"10.1016/j.prdoa.2026.100474","DOIUrl":"10.1016/j.prdoa.2026.100474","url":null,"abstract":"<div><div>Background Hyperkinetic motor features are uncommon in Parkinson's disease and related parkinsonisms and may reflect underlying genetic susceptibility. Methods We describe three sporadic patients with parkinsonism and prominent hyperkinetic manifestations who underwent clinical exome sequencing. To provide preliminary context for these observations, we reviewed genetic data from an additional cohort of 11 patients with sporadic parkinsonism who underwent clinical exome sequencing in our center but did not exhibit early hyperkinetic manifestations Results All patients carried heterozygous variants in genes involved in vascular, inflammatory, and tau related pathways (NOS3 c.774 T &gt; C; APOE c.388 T &gt; C). Clinical phenotypes ranged from late-onset parkinsonism with severe choreic dyskinesias to young-onset dystonic parkinsonism with excellent dopaminergic responsiveness. Dopaminergic dysfunction was supported by functional neuroimaging. Conclusions These cases suggest that APOE and NOS3 variants may act as susceptibility modifiers, predisposing to hyperkinetic phenotypes within the parkinsonian spectrum.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"15 ","pages":"Article 100474"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370080","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}