JAMMI最新文献

{"title":"Emergence of seasonal influenza A(H3N2) variants with immune escape potential warrants enhanced molecular and epidemiological surveillance for the 2025-2026 season.","authors":"Suzana Sabaiduc, Samantha E Kaweski, Lea Separovic, Ruimin Gao, Charlene Ranadheera, Nathalie Bastien, Danuta M Skowronski","doi":"10.3138/jammi-2025-0025","DOIUrl":"10.3138/jammi-2025-0025","url":null,"abstract":"<p><strong>Background: </strong>All of the major antigenic changes in influenza A(H3N2) viruses since 1968 have involved mutations at just nine amino acid positions, called cluster transition sites, surrounding the receptor binding region of the hemagglutinin surface protein. During the Northern Hemisphere (NH) 2024-2025 influenza season, A(H3N2) variants emerged with multiple parallel substitutions affecting cluster transition sites 135, 145, 158, and/or 189, with implications for the 2025-2026 season.</p><p><strong>Methods: </strong>Using >24,000 global A(H3) sequences between September 2024 and August 2025, we assessed the nature and frequency of amino acid mutations among emerging NH and Southern Hemisphere (SH) A(H3N2) variants relative to the 2024-2025 subclade J and updated 2025-2026 subclade J.2 vaccine reference strains. We contextualized based on historic amino acid variation among >210,000 global A(H3) sequences since 1968 and publicly available antigenic characterization data relative to 2024-2025 and 2025-2026 vaccine reference strains.</p><p><strong>Results: </strong>Virtually all circulating A(H3N2) viruses in 2024-2025 were subclade J.2. In Europe, about one-third had cluster transition site mutations, mostly T135A with S145N. In North America, more than two-thirds had cluster transition site mutations, including T135K or S145N, with a late-season increase in doubly mutated J.2.3 (N158K + K189R) and J.2.5 (S145N + N158K) subclades. The SH 2025 season showed an increase in J.2.3 and emergence of J.2.4 (T135K + K189R), including a further drifted J.2.4.1 variant with additional N158D and other mutations, recently renamed subclade K. A substantial proportion of J.2.3 and J.2.4 viruses are antigenically distinct from the 2025-2026 influenza vaccine.</p><p><strong>Conclusion: </strong>Influenza A(H3N2) variants with a combination of cluster transition site mutations emerged during the NH 2024-2025 season. A further drifted and vaccine-mismatched variant, called subclade K, arose during the SH 2025 season and is projected to predominate among A(H3N2) viruses for the NH 2025-2026 season. While mismatched vaccines can still provide protection, enhanced genetic, antigenic, and epidemiological (eg, vaccine effectiveness, disease burden) monitoring are warranted to inform risk assessment and response.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 4","pages":"281-298"},"PeriodicalIF":1.1,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821714","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":"Can switching to doravirine/lamivudine/tenofovir DF halt or reverse INSTI-associated weight gain?","authors":"Alice Tseng, Mona Loutfy, Lianne Thai, Sharon Walmsley","doi":"10.3138/jammi-2025-0016","DOIUrl":"10.3138/jammi-2025-0016","url":null,"abstract":"<p><strong>Background: </strong>In randomized trials, doravirine (DOR) appears relatively weight-neutral, while tenofovir DF (TDF) may be weight-suppressive. Here we designed a prospective, observational pilot study to assess the impact of switching to DOR/3TC/TDF on weight trajectory in patients with significant integrase inhibitor (INSTI)-associated weight gain.</p><p><strong>Methods: </strong>Adults with a ≥10% increase in body weight while on an INSTI (± tenofovir alafenamide) regimen and HIV RNA <50 copies/mL were switched to DOR/3TC/TDF for 12 months. Weight, waist circumference, and routine bloodwork were measured at baseline and every 12 weeks. Total body fat (DXA scan) and body image/self-esteem (B-WISE, modified Fat Redistribution and Metabolic Change in HIV questionnaires) were assessed at baseline and week 48. The target enrolment was 25 participants.</p><p><strong>Results: </strong>Between September 2021 and September 2023, four participants were enrolled, with the results available for three women (Black, age 51/56/70 years, BMI 45.3/33.9/30.8 kg/m², 56%/45.7%/50% total body fat, with a 10%/13%/18% weight increase on the INSTI-regimen for 5.5/4.25/4.5 years). At 12 months, reductions in weight (0%/-7.5%/-6.7%), BMI (0/-2.6/-2 kg/m²), waist circumference (-0.8/-1.1/+1 cm), total body fat (-1.5%/-2.9%/-3.5%), blood pressure, fasting glucose, and lipids were observed. Body image/self-esteem improved; all maintained HIV RNA <50 copies/mL with no proteinuria/significant eGFR change. The study was closed due to futility in attaining timely target enrolment.</p><p><strong>Conclusions: </strong>Two out of three Black women with a ≥10% INSTI-associated increase in body weight had weight loss of >5% after switching to DOR/3TC/TDF for 48 weeks. All three participants experienced small improvements in waist circumference, body fat, and metabolism, and all reported improvements in body image/self-esteem. Pandemic challenges significantly impacted the ability to enrol participants.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 4","pages":"304-309"},"PeriodicalIF":1.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821792","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":"Extended-duration dexamethasone for the treatment of hospitalized COVID-19 patients in Canada: A randomized clinical trial.","authors":"Liran Shechtman, Srinivas Murthy, Alain Tremblay, Michael Silverman, Todd C Lee, Peter Daley, Ruxandra Pinto, Robert A Fowler","doi":"10.3138/jammi-2025-0010","DOIUrl":"10.3138/jammi-2025-0010","url":null,"abstract":"<p><p>The optimal duration of corticosteroid therapy in hospitalized COVID-19 patients remains uncertain. While a 10-day course of dexamethasone reduces mortality, the benefit of extending treatment in patients who continue to require oxygen is unknown. This open-label randomized trial was conducted as part of the Canadian Treatments for COVID-19 (CATCO) trial, the Canadian arm of the WHO Solidarity trial. Between January 19 and October 4, 2022, hospitalized COVID-19 patients who had completed 10 days of dexamethasone and remained on supplemental oxygen were randomized to receive either extended dexamethasone treatment or standard care. The primary outcome was the WHO ordinal scale at day 28. Secondary outcomes included in-hospital and 90-day mortality, oxygen and ventilation requirements, and hospital length of stay. Eleven patients were enrolled across five Canadian sites before early termination due to declining admissions. Median WHO scores at day 28 were similar between groups. One patient in the standard care group required new oxygen therapy; no patients required mechanical ventilation. One patient in the extended group died during hospitalization; by day 90, two had died in the extended group and none in the standard care group. In this small randomized controlled trial, we cannot determine effectiveness of extended dexamethasone for hospitalized patients with COVID-19 who require oxygen after 10 days of therapy. Larger, adequately powered trials are needed.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 4","pages":"299-303"},"PeriodicalIF":1.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821757","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":"Whipple's disease in southern New Brunswick, Canada: A case series.","authors":"Jason Hearn, Stephanie Carpentier, Jaclyn LeBlanc, Stephen Robinson, Duncan Webster","doi":"10.3138/jammi-2024-0020","DOIUrl":"https://doi.org/10.3138/jammi-2024-0020","url":null,"abstract":"<p><strong>Background: </strong>Whipple's disease is a rare systemic disorder caused by infection with <i>Tropheryma whipplei</i>. An increased number of cases of this infectious disease have recently been noted by practitioners in southern New Brunswick, Canada. We analyzed a series of Whipple's disease cases so as to better understand factors that could contribute to its increased incidence in southern New Brunswick.</p><p><strong>Methods: </strong>We conducted a retrospective case series of patients diagnosed with Whipple's disease in the health zone surrounding Saint John, New Brunswick, between January 2020 and January 2024. Demographic data, medical histories, patient assessments, pertinent investigations, and clinical outcomes were reviewed for each case and extracted for further analysis.</p><p><strong>Results: </strong>A total of four cases of Whipple's disease were identified. The estimated annual incidence was 5.7 cases per 1 million during the study time frame - a value nearly six times greater than the incidence proposed in the literature. The four cases varied widely in terms of presenting clinical features. No unifying environmental exposure was immediately apparent among the identified patients.</p><p><strong>Conclusion: </strong>The recent incidence of Whipple's disease in southern New Brunswick is higher than expected based on existing literature. Whipple's disease has a predilection for White and elderly individuals, and these populations have higher prevalence in southern New Brunswick when compared to national averages. Environmental triggers of Whipple's disease have been previously described, and such a trigger may have been present among the study population. Large-scale epidemiologic studies are necessary to further assess possible demographic, environmental, and disease-related triggers of Whipple's disease in Canada.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 3","pages":"245-251"},"PeriodicalIF":1.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12656696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640731","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":"Using routine asymptomatic <i>Clostridioides difficile</i> testing to identify patients at high risk of developing <i>C. difficile</i> infection during hematopoietic cell transplantation.","authors":"Nicole Janusz, Leanne Mortimer, Tamara Leite, Amanda Carroll, Natasha Kekre, Michael Kennah, Austin Yan, Jaxon Senechal, C Arianne Buchan, Derek MacFadden","doi":"10.3138/jammi-2024-0032","DOIUrl":"https://doi.org/10.3138/jammi-2024-0032","url":null,"abstract":"<p><strong>Background: </strong>Colonization with enteropathogens such as <i>Clostridioides difficile</i> has been linked to clinical infection with these same organisms. <i>C. difficile</i> infection (CDI) is associated with increased morbidity and mortality in patients undergoing hematopoietic cell transplantation (HCT). The study aims to evaluate the utility of existing <i>C. difficile</i> stool detection methods used during pre-transplant planning to identify individuals at high risk of developing CDI within 3 months post-transplant.</p><p><strong>Methods: </strong>A prospective cohort study of patients undergoing HCT at a large quaternary care centre was conducted to assess the impact of baseline <i>C. difficile</i> colonization on downstream CDI outcomes. Baseline stool samples were collected prior to admission for conditioning chemotherapy, which were evaluated for <i>C. difficile</i> colonization using routine, short-turnaround-time clinical approaches by performing glutamine dehydrogenase (GDH) enzyme immunoassay (EIA) and toxin B gene <i>(tcdB)</i> polymerase chain reaction (PCR). Clinical data and outcomes were reviewed 3 months post-transplant. Test characteristics for using baseline <i>C. difficile</i> colonization as a screening tool for predicting subsequent CDI were calculated.</p><p><strong>Results: </strong>Sixty patients were enrolled. The prevalence of <i>C. difficile</i> colonization (GDH positive) among patients undergoing HCT was 10% (6/60). Ten patients developed CDI within 3 months post-transplant, 50% of whom were colonized at baseline. Among the colonized patients, 83% (5/6) developed CDI during the follow-up period. Asymptomatic <i>C. difficile</i> colonization pre-admission had a 98% specificity (95% CI 89% to 100%), 50% sensitivity (95% CI 19% to 81%), 83% positive predictive value (95% CI 36% to 100%), and 91% negative predictive value (95% CI 80% to 97%) for developing subsequent CDI.</p><p><strong>Conclusions: </strong>Pre-admission <i>C. difficile</i> screening could support targeted prophylactic strategies for patients at risk of developing CDI, and this approach warrants further evaluation.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 3","pages":"239-244"},"PeriodicalIF":1.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12657026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640736","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":"Canada-wide bloodstream infectious diseases surveillance: Quantum leap or a baby step toward a comprehensive electronic national infections surveillance system?","authors":"Anthony D Bai, Yoav Keynan, Kevin B Laupland","doi":"10.3138/jammi-2025-0509","DOIUrl":"https://doi.org/10.3138/jammi-2025-0509","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 3","pages":"211-215"},"PeriodicalIF":1.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12656791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640754","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":"Congenital measles: A rare but life-threatening consequence of Canada's largest measles outbreak.","authors":"Michelle Barton, Feyifolu Obiri, Nisha Thampi","doi":"10.3138/jammi-2025-0711","DOIUrl":"https://doi.org/10.3138/jammi-2025-0711","url":null,"abstract":"","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 3","pages":"216-218"},"PeriodicalIF":1.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12656697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640758","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":"Management of tattoo-associated <i>Mycobacterium abscessus</i> skin infections by surgery and observation.","authors":"Luiza M Radu, Brett D Edwards, Jamil N Kanji, Julie Jarand, John Arlette","doi":"10.3138/jammi-2025-0004","DOIUrl":"https://doi.org/10.3138/jammi-2025-0004","url":null,"abstract":"<p><p><i>Mycobacterium abscessus</i>, a rapidly growing and frequently multidrug-resistant non-tuberculous mycobacterium, has been linked to cutaneous infections in both immunocompetent and immunocompromised individuals through inoculation via skin-traumatizing procedures such as tattooing. Here we describe two patients with culture-confirmed <i>M. abscessus</i> cutaneous infections acquired from the same tattoo studio in Calgary, Canada. Both patients developed dozens of erythematous papules at the site of inoculation within 2 weeks of a new tattoo using the same grey-wash ink. Despite recommendation for antimicrobial therapy, both patients independently elected to pursue surgical excision and observation. Following excision of multiple papules, both patients showed evidence of infection resolution within 10 weeks, without any evidence of relapsed infection. Conventional treatment of <i>M. abscessus</i> skin and soft tissue infections typically involves susceptibility-guided multidrug regimens for several months and is commonly associated with significant medication toxicity. These cases demonstrate that observation, potentially augmented with surgical removal, may be effective alternatives, especially in immunocompetent individuals with localized infections, which avoids the need for antibiotics.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 3","pages":"257-261"},"PeriodicalIF":1.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12656701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640769","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":"Oxacillin-susceptible methicillin-resistant <i>Staphylococcus aureus</i> septic bursitis identified following clinical failure with β-lactam therapy: A case report.","authors":"Alexander Kipp, Jo-Ann McClure, Johann D D Pitout, Kunyan Zhang, James N Powell, John Conly","doi":"10.3138/jammi-2025-0001","DOIUrl":"https://doi.org/10.3138/jammi-2025-0001","url":null,"abstract":"<p><strong>Background: </strong>Oxacillin-susceptible methicillin-resistant <i>Staphylococcus aureus</i> (OS-MRSA) is a phenotype of <i>S. aureus</i> that presents as methicillin susceptible on traditional screening tests but may have a resistant phenotype, leading to clinical failure.</p><p><strong>Methods: </strong>An isolate of <i>S. aureus</i> screened negative for methicillin resistance in a case of septic bursitis in a 75-year-old female. After failure to improve on cefazolin, a second aspirate was performed and sent for testing. The second sample strain retrieved had an additional PBP2a lateral flow performed, demonstrating the presence of <i>mecA</i> products.</p><p><strong>Results: </strong>Both <i>S. aureus</i> isolates proved to be identical on pulsed-field gel electrophoresis and had faint positive PBP2a bands on lateral flow, despite screening negative for methicillin resistance on oxacillin and cefoxitin testing. A point mutation was found in the <i>mecA</i> start codon, which could explain the OS-MRSA phenotype. Neither oxacillin nor cefoxitin screening tests were positive following a cefoxitin induction assay that was used locally to promote a methicillin-resistant phenotype in small-colony variant <i>S. aureus</i> (SCV).</p><p><strong>Conclusions: </strong>OS-MRSA is a rare but documented phenotype of <i>S. aureus</i> that has the potential to escape typical screening. Simple mutations may lead to reversal under selection pressure. Failure to respond to standard-of-care therapy for methicillin-sensitive <i>S. aureus</i> should prompt additional testing. Such methods could include a PBP2a immunoassay with high sensitivity. The patient recovered by using an antibiotic of a different class, trimethoprim-sulfamethoxazole, for which the isolate tested sensitive.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 3","pages":"262-267"},"PeriodicalIF":1.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12656721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640767","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":"Clinician survey for the management of central venous catheter-related bloodstream infection: Catheter retention versus replacement.","authors":"Fahad Buskandar, Robert A Fowler, Jennie Johnstone, Todd C Lee, Derek R MacFadden, Emily G McDonald, Matthew J Oliver, Sean W X Ong, David Paterson, Ruxandra Pinto, Asgar Rishu, Ben Rogers, Dafna Yahav, Nick Daneman","doi":"10.3138/jammi-2024-0037","DOIUrl":"https://doi.org/10.3138/jammi-2024-0037","url":null,"abstract":"<p><strong>Background: </strong>When bloodstream infection (BSI) occurs in patients with a central venous catheter (CVC), the catheter may be the original source (catheter-related, CR) or may become a source for persistent infection. BSI should prompt an evaluation of CVC necessity, but there are challenges associated with CVC replacement.</p><p><strong>Methods: </strong>An online multinational survey was sent to professional societies of specialties involved in treating patients who have BSI and a CVC. Clinicians were asked to choose retention versus replacement for scenarios involving different CVC types, infection sources, and pathogens. Additional questions explored central venous catheter-related bloodstream infection (CRBSI) diagnosis, management, and willingness to enrol patients in a randomized controlled trial (RCT).</p><p><strong>Results: </strong>A total of 220 physicians responded. For peripherally inserted central catheter-related BSI, most favoured CVC replacement, although there was variability across pathogens (<i>Candida</i> spp 100%, <i>Staphlococcus aureus</i> 99%; <i>Pseudomonas aeruginosa</i> 94%; <i>Enterococcus</i> spp 75%; Enterobacterales 66%; coagulase-negative staphylococci 58%). For tunnelled CVC-related BSI, replacement recommendations also varied (<i>Candida</i> 99%; <i>S. aureus</i> 95%; <i>P. aeruginosa</i> 87%; <i>Enterococcus</i> spp 58%; Enterobacterales 44%; coagulase-negative staphylococci 33%). For catheter-unrelated BSI, there was a lower tendency to replace the CVC. For each combination of pathogen and CVC type, a majority (>50%) of participants reported willingness to enrol patients into an RCT comparing CVC replacement versus retention; the only exceptions below 50% were <i>S. aureus</i> (44%) and <i>Candida</i> spp (44%) CRBSIs from short-term non-tunnelled CVCs.</p><p><strong>Conclusion: </strong>There is heterogeneity in CVC management practices and stated equipoise for an RCT comparing management approaches for a range of CVC types, BSI sources, and pathogens.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"10 3","pages":"219-227"},"PeriodicalIF":1.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12656720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640706","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}