Journal of the ASEAN Federation of Endocrine Societies最新文献

{"title":"Oscillation between Hyperthyroidism and Hypothyroidism in an Adolescent Female with Graves' Disease.","authors":"Yee Lin Lee","doi":"10.15605/jafes.040.01.07","DOIUrl":"10.15605/jafes.040.01.07","url":null,"abstract":"<p><p>Graves' disease (GD) presenting as fluctuations between hyperthyroidism and hypothyroidism is a rare phenomenon and poses a diagnostic challenge. A 14-year-old female with GD, initially thought to have Hashimoto's thyroiditis presented with a goiter and oscillating thyroid function over the course of 4 years. This case depicts a case of GD with oscillating thyroid function and stresses the importance of TSH receptor antibodies (TRAb) in the evaluation of patients with hyperthyroidism without Graves' ophthalmopathy.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"117-120"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143949","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":"Paraganglioma in Pregnancy with Recurrent Pregnancy Loss: A Case Report.","authors":"Wee Mee Cheng, Zanariah Hussein","doi":"10.15605/jafes.040.01.09","DOIUrl":"10.15605/jafes.040.01.09","url":null,"abstract":"<p><p>Due to its rarity, pheochromocytoma or paraganglioma (PPGL) in pregnancy is often not timely diagnosed, thus resulting in high materno-fetal complications. We report a 28-year-old female who presented with paroxysmal symptoms and severe hypertension during early pregnancy. Biochemical confirmatory tests and localization imaging were delayed due to multiple factors. She suffered from two pregnancy losses before she had resection of the paraganglioma.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"98-103"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143950","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":"The Prevalence of Hypophosphatemia and its Associated Risk Factors in Diabetic Ketoacidosis Patients.","authors":"Mohamad Hafis Bin Razali, Suhaimi Hussain, Mohd Hazman Bin Kamaruzaman, Nurul Jannah Binti Ambak","doi":"10.15605/jafes.040.01.13","DOIUrl":"10.15605/jafes.040.01.13","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to study the prevalence of hypophosphatemia and its associated risk factors in Diabetic Ketoacidosis (DKA) patients in the pediatric population.</p><p><strong>Methodology: </strong>We included 65 subjects aged 7 months to 18 years old who were admitted to Hospital Universiti Sains Malaysia (HUSM) for DKA. Patients' socio-demographic and clinical characteristics, and biochemical examinations from their first admission for DKA were analyzed. The diagnosis of DKA was based on the International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria. Multiple logistic regression models examined associations between different variables and hypophosphatemia.</p><p><strong>Result: </strong>The prevalence of hypophosphatemia in DKA was highest on day 1, at 70.8%, with a mean age of 11 on presentation. Multiple logistic regression analysis showed plasma bicarbonate at day 3 [adjusted odds ratio (OR) 1.2, with a p-value of 0.027] and baseline hemoglobin [adjusted OR 0.62, with p-value 0.009] were significantly associated with hypophosphatemia during DKA.</p><p><strong>Conclusion: </strong>The prevalence of hypophosphatemia in DKA pediatric patients admitted to our center was highest on day 1 of admission. There were many factors associated with hypophosphatemia from simple logistic regression analysis. However, our final model revealed that plasma bicarbonate on day 3 and baseline Hb were the only significant risk factors for hypophosphatemia in DKA patients in the pediatric population.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"20-25"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144006","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":"Perceptions, Attitudes, Behaviours and Barriers in Obesity Care: Findings from the ACTION-Vietnam Study.","authors":"Nam Quang Tran, Dao Nguyen Thi Bich, Thu Nghiem Nguyet, Tuan Nguyen Anh, Nghi Le Huu, Thanh Dau Ba, YouSun Ha","doi":"10.15605/jafes.040.01.17","DOIUrl":"10.15605/jafes.040.01.17","url":null,"abstract":"<p><strong>Objective: </strong>The ACTION Asia Pacific (ACTION-APAC) study was designed to identify the perceptions, attitudes, behaviours and potential barriers to effective obesity management in people with obesity (PwO) and healthcare professionals (HCPs) in nine countries of Southeast Asia. This study represents the findings in Vietnam.</p><p><strong>Methodology: </strong>This cross-sectional, non-interventional study gathered information from Vietnamese PwO (n = 1000) and HCPs (n = 200) via an anonymous online survey between April and May 2022.</p><p><strong>Results: </strong>The majority of PwO (67%) and HCPs (80%) believed that obesity is a chronic disease that profoundly impacts a person's overall health (76% PwO, 81% HCPs). About 58% of PwO agreed that managing weight loss was solely their responsibility. Meanwhile, 76% of HCPs believed they should actively contribute to their patients' weight loss efforts. Most of the PwO (82.7%) had attempted weight loss with an average of four times. PwO and HCPs cited lack of exercise (63% vs. 86%) and lack of motivation (60% vs. 80%) as the principal barriers to weight loss. HCPs cited PwOs' lack of interest (52%) and motivation to lose weight (45%) as top reasons for not discussing weight.</p><p><strong>Conclusion: </strong>The study emphasised raising awareness for obesity management among PwO and HCPs and suggested early weight management conversations with HCPs.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"32-44"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143951","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":"Tailoring Educational Content for T2DM Patients: A Qualitative Study on Preferences for Interactive Multimedia Applications.","authors":"Nur Shahirah Mohamed Yasin, Tuan Mazlelaa Tuan Mahmood, Ernieda Hatah, Haniz Aqilah Hazaidi, Nur Amalina Mohd Zainal Abidin","doi":"10.15605/jafes.040.01.18","DOIUrl":"10.15605/jafes.040.01.18","url":null,"abstract":"<p><strong>Background: </strong>The development of interactive multimedia-based applications has become increasingly important in providing effective health education to Type 2 Diabetes Mellitus (T2DM) patients. Understanding the educational content required for such applications from local patients' perspectives is crucial for designing a user-friendly and impactful tool for T2DM management.</p><p><strong>Objective: </strong>This study aims to investigate patients' views and preferences on the educational content and features of an interactive multimedia-based application for T2DM patients.</p><p><strong>Methodology: </strong>Semi-structured qualitative interviews were carried out with a sample of T2DM outpatients (n = 16) at a tertiary referral university hospital in Kuala Lumpur between October 2022 and January 2023. The interviews were recorded, transcribed and subjected to thematic analysis.</p><p><strong>Result: </strong>The majority of participants had been diagnosed with T2DM for less than ten years. The thematic analysis identified several key aspects related to the educational content required for development of a multimedia-based application. These include preference for educational materials, essential contents and interactive features. The participants also proposed a discussion area within such applications that would allow them to communicate and receive immediate advice from healthcare professionals, thus eliminating the need for frequent hospital visits.</p><p><strong>Conclusion: </strong>The findings of this study highlight the significance of interactive multimedia-based applications in providing health education for T2DM patients. The identified essential content areas from the patients' perspectives can inform the development of effective tailored educational materials for patient's benefit.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"45-52"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143987","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":"Lymphocytic Hypophysitis Presenting as Acute-onset Arginine Vasopressin Deficiency and Pituitary Stalk Thickening: A Case Report.","authors":"Lian Zi Yang, Shanty Velaiutham","doi":"10.15605/jafes.040.01.08","DOIUrl":"10.15605/jafes.040.01.08","url":null,"abstract":"<p><p>Lymphocytic hypophysitis (LHy) is a rare autoimmune inflammatory process that selectively affects the neurohypophysis and infundibulum, typically presenting with arginine vasopressin deficiency (AVP-D). On magnetic resonance imaging (MRI) with contrast, there is a thickening of the pituitary stalk, enlargement of the neurohypophysis or both with homogeneous enhancement. LHy can be self-limiting and regression can be seen radiologically during follow-up. A 22-year-old male presented with clinical findings consistent with AVP-D in 2016. MRI brain demonstrated enlargement of the pituitary stalk and absence of a posterior pituitary bright spot. He was given a trial of glucocorticoid treatment. His serial MRI brain showed a reduction of the pituitary stalk, but the AVP-D persisted. He was diagnosed with LHy. LHy is characterized by lymphocytic infiltration, leading to eventual destruction of the pituitary tissue accompanied by varying degrees of pituitary dysfunction. Definite diagnosis can only be established via pituitary stalk biopsy. Due to the wide range of possible aetiologies, close monitoring is strongly recommended for the treatment of presumed cases lacking histopathologic confirmation. The response rate to glucocorticoids has been variable. Periodic monitoring of anterior pituitary function and pituitary MRI are essential in the management of this condition.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"121-125"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143948","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":"Bilateral Pheochromocytoma with a Novel Pathogenic Variant in the MAX gene: A Case Report.","authors":"Chee Koon Low, Kausalyaa Krishnabalan, Azraai Bahari Nasruddin, Zanariah Hussein","doi":"10.15605/jafes.040.01.16","DOIUrl":"10.15605/jafes.040.01.16","url":null,"abstract":"<p><p>Pheochromocytomas and paragangliomas syndrome are grouped into three specific disease clusters based on their underlying genetic alterations. Pathogenic variants affecting the myelocytomatosis-associated factor X (MAX) gene predispose pheochromocytomas and paragangliomas syndrome to occur at younger ages, with more than half having bilateral pheochromocytomas. We report a case of bilateral pheochromocytomas with a novel pathogenic variant identified in the MAX gene (c.234_235dup). This young male was found to have a huge left suprarenal mass after he presented with severe hypertension and myocardial infarction. His endocrine workup confirmed a diagnosis of pheochromocytoma as evidenced by elevated levels of normetanephrine, metanephrine, and 3-methoxytyramine in the urine. CT of the adrenal glands revealed bilateral adrenal masses; the widest diameter for the left adrenal mass was almost 8 cm whereas for the right one was 2 cm. ⁶⁸Gallium-DOTATATE functional imaging showed significant uptake in the left adrenal mass, but indeterminate on the right, and no significant uptake was seen elsewhere to suggest metastatic lesions. He did not have syndromic features associated with multiple endocrine neoplasia, neurofibromatosis or von Hippel Lindau disease. The collective findings raised the clinical dilemma of whether unilateral or bilateral adrenalectomy should be pursued. The detection of pathogenic MAX gene was therefore crucial in guiding personalized treatment strategy. Following the bilateral adrenalectomy, his hypertension was cured. Annual biochemical screening and 2-yearly MRI imaging to look for recurrence of pheochromocytomas were planned according to international consensus.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"108-111"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143947","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":"The Incidence and Severity of Paediatric Diabetic Ketoacidosis Presenting to a Metropolitan Hospital in Western Sydney: A 10-Year Retrospective Review.","authors":"Shahzad Sarwar, Gary Leong, Anthony Liu, Habib Bhurawala","doi":"10.15605/jafes.040.01.02","DOIUrl":"10.15605/jafes.040.01.02","url":null,"abstract":"<p><strong>Objectives: </strong>To report the incidence and clinical characteristics of paediatric patients presenting with diabetic ketoacidosis to the Emergency Department (ED) with new and pre-existing type 1 diabetes mellitus (T1DM).</p><p><strong>Methodology: </strong>A ten-year retrospective data analysis was performed on children under 16 years presenting to the ED with T1DM from January 2010. Demographic and laboratory data were extracted to determine the rates of DKA. Comparative statistics were performed between age groups and pre-existing and newly diagnosed T1DM patients.</p><p><strong>Results: </strong>A total of 196 children with T1DM were included. The mean age of the cohort was 9.3 ± 4.0 years, with female predominance (54%, <i>p</i> = 0.38). Most (60%) were newly diagnosed with T1DM, of which 38% presented in DKA. Amongst the total cohort, 43% presented in DKA.The older children accounted for 50% of the DKA presentations in the newly diagnosed cohort. Amongst the younger age group, 42% presented with severe DKA. There were higher rates of T1DM in areas of relative socioeconomic advantage.</p><p><strong>Conclusion: </strong>Children with T1DM presented with unacceptably high rates of DKA and posed a significant medical, psychosocial and financial burden on families and medical services. These findings suggest that a prospective public health campaign to reduce rates of DKA is warranted.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"40 1","pages":"14-19"},"PeriodicalIF":0.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143991","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":"Diagnosis and Management of Adrenocortical Carcinoma with Co-secretion of Cortisol and Aldosterone: A Case Report.","authors":"Meghan Marie Aliño, Lyzanne Maryl Tam-Go","doi":"10.15605/jafes.039.02.13","DOIUrl":"10.15605/jafes.039.02.13","url":null,"abstract":"<p><p>Adrenocortical carcinoma (ACC) accounts for 0.05-2% of all malignant tumors. Forty-five percent of ACCs with secretory function have excess glucocorticoids alone and only less than 1% secrete aldosterone. This is a case of a 44-year-old Filipino female with hypertension and a 12-year-history of an incidentaloma of the left adrenal gland, with recent-onset complaints of increasing abdominal girth, purple striae, amenorrhea, moon facies and a dorsocervical fat pad. Laboratory findings revealed low potassium levels, non-suppressed cortisol on dexamethasone test suggesting Cushing's syndrome and elevated aldosterone-renin ratio and plasma aldosterone concentration pointing to primary hyperaldosteronism. A computed tomography scan revealed a left-sided adrenal mass measuring approximately 23 cm in largest diameter suggestive of carcinoma without metastasis or lymph node involvement. Complete resection via open adrenalectomy was performed and histopathologic assessment revealed Adrenocortical Carcinoma with Weiss score of 4. The Ki-67 proliferative index was found to be >20%. Radiotherapy was done as an adjuvant treatment. Although rare, co-secretion of cortisol and aldosterone can occur in functional tumors of adrenocortical carcinoma. Malignancy should always be considered in patients who present with a history of a unilateral adrenal mass and/ or in those with signs and symptoms of adrenal hormone excess. Thus, a proper assessment derived from a thorough medical history, physical examination and laboratory work-up is warranted in patients with an adrenal mass to ascertain the diagnosis and provide adequate management.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"39 2","pages":"103-107"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773445","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":"Risk Factors for Perioperative Complications, Treatment Outcomes and Aggressive Behavior of the Tumor in Patients with Pheochromocytoma.","authors":"Gopinath Narayanaswamy, Debanga Sarma, Uma Kaimal Saikia, Abhamoni Baro, Ashok Krishna Bhuyan","doi":"10.15605/jafes.039.02.07","DOIUrl":"10.15605/jafes.039.02.07","url":null,"abstract":"<p><strong>Introduction: </strong>Pheochromocytomas are catecholamine-secreting tumors arising from chromaffin cells of the adrenal gland. Surgery is the only curative treatment with a high biochemical cure rate, low mortality and high risk of perioperative complications.</p><p><strong>Objectives: </strong>To study the demographic characteristics of patients with pheochromocytoma and to identify the risk factors for perioperative complications, treatment outcomes, and aggressive behavior of the tumor.</p><p><strong>Methodology: </strong>We retrospectively studied the data of pheochromocytoma patients registered from 2012 to 2022.</p><p><strong>Results: </strong>In our study, a total of 30 patients with pheochromocytoma were included. The mean age of presentation was 35 ± 12.8 years. Fifty-six percent were females, and the sex ratio was 1.3:1. Pheochromocytoma spells (60%) was the most common complaint, followed by abdominal pain (53%), orthostatic complaints (10%) and incidentalomas (6%). The baseline mean 24-hour urinary total metanephrines was 2963.7 ± 2658 mcg/24 hours, and the mean tumor size was 7.3 ± 0.53 cm. Forty-three percent of patients underwent laparoscopic adrenalectomy, while the rest underwent open surgery. The mean Pheochromocytoma of Adrenal gland Scaled Score(PASS) was 3.41 ± 0.28, and 23% had a high risk for malignancy. Among perioperative complications, hypertensive crisis (17%) was the most common, followed by postoperative hypotension (13%), hypoglycemia (3%) and right-sided pneumothorax (3%). These patients with complications had higher metanephrine levels (5490 vs. 1880 mcg/24 hours, <i>p</i> = 0.001). Blood pressure normalized in 50%, and this was associated with male sex, younger age (29.5 vs. 40 years, <i>p</i> = 0.03), higher metanephrines (4619 vs. 1855 mcg/24 hours, <i>p</i> = 0.001) and smaller tumors (5.91 vs. 8.61 cm, <i>p</i> = 0.046). PASS score greater than or equal to 4 was associated with higher metanephrine levels (5104 vs. 2312 mcg/24 hours, <i>p</i> = 0.021) and larger tumors (9.28 vs. 6.68 cm, <i>p</i> = 0.024). Biochemical cure rate was achieved in 76% of patients after surgery and was associated with older age (37.7 years vs. 27.7 years, <i>p</i> = 0.047) and absence of pheochromocytoma spells (100% vs. 61%, <i>p</i> = 0.014).</p><p><strong>Conclusion: </strong>Young age, smaller tumor size and higher metanephrine concentrations were associated with normalization of blood pressure post-surgery. On the other hand, older patients and those without pheochromocytoma spells had better biochemical cure rates. Patients with higher baseline metanephrine levels had increased perioperative complications. More aggressive tumor behavior was associated with higher metanephrine levels and larger tumors. Sex, baseline blood pressure and mode of surgery did not have any influence on treatment outcomes.</p>","PeriodicalId":41792,"journal":{"name":"Journal of the ASEAN Federation of Endocrine Societies","volume":"39 2","pages":"48-53"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773508","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}