Reumatologia Clinica最新文献

{"title":"Neuromielitis óptica con anticuerpos anti-acuaporina-4 positivos en el contexto de artritis reumatoide de larga evolución: reporte de caso","authors":"Alex Altamirano Calderón,&nbsp;Maybrith Cárdenas Balarezo,&nbsp;Doménica Rivadeneira Arregui","doi":"10.1016/j.reuma.2026.502250","DOIUrl":"10.1016/j.reuma.2026.502250","url":null,"abstract":"<div><div>Neuromyelitis optica spectrum disorder (NMOSD) associated with rheumatoid arthritis (RA) is an uncommon inflammatory demyelinating condition that presents a diagnostic challenge.</div><div>We report the case of a woman with a 10-year history of RA and a six-year progressive paraparesis. Magnetic resonance imaging revealed longitudinally extensive transverse myelitis from T4 to the filum terminale. Cerebrospinal fluid analysis showed negative oligoclonal bands and hyperproteinorachia without pleocytosis. The immunological profile confirmed positivity for anti-aquaporin-4 antibodies (62 UI/ml), along with markedly elevated rheumatoid factor and anti-CCP. Following intravenous methylprednisolone, a partial motor recovery to 3/5 was achieved. The patient voluntarily discontinued medical follow-up, preventing the initiation of maintenance immunosuppressive therapy.</div><div>The onset of atypical neurological symptoms in patients with systemic autoimmunity requires a high clinical suspicion of NMOSD, regardless of the stability of the underlying arthropathy. Early diagnosis and strict treatment adherence are critical to prevent cumulative structural damage and permanent disability.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502250"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096203","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":"Tendencias y variabilidad en el uso de glucocorticoides en los pacientes con lupus eritematoso sistémico incluidos en el registro RELESSER-PROS","authors":"Inigo Rua-Figueroa,&nbsp;David Fernández-Fernández,&nbsp;Zulema Plaza,&nbsp;Karen Roberts,&nbsp;Belén Serrano-Benavente,&nbsp;María Galindo-Izquierdo,&nbsp;Jaime Calvo Alen,&nbsp;Raúl Menor,&nbsp;Natalia Mena-Vázquez,&nbsp;Esther Uriarte,&nbsp;Eva Tomero,&nbsp;Mercedes Freire,&nbsp;Clara Sanguesa,&nbsp;Silvia Gómez-Sabater,&nbsp;Loreto Horcada,&nbsp;Nuria Lozano-Rivas,&nbsp;María Jesús García-Villanueva,&nbsp;Adrián Quevedo-Rodríguez,&nbsp;Elvira Díez-Álvarez,&nbsp;Javier Narváez,&nbsp;Jose M. Pego-Reigosa","doi":"10.1016/j.reuma.2026.502220","DOIUrl":"10.1016/j.reuma.2026.502220","url":null,"abstract":"<div><h3>Context</h3><div>Recommendations for the management of systemic lupus erythematosus (SLE) advocate increasingly restrictive use of glucocorticoids (GC). However, there are no wide-scale data on their use in clinical practice from Spain, nor on compliance with current recommendations. The objective was to analyze this aspect of SLE treatment by autonomous communities (CCAA).</div></div><div><h3>Methods</h3><div>Observational, descriptive, longitudinal, and prospective study of patients with SLE included in RELESSER-PROS regarding patterns of GC use.</div></div><div><h3>Results</h3><div>1,432 patients were included, 89.8% women, mean age 56 years (±13.6), median follow-up 3.80 [2.06, 4.18] years, from 2015 to 2021. Median S-SLEDAI (5 visits): 2.00 [Q-Q3] [0-4.00], PGA: 0.3 [0,0.9]. Median SLICC/ARC DI: 0 [0-1.00], mean: 0.83 (±1.20). Between 30% and 61% of patients received GC at baseline and between 17% and 50% at the end (V5). A progressive decrease in the percentage of patients receiving GC was observed in most CCAs, reaching the minimum at V5. Between 71.45% and 89.47% of patients, by autonomous community, met the criterion of ≤5<!--> <!-->mg of prednisone at V5, with a delta between the autonomous community with the highest percentage and the lowest of 18 points. This percentage increased between visit 1 and visit 5 in all cases.</div></div><div><h3>Conclusions</h3><div>The use of low-dose GCs is common in Spanish lupus patients, although there is a clear downward trend in their use. Most patients typically reach the recommended dose. There are differences between the different autonomous communities in the use of GCs and their dosage.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502220"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096202","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":"Risk of chronic uveitis onset is increased in juvenile idiopathic arthritis in the absence of methotrexate therapy","authors":"Helena M. Amar Muñoz,&nbsp;Daniel Clemente,&nbsp;Alina Boteanu,&nbsp;Isabel Valls,&nbsp;Lucía Ibares Frías,&nbsp;Antía García-Fernández,&nbsp;Pablo González Navarro,&nbsp;Perceval Vellosillo González,&nbsp;Juan Carlos López-Robledillo,&nbsp;Indalecio Monteagudo Sáez,&nbsp;Juan Carlos Nieto González","doi":"10.1016/j.reuma.2026.502221","DOIUrl":"10.1016/j.reuma.2026.502221","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze factors associated with anterior chronic uveitis development in juvenile idiopathic arthritis (JIA), focusing on methotrexate (MTX) exposure and discontinuation.</div></div><div><h3>Methods</h3><div>We conducted a multicenter retrospective study. Patients with JIA-associated uveitis (JIA-U) were compared with JIA patients without uveitis, matched 1:1 according to JIA subtype, age at JIA diagnosis, and serum markers. Data included demographics, clinical features and treatments. The effect of MTX on JIA-U onset was analyzed and adjusted for matching factors.</div></div><div><h3>Results</h3><div>A total of 404 patients with JIA were included, 77 (19%) developed uveitis, mostly chronic anterior uveitis. Uveitis onset occurred within three years of JIA diagnosis, with a median time of 1.7 years (IQR 0.42–3.65). In the matched analysis (62 JIA-U and 62 JIA-no-U), no statistically significant differences were observed in previous MTX exposure within the first two years after JIA diagnosis between patients with and without uveitis (82% vs. 91%; <em>p</em> <!-->=<!--> <!-->0.14). Among patients who discontinued MTX before developing uveitis, the median time from MTX withdrawal to uveitis onset was 1.7 years (IQR 0.89–3.7). At uveitis onset, 57.1% of patients were not receiving systemic treatment, 31.2% were receiving MTX, 7.8% were receiving etanercept and 3.9% were receiving both.</div></div><div><h3>Conclusions</h3><div>Our study suggests that uveitis in JIA occurs more frequently in patients who are not receiving systemic treatment, including those with long-standing disease, although this association was not statistically significant in our cohort. Close ophthalmologic screening during the 18 months following MTX discontinuation may allow earlier diagnosis of uveitis and prevent complications.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502221"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096196","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":"Self-perception of oral health and dental care habits in patients with Sjögren's disease, rheumatoid arthritis, and systemic lupus erythematosus","authors":"Karina Palomo-Arnaud,&nbsp;Jesus Alberto Cardenas-de la Garza,&nbsp;Andrés Manuel Ortiz-Ríos,&nbsp;Hector Alejandro Martinez-Espinosa,&nbsp;Angel Kevin Garza-Elizondo,&nbsp;Dionicio A. Galarza-Delgado,&nbsp;Janett Riega-Torres","doi":"10.1016/j.reuma.2026.502222","DOIUrl":"10.1016/j.reuma.2026.502222","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Oral manifestations are frequent in patients with rheumatic diseases (RD). This study aims to evaluate self-perception of oral health and habits in patients with Sjögren's disease (SjD), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE).</div></div><div><h3>Materials and methods</h3><div>We performed a cross-sectional study including adult patients with SjD, RA, and SLE. We applied the modified Spanish version of the Geriatric/General Oral Health Assessment Index (GOHAI-SPM) survey, which includes 12 questions, and patients were classified as having poor (≤50 points), moderate (51–56 points), and good (≥57 points) oral health. Additionally, we compared the oral health and dental care habits between patients.</div></div><div><h3>Results</h3><div>We included 415 patients, with a median age of 53 (41.25–61) years; 387 (93.3%) were female. Two hundred and ninety-two patients had RA (70.4%), 72 had SLE (17.3%), and 51 had SjD (12.3%). Overall, 136 patients (32.8%) reported poor self-perceived oral health, 101 (24.3%) moderate, and 178 (42.9%) good. SjD patients reported the lowest scores (median GOHAI-SPM<!--> <!-->=<!--> <!-->51 [IQR 42.5–55], SLE 57 (49.8–60), RA 55 (48.0–59.0), <em>p</em> <!-->&lt;<!--> <!-->0.001), lower frequency of dental care appointments (&lt;2/year, 35.3%), and lower brush frequencies per day (≤2/day, 60.8%) than patients with RA or SLE. Patients with SjD are most aware of the relationship between their disease and oral health (68.6%), in contrast to patients with RA (53.1%) or SLE (43.1%).</div></div><div><h3>Discussion and conclusion</h3><div>Most patients with Sjögren's disease (SjD) and half of the patients with rheumatoid arthritis (RA) reported moderate to poor self-perceived oral health. Their primary concerns are pain, physical limitations, and psychosocial aspects. These findings highlight the importance of implementing a multidisciplinary approach involving rheumatologists and allied healthcare professionals in the management of these patients.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502222"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096197","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":"Productos engaño para dolor y artritis, análisis de las alertas sanitarias de la FDA","authors":"Luis del Carpio-Orantes","doi":"10.1016/j.reuma.2026.502271","DOIUrl":"10.1016/j.reuma.2026.502271","url":null,"abstract":"","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502271"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096201","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":"Nursing health promotion interventions in the management of rheumatoid arthritis: A scoping review","authors":"Mónica Grande-Alonso,&nbsp;Emma Aranda-Polo,&nbsp;Carlos Forner-Álvarez,&nbsp;Alba Sebastián-Martín,&nbsp;Rafael Moreno-Gómez-Toledano","doi":"10.1016/j.reuma.2026.502205","DOIUrl":"10.1016/j.reuma.2026.502205","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by an involvement of sensorimotor and psychological factors, which can impact on the sufferer's quality of life. Education and health promotion activities from a multidisciplinary approach including nursing could help in symptom management. This review aims to analyze and evaluate health promotion interventions from a nursing perspective in patients with RA. A scoping review method was employed to identify relevant peer-reviewed articles published between 2019 and 2024 across PubMed and Web of Science databases. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist was followed. The specific search strategy was: (rheumatoid arthritis) AND (health promotion OR health education OR promotion OR education OR therapeutic education OR health care OR health management) AND (nursing intervention AND nursing). Six articles met the inclusion criteria, showing that nursing interventions include educational sessions (for patients or family caregivers), interviews, daily phone calls, written information and professional counseling. They implied an improvement in disease activity (even in biochemical parameters), medical adherence or readiness, self-efficacy, quality of life, and psychological wellbeing. Besides, a reduction in pain intensity was described. This review demonstrates that nursing interventions within multidisciplinary teams, as well as comprehensive and individualized care, significantly improve sensorimotor and psychological variables, which contribute to managing chronic pain in patients with RA.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502205"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096195","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":"Non-infectious uveitis and scleritis in patients with systemic autoimmune diseases and spondyloarthritis: Prevalence and characteristics of a monocentric cohort","authors":"Paola León-Suárez,&nbsp;Félix Francisco Hernández,&nbsp;Soledad Ojeda Bruno,&nbsp;Fayna Rodríguez González,&nbsp;Miguel del Piñal-Álvarez,&nbsp;Antonio Naranjo Hernández","doi":"10.1016/j.reuma.2026.502252","DOIUrl":"10.1016/j.reuma.2026.502252","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the ocular inflammatory disease (non-infectious uveitis and scleritis) in patients with systemic autoimmune diseases (SADs) and compare it with patients with spondyloarthritis (SpA).</div></div><div><h3>Methods</h3><div>Retrospective cohort study including patients older than 16 years registered in the prospective database of a tertiary Ocular Inflammatory Pathology Unit (1991–2023). Demographic characteristics, ocular features, systemic treatments, complications, and time intervals (symptom onset, first visit, diagnosis, and remission) were analyzed.</div></div><div><h3>Results</h3><div>A total of 219 patients were included (100 with SADs and 119 with SpA). Women predominated in the SADs group (64.0%) and men in SpA (62.2%). Ocular involvement in SADs was heterogeneous, including anterior uveitis (30.0%), posterior uveitis (28.0%), panuveitis (25.0%), while acute anterior uveitis predominated in SpA (94.1%). Patients with SADs required more systemic glucocorticoids and conventional immunosuppressants (methotrexate, azathioprine, cyclosporine, mycophenolate) while sulfasalazine was more frequently used in SpA. Biologic therapy was required in a similar proportion of patients (23.0% vs. 20.2%). Longer diagnostic delay was associated with higher rates of cystoid macular edema and glaucoma.</div></div><div><h3>Conclusions</h3><div>Ocular inflammation associated with SADs shows a broader anatomical distribution and requires more intensive systemic therapy compared with SpA, which is predominantly characterized by acute anterior uveitis. Early referral and timely diagnosis appear to influence complication rates and remission. Further prospective studies are needed to confirm these findings and optimize management.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502252"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096198","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":"Efficacy of tapering biologics and JAK inhibitors in rheumatoid arthritis: A systematic review and meta-analysis","authors":"Sandra Rotea-Salvo,&nbsp;Laura Galindo,&nbsp;Belén Acasuso-Pardo de Vera,&nbsp;Vanesa Balboa-Barreiro,&nbsp;Luis Ramudo-Cela,&nbsp;Maite Silva-Díaz,&nbsp;Natividad Oreiro-Villar,&nbsp;Francisco J. De Toro-Santos,&nbsp;Isabel Martín-Herranz,&nbsp;Francisco J. Blanco","doi":"10.1016/j.reuma.2026.502224","DOIUrl":"10.1016/j.reuma.2026.502224","url":null,"abstract":"<div><h3>Objective</h3><div>This study assessed the evidence on the efficacy of tapering anti-TNF, JAK inhibitors, and tocilizumab in patients with rheumatoid arthritis (RA).</div></div><div><h3>Methods</h3><div>In February 2024, a systematic review was conducted by searching Medline, Embase, Web of Sciences, and the Cochrane Library for randomized controlled trials comparing the efficacy of tapering vs standard treatment. The outcomes evaluated were the maintenance of low disease activity (LDA), remission, and flare-ups. A meta-analysis was conducted when data were available. The risk of bias was assessed using RoB 2. The study was registered on PROSPERO and conducted in accordance with the PRISMA guidelines.</div></div><div><h3>Results</h3><div>A total of 2861 records were identified, with 1638 records screened after removing duplicates. Finally, fifteen studies involving 2782 patients were included. Follow-up ranged from 6 months to 3.5 years. Tapering anti-TNF did not affect LDA maintenance while showing a lower probability of maintaining remission (RR 0.69, 95% CI 0.57–0.84) and a higher risk of flare-ups (RR 1.96, 95% CI 1.57–2.45). Tapering JAK inhibitors showed a decreased probability of maintaining LDA (RR 0.83, 95% CI 0.76–0.91) and remission (RR 0.86, 95% CI 0.75–0.99), and more frequent and earlier flares. Tapering tocilizumab also resulted in a lower probability of maintaining LDA or remission and a higher risk of flares. Several included studies presented a risk of bias, mainly related to outcome measurement and open-label designs.</div></div><div><h3>Conclusion</h3><div>Although tapering anti-TNF did not affect LDA maintenance, due to the increased risk of flare-ups and reduced remission probability, routine dose tapering of anti-TNF, JAK inhibitors, and tocilizumab for patients with RA is not recommended in all of them. Identifying patients who may benefit from tapering is crucial.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502224"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096205","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":"Knowledge, intentions, and practices of breastfeeding among women with systemic lupus erythematosus: A cross-sectional survey","authors":"María Pía Izaguirre Germain,&nbsp;Susana Villamizar Pérez,&nbsp;Nicole Josianne Paris,&nbsp;Melissa Brenda Serna Góngora,&nbsp;Ariel Brener,&nbsp;Jerson Claros,&nbsp;Emel Gonzalez,&nbsp;Bárbara Cristina Pérez Cepas,&nbsp;Marina Laura Micelli,&nbsp;Gabriel Sequeira,&nbsp;Eduardo Mario Kerzberg","doi":"10.1016/j.reuma.2026.502244","DOIUrl":"10.1016/j.reuma.2026.502244","url":null,"abstract":"","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502244"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096200","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":"Methotrexate treatment for pain due to osteoarthritis of the hand and knee: A systematic review and meta analysis","authors":"Erin Ozminkowski,&nbsp;Samuel Ozminkowski,&nbsp;Hamid Bashir","doi":"10.1016/j.reuma.2026.502248","DOIUrl":"10.1016/j.reuma.2026.502248","url":null,"abstract":"<div><div>Osteoarthritis is a chronic health condition that causes substantial morbidity globally. Methotrexate has been explored as a therapeutic given its use in inflammatory arthritis. This paper aims to summarize and evaluate the current literature regarding methotrexate as treatment for osteoarthritis. We identified two randomized controlled trials testing methotrexate for hand pain (161 total subjects; 79 control, 82 experimental group) and three randomized controlled trials testing methotrexate for knee pain (313 total subjects; 157 control, 156 experimental). We performed a risk of bias assessment on all included studies. Our meta-analysis revealed significant reduction in hand pain with methotrexate use at 3–4 months (95% CI: −0.66, −0.06), as well as for knee pain at 6 months (95% CI: −1.26, −0.07), but not at 3–4 months (95% CI: −0.69, +0.09). Finally, we performed sensitivity analysis excluding high risk of bias studies, but when looking at all outcomes, this did not change significance for any of the groups.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"22 8","pages":"Article 502248"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149096206","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}