Sao Paulo Medical Journal最新文献

{"title":"Diabetes and smoking are associated with dynapenic abdominal obesity in patients with chronic kidney disease: a cross-sectional study.","authors":"Alessandra Fortes Almeida-Menezes, Maria Ester Pereira da Conceição-Machado, Maria Helena Lima Gusmão, Lílian Barbosa Ramos, Thais Vitorino Neves do Nascimento, Magali Teresópolis Reis Amaral, Jairza Maria Barreto-Medeiros","doi":"10.1590/1516-3180.2023.0232.R2.21102024","DOIUrl":"10.1590/1516-3180.2023.0232.R2.21102024","url":null,"abstract":"<p><strong>Background: </strong>No study has reported about the prevalence and factors associated with dynapenic abdominal obesity in patients with pre-dialysis chronic kidney disease (CKD).</p><p><strong>Objective: </strong>Evaluation of the prevalence of dynapenic abdominal obesity and its relationship with sociodemographic, lifestyle, clinical, and nutritional variables in patients with CKD not dependent on dialysis.</p><p><strong>Design and setting: </strong>A cross-sectional study was conducted at the Nutrition and Nephropathy Outpatient Clinic (public service) in Bahia, Brazil.</p><p><strong>Methods: </strong>This cross-sectional study was conducted on 102 patients of both sexes, aged ≥ 20 years. Dynapenic abdominal obesity (DAO) was defined as the simultaneous presence of dynapenia (handgrip strength less than the first tertile of the sample itself, according to sex and age) and increased waist circumference. Differences between groups with and without DAO were assessed using the Student's Mann-Whitney t-test, Pearson's chi-square test, or Fisher's exact test. Associations were tested using bivariate and multivariate models with Poisson regression to calculate the prevalence ratio and 95% confidence intervals (PR; 95% CI).</p><p><strong>Results: </strong>The mean age of the patients was 58.7 (standard deviation = 11.69); 50.5% were male, 51.6% were elderly, 41.8% had diabetes, 5.5% were smokers, 58.2% were abdominally obese, and 38.5% were dynapenic. DAO was identified in 18.7% of participants and was associated with diabetes mellitus (PR = 2.8; 95% CI = 1.12-6.99) and smoking (PR = 3.22; 95% CI = 1.16-8.96).</p><p><strong>Conclusion: </strong>Non-dialysis dependent patients with CKD showed a significant prevalence of DAO associated with smoking and diabetes mellitus.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2023232"},"PeriodicalIF":1.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors associated with frailty among incident kidney transplant patients: a cross-sectional study.","authors":"Raoni de Oliveira Domingues-da-Silva, Helady Sanders-Pinheiro, Emiliana Holanda Pedrosa, Camila Mendes Dos Santos, Jerônimo Junqueira Junior, Ronaldo de Matos Esmeraldo, Paula Frassinetti Castelo Branco Camurça Fernandes, Claudia Maria Costa de Oliveira, Tainá Veras de Sandes-Freitas","doi":"10.1590/1516-3180.2024.0141.R1.29012025","DOIUrl":"10.1590/1516-3180.2024.0141.R1.29012025","url":null,"abstract":"<p><strong>Background: </strong>Evidence on frailty prevalence in Brazilian patients with kidney transplant (KT) is scarce.</p><p><strong>Objectives: </strong>To estimate frailty prevalence in pre-KT patients and its association with functional, cognitive, and laboratory anomalies.</p><p><strong>Design and setting: </strong>Cross-sectional descriptive study included adult KT candidates assessed within 24 hours before KT, at two medical centers in Northeast Brazil.</p><p><strong>Methods: </strong>Frailty was classified as non-frail (scores 0-1), intermediate frail (score 2), or frail (scores 3-5), using Fried et al. criteria. Patients were divided into: Non-frail (0-1) and Frail (≥ 2) groups. Katz and Lawton's scales assessed the dependence on basic (ADLs) and instrumental (IADLs) activities of daily living, respectively. Montreal Cognitive Assessment was used to evaluate cognition. Laboratory tests were performed during pre-KT evaluation.</p><p><strong>Results: </strong>Among 82 patients, most were male (80.5%), mixed-race (76.8%), and 48.8 ± 14.9-years-old. The Frail group (63.4%) comprised 34.1% intermediate frail, and 29.3% frail individuals. This group had a higher prevalence of hypertension (90.4% vs. 70%, P = 0.018), rheumatological diseases (15.4% vs. 0%, P = 0.024), cognitive impairment (71.0% vs. 40.7%, P = 0.020), dependence on ADLs (32% vs. 0%, P < 0.001) and IADLs (82% vs. 56.7%, P = 0.014), lower hemoglobin (11.9 ± 2.7 g/dL vs. 13.4 ± 1.8 g/d, P = 0.005), and lower creatinine levels (7.1 mg/dL, IQR 6-10 vs. 9.1 mg/dL, IQR 7-11, P = 0.044).</p><p><strong>Conclusions: </strong>Pretransplant frailty was prevalent and associated with functional disability, cognitive impairment, and biomarkers indicating sarcopenia. Early frailty assessment and identification of modifiable factors are essential.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2024141"},"PeriodicalIF":1.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of artificial intelligence to identify ophthalmic biomarkers in cardiovascular disease and stroke: a narrative review.","authors":"Diogo Gonçalves Dos Santos Martins, Thiago Goncalves Dos Santos Martins, Paulo Schor","doi":"10.1590/1516-3180.2023.0369.11022025","DOIUrl":"10.1590/1516-3180.2023.0369.11022025","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) and stroke are among the leading causes of death worldwide.</p><p><strong>Objective: </strong>This article presents a review of the application of artificial intelligence in identifying biomarkers for CVD and stroke.</p><p><strong>Design and setting: </strong>Narrative review conducted by a research group at the Universidade Federal de São Paulo, São Paulo, Brazil.</p><p><strong>Methods: </strong>A literature search was conducted to identify the main applications of artificial intelligence in ophthalmology, using the keywords \"artificial intelligence,\" \"prediction,\" \"biomarker,\" \"cardiovascular disease,\" \"retina,\" and \"stroke,\" covering the period from January 1, 2018, to July 3, 2023. The Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed) and the Latin American and Caribbean Literature in Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde, LILACS, via the Virtual Health Library) were used to identify relevant articles.</p><p><strong>Results: </strong>A total of 30 references were retrieved, of which 14 were considered eligible for intensive review and critical analysis.</p><p><strong>Conclusions: </strong>Artificial intelligence has proven effective in identifying non-invasive biomarkers through the analysis of patients' retinal examinations. These findings contribute to a better understanding of the pathophysiology of CVD and stroke.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2023369"},"PeriodicalIF":1.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in older people in Brazil: prevalence, associated factors, limitations and care practices. A cross-sectional study.","authors":"Priscila Maria Stolses Bergamo Francisco, Athos Paixão Silva Santos, Daniela de Assumpção, Aldiane Gomes de Macedo Bacurau","doi":"10.1590/1516-3180.2024.0132.R1.13082024","DOIUrl":"10.1590/1516-3180.2024.0132.R1.13082024","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases, especially ischemic heart disease and stroke, are the main causes of mortality in older people.</p><p><strong>Objectives: </strong>To estimate the prevalence of stroke in older people in Brazil, we investigated its associations with sociodemographic factors, health-related behaviors, chronic diseases, body mass index and self-rated health and determined the frequency of limitations related to disease and care practices.</p><p><strong>Design and setting: </strong>This population-based, cross-sectional study used data from the 2019 Brazilian National Health Survey.</p><p><strong>Methods: </strong>This study included older people aged ≥ 60 years (n = 22,728) who answered the question, \"Has any doctor ever given you a diagnosis of stroke?\" Adjusted odds ratios were estimated using logistic regression.</p><p><strong>Results: </strong>The prevalence of stroke was 5.6% (95% confidence interval = 5.1-6.1) and was higher in men, individuals aged ≥ 70 years, those with a lower income, those without health insurance, ex-smokers, physically inactive individuals, those with excess weight/obesity, those who rated their own health as fair/poor/very poor and those who reported hypertension, diabetes, kidney failure, depression and heart disease. The most adopted care practices were follow-ups by a healthcare provider (60.8%), medication use (59.3%) and diet (47.2%). Only 17.0% of patients underwent physiotherapy, and 53.7% reported limitations in habitual activities.</p><p><strong>Conclusions: </strong>Subgroups of people more affected by stroke were identified, which included older individuals, those with lower socioeconomic status, ex-smokers and those with neuroendocrine and cardiovascular comorbidities. Less than 20% of patients underwent physiotherapy, which underscores the need to expand multidisciplinary care in the health network.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2024132"},"PeriodicalIF":1.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Musculoskeletal rehabilitation in controlled trials: Is it correct to compare different types of exercise?","authors":"André Pontes-Silva","doi":"10.1590/1516-3180.2024.0374.29012025","DOIUrl":"10.1590/1516-3180.2024.0374.29012025","url":null,"abstract":"<p><strong>Background: </strong>There are several randomized controlled trials (RCTs) in the literature on musculoskeletal rehabilitation that compare different types of exercise; however, the comparison is not relevant because the groups generally perform different physical efforts, and the researchers are not aware of this, nor do they control for the confounding variables.</p><p><strong>Objectives: </strong>To discuss the methods of comparison of different types of exercises in musculoskeletal rehabilitation.</p><p><strong>Design and settings: </strong>Short communication developed at the Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.</p><p><strong>Methods: </strong>A narrative review of the motion cadence, time-under-tension, actual duration of an exercise session, and total physical effort was conducted.</p><p><strong>Results: </strong>To compare the different types of exercise, it is crucial that the parameters of the proposed exercises are the same between the groups, i.e., the exercise intensity, total physical effort, and actual duration of the exercise session.</p><p><strong>Conclusion: </strong>It is correct to compare different types of exercise, however, in the field of musculoskeletal rehabilitation, RCTs adequately controlled for these variables are lacking.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2024374"},"PeriodicalIF":1.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The urgent need for well-being programs in medical residencies in Brazil.","authors":"Marcelo Bruno Generoso, Pedro Shiozawa, Ricardo Uchida, Marsal Sanches","doi":"10.1590/1516-3180.2023.0274.R1.29012025","DOIUrl":"10.1590/1516-3180.2023.0274.R1.29012025","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2023274"},"PeriodicalIF":1.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the integration of palliative care for patients with hematologic malignancies: an analysis of the surprise question in a prospective cohort study.","authors":"Alini Maria Orathes Ponte Silva, Diego Lopes Paim Miranda, David Pereira Ferreira, Camilla Correia de Araujo Pereira Campos, Edvan de Queiroz Crusoé, Felipe Feistauer Gomes, Thiago Favano, Marco Aurélio Salvino","doi":"10.1590/1516-3180.2024.0263.29012025","DOIUrl":"https://doi.org/10.1590/1516-3180.2024.0263.29012025","url":null,"abstract":"<p><strong>Background: </strong>The Surprise Question (SQ), \"Would I be surprised if this patient were to die in the next 12 months?\", identifies patients at high risk of death who might benefit from palliative care (PC). However, little is known about its application in oncohematology.</p><p><strong>Objectives: </strong>To evaluate the performance of the SQ among inpatients with hematologic malignancies.</p><p><strong>Design and setting: </strong>A prospective cohort study was conducted between September and December 2021, including patients admitted to the Hematology Ward of the University Hospital in Salvador, Brazil.</p><p><strong>Methods: </strong>Physicians answered the SQ (not surprised (SQ+) or surprised (SQ-)). Mortality data were assessed after one year.</p><p><strong>Results: </strong>Eighty-one patients were included (56% SQ+ and 44% SQ-). At study closure, 36 patients (44%) had died. Median survival was 10.8 months (95%CI = 9.7-11.8) for SQ- and 5.6 months (95%CI = 4.1-7.1) for SQ+. Sensitivity was 86.1%, specificity 68.9%, positive predictive value 68.8%, negative predictive value 86.1%, and accuracy 76.5%. At the time of the interview, only 15 (18.5%) patients had consulted a PC specialist. By the study's end, 48% had been referred to PC. These patients had poorer performance status (82% vs. 40%, P < 0.001) and more advance care planning records (87% vs. 14%, P < 0.001).</p><p><strong>Conclusions: </strong>Despite the prognostic uncertainty of hematologic malignancies, the SQ effectively estimates mortality and serves as a valuable tool for early PC integration in oncohematology.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2024263"},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Guideline-Directed Medical Therapy Target in patients with heart failure and reduced ejection fraction: a cross-sectional study.","authors":"Fábio Figueirêdo Costa, Andréa Karoline Reis Chagas, Anna Cláudia Monteiro Luz Santos, Lívia Brito Oliveira, Alex Cleber Improta-Caria, Adriana Lopes Latado, Roque Aras Júnior","doi":"10.1590/1516-3180.2023.0315.R2.13082024","DOIUrl":"10.1590/1516-3180.2023.0315.R2.13082024","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with reduced ejection fraction (HFrEF) represents a compelling cause of hospital morbidity and mortality in Brazil. There is low adherence to guideline-directed medical therapy (GDMT), which in turn, can result in higher morbidity and mortality.</p><p><strong>Objectives: </strong>The present study aims to evaluate adherence to GDMT in patients with HFrEF in a Brazilian University hospital service.</p><p><strong>Design and settings: </strong>Observational, cross-sectional, single-center study conducted at the Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil.</p><p><strong>Methods: </strong>The study was conducted with convenience sampling at the cardiology outpatient clinic of a university hospital service. Patients with left ventricular ejection fraction (LVEF) < 40% who had reverse remodeling were excluded.</p><p><strong>Results: </strong>289 patients were included, with mean age 63 years, 54.7% were male, 56,4% mixed-race and 27,7% had Chagasic cardiomyopathy. 93.1% were prescribed ACEi, ARB or ARNi, 95.8% betablockers, 69.2% spironolactone and 8% the combination hydralazine/isosorbide-dinitrate. 71,7% were using enalapril, losartan or ARNi above 50% of GDMT target doses; 81,2% were using beta-blockers and 100% were using spironolactone. Only 21,2% were prescribed GDMT target doses of enalapril, losartan or ARNi and 52,3% of beta-blockers. 98,5% of spironolactone prescriptions reached GDMT target doses.</p><p><strong>Conclusions: </strong>We found high frequencies of prescription of GDMT for HFrEF, considering the therapeutic goals recommended by cardiology guidelines, but, prescription of target doses were low in ACEi, ARB or ARNi and beta-blockers.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2023315"},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice of oxygen administration in patients hospitalized in internal medicine wards and intensive care units: A single-center prospective, observational study.","authors":"Saliha Bozkurt Esengul, Arzu Topeli, Burcin Halacli","doi":"10.1590/1516-3180.2024.0323.29012025","DOIUrl":"10.1590/1516-3180.2024.0323.29012025","url":null,"abstract":"<p><strong>Background: </strong>Oxygen is widely used to treat hypoxemia.</p><p><strong>Objective: </strong>To determine the frequency of inappropriate oxygen administration in patients admitted to Internal Medicine (IM) wards and intensive care units (ICU).</p><p><strong>Design and setting: </strong>Single-center prospective, observational study in a tertiary university hospital in Ankara, Türkiye.</p><p><strong>Methods: </strong>Patients who were hospitalized in the IM wards and ICU and were receiving oxygen were recruited. Every 6 hours, the oxygenation parameters were noted, and the averages over the first 24 hours of oxygen usage were recorded. Inappropriate usage was defined as oxygen flow rates > 6 L/min in the nasal cannula and < 5 L/min and > 10 L/min in the simple face mask, application of the simple face mask in chronic obstructive lung disease (COPD) exacerbation, SpO2 > 98% in general, or SpO2 > 92% in COPD exacerbation.</p><p><strong>Results: </strong>Of the 397 patients, 20% in the IM wards and 50% of 124 in the ICU received oxygen. The oxygen method used was nasal cannula in 51%, simple face mask in 21%, and high-flow nasal cannula in 4% of the patients. Among the simple face mask applications, 46% were < 5 L/min and 5% were > 10 L/min. Among the 62% of patients with COPD exacerbations, the SpO2 was > 92%.</p><p><strong>Conclusion: </strong>The frequency of oxygen use was 20% among patients hospitalized in IM wards and 50% among patients in the ICU. Almost half of the simple face mask applications were inappropriate.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 3","pages":"e2024323"},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Latin American Integration Route and infectious diseases.","authors":"Inara Pereira da Cunha, Sandra Maria do Valle Leone de Oliveira, James Venturini, Ruberval Franco Maciel, Antonio Jose Grande","doi":"10.1590/1516-3180.2024.0049.R1.09092024","DOIUrl":"https://doi.org/10.1590/1516-3180.2024.0049.R1.09092024","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"143 2","pages":"e2024049"},"PeriodicalIF":1.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}