Journal of Clinical Endocrinology & Metabolism最新文献

{"title":"The Role and Regulation of Intramuscular Sex Hormones in Skeletal Muscle: A Systematic Review.","authors":"Viktor Engman, Annabel J Critchlow, Eija K Laakkonen, Mette Hansen, Shaun Mason, Séverine Lamon","doi":"10.1210/clinem/dgaf174","DOIUrl":"10.1210/clinem/dgaf174","url":null,"abstract":"<p><strong>Introduction: </strong>Serum concentrations of androgens and estrogens, the main male and female sex hormones, respectively, naturally fluctuate across the lifespan. Sex hormones are mainly produced in the gonads, but evidence suggests that they can also be locally synthesized in skeletal muscle. However, little is known about the purpose of intramuscular sex hormones and their role in skeletal muscle. This systematic review aimed to investigate (1) how intramuscular sex hormone concentrations vary across the lifespan, (2) whether exercise affects intramuscular sex hormone concentrations, and (3) whether intramuscular sex hormones are associated with skeletal muscle mass and function.</p><p><strong>Methods: </strong>Four databases were searched, and studies were included if they contained measurements of intramuscular sex hormones from rodents or healthy males and females free from any hormonal treatment.</p><p><strong>Results: </strong>Thirteen studies were included. Intramuscular testosterone was reduced in older males compared to their younger counterparts, but comparison of intramuscular sex hormone concentrations between pre- and postmenopausal females yielded inconclusive findings. Chronic exercise decreased androgens and estradiol in females but increased androgens in males. Acute exercise did not change intramuscular hormone concentrations in humans but increased them in rodents. Intramuscular androgens were positively associated with muscle mass and strength in males. In females, conflicting findings were reported for both estradiol and androgens and measures of muscle mass and function.</p><p><strong>Conclusion: </strong>Current evidence suggests that aging and exercise differentially modulate intramuscular sex hormone concentrations, and their association with muscle mass and function, between males and females and model systems.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e1732-e1746"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: \"Metabolic Profiles of Pregnancy With Polycystic Ovary Syndrome: Insights into Maternal-Fetal Metabolic Communication\".","authors":"","doi":"10.1210/clinem/dgaf189","DOIUrl":"10.1210/clinem/dgaf189","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2107"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor from Giles et al: \"Comparison of Cumulative Live Birth Rates After Progestin or GnRH Analogues in Preimplantation Genetic Testing Cycles\".","authors":"Ruiqiong Zhou, Fenghua Liu","doi":"10.1210/clinem/dgaf148","DOIUrl":"10.1210/clinem/dgaf148","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2104"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Endocannabinoids Are Independently Associated With the Metabolic Function of White Adipose Tissue.","authors":"Dany Dion, Christophe Noll, Mélanie Fortin, Lounès Haroune, Sabrina Saibi, Philippe Sarret, André C Carpentier","doi":"10.1210/clinem/dgae657","DOIUrl":"10.1210/clinem/dgae657","url":null,"abstract":"<p><strong>Context: </strong>Little is known about the link between the endocannabinoid (EC) system and the in vivo metabolic function of white adipose tissue (WAT).</p><p><strong>Objective: </strong>We aimed to evaluate whether ECs are linked to postprandial fatty acid metabolism and WAT metabolic function.</p><p><strong>Methods: </strong>Men and women, with (IGT, n = 20) or without impaired glucose tolerance (NGT, n = 20) underwent meal testing with oral and intravenous stable isotope palmitate tracers and positron emission tomography with intravenous [11C]-palmitate and oral [18F]-fluoro-thia-heptadecanoic acid to determine systemic and organ-specific dietary fatty acid (DFA) and nonesterified fatty acid (NEFA) metabolism and partitioning. We determined fasting and postprandial plasma levels of EC by ultra-high performance liquid chromatography-tandem mass spectrometry.</p><p><strong>Results: </strong>All ECs of the 2-monoacylglycerol (2-MAG) family displayed a progressive postprandial increase up to 360 minutes after meal intake that was more pronounced in women with IGT. N-acylethanolamine (NAE) levels decreased between fasting and 180 minutes, followed by a return to preprandial values at 360 minutes and were also increased in women with IGT. Postprandial area under the curve (AUC) of palmitate appearance rate was significantly and independently associated with postprandial AUC of anandamide (AEA; P = .0003) and total energy expenditure (P = .0009). DFA storage in abdominal subcutaneous adipose tissue was positively predicted by fasting 2-arachidonoylglycerol (2-AG; P < .04).</p><p><strong>Conclusion: </strong>EC levels of the NAE family independently follow plasma NEFA metabolism, whereas 2-MAG closely follow the spillover of triglyceride-rich lipoprotein intravascular lipolytic products. Whether these associations are causal requires further investigation.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e1821-e1832"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatic DICER1-Mutant Benign Thyroid Nodules in Adults: A Group of Follicular Nodular Disease With Continuous Growth.","authors":"Lingyang Meng, Haorong Li, Yi'an Fu, Danyan Yu, Jiamin Tang, Yan Hu, Xiaochun Fei, Kaiyu Yang, Ziyuan Liu, Rongguang Peng, Yulin Zhou, Shu Wang, Jiqi Yan, Liyun Shen, Rulai Han, Lei Ye","doi":"10.1210/clinem/dgae750","DOIUrl":"10.1210/clinem/dgae750","url":null,"abstract":"<p><strong>Context: </strong>Germline DICER1 mutations cause familial multinodular goiter (MNG). However, the prevalence of somatic DICER1 mutations in non-MNG benign thyroid nodules and their characteristics remain unknown.</p><p><strong>Objective: </strong>To determine the prevalence of somatic DICER1-mutant non-MNG benign thyroid nodules and their clinicopathological, molecular, behavioral and transcriptional characteristics.</p><p><strong>Methods: </strong>Adult-onset thyroid nodules with a pathological diagnosis were genotyped via targeted sequencing. DICER1-mutant nodules were assessed clinically and pathologically. Organoids were established to investigate follicular formation and growth. Transcriptomic analysis was conducted to evaluate transcriptional features, which were validated by immunofluorescence.</p><p><strong>Results: </strong>Among 931 adult-onset thyroid nodules, we identified 13 benign thyroid nodules with DICER1 hotspot mutations. The majority harbored a somatic DICER1 hotspot mutation with a somatic DICER1 truncating variant. Clinically, 38.5% of the DICER1-mutant nodules exhibited substantial growth. DICER1-mutant nodules with durations longer than 2 years were substantially enlarged (P = .0448). Pathologically, all DICER1-mutant nodules were defined as thyroid follicular nodular disease (TFND). The TFND nodules with DICER1 mutations grew faster than those with wild-type DICER1. Organoid culture of a DICER1-mutant nodule revealed increased active follicular formation. Compared with the normal thyroid tissues, the DICER1-mutant nodules had similar thyroid differentiation scores, significantly higher extracellular signal-related kinase scores (P = .0141) and lower epithelial-mesenchymal transition scores (P = .0001). Moreover, the expression of genes related to follicular polarity, such as CDH16, SLC5A5, TSHR, and TPO, was downregulated in the DICER1-mutant nodules.</p><p><strong>Conclusion: </strong>Somatic DICER1 2-hit mutations represent a notable percentage in adult patients with TFND, and DICER1-mutant benign thyroid nodules were characterized by continuous growth.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1559-1569"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total and Regional Fat-To-Muscle Mass Ratio in Relation to All-Cause and Cause-Specific Mortality in Men and Women.","authors":"Minzhi Xu, Yanhong Gong, Xiaoxv Yin","doi":"10.1210/clinem/dgae595","DOIUrl":"10.1210/clinem/dgae595","url":null,"abstract":"<p><strong>Context: </strong>Fat-to-muscle mass ratio (FMR) has been considered a potentially useful indicator for assessing disease risk. However, the association between FMR and risk of death remains inconclusive.</p><p><strong>Objective: </strong>This work aimed to investigate the associations of FMR (the whole body, trunk, legs, and arms) with all-cause and cause-specific mortality by sex.</p><p><strong>Methods: </strong>A total of 337 951 participants from the UK Biobank were included. Fat mass and muscle mass were estimated using a bioelectrical impedance assessment device. Cox proportional-hazard regression was applied to explore the associations.</p><p><strong>Results: </strong>During a median follow-up of 12.58 years, we recorded 22 391 (6.62%) deaths, of which 4427 were from cardiovascular disease, 11 740 from cancer, and 1458 from respiratory disease. We observed associations of different shapes (U-shaped for whole body and trunk, L-shaped for legs, and J-shaped for arms) between FMR and all-cause mortality (P for nonlinearity <.001). Compared with the lowest quintile of whole body and trunk FMR, the all-cause mortality risk was reduced by 12% to 14% and 7% to 15% in men and women in quintiles 2 to 4, respectively. The hazard ratio (HR) associated with arm FMR in men and leg FMR in men and women (quintile 5 vs 1) were 1.14 (95% CI, 1.05-1.23), 0.76 (0.71-0.82), and 0.78 (0.70-0.88) for all-cause mortality, respectively. The associations between FMR and cause-specific mortality were mostly similar to those for all-cause mortality.</p><p><strong>Conclusion: </strong>Our study revealed statistically significant associations of total and regional FMR with mortality, providing new evidence that FMR may be a potentially useful indicator for assessing mortality risk.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2054-e2063"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Analysis and Network Mapping of Disease Associations in Autoimmune Polyglandular Syndrome.","authors":"Greta Pham-Dobor, Peter Kaltenecker, Viktoria Temesfoi, Laszlo Bajnok, Orsolya Nemes, Beata Bodis, Emese Mezosi","doi":"10.1210/clinem/dgae701","DOIUrl":"10.1210/clinem/dgae701","url":null,"abstract":"<p><strong>Background: </strong>The purpose of our work was to provide a data-driven perspective to autoimmune polyglandular syndrome (APS), a complex autoimmune disorder, supplementing traditional clinical observations.</p><p><strong>Methods: </strong>Medical records of 7559 patients were analyzed, and autoimmune origin was proved in 3180 cases of which 380 (12%) had APS. Associations of component disorders were investigated by computational methods to reveal typical patterns of disease development.</p><p><strong>Results: </strong>Twenty-eight distinct autoimmune disorders were diagnosed forming 113 combinations. The 10 most frequent combinations were responsible for 51.3% of cases. Hashimoto's thyroiditis (HT) and Graves' disease (GD) were differentiated as the main cornerstones of APS, sharing several comorbidities. HT was the most common manifestation (67.4%), followed by GD (26.8%) and type 1 diabetes mellitus (T1D) (20.8%). APS started significantly earlier in men than in women. Thyroid autoimmunity was frequently linked to gastrointestinal and systemic manifestations, and these patterns of associations substantially differed from that of T1D, Addison's disease, or coeliac disease when present as first manifestations, suggesting the possibility of a common biological cause.</p><p><strong>Conclusion: </strong>APS is more frequent than reported. Classifying APS requires a shift of perspective toward disease associations rather than disorder prevalence.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1716-1728"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Minimal Sunlight Exposure on Bone Health: Insights From a Cohort Study in Erythropoietic Protoporphyria.","authors":"Louisa G Kluijver, Margreet A E M Wagenmakers, J H Paul Wilson, Janneke G Langendonk","doi":"10.1210/clinem/dgae729","DOIUrl":"10.1210/clinem/dgae729","url":null,"abstract":"<p><strong>Context: </strong>Erythropoietic protoporphyria (EPP) is a rare inherited metabolic disease, causing lifelong painful phototoxic reactions, minimal sunlight exposure, and vitamin D deficiency. Previous studies reported a high osteoporosis prevalence in EPP patients.</p><p><strong>Objective: </strong>To identify those at risk for low bone mineral density (BMD) and assess which factors, including treatment with cholecalciferol and afamelanotide, improve BMD in EPP.</p><p><strong>Methods: </strong>A longitudinal ambispective single-center cohort study. Data from patient files and two-time questionnaires from adult patients with EPP who underwent at least one dual-energy x-ray absorptiometry (DXA) scan between 2012 and 2023 were used.</p><p><strong>Results: </strong>BMD is low in EPP patients, with 82.7% of the 139 patients having a Z-score below 0 SD at baseline. Low BMD classified as osteopenia was found in 39.5%, and osteoporosis in 15.3%. There were 50 osteoporosis-related fractures in 34.2% of patients. Aging (odds ratio [OR] 1.08; CI, 1.03-1.12), persistent vitamin D deficiency (OR 1.11; 95% CI, 1.00-1.23) and a low body mass index (OR 0.91; 95% CI, 0.82-0.99) increased the odds of low BMD. Patients with a vitamin D deficiency (OR 5.51; 95% CI, 1.69-17.92) and no cholecalciferol at baseline (OR 0.22; 95% CI, 0.04-1.34) had the highest odds of improving their BMD. Afamelanotide did not improve BMD.</p><p><strong>Conclusion: </strong>25-hydroxyvitamin D (25(OH)D) status plays a crucial role in both preventing low BMD and improving BMD. EPP is a natural model for lack of sunlight exposure and vitamin D deficiency, underlining the importance of lifelong adequate vitamin D status for bone health in the general population.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1633-1646"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soluble Immune Checkpoints Associated With Disease Activity and Treatment Response in GD and TED.","authors":"Qinglei Yin, Tianyi Zhu, Dalong Song, Sijie Fang, Huifang Zhou, Haixia Guan","doi":"10.1210/clinem/dgae763","DOIUrl":"10.1210/clinem/dgae763","url":null,"abstract":"<p><strong>Context: </strong>Soluble immune checkpoints play an important role in peripheral tolerance that has seldom been investigated in Graves' disease (GD) and thyroid eye disease (TED).</p><p><strong>Objective: </strong>The objective of this work is to examine the alteration of soluble immune checkpoints in GD and TED.</p><p><strong>Methods: </strong>We performed a quantitative multiplex analysis of 17 immune checkpoint proteins in serum from 50 GD patients without TED, 28 GD patients with TED, and 40 healthy controls. The association with demographic, serologic, clinical features and 27 cytokines was analyzed. A follow-up was conducted in GD patients without TED. Functional outcomes of sLAG-3 and sGITR were assessed in cell cultures using rh-LAG3, rh-GITR, an antagonistic LAG-3 antibody, and an antagonistic GITR antibody.</p><p><strong>Results: </strong>GD Patients with TED had distinct sICP and cytokine profiles compared with GD patients without TED. Active patients with TED exhibited elevation in the levels of sBTLA, sLAG-3, sGITR, sCD80, sCD86, and sPD-L1. Further, GD patients without TED with high sBTLA, sCD27, and sCD40 levels at baseline showed a better improvement in thyrotropin receptor antibody titers after antithyroid drug treatment. Adding recombinant human GITR and LAG-3 to peripheral blood mononuclear cell cultures resulted in increased inflammatory cytokine secretion and decreased anti-inflammatory cytokine secretion.</p><p><strong>Conclusion: </strong>The present study uncovers disturbed soluble immune checkpoints and cytokines in GD patients with and without TED and may pave the way for novel immunological screening, allowing for identification of patients with TED at higher risk of developing active disease and patients with GD a better treatment response after antithyroid drug treatment.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1537-1549"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Comparisons of Different Treatments for Active Graves Orbitopathy: A Systematic Review and Bayesian Model-Based Network Meta-Analysis.","authors":"Yanlin Xu, Ruikang Liu, Liying Huang, You Qin, Wei Liu, Shenyu Huang, Jiaoyue Zhang","doi":"10.1210/clinem/dgae877","DOIUrl":"10.1210/clinem/dgae877","url":null,"abstract":"<p><strong>Context: </strong>Graves orbitopathy is a specialized immunoinflammatory disorder related to abnormal thyroid function. Due to the complexity of the disease and its propensity to reoccur, targeted treatment is essential to improve the symptoms.</p><p><strong>Objective: </strong>This study aims to assess the efficacy and safety of various treatments for active thyroid eye disease.</p><p><strong>Methods: </strong>We conducted a comprehensive search for randomized controlled trials (RCTs), and ongoing RCTs registered on Controlled Trials, targeting treatments for thyroid eye disease until November 20, 2024. Employing a Bayesian framework, this network meta-analysis calculated risk ratios (RRs) or mean differences (MDs) with 95% CIs to size the effects for the predetermined outcomes. The study is registered with PROSPERO (CRD42024548030).</p><p><strong>Outcome: </strong>The primary outcomes evaluated were overall response rate, clinical activity score (CAS), proptosis, diplopia, and adverse events.</p><p><strong>Results: </strong>For the overall response rate, teprotumumab (RR 5.5, 95% CI 2.3 to 16), mycophenolate combined intravenous glucocorticosteroids (IVGCs) demonstrated effectiveness over no treatment, ranked from most to least effective. Notably, teprotumumab showed the highest efficacy in reducing CAS (MD -1.57, 95% CI -3.81 to 0.68) and proptosis (MD -2.29, 95% CI -2.73 to -1.86). For diplopia improvement, teprotumumab and IVGCs were effective compared with no treatment.</p><p><strong>Conclusion: </strong>Teprotumumab emerges as potentially the most effective treatment for reducing inflammation and increasing overall response rates when compared with no treatment; oral mycophenolate combined with IVGCs appears to be the best for improving proptosis. While some treatments raise safety concerns due to reported adverse events, oral methotrexate combined with IVGCs appear to offer a favorable balance between efficacy and safety among the evaluated treatments.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1792-1801"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}