Journal of Clinical Endocrinology & Metabolism最新文献

{"title":"Psychiatric Comorbidities in Women With Complete Androgen Insensitivity Syndrome or Müllerian Duct Aplasia/Agenesis.","authors":"Behzad Sorouri Khorashad, Oumaima Kaabi, Melissa D Gardner, Darios Getahun, Michael Goodman, Timothy L Lash, Peter A Lee, Courtney McCracken, Joshua May, Maria Muzik, Suma Vupputuri, Rami Yacoub, David E Sandberg","doi":"10.1210/clinem/dgae720","DOIUrl":"10.1210/clinem/dgae720","url":null,"abstract":"<p><strong>Context: </strong>Understanding mental health issues facing individuals with disorders/differences of sex development (DSD) is crucial for optimizing evidence-based practices in this population.</p><p><strong>Objectives: </strong>This work aimed to compare the prevalence of psychiatric diagnoses among patients diagnosed with complete androgen insensitivity syndrome (CAIS) or müllerian duct aplasia/agenesis (MA) to male and female reference groups.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted among 3 large integrated health systems. Participants included all individuals with confirmed CAIS or MA enrolled in 1 of 3 Kaiser Permanente health-care systems between January 1, 1988, and January 31, 2017. For each DSD patient, age-, race/ethnicity- and health system-matched male and female referents with typical sex development were randomly selected. Outcome measurements were mental health diagnoses and use of psychiatric medications.</p><p><strong>Results: </strong>The prevalence of anxiety and depressive disorders in the CAIS and MA cohorts was approximately twice as high as in male referents without DSD, but the corresponding differences relative to female referents were less evident. A subgroup of MA patients with uterine agenesis had a higher prevalence of bipolar disorder than either reference group, but these results were accompanied by wide CIs. Women with CAIS and MA more frequently filled psychiatric medications compared to male but not female referents.</p><p><strong>Conclusion: </strong>On balance, these findings are reassuring, albeit requiring confirmation in other settings. Future studies using longitudinal designs and patient-reported outcomes are needed to evaluate changes in mental health status of CAIS and MA patients at different ages and different intervals following initial diagnosis.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1906-1914"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401829","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":"Frequent Use of Premenopausal Progestin in Women With Prior Preeclampsia.","authors":"Johanna M Joensuu, Olavi Ylikorkala, Minttu Venetkoski, Mika Gissler, Hanna Savolainen-Peltonen, Tomi S Mikkola","doi":"10.1210/clinem/dgae677","DOIUrl":"10.1210/clinem/dgae677","url":null,"abstract":"<p><strong>Context: </strong>Women with a history of preeclamptic pregnancy are predisposed to later occlusive vascular diseases.</p><p><strong>Objective: </strong>We compared the use of cyclic progestins or levonorgestrel-releasing intrauterine device (LNG-IUD) for treatment of menstrual cycle abnormalities between premenopausal women with and without a prior preeclamptic pregnancy.</p><p><strong>Methods: </strong>Register-based cohort study during 1994 to 2019 of oral progestin or LNG-IUD in Finnish women with (n = 31 688) and without (n = 91 726) prior preeclampsia in 1969 to 1993. Cyclic progestin or LNG-IUD use and its association with future use of menopausal hormone therapy (MHT).</p><p><strong>Results: </strong>Women with prior preeclampsia had used cyclic progestins more often (23.5% vs 9.1%; P < .001) and initiated the use at younger ages (41.8 years, SD 6.3 vs 45.9 years, 3.1; P < .001) than control women. Also, LNG-IUD was inserted more frequently (P < .001) in women with prior preeclampsia (9.3%) than in controls (4.7%). Cyclic progestin or LNG-IUD use was accompanied by significant 37% to 90% elevations in future MHT use.</p><p><strong>Conclusion: </strong>Increased use of cyclic progestins and LNG-IUD in premenopausal women with a history of preeclamptic pregnancy can be seen as indirect evidence of earlier onset of ovulatory dysfunction. This may contribute to the elevated risk of endometrial cancer in these women. Our findings may indicate an additional late sequela of preeclamptic pregnancy.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1946-1951"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394878","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":"Cardiometabolic Risk Assessment in Transgender Individuals-Differential Effect of Sex Hormones and Sex Chromosomes.","authors":"Yu Lei, Anna Wiik, Margery A Connelly, Linnea Lindberg, Daniel P Andersson, Stefan Arver, Thomas Gustafsson, Uwe J F Tietge","doi":"10.1210/clinem/dgae745","DOIUrl":"10.1210/clinem/dgae745","url":null,"abstract":"<p><strong>Context: </strong>While transgender individuals represent a substantial group seeking medical care, the differential effect of sex on cardiometabolic risk metrics is incompletely understood.</p><p><strong>Objective: </strong>The present study aimed to characterize the effect of sex hormones and chromosomes on a contemporary panel of cardiometabolic risk biomarkers and functional cardiovascular measurements.</p><p><strong>Methods: </strong>A total of 17 transgender men and 17 transgender women were studied at baseline (T0), 4 weeks (hormonal castration, T1), and 11 months following gender-affirming hormone treatment (T12). We analyzed carotid intima-media thickness and arterial stiffness, lipoproteins, and other metabolites comprehensively by nuclear magnetic resonance spectroscopy and high-density lipoprotein-mediated cholesterol efflux capacity (CEC) from macrophages. T0 to T12 comparisons informed the effect of sex hormones, comparisons of genetic XX and XY individuals at T1 the effect of sex chromosomes.</p><p><strong>Results: </strong>Vascular function was comparable at T12 and T0; systolic blood pressure increased in transgender men (P = .002). Transgender men developed a proatherogenic lipoprotein profile; estrogen treatment in transgender women tended to result in improvements. Several metabolites indicating increased diabetes risk including plasma glucose were changed in transgender men (P = .025), with opposite changes in transgender women (P = .002). Interestingly, at T1 apparent diabetes risk was lower in XX compared with XY individuals (P = .002). CEC decreased in transgender women (P < .01), while remaining unchanged in transgender men. However, in both groups the strong positive association of apolipoprotein A-1 with cholesterol efflux observed at T0 was lost at T12.</p><p><strong>Conclusion: </strong>The results are consistent with increased cardiometabolic risk in transgender men, while transgender women show beneficial changes early during gender-affirming hormone therapy. Sex chromosomes have fewer intrinsic effects. XY individuals and transgender men display an increased apparent diabetes risk. Further research on cardiometabolic risk is needed for transgender individuals.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2273-e2284"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512179","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":"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":"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":"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}