Journal of Clinical Densitometry最新文献

{"title":"Direct-Acting Oral Anticoagulant/Vitamin K Antagonists: Do They Affect the Trabecular and Cortical Structure of the Mandible?","authors":"Semih Alperen Bostan ,&nbsp;Savaş Özarslantürk ,&nbsp;Dilara Nil Günaçar ,&nbsp;Merve Gonca ,&nbsp;Duygu Göller Bulut ,&nbsp;Hilal Ok Bostan","doi":"10.1016/j.jocd.2024.101495","DOIUrl":"10.1016/j.jocd.2024.101495","url":null,"abstract":"<div><p><em>Background</em>: This study aimed to evaluate the mandibular bone structure of patients using oral anticoagulants (OACs) vitamin K antagonist drugs (warfarin) and other OACs including direct oral anticoagulants [(DOACs) apixaban, rivaroxaban, dabigatran, edoxaban]. Analyses were based upon the fractal dimension (FD), the panoramic mandibular index (PMI) and the Klemetti index (KI), which is also known as the mandibular cortical index (MCI).</p><p><em>Methodology</em>: Ninety participants were divided into three groups: group 1: 30 systemically healthy individuals who had not used any anticoagulants before, group 2: 30 individuals using warfarin, and group 3: 30 individuals using DOACs. FD was used to analyze trabecular bone architecture in the condyle, angle, and two sites in the alveolar bone. PMI was used to evaluate the quantity of cortical bone and KI was used to evaluate the cortical bone quality.</p><p><em>Results</em>: There was no difference between the groups regarding FD analysis and KI; however, a difference was found between groups 1, 2, and 3 in the PMI (<em>P</em>≤ 0.001). The PMI in group 1 was higher than in groups 2 and 3.</p><p><em>Conclusion</em>: Mandibular radiomorphometric indices can be used on panoramic radiographs to evaluate the quantity of mandibular cortical bone in patients using oral anticoagulants.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 3","pages":"Article 101495"},"PeriodicalIF":2.5,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Change in Spine Bone Density from Different Numbers and Combinations of Lumbar Vertebrae: The Manitoba BMD Registry","authors":"Auryan Szalat ,&nbsp;Harold Rosen ,&nbsp;William D. Leslie","doi":"10.1016/j.jocd.2024.101493","DOIUrl":"10.1016/j.jocd.2024.101493","url":null,"abstract":"<div><p><em>Introduction</em>: Change in bone mineral density (BMD) is considered significant when it exceeds the 95 % least significant change (LSC) derived from that facility's precision study. The lumbar spine is often affected by structural artifact such that not all four lumbar vertebrae are evaluable. Guidelines suggest using a site-matched LSC when omitting vertebrae from the BMD measurement. The current study describes significant BMD change related to intervening anti-osteoporosis treatment for different numbers and combinations of lumbar vertebrae using site-matched LSC values.</p><p><em>Methodology</em>: We identified 10,526 untreated adult women mean age 59.6 years with baseline and repeat spine BMD testing (mean interval 4.7 years) where all 4 lumbar vertebrae were evaluable. Change in spine BMD for different combinations of lumbar vertebrae was assessed in relation to intervening anti-resorptive treatment, contrasting women with high treatment exposure (medication possession ratio, MPR ≥ 0.8) versus women who remained untreated. Site-matched LSC values were derived from 879 test-retest precision measurements.</p><p><em>Results</em>: There was consistent linear trend between increasing MPR and BMD change exceeding the LSC for all lumbar vertebral combinations, positive with BMD increase and negative with BMD decrease (all p-trend &lt;0.001). In the high treatment exposure group, mean percent increases in spine BMD were similar for all vertebral combinations, from L1-4 to a single vertebra. In untreated women, mean percent decreases in spine BMD were also similar for all vertebral combinations. The net treatment response (proportion of women with treatment-concordant changes minus proportion with treatment-discordant changes exceeding the LSC) was 29.7 % for 4 vertebrae, 27.5-30.0 % for 3 vertebrae, 22.4-28.5 % for 2 vertebrae, and 18.1-21.9 % for a single vertebra.</p><p><em>Conclusions</em>: All numbers and combinations of lumbar vertebrae, when used in conjunction with site-matched LSC values, can provide clinically meaningful follow-up in treated and untreated patients, even when spine BMD is based on a single vertebral body.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 3","pages":"Article 101493"},"PeriodicalIF":2.5,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture Risk Assessment Tool-Based Screening for Osteoporosis in Older Adults in Resource-Limited Settings","authors":"Andrea D. Stephanus ,&nbsp;Sara Cristina L. Ramos ,&nbsp;Osvaldo S. Netto ,&nbsp;Luiz Sérgio F. de Carvalho ,&nbsp;Alessandra M. Campos-Staffico","doi":"10.1016/j.jocd.2024.101494","DOIUrl":"10.1016/j.jocd.2024.101494","url":null,"abstract":"<div><p><em>Purpose</em>: Osteoporosis is a pressing public health concern among older adults, contributing to substantial mortality and morbidity rates. Low- to middle-income countries (LMICs) often grapple with limited access to dual-energy X-ray absorptiometry (DXA), the gold standard for early osteoporosis detection. This study aims to assess the performance of the FRAX® score as a population-wide screening tool for predicting osteoporosis risk, rather than fracture, in individuals aged 50 and above within an LMIC context.</p><p><em>Methods</em>: This retrospective cohort study (n=864) assessed the performance of the FRAX® score for predicting osteoporosis risk using comparative c-statistics from Receiver Operating Characteristic (ROC) curves. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated, with p-values &lt;0.05 indicating statistically significant.</p><p><em>Results</em>: The 10-year FRAX® probability for hip fracture, calculated without bone mass density (BMD), exhibited significantly superior performance compared to the 10-year FRAX® probability for major fracture in predicting osteoporosis risk (AUROC: 0.71 <em>versus</em> 0.67, p&lt;0.001). Within 2 to 10 years of follow-up, the 10-year FRAX® probability for hip fracture showed both greater predictive performance and net benefit in the decision curve compared to the FRAX® 10-year probability for major fracture. A newly established cutoff of 1.9 % yielded a negative predictive value of 92.9 % (95 %CI: 90.4-94.8 %) for the 10-year FRAX® probability for hip fracture.</p><p><em>Conclusion</em>: The 10-year FRAX® probability for hip fracture estimated without BMD emerges as an effective 10-year screening tool for identifying osteoporosis risk in aged 50 and older, especially when confronted with limited access to DXA scans in LMICs.</p><p><em>Mini abstract</em>: The Fracture Risk Assessment Tool score performance as an osteoporosis screening tool was assessed in areas with limited dual-energy X-ray access. The hip fracture probability showed better performance than major fracture probability within 2 to 10 years. The tool emerges as effective for screening osteoporosis risk in individuals over 50.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 3","pages":"Article 101494"},"PeriodicalIF":2.5,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Generations of GPT on an Exam Designed for Certifying Physicians: Correspondence","authors":"Hinpetch Daungsupawong,&nbsp;Viroj Wiwanitkit","doi":"10.1016/j.jocd.2024.101484","DOIUrl":"10.1016/j.jocd.2024.101484","url":null,"abstract":"","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 3","pages":"Article 101484"},"PeriodicalIF":2.5,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Lumbar Spine Least Significant Change for Fewer than Four Vertebrae: The Manitoba BMD Registry","authors":"Harold Rosen ,&nbsp;Auryan Szalat ,&nbsp;William D. Leslie","doi":"10.1016/j.jocd.2024.101483","DOIUrl":"https://doi.org/10.1016/j.jocd.2024.101483","url":null,"abstract":"<div><p><em>Introduction</em>: The International Society of Clinical Densitometry recommends omitting lumbar vertebrae affected by structural artifact from spine BMD measurement. Since reporting fewer than 4 vertebrae reduces spine BMD precision, least significant change (LSC) needs to be adjusted upwards when reporting spine BMD change based on fewer than 4 vertebrae.</p><p><em>Methodology</em>: In order to simplify estimating LSC from combinations of vertebrae other than L1-L4 (denoted LSC_L1-4 ), we analyzed 879 DXA spine scan-pairs from the Manitoba BMD Program's ongoing precision evaluation. The additional impact on the LSC of performing the second scan on the same day vs different day was also assessed.</p><p><em>Results</em>: LSC progressively increased when fewer vertebrae were included, and also increased when the scans were performed on different days. We estimated that the LSC_L1-4 should be adjusted upwards by 7 %, 24 % and 65 % to approximate the LSC for 3, 2, or 1 vertebral body, respectively. To additionally capture the greater LSC when the precision study was done on different days, LSC_L1-4 derived from a precision study where scans were done on the same day should be adjusted upwards by 39 %, 60 % and 112 % for 3, 2, or 1 vertebral body, respectively.</p><p><em>Conclusion</em>: LSC_L1-4 derived from a precision study where scans are performed on the same day can be used to estimate LSC for fewer than 4 vertebrae and for scans performed on different days.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 2","pages":"Article 101483"},"PeriodicalIF":2.5,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia/osteoporosis in obstructive sleep apnea Syndrome: beauty lies in the details","authors":"Ahmad J. Abdulsalam ,&nbsp;Mohammad A. Abdulsalam ,&nbsp;Murat Kara","doi":"10.1016/j.jocd.2024.101482","DOIUrl":"10.1016/j.jocd.2024.101482","url":null,"abstract":"","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 2","pages":"Article 101482"},"PeriodicalIF":2.5,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140084248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonalcoholic Fatty Liver Disease, Bone and Muscle Quality in Prolactinoma: A Pilot Study","authors":"İmdat Eroğlu ,&nbsp;Burcin Gonul Iremli ,&nbsp;Aysegul Erkoc ,&nbsp;Ilkay S. Idilman ,&nbsp;Deniz Yuce ,&nbsp;Ebru Calik Kutukcu ,&nbsp;Deniz Akata ,&nbsp;Tomris Erbas","doi":"10.1016/j.jocd.2024.101479","DOIUrl":"10.1016/j.jocd.2024.101479","url":null,"abstract":"<div><p><em>Objective</em>: Hyperprolactinemia has negative impacts on metabolism and musculoskeletal health. In this study, individuals with active prolactinoma were evaluated for nonalcoholic fatty liver disease (NAFLD) and musculoskeletal health, which are underemphasized in the literature.</p><p><em>Methods</em>: Twelve active prolactinoma patients and twelve healthy controls matched by age, gender, and BMI were included. Magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was used to evaluate hepatic steatosis and magnetic resonance elastography (MRE) to evaluate liver stiffness measurement (LSM). Abdominal muscle mass, and vertebral MRI-PDFF was also evaluated with MRI. Body compositions were evaluated by dual energy X-ray absorptiometry (DXA). The skeletal muscle quality (SMQ) was classified as normal, low and weak by using “handgrip strength/appendicular skeletal muscle mass (HGS/ASM)” ratio based on the cut-off values previously stated in the literature.</p><p><em>Results</em>: Prolactin, HbA1c and CRP levels were higher in prolactinoma patients (p&lt;0.001, p=0.033 and p=0.035, respectively). The median MRI-PDFF and MRE-LSM were 3.0% (2.01-15.20) and 2.22 kPa (2.0-2.5) in the prolactinoma group and 2.5% (1.65-10.00) and 2.19 kPa (1.92-2.54) in the control group, respectively and similiar between groups. In prolactinoma patients, liver MRI-PDFF showed a positive and strong correlation with the duration of disease and traditional risk factors for NAFLD. Total, vertebral and pelvic bone mineral density was similar between groups, while vertebral MRI-PDFF tended to be higher in prolactinoma patients (p=0.075). Muscle mass and strength parameters were similar between groups, but HGS/ASM tended to be higher in prolactinoma patients (p=0.057). Muscle mass was low in 33.3% of prolactinoma patients and 66.6 of controls. According to SMQ, all prolactinoma patients had normal SMQ, whereas 66.6% of the controls had normal SMQ.</p><p><em>Conclusion</em>: Prolactinoma patients demonstrated similar liver MRI-PDFF and MRE-LSM to controls despite their impaired metabolic profile and lower gonadal hormone levels. Hyperprolactinemia may improve muscle quality in prolactinoma patients despite hypogonadism.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 2","pages":"Article 101479"},"PeriodicalIF":2.5,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139948791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Progressive Generations of GPT on an Exam Designed for Certifying Physicians as Certified Clinical Densitometrists","authors":"Dustin Valdez ,&nbsp;Arianna Bunnell ,&nbsp;Sian Y. Lim ,&nbsp;Peter Sadowski ,&nbsp;John A. Shepherd","doi":"10.1016/j.jocd.2024.101480","DOIUrl":"10.1016/j.jocd.2024.101480","url":null,"abstract":"&lt;div&gt;&lt;p&gt;&lt;em&gt;Background&lt;/em&gt;: Artificial intelligence (AI) large language models (LLMs) such as ChatGPT have demonstrated the ability to pass standardized exams. These models are not trained for a specific task, but instead trained to predict sequences of text from large corpora of documents sourced from the internet. It has been shown that even models trained on this general task can pass exams in a variety of domain-specific fields, including the United States Medical Licensing Examination. We asked if large language models would perform as well on a much narrower subdomain tests designed for medical specialists. Furthermore, we wanted to better understand how progressive generations of GPT (generative pre-trained transformer) models may be evolving in the completeness and sophistication of their responses even while generational training remains general. In this study, we evaluated the performance of two versions of GPT (GPT 3 and 4) on their ability to pass the certification exam given to physicians to work as osteoporosis specialists and become a certified clinical densitometrists. The CCD exam has a possible score range of 150 to 400. To pass, you need a score of 300.&lt;/p&gt;&lt;p&gt;&lt;em&gt;Methods&lt;/em&gt;: A 100-question multiple-choice practice exam was obtained from a 3rd party exam preparation website that mimics the accredited certification tests given by the ISCD (International Society for Clinical Densitometry). The exam was administered to two versions of GPT, the free version (GPT Playground) and ChatGPT+, which are based on GPT-3 and GPT-4, respectively (OpenAI, San Francisco, CA). The systems were prompted with the exam questions verbatim. If the response was purely textual and did not specify which of the multiple-choice answers to select, the authors matched the text to the closest answer. Each exam was graded and an estimated ISCD score was provided from the exam website. In addition, each response was evaluated by a rheumatologist CCD and ranked for accuracy using a 5-level scale. The two GPT versions were compared in terms of response accuracy and length.&lt;/p&gt;&lt;p&gt;&lt;em&gt;Results&lt;/em&gt;: The average response length was 11.6 ±19 words for GPT-3 and 50.0±43.6 words for GPT-4. GPT-3 answered 62 questions correctly resulting in a failing ISCD score of 289. However, GPT-4 answered 82 questions correctly with a passing score of 342. GPT-3 scored highest on the “Overview of Low Bone Mass and Osteoporosis” category (72 % correct) while GPT-4 scored well above 80 % accuracy on all categories except “Imaging Technology in Bone Health” (65 % correct). Regarding subjective accuracy, GPT-3 answered 23 questions with nonsensical or totally wrong responses while GPT-4 had no responses in that category.&lt;/p&gt;&lt;p&gt;&lt;em&gt;Conclusion&lt;/em&gt;: If this had been an actual certification exam, GPT-4 would now have a CCD suffix to its name even after being trained using general internet knowledge. Clearly, more goes into physician training than can be captured in this exam. However, G","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 2","pages":"Article 101480"},"PeriodicalIF":2.5,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139921246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Sarcopenia and Osteoporosis in Elderly Male Patients with Obstructive Sleep Apnea Syndrome: A Multicenter Study","authors":"Zhen Xue ,&nbsp;Shengguan Song ,&nbsp;Changan Hu ,&nbsp;Shanglong Zhao ,&nbsp;Juan Wang","doi":"10.1016/j.jocd.2024.101481","DOIUrl":"10.1016/j.jocd.2024.101481","url":null,"abstract":"<div><p>The aim of this study was to assess the risk of sarcopenia and osteoporosis in elderly patients with obstructive sleep apnea syndrome (OSAS). We recruited both OSAS patients and non-OSAS subjects from multiple centers and evaluated their skeletal muscle index (SMI), bone mineral density (BMD), and inflammatory factors. All participants underwent polysomnography (PSG) testing, handgrip strength testing, chest CT, and dual-energy x-ray BMD testing. Based on the PSG diagnosis results, the participants were divided into a control group and an OSAS group. The analysis results revealed a higher incidence of sarcopenia in the OSAS group (<em>χ²</em> = 22.367; <em>P</em> = 0.000) and osteoporosis (<em>χ²</em> = 11.730^a; <em>P</em> = 0.001). There were statistically significant differences in BMI (<em>P</em> = 0.000), grip strength (<em>P</em> = 0.000), SMI (<em>P</em> = 0.000), bone density (<em>P</em> = 0.000) and vitamin D (<em>P</em> = 0.000). The independent sample t test results showed that there was no statistical difference between IL-6 (<em>P</em> = 0.247) and CRP (<em>P</em> = 0.246). Considering the potential impact of body weight on the observed indicators, we employed covariance analysis to calculate the modified <em>P</em> value for each observation indicator. The findings demonstrated that the grip strength, IL-6, and CRP levels in the OSAS group were significantly higher compared to the control group. Conversely, the SMI, bone density, and Vitamin D levels were found to be significantly lower in the OSAS group than in the control group. These results suggest a higher likelihood of sarcopenia and osteoporosis among OSAS patients. Further studies should be conducted in larger study populations.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 2","pages":"Article 101481"},"PeriodicalIF":2.5,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139921247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Health ECHO Case Report: Fractures and Hypercalcemia in a Patient with Stage 5 Chronic Kidney Disease","authors":"E. Michael Lewiecki ,&nbsp;Dale G. Erickson ,&nbsp;Roger W. Gildersleeve","doi":"10.1016/j.jocd.2024.101478","DOIUrl":"10.1016/j.jocd.2024.101478","url":null,"abstract":"<div><p>Bone Health ECHO (Extension for Community Healthcare Outcomes) is a virtual community of practice with the aim of enhancing global capacity to deliver best practice skeletal healthcare. The prototype program, established at the University of New Mexico, has been meeting online weekly since 2015, focusing on presentation and discussion of patient cases. These discussions commonly cover issues that are relevant to a broad range of patients, thereby serving as a force multiplier to improve the care of many patients. This is a case report from Bone Health ECHO about a patient with stage 5 chronic kidney disease, hypercalcemia, and low bone density, and the discussion that followed.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"27 2","pages":"Article 101478"},"PeriodicalIF":2.5,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139879959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}