Journal of Obstetrics and Gynecology of India最新文献

{"title":"Is JAK Inhibitor A Therapeutic Option For Endometriosis?","authors":"Arul Rajamurugan Ponniah Subramanian, Anoop Chithrabhanu, Rohit Venugopal, Sudha Narayanswamy, Vairamala Periaswamy","doi":"10.1007/s13224-024-02077-2","DOIUrl":"10.1007/s13224-024-02077-2","url":null,"abstract":"<p><p>Endometriosis is a prevalent gynecological disorder that often leads to infertility and presents a complex challenge in its diagnosis and management. This report describes a case history of a 38-year-old woman suffering from rheumatoid arthritis and primary infertility who became pregnant after the initiation of tofacitinib treatment for rheumatoid arthritis. Her disease activity was well-controlled, and she became pregnant six months after the initiation of tofacitinib. We could not find any earlier reports of pregnancy in humans following tofacitinib treatment for endometriosis-related infertility in the literature. This observation suggests a potential link between the JAK pathway, inflammation associated with endometriosis and fertility. Although promising, cautious exploration of the possibility with large controlled studies are essential to validate these findings and assess the safety and efficacy of JAK inhibitors in endometriosis treatment.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"585-588"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robert's Uterus-Types, Diagnosis, and Management Options: Case Series and Review of Literature.","authors":"Neha Varun, Reeta Mahey, Archana Kumari, Garima Kachhawa, Manasi Deoghare, Rohitha Cheluvaraju, Neerja Bhatla","doi":"10.1007/s13224-024-02074-5","DOIUrl":"10.1007/s13224-024-02074-5","url":null,"abstract":"<p><strong>Objective: </strong>To report three cases of Robert's uterus and to describe the types, diagnostic methods, and management options for this rare Mullerian anomaly.</p><p><strong>Methods: </strong>Three adolescent girls presented with progressive severe dysmenorrhea since menarche. Two girls had undergone inappropriate surgeries due to misdiagnosis in past which did not relieve their symptoms. MRI reported as juvenile cystic adenomyoma (JCA) in one girl and Robert's uterus in other two girls.</p><p><strong>Results: </strong>All three patients underwent surgical intervention. The first patient underwent laparoscopic blind horn resection and residual myometrial closure. The decision was taken in view of severe symptoms, school dropout, large adenomyotic lesion, and previous one appendicectomy following misdiagnosis, and patient was not willing for any conservative management. The other two patients underwent transabdominal ultrasonography-guided hysteroscopic resection of septum and hematometra drainage. All the patients had relieved from dysmenorrhea and are asymptomatic.</p><p><strong>Conclusion: </strong>All girls presenting with progressive dysmenorrhea should be evaluated for Mullerian anomalies including the rare ones like Robert's uterus. USG-guided hysteroscopic septal resection may be considered for all cases of Robert's uterus for immediate symptom relief and better future reproductive outcomes. Further long-term follow-up of these patients undergoing conservative surgeries is warranted.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"215-220"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Locations of Lesions in Patients with Endometriosis Using #ENZIAN Classification: An Observational Study.","authors":"Vimee Bindra, Nikitha Reddy, P Swetha, C Archana Reddy, N Balakrishna","doi":"10.1007/s13224-024-02056-7","DOIUrl":"10.1007/s13224-024-02056-7","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis is a benign gynaecological condition causing chronic pelvic pain, impaired fertility and dysmenorrhoea. It is difficult to describe the lesion distribution due to the complexity of the disease, inconsistent pattern and sometimes even absent progression.</p><p><strong>Aim: </strong>To describe clinical characteristics and locations of lesions in women with endometriosis using #ENZIAN classification.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study of 154 patients with endometriosis who underwent laparoscopic or robotic endometriosis excision between April 2021 and September 2022 by a single surgeon in a multidisciplinary endometriosis centre. Clinical criteria such as age, demographics, menstrual history, previous endometriosis surgeries, size and location of endometriomas, along with clinical symptoms such as dysmenorrhea, dyschezia, infertility, dyspareunia, urinary frequency and rectal pain were documented. The #ENZIAN [2021] classification was used to assess the distribution of disease.</p><p><strong>Results: </strong>Mean age of the patients was 32.25 ± 6.107 years, and mean BMI was 23.9 ± 3.36 kg/m2. 47.2% had taken medical treatment for a period of 5.9 ± 11.7 months. Regarding parity, 75.4% were nulliparous, and 40.8% patients had infertility as co-existing complaint. According to #ENZIAN, the left ovarian involvement was observed in 67.4% and bilateral involvement noted in 46.1%. A (rectovaginal vagina and septum) was involved in 61% cases, B (uterosacral ligaments and pelvic wall) 63.58% on left and 60.33% on right and <i>C</i> (rectum and sigmoid colon) 33.1% cases.</p><p><strong>Conclusion: </strong>#ENZIAN provides a comprehensive and reproducible form of lesion distribution, extent of disease and surgical complexity. It can be a unique language of communication amongst radiologists, clinicians and surgeons.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"173-179"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demystifying Glycemic Variability in GDM Pregnancies: A Cross-Sectional Observational Study.","authors":"Anamika Baghel, Aruna Nigam, Nidhi Gupta","doi":"10.1007/s13224-024-01992-8","DOIUrl":"10.1007/s13224-024-01992-8","url":null,"abstract":"<p><strong>Aim: </strong>To study glycemic variability (GV) and 24-h ambulatory glucose profile (AGP) in gestational diabetes mellitus (GDM) patients who were apparently controlled on drugs and their correlation with fetomaternal outcomes.</p><p><strong>Methodology: </strong>In this cross-sectional observational study, 40 gestational diabetic pregnancies on pharmacotherapy were recruited. Flash glucose monitor was used to record AGP between 32 and 36 weeks of gestation. A total of 600 patient days with 58,600 glucose values were analyzed.</p><p><strong>Results: </strong>Variables of GV: Mean amplitude of glycemic excursion (<i>p</i> = 0.001), standard deviation (<i>p</i> = 0.001), Continuous Overall Net Glycemic Action (<i>p</i> = 0.002) and High Blood Glucose Index (<i>p</i> = 0.001) were significantly high in GDM group when compared to normoglycemic patients and these were well correlated with poor fetomaternal outcome in this group. Time in range was also significantly altered in GDM group. (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>High GV and time in range are the important parameters which get altered in GDM pregnancies despite apparent control of blood glucose, and this can be a reason of adverse fetomaternal outcomes in these pregnancies.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"333-339"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of Correlation of HbA1c with Anemia in Pregnancy.","authors":"Shalini Mishra, Vinita Das, Smriti Agrawal","doi":"10.1007/s13224-025-02108-6","DOIUrl":"https://doi.org/10.1007/s13224-025-02108-6","url":null,"abstract":"<p><strong>Introduction: </strong>HbA1c is a biochemical marker to evaluate hyperglycemia status in past 2-3 months. HbA1c ≥ 6.5% is diagnostic criteria for diabetes mellitus according to the American Diabetes Association. Recent studies suggest that anemia alters HbA1c levels, but results are conflicting. This study was planned to understand utility of HbA1c in relation to hemoglobin (Hb) for the diagnosis of gestational diabetes mellitus (GDM) and also to understand if HbA1c can be used as a screening modality for diagnosis of GDM in countries with higher anemia prevalence.</p><p><strong>Materials and methods: </strong>An observational study was conducted on 193 pregnant women of < 16-week gestation attending antenatal OPD of Department of Obstetrics and Gynecology, KGMU, Lucknow, over a period of one year. Blood glucose levels 2 h after ingestion of 75 gm glucose load irrespective of last meal (DIPSI criterion) were determined at 3 antenatal visits along with HbA1c and Hb level and categorized into diabetic and nondiabetic and anemic and non-anemic group. These patients were followed up till delivery to look for various maternal and neonatal outcomes.</p><p><strong>Results: </strong>A total 416 tests were done for hemoglobin and HbA1c in 193 women. Prevalence of GDM was 32.1%. Cutoff level of HbA1c was 4.8% in our study which also varied according to gestation. Mean HbA1c level found to be higher in anemic compared to non-anemic (4.5 vs. 3.96%) in nondiabetic women. Similar to that in women with GDM, mean HbA1c in anemic women (5.1) was higher compared to non-anemic (4.6) women.</p><p><strong>Conclusion: </strong>This study clearly shows that mean HbA1c varies across all trimesters; even though in diabetic women, mean HbA1c was higher as compared to nondiabetic, and it showed a statistically significant difference in the presence of anemia. HbA1c showed an inverse correlation with hemoglobin in women with or without GDM. Mean HbA1c level was higher among anemic women in both diabetic and nondiabetic group.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 2","pages":"160-165"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Management of Rhesus Alloimmunization Over Two Decades From a Tertiary Care Referral Center in India.","authors":"Vatsla Dadhwal, K Aparna Sharma, Anubhuti Rana, Neha Sahay, Dipika Deka","doi":"10.1007/s13224-024-02055-8","DOIUrl":"10.1007/s13224-024-02055-8","url":null,"abstract":"<p><strong>Introduction: </strong>Hemolytic disease of the fetus and newborn (HDFN) is a serious complication in pregnancy and still remains a cause of perinatal mortality, in developing countries. Antibodies to other red blood cell antigens, leading to hemolysis, are being recognized. The aim of the study is to report the outcomes in women undergoing intrauterine transfusions (IUT) for fetal anemia due to rhesus alloimmunization over the last two decades, over 3 time periods from 2002 to 2021 and to report the prevalence of minor antibodies at our center and their effect on perinatal and neonatal outcomes.</p><p><strong>Material and methods: </strong>A retrospective record review was conducted across two decades between 2002 and 2021 over 3 time periods 2002-2007, 2011-2014, and 2015-2021. The procedures and outcomes of the first two time periods from the same center have been previously reported 7,8. For the third time period, the data were collected from hospital records of maternal and fetal medicine unit of our hospital.</p><p><strong>Results: </strong>The entire data were divided into three time periods. These do not define watertight compartments of change in management protocols but have evolved over the years with different teams and operators. The number of transfusions has remained almost steady throughout these years; however, the percentage being referred with hydrops has decreased. Across the various time periods, a total of 311 women received 882 transfusions. The gestational age range for performing IUTs varied from 18 weeks to 34.5. The majority of the transfusions were performed between 26 and 29 weeks across the time periods. The complication rates have steadily come down over the two decades from 8.57 per procedure to 2.3 per procedure. The POG at delivery gradually increased from 31 to 32 + 6 weeks (39.5%) to between 35 and 36 + 6. The survival rates have remained high with up to 95% survival in the non-hydropic fetuses and 90% in hydropic fetuses. Anti-D antibody was most often combined with anti-C, anti-M or anti-E. In neonates of anti-D and minor antibodies group, the requirement of phototherapy and exchange transfusion was more although it was not significantly different from only anti-D group. The presence of other antibodies in addition to anti-D can be clinically significant, because these combinations reportedly are more frequently associated with therapeutic interventions for the newborn, especially anti-D plus anti-C.</p><p><strong>Conclusion: </strong>HDFN still remains a significant problem requiring early surveillance and timely intervention. Although the survival following intervention is quite favorable, it requires intensive management with a robust support from the blood bank. Prevention strategies must be reviewed to reduce the burden of the disease.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"443-448"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Prenatally Diagnosed Pfeiffer Syndrome with Multicystic Kidney.","authors":"Poornima Sharma, Shreya Singh Kushwaha, Suchandana Dasgupta, Sumitra Bachani","doi":"10.1007/s13224-024-02020-5","DOIUrl":"10.1007/s13224-024-02020-5","url":null,"abstract":"<p><p>Pfeiffer syndrome is a rare syndromic craniosynostosis characterized by bilateral coronal craniosynostosis, midface hypoplasia, beaked nasal tip, broad and medially deviated thumbs and great toes. It is caused by mutations affecting the fibroblast growth factor receptors type 1 or 2 (FGFR1 or FGFR2), with autosomal dominant inheritance. It displays substantial clinical and genetic heterogeneity. The disorder is usually detected in the neonatal period, and very few prenatally diagnosed cases have been reported.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"610-612"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypokelemic Periodic Paralysis in Pregnancy-A Rare Case Study.","authors":"Pooja Hosamani, Shrikant Babar, Ravi Raval, Nilesh Solanke, Tejashree Sawant, Purushottam Hoogar","doi":"10.1007/s13224-024-02068-3","DOIUrl":"10.1007/s13224-024-02068-3","url":null,"abstract":"<p><p>Hypokalemic quadriparesis is a rare, potentially life-threatening condition characterized by hypokalemia and acute systemic weakness. It results from altered potassium distribution and depletion from renal and extra-renal losses. Management depends on the etiology, duration, underlying diseases, family history, medication history and disease state. Here we present a case of 24-year-old multigravida at 20 weeks of pregnancy, presented with history multiple episodes of vomiting and all four limbs weakness. On primary laboratory test, patient was analyzed to have hypokalemic quadriparesis and treated with intravenous potassium chloride that resulted in biochemical and clinical improvement and pregnancy continued.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"635-637"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Observational Study of Heart Diseases in Pregnancy and Fetomaternal Outcomes.","authors":"Tania Verma, Gaurav Singh Manhas, Amita Gupta","doi":"10.1007/s13224-024-02026-z","DOIUrl":"10.1007/s13224-024-02026-z","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the heart diseases during pregnancy the maternal and perinatal outcomes.</p><p><strong>Methods: </strong>This prospective observational study was conducted in a tertiary care hospital on 22,360 antenatal women registered to department of Obstetrics and Gynecology. The data recorded included demographic, clinical and obstetric characteristics, nature of the underlying cardiac lesions, and functional class. ECG and echocardiography were done to know the type and severity of cardiac lesions. Fetomaternal outcomes were assessed at follow-up clinical visits during second, third trimester, peripartum period, and at 6 weeks postpartum.</p><p><strong>Results: </strong>Heart diseases were present in 50(0.2%) women. Congenital heart diseases were present in 16(32%) patients, with most common being ventricular septal defect (VSD) in 7(14%) patients. Rheumatic heart diseases were present in 15(30%) patients, with most common being first degree heart block [4(8%)]. Mode of delivery was lower segment cesarean section in 32(64%) women and medical termination of pregnancy in 1(2%) patient. Postpartum complications were seen in 14(28%) patients; the most common being congestive cardiac failure in 5(10%) patients. Fetal complications were present in 21(42%) neonates which comprised of neonatal intensive care unit admission [13(26%)], intrauterine growth restriction in 7(14%), low birth weight in 6(12%), preterm in 5(10%), meconium aspiration syndrome in 4(8%) and intrauterine death in 3(4%) cases.</p><p><strong>Conclusion: </strong>To conclude, heart diseases are present in 0.2% pregnant women with VSD rheumatic heart diseases being the commonest. Pregnant women with cardiac disease experience cardiac, obstetric, and fetal complications. Thus, cardiac diseases must be diagnosed to lower perinatal morbidity and death.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"399-404"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Maternal Near-miss and Mortality with Hematologic Diseases in a Single Quaternary Referral Center in Southern Thailand.","authors":"Krantarat Peeyananjarassri, Chitkasaem Suwanrath, Ninizna Ratipann, Natthicha Chainarong, Sathana Boonyapipat, Sutham Pinjaroen","doi":"10.1007/s13224-025-02106-8","DOIUrl":"10.1007/s13224-025-02106-8","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the causes and clinical outcomes of maternal near-misses and mortality associated with hematologic diseases.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records from women who experienced maternal near-misses or mortality attributed to hematological diseases during pregnancy or within 42 days of pregnancy termination, following the World Health Organization criteria, at a single quaternary referral center in Southern Thailand, from 2006 to 2021.</p><p><strong>Results: </strong>A total of 109 cases were analyzed, including five maternal deaths and 104 near-miss cases related to hematologic diseases. The median (min-max) maternal age was 29 (14-43) years, with 57.8% of the women being multiparous. The most common hematologic diseases were immune thrombocytopenia (68.8%), acute leukemia (6.4%), and aplastic anemia (6.4%). Of these, 48.6% were diagnosed before pregnancy and 57.8% exhibited a platelet count < 50 × 10⁹/L during the intrapartum period. Acute leukemia was the leading cause of death (3/5). Severe maternal outcomes in cases of immune thrombocytopenia were more frequently observed in women with platelet counts < 50 × 10⁹/L.</p><p><strong>Conclusion: </strong>The primary hematologic diseases causing maternal near-miss and mortality were immune thrombocytopenia, acute leukemia, and aplastic anemia. Acute leukemia was the leading cause of death.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 Suppl 1","pages":"190-197"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}