GE Portuguese Journal of Gastroenterology最新文献

{"title":"Echinococcosis: A Challenging Treatment.","authors":"Ana Isabel Ferreira, Sofia Xavier, Pedro Lopes, Carla Marinho, José Cotter","doi":"10.1159/000550702","DOIUrl":"10.1159/000550702","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"384-386"},"PeriodicalIF":0.6,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576202","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":"The Vanishing Colorectal Tumor: Lessons from an Illustrative Case Report.","authors":"Ricardo Cardoso, Ângela Domingues, Tiago Pavão, Pedro Rodrigues, Américo Silva","doi":"10.1159/000550701","DOIUrl":"10.1159/000550701","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer is the most frequent digestive neoplasia and is usually diagnosed by colonoscopy. Treatment is contingent on staging and other factors and generally includes a combination of endoscopic or surgical resection, chemotherapy, and radiotherapy.</p><p><strong>Case presentation: </strong>A 64-year-old female patient was diagnosed with an adenocarcinoma of the ascending colon following a colonoscopy performed due to anemia. After histological confirmation and staging, she was submitted to a right hemicolectomy. However, the neoplasia was not present in the surgical specimen and follow-up colonoscopy did not find any lesion in the remaining colon. Histopathological and endoscopic results were reappraised and the endoscopic list of the day of the index colonoscopy was reviewed with no potential error to be found. Finally, genetic concordance of the index biopsies and surgical specimen was confirmed.</p><p><strong>Discussion: </strong>Spontaneous regression of neoplasia is very rare, particularly in colorectal cancer. The mechanisms of this phenomenon are not well understood and are probably multifactorial. When the possibility of spontaneous regression is being considered, a very rigorous approach must be followed as errors, such as misidentification, are more likely. In this exemplary case, we describe the steps taken to reach this surprising diagnosis.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"348-352"},"PeriodicalIF":0.6,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379672","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":"Association between Examination Time and Discomfort in Unsedated Esophagogastroduodenoscopy: A Prospective Observational Study.","authors":"Kenichiro Majima, Takeshi Shimamoto, Yosuke Muraki","doi":"10.1159/000550587","DOIUrl":"10.1159/000550587","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged examination time during esophagogastroduodenoscopy is important due to its association with higher lesion detection rates. However, limited research has examined the relationship between examination time and participant discomfort. This study aimed to clarify the association between examination time and discomfort.</p><p><strong>Methods: </strong>The present study is a prospective observational study conducted during esophagogastroduodenoscopy screening examinations in the endoscopy room of a screening center affiliated with a general hospital. Participants without sedation were included. The examination time was defined as the duration from the start of observation (in the laryngopharynx or esophagus) to the end of observation (in the laryngopharynx or esophagus). After the procedure, participant discomfort was assessed using the Numerical Rating Scale (NRS), an 11-point scale ranging from 0 (minimal discomfort) to 10 (maximal discomfort). The primary outcome was the relationship between examination time and participant-reported discomfort, assessed through multiple regression analysis. The dependent variable was the discomfort score on a numerical rating scale. Explanatory variables included age, sex, pethidine use, butylscopolamine use, current smoking status, alcohol intake, endoscopist, and examination time (minutes).</p><p><strong>Results: </strong>A total of 3,414 participants were analyzed. The esophagogastroduodenoscopies were performed by seven endoscopists, whose experience ranged from 9 to 37 years. The rank correlation coefficient between discomfort and examination time was 0.05 (<i>p</i> = 0.007), and the results of the multiple regression analysis showed that the regression coefficient for examination time (minutes) was 0.10 (<i>p</i> < 0.001). Other significant factors contributing to discomfort and their regression coefficients were as follows: female (0.83, <i>p</i> < 0.001), younger age (0.04 per year, <i>p</i> < 0.001), nonuse of pethidine (1.04, <i>p</i> < 0.001), smoking (0.32, <i>p</i> = 0.003), and alcohol consumption (normal drinker 0.15, <i>p</i> = 0.048, excessive drinker 0.42, <i>p</i> = 0.004). Among the seven endoscopists A-G, endoscopist G also exhibited a significant difference (0.59, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This study revealed that in unsedated esophagogastroduodenoscopy, an increase in examination time is a significant factor contributing to increased discomfort, although the magnitude of this increase is quite small. Therefore, the clinical impact of heightened discomfort due to longer examination times is considered to be minimal. Endoscopists should prioritize adequate examination time to ensure the most accurate esophagogastroduodenoscopy.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"367-376"},"PeriodicalIF":0.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476412","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":"Paraneoplastic Pemphigus and Liver Biopsy Needle Track Dissemination in Hepatocellular Carcinoma: A Case Report.","authors":"Carolina Palma, Francisco Vara-Luíz, Ivo Mendes, Bruno Correia, Filipe Nogueira, Cristina Fonseca","doi":"10.1159/000550555","DOIUrl":"https://doi.org/10.1159/000550555","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatocellular carcinoma (HCC) is a common and aggressive liver cancer, typically arising in cirrhotic livers but can also occur in the absence of cirrhosis. Paraneoplastic pemphigus (PNP) is a rare autoimmune blistering disorder mostly linked to hematologic malignancies; its association with HCC is extremely uncommon and poses significant diagnostic and therapeutic challenges, particularly due to the need for immunosuppression in PNP management, which may limit systemic cancer therapies.</p><p><strong>Case presentation: </strong>We report an 80-year-old male with no prior liver disease presenting with painful oral erosions, weight loss, and hepatomegaly. Imaging revealed a large liver mass without signs of cirrhosis. Biopsy confirmed well-differentiated HCC (BCLC stage C). Concurrently, skin biopsy and positive autoantibodies (anti-desmoglein 3, anti-envoplakin) established the diagnosis of PNP. High-dose corticosteroids and intravenous immunoglobulin led to significant mucocutaneous improvement. Systemic HCC therapy with sorafenib was started, as immunotherapy was contraindicated due to PNP. Despite treatment, disease progression occurred, including needle tract seeding at the biopsy site. The patient discontinued treatment and died 16 months after diagnosis.</p><p><strong>Conclusions: </strong>This case illustrates a rare and diagnostically complex association of PNP with HCC in a non-cirrhotic liver. It highlights how immunosuppressive therapy for PNP may adversely affect tumor control and potentially accelerate disease progression. Additionally, it underscores the risk of tumor seeding after liver biopsy, especially in immunosuppressed patients. Recognizing these complexities is essential to guide appropriate diagnosis and therapeutic approaches in similar cases.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214472","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":"Colorectal Cancer Screening at 40: Real Benefit or Justifiable Cost?","authors":"Raúl Honrubia-López","doi":"10.1159/000550583","DOIUrl":"https://doi.org/10.1159/000550583","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12916122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229556","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":"Assessing Inflammatory Bowel Disease Care Quality in Portugal: A Nationwide Gastroenterologist Survey.","authors":"Paula Ministro, Diana Carvalho, Luís Correia, Cláudia Camila Dias, Raquel Gonçalves, Paula Lago, Fernando Magro, Sandra Dias, Francisco Portela","doi":"10.1159/000549922","DOIUrl":"10.1159/000549922","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel disease (IBD) care demands a multidisciplinary approach and adherence to quality indicators to optimize patient outcomes. This study aimed to evaluate the structure and quality of IBD care in Portugal, exploring the perceptions of gastroenterologists and identifying areas for improvement.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted among Portuguese gastroenterologists between January and February 2024. The questionnaire assessed IBD care organization, processes and perceptions regarding quality indicators. Responses from 57 participants were analyzed using descriptive and inferential statistics.</p><p><strong>Results: </strong>Most participants (74%) work in public hospitals, with 89.5% providing specialized IBD consultations. Multidisciplinary teams are present in 58% of the participants' centers. In addition to gastroenterologists, IBD multidisciplinary teams include mostly surgeons (88%) and radiologists (62%). Waiting times for nonurgent IBD-specific consultations varied, with 61% of the respondents reporting delays exceeding 1 month. More than two-thirds reported waiting times for nonurgent endoscopic and cross-sectional exams longer than 3 months. Psychological and nutritional assessments were underprioritized, with only 6% and 37% of centers routinely performing these evaluations, respectively. Only 42% of participants answered that their centers keep updated patient registries and 16% used quality indicators known to all team members. Most responders (76%) reported research activity in their units, mainly through national multicenter (88.1%) and observational studies (71%). Units with multidisciplinary teams were significantly more likely to follow structured protocols, provide timely care, and adopt advanced diagnostic tools. Most participants acknowledge the importance of quality indicators, classifying them as mandatory or relevant, with 96% supporting the auditing of IBD centers.</p><p><strong>Conclusions: </strong>This study highlights strengths in the Portuguese IBD care, including multidisciplinary collaboration, research engagement, and widespread awareness of quality indicators. However, challenges remain, such as delays in specialized IBD consultations, endoscopic and cross-sectional exams, and inadequate scheduling for other consultations. Moreover, gaps persist in integrating psychological and nutritional care and maintaining updated patient registries. Expanding multidisciplinary teams and strengthening quality monitoring are critical for improving care outcomes for Portuguese IBD patients.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159112","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":"Case Report: An Unusual Cause of Massive Ascites.","authors":"Nicole Sciberras, Christian Vassallo, Stefania Chetcuti Zammit, Michela Frendo","doi":"10.1159/000550362","DOIUrl":"10.1159/000550362","url":null,"abstract":"<p><strong>Introduction: </strong>Ascites, the abnormal accumulation of fluid within the peritoneal cavity, is commonly associated with decompensated liver cirrhosis, primary or secondary malignancy, right-sided heart failure, and peritoneal tuberculosis. The underlying pathophysiology is usually related to one of portal hypertension, hypoalbuminaemia, or peritoneal inflammation. When these common causes are excluded, autoimmune aetiologies such as systemic lupus erythematosus (SLE) should be considered, albeit being rare. SLE is a chronic, multisystem autoimmune disease with diverse manifestations, and serositis is a recognized but variably expressed feature. Lupus peritonitis, a form of serosal inflammation leading to ascites, occurs infrequently and is often overshadowed by more typical pulmonary or pericardial involvement. We report an unusual case of massive painless ascites as the presenting feature of SLE in a middle-aged man, underscoring the diagnostic challenges of this rare presentation.</p><p><strong>Case presentation: </strong>A 43-year-old man presented to the Emergency Department with a 2-week history of painless, progressive abdominal distension. He denied any associated symptoms and a thorough physical examination was unremarkable except for ascites. An extensive diagnostic panel followed to identify the cause of ascites, as the hepatobiliary system appeared normal on imaging and serum ascites albumin gradient was less than 1.1, making cirrhosis and portal hypertension unlikely. Echocardiogram and thyroid function tests were normal. His autoimmune serological markers revealed the presence of anti-Smith and anti-RNP antibodies, and the patient fulfilled the 2019 EULAR/ACR classification for SLE.</p><p><strong>Discussion: </strong>Ascites as the initial presentation of SLE is uncommon, especially massive ascites. Lupus peritonitis, the underlying mechanism, is thought to result from immune complex deposition and complement activation leading to peritoneal inflammation and exudative effusion. In this patient, the absence of typical features such as rash, arthritis, or haematological abnormalities initially obscured the diagnosis. This case illustrates how SLE can present insidiously and emphasizes the need for thorough autoimmune evaluation in unexplained exudative ascites once hepatic, cardiac, malignant, and infectious causes have been excluded. The rapid response to corticosteroid therapy underscores the importance of early recognition and immunosuppressive treatment to prevent complications.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107904","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":"Severe Recurrent Gastrointestinal Bleeding and Diagnostic Dilemmas in Zollinger-Ellison Syndrome: A Case Report.","authors":"Sofia Bragança, Luísa Martins Figueiredo, Ana Maria Oliveira, Carolina Padrão, Mariana Nuno Costa, David Horta","doi":"10.1159/000550071","DOIUrl":"10.1159/000550071","url":null,"abstract":"<p><p>Zollinger-Ellison Syndrome (ZES) is a rare condition caused by gastrin-secreting neuroendocrine tumours (gastrinoma) that induce excessive gastric acid production, leading to severe peptic ulcer disease (PUD) and gastrointestinal (GI) complications. Its nonspecific presentation often delays diagnosis, increasing the risk of life-threatening outcomes. We report the case of a 53-year-old man with chronic gastroesophageal reflux disease and long-standing unexplored diarrhoea who presented with worsening abdominal pain and severe diarrhoea. Laboratory tests showed acute kidney injury, and CT revealed gastric wall thickening and a hyperdense nodule at the gastroduodenal junction, raising suspicion for ZES. Despite proton pump inhibitor (PPI) therapy, he developed recurrent upper GI bleeding requiring intensive care unit admission. Hormonal and imaging studies confirmed ZES, and he underwent antrectomy with lymphadenectomy. Postoperatively, he experienced further GI bleeding managed with over-the-scope clip (OTSC®) haemostasis and gastroduodenal artery ligation. Pathology confirmed a well-differentiated neuroendocrine tumour (pT2N1, G1). One year later, he remained asymptomatic with no evidence of recurrence. This case illustrates the diagnostic and therapeutic challenges of ZES, underscoring the risks associated with PPI withdrawal during evaluation and the need for multidisciplinary management. Recurrent GI bleeding in ZES requires a coordinated approach integrating medical, endoscopic, and surgical therapies. Early recognition is essential to prevent severe complications, and a high index of suspicion is warranted in patients with refractory PUD, chronic diarrhoea, or unexplained GI bleeding.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107807","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":"Case Report: Successful Management of Malignant Colostomy Stenosis Using a Self-Expandable Stent with External Exposure.","authors":"Maya Ishizawa, Teppei Masunaga, Motohiko Kato","doi":"10.1159/000550070","DOIUrl":"https://doi.org/10.1159/000550070","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12846314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094833","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":"Allopurinol Use Is Associated with Decreased Incidence of Hepatic Decompensation and Overall Mortality among Individuals with Cirrhosis: A Propensity-Matched Cohort Study.","authors":"Mohammad Al Hayek, Bisher Sawaf, Mohammed S Beshr, Mulham Alom, Abdelaziz H Salam, Mouaz Haffar, Rana H Shembesh, Ahmad Kassem, Mohammed Abu-Rumaileh, Yusuf Hallak, Shahem Abbarh, Elias Batikh, Muhammed Elhadi, Monica Tincopa","doi":"10.1159/000549923","DOIUrl":"10.1159/000549923","url":null,"abstract":"<p><strong>Background: </strong>Cirrhosis is associated with significant morbidity and mortality. Recent studies have highlighted the potential role of allopurinol in reducing the incidence of hepatic decompensation among individuals with cirrhosis. This study aimed to evaluate the association of allopurinol use with the incidence of hepatic decompensation and overall mortality in patients with cirrhosis in a large, propensity-matched cohort.</p><p><strong>Methods: </strong>A retrospective cohort study of adults with cirrhosis was conducted using the national TriNetX database, with 1:1 propensity score matching. Allopurinol exposure was assessed in three categories compared to individuals with no allopurinol use: 100 mg, 300 mg, and exposure at any dose. The primary outcome was the incidence of overall hepatic decompensation. Secondary outcomes included the incidence of ascites, esophageal variceal bleeding, hepatic encephalopathy (HE), hepatorenal syndrome, spontaneous bacterial peritonitis (SBP), hepatocellular carcinoma, and overall mortality. The outcomes were assessed at 6, 12, and 18 months. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>After propensity score matching, 5,358 patients who received allopurinol were compared with 5,358 controls. Dose-specific analyses included two additional matched cohorts: 2,124 patients receiving 100 mg of allopurinol and their matched controls, and 1,020 patients receiving 300 mg of allopurinol and their matched controls. At 18 months, a statistically significantly lower incidence of hepatic decompensation was seen in the overall allopurinol exposure cohort (OR: 0.77; 95% CI: 0.70-0.84), the 100 mg cohort (OR: 0.66; 95% CI: 0.57 to 0.76), and 300 mg cohort (OR: 0.76; 95% CI: 0.62 to 0.94). Allopurinol exposure was associated with a decreased incidence of esophageal variceal bleeding (OR: 0.71; 95% CI: 0.55 to 0.92), ascites (OR: 0.77; 95% CI: 0.69 to 0.84), HE (OR: 0.76; 95% CI: 0.63 to 0.92), SBP (OR: 0.61; 95% CI: 0.46 to 0.80), and overall death (OR: 0.86; 95% CI: 0.77 to 0.96) compared to the control group.</p><p><strong>Conclusion: </strong>In a propensity score-matched analysis of a large national database, individuals with cirrhosis and allopurinol use had significantly lower risk of hepatic decompensation and overall mortality. These findings suggest that allopurinol may play a potential role in managing cirrhosis, and randomized clinical trials are needed to confirm these findings.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999626","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}