{"title":"Perioperative outcomes of 105 cases of ABO-incompatible live donor kidney transplantation: a retrospective single-center observational study.","authors":"Praveenkumar Shekhrajka, Sony Mandal, Vipin Kumar Goyal, Saurabh Mittal, Nihit Khunteta, Akash Mishra","doi":"10.4285/ctr.24.0028","DOIUrl":"10.4285/ctr.24.0028","url":null,"abstract":"<p><strong>Background: </strong>ABO-incompatible (ABOi) kidney transplantation poses significant challenges in achieving successful outcomes. This study aimed to investigate the impact of various interventions and techniques on improving the success rates of ABOi kidney transplantation.</p><p><strong>Methods: </strong>We conducted a retrospective observational analysis of patients who underwent ABOi kidney transplantation from November 2012 to March 2023. The study included a total of 105 patients. We collected and analyzed data on patient demographics, preoperative assessments, surgical details, and postoperative outcomes.</p><p><strong>Results: </strong>The mean ages of the donors and recipients were 50.52±10.32 and 36.63±11.61 years, respectively. The majority of recipients were male (81.9%), while most donors were female (89.5%). The most common blood group among recipients was O (69.5%), and among donors, it was B (46.7%). The median durations of chronic kidney disease and dialysis were 12 months (interquartile range [IQR], 7-28 months) and 6 months (IQR, 2-12 months), respectively. Baseline antibody titers (anti-A and anti-B) ranged from 64.0 to 256.0, while on the day of surgery, they were ≤8. Perioperative complications included hypotension (10.5%), acute tubular necrosis (5.7%), delayed graft function (3.8%), and reexploration (3.8%) due to hematoma.</p><p><strong>Conclusions: </strong>ABOi kidney transplantation is a viable option for recipients lacking available donors with an ABO-compatible match. Perioperative concerns, including hypoalbuminemia, heightened risk of infections, coagulopathies, aseptic precautions, and immunological surveillance, must be carefully addressed.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"197-202"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305785","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}
Jaeseok Yang, Yaerim Kim, Woo Yeong Park, Kyubok Jin, Seungyeup Han, Byung Hoon Kim, Misun Choe, Jin Hyuk Paek
{"title":"Unilateral testicular tuberculosis in a kidney transplant recipient: a case report.","authors":"Jaeseok Yang, Yaerim Kim, Woo Yeong Park, Kyubok Jin, Seungyeup Han, Byung Hoon Kim, Misun Choe, Jin Hyuk Paek","doi":"10.4285/ctr.24.0023","DOIUrl":"10.4285/ctr.24.0023","url":null,"abstract":"<p><p>Tuberculosis (TB) of the genitourinary system is a rare form of extrapulmonary TB. Testicular TB is particularly uncommon among kidney transplantation (KT) recipients. Diagnosing testicular TB is challenging due to the nonspecific nature of clinical presentations and ambiguous imaging results. In this report, we describe a case involving a 36-year-old male KT recipient who presented with left scrotal pain. He had undergone a living donor KT 8 years prior and was receiving tacrolimus, mycophenolate mofetil, and prednisolone. Laboratory tests revealed anemia, leukocytosis, and elevated inflammatory markers. Computed tomography showed left scrotal wall thickening and enlargement, suggestive of a left testicular abscess. We discontinued mycophenolate mofetil and administered intravenous antibiotics. Additionally, we performed an incision and drainage of the abscess. However, there was no improvement in his clinical course. Consequently, we performed a radical left orchiectomy. The biopsy revealed extensive chronic granulomatous inflammation with caseous necrosis, consistent with tuberculous orchiepididymitis. A quadruple anti-TB regimen was administered, leading to an improvement in the patient's condition. To the best of our knowledge, this is the first reported case of testicular TB without other organ involvement in KT recipients. Including testicular TB in the differential diagnosis of testicular infections and masses is necessary to avoid unnecessary surgical procedures.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"235-240"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141862051","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}
João Miguel Pimentel, Susana Nobre, Rui Caetano Oliveira, Ricardo Martins, Maria Augusta Cipriano
{"title":"Hepatocellular carcinoma associated with progressive intrahepatic familial cholestasis type 2: a case report.","authors":"João Miguel Pimentel, Susana Nobre, Rui Caetano Oliveira, Ricardo Martins, Maria Augusta Cipriano","doi":"10.4285/ctr.24.0016","DOIUrl":"10.4285/ctr.24.0016","url":null,"abstract":"<p><p>Progressive familial intrahepatic cholestasis type 2 (PFIC2) is an autosomal recessive disorder typically presenting in infancy with cholestasis and rapidly progressing to cirrhosis. PFIC has been associated with an elevated risk of hepatocellular carcinoma (HCC), a neoplasm that is uncommon in children. PFIC type 4 has the strongest link to this type of cancer, although a few cases have also been connected to PFIC2. Herein, we report the case of a 2-year-old boy who underwent liver transplantation due to PFIC2. Histological examination showed cirrhosis and four small HCCs. Over a 20-year period following the transplantation, there was no recurrence of the disease or HCC. Although rare, HCC development can occur in PFIC and may complicate the prognosis. Liver transplantation offers a potential cure for both the metabolic disease and the neoplasm.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":"38 3","pages":"241-245"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336050","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":"Remdesivir in solid organ transplant recipients with COVID-19: a systematic review and meta-analysis.","authors":"Zia Navidi, Seyed Hamid Pakzad Moghadam, Mojgan Mohajeri Iravani, Amirhossein Orandi, Amirali Orandi, Samrand Fattah Ghazi, Ehsan Fallah, Ebadallah Shiri Malekabad, Saeed Khorramnia","doi":"10.4285/ctr.24.0031","DOIUrl":"10.4285/ctr.24.0031","url":null,"abstract":"<p><strong>Background: </strong>The use of remdesivir in solid organ transplant recipients (SOTRs) with coronavirus disease 2019 (COVID-19) has been studied. The present systematic review and analysis aimed to assess its effectiveness in this population.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Cochrane Library, Web of Science, Embase, medRxiv, and Google Scholar was conducted to identify relevant articles published up to April 2024. The quality of the included studies was evaluated using the Cochrane assessment tool. Data analysis was performed using the Comprehensive Meta-Analysis software ver. 3.0.</p><p><strong>Results: </strong>The meta-analysis included seven eligible retrospective studies, involving a total of 574 SOTRs. The findings indicated no significant differences in mortality rate (odds ratio [OR], 1.19; 95% confidence interval [CI], 0.59-2.39), hospitalization rate (OR, 0.69; 95% CI, 0.10-4.79), need for mechanical ventilation (OR, 0.98; 95% CI, 0.44-2.18), or need for oxygen therapy (OR, 3.73; 95% CI, 0.75-18.34) between the groups that received remdesivir and those that did not. However, a statistically significant difference was observed in the rate of intensive care unit admissions between the two groups (OR, 2.39; 95% CI, 1.24-4.57).</p><p><strong>Conclusions: </strong>Our meta-analysis found that remdesivir offers no clinical benefits to SOTRs infected with COVID-19. Additional high-quality research is required to assess the potential clinical advantages of remdesivir for SOTRs with COVID-19.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":"38 3","pages":"212-221"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336051","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}
Je Ho Ryu, Kwang Ho Yang, Rune Horneland, Su Hyun Ju, Byung Hyun Choi
{"title":"Experience from 100 consecutive pancreas transplants amidst low national transplant activity: a retrospective study at a single center in Korea.","authors":"Je Ho Ryu, Kwang Ho Yang, Rune Horneland, Su Hyun Ju, Byung Hyun Choi","doi":"10.4285/ctr.24.0033","DOIUrl":"10.4285/ctr.24.0033","url":null,"abstract":"<p><strong>Background: </strong>Since 1992, over 800 pancreas transplants have been performed in Korea. However, this number is significantly lower compared to the number of kidney or liver transplants.</p><p><strong>Methods: </strong>Between 2015 and July 2023, Pusan National University Yangsan Hospital conducted 100 pancreas transplants, accounting for about 20% of all transplants performed in Korea during this period. The study comprised 27 simultaneous pancreas and kidney (SPK) transplants, 23 pancreas after kidney (PAK) transplants, and 50 pancreas transplant alone (PTA) cases. Duodenoduodenostomy was the primary surgical technique employed for exocrine drainage, along with various modifications of the venous outflow anastomosis.</p><p><strong>Results: </strong>The availability of brain-dead donors for kidney transplants was lower compared to isolated pancreas transplants. Patients undergoing SPK transplants faced significantly longer waiting times than those receiving PTA or PAK transplants. The rate of surgical complications was acceptable, with a notably low thrombotic graft failure rate of 1.0%. In the PTA group, acute rejection of the graft pancreas occurred frequently (18.0%), though this was not statistically significant (P=0.328). The pancreas transplantation survival rates were 91.0%, 78.5%, and 75.4% at 1, 5, and 9 years, respectively. The PTA group exhibited a lower graft survival rate than the SPK and PAK groups, with marginal statistical significance (P=0.059).</p><p><strong>Conclusions: </strong>Graft survival rates have improved over time due to advancements in surgical techniques and immunosuppressant strategies. By sharing our experiences, we aim to enhance the activity and success of pancreas transplantation in Korea.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":"38 3","pages":"203-211"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336049","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}
Suhee Kim, Sun Young Son, Man Ki Ju, Seungheui Hong, Ji Yeon Park, Hyung Sook Kim
{"title":"Workforce, task performance, and analysis of organ transplant coordinators in Korea: a survey study.","authors":"Suhee Kim, Sun Young Son, Man Ki Ju, Seungheui Hong, Ji Yeon Park, Hyung Sook Kim","doi":"10.4285/ctr.24.0037","DOIUrl":"10.4285/ctr.24.0037","url":null,"abstract":"<p><strong>Background: </strong>The workload of organ transplant coordinators is increasing as administrative tasks become more diverse with changing laws and regulations. These changes have heightened the demand for organ transplant coordinators with expertise in the field. This study aimed to determine the status of human resources of organ transplant coordinators and conduct job analysis using the Developing A Curriculum (DACUM) method.</p><p><strong>Methods: </strong>We conducted a questionnaire survey with 107 transplant coordinators employed at medical centers across Korea. The questionnaire gathered data on general and job-related characteristics of organ transplant coordinators and assessed the importance, difficulty, and frequency of their task elements.</p><p><strong>Results: </strong>The job of organ transplantation was categorized into five duties, 14 tasks, and 97 task elements. These duties included recipient management, donor management, organ donation activation management, organ transplantation administration, and professional capability development. We noted statistically significant differences in the importance scores of organ donation activation based on age, as well as in the difficulty scores for recipient management and administrative tasks based on work experience. Furthermore, the frequency of task performance varied significantly according to the number of coworkers and the total number of transplants conducted.</p><p><strong>Conclusions: </strong>This study confirmed the current status of the workforce and task performance of organ transplant coordinators. The findings will serve as basic data to enhance the expertise of coordinators in the future.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":"38 3","pages":"222-234"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336052","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":"Tixagevimab/cilgavimab prophylaxis against COVID-19 in solid organ transplant recipients: a systematic review and meta-analysis.","authors":"Saeed Khorramnia, Zia Navidi, Amirhossein Orandi, Mojgan Mohajeri Iravani, Amirali Orandi, Ebadallah Shiri Malekabad, Seyed Hamid Pakzad Moghadam","doi":"10.4285/ctr.24.0015","DOIUrl":"10.4285/ctr.24.0015","url":null,"abstract":"<p><strong>Background: </strong>Tixagevimab/cilgavimab (Tix/Cil) shows promise as a prophylactic treatment against coronavirus disease 2019 (COVID-19) in solid organ transplant recipients (SOTRs). This study was performed to assess the effectiveness of Tix/Cil for preexposure prophylaxis against COVID-19 in this population.</p><p><strong>Methods: </strong>We systematically searched the Cochrane Library, Web of Science, PubMed, and Embase databases to identify articles relevant to our study up to December 15, 2023. Comprehensive Meta-Analysis (ver. 3.0) was used for data analysis.</p><p><strong>Results: </strong>The meta-analysis included seven eligible retrospective studies, encompassing a total of 4,026 SOTRs. The analysis revealed significant differences in SOTRs who received Tix/Cil preexposure prophylaxis relative to those who did not. Specifically, these differences were observed in the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.15-0.60), hospitalization (OR, 0.24; 95% CI, 0.08-0.70), and intensive care unit admission (OR, 0.07; 95% CI, 0.02-0.22). However, mortality rate did not differ significantly between the two groups (P=0.06).</p><p><strong>Conclusions: </strong>The evidence supporting the effectiveness of Tix/Cil as preexposure prophylaxis against SARS-CoV-2 in SOTRs is of a low to moderate level. Further high-quality research is necessary to understand its effects on this population.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"136-144"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433695","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":"Polyomavirus nephropathy: diagnosis, histologic features, and differentiation from acute rejection.","authors":"Cynthia C Nast","doi":"10.4285/ctr.24.0006","DOIUrl":"10.4285/ctr.24.0006","url":null,"abstract":"<p><p>Polyomaviruses, particularly BK virus, are ubiquitous latent infections that may reactivate with immunosuppression during kidney transplantation, resulting in polyomavirus nephropathy (PVN). The levels of viruria and viremia serve as tools for screening and making a presumptive diagnosis of PVN, respectively, while a definitive diagnosis requires a kidney biopsy. There are histologic classifications of PVN based on the extent of tubular cell viral infection, interstitial fibrosis, and interstitial inflammation. These classifications correlate to some degree with graft function and loss, aiding in determining treatment efficacy and prognostication. PVN has histologic overlap with acute cell-mediated rejection, making the differential diagnosis challenging, although there are suggestive features for these different causes of graft dysfunction. This article reviews the diagnosis, histologic findings, and classifications of PVN, and discusses how to differentiate viral nephropathy from acute rejection.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"71-89"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900700","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":"Successful kidney transplantation from a live donor with immune thrombocytopenia: a case report.","authors":"Hsiao-Hui Yang, Ching-Chun Ho, Chia-Ling Lee, Yi-Feng Wu, Yen-Cheng Chen","doi":"10.4285/ctr.24.0002","DOIUrl":"10.4285/ctr.24.0002","url":null,"abstract":"<p><p>Organ transplantation from donors with immune thrombocytopenia (ITP), a condition involving the autoantibody-mediated destruction of platelets, is a topic of debate due to the potential for transplantation-mediated autoimmune thrombocytopenia (TMAT), a rare but potentially fatal complication. Previous reports have described transplants from deceased liver donors with ITP who had very low platelet counts and disease largely refractory to treatment. Here, we present the first case of living kidney transplantation from a donor with ITP who underwent preoperative treatment, with concurrent splenectomy performed to reduce the long-term risk of spontaneous hemorrhage. To ensure the safety of the procedure, we monitored perioperative rotational thromboelastometry parameters and platelet counts, leading to the normalization of the donor's platelet levels. The recipient experienced an uneventful recovery of renal function without perioperative bleeding or the development of TMAT. Our report suggests that kidney transplantation from a donor with well-managed ITP is safe, and such a condition should not be considered a contraindication for donation.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"145-149"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900703","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}
Konstantin Semash, Timur Dzhanbekov, Mirshavkat Akbarov, Miraziz Mirolimov, Azimjon Usmonov, Navruz Razzokov, Ziyodulla Primov, Temurbek Gaybullaev, Sardor Yigitaliev
{"title":"Implementation of a living donor liver transplantation program in the Republic of Uzbekistan: a report of the first 40 cases.","authors":"Konstantin Semash, Timur Dzhanbekov, Mirshavkat Akbarov, Miraziz Mirolimov, Azimjon Usmonov, Navruz Razzokov, Ziyodulla Primov, Temurbek Gaybullaev, Sardor Yigitaliev","doi":"10.4285/ctr.24.0013","DOIUrl":"10.4285/ctr.24.0013","url":null,"abstract":"<p><strong>Background: </strong>Living donor liver transplantation (LDLT) is an effective treatment for patients with end-stage liver disease. This study was performed to evaluate the outcomes of the initial series of LDLT procedures performed in the Republic of Uzbekistan and to demonstrate that liver transplantation is viable under the conditions in this country.</p><p><strong>Methods: </strong>Between October 2021 and December 2023, we performed 40 LDLTs. We evaluated both immediate and long-term outcomes.</p><p><strong>Results: </strong>Thrombosis of the hepatic artery developed in one case (2.5%). Arterial anastomotic stenoses were diagnosed in three cases (7.5%) and were successfully treated with endovascular balloon vasodilation. Splenic artery steal syndrome arose in three patients (7.5%) and was managed with endovascular embolization of the splenic artery. One patient (2.5%) developed portal vein thrombosis. Portal vein stenosis occurred in two patients (5%) at 10 months posttransplantation and was addressed with endovascular balloon angioplasty, yielding good clinical outcomes. Biliary complications were observed in 45% of the cases, with bile leakages accounting for 89% of these issues and strictures of the biliary anastomoses for 11%. The in-hospital mortality rate was 12.5%.</p><p><strong>Conclusions: </strong>Our research findings and analysis of complications align with the international literature, and the results are deemed acceptable during this implementation phase of the liver transplantation program. Accordingly, liver transplantation is feasible in the Republic of Uzbekistan; however, improvements in surgical and therapeutic methods are necessary to minimize the development of both early and late postoperative complications.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"116-127"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422422","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}