Journal of investigative medicine : the official publication of the American Federation for Clinical Research最新文献

{"title":"Retraction: \"E-cigarette use and prevalence of lung diseases among the U.S. population: a NHANES survey\".","authors":"","doi":"10.1177/10815589261453801","DOIUrl":"10.1177/10815589261453801","url":null,"abstract":"","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"621"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in attitudes among health professions students and educators toward people experiencing homelessness: Novel correlations with physical comfort, prior experiences, and interest in learning.","authors":"Elisabeth Gilmore, Clarice Szeto, Eli Spector, Yusuke Shono, Andrew Pumerantz","doi":"10.1177/10815589251406146","DOIUrl":"10.1177/10815589251406146","url":null,"abstract":"<p><p>People experiencing homelessness (PEH) face significant barriers to primary care, compounded by stigma from healthcare professionals. Health professions education offers a critical window of time to shape attitudes, yet research suggests these attitudes can worsen during training. A cross-sectional survey at a multi-professional graduate institution assessed attitudes toward PEH among students and educators across seven health professions colleges. Attitudes varied significantly by profession, with osteopathic medicine and graduate nursing reporting more favorable views than pharmacy, veterinary medicine, dental medicine, physician assistant studies, and physical therapy. More positive attitudes were associated with greater physical comfort, more frequent prior experiences with PEH, and higher interest in learning about homelessness. Respondents who expressed interest in receiving more information afterwards also scored significantly higher on attitude measures. Findings suggest that targeted, profession-specific educational interventions that emphasize meaningful exposure to PEH may improve attitudes. Integrating experiential learning alongside didactic content could foster more holistic, equitable care across disciplines.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"597-606"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-powered chronic kidney disease detection integrating TabNet and LSTM for precision diagnosis.","authors":"Winner Pulakhandam, Visrutatma Rao Vallu, Archana Chaluvadi, Nashwan Adnan Othman, Aseel Smerat, Elangovan Muniyandy","doi":"10.1177/10815589251398948","DOIUrl":"10.1177/10815589251398948","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a leading cause of morbidity and mortality worldwide, with early detection being vital for effective treatment and management. Traditional diagnostic methods often struggle with the difficulty of CKD datasets, leading to delays in diagnosis and intervention. Despite advancements in machine learning, there remains a need for more effective and accurate models that can manage the intricacies of CKD data. This paper proposes an advanced AI-based system for early detection and diagnosis of CKD by developing an AI-based system that can efficiently handle complicated healthcare data. The workflow begins with data collection, where the CKD dataset, including patient health features, is gathered. The data is then preprocessed, involving missing data imputation using Expectation Maximization and outlier removal with One-Class SVM. Feature extraction is performed using Principal Component Analysis to reduce dimensionality while retaining significant features. The extracted features are passed through the TabNet model for feature selection and the long short-term memory (LSTM) for capturing temporal dependencies. Finally, the system makes abnormality detections, providing predictions based on the extracted features and temporal patterns. The model achieves a performance of 98.58% accuracy, 98.89% precision, 98.24% recall, and 98.56% F1-score, outperforming existing models such as XGBoost, SVM, and KNN. This work presents an effective combination of TabNet for feature selection and LSTM for sequential pattern recognition, resulting in a robust system for early CKD detection with minimal false positives and false negatives.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"571-584"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral eosinophilia and preserved ratio impaired spirometry (PRISm).","authors":"Yuhan Wang, Hailing Liu, Jingyi Zhang, Mengcan Wang, Ke Hu","doi":"10.1177/10815589251375118","DOIUrl":"10.1177/10815589251375118","url":null,"abstract":"<p><p>Preserved ratio impaired spirometry (PRISm) may be in the pre-stage of chronic obstructive pulmonary disease. However, little is known about peripheral eosinophils in PRISm. This study ultimately enrolled 7301 community-dwelling participants aged 20-79 years without airflow obstruction. Participants were categorized based on spirometry into two groups: normal spirometry and PRISm. Peripheral eosinophilia is defined by peripheral eosinophil counts ≥300 cells/µL. Multivariable logistic regression model was employed to examine the association between peripheral eosinophil counts and PRISm, as appropriate. Among the community adults finally recruited, 9.43% of participants exhibited PRISm, while 90.57% exhibited normal spirometry. Compared with the normal spirometry population, PRISm participants had a higher prevalence of peripheral eosinophilia in individuals aged 40-79 years (27.41% vs 21.37%, <i>p</i> = 0.01), non-Hispanic Whites (29.22% vs 21.32%, <i>p</i> = 0.01), those with a body mass index of 18.5-<25 kg/m² (25.01% vs 16.75%, <i>p</i> = 0.03), never smokers (23.47% vs 18.65%, <i>p</i> = 0.03), individuals without a history of asthma (26.81% vs 20.67%, <i>p</i><0.001), and those with FeNO levels <50 parts per billion (<i>p</i> < 0.05). Multivariable regression analysis showed a significant association between participants with eosinophil counts ≥300 cells/µL and PRISm compared to those with counts <150 cells/µL, with an adjusted odds ratio of 1.39 (95% CI: 1.12, 1.72). Peripheral eosinophilia was associated with PRISm in individuals without airflow obstruction. It is necessary to focus on the characteristics of peripheral eosinophils in this population.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"607-616"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD38 expression on CD8+ T cells as a marker of immune activation and ART efficacy in HIV.","authors":"Gamze Kesre, Hamdi Oguzman, Mehmet Cabalak, Oguzhan Ozcan","doi":"10.1177/10815589251393916","DOIUrl":"10.1177/10815589251393916","url":null,"abstract":"<p><p>Antiretroviral therapy (ART) is treatment for people infected with human immunodeficiency virus (HIV). We aimed to investigate the short-term effects of ART on T lymphocyte counts and the expression of activation markers, CD38 and HLA-DR, on CD4+ and CD8+ T cells. Thirty HIV patients (people with HIV (PWH) group), 30 patients who received 3 months of ART (PWH on ART group), and 20 HIV-negative controls were included in the study. Whole blood samples were collected in ethylenediaminetetraacetic acid-containing tubes. The percentages of CD38- and HLA-DR-expressing T cells were estimated by flow cytometric assay. Absolute counts were calculated by the double platform method. Viral load was analyzed by the PCR method. PWH showed a significant decrease in CD4+ T cells, with numerical recovery after 3 months of ART (<i>p</i> = 0.001), while CD8+ T cells increased (<i>p</i> = 0.011) and remained unchanged post-ART (<i>p</i> = 0.943), despite a percentage decrease (<i>p</i> = 0.031). After adjusting for CD4+ T cell counts, there was no significant difference in the percentage of CD4+CD38+ T cells among the groups. In contrast, CD8+CD38+ and CD8+HLA-DR+ T cells significantly increased in the PWH group (<i>p</i> < 0.001) and decreased after ART (<i>p</i> < 0.001, <i>p</i> = 0.003), even after adjusting for CD8+ T cell counts and other potential confounders. The percentage of CD4+CD38+ T cells was negatively (<i>r</i> = -0.578, <i>p</i> = 0.030), and CD8+CD38+ T cells were positively correlated with viral load (<i>r</i> = 0.530, <i>p</i> = 0.013). However, we observed no correlation between HLA-DR-expressing CD4+ and CD8+ T cells and viral load. These findings suggest that CD8+CD38+ T cells could serve as a useful marker for both immune activation and assessing the effectiveness of ART in HIV patients.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"585-596"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring testosterone's impact on pulmonary health in a rat model of COPD: Investigating MMP-9 and FGF-23.","authors":"Zexuan Ji, Changhong Zhang, Bu Wang, Jianqing Zhao","doi":"10.1177/10815589251378184","DOIUrl":"10.1177/10815589251378184","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory lung disorder with limited treatment options targeting its underlying pathophysiology. This study investigates the therapeutic effects of testosterone on lung function and inflammation in a male rat model of COPD, focusing on matrix metalloproteinase-9 (MMP-9) and fibroblast growth factor-23 (FGF-23), biomarkers linked to tissue remodeling and systemic inflammation. Sixty male Wistar rats were assigned to control, COPD, and testosterone-treated groups. COPD was induced by lipopolysaccharide instillation and cigarette smoke exposure; testosterone was administered via subcutaneous implants. Pulmonary function tests, histopathology, bronchoalveolar lavage fluid (BALF) analysis, and biochemical assays were performed. Testosterone significantly improved forced vital capacity, FEV100, and mid-expiratory flow compared to the COPD group. Histology showed reduced alveolar wall thickening and inflammatory infiltration. Testosterone-treated rats exhibited lower neutrophil counts and malondialdehyde levels in BALF, along with increased superoxide dismutase activity, indicating reduced oxidative stress. At the molecular level, testosterone suppressed MMP-9 and FGF-23 expression at both mRNA and protein levels and significantly decreased MMP-9 enzymatic activity, as confirmed by gelatin zymography. These results suggest that testosterone alleviates pulmonary damage and inflammation by modulating oxidative stress and inhibiting key molecular mediators of COPD progression. This study supports the potential of testosterone as an adjunct therapy in COPD by improving respiratory function and reducing inflammation.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"536-546"},"PeriodicalIF":2.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calprotectin as a biomarker for bipolar disorder.","authors":"Javier Vargas Medrano, Peter M Thompson","doi":"10.1177/10815589261473282","DOIUrl":"https://doi.org/10.1177/10815589261473282","url":null,"abstract":"","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"10815589261473282"},"PeriodicalIF":2.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between serum lactate/albumin ratio and all-cause mortality in critically ill patients: a meta-analysis.","authors":"Xinwei Liu, Xiulin Xie, Chen Zhao, Longyan Zhu, Shan Huang","doi":"10.1177/10815589261473277","DOIUrl":"10.1177/10815589261473277","url":null,"abstract":"<p><strong>Background: </strong>The serum lactate/albumin ratio (LAR) is a low-cost prognostic biomarker in intensive care. Although elevated LAR has been linked to poor outcomes in sepsis, heart failure, and acute kidney injury, existing studies are limited by heterogeneous populations and inconsistent cut-off values.</p><p><strong>Purpose: </strong>To evaluate the association between LAR and short- and long-term all-cause mortality, and its diagnostic accuracy for mortality prediction, in critically ill adults.</p><p><strong>Study type: </strong>Systematic review and meta-analysis of observational studies, conducted following PRISMA guidelines and registered with PROSPERO (CRD420251055330).</p><p><strong>Population: </strong>Twenty-nine observational studies comprising 39,681 critically ill adults identified from PubMed, Embase, Cochrane Library, and Web of Science through February 18, 2025.Assessment techniques/outcomes:LAR was calculated as serum lactate divided by albumin within 24 hours of intensive care unit (ICU) admission. Outcomes were short-term and long-term all-cause mortality and diagnostic accuracy. Quality was appraised using the Quality Assessment of Prognostic Accuracy Studies (QUAPAS) tool and the Newcastle-Ottawa Scale (NOS).</p><p><strong>Statistical tests: </strong>Hazard ratios (HR) with 95% confidence intervals (CI) were pooled using fixed- or random-effects models according to heterogeneity (<i>I</i>²). Diagnostic accuracy was synthesized using a bivariate mixed-effects model, with summary receiver operating characteristic (SROC) area under the curve (AUC) estimated. Evidence certainty was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Elevated LAR was associated with increased short-term (HR 2.63, 95% CI 2.27-3.04; 9 studies, 15,772 patients) and long-term mortality (HR 2.21, 1.70-2.86; 8 studies, 11,372 patients). Pooled sensitivity, specificity, and AUC were 0.71, 0.74, and 0.78, respectively (24 studies, 32,453 patients). Subgroup analyses confirmed stability across countries, data sources, diseases, and measurement timings. QUAPAS indicated overall low-to-moderate risk of bias; NOS scores ranged 7-9. GRADE certainty was high for short-term mortality and low for long-term mortality and diagnostic accuracy.</p><p><strong>Data conclusion: </strong>Elevated LAR is independently associated with increased short- and long-term mortality in critically ill patients, with moderate diagnostic accuracy. LAR may complement existing scoring systems for early risk stratification, pending prospective validation and standardized cut-offs.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"10815589261473277"},"PeriodicalIF":2.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pan-Immune-Inflammatory Value (PIV) and Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) scores: Associations with geriatric syndromes in older adults.","authors":"Merve Yilmaz Kars, Ilyas Akkar, Orhan Cicek, Zeynep Iclal Turgut, Mustafa Hakan Dogan, Cigdem Kucur Yonet, Muhammet Cemal Kizilarslanoglu","doi":"10.1177/10815589261474865","DOIUrl":"10.1177/10815589261474865","url":null,"abstract":"<p><strong>Background: </strong>The Pan-Immune-Inflammation Value (PIV) and Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score are novel biomarkers reflecting systemic inflammation and nutritional status. However, their associations with comprehensive geriatric assessment (CGA) domains and geriatric syndromes have not been fully elucidated.</p><p><strong>Purpose: </strong>To investigate the relationships of PIV and HALP scores with sarcopenia, frailty, nutritional status, cognitive performance, and functional impairment in older adults undergoing CGA.</p><p><strong>Study type: </strong>Retrospective cross-sectional study.</p><p><strong>Population: </strong>A total of 605 adults aged ≥60 years who underwent CGA at a tertiary geriatric outpatient clinic between May 2023 and February 2026.Assessment Techniques/Outcomes:PIV and HALP scores were calculated using routine laboratory parameters. CGA included SARC-F, handgrip strength (HGS), gait speed, Timed Up and Go Test (TUGT), Katz Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADL), Mini Nutritional Assessment-Short Form (MNA-SF), Clinical Frailty Scale (CFS), cognitive tests, and assessments of geriatric syndromes. Primary outcomes were sarcopenia, frailty, malnutrition risk, cognitive impairment, and functional decline.</p><p><strong>Statistical tests: </strong>Group comparisons were performed using Chi-square, Fisher's exact, and Mann-Whitney U tests. Spearman correlation analyses, adjusted linear regression models, and adjusted binary logistic regression models controlling for age, sex, Charlson Comorbidity Index, and body mass index were applied.</p><p><strong>Results: </strong>The median age was 79 years, and 65.1% of participants were female. Higher PIV and lower HALP scores were consistently associated with worse CGA outcomes. Individuals with sarcopenia, frailty, and depression risk exhibited significantly higher PIV and lower HALP scores (all <i>p</i> < 0.05). In adjusted analyses, higher PIV scores were independently associated with lower gait speed, poorer ADL and IADL performance, greater frailty, and increased sarcopenia risk. Lower HALP scores were independently associated with reduced gait speed, poorer ADL, IADL, and MNA-SF scores, as well as increased frailty and sarcopenia risk. HALP additionally demonstrated significant associations with cognitive performance measures.</p><p><strong>Data conclusion: </strong>PIV and HALP are independently associated with major domains of geriatric vulnerability, including sarcopenia, frailty, functional decline, and nutritional impairment. These readily available biomarkers may provide complementary information for risk stratification and geriatric assessment in older adults.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"10815589261474865"},"PeriodicalIF":2.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory bowel disease and cardiovascular risk: A meta-analysis.","authors":"Lan Xu, Bo Chen","doi":"10.1177/10815589261473278","DOIUrl":"10.1177/10815589261473278","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) is a chronic immune-mediated intestinal disorder characterized by recurrent inflammation. Growing research over the last 10 years has connected IBD to heightened heart-related danger, with major adverse cardiovascular events (MACE, including myocardial infarction (MI), ischemic heart disease (IHD), ischemic stroke) arising earlier in life without reliance on conventional risk elements like high blood pressure or abnormal lipid levels.</p><p><strong>Methods: </strong>A systematic literature search was performed in Medline, Embase, and the Cochrane Library to identify observational cohort and case-control studies published from January 2015 through June 2025. Only original observational cohort and case-control studies with adjusted outcome estimates were enrolled; systematic reviews, meta-analyses, Mendelian randomization studies, and preclinical studies were strictly excluded. Two independent reviewers extracted data and assessed methodological quality using the Newcastle-Ottawa Scale. Meta-analysis was performed using random-effects models; forest plots were generated to visualize pooled effect estimates. Heterogeneity, sensitivity analyses, and publication bias were formally evaluated.</p><p><strong>Results: </strong>A total of 3126 records were retrieved, and finally 12 eligible original observational studies (10 cohort studies, 2 case-control studies) were included, involving 3,017,580 participants and 204,328 IBD cases. Pooled results showed that IBD was significantly associated with increased risks of MI (hazard ratio (HR) = 1.41, 95% confidence interval (95%CI): 1.30-1.53, <i>I</i>² = 45%), IHD (HR = 1.37, 95%CI: 1.28-1.47, <i>I</i>² = 53%), and ischemic cerebrovascular accident (CVA; HR = 1.28, 95%CI: 1.19-1.38, <i>I</i>² = 40%). Subgroup analysis indicated Crohn's disease had higher MI and IHD risks than ulcerative colitis; active IBD and patients under 40 years also presented significantly elevated MACE risk. Additional subgroup analysis confirmed that high cumulative glucocorticoid exposure was independently associated with increased MACE risk (HR/relative risk = 1.52, 95%CI: 1.31-1.76, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>This meta-analysis confirms that IBD is independently associated with increased risk of MACE (MI, IHD, and ischemic CVA), with differential risks by subtype, disease activity, and age.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"10815589261473278"},"PeriodicalIF":2.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}