Nephrology (Carlton, Vic.)最新文献

{"title":"Thymic Stromal Lymphopoietin May Induce Steroid Resistance in Minimal Change Disease.","authors":"Maiko Nakayama, Hitoshi Suzuki, Yusuke Fukao, Yoshihito Nihei, Yusuke Suzuki","doi":"10.1111/nep.70123","DOIUrl":"10.1111/nep.70123","url":null,"abstract":"<p><strong>Aim: </strong>Minimal change disease (MCD) is one of the causes of idiopathic nephrotic syndrome, and 40% of patients have allergic diseases. About 30% of MCD patients become resistant to steroid after a long period of steroid therapy; however, the mechanism of steroid resistance is unclear. Thymic stromal lymphopoietin (TSLP), an epithelial cytokine, is known to be associated with steroid-resistant allergic disease. Experiments using mouse models of asthma suggest that TSLP-mediated phosphorylation of signal transducer and activator of transcription 5 (STAT5) binds to corticosteroid receptors, resulting in steroid resistance. In the present study, we aim to investigate whether TSLP is involved in steroid resistance in patients with MCD.</p><p><strong>Methods: </strong>We compared serum TSLP levels in patients with MCD (n = 26) and healthy controls (n = 13). The cultured podocytes were used to investigate whether TSLP attenuates the podocyte-protective effect of dexamethasone (DEX) and whether the administration of a TSLP-neutralising antibody abolishes TSLP-induced steroid resistance.</p><p><strong>Results: </strong>The level of serum TSLP in patients with MCD was significantly higher than that in healthy controls (p < 0.05). Of note, in patients with MCD, serum TSLP levels significantly elevated at recurrence (p < 0.05). In vitro, DEX protected podocytes from Adriamycin-induced injury. The protective effect of DEX on podocytes was attenuated by co-culture with TSLP (p < 0.01). However, treatment with TSLP neutralising antibody improved TSLP-induced steroid resistance (p < 0.001). We also found that TSLP induces STAT5 activation in podocytes, which is blocked by TSLP-neutralising antibodies.</p><p><strong>Conclusion: </strong>TSLP may be involved in steroid resistance via the STAT5 pathway in podocytes.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70123"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071627","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":"CARI Guidelines Commentary on the KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases.","authors":"Bhadran Bose, Simon A Carter, Mia E Abdy, Nicole Scholes-Robertson, Ieyesha Roberts, Tze Liang Goh, Vincent Lee, Emily See, Helen Coolican, Vanessa Cullen, Min Jun, Rathika Krishnasamy, Kelly Lambert, Jonathan Craig, Casey Light, Thu Nguyen, Carla Scuderi, David J Tunnicliffe, Andrea K Viecelli","doi":"10.1111/nep.70119","DOIUrl":"10.1111/nep.70119","url":null,"abstract":"<p><strong>Aim: </strong>The KDIGO 2021 Glomerular Disease Guidelines provide updated recommendations on the management of glomerular diseases (GD), with substantial advances made in diagnosis, treatment, and improvement of outcomes for people with GD.</p><p><strong>Methods: </strong>The Caring for Australians and New Zealanders with kidney Impairment (CARI) Guidelines commentary contextualises the updated guidelines for the Australian and New Zealand setting.</p><p><strong>Results: </strong>Kidney biopsy remains central to diagnosis, with validated scoring systems available. However, genetic testing for suspected monogenic kidney disease is now accessible in Australia, enabling earlier diagnosis and management, particularly in situations where a kidney biopsy is considered high risk or contraindicated. The guideline emphasises timed urine collections for protein excretion over spot tests and we suggest the use of the CKiD u25 eGFR equation for people under 25. For IgA nephropathy (IgAN) and IgA vasculitis (IgAV), emerging therapies such as targeted-release budesonide and sparsentan demonstrate promise but await approval and public subsidy in our region. For membranous nephropathy, the guideline highlights the differences in adult and paediatric management. In nephrotic syndrome, tacrolimus is used as first-line therapy and rituximab as a second-line agent for steroid-dependent or frequently relapsing disease. Minimal change disease recommendations include glucocorticoid tapering after remission, while focal segmental glomerulosclerosis incorporates genetic classifications and advocates for next-generation sequencing.</p><p><strong>Conclusion: </strong>Our commentary underscores the need for increased participation in clinical trials to validate regional applicability and improve long-term outcomes for people with GD in Australia and New Zealand. Clinical trials of new medications have led to more treatment options that are awaiting approval.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70119"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071620","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":"CD45 + C1q + CCR8+ Cells as Emerging Indicators of Kidney Disease Severity and Progression Risk.","authors":"Koichi Sato, Megumi Oshima, Norihiko Sakai, Yu Oshima, Daichi Kaikoi, Daiki Hayashi, Naoki Yamamoto, Takahiro Matsuno, Akihiko Koshino, Keisuke Sako, Keisuke Horikoshi, Takahiro Yuasa, Akira Tamai, Taichiro Minami, Shiori Nakagawa, Shinji Kitajima, Tadashi Toyama, Akinori Hara, Miho Shimizu, Takashi Wada, Yasuhiko Yamamoto, Yasunori Iwata","doi":"10.1111/nep.70126","DOIUrl":"10.1111/nep.70126","url":null,"abstract":"<p><strong>Aim: </strong>Fibrosis is a common mechanism underlying the progression of kidney and other organ failures. Complement protein C1q and chemokine receptor 8 (CCR8), whose ligand is CCL1, are implicated in fibrosis. This study aimed to evaluate the clinical significance of CD45+ mononuclear cells coexpressing C1q and CCR8 (CD45 + C1q + CCR8+ cells) in kidney disease.</p><p><strong>Methods: </strong>This prospective observational study included 44 patients with kidney disease. The percentage of CD45 + C1q + CCR8+ cells among CD45+ mononuclear cells in the peripheral blood was measured using flow cytometry at baseline. Correlations between these percentages and clinical parameters, including serum creatinine (Cr) and urinary protein levels, were examined using linear regression models. The association between baseline percentages of CD45 + C1q + CCR8+ cells and kidney outcomes-defined as end-stage kidney disease or a 30% decrease in the estimated glomerular filtration rate-was examined using Cox proportional hazards models in patients with serum Cr data during follow-up.</p><p><strong>Results: </strong>The median age of the cohort was 57 years, and 61.4% were male. The median serum Cr and urinary protein levels were 1.73 mg/dL and 1.99 g/g Cr, respectively. Baseline percentages of CD45 + C1q + CCR8+ cells positively correlated with serum Cr (p = 0.028) and urinary protein (p = 0.015). Among 21 patients with follow-up data, 10 (48%) reached kidney outcomes. Patients with moderately elevated percentages had a higher risk of kidney outcomes than those with low levels (HR: 27.31, 95% CI: 1.08-692.3; p = 0.04).</p><p><strong>Conclusion: </strong>CD45 + C1q + CCR8+ cell percentages in peripheral blood may reflect kidney function and are associated with disease progression, indicating their potential as biomarkers.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70126"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071642","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":"Comment on \"Irisin: A Promising Diagnostic Biomarker at the Interface Between Systemic Inflammation and Skeletal Muscle Dysfunction in Haemodialysis Patients\".","authors":"Ranjana Sah, Rachana Mehta","doi":"10.1111/nep.70114","DOIUrl":"https://doi.org/10.1111/nep.70114","url":null,"abstract":"","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70114"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042902","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":"Management of Atypical Haemolytic Uraemic Syndrome With Triggers: Diagnostic and Treatment Algorithms From an Asia-Pacific Perspective.","authors":"Hee Gyung Kang, Danny Hsu, Noritoshi Kato, Jin Seok Kim, Masayoshi Okumi, Min-Hua Tseng, Kun-Hua Tu, Desmond Yat Hin Yap, Wai H Lim","doi":"10.1111/nep.70116","DOIUrl":"10.1111/nep.70116","url":null,"abstract":"<p><p>Complement-amplifying events/conditions associated with thrombotic microangiopathy (TMA) include pregnancy/postpartum period, severe hypertension, autoimmune diseases, drug exposures, infections and organ transplantation. Some of these 'triggers' may exist comorbidly with atypical haemolytic uraemic syndrome (aHUS; a complement-mediated form of TMA), unmask previously undiagnosed aHUS, or occur secondary to aHUS, thus creating a considerable diagnostic challenge. A major goal in patients presenting with TMA is to differentiate complement-mediated aHUS from other causes of TMA such that appropriate targeted treatment with complement 5 (C5) inhibitors can be initiated rapidly to avoid irreversible end-organ damage. To this end, nephrologists and haematologists from Australia, Hong Kong, Japan, Korea and Taiwan met virtually to discuss the management of TMA/aHUS in the presence of trigger conditions, focusing on the role of C5 inhibitors. To assist primary healthcare physicians and specialists from other disciplines in identifying and managing aHUS in the presence of triggers, the panel developed diagnostic and treatment algorithms as the main meeting output. Individual algorithms are presented for the settings of pregnancy, hypertension, autoimmune diseases, drug exposures, and kidney transplant. The algorithms combine clinical evidence with the panel's collective expertise to provide practical steps to differentiate aHUS and can be refined by local experts to reflect respective healthcare systems, approval and reimbursement procedures, resources and access to treatments for aHUS in any Asia-Pacific country.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70116"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12429023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042951","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":"Irisin, an Emerging Diagnosis Marker in Haemodialysis Patients: Response to the Comment of Sah and Mehta on \"Irisin: A Promising Diagnostic Biomarker at the Interface Between Systemic Inflammation and Skeletal Muscle Dysfunction in Haemodialysis Patients\".","authors":"Rômulo D Novaes, Reggiani V Gonçalves","doi":"10.1111/nep.70125","DOIUrl":"https://doi.org/10.1111/nep.70125","url":null,"abstract":"","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70125"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071632","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":"Glomerular Galactose-Deficient IgA1 Deposition in 192 Autopsy Cases in Japan.","authors":"Yoshihito Nihei, Ryousuke Aoki, Keiichi Matsuzaki, Ayako Koizumi, Harumi Saeki, Ikumi Sakai, Masao Kihara, Takashi Yao, Yusuke Suzuki","doi":"10.1111/nep.70128","DOIUrl":"10.1111/nep.70128","url":null,"abstract":"<p><strong>Aim: </strong>Glomerular IgA deposition is incidentally observed in asymptomatic individuals; however, it remains unclear whether these cases represent a preclinical stage of IgA nephropathy (IgAN). We aimed to address this question by staining kidney samples from autopsy cases with the anti-galactose-deficient IgA1 (Gd-IgA1: the key effector molecule in the pathogenesis of IgAN) antibody, KM55.</p><p><strong>Methods: </strong>Kidney samples from 192 autopsy cases in Japan were stained with anti-IgA antibody and KM55. The deposition of complement C3, IgG and IgM in glomeruli, as well as the histological findings and clinical data were analysed in cases positive for glomerular IgA.</p><p><strong>Results: </strong>Glomerular IgA deposition was detected in 13 cases (6.8%), all of which were stained with KM55. Of 10 cases with available urinary data prior to admission, six did not have abnormal urinary findings. 7 of 13 were positive for glomerular Gd-IgA1 alone without obvious histological changes. Glomerular IgG and IgM were detected in 1 of 13 and 5 of 13 cases, respectively. 2 of 13 were positive for glomerular C3, with one showing mesangial proliferation.</p><p><strong>Conclusion: </strong>Our results indicate that asymptomatic cases with glomerular IgA deposition may frequently include subclinical IgAN, characterised by glomerular deposition of Gd-IgA1 (KM55-positive) without prominent histopathological changes or obvious clinical symptoms.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70128"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088780","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":"Sodium Polystyrene Sulfonate and Heart Failure Risk: A Comparative Study With Calcium Polystyrene Sulfonate.","authors":"Takashin Nakayama, Hidehiro Kaneko, Yuta Suzuki, Akira Okada, Hiroyuki Morita, Katsuhito Fujiu, Norifumi Takeda, Tatsuhiko Azegami, Takashi Yokoo, Norihiko Takeda, Koichi Node, Hideo Yasunaga, Masaomi Nangaku, Kaori Hayashi","doi":"10.1111/nep.70117","DOIUrl":"10.1111/nep.70117","url":null,"abstract":"<p><strong>Aim: </strong>Sodium polystyrene sulfonate (SPS) is one of the classic potassium-binding agents that remains commonly used in the treatment of hyperkalaemia. However, the potential concern about its sodium load has not been fully investigated. In this study, we evaluated the association between SPS initiation and heart failure (HF), compared with calcium polystyrene sulfonate (CPS).</p><p><strong>Methods: </strong>This retrospective study enrolled individuals from a nationwide claims database who had been newly prescribed either SPS or CPS between April 2014 and August 2023. The incidence of HF between the two groups was compared using inverse probability of treatment weighting based on the propensity scores.</p><p><strong>Results: </strong>We analysed 3481 eligible individuals, of whom 478 received SPS and 3003 CPS. Median age (interquartile range) was 78 (71-83) years, 2160 (62%) were male, and median estimated glomerular filtration rate was 47.0 (32.1-63.1) mL/min/1.73 m². Over a median follow-up of 361 (147-726) days, 709 HF events were documented. Weighted Cox regression analysis demonstrated that SPS users had a higher risk of developing HF (hazard ratio [HR] 1.24; 95% confidence interval [CI] 1.00-1.53). In sub-group analyses, the association of SPS administration with incident HF was more profound in individuals aged ≥ 78 years (HR 1.37; 95% CI 1.05-1.79) than in those aged < 78 years (HR 1.01; 95% CI 0.69-1.48).</p><p><strong>Conclusion: </strong>Our analysis of a nationwide real-world dataset demonstrated that the use of SPS was associated with an increased likelihood of developing HF, suggesting a possible risk related to SPS-induced sodium loading.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70117"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995102","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":"Outcomes of Dialysis Patients Living With HIV in Australia and New Zealand: A Cohort Study Using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).","authors":"Mitchell Hunter-Dickson, Andrea Huang, Douglas Drak, Catherine Zheng, David Gracey","doi":"10.1111/nep.70115","DOIUrl":"https://doi.org/10.1111/nep.70115","url":null,"abstract":"<p><strong>Aim: </strong>To describe the demographics and comorbidities of people living with HIV (PLWH) starting on dialysis in Australia and New Zealand and to assess mortality outcomes and rates of infective complications.</p><p><strong>Methods: </strong>Retrospective population-based cohort study of between 1996 and 2022. The primary outcome was the difference in survival between PLWH and HIV-negative patients started on dialysis. Other outcomes included peritoneal dialysis peritonitis rates and causative organisms.</p><p><strong>Results: </strong>A total of 82 739 patients were included in the study; 95 (0.1%) were HIV-positive. The median age at first dialysis was lower in the PLWH group at 53 years (IQR 44-60) compared to 61 years (IQR 49-71) in the HIV-negative group (p < 0.001). PLWH had higher rates of tubulointerstitial disease (15% vs. 10%) and glomerular disease (29% vs. 23%) than the HIV-negative cohort (p = 0.030). There were similar patterns of other comorbidities. Median survival from commencement of dialysis was similar between PLWH and HIV-negative patients at 7.1 years (95% CI 6.1-10.3 years) and 6.3 years (95% CI 6.2-6.4), respectively, (p = 0.34); the younger age at commencement for PLWH meant that median lifespan was approximately 7 years shorter. Causes of death were similar between groups, with cardiovascular death being most common at 43%, followed by withdrawal at 24% and then infection at 17% (p = 0.64). There was no clinically significant difference in peritonitis rates or causative organisms.</p><p><strong>Conclusion: </strong>PLWH had a shorter median lifespan as compared to HIV-negative patients on dialysis; however, this was entirely a consequence of earlier renal failure in PLWH, with on-dialysis mortality similar between the two groups.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70115"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986798","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":"Novel Pathogenic Genotype in SLC12A3 Associated to Gitelman Syndrome: A Case Report.","authors":"Patricia Tomás-Simó, Antonio Sierra-Rivera, Ana Checa-Ros, Raquel Rodríguez-López, Antonio Galán-Serrano, Luis D'Marco","doi":"10.1111/nep.70127","DOIUrl":"10.1111/nep.70127","url":null,"abstract":"<p><p>Gitelman syndrome (GS) is considered one of the most common hereditary renal tubular disorders, characterised by hypokalemia, hypomagnesemia, hypocalciuria, and metabolic alkalosis. The primary cause of this disorder resides in the SLC12A3 gene, which encodes the NaCl cotransporter in the distal convoluted tubule, and for which more than 500 mutations associated with GS have been described. We present the case of a 51-year-old female referred for evaluation of recurrent hypokalemia and hypomagnesemia, with no clinical symptoms. The blood test also revealed hypocalciuria and metabolic alkalosis. Oral supplementation with potassium and magnesium was prescribed. A next-generation sequencing (NGS) test was performed on her and her child (no other relatives alive), who was also asymptomatic with no obvious electrolytic abnormalities. Two mutations confirmed as pathogenic were found in the SLC12A3 gene (NM_000339.3) of the mother, c.704C>G and c.704C>T, as well as a new heterozygous variant in trans not reported before, c.704C>A p.(Thr235Lys), and identified as a variant of uncertain significance (VUS). This new VUS (c.704C>A p) was also present in the child, increasing evidence of its potential pathogenicity. The new SLC12A3 gene variant could represent a pathogenic mutation associated with GS. The use of NGS-based panel is recommended to cover the large genotypic variability associated with this disease, in an attempt to identify novel SLC12A3 gene variants of potential pathogenicity.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 9","pages":"e70127"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056603","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}