Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association最新文献

{"title":"Multifactorial chronic kidney disease.","authors":"Jose Manuel Arreola Guerra, Jesus-Israel Martinez-Martinez","doi":"10.1093/ndt/gfaf122","DOIUrl":"https://doi.org/10.1093/ndt/gfaf122","url":null,"abstract":"<p><p>The burden of disease due to chronic kidney disease (CKD) has disproportionately grown in the last decades. This growth has not been similar in all regions. In the last few years, the results of clinical trials, particularly those evaluating sodium-glucose-cotransporter-2 (SGLT2) inhibitors and their efficacy in decreasing cardiovascular mortality and chronic kidney disease progression, revealed the relevance of a common protective pathway that remains non-specific as it has been detected in multiple clinical scenarios. However, the injury pathways in kidney disease are now well-defined in immunological, toxic, and genetic kidney pathologies. Therefore, the multifactoriality of chronic kidney disease is evident. Even prenatally, the number of nephrons is mostly determined by multiple factors that influence the maternal environment, and subsequently, throughout life, various exposures and pathologies gradually reduce the total number of nephrons. A better understanding of CKD as a multifactorial entity requires us to be aware of the primary injury pathways that can play a role throughout our lifetimes and implement more concrete measures to decrease the impact of CKD globally. Due to the heterogeneity of the CKD burden between world regions, local epidemiological studies are essential to understand the factors associated with CKD in each region.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562647","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":"Treatment of diabetes in patients with advanced chronic kidney disease or kidney failure.","authors":"George Bonifant, Stephen N Davis, Matthew R Weir","doi":"10.1093/ndt/gfaf083","DOIUrl":"https://doi.org/10.1093/ndt/gfaf083","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is common in both type 1 and type 2 diabetes and complicated glycemic control due to fluctuating insulin resistance and metabolism. In advanced CKD (stage 4 and stage 5, or eGFR <30 ml/min/1.73m2), reduced kidney clearance of insulin can lower or eliminated insulin needs, but glycemic control remains challenging. This article reviews optimal glycemic targets, monitoring, and current therapeutic recommendations for patients with severe CKD or on dialysis, addressing the lack of efficacy data for many antihyperglycemics in this population.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562649","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":"Treatment standard: CKD in the geriatric patient.","authors":"Elke Schaeffner, Markus Ketteler","doi":"10.1093/ndt/gfaf115","DOIUrl":"https://doi.org/10.1093/ndt/gfaf115","url":null,"abstract":"<p><p>The number of older people with CKD is globally increasing. The vast majority of these patients will die before they even have the chance to start kidney replacement therapy. Nevertheless, this clientele of older patients with CKD is often characterized not only by several concomitant diseases but also by frailty. This constellation comes with a general vulnerability and very heterogeneous courses of disease that need to be considered when it comes to diagnosis and treatment. The main difference to younger patients is that therapy and therapy decisions are often preceded by the need for assessments. These can relate to frailty, but also to closely related areas such as cognition, depression or malnutrition among others. The basic therapeutic approaches for CKD treatment in a geriatric patient may not differ fundamentally though from those for younger patients. This also holds true for standard as well as more novel medication administered for nephroprotection. The difference however, lies in the fact that personalized approaches are more frequently required due to survival probability, a more complex mix of chronic conditions, and individual patient's needs and aims. This also applies to the difficult decision as to whether a very old person with CKD G5 should be dialyzed or treated conservatively. Information from different areas should be incorporated into a joint decision-making process, which often requires intensive, patient-centered communication about the patient's preferences and prioritized treatment goals, psychosocial factors and their home environment, as well as their medical needs and prognosis.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562650","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":"Cardioprotection from intradialytic exercise: a randomized trial.","authors":"Claire Maufrais, Matthieu Josse, Laure Patrier, Myriam Isnard, Antoine Grandperrin, Cécile Turc-Baron, Stéphane Nottin, Jean-Paul Cristol, Doria Boulghobra, Cyril Reboul, Philippe Obert","doi":"10.1093/ndt/gfaf126","DOIUrl":"https://doi.org/10.1093/ndt/gfaf126","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Left ventricular (LV) regional wall motion abnormalities (RWMAs) related to transient ischemic events are well-documented during hemodialysis (HD). Intradialytic exercise (IDE) reduces the global occurrence of HD-induced RWMAs. However, the regionalization of its cardioprotective effects within the LV wall, and its underlying mechanisms remain unclear.</p><p><strong>Methods: </strong>We conducted a prospective, crossover, randomized trial. 72 patients underwent two sessions: standard HD (HD-CONT) and HD with 30min of aerobic exercise (HD-EX). Segmental longitudinal strains (LS) were measured before (T0) and at peak stress (30min before HD-ending, Tpeak). An 18-segment model identified RWMAs, defined as a 20% LS reduction at Tpeak compared to T0. To evaluate the impact of circulating factors, we measured fractional shortening, Ca2+ transients and spontaneous Ca2+ waves (SCaW) following anoxia/reoxygenation (A/R) in isolated rat cardiomyocytes pre-treated with human plasma ultrafiltrates (obtained at Tpeak in both sessions).</p><p><strong>Results: </strong>IDE significantly reduced RWMAs during HD-EX compared to HD-CONT (estimated difference: 1.1 segment, 95%CI: 0.33/1.90, p=0.009). A baso-apical gradient of RWMAs was observed during HD-CONT, with higher prevalence at the apex compared to the base (p=0.03). This gradient was abolished during HD-EX, suggesting greater apical cardioprotection. Pre-treatment of cardiomyocytes with ultrafiltrates from HD-EX improved fractional shortening, Ca2+ handlings and SCaW following A/R compared to cells pre-treated with ultrafiltrates from HD-CONT.</p><p><strong>Conclusions: </strong>IDE limits HD-induced RWMAs, and circulating humoral factors may contribute to this cardioprotection. IDE-induced benefits on RWMAs were greater at the apex. Further studies are needed to elucidate the mechanisms underlying the heterogeneous benefits of IDE on regional myocardial function.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562644","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":"Male and female drug prescription patterns and adverse drug reactions in chronic kidney disease.","authors":"Solène M Laville, Agathe Mouheb, Ziad A Massy, Christian Jacquelinet, Maurice Laville, Bénédicte Stengel, Natalia Alencar de Pinho, Sophie Liabeuf","doi":"10.1093/ndt/gfaf125","DOIUrl":"https://doi.org/10.1093/ndt/gfaf125","url":null,"abstract":"<p><strong>Background: </strong>It is acknowledged that men and women differ with regard to pharmacological responses and adverse drug reactions (ADRs), and there is some evidence to suggest that ADR rates are higher in women. However, this topic has not been extensively explored in patients with chronic kidney disease (CKD). The objectives of the present study of a cohort of patients with CKD were to describe the types of drug prescriptions by sex and to examine potential differences between men and women in the incidence of ADRs.</p><p><strong>Methods: </strong>The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study including 3,011 nephrology outpatients with confirmed CKD (eGFR<60 mL/min/1.73 m²) and available data on drug prescriptions. Standard descriptive analyses were conducted to characterize drug prescriptions by gender through follow-up. ADRs were prospectively identified through hospitalization records, medical records, and patient interviews and adjudicated by expert pharmacologists using validated tools. Multivariable Cox proportional hazards model was used to explore the association between sex and ADRs.</p><p><strong>Results: </strong>Among the 3,011 included patients, 1,038 (34%) were women and 1,973 (66%) were men. Compared with men at baseline, women were younger (median [interquartile range] age: 69 [62-77] years vs 67 [58-76], respectively), and had a lower eGFR (mean ± standard deviation, 33.1±12.9 vs 34.7±13.2 mL/min/1.73 m²). Men and women presented some differences with regard to the types of drugs prescribed. Women were more often prescribed drugs for acid-related disorders, anemia, thyroid disorders, analgesics, and psychoactive drugs. Conversely, they were less often prescribed cardiovascular drugs and oral antidiabetics. During a median [interquartile range] follow-up period of 5.0 [3.6-5.2] years, 964 patients experienced a first ADR (incidence rates [95%CI]: 10.8 [9.6-11.9] per 100 person-years (PY) in women and 9.7 [9.0-10.5] in men). The most frequent ADRs were gastrointestinal disorders in women (n=59(17%)) and renal and urinary disorders in men (n=134 (22%)). The likelihood of a first ADR was higher in women than in men (adjusted HR [95%CI]: 1.17 [1.02;1.34]). However, the likelihood of a serious ADR did not differ by sex.</p><p><strong>Conclusions: </strong>In patients with CKD, significant differences between men and women were observed in drug prescriptions and ADR risks.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562645","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":"Urinary orosomucoid and accelerated GFR decline: a 11-year follow-up study in a non-diabetic population.","authors":"Runa M Andreassen, Karl M Brobak, Inger Therese Enoksen, Toralf Melsom, Bjørn O Eriksen, Marit D Solbu","doi":"10.1093/ndt/gfaf113","DOIUrl":"https://doi.org/10.1093/ndt/gfaf113","url":null,"abstract":"","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562651","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":"Moving Beyond Race, Geographical Origin, and Ethnicity: Genomic Insights as a Path Forward in Nephrology Care.","authors":"Alice Doreille, Louis-Georges Tin, Marie-Chantal Fortin, Cédric Rafat, Laurent Mesnard","doi":"10.1093/ndt/gfaf124","DOIUrl":"https://doi.org/10.1093/ndt/gfaf124","url":null,"abstract":"","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562646","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":"Rationale, design and baseline characteristics of REMODEL, a mechanism-of-action trial with semaglutide in people with type 2 diabetes and chronic kidney disease.","authors":"David Z I Cherney, Nicolas Belmar, Petter Bjornstad, Milenta M Chacko, Thomas P Gunnarsson, Jeffrey B Hodgin, Matthias Kretzler, Menno Pruijm, Philip A Schytz, Katherine R Tuttle","doi":"10.1093/ndt/gfaf114","DOIUrl":"https://doi.org/10.1093/ndt/gfaf114","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD) and kidney failure globally. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, reduces the risk of major kidney, cardiovascular, and mortality outcomes in people with T2D and CKD, but the mechanism-of-action (MoA) remains unclear.</p><p><strong>Methods: </strong>REMODEL (NCT04865770) is a 52-week placebo-controlled, double-blind, parallel-group, randomized trial in adults with T2D and CKD. Inclusion criteria include HbA1c ≤ 9%, estimated glomerular filtration rate (eGFR) ≥ 30 to ≤75 mL/min per 1.73m2 and urine albumin-creatinine ratio (UACR) ≥ 20 to < 5,000 mg/g. The co-primary outcome is magnetic resonance imaging (MRI) based, including change in kidney oxygenation, perfusion and inflammation. Secondary outcomes include change from baseline in creatine clearance rate, urinary sodium excretion, albumin excretion rate and kidney fibrosis and blood flow parameters measured by MRI. A subgroup had kidney biopsies at baseline and at end of the treatment for tissue-based interrogation including single nucleus and spatial transcriptomics, pathology, and advanced histological assessment.</p><p><strong>Results: </strong>Across 8 countries, 106 participants (N = 33, biopsy subgroup) were enrolled. The mean age was 65.3 years [SD 9.9] at baseline with hemoglobin A1c of 7.1% [SD 0.9], creatinine-based eGFR of 51.1 mL/min per 1.73m2 [SD 10.4] and median UACR of 187.3 mg/gram (IQR 60.5-546.4). Renin-angiotensin-system (RAS) inhibitor use was 98.1% and sodium glucose cotransporter 2 inhibitor (SGLT2i) use was 38.7%. In the kidney biopsy subgroup, baseline characteristics were like the full population. Histological analysis of kidney tissues revealed 17 participants with primarily diabetic nephropathy, 6 participants with primarily vascular features, 9 with mixed diabetic nephropathy and vascular characteristics, and 1 with membranous nephropathy.</p><p><strong>Conclusion: </strong>The REMODEL trial leverages multi-pronged approaches to investigate the kidney-specific effects and underlying mechanisms of semaglutide in a representative population of people with T2D and CKD, which supports the generalizability and clinical relevance of the findings.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562648","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":"Kidney Function and Mortality in Childhood Nephrotic Syndrome.","authors":"Cal H Robinson, Bess-Joan Ogome, Nithiakishna Selvathesan, Jovanka Vasilevska-Ristovska, Rulan S Parekh","doi":"10.1093/ndt/gfaf118","DOIUrl":"https://doi.org/10.1093/ndt/gfaf118","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Nephrotic syndrome is a common childhood kidney disease. Frequent relapses, acute kidney injuries, and immunosuppressive medications may lead to chronic kidney disease (CKD). Our objective was to determine incidence of kidney failure, CKD, cancer, and mortality.</p><p><strong>Methods: </strong>A systematic literature search was performed on five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, ClinicalTrials.gov) for English abstracts and full-text articles from 1970-2024. Studies that enrolled children with idiopathic nephrotic syndrome (steroid-sensitive and -resistant) and reported kidney failure, CKD, cancer, or mortality incidence were included. Data abstraction was performed following the PRISMA guidelines. Meta-analyses calculated incidence rate (IR) of outcomes.</p><p><strong>Results: </strong>Of 2785 studies screened, 229 were included (32,712 children). Median follow-up was 5.1 (range 0.3-29) years. Among children with steroid-sensitive nephrotic syndrome, incidence of kidney failure was IR 2.65 (95%CI 1.55-4.54), CKD was IR 3.80 (95%CI 2.38-6.07), and mortality was IR 2.30 (95%CI 1.14-4.63) per 1000 person-years. Among children with steroid-resistant nephrotic syndrome, incidence of kidney failure was IR 33.34 (95%CI 27.05-41.11), CKD was IR 46.90 (95%CI 39.31-55.96), and mortality was IR 12.52 (95%CI 8.21-19.09) per 1000 person-years. The most common causes of death were kidney failure and infections. The incidence of CKD and death decreased over time among children with steroid-resistant nephrotic syndrome. Cancer occurred in only 16 children in 13 studies (899 children). Many studies were at moderate-to-high risk of bias and used variable surveillance strategies and outcome definitions.</p><p><strong>Conclusions: </strong>Incidence of kidney failure, CKD, and death are <4 per 1000 person-years among children with steroid-sensitive nephrotic syndrome. Children diagnosed with steroid-resistance had significantly higher incidence of CKD and death, although rates are decreasing over time.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546821","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":"Foam Sclerotherapy for Symptomatic Cysts in ADPKD, ADPLD and Solitary Cysts.","authors":"Newton Neidert, Firas Kseibi, William P Martin, Seif Bugazia, Emily Bendel, Cassie Howe, Ryan Helland, Adriana Gregory, Kathleen Liestikow, Timothy Kline, Lisa Vaughan, Vicente E Torres, Marie C Hogan","doi":"10.1093/ndt/gfaf111","DOIUrl":"https://doi.org/10.1093/ndt/gfaf111","url":null,"abstract":"<p><strong>Background: </strong>This medical center migrated from alcohol to sotradecol foam sclerotherapy (SFS) because of perceived improved efficacy in managing symptomatic kidney and liver cysts. We report technical aspects, change in short and long-term cyst volumes, patient reported outcomes, safety, and applications of the technique.</p><p><strong>Methods: </strong>In this retrospective observational study, cases from 1/2017-12/2021 had TKCV/TLCV (per Targeted Kidney or Liver or Cyst analysis) segmented using a deep-learning algorithm and cyst segmentation software (pre, post procedure and longitudinally). TKCV/TLCV percent change were evaluated using the 1-sample Wilcoxon signed rank test. For analyses involving changes in cyst volumes, the median percent change in cyst volume per patient was assessed. Longitudinal changes in cyst volumes were assessed using linear mixed models. Changes in quality of life (LASA, SF12, PLD-Q) were also assessed.</p><p><strong>Results: </strong>There were 102 SFS sessions (38 kidney, 58 liver, 6 combined liver/kidney cysts) performed on 77 unique individuals included for analysis. Median [interquartile range, IQR] percent reductions in TKCV were-92.0% [IQR -98.2%, -82.7%, P<0.001) and for TLCV were -83.1% [IQR -93.5%, -52.9%, P<0.001). Among patients with multiple kidney procedures (n=7), median percent reduction in TKCV was -94.3% [IQR -96.6%, -92.4%, P=0.023]. For patients with multiple liver procedures (n=11), median percent reduction in TLCV was -63.3% [IQR -85.2%, -28.3%, P=0.004]. Results were similar among the 4 patients undergoing multi-stage procedures (n=1 kidney, n=3 liver). When measured longitudinally, both liver and kidney cyst volumes declined to levels near 0mL by 1 year follow-up and remained stable several years later. LASA physical domain and PLD-Q QOL scores improved post SFS procedure.</p><p><strong>Conclusion: </strong>SFS led to substantial long-term reductions in TKCV/TLCV and improved QOL. SFS can augment cyst volume reduction in addition to tolvaptan (kidney cysts) and octreotide (liver cysts). In some individuals with large symptomatic cysts, multiple SFS procedures were safe and effective in reducing TLCV/TKCV and improving symptoms.</p>","PeriodicalId":520717,"journal":{"name":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532851","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}