Diseases of the Esophagus最新文献

{"title":"Prognostic significance of subcarinal lymph node involvement in patients with Siewert type I and II gastro-esophageal junctional adenocarcinoma: an analysis of 698 patients undergoing Ivor-Lewis esophagectomy.","authors":"James A Walmsley, Mohamed Abdelrahman, Arun Ariyarathenam, Richard Berrisford, Lee Humphreys, Grant Sanders, Ji Chung Tham, Tim Wheatley, David S Y Chan","doi":"10.1093/dote/doaf003","DOIUrl":"https://doi.org/10.1093/dote/doaf003","url":null,"abstract":"<p><p>Gastro-esophageal junction (GOJ) adenocarcinoma is increasingly common and despite significant changes in management over the past decade, overall survival remains poor. Determining factors that influence survival is important for optimizing curative surgery. The prognostic significance of subcarinal lymph node involvement is unclear. The purpose of this study was to assess the prognostic significance of subcarinal lymph node involvement in patients undergoing curative resection of GOJ adenocarcinoma. Consecutive patients undergoing curative 2-stage Ivor-Lewis esophagectomy between February 2010 and January 2022 were analyzed retrospectively from a prospectively maintained database for Siewert type I and II GOJ adenocarcinoma confirmed on histopathology. Outcomes were compared based on subcarinal node involvement confirmed on histopathology. A total of 698 patients with Siewert type I (n = 314) and II (n = 384) adenocarcinoma were analyzed [median age 68 (31-85), 604 males (87%) neo-adjuvant use 491 (74.4%)]. Eighteen patients (2.6%) had subcarinal lymph node involvement. These patients had more advanced overall stage of disease and positive node involvement than those without and a significantly lower median survival of 6 months (<1-25) compared to 53 months (41-65) (p < 0.001). On multivariate analysis, pathological T stage, para-gastric and subcarinal lymph node involvement were found to be the independent and significant factors influencing survival. Subcarinal lymph node involvement is an indicator of advanced disease and high positive node burden. It is an independent prognostic factor in patients undergoing curative surgery for Siewert type I and II GOJ adenocarcinoma.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for failure of neoadjuvant docetaxel, cisplatin, and 5-fluorouracil therapy in esophageal squamous cell carcinoma.","authors":"Masayoshi Terayama, Akihiko Okamura, Akira Oki, Kengo Kuriyama, Naoki Takahashi, Masahiro Tamura, Jun Kanamori, Shohei Udagawa, Keitaro Shimozaki, Hiroki Osumi, Shota Fukuoka, Mariko Ogura, Keisho Chin, Masayuki Watanabe","doi":"10.1093/dote/doae115","DOIUrl":"10.1093/dote/doae115","url":null,"abstract":"<p><p>Recently, neoadjuvant chemotherapy comprising docetaxel, cisplatin, and 5-fluorouracil showed promising efficacy for esophageal squamous cell carcinoma. However, some patients do not achieve curative resection despite neoadjuvant chemotherapy using these drugs. This study aimed to clarify the pretherapeutic characteristics of these patients. We included 113 patients who underwent neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for potentially resectable esophageal squamous cell carcinoma and compared the clinical characteristics between patients who achieved curative resection (curative group) and those who failed to achieve curative resection after planned neoadjuvant chemotherapy (noncurative group). Moreover, we determined the factors predicting noncurative outcomes. Ninety-one (81%) and 22 patients (19%) were in the curative and noncurative groups, respectively. The noncurative group had significantly more tumors located in the upper third of the esophagus, larger-sized tumors, and borderline resectable tumors than the curative group (P = 0.003, 0.049, and <0.001, respectively). Moreover, the noncurative group had significantly higher serum squamous cell carcinoma antigen concentrations than the curative group (P = 0.008). Multivariable analysis identified tumor location in the upper third of the esophagus (odds ratio 7.31, P = 0.002), tumor size ≥50 mm (odds ratio 4.71, P = 0.037), and borderline resectable tumors (odds ratio 6.65, P = 0.003) as independent predictors for noncurative outcomes. Tumor location in the upper third of the esophagus, larger-sized tumors, and borderline resectable tumors might be significant predictors for noncurative outcomes in patients who received neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the quality of care in eosinophilic esophagitis: gaps and challenges.","authors":"Amir Farah, Amir Mari","doi":"10.1093/dote/doaf020","DOIUrl":"https://doi.org/10.1093/dote/doaf020","url":null,"abstract":"","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between laryngopharyngeal reflux clinical scores and esophageal multichannel intraluminal impedance pH monitoring interpretation according to Lyon Consensus 2.0.","authors":"Tanawat Geeratragool, Monthira Maneerattanaporn, Jerdnaphang Prapruetkit, Pritsana Chuenprapai, Cheerasook Chongkolwatana, Somchai Leelakusolvong","doi":"10.1093/dote/doae098","DOIUrl":"10.1093/dote/doae098","url":null,"abstract":"<p><p>Laryngopharyngeal reflux remains a diagnostic challenge due to the lack of a definitive diagnostic tool. Esophageal multichannel intraluminal impedance (MII) pH monitoring has been proven reliable for detecting gastric reflux. This study aims to evaluate the association between clinical scores and MII/pH monitoring according to the Lyon Consensus 2.0. Patients with laryngo-pharyngeal symptoms (LPS) who had a reflux symptom index (RSI) ≥13 or reflux finding score (RFS) ≥7 underwent MII/pH monitoring. The findings were analyzed in comparison with clinical scores. A total of 100 patients meeting the inclusion criteria were recruited for this study. MII/pH monitoring revealed a median acid exposure time (AET) of 1.9% (interquartile range [IQR] = 0.2, 4.9), with 22% of patients recording an AET above 6%. The median number of reflux episodes was 29.5 episodes per day (IQR = 19.0, 43.8), with 7% experiencing more than 80 episodes per day. Gas reflux was identified as the most prevalent type. Based on the Lyon Consensus 2.0, 25 patients exhibited conclusive pathological reflux, while 75 patients showed no conclusive evidence of pathological reflux. No significant differences were found in RSI and RFS between these groups. Only gas reflux episodes showed a significant correlation with RSI (r = 0.255, P = 0.011). RSI and RFS among patients with LPS showed no statistically significant differences in identifying pathological reflux or no conclusive evidence of pathological reflux. This finding suggests that the pathophysiology underlying LPS may not be solely attributable to reflux.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased expression of proton pump and allergic inflammation genes predicts PPI failure in pediatric eosinophilic esophagitis.","authors":"Paroma Bose, Wenwu Zhang, Pegah Mehrpouya-Bahrami, Katrina Collins, Jennifer Zhao, Anthony M Cannon, Eric Albright, Muhammad T Idrees, Anthony Perkins, Sandeep K Gupta, Emily C Hon, Mark H Kaplan","doi":"10.1093/dote/doae071","DOIUrl":"10.1093/dote/doae071","url":null,"abstract":"<p><p>Proton pump inhibitors (PPIs) are one of the standards of care of eosinophilic esophagitis (EoE) treatment, though PPI response rates are variable ranging from 23 to 63% in pediatric studies. We sought to determine if expression of select genes in esophageal mucosa can predict PPI responsiveness in EoE. Children with a new diagnosis of EoE (15 or more eosinophils/hpf on esophageal biopsy) were prospectively treated with 8 weeks of PPI therapy before follow-up esophagogastroduodenoscopy (EGD). Children with <15 eosinophils/hpf on follow-up were classified as having PPI-Responsive EoE (PPI-R) and ≥ 15 eosinophils/hpf as PPI-Nonresponsive EoE (PPI-NR). Using the Nanostring nCounter Analysis System, mRNA expression of a custom panel of genes was measured in esophageal biopsies. Immunohistochemical staining of biopsies was performed. Among children with EoE, 32% (8/25) had PPI-R EoE. ATP12A, ATP4A, tryptase-beta 2 (TPSB2), CLC and IL13 had higher expression in PPI-NR EoE compared to PPI-R EoE or controls. Immunohistochemical staining of ATP12A was higher among PPI-R EoE and PPI-NR EoE, compared to non-EoE controls. In this study, PPI-NR EoE had significantly higher baseline gene expression of mast cell, cytokine, proton pump, and eosinophil genes compared to PPI-R EoE. PPIs may be involved in an inflammatory cascade of mast cell activation that stimulates IL-13 release, which upregulates ATP12A and ATP4A that leads to eosinophil recruitment. Histologic PPI failure may occur when increased gene expression of these components is high and cannot be overcome pharmacologically, especially in the case of proton pump genes.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of persistent symptoms in eosinophilic esophagitis after remission: fibrostenosis, eosinophilia, anxiety, and depression.","authors":"Claire A Beveridge, Christina Hermanns, Shivani Thanawala, Arjun Chatterjee, Neha Sharma, Naga Venkata Rama Kirshna Vura, Qijun Yang, Yi Qin, Prashanthi Thota, Matthew Hoscheit, J Mark Brown, Andrei I Ivanov, Anthony Lembo, Scott Gabbard, Florian Rieder","doi":"10.1093/dote/doae110","DOIUrl":"10.1093/dote/doae110","url":null,"abstract":"<p><p>Eosinophilic Esophagitis (EoE) is a chronic inflammatory esophageal disorder, often associated with dysphagia, chest discomfort, and heartburn. There is limited information on persistent esophageal symptoms despite histologic remission (HR). We aimed to assess the prevalence and predictors of persistent esophageal symptoms in adult patients with EoE in HR. We performed a retrospective cohort study of adult EoE patients in HR (<15 eosinophils per high power field [eos/hpf]). Exclusion criteria included: no available data on symptoms, chronic opiate use, disorders of esophagogastric junction outflow on Chicago Classification version 4 diagnosis, esophageal candidiasis, erosive esophagitis, or other known cause of esophageal dysphagia besides EoE. Based on prior literature, definitions include: complete HR (<5 eos/hpf), partial HR (5-14 eos/hpf), and endoscopic fibrostenosis (rings and/or stricture). Esophageal symptoms were assessed within 2 weeks of HR and categorized into the major symptoms of dysphagia, chest pain, and heartburn. Given the retrospective nature of the study, a global symptom response (absence or presence) was used. Demographics, disease history, endoscopy reports, EoE endoscopic reference score, and histology were recorded. Univariate and multivariable logistic regression analyses were performed. Eosinophil thresholds for persistent symptoms were determined using receiver operating characteristics analyses. Of 289 EoE patients in HR, 133 (46%) had esophageal symptoms: dysphagia (N = 119; 41.2%), heartburn (N = 28; 20.8%), and chest pain (N = 10; 7.5%). Significant predictors for persistent dysphagia were anxiety (adjusted odds ratio [aOR] 3.77) and endoscopic fibrostenosis (aOR 3.87). Significant predictors for persistent heartburn with or without chest pain were anxiety or depression (aOR 12.2 and aOR 11.0) and partial HR (aOR 1.17 and aOR 1.18). Threshold eosinophil counts for persistent heartburn and chest pain were 2.5 and 3.5 eos/hpf, respectively (AUC 0.71 and 0.69). We report a high prevalence of persistent esophageal symptoms in EoE patients who are in HR. Risk factors include anxiety, depression, endoscopic fibrostenosis, and partial HR. These findings can help direct patient care, including endoscopic dilation and managing psychiatric comorbidities. Targeting less than 2.5 and 3.5 eos/hpf for heartburn and chest pain may be warranted.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sling fiber preservation during POEM reduces incidence of postoperative reflux symptoms.","authors":"Yusuke Fujiyoshi, Mary Raina Angeli Fujiyoshi, Kareem Khalaf, Gary R May, Christopher W Teshima","doi":"10.1093/dote/doae097","DOIUrl":"10.1093/dote/doae097","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM) has been a limiting factor with POEM. Sling-fiber preservation during POEM was reported to reduce postoperative GERD in Japan. This study investigates the efficacy of this technique in a western population. This is a retrospective, single-center study of patients undergoing POEM from October 2017 to January 2023. The initial cohort of patients were treated by conventional POEM, after which a second cohort underwent POEM with sling-fiber preservation. The primary outcome was the incidence of postoperative reflux symptoms. The secondary outcomes were clinical success rate (Eckardt score ≤ 3), procedure time, and adverse events rate. Multivariate regression was then performed to identify factors associated with the incidence of postoperative reflux symptoms. One hundred and forty eight POEM cases (52.5 ± 15.6 y/o, female: 61[43%]) were included. The mean procedure time (108.6 ± 34.5 vs. 109.1 ± 45.7 min, P = 0.93) was similar between the groups. In the sling-fiber preservation group, gastric myotomy length was significantly longer (2.2 ± 0.7 vs. 1.6 ± 0.8 cm, P < 0.05), yet the incidence rate of postoperative reflux symptoms at follow-up was significantly lower (22.4% vs. 42.3%, P < 0.05). The clinical success rate was similar between groups (89.5% vs. 83.1%, P = 0.32), and the rate of adverse events requiring intervention (13.5% vs. 12.2%, P = 0.36) was similar. Regression analysis indicated that, after adjusting for other risk factors of postoperative GERD, sling-fiber preservation during POEM had an odds ratio of 0.24 (95% CI: 0.07-0.85, P < 0.05) for the incidence of reflux symptoms. Sling-fiber preservation during POEM reduces the incidence of postoperative reflux symptoms. As such, sling-fiber preservation may be a useful solution to reduce post-POEM GERD in western populations.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental downstream resource utilization due to endoscopic screening for Barrett's esophagus.","authors":"Matthew Harbrecht, Maria E Arasim, Yue Liu, Joel H Rubenstein","doi":"10.1093/dote/doaf021","DOIUrl":"https://doi.org/10.1093/dote/doaf021","url":null,"abstract":"<p><p> Cost-effectiveness analyses have demonstrated benefit in screening for Barrett's esophagus (BE) but have not included resource utilization due to incidental findings. We abstracted longitudinal data from a study of male patients aged 50-79 years undergoing research esophagogastroduodenoscopy (EGD) for BE screening regardless of symptoms. Patients were enrolled at the time colonoscopy for colorectal cancer screening at two facilities. Costs were estimated from Centers for Medicare and Medicaid Services median national reimbursements and average wholesale prices of medications. Of 822 men enrolled, almost one-third of patients had gastric biopsies obtained (32.4%) and an additional 15.7% were recommended acid suppression. Repeat EGD was recommended in only 2.0% of patients, but was the second most costly weighted resource. The total additional expected cost due to incidental findings was $66 per EGD. We conclude that incidental findings during EGD for BE leads to a modest increase in resource utilization, primarily due to biopsies and acid suppression, which should be considered in future cost-effectiveness analyses.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring X: barriers to care for eosinophilic esophagitis.","authors":"Shivani U Thanawala, Ari Klein, Krish Raval, Jesus Ivan Flores Amaro, Claire A Beveridge, Amanda B Muir, Gary W Falk, Graciela Gonzalez-Hernandez, Kristle L Lynch","doi":"10.1093/dote/doae043","DOIUrl":"10.1093/dote/doae043","url":null,"abstract":"<p><p>Patients with chronic diseases have increasingly turned to social media to discuss symptoms and share the challenges they face with disease management. The primary aim of this study is to use naturally occurring data from X (formerly known as Twitter) to identify barriers to care faced by individuals affected by eosinophilic esophagitis (EoE). For this qualitative study, the X application programming interface with academic research access was used to search for posts that referenced EoE between 1 January 2019 and 10 August 2022. The posts were identified as being either related to barriers to care for EoE or not. Those related to barriers to care were further categorized by the type of barrier that was expressed. A total of 8636 EoE-related posts were annotated of which 12.1% were related to barriers to care in EoE. The themes that emerged about barriers to care included: dietary challenges, limited treatment options, lack of community support, lack of physician awareness of disease, misinformation, cost of care, lack of patient belief in disease or trust in physician, and limited access to care. Saturation of themes was achieved. This study highlights barriers to care in EoE using readily accessible social media data that is not derived from a curated research setting. Identifying these obstacles is key to improving care for this chronic disease.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and predictors of Barrett's esophagus and esophageal cancer in patients with eosinophilic esophagitis.","authors":"Margaret J Zhou, Ann W Hsing, John O Clarke","doi":"10.1093/dote/doae120","DOIUrl":"https://doi.org/10.1093/dote/doae120","url":null,"abstract":"<p><p>Data on Barrett's esophagus (BE) and esophageal cancer (EC) outcomes in patients with eosinophilic esophagitis (EoE) are limited. We aimed to determine the risk of prevalent BE (<1 year after endoscopy), incident BE (≥1 year after endoscopy), and incident EC in patients with versus without EoE, and to identify predictors of BE/EC in EoE patients. We identified adult patients in the Merative MarketScan Database who underwent first-time upper endoscopy between 2008 and 2020. Chi-square analysis compared proportions of patients with versus without EoE who had BE or EC. Multivariate Cox regression determined associations between demographics/comorbidities and incident BE/EC in the EoE cohort, adjusting for established BE risk factors. Among 2,947,003 patients who underwent upper endoscopy, 20,588 patients (0.70%) had EoE (mean age 40.6 years, 63.8% male, gastroesophageal reflux disease in 44.9%). Prevalent BE, incident BE, and incident EC was found in 1.03%, 0.57%, and 0.06% of patients with EoE versus 1.06%, 0.54%, and 0.05% of patients without EoE, respectively (P = 0.13, 0.21, and 0.36, respectively). Among individuals with EoE, older age, male sex, presence of a hiatal hernia, gastroesophageal reflux disease, and location in North Central or Southern USA were independently associated with incident BE. Older age and prevalent BE were independently associated with incident EC. BE/EC risk in EoE is comparable to that of the baseline population undergoing upper endoscopy. Our findings support current understanding that EoE is not associated with an increased risk of BE/EC and reinforce that conventional BE screening strategies can be applied in patients with EoE.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}