Archives of Endocrinology Metabolism最新文献

{"title":"Budget impact analysis of cabergoline for medical treatment of Cushing's disease in Brazil.","authors":"Lukas Fernando de Oliveira Silva, Julia Simões Corrêa Galendi, Manoel Ricardo Alves Martins, Vania Dos Santos Nunes Nogueira","doi":"10.20945/2359-4292-2023-0311","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0311","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to estimate the budget impact of adding cabergoline to the Brazilian Unified Health System (SUS) formulary for the treatment of patients with Cushing's disease (CD) who do not achieve disease control after transsphenoidal surgery.</p><p><strong>Materials and methods: </strong>We conducted a budget impact analysis (BIA) from the perspective of the Brazilian SUS over a 5-year time horizon. We compared two scenarios: ketoconazole (Scenario 1) versus including cabergoline as a treatment option (Scenario 2). All analyses were conducted using Microsoft Excel. Uncertainty was explored in univariate sensitivity analyses.</p><p><strong>Results: </strong>The total costs were BRL $25,596,729 for Scenario 1 and BRL $32,469,169 for Scenario 2. The budget impact of adding cabergoline to the formulary for CD treatment within the SUS would be BRL $6,091,036 over 5 years. On univariate analyses, variations in the rates of surgical failure and CD recurrence had the greatest potential to affect the final costs associated with cabergoline.</p><p><strong>Conclusions: </strong>The estimated budget impact of adding cabergoline to the formulary for CD treatment within the Brazilian SUS would be about BRL $6 million. While cost savings cannot be expected, the budget impact of adding cabergoline would be lower than that of adding other treatment options for CD.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230311"},"PeriodicalIF":1.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified-release gliclazide acutely improves recovery but causes undesirable blood glucose decrease after a resistance exercise session in healthy adults: a pilot study for a randomized clinical trial.","authors":"Jocelito B Martins, Diego Zanella, Ramiro B Nunes, Pilar S Collado, Alexandre Machado Lehnen","doi":"10.20945/2359-4292-2023-0381","DOIUrl":"10.20945/2359-4292-2023-0381","url":null,"abstract":"<p><strong>Objective: </strong>Sulfonylureas have been used to improve performance in strength sports. However, this hypothetical effect has not been proven. We examined the ergogenic acute effect of gliclazide on resistance training performance and muscle recovery.</p><p><strong>Subjects and methods: </strong>We conducted a double-blind, randomized, crossover pilot study with 10 healthy resistance-trained adults (29.3 ± 4.4 years), nonusers of anabolic steroids. The participants were randomized to two exercise sessions. In the first session, five participants received placebo and the other five received gliclazide modified release, both administered 8 hours before the session. Session two was performed in a crossover fashion a week later. The volume load was calculated as the maximum number of repetitions of four sets multiplied by load (65% 1-RM). Blood samples were collected before and after exercise, as well as 24 hours and 48 hours after exercise for measurement of creatine kinase (CK-MM) and lactate dehydrogenase (LDH) activity. Blood glucose was measured with a glucometer before, during, and after the exercise sessions.</p><p><strong>Results: </strong>Gliclazide did not enhance volume load for bench press (placebo: 2,698.0 ± 923.0 kg; gliclazide: 2,675.0 ± 1,088.0 kg; p = 0.073) or leg press (placebo: 10,866.0 ± 2,671.0 kg; gliclazide: 10,817.0 ± 2,888.0 kg; p = 0.135). However, CK-MM (-27.7%; p = 0.034) and LDH (-21.1%; p = 0.021) activities were decreased with gliclazide 48 hours after exercise. There was also a decrease in blood glucose in the gliclazide compared with the placebo session (p = 0.018).</p><p><strong>Conclusion: </strong>Gliclazide did not enhance performance in a single resistance training session, but promoted faster muscle recovery. The decrease in blood glucose post-exercise with gliclazide was an undesirable effect that could lead to long-term glucose metabolism disorders. Registered in ClinicalTrials.gov under number NCT04443777.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230381"},"PeriodicalIF":1.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case series of maturity-onset diabetes of the young highlighting atypical presentations and the implications of genetic diagnosis.","authors":"Meghana Narasimhegowda, Vani Hebbal Nagarajappa, Raghupathy Palany","doi":"10.20945/2359-4292-2023-0239","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0239","url":null,"abstract":"<p><p>Maturity-onset diabetes of the young (MODY) is a clinically heterogeneous group of monogenic diabetes characterized by onset at a young age and an autosomal dominant mode of inheritance. Notably, MODY accounts for 2%-5% of all diabetes cases, and its distinction from types 1 (T1DM) and 2 (T2DM) diabetes mellitus is often challenging. We report herein the cases of two girls and a boy who presented initially with diabetic ketoacidosis. In view of the strong family history of diabetes in all three of them, the diagnosis of MODY was considered and confirmed by molecular testing. The patient in Case 1 (a 10-year-old girl) had a variation in the HNF1A gene (MODY 3). The patient in Case 2 (a 13-year-old girl) had a variation in the HNF1B gene (MODY 5) and was also clinically diagnosed with HNF1B MODY due to short stature, abnormal renal function, renal cysts, unicornuate uterus, and diabetic ketoacidosis at presentation. The patient in Case 3 (a 14-year-old boy) had a variation in the KCNJ11 gene (MODY 13) and presented with diabetic ketoacidosis; after initially being treated as having T1DM, he developed progressive weight gain, acanthosis nigricans, and decreased requirement of insulin. The patients in Cases 1 and 3 were subsequently treated with oral sulfonylureas and insulin was gradually tapered and interrupted, resulting in drastic improvement in glucose control. The patient in Case 2 remained on insulin, as this is the appropriate management for MODY 5. This case series demonstrates that atypical cases of MODY with ketoacidosis do occur, underscoring the potential for this complication within the phenotypic spectrum of MODY. In patients with atypical presentations, a thorough family history taking may reveal the diagnosis of MODY.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230239"},"PeriodicalIF":1.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we adequately training our healthcare providers facing the pandemic of obesity?","authors":"Eric Ravussin","doi":"10.20945/2359-4292-2024-0272","DOIUrl":"https://doi.org/10.20945/2359-4292-2024-0272","url":null,"abstract":"","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e240272"},"PeriodicalIF":1.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the care and treatment of patients with extreme obesity.","authors":"Matheo A M Stumpf, Marcio C Mancini","doi":"10.20945/2359-4292-2023-0335","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0335","url":null,"abstract":"<p><p>Obesity is a prevalent chronic disease. The management of extreme obesity - i.e., body mass index (BMI) ≥ 50 kg/m² or obesity class IV and V - is still far from ideal. Individuals with extreme obesity have a high risk of surgical complications, mortality, comorbidities, and reduced weight loss following bariatric surgery. Although lifestyle changes and anti-obesity medications are recommended for all patients with extreme obesity as adjuvants to weight loss, these measures are less effective than bariatric surgery. As a first step, sleeve gastrectomy or an inpatient very-low-calorie diet should be incentivized to enhance weight loss before definitive surgery. Although malabsorptive procedures lead to greater weight loss, they are associated with an increased risk of early complications and malnutrition. Nonstandard techniques employed in clinical trial protocols, such as transit bipartition, may be performed as they maintain a weight loss potency comparable to that of the classic duodenal switch but with fewer nutritional problems. Anatomical causes should be investigated in patients with postoperative suboptimal clinical response or recurrent weight gain. In these cases, the initiation of anti-obesity drugs, endoscopic therapies, or a conversion procedure might be recommended. More studies are needed to address the specific population of patients with extreme obesity, as their outcomes are expected to be distinct from those of patients with lower BMI.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230335"},"PeriodicalIF":1.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cooking for Health: a comprehensive narrative review of Culinary Medicine as an educational tool in medical training in Brazil and Globally.","authors":"Ana Carolina Junqueira Vasques, Caroline Dário Capitani, David M Eisenberg, Licio Augusto Velloso, Bruno Geloneze","doi":"10.20945/2359-4292-2023-0491","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0491","url":null,"abstract":"<p><p>The poor diet quality in line with the rising prevalence of noncommunicable chronic diseases, coupled with the substantial deficit in nutritional education within medical training programs, has precipitated the emergence of Culinary Medicine as an evolving discipline. Culinary Medicine fuses the art of home cooking with the sciences of human nutrition, psychology, gastronomy, and medicine to promote health and well-being. This comprehensive narrative review explores the diverse facets of Culinary Medicine, elucidating its historical evolution, theoretical foundations, educational initiatives in Brazil and worldwide, and its practical implementation in clinical contexts. By integrating evidence-based nutrition knowledge with culinary skills, behavior change tools, and well-established principles of healthy dietary practices, Culinary Medicine arrives to empower individuals - physicians and patients - to make informed dietary choices and enhance their overall health outcomes. Moreover, this review contemplates the roles of physicians in providing dietary guidance within the Culinary Medicine paradigm and the challenges associated with incorporating Culinary Medicine as a complementary facet of conventional medical care and medical education.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230491"},"PeriodicalIF":1.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare diagnosis of primary fibrosarcoma of the thyroid - Case report and mini-review.","authors":"Ekin Yiğit Köroğlu, Kübra Turan, Feride Pinar Altay, Fatma Dilek Dellal Kahramanca, Aydan Kiliçarslan, Bilgehan Karadayi, Oya Topaloğlu, Reyhan Ersoy, Bekir Çakir","doi":"10.20945/2359-4292-2023-0467","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0467","url":null,"abstract":"<p><p>Malignant mesenchymal thyroid tumors are one of the rarest types of thyroid cancer. Clinically, these tumors present as a rapidly growing thyroid mass. Due to their rarity and nonspecific findings, they are not the first conditions that come to mind during differential diagnosis. We report herein the case of an 87-year-old woman presenting with a rapidly growing thyroid mass in whom the differential diagnosis of anaplastic cancer was challenging. Following work up, the patient was diagnosed with primary fibrosarcoma of the thyroid, a rare type of malignant mesenchymal thyroid tumor. Because she declined surgery and her clinical condition was unsuitable for chemotherapy, she was treated with palliative radiotherapy. Primary thyroid fibrosarcoma is a rare cause of thyroid cancer and should be considered in the differential diagnosis of rapidly growing thyroid masses.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230467"},"PeriodicalIF":1.6,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active surveillance versus immediate surgery in the management of low-risk papillary thyroid microcarcinoma: comparison of long-term costs in Brazil.","authors":"Fernanda Nascimento Faro, Antônio Augusto Tupinambá Bertelli, Nilza Maria Scalissi, Adriano Namo Cury, Rosália do Prado Padovani, Carolina Ferraz","doi":"10.20945/2359-4292-2023-0349","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0349","url":null,"abstract":"<p><strong>Objective: </strong>To compare the long-term medical costs of active surveillance (AS), partial thyroidectomy (PT), and total thyroidectomy (TT) in patients with low-risk papillary thyroid microcarcinoma (PTMC) receiving care covered by the Brazilian Public Health System.</p><p><strong>Materials and methods: </strong>After reviewing AS cohorts and our own data, we created a model of AS, PT, and TT flow care for low-risk PTMC over 10, 20, and 30 years. The medical costs included those associated with diagnosis, surgery, and follow-up. We considered that 13.3% of the patients on AS would require surgery after a mean of 21.3 months, 4% undergoing TT would develop permanent hypoparathyroidism, and 43% undergoing PT would develop hypothyroidism.</p><p><strong>Results: </strong>The most economical alternative was AS. The costs of TT per patient were higher than those of AS by 182.8% over 10 years (866.89 versus 306.49 US dollars [USD], respectively), by 152.9% over 20 years (1,023.66 versus 404.73 USD, respectively), and by 134.7% over 30 years (1,180.42 versus 502.96 USD, respectively). The costs of PT per patient were higher than those of AS by 16.0% over 10 years (355.66 versus 306.49 USD, respectively), by 16.9% over 20 years (473.41 versus 404.73 USD, respectively), and by 17.5% over 30 years (591.17 versus 502.96 USD, respectively).</p><p><strong>Conclusion: </strong>The AS approach was less costly than immediate surgery throughout 30 years of follow-up. Hence, the implementation of AS in Brazil should not be hindered by cost considerations.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230349"},"PeriodicalIF":1.6,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health and weight regain after bariatric surgery: associations between weight regain and psychiatric and eating-related comorbidities.","authors":"Maria Francisca F P Mauro, Marcelo Papelbaum, Marco Antônio Alves Brasil, João Regis Ivar Carneiro, Ronir Raggio Luiz, João C Hiluy, José Carlos Appolinario","doi":"10.20945/2359-4292-2023-0208","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0208","url":null,"abstract":"<p><strong>Objective: </strong>Weight regain is a common outcome of weight loss interventions. Mental health-related comorbidities, among other factors, can mediate weight regain regardless of the implemented treatment modality. This study explores whether postoperative psychopathological comorbidities are associated with weight regain after bariatric surgery.</p><p><strong>Subjects and methods: </strong>This cross-sectional study recruited 90 outpatients who underwent Roux-en-Y gastric bypass surgery. Anthropometric measurements were collected retrospectively from medical charts. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) Axis I Disorders (SCID-I) was applied to evaluate psychiatry diagnoses. Validated self-report instruments were used to assess depression, anxiety, alcohol use, impulsivity, binge eating, and body image dissatisfaction. Weight regain was defined as a ≥20% increase from the maximum weight lost. Level of evidence: Level III, cross-sectional study based on a well-designed study.</p><p><strong>Results: </strong>Overall, 55.6% of participants experienced weight regain. Notably, mental disorders such as current binge-eating disorder and lifetime diagnoses including bulimia nervosa, alcohol abuse/dependence, and obsessive-compulsive disorder were significantly associated with weight regain. However, controlled analysis found that, for mental disorders, only current binge-eating disorder (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.26-31.06, p = 0.024) remained associated with weight regain. Eating-related psychopathologies also associated with weight regain included binge eating (d = 0.55; p = 0.013), eating disinhibition (d = 0.76; p = 0.001), higher hunger levels (d = 0.39; p = 0.004), and non-planning trait impulsivity (d = 0.69; p = 0.0001).</p><p><strong>Conclusion: </strong>Postoperative presence of psychopathological comorbidities, such as eating psychopathology and trait impulsivity, were associated with weight regain after bariatric surgery. These findings highlight the importance of addressing mental health in individuals experiencing postsurgical weight regain.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230208"},"PeriodicalIF":1.6,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of self-assessed and clinician-assessed hirsutism diagnosed according to the modified Ferriman-Gallwey scale among female outpatients in Brazil.","authors":"Talita Fernanda Oliveira, Talita Fischer Oliveira, Dayane Campos Santana, Ana Luiza Lunardi Rocha, Ana Lucia Cândido, Fabio Vasconcellos Comim","doi":"10.20945/2359-4292-2023-0271","DOIUrl":"https://doi.org/10.20945/2359-4292-2023-0271","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the efficacy of a self-assessment questionnaire for hirsutism using the latest cutoff values recommended by the Endocrine Society (ES) for Latin-American women and by the European Society for Human Reproduction and Embryology (ESHRE).</p><p><strong>Subject and methods: </strong>Female premenopausal outpatients (n = 188) completed a self-assessment questionnaire, scoring hair presence across the nine areas evaluated by the modified Ferriman-Gallwey (mFG) scale. The results were compared with clinician-assessed scores rated independently by two trained physicians. Scores in the Hirsuta questionnaire, derived from self-assessment of five areas of the mFG scale, were also evaluated.</p><p><strong>Results: </strong>The ethnic composition of the sample was as follows: 23.1% white, 25.8% black, 48.9% mixed, and 2.1% other backgrounds (Indigenous, Asian). The participants had age and BMI of (mean ± standard deviation) 33.7 ± 9.9 years and 29.8 ± 7.21 kg/m², respectively. The most common areas of excessive hair growth were the chin, upper and lower abdomen, and thighs. Relative to clinician-assessed mFG scores, self-assessed mFG scores had an accuracy of 80% using ES criteria for hirsutism diagnosis, with a sensitivity of 95.45%, specificity of 56.25%, positive predictive value of 30.10%, and negative predictive value of 98.40%. Self-assessed mFG had lower accuracy (71%) for diagnosing hirsutism when the ESHRE criteria were applied.</p><p><strong>Conclusions: </strong>Self-assessed mFG had low specificity, limiting its application. The results of this study do not support the use of the self-assessed mFG or Hirsuta scores for diagnosing hirsutism in a clinical setting, although both scoring systems may be useful for screening hirsutism in epidemiological studies.</p>","PeriodicalId":54303,"journal":{"name":"Archives of Endocrinology Metabolism","volume":"68 ","pages":"e230271"},"PeriodicalIF":1.6,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}