Journal of Rheumatic Diseases最新文献

{"title":"The correlation between retinal microvascular changes by optical coherence tomography angiography and nailfold capillaroscopic findings in patients with systemic sclerosis.","authors":"Sahar Abd-Elrahman Elsayed, Amr Mounir, Engy Mohamed Mostafa, Dalia Salah Saif, Ola Mounir","doi":"10.4078/jrd.2024.0124","DOIUrl":"10.4078/jrd.2024.0124","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to detect the correlation between retinal microvascular changes by optical coherence tomography angiography (OCTA) and nailfold capillaroscopic findings in patients with systemic sclerosis (SSc).</p><p><strong>Methods: </strong>Forty SSc patients and thirty healthy controls were included. A complete history was taken, general and rheumatological examination and laboratory investigations were performed. In addition, all the participants were examined using nail fold capillaroscopy (NFC) and OCTA.</p><p><strong>Results: </strong>Our patients have decreased nailfold capillary density, central macular thickness, superficial full vessel density (VD), superior, inferior, and medial superficial peri-foveal VD, superior, inferior, and temporal superficial parafoveal VD, and temporal para-foveal full VD compared to the controls. The modified Rodnan skin score was negatively correlated with the nail fold capillary density, central macular thickness, superficial full VD, superior, temporal, and medial superficial perifoveal VD, superior superficial parafoveal VD, and temporal perifoveal full VD. The nailfold capillary density was positively correlated with the central macular thickness, the superficial full VD, the superior, temporal, and medial superficial perifoveal VD, the superior superficial parafoveal VD, and temporal perifoveal full VD.</p><p><strong>Conclusion: </strong>The nailfold capillary density measured by NFC positively correlates with the retinal VD measured by OCTA, suggesting that NFC could be a valuable marker for retinal vessel involvement in SSc patients. In addition, our results highlight the importance of combining OCTA with NFC for diagnosing and monitoring microvascular changes in SSc patients.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"198-210"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531313","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":"Efficacy of early rituximab treatment in primary Sjögren's syndrome: a systematic review and meta-analysis.","authors":"Mohammad Shahdadian, Mohammad Ali Saghiri, Eugenio Capitle","doi":"10.4078/jrd.2024.0149","DOIUrl":"10.4078/jrd.2024.0149","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to assess Rituximab (RTX)'s efficacy and safety in primary Sjögren's syndrome (pSS), particularly how treatment timing influences outcomes.</p><p><strong>Methods: </strong>The study included randomized controlled trials (RCTs) and quasi-experimental studies evaluating RTX in pSS patients, focusing on disease activity (European League Against Rheumatism Sjögren's Syndrome Disease Activity Index [ESSDAI] score) and adverse events (AEs). Searches were conducted in MEDLINE, Embase, SCOPUS, and Cochrane Library databases up to July 2024. Risk of bias was assessed using Cochrane Risk of Bias 2.0 (RoB 2) and Joanna Briggs Institute (JBI) checklists. Meta-analysis was performed in Stata 17 with a random-effects model, reporting mean differences in ESSDAI and I² for heterogeneity.</p><p><strong>Results: </strong>From 555 articles, 15 studies were included (4 RCTs and 11 quasi-experimental studies). RCT meta-analysis showed a mean difference of 0.09 (95% confidence interval [CI] -0.43, 0.61), indicating no significant RTX efficacy. In contrast, the pooled quasi-experimental analysis revealed a mean difference of -4.36 (95% CI -5.83, -2.89), suggesting a significant reduction in disease activity. Meta-regression indicated no significant correlation between RTX efficacy and mean disease duration. Subgroup analysis of disease duration (under vs. over 60 months) showed no significant difference. Safety assessment indicated no significant differences in AEs between RTX and placebo in RCTs. In quasi-experimental studies, infusion reactions and infections were the most common AEs, with serious infections being the most severe.</p><p><strong>Conclusion: </strong>RTX did not show significant improvement in RCTs. However, RTX significantly reduced pSS activity at week 24 or month 6 following treatment, based on quasi-experimental studies. We found no significant correlation between RTX efficacy and disease duration.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"211-224"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531310","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":"Frequency of lumbosacral transitional vertebra and its relationship with disease related parameters of patients with axial spondyloarthritis.","authors":"Serkan Sevindik, Kemal Erol, Funda Levendoğlu, Ilknur Albayrak Gezer","doi":"10.4078/jrd.2025.0013","DOIUrl":"10.4078/jrd.2025.0013","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the prevelance of lumbosacral transitional vertebrae (LSTV) in patients with axial spondyloarthritis (ax-SpA), and to explore the relationship of the presence of LSTV with the burden of disease.</p><p><strong>Methods: </strong>A total of 177 patients classified with ax-SpA according to ASAS (Assessment of Spondyloarthritis International Society) criteria who were admitted to Selçuk University Medical Faculty rheumatology outpatient clinic were included, consecutively. Demographic, clinical, and laboratory data were recorded. LSTV was evaluated on AnteroPosterior (AP) pelvic radiographs and AP lumbar radiographs according to the Castellvi classification.</p><p><strong>Results: </strong>Of 177 patients with axSpA, 99 (55.9%) were radiographic axSpA (r-axSpA). LSTV was detected in 51 (28.8%) patients with ax-SpA (with the frequency of 32.3% in r-axSpA and 24.4% in non-r-axSpA [nr-axSpA] [p>0.05]). Most frequent LSTV subtype was type 1 (32 of 51 [62.7%]). Thirty-two (62.7%) of 51 patients with LSTV were r-axSpA, and 19 (37.3%) patients with LSTV were nr-axSpA (p=0.245). The demographic characteristics of the group with and without LSTV were similar. There was no significant difference in terms of VAS, BASDAI, BASFI, ASDAS-CRP, BASMI, HAQ, EQ-5D-3L scores and no difference in disease activity in terms of presence of LSTV in patients with ax-SpA.</p><p><strong>Conclusion: </strong>The prevalence of LSTV in patients with ax-SpA was 28.8%, consistent with some population based studies in the literature. There was no difference between patients with and without LSTV in terms of burden of disease in patients with ax-SpA.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"190-197"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531311","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":"Understanding and addressing anti-drug antibody formation in tumor necrosis factor-α inhibitor therapy for ankylosing spondylitis.","authors":"Tae-Jong Kim","doi":"10.4078/jrd.2025.0067","DOIUrl":"10.4078/jrd.2025.0067","url":null,"abstract":"","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"151-153"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531314","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":"Change of autoantibody levels in established rheumatoid arthritis patients treated by biological disease-modifying anti-rheumatic drugs -the AIRTIGHT study.","authors":"Shohei Anno, Kentaro Inui, Masahiro Tada, Yuko Sugioka, Tadashi Okano, Kenji Mamoto, Tatsuya Koike","doi":"10.4078/jrd.2024.0130","DOIUrl":"10.4078/jrd.2024.0130","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies reported that abatacept (ABT) decreased autoantibodies in early rheumatoid arthritis (RA) patients. We investigated the impact of ABT, and other biological disease-modifying anti-rheumatic drugs (bDMARDs) on autoantibody levels in established RA patients.</p><p><strong>Methods: </strong>This prospective observational study included 50 RA patients treated with ABT and 115 RA patients treated with non-ABT bDMARDs. Serum levels of anticitrullinated peptide antibodies (ACPA), immunoglobulin (Ig) M-rheumatoid factor (IgM-RF), IgG-RF, and anti-agalactosyl IgG antibody (anti-Gal (0) IgG) were measured at baseline and after 48 weeks of treatment.</p><p><strong>Results: </strong>After propensity score matching, 25 patients with ABT and 25 patients with non-ABT were finally analyzed. Disease activity score in 28 joints using C-reactive protein significantly decreased in both ABT group (4.5 to 3.3, p<0.01) and non-ABT group (4.4 to 2.5, p<0.01) after 48 weeks treatment. In ABT group, median titers at baseline and 48 weeks were 62.7 and 57.8 U/mL for ACPA (p=0.22), 35.0 and 39.0 IU/mL for IgM-RF (p=0.21), 0.5 and 0.5 IU/mL for IgG-RF (p=0.19), and 50.4 and 53.5 AU/mL for anti-Gal (0) IgG (p=0.22), respectively. Changes of all autoantibody titer were not significant in ABT group. Non-ABT group showed significant decreases in ACPA (baseline 143.0 to 57.8 U/mL at week 48, p=0.03), IgM-RF (50.0 to 37.0 IU/mL, p<0.01), and anti-Gal (0) IgG (93.2 to 61.8 AU/mL, p<0.01) except IgG-RF (0.6 to 0.5 IU/mL, p=0.22).</p><p><strong>Conclusion: </strong>Autoantibody-lowering effect of ABT was not strong in established RA patients in our study.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"182-189"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531307","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":"Chimeric Antigen Receptor T-cell therapy in systemic autoimmune rheumatic diseases: current insights and future prospects.","authors":"Bong-Woo Lee, Eui-Jong Kwon, Ji Hyeon Ju","doi":"10.4078/jrd.2024.0122","DOIUrl":"10.4078/jrd.2024.0122","url":null,"abstract":"<p><p>Chimeric Antigen Receptor (CAR) T-cell therapy, revolutionary in treating hematological malignancies, is emerging as a promising approach for systemic autoimmune rheumatic diseases (SARDs). This review examines the potential of CAR T-cell therapy in treating conditions such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and idiopathic inflammatory myopathies (IIMs). The evolution of CAR T cells technology, from first to fifth generation, has enhanced its efficacy and persistence. Early clinical studies in SARDs have shown encouraging results, with some patients achieving drug-free remission. CD19-targeted CAR T cells have demonstrated significant B-cell depletion and clinical improvement in patients with SLE, SSc, and IIMs. Despite promising outcomes, challenges remain, including cytokine release syndrome and the need for careful patient selection. Future directions include exploring dual-targeting CARs, chimeric autoantibody receptors (CAARs), and alternative cell sources like γδ T cells, regulatory T cells, natural killer cells. The integration of CAR-based cell therapy into treatment paradigms of patients with SARDs requires further research to optimize efficacy, mitigate side effects, and identify suitable target biomarkers. While hurdles exist CAR-based cell therapy holds the potential to revolutionize management of patients with SARDs, offering hope for long-term, drug-free remission in these complex autoimmune conditions.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"154-165"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531308","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":"Current state and future directions of basic research in rheumatoid arthritis.","authors":"Byeongzu Ghang, Jin Kyun Park, Ji Hyeon Ju, Seungwoo Han","doi":"10.4078/jrd.2024.0151","DOIUrl":"10.4078/jrd.2024.0151","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation and joint destruction. Despite advances in biologic therapies targeting inflammatory mediators such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, Janus kinase (JAK), and B cells, many patients do not respond adequately, emphasizing the need for deeper insights into RA pathogenesis. Research highlights the intricate interplay of genetic and epigenetic factors driving immune dysregulation. The breakdown of immune tolerance, often initiated in mucosal sites such as the gut, lung, and oral cavity, promotes the citrullination of antigens, leading to anti-citrullinated protein antibody production and subsequent immune activation. Single-cell and multi-omics approaches have shed light on underexplored immune cell types, such as T peripheral helper cells, CD4+/CD8+ cytotoxic T cells, and autoreactive B cells, broadening the understanding beyond traditionally studied Th17, Th1 cells, macrophages, and fibroblast-like synoviocytes. Future basic research in RA should prioritize elucidating the mechanisms behind peripheral tolerance breakdown, the pathogenesis of seronegative RA, and the molecular pathways driving refractory and recurrent disease. Moreover, leveraging multi-omics approaches to dissect disease heterogeneity will be pivotal for advancing personalized treatment strategies and improving long-term outcomes in RA patients.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"166-181"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531309","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":"Resolution of long-lasting laryngeal manifestations using glucocorticoids and tumor necrosis factor-α inhibitor therapy in a patient with mouth and genital ulcers with inflamed cartilage syndrome.","authors":"Tomohiro Suzuki, Toshihiko Komai, Misaki Koyama, Kento Koda, Rumi Ueha, Hirofumi Shoda, Keishi Fujio","doi":"10.4078/jrd.2024.0144","DOIUrl":"10.4078/jrd.2024.0144","url":null,"abstract":"<p><p>Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome is a rare disorder characterized by features of both relapsing polychondritis (RP) and Behçet's disease (BD), with multi-organ involvement, including inflammation and destruction of cartilaginous tissues. This report describes a patient with MAGIC syndrome who responded to immunosuppressive therapy for long-lasting laryngeal inflammation and provides the first description of a patient with MAGIC syndrome positive for human leukocyte antigen (HLA)-A26. Here we present a 49-year-old male with recurrent oral and genital ulcers, hoarseness, and swallowing difficulties. Laryngoscopy showed bilateral vocal fold immobility, and contrast-enhanced magnetic resonance imaging (MRI) demonstrated inflammation in the cricoid, arytenoid, and auricular cartilages. The patient was diagnosed with MAGIC syndrome based on the presence of both RP and BD criteria. Treatment with high-dose corticosteroids and adalimumab biosimilar resulted in significant improvement in hoarseness and MRI findings of cartilage inflammation. This case highlights the effective use of immunosuppressive therapy for managing long-lasting laryngeal involvement in MAGIC syndrome, potentially avoiding the need for invasive interventions such as tracheostomy.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 3","pages":"225-228"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531312","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":"Pathogenesis of systemic sclerosis: an integrative review of recent advances.","authors":"Ha-Hee Son, Su-Jin Moon","doi":"10.4078/jrd.2024.0129","DOIUrl":"10.4078/jrd.2024.0129","url":null,"abstract":"<p><p>Systemic sclerosis (SSc), or scleroderma, is a complex autoimmune connective tissue disease characterized by autoimmunity, vasculopathy, and progressive organ fibrosis, leading to severe organ dysfunction. The disease begins with a vascular injury triggered by autoimmune responses and environmental factors against a backdrop of genetic predisposition. This injury impairs angiogenesis and vasculogenesis, resulting in capillary loss and arteriolar constriction, which promotes immune cell infiltration and sustained inflammation within affected tissues. These vascular anomalies cause severe complications, including pulmonary artery hypertension, scleroderma renal crisis, and skin ulcers. Chronic inflammation fosters persistent fibroblast activation, resulting in extensive fibrosis that defines SSc. This review synthesizes the latest research on pathogenesis of SSc, highlighting the shift from fundamental research to a precision therapeutic approach. It explores the potential of technologies like flow cytometry and single-cell RNA sequencing to investigate pathogenic cell subtypes. These platforms integrate transcriptomic, genomic, proteomic, and epigenomic data to uncover insights into the underlying mechanisms of SSc pathogenesis. This review advocates for a multidisciplinary, patient-centric approach that harnesses recent scientific advances, directing future SSc research toward personalized and precise interventions.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 2","pages":"89-104"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712158","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":"Factors associated with anti-drug antibody production in ankylosing spondylitis patients treated with the infliximab biosimilar CT-P13.","authors":"Yongbum Kim, Nayeon Choi, Ji-Hui Shin, Sungsin Jo, Bora Nam, Tae-Hwan Kim","doi":"10.4078/jrd.2024.0114","DOIUrl":"10.4078/jrd.2024.0114","url":null,"abstract":"<p><strong>Objective: </strong>CT-P13, a biosimilar of infliximab, is widely used for treating ankylosing spondylitis (AS). However, the formation of anti-drug antibodies (ADAs) can reduce its efficacy. This study aimed to identify risk factors associated with high ADA levels in AS patients treated with CT-P13.</p><p><strong>Methods: </strong>A prospective observational study enrolled patients with intravenous CT-P13. Clinical data and disease activity was assessed at baseline, 24 weeks, and 54 weeks after CT-P13 treatment. Blood concentrations of CT-P13 and ADAs were measured at 24 and 54 weeks, and their correlation was investigated. Patients were grouped by ADA levels at 54 weeks. Univariable and multivariable logistic regression identified factors associated with high ADA concentrations.</p><p><strong>Results: </strong>A total of 34 patients was enrolled. Significant decreases in Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores were observed relative to baseline after 24 weeks of CT-P13 therapy. Serum concentrations of CT-P13 and ADA levels increased following treatment. The median serum CT-P13 concentration was 17.6 [12.8, 22.7] µg/mL at 24 weeks and 23.5 [11.7, 34.2] µg/mL at 54 weeks. ADA levels were 6.7 [6.5, 9.1] AU/mL at 24 weeks and 11.4 [9.0, 28.4] AU/mL at 54 weeks. The serum concentrations of CT-P13 and ADA exhibited a negative correlation. In multivariable analysis, current smoking was associated with high ADA production at 54 weeks.</p><p><strong>Conclusion: </strong>Smoking is identified as a significant risk factor for elevated ADAs in AS patients treated with CT-P13. The findings underscore the importance of smoking-cessation strategies in the management of AS patients.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":"32 2","pages":"136-144"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712221","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}