Frontiers in gastroenterology (Lausanne, Switzerland)最新文献

{"title":"The potential links between human gut microbiota and cardiovascular health and disease - is there a gut-cardiovascular axis?","authors":"Cátia Almeida, J. Guilherme Gonçalves-Nobre, Diogo Alpuim Costa, Pedro Barata","doi":"10.3389/fgstr.2023.1235126","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1235126","url":null,"abstract":"The gut-heart axis is an emerging concept highlighting the crucial link between gut microbiota and cardiovascular diseases (CVDs). Recent studies have demonstrated that gut microbiota is pivotal in regulating host metabolism, inflammation, and immune function, critical drivers of CVD pathophysiology. Despite a strong link between gut microbiota and CVDs, this ecosystem’s complexity still needs to be fully understood. The short-chain fatty acids, trimethylamine N-oxide, bile acids, and polyamines are directly or indirectly involved in the development and prognosis of CVDs. This review explores the relationship between gut microbiota metabolites and CVDs, focusing on atherosclerosis and hypertension, and analyzes personalized microbiota-based modulation interventions, such as physical activity, diet, probiotics, prebiotics, and fecal microbiota transplantation, as a promising strategy for CVD prevention and treatment.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136114134","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":"Case report and narrative review of the literature: a rare colonic stent failure in a palliative patient","authors":"Morgan Bressington, Alexander O’Connor, Karen Telford","doi":"10.3389/fgstr.2023.1279085","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1279085","url":null,"abstract":"Introduction With palliative patients, a holistic approach is important. Interventions should minimise length of hospital stay, maximise quality of life, and control symptoms. A self-expanding metal stent (SEMS) for the palliative treatment of malignant large bowel obstruction (MLBO) is designed to provide these benefits to patients approaching the end of their life. We present the case of a patient treated with a SEMS over 2 years earlier for MLBO. He was treated with palliative intent at diagnosis because his frailty and medical co-morbidities precluded surgery. He later presented with severe tenesmus, and these new symptoms were later found to be due to a rare stent failure in which the stent had fractured and was irretrievable. This had to be managed conservatively before the patient sadly passed away 7 months later. Discussion A SEMS is considered the first-line treatment to relieve MLBO caused by inoperable left-sided colonic cancer. This treatment offers a reduced length of hospital stay, reduced stoma rates, fewer complications, and comparable survival compared to de-functioning stoma. However, SEMSs are not expected to be in use for extended periods of time. The literature reports an average survival after a colonic stent insertion of between 121 and 199 days when used in a palliative setting. Conclusion This is one of the first case reports to describe a colonic stent failure occurring over 2 years after insertion. This case argues that further research into the longer-term outcomes of this management option is warranted, particularly as palliative patients are living longer.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136209245","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":"Unresectable intrahepatic cholangiocarcinoma: TARE or TACE, which one to choose?","authors":"Maria Adriana Cocozza, Lorenzo Braccischi, Antonio De Cinque, Antonio Bruno, Alberta Cappelli, Matteo Renzulli, Antonello Basile, Massimo Venturini, Pierleone Lucatelli, Francesco Modestino, Cristina Mosconi","doi":"10.3389/fgstr.2023.1270264","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1270264","url":null,"abstract":"Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and its incidence is rising in Western countries. Although surgical resection is considered the only curative treatment, up to 70% of patients are diagnosed at an advanced stage, which precludes surgical intervention. Those who are inoperable become candidates for systemic treatment. Currently, the combination of gemcitabine and cisplatin is the first-line chemotherapy, with a median overall survival (OS) of about one year. Recently, there has been a notable increase in evidence regarding chemotherapy for biliary tract cancer; however, the effectiveness of the new chemotherapy drugs still needs to be evaluated. Today, intra-arterial therapies (IAT), especially trans-arterial chemoembolization (TACE) and trans-arterial radioembolization (TARE), are widely used. Both TACE and TARE have demonstrated good efficacy in controlling localized disease and in improving survival. However, current literature does not conclusively show whether TACE is superior to TARE or vice versa. As recent meta-analyses have indicated, both TACE and TARE offer suboptimal objective response rates but yield similar positive outcomes. It’s important to note that these findings are based on single-center studies, which often include a small number of patients and lack a comparative design. Therefore, when comparing such studies, there’s an inevitable selection bias among the treatment groups (TACE or TARE) and significant heterogeneity. This review outlines the current evidence on the use of interventional IAT in managing ICC.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136295841","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":"Sex- and gender-related differences in inflammatory bowel diseases","authors":"Irina Blumenstein, Elena Sonnenberg","doi":"10.3389/fgstr.2023.1199687","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1199687","url":null,"abstract":"This review provides an overview of the current data regarding sex- and gender-specific aspects in patients with inflammatory bowel diseases. A particular focus will be on disease course, medical and surgical treatment strategies, psychosocial differences, and special requirements during pregnancy and family planning. The most significant and clinically meaningful gender differences in IBD relate to psychosocial functioning. Although depression, fatigue, anxiety disorders, eating disorders, and sexual dysfunction also occur in male IBD patients, women seem to be affected much more frequently and severely in these areas.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135696532","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":"Role of peroral cholangioscopy and pancreatoscopy in the diagnosis and treatment of biliary and pancreatic disease: past, present, and future","authors":"Harishankar Gopakumar, Neil R. Sharma","doi":"10.3389/fgstr.2023.1201045","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1201045","url":null,"abstract":"Peroral cholangiopancreatoscopy was described as early as the 1950s. However, the small caliber of these ducts and the technological limitations in developing slender, maneuverable, high-definition scopes posed a challenge. Peroral cholangiopancreatoscopy has now rapidly evolved. What began as dual-operator mother–daughter cholangioscopy systems that were fragile and difficult to use are now single-operator systems. The development of high-definition video cholangioscopes, along with improved flexibility and accessory technologies in recent years, has permitted single-operator, high-quality endoluminal examination and therapies of the biliary and pancreatic ducts. It is now an indispensable tool in the comprehensive diagnosis and definitive management of complex biliary and pancreatic conditions, such as indeterminate biliary strictures and difficult-to-remove biliary and pancreatic stones. With the enhanced imaging capabilities and refined maneuverability of the latest generation of cholangioscopes, the role of cholangiopancreatoscopy is expanding, with applications in advanced gall bladder drainage, accurate determination of tumor stage, cholangioscopy-directed tumor ablation, and selective biliary cannulation. In this review, we detail the evolution of this technology, the various approaches to peroral cholangiopancreatoscopy, and its established and emerging diagnostic and therapeutic indications. Furthermore, we discuss the current limitations and potential future applications of cholangioscopy and pancreatoscopy in managing various biliary and pancreatic pathologies.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135695558","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":"Addressing the unmet clinical need for low-volume assays in early diagnosis of pancreatic cancer","authors":"Daniel A. Sheik, Kaleb Byers, Mini Thomas, Ummadisetti Chinna Rajesh, Kelli Ifuku, Kimberly Kirkwood, Mohammed Al-Haddad, Charles S. Craik, V. Jo Davisson","doi":"10.3389/fgstr.2023.1258998","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1258998","url":null,"abstract":"The incidental detection of pancreatic cysts, an opportunity for the early detection of pancreatic cancer, is increasing, owing to an aging population and improvements in imaging technology. The classification of pancreatic cystic precursors currently relies on imaging and cyst fluid evaluations, including cytology and protein and genomic analyses. However, there are persistent limitations that obstruct the accuracy and quality of information for clinicians, including the limited volume of the complex, often acellular, and proteinaceous milieu that comprises pancreatic cyst fluid. The constraints of currently available clinical assays lead clinicians to the subjective and inconsistent application of diagnostic tools, which can contribute to unnecessary surgery and missed pancreatic cancers. Herein, we describe the pathway toward pancreatic cyst classification and diagnosis, the volume requirements for several clinically available diagnostic tools, and some analytical and diagnostic limitations for each assay. We then discuss current and future work on novel markers and methods, and how to expand the utility of clinical pancreatic cyst fluid samples. Results of ongoing studies applying SERS as a detection mode suggest that 50 µL of pancreatic cyst fluid is more than sufficient to accurately rule out non-mucinous pancreatic cysts with no malignant potential from further evaluation. This process is expected to leave sufficient fluid to analyze a follow-up, rule-in panel of markers currently in development that can stratify grades of dysplasia in mucinous pancreatic cysts and improve clinical decision-making.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107854","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":"Efficacy and safety of Lacticaseibacillus rhamnosus R0011 and Lactobacillus helveticus R0052 as an adjuvant for Helicobacter pylori eradication: a double-blind, randomized, placebo-controlled study","authors":"Anya Kiattiweerasak, Natsuda Aumpan, Soonthorn Chonprasertsuk, Bubpha Pornthisarn, Sith Siramolpiwat, Patommatat Bhanthumkomol, Pongjarat Nunanan, Navapan Issariyakulkarn, Varocha Mahachai, Yoshio Yamaoka, Ratha-korn Vilaichone","doi":"10.3389/fgstr.2023.1245993","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1245993","url":null,"abstract":"Background Helicobacter pylori eradication is recommended as a way of providing symptomatic relief for dyspepsia. The limited efficacy of triple therapy is a major problem in many countries, including Thailand. Some probiotics have been shown to improve the H. pylori eradication rate and reduce side effects. This study aimed at evaluating the efficacy of probiotic (Lacidofil ® STRONG) as adjuvant to standard triple therapy. Methods This randomized, double-blind, placebo-controlled study was conducted between July 2020 and June 2022. Eligible patients with H. pylori gastritis (i.e., n =90 out of the 160 patients screened) were randomized to receive 14-day standard triple therapy either with probiotics or with a placebo (N=45/group). The treatment regimen entailed 30 mg lansoprazole administered twice daily, 1,000 mg amoxicillin administered twice daily, and 1 g clarithromycin modified-release formulation administered once daily. A probiotic capsule containing Lacticaseibacillus rhamnosus R0011 and Lactobacillus helveticus R0052 (Lacidofil ® STRONG) or placebo were given twice daily during the eradication therapy and for an additional 4 weeks. Successful H. pylori eradication was defined as a negative 13 C-urea breath test at least 4 weeks after complete eradication. Results As per-protocol analysis, eradication rates after the 14-day regimen with probiotic or placebo were 90.9% and 75.0% ( p =0.047), respectively. Antibiotic susceptibility testing demonstrated high clarithromycin resistance (24%). For clarithromycin-resistant strains, there was no statistical difference in eradication rates between the probiotic and placebo groups. Furthermore, probiotic supplementation significantly reduced treatment side effects, including bloating (OR 0.27 [95% CI 0.10 to 0.75], p =0.012), diarrhea (OR 0.23 [95% CI 0.28 to 0.65], p =0.006), nausea (OR 0.05 [95% CI 0.01 to 0.36], p =0.003), and bitter taste (OR 0.14 [95% CI 0.03 to 0.69], p =0.015). In addition, the probiotic group had lower gastrointestinal symptom rating scale (GSRS) scores (1.46 ± 0.36 vs. 2.65 ± 0.66, p <0.001) and higher SF-36 health-related quality-of-life scores (63.3 ± 10.2 vs. 57.3 ± 13.4, p =0.020) after treatment than the placebo group. Conclusion The probiotic adjuvant with 14-day standard triple therapy improved the H. pylori eradication rate. Supplementation with Lacidofil ® STRONG during the 2-week eradication treatment and 4-week follow-up phase can help to reduce the gastrointestinal side effects of eradication therapy and increase patients’ general health-related quality of life.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134970720","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":"The relations between constipation and characteristics of intestinal morphologies by colonoscopy","authors":"Yuting Xu, Qili Xiao","doi":"10.3389/fgstr.2023.1255129","DOIUrl":"https://doi.org/10.3389/fgstr.2023.1255129","url":null,"abstract":"Background Constipation is commonly diagnosed throughout the world, and it is typically associated with various factors. However, data on the characteristics of intestinal morphologies linked with constipation are scarce. We examined the association between the characteristics of different intestinal morphologies and constipation. Patients and methods Between March 2020 and February 2021, we enrolled 510 patients from the Affiliated Zhongshan Hospital of Guangzhou University of Chinese Medicine into two groups: 260 in the constipation group and 250 in the control group. Of these patients, intestinal morphology characteristics obtained via colonoscopy were compared and analyzed. Results There were meaningful differences between the cohorts based on the intestinal morphology characteristics of tortuousness ( p < 0.001) and dissociation ( p < 0.001). In addition, a significant difference in characteristics was determined for either both intestinal morphologies ( p < 0.001) or only tortuousness without any other conditions ( p =0.015), but there was no significant difference between the two groups with respect to only dissociation without any other conditions ( p = 0.077). A subgroup analysis was performed on statistically significant variables—gender ( p < 0.001), age ( p = 0.002), and operation time ( p < 0.001)—and the results showed that regardless of the subgroup analysis, there was a statistically significant difference in tortuousness between the two groups. In addition, there were significantly differences in dissociation between the groups for elderly men and those with a longer operation time. Conclusion Compared with the general population, people with the intestinal morphologies of dissociation and, in particular, tortuousness seem to experience constipation more frequently.","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135982543","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":"Effects of a sucralfate-containing ointment on quality of life and symptoms associated with hemorrhoidal disease: patient-reported results of a Slovakian, pharmacist-led observational survey.","authors":"Miroslava Snopková, Ondrej Sukel', Jan Micanko","doi":"10.3389/fgstr.2023.1213433","DOIUrl":"10.3389/fgstr.2023.1213433","url":null,"abstract":"<p><strong>Purpose: </strong>This pharmacist-led study evaluated the effect of a rectal ointment containing sucralfate on quality of life, symptom frequency and time to relief of symptoms in Slovakian individuals with hemorrhoidal disease (HD).</p><p><strong>Methods: </strong>The multicenter prospective survey was conducted at 45 community pharmacies in Slovakia. Pharmacists invited adults (≥18 years) using sucralfate-containing ointment for their HD-related symptoms to participate.</p><p><strong>Results: </strong>241 patients completed the HEMO-FISS-QoL questionnaire and a survey of symptom frequency at the beginning and end of the 14-day survey period. The primary endpoint was the change in HEMO-FISS-QoL scores in patients with hemorrhoidal symptoms during the 7 days before the initial pharmacy visit. Of the 241 patients enrolled in the survey, 144 had experienced hemorrhoidal symptoms within the preceding 7 days (mean age 51 years; 59.0% female). For these 144 patients, the total HEMO-FISS-QoL score decreased (i.e., quality of life was improved) from baseline by a mean of -8.7 (95% confidence interval -12.6, -6.2; P<0.001) at day 14. The frequency of hemorrhoidal symptoms was significantly reduced (P<0.001 vs baseline). Symptom relief was rapid; at 1-hour post-treatment 54.6% of patients had relief from pain and 56.3% from itching, and by 24 hours post-treatment most patients had relief from these symptoms (77.2% and 73.0%, respectively). No incidents nor adverse events related to sucralfate-containing ointment were reported to pharmacists.</p><p><strong>Conclusion: </strong>The results of this pharmacist-led observational survey suggest that the sucralfate-containing ointment could improve quality of life in patients with HD, providing rapid relief with a good safety profile. To confirm these results in a larger, well-defined patient population, randomized controlled trials in patients with clinically diagnosed HD are warranted.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":" ","pages":"1213433"},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12952410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43771385","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":"Case Report: Primary small bowel adenocarcinoma with peritoneal metastasis responded well to a CapeOX + bevacizumab regimen.","authors":"Guang Fu, Zhen Tang, Zishun Xu, Shao Zhang","doi":"10.3389/fgstr.2023.1187194","DOIUrl":"10.3389/fgstr.2023.1187194","url":null,"abstract":"<p><strong>Background: </strong>Small bowel adenocarcinoma (SBA) is a rare condition often presenting with various non-specific gastrointestinal symptoms, making its diagnosis challenging. Delayed diagnosis is common, as patients may not receive the correct diagnosis until complications arise, necessitating further investigations. Furthermore, the management of SBA patients poses difficulties due to the scarcity of high-quality evidence.</p><p><strong>Case presentation: </strong>In this report, we present the case of an elderly man with SBA in the ileum who arrived at our emergency room with acute abdominal pain. The diagnosis was not made until the SBA caused a perforation, leading to acute abdominal pain. An emergent exploratory laparotomy revealed a 3 cm × 3 cm perforated tumor in the ileum, along with widespread metastatic nodules on the omentum, ascending colon, descending colon, and rectum. Postoperative pathological evaluation confirmed the diagnosis of SBA with peritoneal metastasis (pT4N2M1, stage IV). Following surgery, the patient received palliative systemic chemotherapy, which included the CapeOX regimen and the anti-VEGF monoclonal antibody bevacizumab. Remarkably, the patient responded well to this therapy, displaying good tolerance, and we observed no signs of disease progression. As of now, the patient is in good health and continuing with regular follow-up.</p><p><strong>Conclusion: </strong>The early diagnosis of small bowel adenocarcinoma remains a challenge. Delayed diagnosis can lead to a poor prognosis, underscoring the importance of considering SBA as a potential diagnosis for patients with unexplained abdominal pain and gastrointestinal symptoms. This case also highlights the efficacy of palliative chemotherapy with the CapeOX regimen combined with bevacizumab in controlling SBA.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":" ","pages":"1187194"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12952338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45138928","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}