Journal of rural medicine : JRM最新文献

{"title":"Fanconi syndrome induced by red yeast rice supplement.","authors":"Tadashi Oshita, Shinichi Higuchi, Takashi Kanayama, Motoki Inoue, Yuka Tadanawa, Yuki Tanaka, Atsuki Ohashi","doi":"10.2185/jrm.2024-057","DOIUrl":"10.2185/jrm.2024-057","url":null,"abstract":"<p><p>Fanconi syndrome is a disorder of the proximal renal tubules characterized by metabolic acidosis, renal glycosuria, and aminoaciduria. Recently, Fanconi syndrome caused by red yeast rice supplements has been reported. We encountered a 60-year-old woman with acute kidney injury and Fanconi syndrome caused by a red yeast rice supplement. The patient discontinued the supplements, leading to an improvement in her serum creatinine and urinary protein levels. Early detection and discontinuation of the suspected drugs are important for the treatment of drug-induced Fanconi syndrome.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 3","pages":"238-240"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602391","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":"Tips for multidisciplinary pain management in advanced dementia based on expert opinions.","authors":"Yoshihisa Hirakawa, Takashi Yamanaka, Satoshi Hirahara, Jiro Okochi, Masafumi Kuzuya, Hisayuki Miura","doi":"10.2185/jrm.2024-052","DOIUrl":"10.2185/jrm.2024-052","url":null,"abstract":"<p><strong>Objective: </strong>Although pain is one of the most common symptoms experienced by people with dementia in long-term care, there have been few studies on the actionable knowledge of pain assessment and management in dementia care from a multidisciplinary perspective. This study aimed to identify practical tips for pain management of patients with advanced dementia using a multidisciplinary approach.</p><p><strong>Patients and methods: </strong>Individual in-depth interviews were conducted between January and March 2022 with 24 healthcare professionals who had ample experience in primary palliative care for dementia. The qualitative data were analyzed using a qualitative content analysis.</p><p><strong>Results: </strong>Three main themes and nine subthemes capturing advice in pain assessment and management for advanced dementia were identified: patient assessment (early detection, multidisciplinary comprehensive assessment, drowsiness and inactivity, diagnostic therapy), assessment of family understanding of pain in dementia (willingness to accept guidance from experts, understanding and acceptance of dementia), and intervention (distraction, resistance and nonadherence to care, care-related pain).</p><p><strong>Conclusion: </strong>These findings identified dementia-specific practical advice for pain management. First, multidisciplinary teams are required to better understand slight behavioral changes of people with advanced dementia. Second, they must be equipped with the necessary knowledge to differentiate symptoms of advanced dementia from those of other conditions. Third, pain medicine administration, along with a diagnostic procedure, is recommended. Fourth, distraction from chronic pain, reduced resistance and nonadherence to care were offered as pain management strategies for advanced dementia. Finally, family members must be educated about pain in those with advanced dementia because pain management was the most identified burden faced by family caregivers.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 3","pages":"207-215"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602397","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":"Changes in the rate of do-not-attempt-resuscitation orders in out-of-hospital cardiac arrest: a comparative study between 2019 and 2023.","authors":"Yutaro Kurihara, Takaaki Maruhashi, Jun Hattori, Yasushi Asari","doi":"10.2185/jrm.2024-055","DOIUrl":"10.2185/jrm.2024-055","url":null,"abstract":"<p><strong>Objective: </strong>Japan has the highest aging rate globally, with 29.1% of its population aged ≥65 years; however, the concepts of do-not-attempt-resuscitation (DNAR) and advance care planning (ACP) are less prevalent than in other countries. We aimed to survey DNAR orders in out-of-hospital cardiac arrest (OHCA) and compare them with previous surveys to examine changes in end-of-life care.</p><p><strong>Methods: </strong>This prospective study examined all OHCA cases attended to by the Sagamihara City Fire Department between May 30, 2023, and February 15, 2024. Data were collected through emergency services and compared with those of a similar 2019 survey.</p><p><strong>Results: </strong>The 2023 OHCA survey included 513 patients, a 25.9% increase from 2019. The mean age was 75.9 ± 15.1 years, similar to 2019 (74.9±17.7 years, <i>P</i>=0.986). A subgroup analysis of patients with DNAR orders revealed a significant decrease in DNAR orders, from 45 patients (11.4%) in 2019 to 27 patients (5.3%) (<i>P</i>=0.000). No significant differences were found in ambulance treatment services (airway security, peripheral intravenous route security, and drug administration) (7.4% vs. 8.9%, <i>P</i>=1.000). Emergency transport differed significantly (<i>P</i>=0.001), with non-transport cases (death confirmed by a house-call doctor on site) increasing from 2.2% to 33.3% in 2019.</p><p><strong>Conclusion: </strong>This study revealed a decrease in OHCA cases involving DNAR declarations during the COVID-19 pandemic, reflecting a positive shift toward respecting individual dignity owing to increased ACP. However, certain DNAR cases still undergo resuscitation and transport, highlighting the need for legal DNAR protocol implementation to reduce emergency-setting challenges.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 3","pages":"182-188"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602452","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":"Implications of the dissemination of healthy lifestyle advice for Afghan adults without histories of hypertension diagnosis or treatment.","authors":"Iftikhar Halimzai, Keiko Nakamura, Kaoruko Seino, Ayano Miyashita, Shafiqullah Hemat, Sharifullah Alemi, Sayed Ataullah Saeedzai","doi":"10.2185/jrm.2024-046","DOIUrl":"10.2185/jrm.2024-046","url":null,"abstract":"<p><strong>Objectives: </strong>This study explored the relationship between receiving healthy lifestyle advice from healthcare providers and hypertension among undiagnosed individuals in Afghanistan, defined as adults with no previous hypertension diagnosis or treatment history.</p><p><strong>Materials and methods: </strong>Data were extracted from the 2018-19 Afghanistan National Non-Communicable Diseases Risk Factors Survey, comprising 2,838 participants. Outcomes included hypertension (systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg) and elevated blood pressure (systolic blood pressure 120-129 mmHg and diastolic blood pressure <80 mmHg). Bivariate and multivariable multinomial logistic regression analyses were conducted to assess associated factors.</p><p><strong>Results: </strong>Among the 2,838 participants, 1,344 (47.4%) had hypertension and 344 (12.1%) had elevated blood pressure. Most participants were aged <40 years (63.8%), male (55.8%), and ever-married (80.2%). Multivariable analysis revealed that not receiving healthy lifestyle advice was significantly associated with hypertension (adjusted relative risk ratio [aRRR]=1.24; 95% confidence interval [CI]: 1.04-1.47) and elevated blood pressure (aRRR=1.40; 95% CI: 1.08-1.81). Sociodemographic and behavioral factors such as age, sex, marital status, education, occupation, fruit consumption, physical activity, and excess weight were significantly associated with hypertension, whereas only sex and excess weight were significantly associated with elevated blood pressure.</p><p><strong>Conclusion: </strong>Our findings underscore the association between receiving healthy lifestyle advice from healthcare providers and a lower prevalence of hypertension among undiagnosed Afghan adults. Accordingly, healthcare providers should recommend lifestyle changes to help manage hypertension among adults.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"102-111"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781957","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":"A case of hypersensitivity pneumonitis caused by a humidifier: diagnosis and management in rural practice.","authors":"Takamitsu Sakamoto, Teruyoshi Amagai","doi":"10.2185/jrm.2024-028","DOIUrl":"10.2185/jrm.2024-028","url":null,"abstract":"<p><p>Hypersensitivity Pneumonitis (HP) is an allergic interstitial lung disease that arises from type III and IV allergic reactions. During the COVID-19 outbreak, HP was established as having similar manifestations to COVID-19. In remote rural regions of Japan, where respiratory specialists are not readily accessible, HP is not always easy to differentiate, and establishing a definitive diagnosis can be challenging due to insufficient laboratory examinations. Herein, we present a case of a moderately definite diagnosis of acute non-fibrosing HP. The foundation of treatment included antigen avoidance, which necessitates a comprehensive analysis of the patient's medical history. In instances where anomalous chest imaging outcomes are observed, it is imperative to conduct a comprehensive review of the patient's medical history, and to consider the possibility of HP.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"156-160"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782285","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":"Intentional transit practice through a nearby hospital for remote area emergencies provides earlier primary care than helicopter emergency medical services alone in rural emergencies: a single-center, observational study.","authors":"Katsutoshi Saito, Tomohiro Abe, Rina Tanohata, Takehiko Nagano, Hidenobu Ochiai","doi":"10.2185/jrm.2024-038","DOIUrl":"10.2185/jrm.2024-038","url":null,"abstract":"<p><strong>Objective: </strong>Providing emergency care to serious patients in rural areas remains challenging. Intentional transit practice involves transporting a serious patient to a nearby hospital while requesting the Helicopter Emergency Medical Services (HEMS). This study aims to evaluate its effectiveness on earlier primary medical interventions and the decision of the destination hospital.</p><p><strong>Patient and methods: </strong>We conducted a single-center, retrospective observational study at a HEMS base hospital in a rural area of Japan. The study participants included patients who underwent the intentional transit practice between April 2012 and March 2019. We compared actual times to estimated times for each case treated with the HEMS alone (HEMS-alone model). Outcomes were the time from ambulance call to reaching the physician (physician reaching time), arrival at the final destination facility (destination hospital arrival time), and helicopter waiting time at the landing zone (helicopter waiting time). Subgroup analyses by region and an analysis of the relationship between diagnostic tests performed at the transit hospital and the type of destination facility were performed.</p><p><strong>Results: </strong>Eighty-seven patients were eligible for analysis. Compared to the HEMS-alone model, the intentional transit practice reduced the physician reaching time (median [interquartile] min) (26 [21-32] vs. 37 [29-47], <i>P</i><0.0001) while increasing the destination hospital arrival time and the helicopter waiting time (71 [58-93] vs. 65 [59-80], <i>P</i>=0.03; 24 [18-34] vs. 19 [18-21], <i>P</i><0.0001; respectively). Subgroup analysis showed a consistent result for physician reaching time but heterogeneity in the other time courses by region. Diagnostic tests were related to transportation to facilities other than the HEMS base hospital.</p><p><strong>Conclusion: </strong>The intentional transit practice is beneficial for providing primary care earlier than the HEMS alone and for transport to more specific facilities. However, it delays arrival at the destination facility and increases helicopter waiting time.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"92-101"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781962","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":"Acyclovir-associated encephalopathy triggered by nonsteroidal anti-inflammatory drugs.","authors":"Hiroki Takahashi, Yasufumi Takahashi, Takehiro Hirayama, Yui Kamijo, Naoki Ezawa, Teppei Furukawa, Rikiya Furutani","doi":"10.2185/jrm.2024-040","DOIUrl":"10.2185/jrm.2024-040","url":null,"abstract":"<p><strong>Objective: </strong>Both acyclovir (ACV) and valacyclovir (VACV) can cause drug-induced encephalopathy, which occurs primarily in patients with renal impairment because of delayed drug metabolism. Here, we report a case of ACV-associated encephalopathy precipitated by the addition of nonsteroidal anti-inflammatory drugs (NSAIDs).</p><p><strong>Patient: </strong>A 97-year-old woman with a 1-d history of altered consciousness was admitted to our hospital. After treatment with ACV and VACV for herpes zoster, NSAIDs were introduced for pain 5 d prior to admission. VACV and NSAIDs were subsequently administered by her primary care physician 3 d before admission.</p><p><strong>Results: </strong>The patient presented with altered consciousness and acute kidney injury, leading to a suspicion of ACV-associated encephalopathy. Her consciousness improved rapidly with hemodialysis. We diagnosed ACV-associated encephalopathy based on a significantly elevated ACV blood level of 32.7 µg/dL.</p><p><strong>Conclusion: </strong>The addition of NSAIDs during ACV or VACV administration may precipitate ACV-associated encephalopathy. When combining ACV or VACV with NSAIDs for the treatment of herpes zoster, careful monitoring of consciousness level and renal function is recommended.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"147-149"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782290","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":"Impact of heart rate on the outcome of hypothermic patients.","authors":"Soichiro Ota, Hiroki Nagasawa, Hiroaki Taniguchi, Tatsuro Sakai, Hiromichi Ohsaka, Kazuhiko Omori, Youichi Yanagawa","doi":"10.2185/jrm.2024-016","DOIUrl":"10.2185/jrm.2024-016","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify prognostic factors for hypothermia, including hormone levels.</p><p><strong>Materials and methods: </strong>This retrospective analysis used data from our department's database from November 2018 to December 2023. Inclusion criteria comprised cases with a prehospital diagnosis of hypothermia (body temperature <35°C) established by emergency medical technicians. Patients in cardiac arrest upon arrival were excluded from the study. This study investigated various parameters, including age, sex, body temperature, systolic blood pressure, heart rate, Glasgow Coma Scale (GCS) score, and adrenocorticotropic hormone (ACTH), cortisol, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), C-reactive protein, total protein, albumin levels, and outcomes. Patients were categorized into two groups based on the discharge outcome: fatal and survival groups. This study compared the variables between the two groups.</p><p><strong>Results: </strong>There were 28 and 53 patients in the fatal and survival groups, respectively. The average heart rate and FT3 levels in the fatal group were significantly lower than those in the survival group. The average cortisol and CRP levels in the fatal group were significantly higher than those in the survival group.</p><p><strong>Conclusion: </strong>This is the first report to demonstrate that hypothermic patients with a fatal outcome tend to have low heart rate, low FT3 levels, high cortisol levels, and inflammation upon arrival at the hospital. Further studies with larger sample sizes are needed to confirm the clinical significance of our findings.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781953","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":"Comparison between blood ketone and blood gas analysis indices in management of diabetic ketoacidosis.","authors":"Hirofumi Yamagishi, Akiko Kawasaki, Takami Seki, Atsushi Ohshima, Taihei Imai","doi":"10.2185/jrm.2024-032","DOIUrl":"10.2185/jrm.2024-032","url":null,"abstract":"<p><strong>Objective: </strong>Blood ketone monitoring is commonly used in the management of diabetic ketoacidosis (DKA). However, bedside ketone meters have limited availability in hospitals. This study aimed to clarify the correlation between blood ketones and blood gas analysis (BGA) in the treatment of DKA and thereby identify parameters that can be used as surrogates for blood ketones.</p><p><strong>Patients and methods: </strong>This retrospective observational study included patients with DKA admitted to the JA Toride General Medical Center between November 2021 and March 2024. Multiple regression analysis was performed using blood ketone levels as the objective variable and BGA indices as explanatory variables. Additionally, the study evaluated 1) the time course of ketone levels and BGA indices during the DKA treatment and 2) the correlation between ketone levels and the BGA indices.</p><p><strong>Results: </strong>Sixteen patients were enrolled. Multiple regression analysis showed that the corrected anion gap (cAG), defined as the anion gap minus lactate concentration, was a significant predictor of blood ketones. Among pH, HCO₃ ^-, and cAG, only cAG had significant regression coefficients (-0.061 [95% confidence interval (CI): -3.49 to 1.98], -0.233 [-0.156 to 0.0118], 0.636 [0.129 to 0.246], respectively; coefficient of determination: 0.765). The correlation coefficient between cAG and blood ketone levels was high (0.9694).</p><p><strong>Conclusion: </strong>cAG levels strongly correlate with blood ketone concentrations and may serve as a surrogate marker for blood ketones in the management of DKA. Because measurements of the anion gap and lactate concentrations are inexpensive and widely available in most medical facilities, cAG is a promising indicator for DKA management.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"119-124"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781928","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":"Clinical significance of C-reactive protein in patients with severe fever with thrombocytopenia syndrome.","authors":"Youichi Yanagawa, Chihiro Maekawa, Noriko Tanaka, Namiko Suda, Kenji Kawai, Michika Hamada, Soichiro Ota","doi":"10.2185/jrm.2024-059","DOIUrl":"10.2185/jrm.2024-059","url":null,"abstract":"<p><strong>Objective: </strong>To examine the clinical significance of elevated C-reactive protein (CRP) levels in cases of severe fever with thrombocytopenia syndrome (SFTS), with a particular focus on their role in predicting outcomes beyond that of previous reports.</p><p><strong>Patients and methods: </strong>CRP values and SFTS case data retrieved from a PubMed search were extracted for analysis. For comparison, the subjects were divided into two groups based on their CRP levels: normal (CRP ≤0.3 mg/mL) and elevated (CRP >0.3 mg/dL).</p><p><strong>Results: </strong>Forty-four cases were identified: 25 with normal CRP levels and 19 with elevated CRP levels. In an univariate analysis, no significant differences were observed between the two groups with respect to age, sex, date of blood examination, white blood cell count, outcome, or lactate dehydrogenase, alanine transaminase, creatine, or ferritin levels. However, the normal group contained a higher proportion of women, and the incidence of other infectious diseases was relatively low.</p><p><strong>Conclusion: </strong>In cases of SFTS, a CRP level >0.3 mg/dL in the first collection indicates the potential for a mixed infection other than an SFTS-associated infection and male prevalence. Further prospective studies are necessary to confirm whether the findings of the present study are generalizable among patients with SFTS.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"66-70"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781927","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}