American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Policy Recommendations for Chagas Disease: An Emerging Concern of Public Health Significance for the U.S. Military.","authors":"Gerardo J Pacheco, Jose A Betancourt, Diane Dolezel, Bradley M Beauvais, Joseph E Marcus, Paul Lenhart, Paula S Granados","doi":"10.4269/ajtmh.26-0052","DOIUrl":"10.4269/ajtmh.26-0052","url":null,"abstract":"<p><p>Chagas disease, caused by Trypanosoma cruzi, poses an emerging and under recognized threat to U.S. military personnel deployed in endemic regions. Despite significant morbidity and mortality risks, the US Department of Defense (DoD) lacks comprehensive policies for Chagas disease prevention, screening, or treatment, unlike other similar infectious diseases. We conducted a comparative policy analysis of existing DoD policies on tuberculosis, HIV, and hepatitis C to inform the development of Chagas disease policy. Using an adapted Political, Administrative, Social, Technological, Economic, Legal factors (PASTEL) framework, we evaluated five policy alternatives through expert consensus scoring. Military health policies and literature were systematically reviewed to identify screening protocols, risk assessment tools, and prevention strategies. Analysis of current military screening policies revealed significant gaps in Chagas disease coverage in comparison with analogous infectious diseases. The decision matrix analysis identified an integrated Periodic Health Assessment (PHA) approach as the optimal policy alternative (weighted score 4.20/5.0), followed by targeted risk-based screening (3.85/5.0). Universal screening scored lowest (2.20/5.0) due to poor cost-effectiveness and implementation challenges. The recommended approach leverages existing annual health assessment infrastructure while incorporating Chagas disease-specific risk evaluation tools. A tiered policy strategy integrating Chagas disease risk assessment into routine military health evaluations offers the most feasible approach for protecting service members. Implementation should prioritize risk-based screening, vector-control measures (e.g., insecticide-treated uniforms), and enhanced surveillance in endemic deployment areas. This framework provides an evidence-based foundation for developing comprehensive DoD Chagas disease policies.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872719","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":"Predictors of Delayed Defervescence in Scrub Typhus: A Retrospective Cohort Analysis.","authors":"Sadia Tamanna, Dong-Min Kim, Choon-Mee Kim, You-Mi Lee, Da Young Kim, Jun-Won Seo, Na-Ra Yun","doi":"10.4269/ajtmh.26-0157","DOIUrl":"10.4269/ajtmh.26-0157","url":null,"abstract":"<p><p>Scrub typhus, caused by Orientia tsutsugamushi, is a mite-borne febrile illness endemic to the Asia-Pacific region. Although most patients respond promptly to appropriate antibiotic therapy, a subset exhibits delayed defervescence, the clinical significance and predictors of which remain insufficiently understood. In the present study, the authors aimed to identify clinical, laboratory, and radiological factors associated with delayed defervescence in patients with scrub typhus. In this retrospective cohort study, scrub typhus patients who were hospitalized at Chosun University Hospital, Gwangju, South Korea, between November 2005 and November 2008 were assessed. Demographic characteristics, clinical manifestations, laboratory values, and radiological findings were compared. Multivariate logistic regression was used to identify independent predictors. During the study period, 413 patients were recorded initially. Among 160 confirmed scrub typhus patients, 22 (13.8%) experienced delayed defervescence. Compared with patients with early defervescence, those with delayed defervescence had significantly lower hemoglobin levels (P = 0.045), higher rates of anemia (P = 0.006) and leukocytosis (P = 0.017), and elevated C-reactive protein levels (P = 0.034). Pneumonia was also more common in the delayed group. In multivariate logistic regression analysis, anemia (odds ratio [OR]: 2.79; 95% CI: 1.00-7.79) and pneumonia (OR: 2.86; 95% CI: 1.07-7.59) were the strongest independent predictors of delayed defervescence. Delayed defervescence may reflect ongoing systemic inflammation and greater disease severity. Pneumonia and anemia could help identify patients at risk of a more severe clinical course or complications despite appropriate treatment, underscoring the importance of close monitoring.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872679","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":"Invasive Aspergillosis Following Dengue: An Autopsy Case and Review of the Literature.","authors":"Avichal Rajpal, Immanuvel Jebaraj, Inderpaul Singh Sehgal, Kritarth Rathi, Sangamitra Rajasekaran, Uma Nahar, Kuruswamy Thurai Prasad, Shivaprakash M Rudramurthy, Ritesh Agarwal, Valliappan Muthu","doi":"10.4269/ajtmh.26-0140","DOIUrl":"10.4269/ajtmh.26-0140","url":null,"abstract":"<p><p>Invasive aspergillosis typically occurs in immunocompromised hosts but has been increasingly recognized following viral illnesses, including dengue and coronavirus disease 2019. Herein, a fatal case of disseminated aspergillosis following severe dengue is described, and the association is systematically reviewed. A previously healthy 25-year-old woman presented with fever and multiorgan dysfunction. Dengue IgM results were positive, and other tropical infections were excluded. Despite intensive care, the patient developed progressive respiratory failure, refractory shock, and acute kidney injury and died. An autopsy revealed diffuse alveolar damage and extensive invasive aspergillosis involving the bronchi, pulmonary vasculature, and myocardium. In the present systematic review, 21 additional cases of invasive aspergillosis following dengue (total n = 22; median age 36 years, 59% male) were identified, predominantly in Asia. Fifteen cases (68%) had pulmonary involvement. Most patients had severe dengue with multiorgan dysfunction. The overall mortality was 63.6%; 23% of cases were diagnosed postmortem. Invasive aspergillosis complicating severe dengue broadens the spectrum of viral-associated aspergillosis.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872729","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":"Development of a Real-Time Reverse Transcription Polymerase Chain Reaction Assay for Una Virus.","authors":"Sara Ping, Jesse Waggoner","doi":"10.4269/ajtmh.26-0326","DOIUrl":"10.4269/ajtmh.26-0326","url":null,"abstract":"<p><p>Una virus (UNAV) is an understudied alphavirus with the capacity to infect humans. Although it was discovered decades ago in South America, little is still known about this virus because accurate diagnostic tests are still needed. The first UNAV-specific real-time reverse transcription polymerase chain reaction (rRT-PCR) test is described in the present study. This assay targets the nonstructural protein 1 coding region and was designed from an alignment using all available UNAV sequences. The linear range of the UNAV rRT-PCR extended from 6.2 to 0.2 log10 copies/µL, with a lower limit of 95% detection of 2.0 copies/µL. The assay offered sensitive UNAV detection in contrived whole-blood samples. In addition, no amplification was observed in the assay when tested with genomic RNA from multiple closely related arboviruses. The UNAV rRT-PCR exhibits high sensitivity and specificity, which is critical for research into this virus in regions where multiple related alphaviruses co-circulate.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872689","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":"How Should We Treat Severe Malaria in the Setting of Artemisinin Partial Resistance?","authors":"Philip J Rosenthal, Moses R Kamya, Ruth Namazzi, Chandy C John","doi":"10.4269/ajtmh.26-0514","DOIUrl":"10.4269/ajtmh.26-0514","url":null,"abstract":"<p><p>Artemisinin partial resistance (ART-R) threatens the control of falciparum malaria, but its impact on the treatment of severe malaria has been unclear. Two recent studies in Uganda have considered associations between PfK13 mutations linked to ART-R and treatment outcomes in children hospitalized with complicated or severe malaria and treated with intravenous artesunate. Children infected with ART-R parasites experienced delayed parasite clearance compared to those infected with drug-sensitive parasites. However, clinical outcomes, including mortality, length of hospital stay, incidence of subsequent febrile illness, and incidence of readmission did not differ between children infected with ART-R or drug-sensitive parasites. Therefore, at present treatment with intravenous artesunate should remain the standard-of-care to treat severe malaria in sub-Saharan Africa, even in the setting of ART-R, although continued study of treatment efficacy is warranted.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"658-659"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872705","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":"First Identification of Naturally Infected Paratriatoma hirsuta: A Vector for Trypanosoma cruzi and Implications for Chagas Disease Transmission.","authors":"Paul A Lenhart, Walter Roachell, Robert Fathke, Bernardo Delgado, Alexander M Potter, Ian Copeland, Francisco Sanchez, Mauricio Solis, Amanda Cline, MaeJean Ramnarace, Gena G Lawrence, Eyal Oren, Penelope J Quintana, Shannon McBride, Cassandra Kerwin, Isydra G Lujan, Tolulope Morawo, Riley E Tedrow, Gerardo Pacheco, Jose Betancourt, Paula E Stigler Granados","doi":"10.4269/ajtmh.26-0007","DOIUrl":"10.4269/ajtmh.26-0007","url":null,"abstract":"<p><p>The first detection of Trypanosoma cruzi (T. cruzi) in wild-caught Paratriatoma hirsuta (P. hirsuta) from military installations near the United States/Mexico border in California and Arizona is reported in the present study. As part of a Chagas disease surveillance initiative, 20 adult and 63 immature P. hirsuta were collected from 16 wood rat nests, along with sympatric Triatoma rubida (T. rubida). Initial polymerase chain reaction (PCR) screening revealed presumptive T. cruzi-positive samples, which were reanalyzed using a novel kinetoplast PCR assay with validated targets. Amplicons were sequenced using Sanger analysis, confirming T. cruzi infection. The presence of T. cruzi was confirmed in P. hirsuta (9%) and T. rubida (7%). The present study highlights the potential role of P. hirsuta as a secondary vector in sylvatic zoonotic T. cruzi transmission cycles in the Sonoran and Mojave Deserts and how this informs Chagas disease surveillance and prevention in the region.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"811-815"},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838910","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":"Monitoring Cholera Transmission in Zambia Using the Cholera Elimination Scorecard.","authors":"Caroline C Chisenga, Lilian Lamba, Charlie C Luchen, Ashley Duncan, Nyuma Mbewe, Masuzyo Zyambo, Maisa Kasanga, Fraser Liswaniso, Harriet Ng'ombe, Michelo Simuyandi, Amanda K Debes, Roma Chilengi, David A Sack","doi":"10.4269/ajtmh.26-0057","DOIUrl":"10.4269/ajtmh.26-0057","url":null,"abstract":"<p><p>We used the cholera elimination scorecard to better understand the changing cholera patterns in Zambia. The method used surveillance data from the Zambia National Public Health Institute to identify districts that had eliminated cholera or continued to be endemic between 2015 and 2024. Between 2017 and 2022 the number of cholera-endemic districts decreased from 27 to 6; however, in 2023 and 2024, a severe outbreak occurred in Lusaka and expanded to neighboring districts. Concurrently, a separate outbreak occurred in the northern areas of Zambia. We found the cholera elimination scorecard to be a practical and simple to use tool to understand changes in cholera transmission, including identifying persistently endemic districts and districts that had relapsed after having eliminated cholera. We suggest that the cholera elimination scorecard can supplement the Priority Areas for Multisectoral Interventions methodology for countries attempting to eliminate cholera.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"715-720"},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838994","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":"Malaria Vaccine Rollout in Nigeria: Current Status and Challenges.","authors":"Samuel Adeniyi Oyegbade, Samson Olusola Adeboye, Gbotemi Jerry Oni, Abosede Peace Oyegbade, James Joy Oziohu, Zawu Yoowa Duyann, Oluwatoyin Comfort Owoyemi","doi":"10.4269/ajtmh.26-0371","DOIUrl":"10.4269/ajtmh.26-0371","url":null,"abstract":"<p><p>Malaria remains a leading cause of morbidity and mortality in Nigeria, particularly among children under 5 years of age, despite ongoing control efforts. The introduction of RTS,S/AS01, and R21/Matrix-M vaccines provides a promising complementary prevention strategy. This systematic review assessed malaria vaccine rollout in Nigeria, focusing on implementation, awareness, acceptance, willingness to pay, and health system readiness. A comprehensive search of PubMed, ScienceDirect, Google Scholar, African Index Medicus, and gray literature (2015-2026) identified 12 eligible studies. Caregiver acceptance ranged from 76.6% in Lagos to 95.6% in Owerri, and exceeding 90% in Enugu, Ondo State, and Gombe. Among health care professionals, only 54.1% of pharmacists were willing to vaccinate their children. Caregiver awareness ranged from 9.7% in Lagos to 72.1% in Enugu. Physicians demonstrated higher adequate knowledge (68.9%) than nurses (35.9%), with 55.5% of nurses having only heard of the vaccine. Pharmacists expressed concerns about vaccine failure (53.6%), adverse effects (63.4%), and storage conditions (77.8%). Willingness to pay was moderate; median willingness in Enugu was USD $0.82 per dose; 71.2% of Lagos caregivers expressed willingness to pay; and 90% of respondents nationally preferred government-funded vaccination. Health system readiness was critically inadequate, with overall facility preparedness scores ranging from 33% to 51%. Advocacy and social mobilization were at 0% across all three facilities, and monitoring and supervision ranged from 0% to 33%, all far below the WHO-recommended 95% threshold. Strengthening health systems, targeted communication, and sustainable public financing are essential for a successful nationwide malaria vaccine rollout.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"702-708"},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839003","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":"Serology Confirms Near-Absence of Malaria Transmission in Timor-Leste.","authors":"Elfiana De Fatima Amaral, Isabel Byrne, Helena Brazal Monzo, Raul Sarmento, Maria Do Rosario De Fatima Mota, Gregorio Rangel, Maria Tanesi, Antonio Salles de Sousa, Nelson Martins, Tessa Oakley, Lucsendar Alves, Jennifer Yan, Paul Arkell, Joshua R Francis, Chris Drakeley","doi":"10.4269/ajtmh.25-0700","DOIUrl":"10.4269/ajtmh.25-0700","url":null,"abstract":"<p><p>Despite malaria remaining a major public health threat, several countries have made significant progress toward elimination. Timor-Leste has reduced the number of malaria cases from more than 200,000 to zero, with no indigenous cases reported since 2022, and has recently been certified as malaria-free by the WHO. At low transmission levels, serological surveys, which detect antibodies to malaria parasites, can augment conventional surveillance by revealing the absence of antibodies and, therefore, of exposure in previously endemic populations. Exposure to malaria, as determined using antibody responses to antigens from Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax), was assessed in 4,631 participants recruited from all municipalities in Timor-Leste. These antigens are associated with recent and cumulative exposure to each species. Age-specific seroprevalence was assessed, and seroconversion was estimated using reverse catalytic models. Risk analysis for individual and geographical exposure was also conducted. Seroprevalence to recent exposure to P. falciparum antigens was uniformly low across age groups (1.4% [95% CI: 1%-2%]) and consistent with the absence of ongoing transmission. The recent seroprevalence of P. vivax was similarly low (0.2% [95% CI: 0.1%-0.3%]). The time of change in the force of infection was consistent with the country's scale-up for elimination. Areas at lower altitudes and those with higher historical tree cover had evidence of the highest co-endemic historical exposure. The serological analysis supports passive and active surveillance malaria data in confirming the near-absence of ongoing transmission in Timor-Leste. In low-transmission settings, sero-epidemiological surveillance can provide key information on transmission that will benefit control programs.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"785-794"},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839034","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":"Multistakeholder Consultations on Programmatic Progress, Challenges, and Policy Priorities for Lymphatic Filariasis Elimination in India.","authors":"Muhammed Jabir, Raja Jeyapal Dinesh, Adinarayanan Srividya, Anju Viswan, Manikandan Kishanthini, Richa Sharma, Manju Rahi","doi":"10.4269/ajtmh.26-0054","DOIUrl":"10.4269/ajtmh.26-0054","url":null,"abstract":"<p><p>This report presents the key proceedings and outcomes of three regional consultative workshops convened to review progress, identify challenges, and propose strategic actions for lymphatic filariasis elimination in India. The workshops were organized by the Indian Council of Medical Research-Vector Control Research Centre, Puducherry in collaboration with the Women's Collective Forum, New Delhi from June 2025 to August 2025. Consultations were held in three endemic states representing different regions of India (Uttar Pradesh, Gujarat, and Tamil Nadu), bringing together stakeholders from the national program, the WHO, donor agencies, nongovernmental organizations, academia, and research institutions. The consultations revealed that the nature of challenges varied considerably by region. Common challenges included gaps in mass drug administration (MDA) coverage and associated reporting and the persistence of never-treated populations. Shortfalls in diagnostic availability, surveillance capacity, and morbidity management services were also reported across regions. Rapid urbanization and an increase in informal settlements with poor facilities were identified as a cause of concern. Recommended programmatic actions included strengthening field supervision, real-time MDA monitoring, targeted strategies for never-treated and high-refusal populations, and improving diagnostic supplies and surveillance capacities. Context-specific interventions included migrant-focused surveillance and treatment, urban microplanning, and intensified post-MDA surveillance in areas that have passed transmission assessment surveys. Long-term priorities included strengthening intersectoral coordination, scaling up molecular xenomonitoring for vector surveillance, and expanding public-private partnerships for morbidity management. Thus, the workshop enabled the identification and discussion of the critical region-specific challenges and also helped to provide operationally feasible strategies to address these issues.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"869-877"},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838998","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}