Annals of the Rheumatic Diseases最新文献

{"title":"The immune response to the dermatomyositis-specific autoantigen nuclear matrix protein 2 can result in experimental autoimmune myositis.","authors":"Yikang Wang, Qingyue Yuan, Yawen Zhao, Qiang Gang, Yuanyuan Ma, Hongjun Hao, Feng Gao, Jianwen Deng, Wei Zhang, Zhaoxia Wang, Yun Yuan, Yiming Zheng","doi":"10.1016/j.ard.2025.02.016","DOIUrl":"10.1016/j.ard.2025.02.016","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1442-1444"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician's global assessment of disease activity in juvenile idiopathic arthritis: consensus-based recommendations from an international task force.","authors":"Veronika Rypdal, Hermine I Brunner, Brian M Feldman, Nicolino Ruperto, Amita Aggarwal, Sheila T Angeles-Han, Maria Backström, Erin Balay-Dustrude, Claudia Bracaglia, Fabrizio De Benedetti, Pavla Doležalová, Marco Garrone, Jaime Guzman, Daniel B Horton, Ronald M Laxer, Daniel J Lovell, Tonje Løvli, Silvia Magni-Manzoni, Francesca Minoia, Esi M Morgan, Jane Munro, Ellen B Nordal, Christophe Normand, Nancy Pan, Elisa Patrone, Angelo Ravelli, Claudia Saad Magalhães, Rashmi Sinha, Joost F Swart, Maarit Tarkiainen, Marinka Twilt, Paula Vähäsalo, Sebastiaan Vastert, Jelena Vojinovic, Pamela F Weiss, Beth Gottlieb, Alessandro Consolaro","doi":"10.1016/j.ard.2025.01.013","DOIUrl":"10.1016/j.ard.2025.01.013","url":null,"abstract":"<p><strong>Objectives: </strong>To develop consensus-based recommendations for physician's global assessment of disease activity (PhGA) scoring and to standardise definitions of disease activity.</p><p><strong>Methods: </strong>An international task force of 34 members was assembled, and recommendations were developed in 3 phases: (1) 2 preliminary surveys of paediatric rheumatologists and a literature review; (2) 14 videoconference meetings, informed by multicriteria decision analysis and formal anonymous voting; and (3) a 2-day in-person consensus conference using structured nominal group technique discussions and formal voting. The threshold for achieving consensus was ≥78% of voting task force members. Agreement with the final statements was rated using a numerical rating scale from 0, strongly disagree, to 10, strongly agree.</p><p><strong>Results: </strong>Eighteen points to consider were agreed upon. All statements achieved consensus (≥78%), with a level of agreement ≥9.2. Points included the definition of disease activity in juvenile idiopathic arthritis (JIA), factors to assess in nonsystemic JIA and systemic JIA, consideration of available imaging and laboratory tests, the role of extra-articular manifestations, the evaluation of treatment, and the timing of PhGA scoring.</p><p><strong>Conclusions: </strong>The task force developed consensus-based recommendations when scoring the PhGA in nonsystemic and systemic JIA. These recommendations will lead to more reliable scoring of disease activity in patients with JIA.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1425-1436"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adalimumab serum concentration to choose a subsequent biological DMARD in patients with rheumatoid arthritis (ADDORA-switch): results of a blinded randomised test-treatment trial.","authors":"Maike H M Wientjes, Sadaf Atiqi, Gerrit J Wolbink, Michael T Nurmohamed, Maarten Boers, Femke Hooijberg, Theo Rispens, Annick de Vries, Ronald F van Vollenhoven, Sofia Ramiro, Noortje van Herwaarden, Bart J F van den Bemt, Alfons A den Broeder","doi":"10.1016/j.ard.2025.03.015","DOIUrl":"10.1016/j.ard.2025.03.015","url":null,"abstract":"<p><strong>Objectives: </strong>A substantial proportion of patients with rheumatoid arthritis (RA) discontinue adalimumab due to ineffectiveness. The next treatment step can be another tumour necrosis factor inhibitor (TNFi) or a biological/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD). Therapeutic drug monitoring (TDM) of serum drug levels may help guide this choice. This study evaluated whether switching treatments based on adalimumab trough levels is more effective than random switching.</p><p><strong>Methods: </strong>In this 24-week, multicentre, triple-blinded, randomised controlled trial, patients with RA who stopped adalimumab due to inefficacy (disease activity score based on 28 joint count and C-reactive protein [DAS28-CRP] >2.9) were enrolled. Participants were randomly assigned (1:1) to a TDM-based or random switching (control) strategy. The primary outcome was the difference in mean time-weighted DAS28-CRP between groups at 24 weeks.</p><p><strong>Results: </strong>From July 2020 to November 2023, 83 consecutive patients with RA were included, with 78 initiating a new b/tsDMARD (TDM-based group: n = 38; control: n = 40). The mean time-weighted DAS28-CRP was 3.15 in both groups (TDM: SD, 0.99; control: SD, 1.01; 95% CI of difference: -0.46 to 0.47). There were no significant differences between the groups in flare rates, escape medication use, disease activity, or adverse events. Receiver operating characteristic analyses in the control group found no predictive value of adalimumab levels for response to TNFi or non-TNFi.</p><p><strong>Conclusions: </strong>Switching treatments based on adalimumab trough levels was not more effective than random switching in patients with RA who failed adalimumab treatment. Therefore, serum drug level measurements to guide therapy choices in this context is not recommended.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1293-1300"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and validation of interferon-driven gene signature as a predictor of response to methotrexate in juvenile idiopathic arthritis.","authors":"Melissa Kartawinata, Wei-Yu Lin, Beth Jebson, Kathryn O'Brien, Elizabeth Ralph, Emma Welsh, Restuadi Restuadi, Elizabeth C Rosser, Claire T Deakin, Lucy R Wedderburn, Chris Wallace","doi":"10.1016/j.ard.2025.03.007","DOIUrl":"10.1016/j.ard.2025.03.007","url":null,"abstract":"<p><strong>Objectives: </strong>To identify and validate gene expression biomarkers of response to methotrexate (MTX) treatment in peripheral blood of children with juvenile idiopathic arthritis (JIA) measured before starting MTX treatment.</p><p><strong>Methods: </strong>RNA sequencing was performed on sorted CD4+, CD8+, CD14+, and CD19+ cells, as well as peripheral blood mononuclear cells (PBMC) taken pre-treatment in a discovery cohort (n = 97) and 2 validation cohorts (n = 26 and n = 47, respectively) of patients with non-systemic JIA. Clinical data were recorded at baseline (timepoint 1) prior to treatment and 6 months (timepoint 2) of MTX treatment. Analysis tested the association of gene expression in specific cell types with treatment response using limma-voom, gene set enrichment analysis, and a novel 51-gene score against response to treatment. Parallel analysis, also using pre-treatment gene expression data, was performed in adult rheumatoid arthritis (RA) data (n = 240).</p><p><strong>Results: </strong>In patients with JIA, the baseline expression of genes driven by interferon (IFN) alpha (type-I) or gamma (type-II) was associated with response to treatment at 6 months in 3 independent JIA cohorts. The direction of the association indicated that children with higher baseline expression of IFN-stimulated genes prior to MTX were more likely to be good responders. Comparison with adult RA indicated differences between PBMC and whole blood gene expression associations with response.</p><p><strong>Conclusions: </strong>In children with JIA, a high IFN-driven gene signature is associated with a better response to MTX than those with a low IFN-driven gene signature. These data could pave the way to clinically validated tools to identify those most likely to require medications in addition to MTX to control inflammation.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1412-1424"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced B cell and complement cascade gene signatures in patients with neuropsychiatric systemic lupus erythematosus.","authors":"Dionysis Nikolopoulos, George Sentis, Iasonas Kitsios, Panagiotis Garantziotis, Noemin Kapsala, Antigone Pieta, Sofia Flouda, Theodora Manolakou, Myrto Nikoloudaki, Aggelos Banos, Katerina Chavatza, Ioannis Parodis, Anastasia Filia, George Bertsias, Antonis Fanouriakis, Dimitrios T Boumpas","doi":"10.1016/j.ard.2025.04.006","DOIUrl":"10.1016/j.ard.2025.04.006","url":null,"abstract":"<p><strong>Objectives: </strong>The management of neuropsychiatric systemic lupus erythematosus (NPSLE) remains challenging because of clinical heterogeneity and the complexity of pathophysiologic mechanisms involved. We sought to determine the molecular signature of NPSLE and its endotypes towards novel biomarkers and targeted therapies.</p><p><strong>Methods: </strong>Whole-blood RNA sequencing from 308 patients with systemic lupus erythematosus (119 with NPSLE, 189 non-NPSLE) and 72-matched healthy controls (HCs) were performed. Supervised pathway enrichment analysis and unsupervised weighted gene coexpression network analysis were applied to distinguish clinically and molecularly defined NPSLE endotypes.</p><p><strong>Results: </strong>Compared with HCs, patients with NPSLE demonstrated dysregulation of adaptive immune responses along with upregulation of interleukin (IL)-1, IL-6, IL-17, and IL-12/IL-23 signalling pathways. The comparison between NPSLE and non-NPSLE groups revealed a robust upregulation of complement cascade, DNA damage response, adaptive immunity, and IL-1 and IL-6 signalling. Furthermore, active NPSLE exhibited a strong autophagy signature. The B cell and complement cascade signatures exhibited a gradual upregulation across the non-NPSLE, inactive NPSLE, and active NPSLE subgroups. Within NPSLE, diffuse syndromes correlated positively with the oxidative phosphorylation module, while antiphospholipid antibody-positive NPSLE was not associated with specific signatures by unsupervised analysis. NPSLE endotypes such as cognitive dysfunction, seizures, psychosis, and optic neuritis were associated with distinct transcriptomic signatures namely IL-6 signalling and leukocyte migration, DNA damage response, inflammation, and type-I interferon, respectively.</p><p><strong>Conclusions: </strong>The clinical heterogeneity of NPSLE appears to be associated with molecular diversity, with certain endotypes or syndromes exhibiting distinct gene signatures. Upregulation of adaptive immune response and complement cascade suggests that complement inhibitors and B cell-targeted therapies could be further explored in NPSLE.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1342-1353"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the correspondence on \"CD19-CAR T-cell therapy induces deep tissue depletion of B cells\".","authors":"Carlo Tur, Markus Eckstein, Georg Schett, Maria Gabriella Raimondo","doi":"10.1016/j.ard.2025.03.006","DOIUrl":"10.1016/j.ard.2025.03.006","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"e38-e39"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A coding single nucleotide polymorphism in the interleukin-6 receptor enhances IL-6 signalling in CD4 T cells and predicts treatment response to tocilizumab in giant cell arteritis.","authors":"Robert Zorc, Christopher Redmond, McKella Sylvester, Mary Maclean, Luciana Yamamoto de Almeida, Kaitlin A Quinn, Alessandro Tomelleri, Corrado Campochiaro, Lorenzo Dagna, Fernanda Gutierrez-Rodrigues, Kristina V Wells, Cameron Rankin, Sabrina Helmold Hait, Chloe Palmer, Robert Corty, Alexander Bick, Kathi Lambert, Jane H Buckner, John J O'Shea, Jin Kyun Park, Massimo Gadina, Peter C Grayson","doi":"10.1016/j.ard.2025.01.049","DOIUrl":"10.1016/j.ard.2025.01.049","url":null,"abstract":"<p><strong>Objectives: </strong>The study objective was to determine if a common single nucleotide polymorphism in the interleukin 6 (IL-6) receptor (rs2228145, p.Asp358Ala) predicted treatment response to tocilizumab in giant cell arteritis (GCA).</p><p><strong>Methods: </strong>Genetic sequencing of the rs2228145 locus was performed in 2 independent cohorts of patients with GCA. Peripheral blood mononuclear cells (PBMCs) from patients and controls were evaluated for expression of the interleukin 6 receptor (IL-6R) and its coreceptor, gp130, using flow cytometry. The same PBMCs were stimulated with IL-6 and evaluated for downstream targets of IL-6: STAT3 phosphorylation (pSTAT3) and IL-17A expression.</p><p><strong>Results: </strong>In total, 100 patients with GCA were included (derivation cohort n = 58; validation cohort n = 42). The rs2228145 variant predicted tocilizumab response in each cohort. In the derivation cohort, a gene dose-dependent response was observed with a 36% response rate in the homozygous patients and 95% response rate in patients without the variant (P = .003). In the validation cohort, tocilizumab response rates were 50% for homozygotes and 85% for patients without the variant (P = .04). pSTAT3 levels were significantly increased in response to IL-6 stimulation in a gene dose-dependent manner in CD4 T cells from patients with GCA but not controls. CD4 T cells from patients with GCA had significantly higher membrane expression of gp130 than healthy controls, and response to IL-6 correlated with gp130 expression. IL-17 producing CD4 T cells were increased in a gene dose-dependent response to IL-6 (P < .01).</p><p><strong>Conclusions: </strong>The rs2228145 variant is associated with decreased treatment response to tocilizumab and worse outcomes in GCA by enhancing CD4 T cell response to IL-6.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1401-1411"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-independent disease state identification defines distinct trajectories determined by localised vs systemic inflammation in patients with early rheumatoid arthritis.","authors":"Nils Steinz, Tjardo D Maarseveen, Erik B van den Akker, Andrew P Cope, John D Isaacs, Aaron R Winkler, Tom W J Huizinga, Yann Abraham, Rachel Knevel","doi":"10.1016/j.ard.2025.04.011","DOIUrl":"10.1016/j.ard.2025.04.011","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with rheumatoid arthritis (RA) display different trajectories towards improvement of disease. We aimed to disentangle the heterogeneity of RA disease trajectories from the first clinical visit onwards using graph-based pseudotime analysis.</p><p><strong>Methods: </strong>We studied early patients with RA over 1.5 years in 2 data sets: Leiden (Netherlands), n = 1237, with 5017 visits, and Towards a Cure for Early Rheumatoid Arthritis (TACERA) (United Kingdom), n = 243, with 750 visits. We created a pipeline for time-independent clustering of clinical and haematologic features to identify disease states. Sequence analyses of these states defined the trajectories. We studied the predictability of the trajectories with baseline features.</p><p><strong>Results: </strong>Clustering identified 8 disease states with localised inflammation (joints) and systemic inflammation (erythrocyte sedimentation rate [ESR] or leucocytes) as the main discriminating factors. The disease state sequences consisted of 4 trajectories, which we independently replicated in TACERA: A, high ESR; B, rapid progression from many inflamed joints towards remission; C, high leucocytes; and D, many inflamed joints with poor prognosis. Systemic vs local inflammation patterns showed moderate predictability at baseline (sensitivity of 71% and precision of 0.73 for trajectory A, although lower precision of 0.52 for trajectory B), while other trajectories were less predictable. Trajectories C and D had strong resemblance with B at baseline but deteriorated into less favourable trajectories. Patients in trajectory A were more often female and on average older. The trajectories were not explained by time till disease-modifying antirheumatic drug, baseline disease activity, or symptom duration. The suboptimal trajectories coincided with worse patient-reported outcomes, even when the inflammation was mainly systemic.</p><p><strong>Conclusions: </strong>We identified 4 distinct trajectories in early RA, differentiating RA into localised vs systemic inflammation. Our results highlight potential differences in disease pathology and opportunities for further targeted treatment. Inevitably, patterns without linkage to our selected features could not be detected.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1301-1312"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mosaic loss of chromosome Y characterises late-onset rheumatoid arthritis and contrasting associations of polygenic risk score based on age at onset.","authors":"Shunsuke Uchiyama, Yuki Ishikawa, Katsunori Ikari, Suguru Honda, Keiko Hikino, Eiichi Tanaka, Yoichiro Kamatani, Takahisa Gono, Giulio Genovese, Masataka Kuwana, Chikashi Terao","doi":"10.1016/j.ard.2025.01.034","DOIUrl":"10.1016/j.ard.2025.01.034","url":null,"abstract":"<p><strong>Objectives: </strong>Mosaic chromosomal alterations (mCAs) increase with age and are associated with age-related diseases. The association between mCAs and rheumatoid arthritis (RA), particularly late-onset RA (LORA), has not been explored.</p><p><strong>Methods: </strong>mCAs were detected in peripheral blood samples from 2 independent Japanese datasets (Set 1: 2107 RA cases and 86,998 controls; Set 2: 2359 RA cases and 86,998 controls). The associations between mCAs and RA were evaluated in each dataset using logistic regression models and meta-analysis. In each dataset, the effect sizes of mosaic loss of Y (mLOY) and polygenic risk score (PRS) of RA in males was evaluated, and a meta-analysis was subsequently performed. The interaction between mLOY and PRS was assessed. These models were applied separately to RA, LORA, and young-onset RA (YORA).</p><p><strong>Results: </strong>mLOY increased significantly in LORA (odds ratio [OR] = 1.43, P = .0070). We observed a negative association between mLOY and YORA (OR = 0.66, P = .0034). On the other hand, we found consistently negative associations of autosomal mCAs or mosaic loss of X with RA, LORA, and YORA. The PRS effect sizes were lower for LORA than for YORA. mLOY with a high cell fraction strengthened the association between PRS and LORA (P = .0036), whereas the association with YORA was independent of mLOY.</p><p><strong>Conclusions: </strong>LORA was characterised by the presence of a high burden of mLOY. The observed interaction between mLOY and PRS in LORA, but not in YORA, supports different gene-environment interactions between the subsets. These data suggest that distinct pathophysiological mechanisms underlie the development of LORA and YORA.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1313-1323"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticitrullinated caspase 14 peptide antibody is a novel biomarker for seronegative rheumatoid arthritis.","authors":"Xihua Wei, Chaonan Wei, Hongying Lin, Yang Xie, Zhanguo Li, Fanlei Hu","doi":"10.1016/j.ard.2025.03.019","DOIUrl":"10.1016/j.ard.2025.03.019","url":null,"abstract":"","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":"1439-1441"},"PeriodicalIF":20.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}