Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Application of machine learning algorithms to identify risk factors for depression in type 2 diabetes mellitus patients: A Taiwan diabetes registry study.","authors":"Yu-Wen Su, Wayne Huey-Herng Sheu, Chii-Min Hwu, Yu-Cheng Chen, Jung-Fu Chen, Yun-Shing Peng, Chien-Ning Huang, Yi-Jen Hung, Harn-Shen Chen","doi":"10.1097/JCMA.0000000000001250","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001250","url":null,"abstract":"<p><strong>Background: </strong>We analyzed variables reported during routine clinical practice using a registrational database to estimate risk factors for depression in people with type 2 diabetes mellitus.</p><p><strong>Methods: </strong>A Patient Health Questionnaire (PHQ-9) score of 15 was selected as the cut-off for clinically meaningful depression. Missing data was either filled in with a median value, the k-nearest neighbors' method, or the entire variable was removed. Logistic regression, random forest, and decision tree machine learning models were used to decide which factors were most relevant to depression. The accuracy of each algorithm was evaluated with a testing set.</p><p><strong>Results: </strong>When all variables were included in the logistic regression model, the area under the receiver operating characteristic curve was 0.81. In the random forest model, the most important factor was quality of life (QoL). Upon removing QoL-related variables, bloating, and autoimmune disease became the greatest contributing factors. Model accuracy was 83.1%. In the decision tree model, QoL was also observed as the most decisive factor. Upon removing QoL variables, bloating was the first node. Model accuracy was 82.5%.</p><p><strong>Conclusion: </strong>Quality of life, bloating, and autoimmune disease were the most important factors associated with depression in type 2 diabetes mellitus patients.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183502","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":"Incidence and characteristics of Guillain-Barré syndrome in Taiwan before and during the COVID-19 pandemic: A 12-year single-center experience.","authors":"Yu-Hsin Chen, Kuan-Lin Lai, Yi-Chung Lee, Yi-Chu Liao","doi":"10.1097/JCMA.0000000000001251","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001251","url":null,"abstract":"<p><strong>Background: </strong>There is substantial regional disparity in the presentation of Guillain-Barré syndrome (GBS), and coronavirus disease 2019 (COVID-19) possibly influences the development of GBS, but the association remains uncertain. This study aimed to investigate the incidence of GBS before and during the COVID-19 pandemic and delineate the clinical profile of GBS in Taiwanese patients.</p><p><strong>Methods: </strong>Medical records of 185 ascertained GBS cases at Taipei Veterans General Hospital between 2011 and 2022 were reviewed. Patients were analyzed based on age, clinical subtypes, and electrophysiological findings. A multivariable ordinal logistic regression was conducted to identify factors related to outcomes measured by the GBS disability scale (GBS-DS), which ranges from 0 to 6, with higher scores indicating greater disability.</p><p><strong>Results: </strong>The single center incidence (SCI) of GBS, defined as the number of GBS cases relative to the total number of outpatient and emergency department visits per year, remained stable during the COVID-19 pandemic (14.3 cases per year) compared to the pre-pandemic period (15.8 cases per year). COVID-19 infection or vaccination was reported as a preceding event in six cases, five of which had good outcomes (GBS-DS≤2). In our cohort, 12% were diagnosed with Miller Fisher syndrome (MFS), 13% had GBS/MFS overlap, and the remaining patients had typical GBS. One-third had axonal GBS, associated with significantly worse outcomes compared to demyelinating GBS. The overall mortality rate was 1.1%. Old age, low Medical Research Council sum score, ventilator dependency, and autonomic dysfunction were independent predictors of high GBS-DS scores.</p><p><strong>Conclusion: </strong>This single-center study found no increase in GBS occurrence during the COVID-19 pandemic. In Taiwan, GBS is characterized by a higher occurrence of MFS and GBS/MFS overlap and more frequent axonal GBS, highlighting geographical variations in GBS features between Asian and Western countries.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183498","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":"A 2025 update on treatment strategies for the Alzheimer's disease spectrum.","authors":"Chuang-Kuo Wu, Jong-Ling Fuh","doi":"10.1097/JCMA.0000000000001252","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001252","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is a complex and progressive neurodegenerative disorder with a continuum of stages ranging from preclinical/asymptomatic phase to severe dementia. Over the past decades, significant advances in diagnostic biomarkers and disease-modifying therapies have reshaped the treatment landscape. This review provides a comprehensive overview of the current treatment paradigm for AD in 2025, incorporating the latest developments in pharmacological and non-pharmacological interventions. The advent of anti-amyloid immunotherapy, including FDA-approved monoclonal antibodies such as lecanemab and donanemab, has proven efficacy in slowing cognitive decline in early-stage AD. These therapies mark a change in thinking in AD management, emphasizing the importance of early diagnosis and intervention. Cholinesterase inhibitors and memantine remain the standard treatments for mild, moderate to severe dementia, providing symptomatic relief and functional stabilization. Additionally, emerging strategies targeting tau pathology and neuroinflammation are under investigation, offering hope for future breakthroughs. Beyond pharmacotherapy, this review highlights the importance of personalized, multimodal treatment approaches that integrate lifestyle modifications, cognitive training, and caregiver support. The updated diagnostic framework, incorporating fluid and imaging biomarkers, enables more precise staging and individualized treatment plans. Despite these advances, challenges still lie in refining patient selection, addressing treatment-related side effects, and ensuring accessibility to appropriate therapies. As the field moves forward, ongoing clinical trials and real-world evidence will further refine treatment strategies. A proactive approach, combining early detection with disease-modifying and symptomatic therapies, is essential for improving patient outcomes and quality of life. This article synthesizes current knowledge and provides a roadmap for clinicians and researchers navigating the evolving landscape of AD treatment.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183238","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":"Redefined complement C3c structures have significant increase in the plasma of ovarian cancer patients.","authors":"Dong-Hao Chen, Yi-Wen Chang, Chin-Hsiang Chien, Pao-Ling Torng, Yeou-Guang Tsay","doi":"10.1097/JCMA.0000000000001249","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001249","url":null,"abstract":"<p><strong>Background: </strong>Ovarian cancer (OC) is the third among the most common gynecological cancers. Effective biomarkers are required for OC as in the case of other cancers. Therefore, here we explored whether plasma proteolytic products could serve as potential biomarkers.</p><p><strong>Methods: </strong>We devised a platform that incorporates CyDye labeling, macroporous reversed-phase liquid chromatography, reducing/non-reducing SDS-PAGE, and fluorescence imaging. Paired preoperative and postoperative plasma samples from four patients were used to screen for possible proteolytic changes. For identified difference proteins, liquid chromatography-tandem mass spectrometry was used to analyze the protein digests using various proteases. Plasma samples from 33 healthy controls and 85 patients with OC were examined using enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Our analyses revealed that the circulating complement C3 derivative was present only in the diseased state. This 145-kDa species, under non-reducing conditions, could split into 72-, 39-, and 29-kDa fragments upon reduction, reminiscent of the C3c structure. While confirming the C3c identity, mass spectrometric analyses showed multiple C-terminal ends in the C3c α'1 fragment, which were utilized differently among patients with OC. Various ends were also observed in serum samples prepared using different complement activators, thus redefining C3c as a mixture of multiple molecular entities. ELISA assay targeting only canonical C3c demonstrated a strong correlation between increased plasma levels and the occurrence and progression of OC.</p><p><strong>Conclusion: </strong>Our findings suggest that plasma proteolysis during complement deactivation is explicitly involved in ovarian tumorigenesis and the associated protein changes may aid in developing next-generation cancer biomarkers.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082854","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":"Artificial intelligence algorithm improves radiologists' bone age assessment accuracy artificial intelligence algorithm improves radiologists' bone age assessment accuracy.","authors":"Tien-Yu Chang, Ting Ywan Chou, I-An Jen, Yeong-Seng Yuh","doi":"10.1097/JCMA.0000000000001248","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001248","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) algorithms can provide rapid and precise radiographic bone age (BA) assessment. This study assessed the effects of an AI algorithm on the BA assessment performance of radiologists, and evaluated how automation bias could affect radiologists.</p><p><strong>Methods: </strong>In this prospective randomized crossover study, six radiologists with varying levels of experience (senior, mi-level, and junior) assessed cases from a test set of 200 standard BA radiographs. The test set was equally divided into two subsets: datasets A and B. Each radiologist assessed BA independently without AI assistance (A- B-) and with AI assistance (A+ B+). We used the mean of assessments made by two experts as the ground truth for accuracy assessment; subsequently, we calculated the mean absolute difference (MAD) between the radiologists' BA predictions and ground-truth BA and evaluated the proportion of estimates for which the MAD exceeded one year. Additionally, we compared the radiologists' performance under conditions of early AI assistance with their performance under conditions of delayed AI assistance; the radiologists were allowed to reject AI interpretations.</p><p><strong>Results: </strong>The overall accuracy of senior, mid-level, and junior radiologists improved significantly with AI assistance than without AI assistance (MAD: 0.74 vs. 0.46 years, p < 0.001; proportion of assessments for which MAD exceeded 1 year: 24.0% vs. 8.4%, p < 0.001). The proportion of improved BA predictions with AI assistance (16.8%) was significantly higher than that of less accurate predictions with AI assistance (2.3%; p < 0.001). No consistent timing effect was observed between conditions of early and delayed AI assistance. Most disagreements between radiologists and AI occurred over images for patients aged ≤8 years. Senior radiologists had more disagreements than other radiologists.</p><p><strong>Conclusion: </strong>The AI algorithm improved the BA assessment accuracy of radiologists with varying experience levels. Automation bias was prone to affect less experienced radiologists.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082903","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":"Circular RNA LDLRAD3 promotes gastric cancer progression by upregulating COL4A5 through sponging miR-137: Erratum.","authors":"Chenghui Li, Xiao Xing, Sinian Huang, Ting Zhu, Bin Yan","doi":"10.1097/JCMA.0000000000001247","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001247","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082906","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 retractions in primary health care.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1097/JCMA.0000000000001244","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001244","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061228","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":"Bacillus coagulans TCI803 confers gastroesophageal protection against Helicobacter pylori-evoked gastric oxidative stress and acid-induced lower esophageal sphincter inflammation.","authors":"Yu-Hsuan Cheng, Hung-Keng Li, Kai-Hsian Chang, Yung-Kai Lin, Yung-Hsiang Lin, Chi-Fu Chiang, Jyh-Chin Yang, Chiang-Ting Chien","doi":"10.1097/JCMA.0000000000001246","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001246","url":null,"abstract":"<p><strong>Background: </strong>Probiotic Bacillus coagulans (BC) may have an impact on gastrointestinal protection. This study was designed to investigate the BC effects on Helicobacter pylori (H. pylori) induced gastric inflammation in mice and acid-induced lower esophageal sphincter (LES) dysfunction in rats. We determined the oxidative stress/apoptosis/autophagy signaling pathways in H. pylori-induced gastric inflammation and HCl-evoked LES inflammation.</p><p><strong>Methods: </strong>H. pylori-induced gastric inflammation was used in 40 mice and HCl-evoked LES inflammation in 40 Wistar rats. Western blot, immunohistochemistry and cytokine array were used to determine the pathophysiologic mechanisms.</p><p><strong>Results: </strong>H. pylori increased leukocyte infiltration mediated inflammation and the expression levels of gastric cytokines, 3NT/4HNE-mediated oxidative stress and Bax/Caspase 3-mediated apoptosis, but decreased Beclin-1/LC3-II-mediated autophagy in the mice gastric mucosa. BC treatment decreased inflammation, cytokines release, oxidative stress and apoptosis and reversed autophagy in H. pylori infected gastric mucosa. To replace the antibiotic therapy, BC TCI803 was selected to inhibit H. pylori infection for commercial interests. Saline esophageal infusion evoked an increase in LES pressure and efferent vagus nerve activity during the emptying phase. However, HCI dysregulated LES motility esophageal infusion by a decrease in threshold pressure, intercontraction interval and an increase in efferent vagus nerve activity. BC treatment significantly recovered the level of threshold pressure, intercontraction interval and depressed the enhanced efferent vagus nerve activity. In vitro LES wire myography data displayed that HCl treated LES significantly decreased the contractile response to acetylcholine. BC treatment significantly restored the contractile response to acetylcholine in LES wire myography. LES after HCl stimulation significantly increased leukocyte infiltration-mediated inflammation, whereas BC treatment effectively reduced the leukocyte infiltration-mediated inflammation in the HCl treated LES.</p><p><strong>Conclusion: </strong>BC via anti-oxidation and anti-inflammation confers gastroesophageal protection against H. pylori involved oxidative stress/inflammation/apoptosis/autophagy signaling in mice with gastric inflammation and HCl induced LES dysregulation and inflammation.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995694","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":"Association of PBRM1 rs2251219 with major depressive disorder and biochemical variables in a Taiwanese cohort.","authors":"Kuan-Ju Chou, Chuan-Hsun Yu, Yu-Ting Yan, Po-Hsiu Kuo, Shih-Jen Tsai","doi":"10.1097/JCMA.0000000000001245","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001245","url":null,"abstract":"<p><strong>Background: </strong>Genetic studies have identified more than 100 loci linked to major depressive disorder (MDD), underscoring its polygenic characteristics. Although the protein polybromo-1 (PBRM1) rs2251219 polymorphism was reported to be associated with MDD, this has not been corroborated by additional studies. In the present study, the associations between PBRM1 rs2251219, MDD, and key biochemical variables were evaluated in a large Taiwanese cohort.</p><p><strong>Methods: </strong>Data were collected from 117,679 individuals aged 30 to 90 years who were enrolled in the Taiwan Biobank. MDD diagnoses were based on self-reported data validated through national insurance claims records. Genotyping was conducted with an Axiom Genome-Wide Array, and associations with biochemical variables were analyzed through a general linear model adjusted for age and sex.</p><p><strong>Results: </strong>A significant association was observed between PBRM1 rs2251219 and MDD risk (p = 0.021 for genotype and p = 0.025 for allele). Individuals with the T allele had a higher MDD risk than C/C genotype carriers did. Biochemical differences were also observed, with T/T carriers with lower body mass index, platelet counts, albumin concentrations, and fasting glucose levels and higher red blood cell counts, hematocrit levels, and uric acid levels.</p><p><strong>Conclusion: </strong>The PBRM1 rs2251219 polymorphism was associated with both MDD and biochemical measurement variation. These findings support the effects of the PBRM1 rs2251219 polymorphism on blood protein levels and psychiatric traits.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059207","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":"High muscle-to-fat ratio predicts slow muscle strength decline in middle-aged and older adults: Longitudinal aging study of Taipei.","authors":"Ching-Jen Chang, Ming-Hsien Lin, Liang-Yu Chen, Sung-Hua Tseng, An-Chun Hwang, Chung-Yu Huang, Ko-Han Yen, Liang-Kung Chen, Li-Ning Peng","doi":"10.1097/JCMA.0000000000001229","DOIUrl":"10.1097/JCMA.0000000000001229","url":null,"abstract":"<p><strong>Background: </strong>Handgrip strength is a vital marker of muscle function and predictor of health outcomes in older adults. This study investigated the relationship between the muscle-to-fat ratio and 3-year decrease in handgrip strength in community-dwelling adults aged ≥50 years.</p><p><strong>Methods: </strong>Data were obtained from the Longitudinal Aging Study of Taipei (LAST), a cohort study of adults aged 50 years and older. Measurements from two waves, 3 years apart, were analyzed. Demographics, laboratory data, and handgrip strength data were collected. Appendicular skeletal muscle mass was assessed using bioimpedance analysis, and the relative appendicular skeletal muscle mass index was calculated by dividing appendicular muscle mass by height squared. The muscle-to-fat ratio was derived by dividing appendicular muscle mass by total body fat. Handgrip strength decrease was divided into quartiles; slow decliners experienced the smallest decrease, whereas rapid decliners had the greatest decrease. Associations between the muscle-to-fat ratio and other risk factors were analyzed.</p><p><strong>Results: </strong>Over 3 years, the Charlson Comorbidity Index, medication use, waist-to-hip ratio, and fat percentage increased, whereas skeletal muscle mass, the muscle-to-fat ratio, and handgrip strength decreased. Rapid decliners were less likely to be male (21.6% vs 33.3%, p = 0.008) or alcohol drinkers (53.8% vs 66.2%, p = 0.01) and had lower skeletal muscle mass (6.3 ± 0.9 vs 6.6 ± 1.0, p = 0.006) and muscle-to-fat ratios (1.0 ± 0.4 vs 1.1 ± 0.5, p = 0.004) but greater fat percentages (30.4 ± 6.6 vs 29.0 ± 7.6, p = 0.045). A greater muscle-to-fat ratio (odds ratio [OR] = 3.751, p = 0.047), greater physical activity (OR = 1.694, p = 0.04), and lower glycated hemoglobin (HbA1c; OR = 0.61, p = 0.008) reduced the risk of rapid decline.</p><p><strong>Conclusion: </strong>The muscle-to-fat ratio, together with physical activity and glycemic control, predicts a decrease in handgrip strength, highlighting its potential as a biomarker of intrinsic capacity and muscle-fat interplay. Further research is needed to explore the underlying biological mechanisms involved.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"367-374"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702505","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}