Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Potential risk factors for delayed neurological sequelae and myocardial injury following acute carbon monoxide poisoning: a retrospective study: Erratum.","authors":"Min-Po Ho, Yuan-Hui Wu, Tsan-Chi Chen, Kuang-Chau Tsai, Chen-Chang Yang","doi":"10.1097/JCMA.0000000000001240","DOIUrl":"10.1097/JCMA.0000000000001240","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"492"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059074","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":"Elevated CCL20 expression was associated with poor prognosis for breast cancer.","authors":"Xia Zhao, Yanping Li, Yu Feng, Shuzhen Lv","doi":"10.1097/JCMA.0000000000001233","DOIUrl":"10.1097/JCMA.0000000000001233","url":null,"abstract":"<p><strong>Background: </strong>The chemokine (C-C motif) ligand 20 (CCL20) exhibits pronounced expression within tumor cells, effectively facilitating tumor progression by modulating the immunosuppressive microenvironment and promoting tumor cell aggressiveness.</p><p><strong>Methods: </strong>Breast cancer and matched adjacent normal tissues from 113 adult breast cancer patients were collected for immunohistochemical staining of CCL20, E-cadherin, vimentin, and N-cadherin. The assessment evaluated the association between CCL20 expression and clinicopathological factors using Pearson chi-squared test, epithelial-mesenchymal transition (EMT) markers expression using Spearman's rank correlation test, both OS and DFS using Kaplan-Meier survival analysis, and Cox proportional hazards regression modeling.</p><p><strong>Results: </strong>Cytoplasmic CCL20 expression was stronger in cancer tissues, compared to normal tissue (69.9% vs 23%). Strong correlations were observed between CCL20 expression and many clinicopathological features, including tumor size ( p = 0.000), estrogen receptor (ER) status ( p = 0.003), Ki67 status ( p = 0.000), vascular invasion ( p = 0.001), and tumor-node-metastasis stage ( p = 0.001). Additionally, CCL20 expression was an independent prognostic predictor for overall survival (OS) (hazard ratio [HR], 3.207; 95% CI, 1.142-9.005, p = 0.027). Furthermore, a significant association between CCL20 expression and EMT markers was observed. CCL20 expression was linked to unfavorable outcomes in all patients ( p = 0.000), ER-positive patients ( p = 0.001), and node-positive/negative ( p = 0.005/0.001) subgroups.</p><p><strong>Conclusion: </strong>These findings highlighted that elevated CCL20 expression was linked to a more aggressive tumor phenotype and a disappointing OS in breast cancer patients, thus advocating for the consideration of CCL20 expression being a novel independent prognostic biomarker for guiding bespoke treatment strategies.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"469-480"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756541","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":"Causal relationships between air pollutants and upper respiratory tract infections: A two-sample, Mendelian randomization study.","authors":"Fuhai Chen, Jin Zhang, Jing Xie, Xiao Fu","doi":"10.1097/JCMA.0000000000001242","DOIUrl":"10.1097/JCMA.0000000000001242","url":null,"abstract":"<p><strong>Background: </strong>The issue of air pollution is a concern that affects the health of individuals globally. Air pollutants (APs) have been linked to upper respiratory tract infections (URTIs); however, the exact association between them remains unclear.</p><p><strong>Methods: </strong>Two-sample Mendelian randomization (MR) was performed to examine the causal relationship between APs and URTIs. Data regarding APs and URTIs were obtained from genome-wide association studies. Single-nucleotide polymorphisms associated with each exposure were defined as instrumental variables. Inverse variance weighting is the primary method for analyzing causal effects. Quality control was performed using MR-Egger, weighted mode, simple mode, and weighted median. Heterogeneity was assessed using Cochran's Q. The MR-Egger test was used to evaluate pleiotropy. Sensitivity analysis was performed using the \"leave-one-out\" method.</p><p><strong>Results: </strong>MR analysis revealed that airborne particulate matter with a diameter ≤10 micrometers (PM 10 ) had a notable impact on acute pharyngitis, whereas nitrogen dioxide had a significant impact on chronic rhinitis, chronic nasopharyngitis, and chronic pharyngitis. Pleiotropy and heterogeneity were not observed.</p><p><strong>Conclusion: </strong>Higher PM 10 levels were associated with a greater likelihood of developing acute pharyngitis. Increased nitrogen dioxide concentrations were associated with an increased risk for chronic rhinitis, nasopharyngitis, and pharyngitis. As such, controlling APs is crucial for preventing and treating URTIs.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"481-485"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of repetitive transcranial magnetic stimulation in patients with spinocerebellar ataxia: A systematic review and meta-analysis.","authors":"Yi-Cheng Lin, Sheng-Han Kuo, Chin-Po Lin, Li-Hung Chang","doi":"10.1097/JCMA.0000000000001243","DOIUrl":"10.1097/JCMA.0000000000001243","url":null,"abstract":"<p><p>Spinocerebellar ataxia (SCA) is a group of hereditary neurodegenerative disorders characterized by the progressive incoordination of gait, impaired motor control, and various neurological deficits. Therapeutic options for SCA remain limited. However, repetitive transcranial magnetic stimulation (rTMS) has gained attention as a potential intervention due to its noninvasive nature, ease of application, and favorable safety profile. To evaluate the therapeutic efficacy of rTMS in SCA, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs). A comprehensive search of PubMed, Medline, and the Cochrane Library databases was conducted to identify RCTs assessing rTMS for SCA management. The primary outcomes of interest included changes in motor function as measured by the Scale for the Assessment and Rating of Ataxia (SARA) or the International Cooperative Ataxia Rating Scale (ICARS). Our analysis included eight RCTs involving a total of 237 participants. Meta-analysis results demonstrated statistically significant improvements in motor function. Specifically, SARA scores showed a mean difference (MD) of -1.56 (95% CI, -2.88 to -0.24; p = 0.02), and ICARS scores improved with an MD of -3.16 (95% CI, -3.93 to -2.39; p < 0.001) compared with a sham group. To evaluate the effects of different rTMS protocols on SCA, we performed subgroup analyses of low-frequency (LF), high-frequency (HF), and intermittent theta burst stimulation (iTBS). We revealed that LF (MD, -1.60; 95% CI, -3.06 to -0.13; p = 0.03) and iTBS (MD, -1.68; 95% CI, -2.29 to -1.08; p < 0.001) were effective in significantly improving SARA. The HF group showed a reduction in SARA scores (MD, -1.52; 95% CI, -6.34 to 3.30; p = 0.54) but without significance because of the small sample size. These findings indicate that overall rTMS is a promising therapeutic approach for alleviating motor symptoms in hereditary SCA patients.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"417-424"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of veterans hospitals in Taiwan's medically underserved areas.","authors":"Ying-Mei Wang, Hung-Wei Shen, Tzeng-Ji Chen, Feng-Yuan Yang","doi":"10.1097/JCMA.0000000000001241","DOIUrl":"10.1097/JCMA.0000000000001241","url":null,"abstract":"<p><strong>Background: </strong>Notable healthcare disparities can be observed in medical services in remote, rural areas with those in urban areas, primarily because of specialist shortages, inadequate healthcare, and poor transportation. Globally, remote and rural areas face economic, health, and service challenges resulting in a shift toward telemedicine and adjusted insurance systems in such areas. In Taiwan, similar problems have prompted initiatives to improve healthcare access and medical capacity, particularly in medically underserved areas (MUAs). We evaluated the healthcare distribution and capacity in MUAs, highlighting the crucial role of veterans hospitals.</p><p><strong>Methods: </strong>Using government data and a hierarchical approach, we analyzed the distribution of healthcare facilities and professionals, focusing on the effects of the veterans healthcare system.</p><p><strong>Results: </strong>Taiwan's MUAs face significant health challenges. While they cover 64.9% of the land, they are home to only 10.9% of the population. These areas rely heavily on clinics, while advanced medical facilities and specialists are sparse, particularly in highly remote regions. Public and affiliated hospitals are essential, but insufficient; they face major shortages in emergency medicine, pediatrics, and surgery. Bed utilization rates are lower in highly remote areas (34.9%) compared with remote areas (81.4% in medical centers). Veterans affairs hospitals play a key role contributing 8.9% of the service capacity. However, workforce and resource deficiencies persist, requiring targeted interventions.</p><p><strong>Conclusion: </strong>Veterans hospitals play an important role in addressing healthcare disparities in Taiwan's MUAs. By supporting emergency care, community education, and workforce development, these hospitals help to improve medical access in remote regions. Facilities, such as the Hsinchu Branch, exemplify this role by enhancing the local service capacity and medical training. Strengthening rural medical education, expanding telemedicine, and optimizing resource allocation are essential strategies for building a more equitable and sustainable healthcare system.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"442-450"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039270","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":"Multimodal analgesia with thoracic paravertebral block decrease pain and side effects in mastectomy patients.","authors":"Pei-Chin Liu, Fu-Wei Su, Yi-Fang Tsai, Yen-Shu Lin, Chun-Sung Sung, Ling-Ming Tseng, Wei-Nung Teng","doi":"10.1097/JCMA.0000000000001218","DOIUrl":"10.1097/JCMA.0000000000001218","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols incorporating multimodal analgesia (MMA) have become increasingly popular for breast cancer surgery. Our study evaluated an ERAS approach that combined nonintubated general anesthesia (GA) with thoracic paravertebral block (TPVB) as part of the MMA and compared it with traditional GA. Postoperative outcomes were assessed using numerical rating scale (NRS) pain scores, total analgesic consumption, and postoperative nausea and vomiting (PONV).</p><p><strong>Methods: </strong>We reviewed the medical records of 60 female patients aged 30 to 85 years who underwent unilateral mastectomy with or without sentinel lymph node biopsy (SLNB). Thirty patients received nonintubated GA with a regional block (MMA group), whereas the remaining 30 patients received conventional GA and were matched based on their anesthesia records. Postoperative analgesics, including pethidine and tramadol, were converted into intravenous morphine equivalents. We compared the groups using paired t tests for age, height, weight, operation duration, NRS scores, total analgesic dosage, and the Fisher exact test for PONV rates.</p><p><strong>Results: </strong>The MMA group showed significantly lower NRS scores ( p < 0.001) and total analgesic consumption ( p < 0.001) than the GA group. Although PONV rates were lower in the MMA group (0% vs 13%, p = 0.112), this difference was not statistically significant, likely due to the effective PONV management in the GA group with dexamethasone or 5-Hydroxytryptamine type 3 (5HT-3) antagonist. There was no significant difference in pain scores ( p = 0.722) or the need for additional analgesics ( p = 0.419) between double- and triple-level TPVB.</p><p><strong>Conclusion: </strong>Nonintubated GA with total intravenous anesthesia (TIVA) and MMA using TPVB is a viable and safe alternative for breast cancer surgery. It results in reduced pain scores and analgesic needs compared with conventional GA, with PONV outcomes comparable to those managed with standard intravenous medications.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"486-491"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401014","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":"AI's deep research revolution: Transforming biomedical literature analysis.","authors":"Ying-Mei Wang, Tzeng-Ji Chen","doi":"10.1097/JCMA.0000000000001231","DOIUrl":"10.1097/JCMA.0000000000001231","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"415-416"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702504","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":"Vitamin D deficiency and associated factors among children in a tertiary care hospital setting: A retrospective cohort study.","authors":"Tzu-Ching Lin, Hsiao-Yun Yeh, Hsin-Lin Tsai, Pin-Hsuan Chiang, Zih-Kai Kao, Ling-Yu Yang, Yu-Chun Chen, Jei-Wen Chang","doi":"10.1097/JCMA.0000000000001235","DOIUrl":"10.1097/JCMA.0000000000001235","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D plays important roles in skeletal and extra-skeletal tissues. However, little is known about the vitamin D status in children in a hospital setting. We aimed to assess the vitamin D status, risk factors for vitamin D deficiency (VDD), and changes in biochemical profiles among children at a tertiary medical center in Taiwan.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from the Big Data Center of Taipei Veterans General Hospital. Children under 18-year-old who underwent 25-hydroxyvitamin D measurements between 2018 and 2023 were enrolled. Logistic regression analysis was performed to determine the risk factors for VDD.</p><p><strong>Results: </strong>Among 1222 children enrolled, with a mean age of 8.5 ± 5.4 years, 597 (48.9%) had VDD. VDD was significantly associated with female sex (odds ratio [OR] = 1.624, 95% CI = 1.270-2.076), age >12 years (OR = 2.479, 95% CI = 1.584-3.881), vitamin D measurement during the spring/winter seasons (OR = 1.716, 95% CI = 1.340-2.197), and hospitalized children (OR = 1.949, 95% CI = 1.439-2.640). Age >1 to 6 years was a protective factor against VDD (OR = 0.391, 95% CI = 0.244-0.628). In addition, the OR of VDD was higher in those with an elevated intact parathyroid hormone level (OR = 8.667, 95% CI = 1.338-56.157).</p><p><strong>Conclusion: </strong>Despite the high sun exposure in Taiwan, VDD is prevalent among children and adolescents. Physicians should be aware of VDD, especially in children who are female, aged >12 years, hospitalized, have increased intact parathyroid hormone levels, and during the spring/winter.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"433-441"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805115","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":"Risk factors of early dysfunction after switching from plastic to metal stents in malignant extrahepatic biliary obstruction.","authors":"Chia-Chia Lu, Chun-Fang Tung, Yen-Chun Peng, Yi-Jun Liao, Hsin-Ju Tsai, Sheng-Shun Yang, Chia-Chang Chen","doi":"10.1097/JCMA.0000000000001234","DOIUrl":"10.1097/JCMA.0000000000001234","url":null,"abstract":"<p><strong>Background: </strong>Patients diagnosed with extrahepatic malignant biliary obstruction (MBO) often initially undergo endoscopic retrograde biliary drainage with a plastic stent (PS). Self-expandable metallic stents (SEMSs) have been shown to yield better outcomes than PS. This study aimed to identify predictors of early SEMS dysfunction in MBO patients who initially received PS and subsequently underwent SEMS placement.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who received their first SEMS insertion following prior PS placement for distal extrahepatic MBO between January 2015 and December 2021. We also analyzed the possible risk factors for early SEMS dysfunction defined as occurring within 90 days.</p><p><strong>Results: </strong>Fifty-six patients who received their first SEMS for distal extrahepatic MBO were identified. The rate of early SEMS dysfunction was 30.1%. The main causes of early SEMS dysfunction were nonspecific cholangitis (35.3%) and stent clogging (35.3%). Multivariate logistic regression analysis identified two independent predictors of early SEMS dysfunction: (a) a history of a short PS patency (<60 days), and (b) post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis following SEMS placement. The odds ratio (OR) for (a) was 10.77 (95% confidence interval [CI] 2.54 to 45.66, p = 0.001), and for (b) was (OR) 6.59 (CI 1.00-43.43, p = 0.050).</p><p><strong>Conclusion: </strong>Two risk factors associated with early SEMS dysfunction in patients with extrahepatic MBO are short PS patency (<60 days) before SEMS insertion and the development of post-ERCP cholangitis following SEMS placement.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"451-460"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805088","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}