Journal of otology最新文献

{"title":"Interpretative Challenges of the 'Missing Perilymph' Sign in PLF Diagnosis - A Letter To The Editor.","authors":"Jamil Ammara","doi":"10.26599/JOTO.2025.9540043","DOIUrl":"10.26599/JOTO.2025.9540043","url":null,"abstract":"","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"281"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle Ear Transfer Function for Sound Conduction Study of Middle Ear Implants: A New Method.","authors":"Yueqi Li, Xiao Qin, Guodong Feng, Zhiqiang Gao","doi":"10.26599/JOTO.2025.9540034","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540034","url":null,"abstract":"<p><p>Human temporal bone specimens are used in experiments to measure the sound transfer function of the middle ear. This standard method for the development of middle ear implants requires temporal bones that possess appropriate mechanical properties and structural stability and are free from pathological conditions. A laser Doppler vibrometer is commonly employed to measure the vibration of the stapes footplate. These experiments are typically conducted in the middle ear by leaving the inner ear intact, exposing the stapes footplate through the tympanic cavity, and directing the laser beam onto the footplate. However, previous studies have shown that the influence of inner ear impedance on the middle ear transfer function cannot be ignored, and any surgical manipulation may cause a change in inner ear pressure, resulting in instability in the middle ear transfer function. Therefore, this study aims to eliminate the influence of the inner ear and to establish a new experimental method in human temporal bone specimens that is more suitable for the study of sound conduction in middle ear implants. As a result, a range for middle ear transfer function was developed, which serves as a reference for assessing the conformity of temporal bone specimens to experimental standards, and the stability of this range was demonstrated under experimental conditions.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"219-224"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle Ear Glial Heterotopia Coexisting with Cholesteatoma: A Case Study.","authors":"Ting Liu, Haijin Yi","doi":"10.26599/JOTO.2025.9540037","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540037","url":null,"abstract":"<p><strong>Objective: </strong>To present a rare case of glial heterotopia in the middle ear occurring in association with cholesteatoma.</p><p><strong>Patient and intervention: </strong>A 56-year-old female presented with right-sided hearing loss and otorrhea. ENT examination and CT imaging revealed middle ear cholesteatoma. Right canal wall down mastoidectomy with type III tympanoplasty revealed a well-demarcated, soft, pinkish mass in the right middle ear without tegmen tympani dehiscence. Histopathological analysis confirmed glial heterotopia.</p><p><strong>Main outcome measures: </strong>Complete cholesteatoma resection, resolution of otorrhea, absence of neurological complications, and right-sided hearing improvement.</p><p><strong>Results: </strong>The patient demonstrated an uneventful postoperative recovery. At the five-month follow-up, tympanoplasty outcomes remained stable. Repeat imaging confirmed absence of skull base defects, with clinical resolution of otorrhea. No postoperative neurological complications (including cerebrospinal fluid leakage) were observed.</p><p><strong>Conclusions: </strong>Middle ear glial heterotopia is a rare entity that may be discovered incidentally or in association with infection/cholesteatoma. Definitive management requires surgical excision of the heterotopic tissue and concurrent repair of skull base bone defects when identified. Preoperative imaging evaluation with CT or MRI can be valuable to delineate anatomical relationships and exclude intracranial connections.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"243-244"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Interpretative Challenges of the 'Missing Perilymph' Sign in PLF Diagnosis- A Thoughtful Discussion.","authors":"Jing Zou","doi":"10.26599/JOTO.2025.9540044","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540044","url":null,"abstract":"","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"282"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Models for Predicting Vestibular Function After Cochlear Implantation.","authors":"Mengya Shen, Xiaozhang Zhu, Weirui Zhang, Shujin Xue, Xingmei Wei, Ying Kong, Jiaqiang Sun, Yongxin Li, Haihui Wang","doi":"10.26599/JOTO.2025.9540035","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540035","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness of machine learning in automating the prediction of vestibular abnormalities after cochlear implantation (CI) in patients with sensorineural hearing loss (SNHL), with the goal of developing a practical model that can accurately predict long-term vestibular function outcomes and identify associated risk factors.</p><p><strong>Methods: </strong>Clinical data, including imaging, vestibular evoked myogenic potentials (VEMPs), and auditory information, were collected from patients with sensorineural hearing loss (SNHL) before and after CI. The decision tree algorithm was employed to address missing values and screen pre-CI clinical features. Six machine learning methods were subsequently utilized to predict the relationships between the extracted features and post-CI vestibular dysfunction. The best-performing method determined the ranking of feature importance, which was regarded as risk factors for predicting symptoms and VEMPs results after CI.</p><p><strong>Results: </strong>Logistic regression models effectively predicted both post-CI vestibular dysfunction and abnormal cervical VEMP (cVEMP), with accuracies of 80% and 78%, respectively. The relative importance of the features, in descending order, was as follows: cVEMP latency, cVEMP amplitude, and residual hearing threshold. Moreover, the support vector machine (SVM) model attained an accuracy of 88% in predicting abnormal ocular VEMP (oVEMP) post-CI. For the SVM model, the feature importance ranking was as follows: oVEMP latency, oVEMP amplitude, and residual hearing threshold.</p><p><strong>Conclusions: </strong>This study successfully leverages machine learning techniques, specifically support vector machines (SVM) and logistic regression models, to predict the impact of CI on vestibular function. These predictive models provide valuable insights for presurgical planning and decision-making in CI procedures. Moreover, the findings highlight the critical risk factors associated with vestibular dysfunction, offering a robust reference for guiding vestibular rehabilitation strategies.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"225-235"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optogenetic Infection and Optical Stimulation: A Study on Auditory Responses in Guinea Pig Cochlear Neurons.","authors":"Chen Liu, Ning Yu","doi":"10.26599/JOTO.2025.9540036","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540036","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to establish an economically viable and easily accessible adult animal model for optogenetic activation of auditory neurons using adeno-associated viruses (AAVs) carrying ChR2(H134R) to explore the potential of cochlear optogenetics as a hearing restoration technology.</p><p><strong>Methods: </strong>Healthy adult guinea pigs were used in the experiments. The viral vector AAV2/8-ChR2(H134R)-hSyn-eYFP was administered to the right cochlea via the round window membrane. The confocal microscopy and reverse transcription polymerase chain reaction (RT-PCR) were utilized to analyze the ChR2(H134R) expression localized to spiral ganglion neurons (SGNs). The auditory pathway activation was assessed by recording the optical compound action potential (oCAP) and acoustic compound action potential (aCAP) at various laser intensities.</p><p><strong>Results: </strong>The ChR2(H134R)-eYFP expression was confirmed in 90% of the tested animals, localized to the SGNs of the injected ear. Higher mRNA levels of ChR2(H134R) and eYFP were observed in the injected ear compared to the non-injected ear, while actin (Actb) mRNA levels were not significantly different. The oCAP was successfully elicited by a 470 nm blue light laser stimulus, with similar amplitudes and latency periods to those of aCAPs when the oCAP was evoked by 5.80 mW blue light and the aCAP was evoked by a 40 dB SPL click. The amplitudes of oCAPs increased with increasing laser intensity.</p><p><strong>Conclusion: </strong>This study demonstrates the viability of optogenetic activation of the auditory system in adult guinea pigs through the transduction of AAV-ChR2(H134R) in SGNs. Cochlear optogenetics demonstrates potential as a hearing restoration technology, providing a basis for further clinical research and opening new avenues for investigation.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"236-242"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Stem Cells Restore Hearing? A Narrative Review Exploring Regenerative Medicine for Congenital Hearing Loss.","authors":"Ainulakbar Mughal, Fatima Syed Amanullah, Hamdan Ahmed Pasha, Syed Abbas Moazzam Kazmi, Abdul Basit Shah Vardag, Muhammad Sohail Awan","doi":"10.26599/JOTO.2025.9540039","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540039","url":null,"abstract":"<p><strong>Introduction: </strong>Hearing loss, particularly congenital hearing loss, poses significant challenges to affected individuals and their families. Recent advancements in regenerative medicine have fueled interest in stem cell therapy as a potential solution for hearing restoration. This review discusses the feasibility of using stem cells to regenerate damaged cochlear structures and auditory neurons, focusing on their differentiation potential and integration into the cochlear environment.</p><p><strong>Discussion: </strong>Congenital hearing loss remains a significant global health challenge, with genetic mutations and syndromic conditions contributing to its high prevalence. Advances in regenerative medicine have led to increased interest in stem cell therapy as a potential solution for auditory restoration. Research on embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and mesenchymal stem cells (MSCs) has demonstrated their ability to differentiate into auditory cell types, offering a potential avenue for cochlear regeneration. Gene therapies also present a promising approach for addressing hereditary hearing loss by targeting specific genetic mutations. iPSCs in particular show promise, especially when combined with gene therapy for hereditary hearing loss. Despite encouraging preclinical findings, persistent hurdles remain: immune rejection, limited cell survival, difficulty with cochlear integration, and complex ethical and regulatory considerations. Addressing these barriers is crucial for safe and effective translation into clinical care. In Pakistan, there is a critical need to promote advancements in this field. Positioning Pakistan as an illustrative case within broader low- and middle-income country (LMIC) disparities underscores how limited infrastructure, funding gaps, and weak regulatory frameworks constrain progress and highlight opportunities for regional collaboration.</p><p><strong>Conclusion: </strong>As stem cell research advances, it is crucial to address ethical and regulatory considerations to ensure the responsible translation of these therapies into clinical practice. By integrating stem cell therapy with gene editing techniques and biomaterial scaffolding, the future of regenerative treatment for congenital hearing loss holds transformative potential.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"253-258"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of 3D Radiological Segmentation and Anatomical Parameters for Cochlear Implantation Electrode Insertion Depth Based on a Large Sample of Patients with Inner Ear Malformations.","authors":"Shujin Xue, Xingmei Wei, Ying Kong, Biao Chen, Zhencheng Gao, Chunling Ma, Yongxin Li","doi":"10.26599/JOTO.2025.9540040","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540040","url":null,"abstract":"<p><strong>Objective: </strong>The aims of this study were to investigate the clinical applicability of 3D segmentation in measuring cochlear anatomical parameters, explore factors that influence the insertion angle of cochlear implant electrodes in patients with inner ear malformations, and determine the value of 3D segmentation in predicting cochlear implant electrode insertion depth by simulating electrode implantation in a reconstructed 3D model.</p><p><strong>Methods: </strong>Data from 208 temporal bone CT scans of patients with a variety of inner ear malformations (including the CH, IP-I, IP-II, and IP-III types) who underwent cochlear implantation at our center were retrospectively analyzed. Preoperative temporal bone CT data were subjected to three-dimensional (3D) segmentation of the cochlea with a 3D slicer.</p><p><strong>Results: </strong>Cochlear malformation types, including IP types I (42 ears), II (278 ears), III (20 ears), and CH (65 ears), were diagnosed and measured in 208 preoperative CT datasets. Cochlear anatomical parameters and electrode length were correlated, which partially explained the variations in electrode insertion angle. The mean angle of implantation among the enrolled patients was 564.33°, and the mean implantation angle prediction error in the 3D segmentation was |23.74|°.</p><p><strong>Conclusion: </strong>Three-dimensional segmentation from temporal bone CT is valuable for surgeons, especially in treating patients with inner ear malformation. Such insights will help surgeons understand overall anatomical variations, predict electrode implantation depth, and complete preoperative imaging assessments for cochlear implant insertion depth in patients with inner ear malformations.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"259-267"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective visual vertical in first time seafarers experiencing sea sickness.","authors":"Bhaumik Patel, Deepika Tanwar, Sunil Goyal","doi":"10.26599/JOTO.2025.9540041","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540041","url":null,"abstract":"<p><strong>Objectives: </strong>Sea sickness, a form of motion sickness, is a common condition among sailors on various sailing vessels, primarily due to their roll and pitch movements. While the exact neurobiological mechanisms remain unclear, the most widely accepted explanation is the sensory conflict theory<b>,</b> which identifies two main sources of conflict: discrepancies between visual and vestibular inputs and conflicts within the vestibular system itself. This study aims to evaluate otolith-mediated verticality perception in first-time seafarers on board a naval frigate ship using the Subjective Visual Vertical (SVV) test.</p><p><strong>Methods: </strong>This observational study was conducted on board a naval frigate and involved two groups. The case group consisted of 50 newly recruited sailors experiencing their first sea voyage. The SVV test was conducted at three time points: prior to embarkation<b>,</b> during an active episode of sea sickness, and after disembarkation. A control group of 50 healthy, experienced sailors-regular seafarers with no history of vestibular symptoms underwent the same SVV testing at corresponding intervals. The results from both groups were collected and analyzed to assess changes in verticality perception related to sea exposure and sea sickness.</p><p><strong>Results: </strong>Analysis of the SVV test data from the 50 newly recruited sailors (case group) demonstrated a statistically significant difference compared to the control group of experienced sailors. During an active episode of sea sickness, the case group exhibited a notable tilt and deviation in SVV angles, indicating altered verticality perception. These deviations reduced significantly 24 hours post-disembarkation, suggesting an improvement in verticality perception once the motion stimulus was removed.</p><p><strong>Conclusion: </strong>This distinctive study assessed otolith-mediated verticality perception using the SVV test in first-time seafarers experiencing sea sickness aboard a naval frigate. Our findings emphasize the functional importance of the otolith organs in maintaining spatial orientation during maritime motion exposure. The observed SVV deviations support the subjective vertical conflict theory, highlighting the role of vestibular-visual mismatch in the development of sea sickness. However, our findings more likely reflect transient functional disturbance or overstimulation rather than a pre-existing utricular asymmetry alone. Based on the pattern of SVV deviation and recovery, we propose that the utricle may play a more significant role than the saccule in inducing sea sickness.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"268-273"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Changes in Free Triiodothyronine (FT3) and Their Correlation with Hearing Recovery in Sudden Sensorineural Hearing Loss: Clinical Implications.","authors":"Qianyou Zheng, Jing Wu, Ruihan Xia, Zhuangchenyang Wang, Qiuyang Zhu, Shaokang Ren, Xiaowen Zhang, Shenling Li, Tao Fu","doi":"10.26599/JOTO.2025.9540042","DOIUrl":"https://doi.org/10.26599/JOTO.2025.9540042","url":null,"abstract":"<p><strong>Objectives: </strong>Sudden sensorineural hearing loss (SSNHL) is a sudden onset condition of unknown etiology, often accompanied by tinnitus and vertigo, significantly affecting patients' quality of life. While some individuals experience spontaneous recovery, the unpredictability of treatment outcomes and potential complications pose clinical challenges. Recent studies suggest a potential link between thyroid hormone levels-particularly free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH)-and both the pathogenesis and prognosis of SSNHL. However, the precise mechanisms remain unclear. This study aims to investigate the correlation between thyroid hormone abnormalities and hearing recovery in SSNHL patients, providing insights to enhance diagnostic and therapeutic approaches.</p><p><strong>Methods: </strong>This prospective observational study included 66 SSNHL patients admitted to the Affiliated Hospital of Qingdao University between April 2024 and February 2025. Serum TSH and FT3 levels were measured using chemiluminescence immunoassay, while hearing function was evaluated through pure-tone audiometry following standard guidelines. The \"post-treatment hearing gap (PTHG)\" was introduced as a quantitative measure of treatment efficacy. All patients received comprehensive treatment, including glucocorticoid therapy and hyperbaric oxygen therapy, and were classified into effective and ineffective groups based on hearing recovery outcomes.</p><p><strong>Results: </strong>No significant differences in gender or comorbidities (tinnitus, ear fullness, dizziness) were observed between the abnormal thyroid function group (n = 45) and the normal thyroid function group (n = 21) (all p > 0.05). Similarly, initial TSH and FT3 levels did not differ significantly among patients with varying degrees of hearing impairment (mild, moderate, severe) (p > 0.05). However, during treatment, ΔFT3 demonstrated a significant negative correlation with PTHG (r = -0.739, p = 0.002), suggesting that a greater increase in ΔFT3 is associated with improved hearing recovery. Additionally, TSH levels showed a significant positive correlation with ΔFT3 (p < 0.05).</p><p><strong>Conclusions: </strong>Abnormal thyroid function in SSNHL patients was not associated with the severity of hearing loss. However, dynamic changes in FT3 during treatment showed a significant correlation with therapeutic efficacy, suggesting that monitoring ΔFT3 may have clinical value in prognostic assessment. Nonetheless, this study had a limited sample size, and the potential influence of hormone therapy on thyroid function was not accounted for. Therefore, the role of thyroid hormones in SSNHL warrants further validation through large-scale prospective studies and mechanistic investigations.</p>","PeriodicalId":94336,"journal":{"name":"Journal of otology","volume":"20 4","pages":"274-280"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}