Neuromuscular Disorders最新文献

{"title":"220VP Wearable sensors to evaluate and monitor neuromuscular patients in real world environment","authors":"E. Diella ,&nbsp;F. Storm ,&nbsp;L. Molteni ,&nbsp;M. Delle Fave ,&nbsp;G. Canella ,&nbsp;G. Meola ,&nbsp;E. Biffi ,&nbsp;M. D'Angelo","doi":"10.1016/j.nmd.2024.07.071","DOIUrl":"10.1016/j.nmd.2024.07.071","url":null,"abstract":"<div><div>Wearable sensors are becoming increasingly popular for complementing standard clinical assessments of gait deficits and for remote monitoring patient's motor function in real world. Monitoring gait during the 6MWT offers an opportunity to investigate the dynamic changes that occur in prolonged walking. Besides, continuous monitoring at home gives information on patient's daily physical activity. Our first aim is to determine if gait parameters worsen during sustained walking in patients affected by myotonic dystrophy (MD). Our secondary aim is to evaluate the feasibility of acquiring physical activity biomarkers in daily living conditions. We collected data of 30 patients with MD during a standard 6MWT wearing a sensor (GSensor, BTS) at L5 level. Gait parameters were extracted from raw signals, corresponding to early, middle and late segments of the 6MWT and we applied non-parametric tests to compare gait segments. Home monitoring for extraction of physical activity data will be performed using a wearable sensor (DynaPort 7, McRoberts) worn consecutively for 7-days. Preliminary results show an increase in gait acceleration and significant changes in smoothness and stability of gait in the MD group between the early and the late section of the 6MWT. Our preliminary results suggest that gait parameters associated to fatigability can be measured during a 6MWT using a wearable device and that the method allows to highlight variations during sections of the 6MWT in patients with MD. Evaluating patients with a neuromuscular disease in their ecologic setting could significantly impact rehabilitation management with the aim of promoting an active lifestyle.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.62"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"222P Development of a standardized information model for rare neuromuscular diseases","authors":"E. Gazzerro ,&nbsp;M. Hübner ,&nbsp;E. Nyoungui ,&nbsp;D. Krefting ,&nbsp;S. Spuler ,&nbsp;J. Zschüntzsch ,&nbsp;J. Schepers ,&nbsp;R. Röttger","doi":"10.1016/j.nmd.2024.07.073","DOIUrl":"10.1016/j.nmd.2024.07.073","url":null,"abstract":"<div><div>New promising genetic and cell-based therapeutic approaches are becoming a reality for untreatable neuromuscular disorders. However, their effective translation to clinical practice is impeded by various challenges, including delays in precise genetic diagnosis, heterogeneous guidelines for longitudinal monitoring, inconsistent capture of Patients-Reported Outcome Measures, documentation of data in incompatible formats and disparate data documentation practices across countries. Leveraging methods like machine learning and AI-based algorithms for diagnostics and post-marketing surveillance necessitate organized and standardized data. In this study, we aimed to create a comprehensive, standardized information model for clinical data, facilitating research and international collaboration efforts. The documentation addresses: 1. Easy and coherent access to clinical, genetic, functional, histological data and imaging findings with the use of branching logic for data capture, minimizing documentation effort 2. Data comparability and international application through coding using the international terminology SNOMED CT and HPO terms 3. User-friendly data collection and subsequent analysis regardless of linguistic differences through the development of value sets with frequent values for the individual data elements 4. Documentation of negative findings and exclusions 5. Possibility of implementation in different systems and environments, thus guaranteeing comparability of the data. Embracing digital health technologies paves the way for streamlining data capture, facilitating knowledge sharing, improving interoperability between electronic health record systems. Addressing the challenges requires consideration of the complex nature of neuromuscular diseases, collaboration among stakeholders, iterative refinement of the information model, enhancement of interoperability and incorporation of innovative solutions such as patient engagement strategies and digital health technologies.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.64"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"227P Advancing neuromuscular education and care within physiotherapy: POD-NMD (Physiotherapy Online Delivery - Neuromuscular Diseases)","authors":"C. Slim ,&nbsp;D. Allison ,&nbsp;A. Mayhew","doi":"10.1016/j.nmd.2024.07.078","DOIUrl":"10.1016/j.nmd.2024.07.078","url":null,"abstract":"<div><div>Providing physiotherapists with updated knowledge and developments in neuromuscular conditions is crucial as advancements in therapies progress. POD-NMD therefore aims to:<ul><li><span>•</span><span><div>Deliver a digital suite of curated, educational resources for physiotherapists seeking the best management strategies for their patients.</div></span></li><li><span>•</span><span><div>Upskill physiotherapists to reliably deliver functional assessments and accurately record outcome measures.</div></span></li><li><span>•</span><span><div>Raise awareness of the additional care needs and concerns amongst patients and identify strategies that support patient independence with dignity.</div></span></li><li><span>•</span><span><div>Provide greater visibility of physiotherapy training achievements and understanding of user profiles via platform analytics.</div></span></li><li><span>•</span><span><div>Foster new and international collaborations to share best practice opportunities across borders.</div></span></li></ul></div><div>Launched in December 2023, POD-NMD replaced the existing OPENTACT website and additionally introduced POD-LMS, an e-learning platform with thirteen interactive courses that generate certificates and digital badges for professional CPD portfolios. The POD-NMD steering group oversees progress, ensuring alignment with the evolving educational needs for therapists within NMD communities. Partnerships are key to delivering high-quality resources and collaborations for 2024 have included the development of continence care resources (HAP-PEE) with the Danish Rehabilitation Centre for Neuromuscular Diseases for use amongst both physiotherapists and patients. In addition to this, collaborations with NHS Greater Glasgow &amp; Clyde have developed resources on Falls Management and Timed Tests, as well as an interactive e-learning module for therapists performing the North Star Ambulatory Assessment with Duchenne patients. Consequently, within the first three months of launching, POD-NMD garnered over 4,200 visits and 11,400 page views, with 27% of the viewership originating from regions beyond Europe and North America.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.69"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"268P Age and sex affect human skeletal muscle secretome.","authors":"B. Crisol ,&nbsp;N. Pinzon ,&nbsp;J. Orio ,&nbsp;L. Gaut-Serey ,&nbsp;J. Ohana ,&nbsp;M. Bensalah ,&nbsp;C. Peterson ,&nbsp;G. Butler-Browne ,&nbsp;V. Mouly ,&nbsp;A. Bigot ,&nbsp;C. Trollet","doi":"10.1016/j.nmd.2024.07.086","DOIUrl":"10.1016/j.nmd.2024.07.086","url":null,"abstract":"<div><div>Aging is a gradual decline in physiological well-being, resulting in diminished tissue functionality. During aging, skeletal muscle strength and mass decrease and this is accompanied by a decrease in regenerative capacity. Muscle is a secretory organ capable of regulating its own function and/or influencing the activity of other tissues via myokines. In this context, how muscle secretion is modified during aging and how this affects muscle regeneration and homeostasis is still not known. Here, combining bioinformatic analysis and in vitro experiments we have identified alterations in the secretome of human muscle cells during aging. We have analyzed the medium of differentiated muscle cells isolated from muscles of young and old human subjects by proteomic approaches and we have identified 127 proteins differentially secreted between the young and old samples. The old cells presented already known aging phenotypes, as increased in the lipids stock, defect in differentiation and impaired mitochondrial function. Interestingly, more proteins are increasingly secreted upon aging than less secreted, suggesting that old cells adapt to aging mainly by modifying its secretion. In parallel, it is known that men and women respond differently to muscle aging and present different DNA methylation and gene expression profiles. Here we also identified that the secreted proteins were also affected by the sex-bias, especially in the young donors’ samples. Using in silico transcriptome analyses from men and women using the Genotype-Tissue Expression study of young adults (12 females and 30 males) and older adults (6 females and 12 males) we observed that besides age, sex acts as a major source of variation in the muscle transcriptome. Taking sex as an important factor, we identified in our data that sex affects muscle secretome, but not muscle proteome. Altogether, these results suggest that aging and sex difference have major effects in the muscle secretome and now we aim to identify specific targets to reduce the effects of muscle aging in the elderly, by testing in vitro the proteins of interest identified in the muscle secretome.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.77"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"214P The 10-meter model: predicting the 6-minute walk test in Pompe disease","authors":"A. El Kaim,&nbsp;F. Fer,&nbsp;J. Hogrel","doi":"10.1016/j.nmd.2024.07.065","DOIUrl":"10.1016/j.nmd.2024.07.065","url":null,"abstract":"<div><div>The 6-Minute Walk Test (6MWT) is a widely used outcome measure to evaluate functional exercise capacity in patients with Pompe disease, a rare genetic disorder that severely impairs muscular and respiratory function. Despite its extensive use, the test can be particularly challenging for some patients due to the considerable effort it requires. This retrospective study aimed to analyze data acquired during the follow-up of 203 patients with Pompe disease across 1481 complete visits. Correlation analyses and stepwise regressions were performed to test the associations between variables. Each of the visits potentially included the 6MWT, the 10-meter walk test (10mWT), the Motor Function Measure (MFM-32), the maximum voluntary isometric contraction (MVIC) in extension and flexion of knee (KE/KF) and elbow (EE/EF), timed tests as chair stand time (CST), and pulmonary functional tests (PFT) such as functional vital capacity (FVC), maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP). Clinical and anthropometric data were also collected. Pearson's correlation analysis was utilized to construct a correlation matrix and test associations with the 6MWT. Variables that showed a significant strong correlation with the 6MWT underwent a regression analysis using a subset comprising one-third of the data (training phase) to propose predictive equation to calculate the theoretical 6MWT speed. Validation was performed on the two-thirds of the data. Three models were developed based on the analysis. The single parameter model included only the 10mWT speed, which was the variable most correlated with the 6MWT speed (ρ = 0.85), yielding a R² of 0.70. The five-parameter model incorporated anthropometric variables as age and sex and the CST and knee flexion (KF) to increase prediction, increase the predictive accuracy (adjusted R²=0.78). The Six parameter model. A model more complete including 10mWT, age, sex, CST, KF and MFM was validated with an adjusted R² of 0.83. The 6-Minute Walk Test can be challenging for some patients with neuromuscular diseases due to their substantial fatigue. Simpler and less tiring alternatives, such as the 10-Meter Walk Test, or models combining standard clinical assessments, may be better options to reliably evaluate the functional capacity of these patients in a manner suited to their condition. The adoption of appropriate assessment tools is essential to monitor the progression of these complex diseases and guide management strategies effectively.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.56"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scientific Title Page","authors":"","doi":"10.1016/S0960-8966(24)00954-4","DOIUrl":"10.1016/S0960-8966(24)00954-4","url":null,"abstract":"","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104458"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"206P A quality improvement proposal: improving care management of complex neuromuscular patients – establishing a neuromuscular complex care centre as part of the translational neuromuscular pathway","authors":"C. Marini Bettolo,&nbsp;K. Wong,&nbsp;S. Segovia,&nbsp;R. Muni Lofra,&nbsp;M. Elseed","doi":"10.1016/j.nmd.2024.07.057","DOIUrl":"10.1016/j.nmd.2024.07.057","url":null,"abstract":"<div><div>Patients with complex neuromuscular diseases require multidisciplinary care which results in multiple outpatient hospital appointments. The lack of coordination may result in unnecessary unplanned admissions and delay in timely care provision. The multiple hospital appointments add to the burden of care for patients and their caregivers and may have an impact on QoL and participation in ADLs. One-stop shop model of care has been implemented in other centres and proven to be a successful model for neuromuscular patients. We aim to establish a Neuromuscular Complex Care Day Unit for multidisciplinary management of neuromuscular patients from North East and Cumbria in England where Standards of Care appointments will be scheduled over a 1-2 day admission. We applied quality improvement methodology to demonstrate the necessity and impact of this service improvement proposal. Driver diagrams helped plan and structure the initiative, identifying change ideas that will be implemented using PDSA cycles. To measure the effects of this proposal we defined 1) Outcome measures: completion of care pathway and patient experience; 2) Process measures: identification of complex patients; 3) Balance measures: rate of fail to attend and unplanned admissions. A survey (PDSA cycle 1) circulated nationally to patients with neuromuscular diseases and their caregivers: 107 patients and care givers took part in the survey. Patients on average attend 4.7 specialist appointments a year. 19% of patients have had an unplanned hospital admission in the last 12 months. 45.8% of patients report that their physiotherapy needs are not met in the community. On average 37.4 % of patients travel 30-60 minutes to attend their clinic appointment. 69.8% of patients and 48.1 % of parent/care givers prefer to have their neuromuscular care appointments scheduled over one day. 80% of patients would be keen to attend such a unit, should this be available to them. Overall, the survey showed patients are supportive of such a model of care and allowed us to better shape this initiative to meet their needs. We are carrying out stakeholder engagement meetings (PDSA cycle 2) to gather feedback. We are also collecting data retrospectively on patients‘ attendance to appointments with other MDTs involved. Based on these results we will establish criteria for patients entering the pathway and refine the proposed model of care for the business case.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.48"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"121P Insulin resistance and liver fibrosis and -steatosis in adult patients with spinal muscular atrophy","authors":"N. Receveur ,&nbsp;S. Frølich ,&nbsp;N. Scharff Poulsen ,&nbsp;C. Ewertsen ,&nbsp;A. Espe Hansen ,&nbsp;J. Vissing","doi":"10.1016/j.nmd.2024.07.028","DOIUrl":"10.1016/j.nmd.2024.07.028","url":null,"abstract":"<div><div>Spinal muscular atrophy (SMA) is an autosomal neuromuscular disorder affecting the motor neurons of the spinal cord. Many patients with SMA struggle with their low weight, leading to recommendations by clinicians to eat a high-fat diet. Further, patients are advised to avoid exercise to prevent muscle damage. These factors expose the patients to metabolic complications. In fact, prior studies have found higher rates of insulin resistance, dyslipidemia, and liver involvement in patients with SMA, which could be caused by inactivity, diet, and metabolic factors. Former studies on insulin resistance and dyslipidemia have focused on children and adolescents; therefore, the prevalence amongst adult patients is unknown. The few studies investigating the liver have examined children and mice, and none have used MR-elastography (MRE). This study is the first to investigate insulin resistance and liver fibrosis and -steatosis in adult patients with SMA, and to investigate their liver involvement using MRE. The study is a cross-sectional study. We hope to include 24 patients with SMA type II-III from different age groups and sex. First, the insulin resistance will be estimated with the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) using the glucose and insulin levels. Lipid levels will be measured. Secondly, a Dixon MRI of the liver, MRE, and a liver ultrasound will be performed to evaluate the liver size and degree of fibrosis and steatosis. The study is ongoing and expected to end in the Summer of 2024. Results will be presented at the conference.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.19"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"115P MRI of whole-body muscles and tongue of patients with Spinal Muscular Atrophy","authors":"S. Froelich ,&nbsp;N. Receveur ,&nbsp;N. Scharff Poulsen ,&nbsp;A. Espe Hansen ,&nbsp;J. Vissing","doi":"10.1016/j.nmd.2024.07.022","DOIUrl":"10.1016/j.nmd.2024.07.022","url":null,"abstract":"<div><div>Patients with spinal muscular atrophy (SMA) have an autosomal recessive motor neuron disorder that causes their muscles to degenerate. The muscle affection is visible on MRI as progressive muscle atrophy and increased intramuscular fat content. Multiple studies have shown increased intramuscular fat fraction in sections of the body. The bulbar function can also be affected but is not well documented with MRI or functional tests. This study is the first to describe the intramuscular fat fraction of the whole body from the tongue, axial muscles, and arm muscles to muscles of the thigh and calf and to correlate MRI findings of the tongue to bulbar function. The study is a cross-sectional study. We hope to include 24 patients with SMA type II-III and investigate them with MRI T1- and Dixon-imaging, motor function measure 32 (MFM32), lung function, the bulbar rating scale, a timed swallowing test, and questionnaires on swallowing and talking. We will make a heatmap of the involved muscles and correlate the findings to the type of SMA, number of survival motor neuron 2-copies, MFM32 score, and questionnaires. The study is ongoing and expected to end in the Summer of 2024. Results will be presented at the conference.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.13"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"120P Diagnostic delay in Korean adults with spinal muscular atrophy","authors":"S. Kim ,&nbsp;Y. Choi ,&nbsp;J. Cho ,&nbsp;Y. Choi ,&nbsp;H. Park","doi":"10.1016/j.nmd.2024.07.027","DOIUrl":"10.1016/j.nmd.2024.07.027","url":null,"abstract":"<div><div>Spinal muscular atrophy (SMA) is an autosomal recessive genetic disease characterized by the loss of motor neurons in the spinal cord and brainstem, leading to muscle atrophy and weakness. To understand the diagnostic process of Korean patients with SMA, we analyzed their clinical characteristics and challenges. We conducted a retrospective study of 38 patients with SMA (9 type II and 29 type III) between January 2000 and September 2023. Clinical, laboratory, and genetic data were reviewed. The median ages at symptom onset and diagnosis were 3.0 years [interquartile range: 1.0–7.3 years] and 25.0 years [interquartile ranges: 10.5–37.3 years], respectively. The median diagnostic delay was 19.6 years [interquartile range: 6.4–31.0]. A significantly longer delay was observed in SMA type III patients (median: 21.0 years, interquartile range: 11.0–31.0) compared to SMA type II patients (median: 3.0 years, interquartile range: 0.9–12.9 years) (p=0.006). No significant difference was observed in the number of clinic visits before diagnosis between patients with SMA type II (median: 2.0, interquartile range: 1.0–4.5) and type III (median: 2.0, interquartile range: 2.0–6.0, p=0.282). The number of clinic visits before diagnosis showed no significant association with the age at symptom onset and diagnosis (p=0.998 and 0.291, respectively). Our investigation is the first examination of the diagnostic journey of Korean patients with SMA. As treatments for SMA progress, the significance of an accurate diagnosis has increased, highlighting the importance of reviewing the diagnostic advancements made thus far.</div></div>","PeriodicalId":19135,"journal":{"name":"Neuromuscular Disorders","volume":"43 ","pages":"Article 104441.18"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}