Pub Date : 2024-04-08DOI: 10.14309/ajg.0000000000002796
A. Barritt, Feng Yu, Andrea R. Mospan, Philip Newsome, M. Roden, Heather L Morris, R. Loomba, B. Neuschwander‐Tetri
INTRODUCTION This study investigates the applicability of the new MASLD nomenclature to the real-world TARGET-NASH US adult cohort. METHODS The new MASLD/MASH nomenclature was applied to patients enrolled with pragmatic diagnoses of NAFL, NASH and NASH cirrhosis and concordance was determined between the definitions. RESULTS 99% of TARGET-NASH participants met the new MASLD diagnostic criteria. 1484/1541 (96.3%, kappa 0.974) NAFL patients (MASL), 2195/2201 (99.7%, kappa 0.998) NASH patients (MASH), and 1999/2003 (99.8%, kappa 0.999) NASH cirrhosis patients met the new criteria. CONCLUSION The new MASLD nomenclature is highly concordant with the prior TARGET-NASH pragmatic definitions.
{"title":"High concordance between nonalcoholic fatty liver disease and metabolic dysfunction associated steatotic liver disease in the TARGET-NASH real world cohort.","authors":"A. Barritt, Feng Yu, Andrea R. Mospan, Philip Newsome, M. Roden, Heather L Morris, R. Loomba, B. Neuschwander‐Tetri","doi":"10.14309/ajg.0000000000002796","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002796","url":null,"abstract":"INTRODUCTION\u0000This study investigates the applicability of the new MASLD nomenclature to the real-world TARGET-NASH US adult cohort.\u0000\u0000\u0000METHODS\u0000The new MASLD/MASH nomenclature was applied to patients enrolled with pragmatic diagnoses of NAFL, NASH and NASH cirrhosis and concordance was determined between the definitions.\u0000\u0000\u0000RESULTS\u000099% of TARGET-NASH participants met the new MASLD diagnostic criteria. 1484/1541 (96.3%, kappa 0.974) NAFL patients (MASL), 2195/2201 (99.7%, kappa 0.998) NASH patients (MASH), and 1999/2003 (99.8%, kappa 0.999) NASH cirrhosis patients met the new criteria.\u0000\u0000\u0000CONCLUSION\u0000The new MASLD nomenclature is highly concordant with the prior TARGET-NASH pragmatic definitions.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140731133","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}
Pub Date : 2024-04-08DOI: 10.14309/ajg.0000000000002791
S. L. Gold, A. Kornbluth
{"title":"The Role of the Gastroenterologist in Obesity Management: Now Is the Right Time for Our Involvement.","authors":"S. L. Gold, A. Kornbluth","doi":"10.14309/ajg.0000000000002791","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002791","url":null,"abstract":"","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140729939","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}
OBJECTIVE Investigate whether increased IPFD heightens the risk of diseases of the exocrine and endocrine pancreas. METHODS A prospective cohort study was conducted using data from the UK Biobank. IPFD was quantified using MRI and a deep learning-based framework called nnUNet. The prevalence of fatty change of the pancreas (FP) was determined using gender- and age-specific thresholds. Associations between IPFD and pancreatic diseases were assessed with multivariate Cox proportional hazard model adjusted for age, sex, ethnicity, body mass index, smoking and drinking status, central obesity, hypertension, dyslipidemia, liver fat content, and spleen fat content. RESULTS Of the 42,599 participants included in the analysis, the prevalence of FP was 17.86%. Elevated IPFD levels were associated with an increased risk of acute pancreatitis (AP) (HR per one quintile change [95%CI]: 1.513 [1.179-1.941]), pancreatic cancer (PC) (HR per one quintile change [95%CI]: 1.365 [1.058-1.762]) and diabetes mellitus (DM) (HR per one quintile change [95%CI]: 1.221 [1.132-1.318]). FP was also associated with a higher risk of AP (HR [95%CI]: 3.982 [2.192-7.234]), PC (HR [95%CI]: 1.976 [1.054-3.704]), and DM (HR [95%CI]: 1.337 [1.122-1.593], P=0.001). CONCLUSIONS FP is a common pancreatic disorder. Fat in the pancreas is an independent risk factor for diseases of both the exocrine pancreas and endocrine pancreas.
{"title":"Associations of intra-pancreatic fat deposition with incident diseases of the exocrine and endocrine pancreas: A UK Biobank prospective cohort study.","authors":"Xiaowu Dong, Qingtian Zhu, Chenchen Yuan, Yaodong Wang, Xiaojie Ma, Xiaolei Shi, Weiwei Chen, Zhao Dong, Lin Chen, Qinhao Shen, Hongwei Xu, Yanbing Ding, Weijuan Gong, W. Xiao, Shengfeng Wang, Weiqin Li, Guotao Lu","doi":"10.14309/ajg.0000000000002792","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002792","url":null,"abstract":"OBJECTIVE\u0000Investigate whether increased IPFD heightens the risk of diseases of the exocrine and endocrine pancreas.\u0000\u0000\u0000METHODS\u0000A prospective cohort study was conducted using data from the UK Biobank. IPFD was quantified using MRI and a deep learning-based framework called nnUNet. The prevalence of fatty change of the pancreas (FP) was determined using gender- and age-specific thresholds. Associations between IPFD and pancreatic diseases were assessed with multivariate Cox proportional hazard model adjusted for age, sex, ethnicity, body mass index, smoking and drinking status, central obesity, hypertension, dyslipidemia, liver fat content, and spleen fat content.\u0000\u0000\u0000RESULTS\u0000Of the 42,599 participants included in the analysis, the prevalence of FP was 17.86%. Elevated IPFD levels were associated with an increased risk of acute pancreatitis (AP) (HR per one quintile change [95%CI]: 1.513 [1.179-1.941]), pancreatic cancer (PC) (HR per one quintile change [95%CI]: 1.365 [1.058-1.762]) and diabetes mellitus (DM) (HR per one quintile change [95%CI]: 1.221 [1.132-1.318]). FP was also associated with a higher risk of AP (HR [95%CI]: 3.982 [2.192-7.234]), PC (HR [95%CI]: 1.976 [1.054-3.704]), and DM (HR [95%CI]: 1.337 [1.122-1.593], P=0.001).\u0000\u0000\u0000CONCLUSIONS\u0000FP is a common pancreatic disorder. Fat in the pancreas is an independent risk factor for diseases of both the exocrine pancreas and endocrine pancreas.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140728811","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}
Pub Date : 2024-04-08DOI: 10.14309/ajg.0000000000002798
K. Vantanasiri, Abel Joseph, Karan Sachdeva, Rohit Goyal, Nikita Garg, D. Adoor, A. Kamboj, D. Codipilly, C. Leggett, Kenneth K. Wang, William Harmsen, Umar Hayat, Amitabh Chak, Amit Bhatt, Prasad G. Iyer
BACKGROUND Endoscopic eradication therapy (EET) combining endoscopic resection (ER) with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) followed by ablation is the standard of care for the treatment of dysplastic Barrett's esophagus (BE). We have previously shown comparable rates of complete remission of intestinal metaplasia (CRIM) with both approaches. However, data comparing recurrence after CRIM are lacking. We compared rates of recurrence after CRIM with both techniques in a multicenter cohort. METHODS Patients undergoing EET achieving CRIM at 3 academic institutions were included. Demographic and clinical data were abstracted. Outcomes included rates and predictors of any BE and dysplastic BE recurrence in the two groups. Cox proportional hazards models and inverse probability treatment weighting (IPTW) analysis were utilized for analysis. RESULTS 621 patients (514 EMR, 107 ESD) achieving CRIM were included in the recurrence analysis. The incidence of any BE (15.7, 5.7 per 100 patient years) and dysplastic BE recurrence (7.3, 5.3 per 100 patient-years) were comparable in the EMR and ESD groups, respectively. On multivariable analyses, the chances of BE recurrence were not influenced by ER technique (HR, 0.87; 95% CI, 0.51-1.49; p= 0.62), which was also confirmed by IPTW analysis (ESD vs EMR: HR, 0.98; 95% CI, 0.56-1.73; p= 0.94). BE length, lesion size, and history of cigarette smoking were independent predictors of BE recurrence. CONCLUSIONS Patients with BE dysplasia/neoplasia achieving CRIM, initially treated with EMR/ablation had comparable recurrence rates to ESD/ablation. Randomized trials are needed to confirm these outcomes between the two ER techniques.
{"title":"Rates of Recurrent Intestinal Metaplasia and Dysplasia After Successful Endoscopic Therapy of Barrett's Neoplasia by EMR vs ESD and Ablation: A Large North American Multicenter Cohort.","authors":"K. Vantanasiri, Abel Joseph, Karan Sachdeva, Rohit Goyal, Nikita Garg, D. Adoor, A. Kamboj, D. Codipilly, C. Leggett, Kenneth K. Wang, William Harmsen, Umar Hayat, Amitabh Chak, Amit Bhatt, Prasad G. Iyer","doi":"10.14309/ajg.0000000000002798","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002798","url":null,"abstract":"BACKGROUND\u0000Endoscopic eradication therapy (EET) combining endoscopic resection (ER) with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) followed by ablation is the standard of care for the treatment of dysplastic Barrett's esophagus (BE). We have previously shown comparable rates of complete remission of intestinal metaplasia (CRIM) with both approaches. However, data comparing recurrence after CRIM are lacking. We compared rates of recurrence after CRIM with both techniques in a multicenter cohort.\u0000\u0000\u0000METHODS\u0000Patients undergoing EET achieving CRIM at 3 academic institutions were included. Demographic and clinical data were abstracted. Outcomes included rates and predictors of any BE and dysplastic BE recurrence in the two groups. Cox proportional hazards models and inverse probability treatment weighting (IPTW) analysis were utilized for analysis.\u0000\u0000\u0000RESULTS\u0000621 patients (514 EMR, 107 ESD) achieving CRIM were included in the recurrence analysis. The incidence of any BE (15.7, 5.7 per 100 patient years) and dysplastic BE recurrence (7.3, 5.3 per 100 patient-years) were comparable in the EMR and ESD groups, respectively. On multivariable analyses, the chances of BE recurrence were not influenced by ER technique (HR, 0.87; 95% CI, 0.51-1.49; p= 0.62), which was also confirmed by IPTW analysis (ESD vs EMR: HR, 0.98; 95% CI, 0.56-1.73; p= 0.94). BE length, lesion size, and history of cigarette smoking were independent predictors of BE recurrence.\u0000\u0000\u0000CONCLUSIONS\u0000Patients with BE dysplasia/neoplasia achieving CRIM, initially treated with EMR/ablation had comparable recurrence rates to ESD/ablation. Randomized trials are needed to confirm these outcomes between the two ER techniques.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140731211","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}
Pub Date : 2024-04-08DOI: 10.14309/ajg.0000000000002799
M. E. Cook, Niels Henrik Bruun, Line Davidsen, P. Vestergaard, A. M. Drewes, S. S. Olesen
OBJECTIVES To investigate the risk of metabolic sequelae and all-cause mortality in a population-based cohort of chronic pancreatitis (CP) patients with and without prior acute pancreatitis (AP). METHODS We used nationwide health registries to identify all Danish residents (>18 years) with incident CP from 2000-2018. Information on AP/CP diagnoses, metabolic sequelae (post-pancreatitis diabetes mellitus (PPDM), exocrine pancreatic dysfunction (EPD), and osteoporosis), and all-cause mortality were obtained from Danish national health registries. CP cases were stratified based on the presence of AP prior to CP diagnosis. The risk of metabolic sequelae and all-cause mortality was expressed as hazard ratios (HRs) with 95% confidence intervals (CIs), calculated using multivariate Cox proportional hazards models. RESULTS A total of 9655 CP patients were included. Among CP patients, 3913 (40.5%) had a prior AP diagnosis. Compared to patients without a history of AP, patients with prior AP had a decreased risk of death (HR 0.79 (95% CI, 0.74-0.84)), which was largely confined to the initial period after CP diagnosis. Patients with prior AP had an increased risk of PPDM (HR 1.53 (95% CI, 1.38-1.69)), which persisted for up to a decade after CP diagnosis. No overall differences in risk were observed for EPD (HR 0.97 (95% CI, 0.87-1.07)) and osteoporosis (HR 0.87 (95% CI, 0.74-1.02)). CONCLUSIONS This nationwide study revealed that the majority of CP patients have no prior episode(s) of AP, indicating that an attack of AP sensitizing the pancreas is not essential for CP development. CP patients with and without prior AP have different risk profiles of PPDM and all-cause mortality.
{"title":"Metabolic Sequelae and All-Cause Mortality in Chronic Pancreatitis With and Without Prior Acute Pancreatitis: A Nationwide Population-Based Cohort Study.","authors":"M. E. Cook, Niels Henrik Bruun, Line Davidsen, P. Vestergaard, A. M. Drewes, S. S. Olesen","doi":"10.14309/ajg.0000000000002799","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002799","url":null,"abstract":"OBJECTIVES\u0000To investigate the risk of metabolic sequelae and all-cause mortality in a population-based cohort of chronic pancreatitis (CP) patients with and without prior acute pancreatitis (AP).\u0000\u0000\u0000METHODS\u0000We used nationwide health registries to identify all Danish residents (>18 years) with incident CP from 2000-2018. Information on AP/CP diagnoses, metabolic sequelae (post-pancreatitis diabetes mellitus (PPDM), exocrine pancreatic dysfunction (EPD), and osteoporosis), and all-cause mortality were obtained from Danish national health registries. CP cases were stratified based on the presence of AP prior to CP diagnosis. The risk of metabolic sequelae and all-cause mortality was expressed as hazard ratios (HRs) with 95% confidence intervals (CIs), calculated using multivariate Cox proportional hazards models.\u0000\u0000\u0000RESULTS\u0000A total of 9655 CP patients were included. Among CP patients, 3913 (40.5%) had a prior AP diagnosis. Compared to patients without a history of AP, patients with prior AP had a decreased risk of death (HR 0.79 (95% CI, 0.74-0.84)), which was largely confined to the initial period after CP diagnosis. Patients with prior AP had an increased risk of PPDM (HR 1.53 (95% CI, 1.38-1.69)), which persisted for up to a decade after CP diagnosis. No overall differences in risk were observed for EPD (HR 0.97 (95% CI, 0.87-1.07)) and osteoporosis (HR 0.87 (95% CI, 0.74-1.02)).\u0000\u0000\u0000CONCLUSIONS\u0000This nationwide study revealed that the majority of CP patients have no prior episode(s) of AP, indicating that an attack of AP sensitizing the pancreas is not essential for CP development. CP patients with and without prior AP have different risk profiles of PPDM and all-cause mortality.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140731057","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}
Pub Date : 2024-04-05DOI: 10.14309/ajg.0000000000002790
Gabriela Leite, G. Barlow, Mohamad Rashid, Ava Hosseini, D. Cohrs, Gonzalo Parodi, W. Morales, S. Weitsman, A. Rezaie, Mark Pimentel, R. Mathur
OBJECTIVES Gut microbiome changes are linked to obesity, but findings are based on stool data. Here, we analyzed the duodenal microbiome and serum biomarkers in subjects with normal weight, overweight, and obesity. METHODS Duodenal aspirates and serum samples were obtained from subjects undergoing standard-of-care esophagogastroduodenoscopy without colon preparation. Aspirate DNAs were analyzed by 16S rRNA and shotgun sequencing. Predicted microbial metabolic functions and serum levels of metabolic and inflammatory biomarkers were also assessed. RESULTS Subjects with normal weight (N=105), overweight (N=67) and obesity (N=42) were identified. Overweight-specific duodenal microbial features include lower relative abundance (RA) of Bifidobacterium species and Escherichia coli strain K-12, and higher Lactobacillus intestinalis, L. johnsoni, and Prevotella loeschii RA. Obesity-specific features include higher Lactobacillus gasseri RA and lower L. reuteri (subspecies rodentium), Alloprevotella rava and Leptotrichia spp RA. Escalation features (progressive changes from normal weight through obesity) include decreasing Bacteroides pyogenes, Staphylococcus hominis, and unknown Faecalibacterium species RA, increasing RA of unknown Lactobacillus and Mycobacterium species, and decreasing microbial potential for biogenic amines metabolism. De-escalation features (direction of change altered in normal-to-overweight and overweight-to-obesity) include Lactobacillus acidophilus, L. hominis, L. iners, and Bifidobacterium dentium. An unknown Lactobacillus species is associated with Type IIa dyslipidemia and overweight, whereas Alloprevotella rava is associated with Type IIb and IV dyslipidemias. CONCLUSIONS Direct analysis of the duodenal microbiome has identified key genera associated with overweight and obesity, including some previously identified in stool, e.g. Bifidobacterium and Lactobacillus. Specific species and strains exhibit differing associations with overweight and obesity, including escalation and de-escalation features that may represent targets for future study and therapeutics.
目的肠道微生物组的变化与肥胖有关，但研究结果基于粪便数据。在此，我们分析了体重正常、超重和肥胖受试者的十二指肠微生物组和血清生物标志物。方法从接受标准食管胃十二指肠镜检查的受试者处获取十二指肠吸出物和血清样本，无需进行结肠制备。采用 16S rRNA 和枪式测序法对吸出物 DNA 进行分析。结果确定了体重正常（105 人）、超重（67 人）和肥胖（42 人）的受试者。超重特异性十二指肠微生物特征包括双歧杆菌和大肠埃希氏菌株K-12相对丰度（RA）较低，肠乳杆菌、约翰逊乳杆菌和loeschii普雷沃特氏菌RA较高。肥胖特异性特征包括较高的 Lactobacillus gasseri RA 和较低的 L. reuteri（亚种 rodentium）、Alloprevotella rava 和 Leptotrichia spp RA。升级特征（从正常体重到肥胖的渐进变化）包括化脓性乳杆菌、人葡萄球菌和未知粪杆菌RA的减少，未知乳杆菌和分枝杆菌RA的增加，以及生物胺代谢微生物潜能的降低。降级特征（从正常到超重和从超重到肥胖的变化方向改变）包括嗜酸乳杆菌、人乳杆菌、猪乳杆菌和双歧杆菌。一种未知的乳酸杆菌与 IIa 型血脂异常和超重有关，而 Alloprevotella rava 与 IIb 型和 IV 型血脂异常有关。特定菌种和菌株与超重和肥胖有不同的关联，包括升级和降级特征，这可能是未来研究和治疗的目标。
{"title":"Characterization of the Small Bowel Microbiome Reveals Different Profiles in Human Subjects who are Overweight or have Obesity.","authors":"Gabriela Leite, G. Barlow, Mohamad Rashid, Ava Hosseini, D. Cohrs, Gonzalo Parodi, W. Morales, S. Weitsman, A. Rezaie, Mark Pimentel, R. Mathur","doi":"10.14309/ajg.0000000000002790","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002790","url":null,"abstract":"OBJECTIVES\u0000Gut microbiome changes are linked to obesity, but findings are based on stool data. Here, we analyzed the duodenal microbiome and serum biomarkers in subjects with normal weight, overweight, and obesity.\u0000\u0000\u0000METHODS\u0000Duodenal aspirates and serum samples were obtained from subjects undergoing standard-of-care esophagogastroduodenoscopy without colon preparation. Aspirate DNAs were analyzed by 16S rRNA and shotgun sequencing. Predicted microbial metabolic functions and serum levels of metabolic and inflammatory biomarkers were also assessed.\u0000\u0000\u0000RESULTS\u0000Subjects with normal weight (N=105), overweight (N=67) and obesity (N=42) were identified. Overweight-specific duodenal microbial features include lower relative abundance (RA) of Bifidobacterium species and Escherichia coli strain K-12, and higher Lactobacillus intestinalis, L. johnsoni, and Prevotella loeschii RA. Obesity-specific features include higher Lactobacillus gasseri RA and lower L. reuteri (subspecies rodentium), Alloprevotella rava and Leptotrichia spp RA. Escalation features (progressive changes from normal weight through obesity) include decreasing Bacteroides pyogenes, Staphylococcus hominis, and unknown Faecalibacterium species RA, increasing RA of unknown Lactobacillus and Mycobacterium species, and decreasing microbial potential for biogenic amines metabolism. De-escalation features (direction of change altered in normal-to-overweight and overweight-to-obesity) include Lactobacillus acidophilus, L. hominis, L. iners, and Bifidobacterium dentium. An unknown Lactobacillus species is associated with Type IIa dyslipidemia and overweight, whereas Alloprevotella rava is associated with Type IIb and IV dyslipidemias.\u0000\u0000\u0000CONCLUSIONS\u0000Direct analysis of the duodenal microbiome has identified key genera associated with overweight and obesity, including some previously identified in stool, e.g. Bifidobacterium and Lactobacillus. Specific species and strains exhibit differing associations with overweight and obesity, including escalation and de-escalation features that may represent targets for future study and therapeutics.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140737668","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}
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