Pub Date : 2024-05-01Epub Date: 2024-05-15DOI: 10.1055/a-2216-9634
Uwe Walter
{"title":"[Brain death diagnostics: use of ancillary tests].","authors":"Uwe Walter","doi":"10.1055/a-2216-9634","DOIUrl":"https://doi.org/10.1055/a-2216-9634","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946611","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 : 2024-05-01Epub Date: 2024-05-15DOI: 10.1055/a-2160-5397
Stefan Alig, Christiane Pott, Björn Chapuy
The diagnosis and treatment of malignant lymphoma is rapidly advancing, offering hope but also highlighting inherent limitations. Technological breakthroughs in sequencing technologies enable more precise subtyping and risk stratification. For example, in diffuse large B-cell lymphoma (DLBCL), exome sequencing revealed molecular subtypes. Understanding these subtypes sheds light on lymphomagenesis and prognosis, and may provide targets for tailored therapies. Additionally, tumor-derived cell-free DNA (ctDNA) detected in blood plasma allows for genotyping, risk stratification, and measurement of minimal residual disease (MRD). Current studies often examine drug effectiveness through "all-comer" approaches or in transcriptionally defined subtypes. Molecular agnostic studies increasingly focus on clinically defined high-risk patients (e.g., using the IPI) to better demonstrate the statistical significance of therapy effects. Improved patient selection can enhance the cost-effectiveness of modern, often expensive, therapies.
恶性淋巴瘤的诊断和治疗进展迅速,给人们带来了希望,但也凸显了其固有的局限性。测序技术的突破使亚型和风险分层更为精确。例如,在弥漫大 B 细胞淋巴瘤(DLBCL)中,外显子测序揭示了分子亚型。对这些亚型的了解揭示了淋巴瘤的发生和预后,并可能为定制疗法提供靶点。此外,血浆中检测到的肿瘤衍生无细胞DNA(ctDNA)可用于基因分型、风险分层和最小残留病(MRD)测量。目前的研究通常通过 "全基因组 "方法或转录定义的亚型来检查药物的有效性。分子不可知论研究越来越多地关注临床定义的高危患者(如使用 IPI),以更好地证明治疗效果的统计学意义。改进患者的选择可以提高现代疗法的成本效益,而现代疗法往往价格昂贵。
{"title":"[Malignant lymphomas - quo vadis? - What developments await us in diagnostics and therapy?]","authors":"Stefan Alig, Christiane Pott, Björn Chapuy","doi":"10.1055/a-2160-5397","DOIUrl":"https://doi.org/10.1055/a-2160-5397","url":null,"abstract":"<p><p>The diagnosis and treatment of malignant lymphoma is rapidly advancing, offering hope but also highlighting inherent limitations. Technological breakthroughs in sequencing technologies enable more precise subtyping and risk stratification. For example, in diffuse large B-cell lymphoma (DLBCL), exome sequencing revealed molecular subtypes. Understanding these subtypes sheds light on lymphomagenesis and prognosis, and may provide targets for tailored therapies. Additionally, tumor-derived cell-free DNA (ctDNA) detected in blood plasma allows for genotyping, risk stratification, and measurement of minimal residual disease (MRD). Current studies often examine drug effectiveness through \"all-comer\" approaches or in transcriptionally defined subtypes. Molecular agnostic studies increasingly focus on clinically defined high-risk patients (e.g., using the IPI) to better demonstrate the statistical significance of therapy effects. Improved patient selection can enhance the cost-effectiveness of modern, often expensive, therapies.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946646","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 : 2024-05-01Epub Date: 2024-05-15DOI: 10.1055/a-2293-4567
Friedemann Thieme, Hans-Jonas Meyer
{"title":"[34-years old male with rheumatological disease].","authors":"Friedemann Thieme, Hans-Jonas Meyer","doi":"10.1055/a-2293-4567","DOIUrl":"10.1055/a-2293-4567","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946607","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 : 2024-05-01Epub Date: 2024-05-15DOI: 10.1055/a-2160-5353
Johannes C Hellmuth, Raphael Koch, Oliver Weigert
Advances in the understanding of the biology of malignant lymphoma has facilitated the development of numerous molecularly targeted therapies. The incorporation of these precision therapeutics has produced more effective and often less-toxic treatment regimens leading to a significant improvement of treatment outcomes for individuals with lymphoid malignancies.In relapsed diseases, molecularly targeted therapeutic approaches have demonstrated superior outcomes compared to conventional chemotherapy, leading to a growing number of patients being treated entirely chemotherapy-free. This review outlines the current landscape of targeted therapies for both B-cell (B-NHL) and T-cell non-Hodgkin lymphomas (T-NHL) and provides an overview of targeted agents currently approved for the treatment of malignant lymphoma.
{"title":"[Targeted therapies in the management of malignant lymphoma - is the end of conventional chemotherapy near?]","authors":"Johannes C Hellmuth, Raphael Koch, Oliver Weigert","doi":"10.1055/a-2160-5353","DOIUrl":"10.1055/a-2160-5353","url":null,"abstract":"<p><p>Advances in the understanding of the biology of malignant lymphoma has facilitated the development of numerous molecularly targeted therapies. The incorporation of these precision therapeutics has produced more effective and often less-toxic treatment regimens leading to a significant improvement of treatment outcomes for individuals with lymphoid malignancies.In relapsed diseases, molecularly targeted therapeutic approaches have demonstrated superior outcomes compared to conventional chemotherapy, leading to a growing number of patients being treated entirely chemotherapy-free. This review outlines the current landscape of targeted therapies for both B-cell (B-NHL) and T-cell non-Hodgkin lymphomas (T-NHL) and provides an overview of targeted agents currently approved for the treatment of malignant lymphoma.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946651","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 : 2024-05-01Epub Date: 2024-05-15DOI: 10.1055/a-2160-5320
Veit Bücklein, Bastian von Tresckow, Marion Subklewe
The introduction of immunologically targeted therapies has represented a significant advancement in the treatment of B-cell lymphomas, particularly aggressive B-cell lymphoma. CD19 CAR-T cells such as Axicabtagen-Ciloleucel (Axi-cel) and Lisocabtagen Maraleucel (Liso-cel) have been approved since 2022 and 2023, respectively, for second-line therapy of Diffuse Large B-Cell Lymphomas (DLBCL), when there is primary refractory disease or relapse within 12 months after the end of first-line therapy. These therapies result in a significant improvement in progression-free survival compared to the previous standard therapy (salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation). Especially in elderly patients or patients with underlying medical conditions, CAR-T cell therapies like Axi-cel and Liso-cel demonstrate acceptable tolerability and high efficacy.Furthermore, bispecific T-cell-engaging antibodies ("bispecifics") such as Glofitamab, Epcoritamab, and Mosunetuzumab also represent promising treatment options for patients with relapsed disease after failure of second- or later line therapy and show efficacy even in a subset of patients relapsing after CD19 CAR-T cells. However, randomized study results for these substances are not yet available. They are expected to be used in earlier lines of therapy in the future, especially in combination with standard chemotherapy regimens. Common side effects of bispecific antibody therapies are cytokine release syndrome (CRS) and immune-mediated cytopenias, whereas immune-cell associated neurotoxicity syndrome (ICANS) is relatively rare compared to CD19 CAR T cells. In summary, bispecifics represent a novel, highly effective immunotherapy for the treatment of lymphomas with a very favourable toxicity profile.
免疫靶向疗法的引入标志着 B 细胞淋巴瘤(尤其是侵袭性 B 细胞淋巴瘤)治疗的重大进步。Axicabtagen-Ciloleucel(Axi-cel)和Lisocabtagen Maraleucel(Liso-cel)等CD19 CAR-T细胞已分别于2022年和2023年获批用于弥漫性大B细胞淋巴瘤(DLBCL)的二线治疗,即在一线治疗结束后12个月内出现原发性难治性疾病或复发的情况。与之前的标准疗法(抢救性化疗后进行大剂量化疗和自体干细胞移植)相比,这些疗法能显著改善无进展生存期。此外,Glofitamab、Epcoritamab和Mosunetuzumab等双特异性T细胞诱导抗体("双特异性抗体")也是二线或三线治疗失败后复发患者的治疗选择,甚至对CD19 CAR-T细胞治疗后复发的部分患者也有疗效。不过,这些药物的随机研究结果尚未公布。预计未来它们将用于早期治疗,尤其是与标准化疗方案联合使用。双特异性抗体疗法的常见副作用是细胞因子释放综合征(CRS)和免疫介导的细胞减少症,而与 CD19 CAR T 细胞相比,免疫细胞相关神经毒性综合征(ICANS)则相对罕见。总之,双特异性疗法是治疗淋巴瘤的一种新型、高效的免疫疗法,而且毒性非常小。
{"title":"[T-cell recruiting immunotherapies in B-cell lymphoma - the future backbone for all therapy lines?]","authors":"Veit Bücklein, Bastian von Tresckow, Marion Subklewe","doi":"10.1055/a-2160-5320","DOIUrl":"10.1055/a-2160-5320","url":null,"abstract":"<p><p>The introduction of immunologically targeted therapies has represented a significant advancement in the treatment of B-cell lymphomas, particularly aggressive B-cell lymphoma. CD19 CAR-T cells such as Axicabtagen-Ciloleucel (Axi-cel) and Lisocabtagen Maraleucel (Liso-cel) have been approved since 2022 and 2023, respectively, for second-line therapy of Diffuse Large B-Cell Lymphomas (DLBCL), when there is primary refractory disease or relapse within 12 months after the end of first-line therapy. These therapies result in a significant improvement in progression-free survival compared to the previous standard therapy (salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation). Especially in elderly patients or patients with underlying medical conditions, CAR-T cell therapies like Axi-cel and Liso-cel demonstrate acceptable tolerability and high efficacy.Furthermore, bispecific T-cell-engaging antibodies (\"bispecifics\") such as Glofitamab, Epcoritamab, and Mosunetuzumab also represent promising treatment options for patients with relapsed disease after failure of second- or later line therapy and show efficacy even in a subset of patients relapsing after CD19 CAR-T cells. However, randomized study results for these substances are not yet available. They are expected to be used in earlier lines of therapy in the future, especially in combination with standard chemotherapy regimens. Common side effects of bispecific antibody therapies are cytokine release syndrome (CRS) and immune-mediated cytopenias, whereas immune-cell associated neurotoxicity syndrome (ICANS) is relatively rare compared to CD19 CAR T cells. In summary, bispecifics represent a novel, highly effective immunotherapy for the treatment of lymphomas with a very favourable toxicity profile.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946619","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}
Eva-Maria Skiba, K. Drewitz, I. Panchyrz, Stefanie Deckert, Christian Apfelbacher, Katharina Piontek
Zusammenfassung Hintergrund Nach akuter Infektion mit dem SARS-CoV-2-Virus leiden bis zu 10 % der Erkrankten an längerfristigen gesundheitlichen Beeinträchtigungen, dem sogenannten „Long-COVID-Syndrom“. Zur Versorgung dieser Patient*innen wurden in Deutschland spezialisierte Ambulanzen eingerichtet. Eine strukturierte Erfassung der Versorgungssituation ist für eine bedarfsgerechte Versorgung essenziell. Ziel der vorliegenden Studie ist strukturelle und prozessbezogene Versorgungsaspekte von Long-COVID-Ambulanzen in Deutschland darzustellen. Methoden Mittels Online-Befragung wurden Aspekte wie Struktur und Organisation der Ambulanzen, Leistungsangebote und Vernetzung der Versorgung erhoben. Insgesamt konnten 95 Ambulanzen identifiziert werden. Die Einladung der Ambulanzleiter*innen zur Teilnahme an der Befragung erfolgte per E-Mail. Die Datenerhebung fand zwischen Februar und Mai 2022 statt. Die Auswertung der Daten erfolgte deskriptiv. Ergebnisse Insgesamt haben 28 Ambulanzleiter*innen (29 %) an der Umfrage teilgenommen. Die Befragten waren zwischen 32 und 66 Jahre alt; 61 % davon (n = 17) waren männlich. Die Ambulanzen waren am häufigsten an die Fachbereiche Pneumologie (n = 10; 36 %), Innere Medizin, Psychiatrie und Psychosomatische Medizin sowie Neurologie (jeweils n = 8; 29 %) angegliedert. Nach Aussage der Ambulanzleiter*innen betrug die Wartezeit auf einen Termin in 64 % der Fälle (n = 18) mehr als einen Monat. Die Auslastung (n = 25; 89 %), die Terminnachfrage (n = 26; 93 %) sowie der Bedarf an weiteren Post-COVID-Ambulanzen (n = 20; 71 %) wurden von den Befragten als hoch bewertet. Nahezu alle Ambulanzleiter*innen gaben an, mit klinikinternen Einrichtungen (n = 27; 96 %) sowie Haus- und niedergelassenen Fachärzt*innen (jeweils n = 21; 75 %) vernetzt zu sein. Schlussfolgerung Die Ergebnisse zeigen einen Schwerpunkt der Versorgung im Bereich der Pneumologie sowie zu gleichen Teilen in der Inneren Medizin, Psychiatrie/Psychosomatik und Neurologie. Weiterhin weisen die Ergebnisse auf einen hohen Bedarf an Post-COVID-Ambulanzen und die Notwendigkeit des Ausbaus dieses Versorgungsangebotes hin.
{"title":"Nachsorgeambulanzen für Patient*innen mit Post-COVID: eine Befragung zur Bestandsaufnahme und Charakterisierung von Versorgungsaspekten","authors":"Eva-Maria Skiba, K. Drewitz, I. Panchyrz, Stefanie Deckert, Christian Apfelbacher, Katharina Piontek","doi":"10.1055/a-2255-9252","DOIUrl":"https://doi.org/10.1055/a-2255-9252","url":null,"abstract":"Zusammenfassung Hintergrund Nach akuter Infektion mit dem SARS-CoV-2-Virus leiden bis zu 10 % der Erkrankten an längerfristigen gesundheitlichen Beeinträchtigungen, dem sogenannten „Long-COVID-Syndrom“. Zur Versorgung dieser Patient*innen wurden in Deutschland spezialisierte Ambulanzen eingerichtet. Eine strukturierte Erfassung der Versorgungssituation ist für eine bedarfsgerechte Versorgung essenziell. Ziel der vorliegenden Studie ist strukturelle und prozessbezogene Versorgungsaspekte von Long-COVID-Ambulanzen in Deutschland darzustellen. Methoden Mittels Online-Befragung wurden Aspekte wie Struktur und Organisation der Ambulanzen, Leistungsangebote und Vernetzung der Versorgung erhoben. Insgesamt konnten 95 Ambulanzen identifiziert werden. Die Einladung der Ambulanzleiter*innen zur Teilnahme an der Befragung erfolgte per E-Mail. Die Datenerhebung fand zwischen Februar und Mai 2022 statt. Die Auswertung der Daten erfolgte deskriptiv. Ergebnisse Insgesamt haben 28 Ambulanzleiter*innen (29 %) an der Umfrage teilgenommen. Die Befragten waren zwischen 32 und 66 Jahre alt; 61 % davon (n = 17) waren männlich. Die Ambulanzen waren am häufigsten an die Fachbereiche Pneumologie (n = 10; 36 %), Innere Medizin, Psychiatrie und Psychosomatische Medizin sowie Neurologie (jeweils n = 8; 29 %) angegliedert. Nach Aussage der Ambulanzleiter*innen betrug die Wartezeit auf einen Termin in 64 % der Fälle (n = 18) mehr als einen Monat. Die Auslastung (n = 25; 89 %), die Terminnachfrage (n = 26; 93 %) sowie der Bedarf an weiteren Post-COVID-Ambulanzen (n = 20; 71 %) wurden von den Befragten als hoch bewertet. Nahezu alle Ambulanzleiter*innen gaben an, mit klinikinternen Einrichtungen (n = 27; 96 %) sowie Haus- und niedergelassenen Fachärzt*innen (jeweils n = 21; 75 %) vernetzt zu sein. Schlussfolgerung Die Ergebnisse zeigen einen Schwerpunkt der Versorgung im Bereich der Pneumologie sowie zu gleichen Teilen in der Inneren Medizin, Psychiatrie/Psychosomatik und Neurologie. Weiterhin weisen die Ergebnisse auf einen hohen Bedarf an Post-COVID-Ambulanzen und die Notwendigkeit des Ausbaus dieses Versorgungsangebotes hin.","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775629","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 : 2024-04-01Epub Date: 2024-03-18DOI: 10.1055/a-2258-7265
Maria J G T Vehreschild, Gerd Fätkenheuer, Leif Erik Sander, Christoph Lübbert, Siegbert Rieg, Georg Ertl, Bernd Salzberger
Medicine in Germany is currently facing major structural and economic challenges. Infectious Diseases, with the recent introduction of a new specialty in "Internal Medicine and Infectious Diseases" and with the existing additional training for almost all specializations, will make an important contribution to overcoming these challenges. Expertise in infectious diseases has to be very broad and requires high interdisciplinarity, which makes infectious diseases an attractive and demanding specialty. The complex fundamentals of infectious diseases must now be quickly conveyed to as many physicians as possible in a short period of time, as part of their specialization or as additional training. Until this is achieved, transitional solutions will be necessary for some time. The adaptation of the current billing and reimbursement system for infectious diseases services and improved intersectoral cooperation are of the utmost importance for the further development of the specialty.
{"title":"[Infectious Diseases - a new specialty for postgraduate training in Germany].","authors":"Maria J G T Vehreschild, Gerd Fätkenheuer, Leif Erik Sander, Christoph Lübbert, Siegbert Rieg, Georg Ertl, Bernd Salzberger","doi":"10.1055/a-2258-7265","DOIUrl":"10.1055/a-2258-7265","url":null,"abstract":"<p><p>Medicine in Germany is currently facing major structural and economic challenges. Infectious Diseases, with the recent introduction of a new specialty in \"Internal Medicine and Infectious Diseases\" and with the existing additional training for almost all specializations, will make an important contribution to overcoming these challenges. Expertise in infectious diseases has to be very broad and requires high interdisciplinarity, which makes infectious diseases an attractive and demanding specialty. The complex fundamentals of infectious diseases must now be quickly conveyed to as many physicians as possible in a short period of time, as part of their specialization or as additional training. Until this is achieved, transitional solutions will be necessary for some time. The adaptation of the current billing and reimbursement system for infectious diseases services and improved intersectoral cooperation are of the utmost importance for the further development of the specialty.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11018382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159821","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}
Pub Date : 2024-03-01Epub Date: 2024-03-07DOI: 10.1055/a-2281-9396
Christian Waydhas, Matthias Deininger, Rolf Dubb, Florian Hoffmann, Thomas van den Hooven, Uwe Janssens, Arnold Kaltwasser, Andreas Markewitz, Sabrina Pelz
{"title":"Erratum: Interprofessionelle Handlungsfelder in der Intensivmedizin – Empfehlungen der DIVI.","authors":"Christian Waydhas, Matthias Deininger, Rolf Dubb, Florian Hoffmann, Thomas van den Hooven, Uwe Janssens, Arnold Kaltwasser, Andreas Markewitz, Sabrina Pelz","doi":"10.1055/a-2281-9396","DOIUrl":"10.1055/a-2281-9396","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10937097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061576","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}