Anesthesia and pain medicine最新文献

{"title":"Oliceridine for acute pain management: pharmacology, clinical efficacy, safety, and future perspectives: a narrative review.","authors":"Min Kyoung Kim, Hyun Kang","doi":"10.17085/apm.26619","DOIUrl":"https://doi.org/10.17085/apm.26619","url":null,"abstract":"<p><p>Opioids are a cornerstone in the management of moderate-to-severe acute pain; however, their clinical utility is limited by well-recognized challenges, including respiratory depression, gastrointestinal (GI) dysfunction, and the potential for misuse and abuse. Oliceridine is a novel μ-opioid receptor agonist with G-protein-biased signaling and reduced β-arrestin recruitment. It exhibits potent analgesic effects while potentially reducing opioid-related adverse events. In preclinical investigations, oliceridine was associated with lower rates of GI dysfunction and respiratory depression than morphine. In the phase III clinical trials APOLLO-1 and APOLLO-2, certain oliceridine regimens produced rapid and effective analgesia comparable to that of morphine, with lower incidences of nausea, vomiting, and respiratory events. However, current evidence has not demonstrated a clinically meaningful overall advantage compared to conventional opioids. In addition, a clinically meaningful reduction in abuse liability relative to conventional opioids has not been established, underscoring the complexity of opioid reward mechanisms. This narrative review examines the pharmacological properties, clinical efficacy, safety profile, and ongoing controversies surrounding oliceridine and evaluates its potential role in perioperative pain management.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paradoxical bradycardia from occult venous hemorrhage mimicking vasovagal syncope - A case report.","authors":"Jaehun Lee, Geal Hong Hwang, Heejung Choi","doi":"10.17085/apm.26633","DOIUrl":"https://doi.org/10.17085/apm.26633","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhagic shock typically presents with tachycardia; however, profound hypovolemia can paradoxically induce bradycardia via the Bezold-Jarisch reflex. This can lead to misdiagnosis of vasovagal syncope, causing dangerous treatment delays.</p><p><strong>Case: </strong>A 50-year-old woman developed profound bradycardia and hypotension after vomiting in the post-anesthesia care unit after undergoing hysterectomy. Despite initial management of vasovagal syncope, her condition remained refractory to vasopressors. A critically low hemoglobin level of 5.5 g/dL strongly suggested massive occult hemorrhage. She underwent emergency laparotomy for a 1,500 ml pelvic hematoma and recovered without complications.</p><p><strong>Conclusions: </strong>Paradoxical bradycardia is a rare, but life-threatening, sign of occult hemorrhage. Clinicians must maintain a high index of suspicion for hemorrhage when hemodynamic instability is refractory to standard vagal management.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phrenic-sparing approaches in the interscalene block for shoulder surgery: a narrative review.","authors":"Mina Adolf Helmy, Kerlous Adolf Helmy, Mohamed Ramadan Ahmed Mohamed, Lydia Magdy Milad","doi":"10.17085/apm.26607","DOIUrl":"https://doi.org/10.17085/apm.26607","url":null,"abstract":"<p><p>The interscalene brachial plexus block is widely regarded as the gold standard for perioperative analgesia in shoulder surgery. However, its near-universal association with phrenic nerve block and subsequent hemidiaphragmatic paralysis has raised concerns, particularly in patients with compromised pulmonary reserve. This narrative review examines the mechanisms underlying phrenic nerve involvement, including cephalad and anterior spread of local anesthetic, and summarizes current evidence on preventive strategies. We investigate approaches such as low-volume injection, reduced local anesthetic concentration, superior trunk block, extrafascial deposition, and slow injection under ultrasound guidance to minimize phrenic nerve blockade while maintaining effective analgesia. Each technique presents potential advantages and limitations, including technical challenges, reduced block consistency, and diminished analgesic efficacy. In addition, we discuss the clinical implications of these strategies, highlight gaps in the literature, and propose future research to optimize analgesia while preserving diaphragmatic function. The present review aims to provide clinicians with a comprehensive overview of phrenic-sparing modifications to the interscalene block, thereby enhancing patient safety and promoting individualized patient care.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of patient preference for and interpretability of video-based pain-expression scenarios and the numerical rating scale for postoperative pain assessment: a prospective observational study.","authors":"Engin İhsan Turan, Abdurrahman Engin Baydemir, Zehra Polat Turan, Anıl Berkay Balıtatlı, Halil Güler, Göktürk Yıldırım, Ayça Sultan Şahin","doi":"10.17085/apm.26575","DOIUrl":"https://doi.org/10.17085/apm.26575","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain assessment relies primarily on numeric self-report tools, such as the numerical rating scale (NRS); these tools require abstract numerical cognition and may be challenging for some patients in the immediate postoperative period. Thus, in this prospective observational study, we aimed to evaluate a novel video-based pain-expression method in postoperative adults, with the primary objective of assessing patient preference for the video-based pain-expression method compared with that for the NRS.</p><p><strong>Methods: </strong>This prospective single-center observational study was conducted in a post-anesthesia care unit. Adult patients reporting postoperative pain (NRS ≥ 1) were shown five standardized artificial intelligence-generated video scenarios representing increasing pain ranges and asked to select the video best reflecting their pain. Patients also reported their NRS scores. The primary outcome was method preference. Secondary outcomes included exact and ± 1-category agreement, Spearman correlation, and decision-making time.</p><p><strong>Results: </strong>Of 240 enrolled patients, 239 were included in the final analysis. Overall, 133 patients (55.6%; 95% confidence interval [CI] 49.3-61.8) preferred the NRS, whereas 106 patients (44.4%; 95% CI 38.2-50.7) preferred the video-based method. Exact agreement between the video category and NRS was 40.6%, while ± 1-category agreement reached 80.8%. Quadratic weighted kappa demonstrated substantial agreement between the two methods (κ = 0.65). Mean decision time was longer for the video-based method than for NRS (32.87 ± 15.83 vs. 21.04 ± 8.21 s; mean difference 11.83 s, 95% CI 9.92-13.74).</p><p><strong>Conclusions: </strong>Agreement between the NRS and video-based method was strongest at pain extremes. Although NRS is more time-efficient, video-based assessment appears to be a feasible complementary tool that may enhance patient-centered postoperative pain communication.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and recovery of rocuronium and sugammadex versus cisatracurium or atracurium and pyridostigmine in surgical patients with chronic kidney disease: a multi-center retrospective propensity score-matched study.","authors":"Doyeop Lee, Seok Kyeong Oh, Heezoo Kim, Seokwoo Jeong, Eun-Su Choi, Eun Ji Ko, Byung Gun Lim","doi":"10.17085/apm.25496","DOIUrl":"https://doi.org/10.17085/apm.25496","url":null,"abstract":"<p><strong>Background: </strong>Rocuronium and sugammadex are used cautiously in patients with chronic kidney disease (CKD) undergoing anesthesia because of delayed excretion. This multicenter retrospective study explored the safety and recovery of rocuronium-sugammadex compared to cisatracurium/atracurium-pyridostigmine in patients with CKD.</p><p><strong>Methods: </strong>Patients with CKD who received rocuronium-sugammadex (RS group) or cisatracurium/atracurium-pyridostigmine (CP group) between 2020 and 2021 at three tertiary referral hospitals were included. Propensity score-matching was performed using a logistic regression model. The primary outcomes were safety-related indicators (e.g., reintubation, deferred extubation, and desaturation). Secondary outcomes included recovery-related profiles (e.g., extubation time). Subgroup analyses were conducted according to the CKD stage.</p><p><strong>Results: </strong>Of the total 1,241 patients (RS = 630, CP = 611), 804 (402 per group) were matched and analyzed. Among them, 51.1% had advanced CKD (estimated glomerular filtration rate < 30 ml/min/1.73 m2). Primary safety outcomes, including the incidence of reintubation within 48 h (RS: 1.24% vs. CP: 1.24%, P = 1.000) and deferred extubation (1.74% vs. 1.49%, P = 0.780), were not significantly different. Postoperative desaturation and renal outcomes were similar between groups. Extubation time was shorter in the RS group than in the CP group (median 7.00vs. 8.00 min, P = 0.005).</p><p><strong>Conclusions: </strong>Rocuronium-sugammadex demonstrated no clear signal of increased major respiratory or renal risk compared with cisatracurium/atracurium-pyridostigmine in patients with CKD. Although the extubation time was shorter in the RS group, this exploratory finding must be interpreted cautiously because of the heterogeneous practice and limited quantitative neuromuscular monitoring (22%).</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of transversalis fascia plane block and transversus abdominis plane block for postoperative pain management following cesarean delivery: a systematic review and meta-analysis.","authors":"Mahmoud Bahr, Saeed Baradwan, Wael Mohamed Elmahdi Ibrahim, Othman Saadeldien Yahia, Reda A Ismail, Abizer Juzer Firoz, Nahla Mohammed Eldeeb, Doaa Mohamed Almonayery, Ahmed Mohamed Abdelhakim, Doaa Moaz Sayem","doi":"10.17085/apm.26626","DOIUrl":"https://doi.org/10.17085/apm.26626","url":null,"abstract":"<p><strong>Background: </strong>Cesarean section is among the most widely performed obstetric procedures globally and is frequently complicated by moderate to severe postoperative pain. The transversalis fascia plane block (TFPB) and transversus abdominis plane block (TAPB) are regional anesthetic techniques commonly used for post-cesarean analgesia. This study aimed to compare the analgesic effectiveness of TFPB versus TAPB in women undergoing cesarean section under spinal anesthesia.</p><p><strong>Methods: </strong>PubMed, Scopus, Cochrane Library, and Web of Science were searched from inception through December 2025 for randomized controlled trials (RCTs) comparing TFPB with TAPB in women undergoing cesarean delivery. The primary outcome was pain scores during movement assessed by the numeric rating scale (NRS). Secondary outcomes included cumulative 24-h opioid consumption, requirement for rescue analgesia, time to first request for postoperative analgesia, and patient satisfaction.</p><p><strong>Results: </strong>Six RCTs encompassing 491 participants met the inclusion criteria. Compared with TAPB, TFPB was associated with lower NRS pain scores during movement at 6, 12, and 24 h postoperatively. TFPB was further associated with lower total opioid requirements, a reduced likelihood of needing rescue analgesia, a prolonged interval to the first analgesic request, and higher patient-reported satisfaction scores.</p><p><strong>Conclusions: </strong>Among women undergoing cesarean section under spinal anesthesia, TFPB appears associated with better short-term analgesic outcomes compared with TAPB, reflected by lower pain scores, decreased opioid requirements, reduced rescue analgesia use, and higher patient satisfaction. However, substantial heterogeneity and limited sample size warrant cautious interpretation. Larger, adequately powered, and methodologically standardized RCTs are warranted to confirm these findings.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of transdermal buprenorphine and transdermal fentanyl patch on quality of recovery-15 and analgesic effect following inguinal hernia surgery: a randomized controlled study.","authors":"Chaitanya Pratyusha A, Rama Krishna Prasad Ch, Sandeep Garre, Kalyani Sdl S, Ayya Syamasundar, Preethi R","doi":"10.17085/apm.25462","DOIUrl":"https://doi.org/10.17085/apm.25462","url":null,"abstract":"<p><strong>Background: </strong>Effective postoperative analgesia is essential for optimizing recovery and patient satisfaction after inguinal hernia surgery. Therefore, we compared transdermal buprenorphine and fentanyl patches with conventional analgesia for pain control and quality of recovery-15 (QoR-15).</p><p><strong>Methods: </strong>In this prospective, randomized study 150 patients classified as American Society of Anesthesiologists (ASA) I-III scheduled for elective open inguinal hernia repair were randomized into three groups; (n=50 each) Group B (buprenorphine 10 µg/h patch), Group F (fentanyl 25 µg/h patch), and Group C (intravenous paracetamol and tramadol). Patches were applied 12 h preoperatively. The primary outcome was visual analog scale (VAS) pain score, assessed at 1, 6, 12, and 24 h. Secondary outcomes included QoR‑15 scores and rescue‑analgesic requirements. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction.</p><p><strong>Results: </strong>Baseline demographic characteristics and perioperative hemodynamic parameters were comparable across groups. Median postoperative VAS scores at 6, 12, and 24 h were significantly lower in both transdermal groups than in the control group. QoR-15 scores at 24 h were 124 (122-125) (C), 127 (125-129) (F), and 133 (131-134) (B), at 48 h were 129 (128-130), 136 (134-138), and 137 (135-139) for Groups C, F, and B, respectively (P = 0.001).</p><p><strong>Conclusions: </strong>Transdermal buprenorphine and fentanyl provided effective postoperative analgesia and were associated with improved quality of recovery compared with standard analgesia. Buprenorphine showed a significant advantage over fentanyl in QoR-15 at 24 h, however, this difference was not significant at 48 h.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Use of Electromyography Guidance for Epidural Blood Patch Injection in a Comatose Patient due to Severe Spontaneous Intracranial Hypotension - A case report.","authors":"Antonio Pereira, Elizabeth Kasparov, Dominique Williams, Oktay Shuminov","doi":"10.17085/apm.26524","DOIUrl":"https://doi.org/10.17085/apm.26524","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracranial hypotension (SIH) is a rare disorder characterized by cerebrospinal fluid loss and associated neurological effects, including coma. An epidural blood patch (EBP) is an established treatment, but procedural assessment often relies on patient feedback. In patients with impaired consciousness, an objective surrogate is needed.</p><p><strong>Case: </strong>A 40-year-old man with a newly identified intracranial lesion developed progressive cognitive decline with subsequent imaging demonstrating SIH. Despite medical and neurosurgical interventions, his neurological status continued to deteriorate. An EBP was performed based on clinical and radiographic findings. Given his comatose state and inability to provide verbal feedback, electromyography (EMG) with fluoroscopic guidance was used to assess procedural safety and efficacy. Following EMG-assisted EBP, the patient demonstrated progressive neurological improvement.</p><p><strong>Conclusions: </strong>This case highlights the utility of electromyography as an innovative adjunct in performing epidural blood patch in patients with compromised consciousness, offering an effective approach for managing severe spontaneous intracranial hypotension.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic management of patient with myoclonic epilepsy with ragged red fibers, a mitochondrial disease - A case report.","authors":"Yunho Kang, Bo-Eun Kim, Ji Hyeon Kim, Se Hun Park","doi":"10.17085/apm.26610","DOIUrl":"https://doi.org/10.17085/apm.26610","url":null,"abstract":"<p><strong>Background: </strong>Myoclonic epilepsy with ragged red fibers (MERRF) is a rare mitochondrial disorder caused by pathogenic mutations in mitochondrial DNA. Anesthetic management in these patients is challenging because, commonly used anesthetic agents may exacerbate mitochondrial dysfunction and increase the risk of perioperative respiratory, cardiac, and metabolic complications.</p><p><strong>Case: </strong>A 44-year-old woman with MERRF underwent a unilateral salpingo-oophorectomy. General anesthesia was induced applying low-dose midazolam, remifentanil and rocuronium, and maintained with desflurane and remifentanil. Perioperative management focused on minimizing metabolic stress through the maintenance of normothermia, avoidance of lactate-containing solutions, and close hemodynamic and respiratory monitoring. The intraoperative and immediate postoperative courses were uneventful.</p><p><strong>Conclusions: </strong>This case highlights that safe anesthetic care in patients with MERRF can be achieved through comprehensive preoperative evaluation, cautious selection and dosing of anesthetic agents, strict metabolic control, and perioperative monitoring. Hence, individualized anesthetic strategies are essential to optimize perioperative outcomes in patients with mitochondrial disorders.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of sugammadex for reversal of neuromuscular blockade in pediatric patients: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.","authors":"Hyosung Kim, Byung Gun Lim, Young Sung Kim, Seok Woo Jeong, Jisung Bae","doi":"10.17085/apm.25488","DOIUrl":"10.17085/apm.25488","url":null,"abstract":"<p><strong>Background: </strong>Sugammadex has recently been approved globally for use in pediatric patients aged ≥ 2 years. This meta-analysis with trial sequential analysis (TSA) evaluated the efficacy and safety of sugammadex for reversal of neuromuscular blockade (NMB) in pediatric patients.</p><p><strong>Methods: </strong>PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, KoreaMed, and ClinicalTrials.gov were searched from inception to December 31, 2023. Randomized controlled trials (RCTs) evaluating sugammadex in pediatric patients were included. Efficacy outcomes were time to recovery to a train-of-four (TOF) ratio ≥ 0.9 and extubation time. Safety outcomes included overall post-anesthetic adverse events, bradycardia, tachycardia, postoperative nausea and vomiting (PONV), recurarization, and desaturation. Data were analyzed using RevMan, and TSA was performed using Copenhagen Trial Unit software.</p><p><strong>Results: </strong>A total of 21 RCTs (n=1,394 pediatric patients) were included in the study. Time to TOF ratio ≥ 0.9 was significantly shorter with sugammadex than with control (neostigmine or placebo) for both 2 mg/kg (mean difference [95% confidence interval], -6.03 [-7.85 to -4.21] min) and 4 mg/kg (-30.06 [-37.58 to -22.55] min). The extubation time was shorter with sugammadex (-14.26 [-17.22 to -11.30] min). The TSA for both efficacy outcomes indicated that the required information size had been reached, suggesting that additional trials are unlikely to change the efficacy conclusions. PONV, tachycardia, and desaturation occurred less frequently with sugammadex, whereas the overall post-anesthetic adverse events, recurarization, and bradycardia were comparable.</p><p><strong>Conclusions: </strong>Sugammadex was associated with faster and more effective reversal of rocuronium-induced NMB in pediatric patients.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564332","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}