Clinical Microbiology and Infection最新文献

{"title":"Utilisation of population-wide digital contact tracing to estimate real-world vaccine-effectiveness in a pandemic setting.","authors":"Jeremy Wei Quan Chan, Liang En Wee, Muhammad Ismail Bin Abdul Malek, Calvin Chiew, Zheng Jie Marc Ho, Benjamin Ong, Derrick Heng, Vernon Lee, David Lye, Kelvin Bryan Tan","doi":"10.1016/j.cmi.2025.06.014","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.014","url":null,"abstract":"<p><strong>Objectives: </strong>Observational cohort methods for evaluating real-world vaccine-effectiveness can introduce biases and yield negative vaccine-effectiveness estimates. We evaluated if utilisation of digital-contact-tracing (DCT) data could yield more realistic estimates of vaccine-effectiveness.</p><p><strong>Methods: </strong>Vaccine-effectiveness against SARS-CoV-2 infection was estimated using an observational population-based cohort of older Singaporeans (≥60 years) and DCT data of contacts (≥60 years) significantly exposed to COVID-19 cases, during Delta/Omicron-predominance. Person-day generalised Poisson regressions adjusted for sociodemographic characteristics were performed to estimate adjusted incidence-rate-ratios (IRRs) of infection at different time-intervals from second/third vaccine doses up to 5 months post-vaccination, with unvaccinated/partially-vaccinated person-time as the reference group. Vaccine-effectiveness against infection (VE-I) was calculated as 1-minus-IRR.</p><p><strong>Results: </strong>883,227 and 853,435 older Singaporeans were included in the observational cohort during Delta and Omicron-predominance. 102,208 and 347,817 case-contact pairs were identified from national DCT data during Delta and Omicron-predominant transmission. During Delta, estimates derived using the observational population-based cohort method mirrored DCT-based estimates (eg. boosting, 60-69 years: VE-I=0.60, 95%CI=0.57-0.63[observational cohort]; VE-I=0.76, 95%CI=0.72-0.78) [DCT-based estimates]). However, during the Omicron surge, observational cohort methods yielded negative vaccine-effectiveness estimates (eg. boosting <2 months post-vaccination, 60-69 years: VE-I=-1.12, 95%CI=-1.29- -0.96). When DCT data was utilised to estimate vaccine-effectiveness, boosting restored protection (eg. boosting <2 months post-vaccination, 60-69 years: VE-I=0.32, 95%CI=0.23-0.39), with subsequent waning 2-months post-booster (eg. boosting >5 months post-vaccination, 60-69 years: VE-I=0.14, 95%CI=0.04-0.23).</p><p><strong>Conclusions: </strong>During an Omicron COVID-19 surge, observational cohort methods yielded negative vaccine-effectiveness estimates, whereas use of national DCT data yielded more realistic estimates. DCT data can augment real-world estimates of vaccine-effectiveness in the population at-large and convey a more complete picture of vaccine-derived protection, especially in the context of a complex immunization landscape and an evolving pandemic situation.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical considerations for the Implementation of Syndromic Panels and Diagnostic stewardship in the era of syndromic panel testing.","authors":"Shradha Subedi, Na Patrick Harris, Lisa Hall, L David Paterson","doi":"10.1016/j.cmi.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.013","url":null,"abstract":"<p><strong>Background: </strong>The significant advancements in the development of syndromic panel testing for infectious diseases have brought about a paradigm shift in the clinical microbiology laboratory and the practices of Infectious Diseases Physicians. Due to the considerable costs associated with these tests, it is crucial for laboratories and healthcare services to devise implementation strategies and prioritise diagnostic stewardship when incorporating these panels into the laboratory.</p><p><strong>Objectives: </strong>To describe the implementation considerations and the diagnostic stewardship strategies for integrating syndromic panels in the clinical microbiology laboratory.</p><p><strong>Sources: </strong>Peer reviewed publications were searched through Pubmed and Embase databases. Further citation search was carried out using google scholar.</p><p><strong>Content: </strong>Evidence from clinical and laboratory studies on syndromic panels of blood stream infection, meningitis and encephalitis, and pneumonia suggest that syndromic panels can improve antimicrobial optimisation and shorten time to targeted therapy, particularly when implemented alongside antimicrobial stewardship interventions. However, there are limited numbers of randomised controlled trials, and many studies are observational, with variable endpoints and limited generalisability. Cost-effectiveness analyses are often model-based and lack real-world validation. Behavioural drivers of inappropriate test use are underexplored, highlighting the need for comprehensive diagnostic stewardship strategies. Effective implementation requires careful panel selection, local validation, and sustained collaboration between clinical microbiology and antimicrobial stewardship teams.</p><p><strong>Implications: </strong>Incorporation of syndromic panel in clinical microbiology laboratory requires careful consideration of implementation and diagnostic stewardship strategies. Future research should focus on standardising implementation frameworks, generating real-time cost-effectiveness data, and exploring decision-support tools including artificial intelligence to augment antimicrobial stewardship efforts as well as more evidence from low resource settings. Additionally, qualitative research is needed to understand behavioural influences on test utilisation and to develop interventions that promote appropriate use in real-world settings.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of post-acute multi-organ sequelae following dengue infection.","authors":"Jue Tao Lim, Liang En Wee, Wei Zhi Tan, Calvin Chiew, Lalitha Kurupatham, Cuiqin Poh, Nur-Afidah Md Suhaimi, Hui Zi Chua, Lee Ching Ng, Po Ying Chia, David Chien Boon Lye, Kelvin Bryan Tan","doi":"10.1016/j.cmi.2025.06.012","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.012","url":null,"abstract":"<p><strong>Objectives: </strong>Population-based cohort studies on long-term sequelae post-dengue are lacking, given dengue's disproportionate burden in tropical low-and-middle-income countries (LMICs) with limited access to diagnostic testing and follow-up. We estimated the 300-day post-acute risk of new-incident multi-systemic complications following dengue infection.</p><p><strong>Methods: </strong>National dengue registries and healthcare-claims databases in Singapore were utilised to build a retrospective population-based adult cohort with laboratory-confirmed dengue infection (1 Jan 2017-30 Jun 2023) and a cohort of uninfected controls. Differences in baseline characteristics were adjusted using overlap weighting. Risks of new-incident complications across multiple organ systems, all-cause hospitalisation and death up to 300 days post-dengue infection were systematically contrasted against population-based-controls, using competing risk regression.</p><p><strong>Results: </strong>55,870 dengue-infected individuals and 3,072,309 uninfected controls were included; the majority had mild initial infection not requiring hospitalisation. In the post-acute period, there was 19.0% (aHR=1.19[1.13,1.26]) increased risk of any post-acute sequelae, with an 46.0% increase in risk of cardiovascular sequelae (aHR=1.46[1.01,2.10]) and 29.0% increase in risk of neuropsychiatric sequelae (aHR=1.29[1.14,1.45]) in dengue-infected individuals versus controls. There was also a 37.0% increase in risk of autoimmune disorders (aHR=1.37 [1.24,1.52]), a 19% increase in risk of endocrine disorders (aHR=1.19[1.12,1.25]), a 42.0% increase in risk of gastrointestinal sequelae (aHR=1.42[1.17,1.72]). and 230.0% increase in risk of renal sequelae (aHR=2.30[1.69,3.12]). Post-acute risk of all-cause hospitalisation (aHR= 1.22[1.20,1.25]) and death (aHR= 2.08[1.85,2.33]) were also elevated in dengue-infected cases. The cumulative number of post-acute outcomes amongs dengue-infected cases increased over the 31-300 day follow-up period, versus uninfected controls. Risks of post-acute sequelae were increased in hospitalised dengue patients, older age groups (61+ years), those with comorbidities and across DENV-2/DENV-3 predominant transmission.</p><p><strong>Conclusions: </strong>Increased post-acute risk of multi-organ complications, all-cause hospitalisations and death was observed in dengue survivors, versus uninfected population-based-controls. Development of multidisciplinary care strategies to reduce chronic health loss post-dengue infection is crucial.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A time-series analysis approach to quantify change in antibiotic resistance and antibiotic consumption during COVID-19 Epidemics: a multicenter cross-national ecological study on behalf of QUARANTINE (QUantifying change in Antibiotic Resistance, ANTibiotic use, and INfection control during COVID-19 Epidemics) study project.","authors":"Marianna Meschiari, José María López Lozano, Filippo Medioli, Erica Bacca, Mario Sarti, Laura Cancian, Xavier Bertrand, Marlène Sauget, Béatrice Rosolen, Geraldine Conlon Bingham, Cara McKeating, Claire Donnelly, Gary Warnock, Mical Paul, Yael Dishon-Benattar, Maja Abram, Igor Rubinić, Dora Palčevsi, Andrej Belančić, Nataša Skočibušić, Vera Vlahović-Palčevski, Dafna Yahav, Vered Daitch, Michael A Borg, Peter Zarb, Michael Scott, David Farren, Fidelma Magee, Mateja Pirš, Sergeja Gregorčič, Bojana Beović, Cristina Mussini","doi":"10.1016/j.cmi.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.009","url":null,"abstract":"<p><strong>Objectives: </strong>We aim to assess the impact of COVID-19 on antibiotic consumption (AMC) and antimicrobial-resistance (AMR) in the new epidemiological scenario from a cross-national perspective.</p><p><strong>Methods: </strong>A quasi-experimental retrospective multicenter ecological study was conducted to explore the impact of COVID-19 on AMC and AMR using routinely generated retrospectively time series data. This study included nine Healthcare University Hospitals from Europe and Israel on behalf of QUARANTINE project. Total effects were defined as the difference between the pre-COVID-19 period (ranging from January 2015 or January 2016 to February 2020) and during the COVID-19 pandemic period (March 2020 to July 2021 or December 2021. The outcomes were incidence density (ID) of carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Klebsiella pneumoniae (CRKP), extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and Clostridiodies difficile, as monthly isolates per 1000 patient days (PD) and the monthly AMC ranked according to the Access, Watch, and Reserve (AWaRe) WHO classification system.</p><p><strong>Results: </strong>We assessed 15.9 million total hospital bed-days, 315,736 COVID-19 bed-days, 52,557 monthly bacterial isolates, and 461,739 monthly antimicrobial DDDs. The COVID-19 pandemic had a significant impact on the consumption of overall hospital antibiotics combined in all centers except two. Prescriptions for piperacillin/tazobactam, glycopeptides, and ceftazidime/avibactam increased, while third-generation cephalosporins, macrolides, and fluoroquinolones returned to pre-pandemic levels after an initial surge, in all centres. A positive relationship between the pandemic intensity and VRE ID was observed in 6/9 (66%) centres followed by MRSA-ID and CRPA-ID 3/4 (44%) for both. A negative relationship was found for ESBL-producing E. coli ID.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic was associated with higher usage of broad-spectrum antibiotics and higher incidence of multi-drug-resistant bacteria, with great variability by Countries. These results could support international action plans that embed AMR as a priority in the post- COVID-19 era.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: 'Dosing and route of administration of clindamycin given in combination with rifampicin' by Magreault et al.","authors":"Mahableshwar Albur, Amy Carson, Elizabeth Darley","doi":"10.1016/j.cmi.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.011","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival and quality-of-life in Mucormycosis: a multicentric ambispective cohort study.","authors":"","doi":"10.1016/j.cmi.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.001","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate long-term survival and identify predictors of mortality among patients hospitalised with mucormycosis.</p><p><strong>Methods: </strong>This prospective, multicentre cohort study included patients hospitalised for mucormycosis across 26 sites in India from March to July 2021. Follow-up data were collected at 1-, 3-, 6-, and 12-month intervals post-discharge through telephonic or in-person interviews with patients or caregivers. Primary outcomes were survival, sequelae, and quality of life, assessed using the EURO-QOL 5D-5L scale. Survival analyses were performed using the shared frailty Cox proportional hazards model for predefined subgroups. Additional sensitivity analyses using inverse probability of censoring weights and marginal structural modelling were conducted to account for loss to follow-up and the time-varying nature of the treatment and confounders.</p><p><strong>Results: </strong>Of the 686 patients, 101 deaths (14.7%) occurred within one year, with a median survival time of 230 days. The majority of deaths (64.3%) occurred early, i.e., during hospitalisation. Independent predictors of mortality included orbit involvement (HR: 2.0, 95% CI: 1.2-3.4), intracranial/cerebral involvement (HR: 2.6, 95% CI: 1.5-4.4), admission to an intensive care unit (HR: 6.4, 95% CI: 3.5-11.6), poor glycaemic control (HR: 2.3, 95% CI: 1.1-4.7), and other comorbidities (HR: 1.6, 95% CI: 1.0-2.5), and those associated with lower mortality were combination antifungal therapy (HR: 0.2, 95% CI: 0.1-0.4) and receipt of surgical treatment (HR: 0.1, 95% CI: 0.07-0.2). Survivors demonstrated improved quality of life, especially those who were gainfully employed. Sensitivity analysis indicated no major impact of loss to follow-up on survival.</p><p><strong>Conclusions: </strong>Poor glycaemic control, severe disease, and involvement of the orbit or intracranial/cerebral regions predict higher mortality in mucormycosis. Aggressive therapeutic strategies, including combination antifungal therapy and surgical interventions, substantially improved survival. The study highlights the importance of integrating psychological rehabilitation and socioeconomic support into management protocols to enhance the quality of life among survivors.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Learning from Post COVID-19 condition for epidemic preparedness' - Author's reply.","authors":"A Górska, L M Canziani, A Judd, E Tacconelli, J L Peñalvo","doi":"10.1016/j.cmi.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.010","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which trials do we need? A pragmatic randomized controlled trial on the duration of antibiotic therapy after debridement of midfoot region: fixed duration versus personalized approach.","authors":"Erlangga Yusuf, Johan Van Laethem, Jorg L de Bruijn, Sander Ten Raa, Maya Hites, Edgar Jg Peters","doi":"10.1016/j.cmi.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.006","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humoral and cellular immune responses in people living with HIV following successive COVID-19 vaccine booster doses.","authors":"José L Casado, Pilar Vizcarra, Adrián Martín-Hondarza, Ana Moreno, María J Pérez-Elías, Cristina Fernández-Chica, Sara Martín-Colmenarejo, Alejandro Vallejo","doi":"10.1016/j.cmi.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.007","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate humoral and cellular immune responses in people living with HIV (PLWH) following successive COVID-19 vaccine booster doses, in order to determine immune correlates associated with clinical outcomes (avoiding severe infections) and epidemiological impacts (preventing new infections), a topic of growing controversy in this vulnerable population.</p><p><strong>Methods: </strong>A prospective study followed 151 PLWH on suppressive antiretroviral therapy who completed initial COVID-19 vaccination and received two additional vaccine doses. The study evaluated changes in SARS-CoV-2-specific antibodies, SARS-CoV-2-ACE2 binding inhibition rates, Spike-specific memory B cells, and CD4/CD8 cell responses to variants (Ancestral, Delta, and Omicron), considering initial vaccine type, prior infections, and levels of immunosuppression.</p><p><strong>Results: </strong>Vaccine doses progressively enhanced antibody levels, memory B cells, and T-cell responses. PLWH with CD4 counts ≤350 cells/mm³ showed impaired memory B cell production versus those with CD4 >500 cells/mm³ after the third dose (0.39% [0.29-0.55] vs 0.68% [0.49-0.86]; p<0.001). Immune responses remained consistent across variants. Non-infected PLWH receiving plasmid vector vaccines demonstrated lower antibody levels against Delta and Omicron (10930 ng/mL [9623-12511] vs 13340 ng/mL [10602-14724], p=0.018; 399 ng/mL [335-702] vs 615 ng/mL [492-924], p=0.041) compared to infected PLWH. IgA-producing memory B cells increased after the third booster, particularly with mRNA vaccines (0.05% [0.0-0.09] vs 0.11 [0.07-0.17], p<0.001 in non-infected individuals). Post-booster infection rates were higher in previously uninfected individuals (25% vs 4% after second booster, p<0.001), especially among vector vaccine recipients (34.6% vs 14.5%, p=0.028).</p><p><strong>Conclusions: </strong>This study reveals that successive vaccine doses significantly enhance immune responses in PLWH, improving antibody levels, IgA⁺ memory B cells and T-cell responses, thereby reducing the risk of severe infections and potentially new infections. Nevertheless, low CD4 counts result in reduced memory B cells, necessitating tailored vaccination strategies. mRNA vaccines also offer superior protection against breakthrough infections during variant surges.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Towards Equitable and Structured Training in Pediatric Infectious Diseases Across Europe' - Author's reply.","authors":"Jon Salmanton-García, André Oberthuer, Oliver A Cornely","doi":"10.1016/j.cmi.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.008","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}