Critical Care最新文献

{"title":"Beware the self-fulfilling prophecy: enhancing clinical decision-making with AI.","authors":"Taotao Liu, Yaocong Duan","doi":"10.1186/s13054-024-05062-3","DOIUrl":"10.1186/s13054-024-05062-3","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on the article \"Physiological effects and safety of bed verticalization in patients with acute respiratory distress syndrome\", from Bouchant et al.","authors":"Ricardo Castro, Eduardo Kattan, Glenn Hernández","doi":"10.1186/s13054-024-05066-z","DOIUrl":"10.1186/s13054-024-05066-z","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive end-expiratory pressure management in patients with severe ARDS: implications of prone positioning and extracorporeal membrane oxygenation.","authors":"Christoph Boesing, Patricia R M Rocco, Thomas Luecke, Joerg Krebs","doi":"10.1186/s13054-024-05059-y","DOIUrl":"10.1186/s13054-024-05059-y","url":null,"abstract":"<p><p>The optimal strategy for positive end-expiratory pressure (PEEP) titration in the management of severe acute respiratory distress syndrome (ARDS) patients remains unclear. Current guidelines emphasize the importance of a careful risk-benefit assessment for PEEP titration in terms of cardiopulmonary function in these patients. Over the last few decades, the primary goal of PEEP usage has shifted from merely improving oxygenation to emphasizing lung protection, with a growing focus on the individual pattern of lung injury, lung and chest wall mechanics, and the hemodynamic consequences of PEEP. In moderate-to-severe ARDS patients, prone positioning (PP) is recommended as part of a lung protective ventilation strategy to reduce mortality. However, the physiologic changes in respiratory mechanics and hemodynamics during PP may require careful re-assessment of the ventilation strategy, including PEEP. For the most severe ARDS patients with refractory gas exchange impairment, where lung protective ventilation is not possible, veno-venous extracorporeal membrane oxygenation (V-V ECMO) facilitates gas exchange and allows for a \"lung rest\" strategy using \"ultraprotective\" ventilation. Consequently, the importance of lung recruitment to improve oxygenation and homogenize ventilation with adequate PEEP may differ in severe ARDS patients treated with V-V ECMO compared to those managed conservatively. This review discusses PEEP management in severe ARDS patients and the implications of management with PP or V-V ECMO with respect to respiratory mechanics and hemodynamic function.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of different VV ECMO blood flow rates on lung perfusion assessment by hypertonic saline bolus-based electrical impedance tomography","authors":"Hongling Zhang, Yongran Wu, Xuehui Gao, Chengchao Peng, Ruirui Li, Azhen Wang, Jiancheng Zhang, Shiying Yuan, Le Yang, Xiaojing Zou, You Shang","doi":"10.1186/s13054-024-05055-2","DOIUrl":"https://doi.org/10.1186/s13054-024-05055-2","url":null,"abstract":"Our study aimed to investigate the effects of different extracorporeal membrane oxygenation (ECMO) blood flow rates on lung perfusion assessment using the saline bolus-based electrical impedance tomography (EIT) technique in patients on veno-venous (VV) ECMO. In this single-centered prospective physiological study, patients on VV ECMO who met the ECMO weaning criteria were assessed for lung perfusion using saline bolus-based EIT at various ECMO blood flow rates (gradually decreased from 4.5 L/min to 3.5 L/min, 2.5 L/min, 1.5 L/min, and finally to 0 L/min). Lung perfusion distribution, dead space, shunt, ventilation/perfusion matching, and recirculation fraction at different flow rates were compared. Fifteen patients were included. As the ECMO blood flow rate decreased from 4.5 L/min to 0 L/min, the recirculation fraction decreased significantly. The main EIT-based findings were as follows. (1) Median lung perfusion significantly increased in region-of-interest (ROI) 2 and the ventral region [38.21 (34.93–42.16)% to 41.29 (35.32–43.75)%, p = 0.003, and 48.86 (45.53–58.96)% to 54.12 (45.07–61.16)%, p = 0.037, respectively], whereas it significantly decreased in ROI 4 and the dorsal region [7.87 (5.42–9.78)% to 6.08 (5.27–9.34)%, p = 0.049, and 51.14 (41.04–54.47)% to 45.88 (38.84–54.93)%, p = 0.037, respectively]. (2) Dead space significantly decreased, and ventilation/perfusion matching significantly increased in both the ventral and global regions. (3) No significant variations were observed in regional and global shunt. During VV ECMO, the ECMO blood flow rate, closely linked to recirculation fraction, could affect the accuracy of lung perfusion assessment using hypertonic saline bolus-based EIT.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141994545","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":"Correction: A critical reappraisal of vasopressin and steroids in in-hospital cardiac arrest","authors":"Spyros D. Mentzelopoulos, Athanasios Chalkias","doi":"10.1186/s13054-024-05043-6","DOIUrl":"https://doi.org/10.1186/s13054-024-05043-6","url":null,"abstract":"<p><b>Correction: Mentzelopoulos and Chalkias Critical Care (2024) 28:191</b> <b>https://doi.org/10.1186/s13054-024-04962-8</b></p><p>Following publication of the original article [1], the authors identified an error within row 7 of Table 2. In Table 2, row 7, the lowest percentages of postresuscitation hypotension (i.e. 17% and 15%) actually correspond to the intervention group(s) and the highest (i.e. 28% and 29%) to control.</p><br/><p>Table 2 row 7 currently reads:</p><table><tbody><tr><td><p>Lowest MAP ≤ 50 mmHg and SAP ≤ 80 mmHg, intervention group(s) versus control (%)</p></td><td><p>28% versus 17%—<i>P</i> = 0.12 and 29% versus 15%; <i>P</i> = 0.03^d</p></td><td><p>NR but significant difference unlikely^c</p></td></tr></tbody></table><figure><figcaption><b data-test=\"table-caption\">Table 2 Key differences between the Greek VSE trials and the Danish VAM IHCA trial</b></figcaption><span>Full size table</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>]</p><br/><p>Table 2 row 7 should read:</p><table><tbody><tr><td><p>Lowest MAP ≤ 50 mmHg and SAP ≤ 80 mmHg, intervention group(s) versus control (%)</p></td><td><p>17% versus 28%—<i>P</i> = 0.12 and 15% versus 29%; <i>P</i> = 0.03^d</p></td><td><p>NR but significant difference unlikely^c</p></td></tr></tbody></table><figure><figcaption><b data-test=\"table-caption\">Table 2 Key differences between the Greek VSE trials and the Danish VAM IHCA trial</b></figcaption><span>Full size table</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>]</p><p>Table 2 has been updated in this correction and the original article [1] has been corrected.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Mentzelopoulos SD, Chalkias A. A critical reappraisal of vasopressin and steroids in in-hospital cardiac arrest. Crit Care. 2024;28:191. https://doi.org/10.1186/s13054-024-04962-8.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><h3>Authors and Affiliations</h3><ol><li><p>First Department of Intensive Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece</p><p>Spyros D. Mentzelopoulos</p></li><li><p>Department of Intensive Care Medicine, Evaggelismos General Hospital, 45‑47 Ipsilandou St, 10675, Athens, Greece</p><p>Spyros D. Mentzelopoulos</p></li><li><p>Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Phil","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141986363","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":"High expression of L-GILZ transcript variant 1 (GILZ TV 1) is associated with increased 30-day sepsis mortality, and a high expression ratio possibly contraindicates hydrocortisone administration","authors":"Stefan Rusev, Patrick Thon, Birte Dyck, Dominik Ziehe, Tim Rahmel, Britta Marko, Lars Palmowski, Hartmuth Nowak, Björn Ellger, Ulrich Limper, Elke Schwier, Dietrich Henzler, Stefan Felix Ehrentraut, Lars Bergmann, Matthias Unterberg, Michael Adamzik, Björn Koos, Katharina Rump","doi":"10.1186/s13054-024-05056-1","DOIUrl":"https://doi.org/10.1186/s13054-024-05056-1","url":null,"abstract":"Sepsis presents a challenge due to its complex immune responses, where balance between inflammation and anti-inflammation is critical for survival. Glucocorticoid-induced leucine zipper (GILZ) is key protein in achieving this balance, suppressing inflammation and mediating glucocorticoid response. This study aims to investigate GILZ transcript variants in sepsis patients and explore their potential for patient stratification and optimizing glucocorticoid therapy. Sepsis patients meeting the criteria outlined in Sepsis-3 were enrolled, and RNA was isolated from whole blood samples. Quantitative mRNA expression of GILZ transcript variants in both sepsis patient samples (n = 121) and the monocytic U937 cell line (n = 3), treated with hydrocortisone and lipopolysaccharides, was assessed using quantitative PCR (qPCR). Elevated expression of GILZ transcript variant 1 (GILZ TV 1) serves as a marker for heightened 30-day mortality in septic patients. Increased levels of GILZ TV 1 within the initial day of sepsis onset are associated with a 2.2-[95% CI 1.2–4.3] fold rise in mortality, escalating to an 8.5-[95% CI 2.0–36.4] fold increase by day eight. GILZ TV1 expression is enhanced by glucocorticoids in cell culture but remains unaffected by inflammatory stimuli such as LPS. In septic patients, GILZ TV 1 expression increases over the course of sepsis and in response to hydrocortisone treatment. Furthermore, a high expression ratio of transcript variant 1 relative to all GILZ mRNA TVs correlates with a 2.3-fold higher mortality rate in patients receiving hydrocortisone treatment. High expression of GILZ TV 1 is associated with a higher 30-day sepsis mortality rate. Moreover, a high expression ratio of GILZ TV 1 relative to all GILZ transcript variants is a parameter for identifying patient subgroups in which hydrocortisone may be contraindicated.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918765","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":"Redefining urine output thresholds for acute kidney injury criteria in critically Ill patients: a derivation and validation study","authors":"Guido Dias Machado, Leticia Libório Santos, Alexandre Braga Libório","doi":"10.1186/s13054-024-05054-3","DOIUrl":"https://doi.org/10.1186/s13054-024-05054-3","url":null,"abstract":"The current definition of acute kidney injury (AKI) includes increased serum creatinine (sCr) concentration and decreased urinary output (UO). Recent studies suggest that the standard UO threshold of 0.5 ml/kg/h may be suboptimal. This study aimed to develop and validate a novel UO-based AKI classification system that improves mortality prediction and patient stratification. Data were obtained from the MIMIC-IV and eICU databases. The development process included (1) evaluating UO as a continuous variable over 3-, 6-, 12-, and 24-h periods; (2) identifying 3 optimal UO cutoff points for each time window (stages 1, 2, and 3); (3) comparing sensitivity and specificity to develop a unified staging system; (4) assessing average versus persistent reduced UO hourly; (5) comparing the new UO-AKI system to the KDIGO UO-AKI system; (6) integrating sCr criteria with both systems and comparing them; and (7) validating the new classification with an independent cohort. In all these steps, the outcome was hospital mortality. Another analyzed outcome was 90-day mortality. The analyses included ROC curve analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and logistic and Cox regression analyses. From the MIMIC-IV database, 35,845 patients were included in the development cohort. After comparing the sensitivity and specificity of 12 different lowest UO thresholds across four time frames, 3 cutoff points were selected to compose the proposed UO-AKI classification: stage 1 (0.2–0.3 mL/kg/h), stage 2 (0.1–0.2 mL/kg/h), and stage 3 (< 0.1 mL/kg/h) over 6 h. The proposed classification had better discrimination when the average was used than when the persistent method was used. The adjusted odds ratio demonstrated a significant stepwise increase in hospital mortality with advancing UO-AKI stage. The proposed classification combined or not with the sCr criterion outperformed the KDIGO criteria in terms of predictive accuracy—AUC-ROC 0.75 (0.74–0.76) vs. 0.69 (0.68–0.70); NRI: 25.4% (95% CI: 23.3–27.6); and IDI: 4.0% (95% CI: 3.6–4.5). External validation with the eICU database confirmed the superior performance of the new classification system. The proposed UO-AKI classification enhances mortality prediction and patient stratification in critically ill patients, offering a more accurate and practical approach than the current KDIGO criteria.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918752","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":"The role of lipid emulsions containing omega-3 fatty acids for medical and surgical critical care patients","authors":"Christian Stoppe, Robert G. Martindale, Stanislaw Klek, Philip C. Calder, Paul E. Wischmeyer, Jayshil J. Patel","doi":"10.1186/s13054-024-05053-4","DOIUrl":"https://doi.org/10.1186/s13054-024-05053-4","url":null,"abstract":"In critical illness the regulation of inflammation and oxidative stress can improve patient outcomes, and thus omega-3 polyunsaturated fatty acids (PUFAs) have been used as part of parenteral nutrition (PN) owing to their potential anti-inflammatory effects. The international lipids in PN Summit, encompassed discussions and the production of consensus guidelines concerning PN intravenous lipid emulsion (ILE) use in critical care. The Lipid Summit participants agreed that the inclusion of fish oil in ILEs is associated with meaningful clinical benefits without signals of harm, based on a strong biological rationale and current clinical evidence. Decisions concerning ILE choice should be made based on current evidence, thus addressing clinical requirements for guidance, particularly as further definitive evidence seems unlikely to occur. In addition, a future of individualized ICU care is envisioned, yielding better clinical outcomes. This approach will require the greater use of intelligent study designs incorporating the use of biomarkers of omega-3 derivatives, inflammatory-resolving processes, and/or muscle protein breakdown.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918753","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":"Sex matters: Is it time for a SOFA makeover?","authors":"Emma Larsson","doi":"10.1186/s13054-024-05030-x","DOIUrl":"https://doi.org/10.1186/s13054-024-05030-x","url":null,"abstract":"<p>While sepsis affects individuals regardless of sex, emerging research has highlighted notable differences in how women and men experience, respond to, and recover from sepsis treated in intensive care units (ICU). These differences are influenced by a complex interplay of biological, hormonal, and sociocultural factors. As we explore sepsis management in ICU settings, it becomes evident that understanding the factors contributing to these sex-based variations is important for tailoring therapeutic approaches and improving overall patient outcomes. Moreover, for a nuanced interpretation of current evidence, it is worth noting the distinction between the terms gender and sex: gender refers to the socially constructed roles and behaviors that a given society considers appropriate, while sex pertains to biological characteristics.</p><p>The ICU sepsis patient population comprises individuals of all ages and with diverse comorbidities and clinical conditions, leading to acute organ failure. Efforts have been made to identify distinct phenotypes and establish correlations with host-response patterns and clinical outcomes [1]. As clinicians, it is increasingly clear that personalized treatment and prognostication strategies are essential for optimizing patient care, but somewhat limited by our current diagnostic and therapeutic tools. While patient sex is often a readily available characteristic, the extent to which we incorporate it as a variable into our comprehensive clinical assessments for critically ill sepsis patients could warrant further consideration and refinement. Are we taking it into account as thoroughly as we should? In their recent publication in this journal, Zimmermann and colleagues conducted a retrospective study on sex differences in the sequential organ failure assessment (SOFA) score among ICU patients with sepsis or septic shock, analyzing data from 85 ICUs across Switzerland [2]. They concluded that significant variations exist, although the full clinical implications remain to be elucidated. Notably, they found no disparity in ICU mortality rates between male and female patients. The authors suggested that reevaluation of sex-specific thresholds for SOFA score components could potentially refine future individualized classifications, addressing a current oversight in the consideration of patient sex within the SOFA scoring system.</p><p>Aligned with these findings, emerging insights into sepsis pathophysiology indicate that sex-based differences in host responses to pathogens may play an important role [3]. Animal models suggest that females exhibit lower susceptibility to sepsis and tend to recover more effectively than males. Distinct host responses to pathogens between females and males could be partly attributed to the sex-specific polarization of intracellular pathways responding to pathogen–cell receptor interactions [4]. Sex hormones are believed to play a role in these disparities and have been shown to target most ","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904301","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":"The kidney: the critical organ system for guiding nutrition therapy in the ICU-patient?","authors":"Wilfred Druml, Thomas Staudinger, Michael Joannidis","doi":"10.1186/s13054-024-05052-5","DOIUrl":"https://doi.org/10.1186/s13054-024-05052-5","url":null,"abstract":"Most randomized controlled studies on nutrition in intensive care patients did not yield conclusive results or were neutral or negative concerning the primary endpoints but also in most secondary endpoints. However, there is a consistent observation that in several of these studies there was a negative effect of the nutrition intervention on the kidneys in one of the study arms. During the early phase and in unstable periods during further course of disease an inadequate clinical nutrition can damage the kidneys, can elicit or aggravate acute kidney injury and/ or increase requirements of renal replacement therapy (RRT). This relates to total energy intake, glucose intake/hyperglycemia and protein/ amino acid intake at various stages of renal dysfunction. The kidney could present a critical organ system for guiding nutrition therapy, a close monitoring of kidney function should be observed and nutrition therapy may need to be adapted accordingly. The long-held dogma of performing full nutrition and accept an otherwise not necessary RRT is definitely to be refuted.","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":null,"pages":null},"PeriodicalIF":15.1,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899497","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}