European Journal of Anaesthesiology最新文献

{"title":"The immunomodulatory effect of sugammadex in vitro and after total hip arthroplasty : A randomised controlled pilot and retrospective cohort study.","authors":"Veerle Bijkerk, Lotte M C Jacobs, Jetze Visser, Esmee V van Helden, Christiaan Keijzer, Leonie S Helder, Kim I Albers, Michiel C Warlé","doi":"10.1097/EJA.0000000000002132","DOIUrl":"10.1097/EJA.0000000000002132","url":null,"abstract":"<p><strong>Background: </strong>Postoperative immunosuppression is a well known phenomenon associated with infectious complications. Peri-operative immune dysregulation is likely induced by surgical damage and anaesthetics, but remains far from comprehensively characterised. To address this, the effects of individual drugs on immune function must be explored. Sugammadex, a cyclodextrin that encapsulates rocuronium, also binds other drugs and structures and may influence the inflammatory response.</p><p><strong>Objective: </strong>Investigate the potential immunomodulatory effect of sugammadex.</p><p><strong>Design: </strong>An in-vitro experiment, randomised controlled pilot study and retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary teaching hospital.</p><p><strong>Patients: </strong>Twelve healthy donors, 20 adults undergoing total hip arthroplasty and 1000 major abdominal surgery patients.</p><p><strong>Intervention: </strong>In vitro: isolated peripheral blood mononuclear cells were exposed to sugammadex and rocuronium before stimulation with Escherichia coli lipopolysaccharides (LPS).Pilot study: patients undergoing total hip arthroplasty under single shot spinal anaesthesia randomised to sugammadex (8 mg kg -1 ) or placebo at the end of surgery.</p><p><strong>Main outcome measure: </strong>In vitro: TNF, IL-1β and IL-6 production capacity.Pilot study: Ex-vivo cytokine production capacity after whole blood stimulation with LPS.Retrospective cohort: sugammadex as a predictor of postoperative infectious complications.</p><p><strong>Results: </strong>In vitro : rocuronium suppressed TNF and IL-1β production capacity. Higher doses of sugammadex (100 and 1000 μg ml -1 ; 100 μg ml -1 corresponds to plasma concentration reached upon 8 mg kg -1 sugammadex) restored suppression of TNF and IL-1β.Pilot study: no differences in ex-vivo cytokine production capacity between the sugammadex and placebo group at the end of surgery or on postoperative day 1.Retrospective cohort study : no association between sugammadex and postoperative infectious complications (OR = 1.000, 95% CI 0.998 to 1.002).</p><p><strong>Conclusion: </strong>Sugammadex preserved cytokine production capacity of TNF and IL-1β in vitro . The clinical pilot study and retrospective cohort study revealed no early postoperative immunomodulatory effects for sugammadex in the clinically used dosing range.</p><p><strong>Trial registration: </strong>clinicaltrials.gov identifier: NCT05723406 and NCT05244655.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"676-686"},"PeriodicalIF":6.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of transient sinus pause in cardiac rhythm increases with the use of hyperangulated videolaryngoscope blade compared to standard angle blade during tracheal intubation: A prospective randomised controlled trial.","authors":"Yea-Ji Lee, Sookyung Lee, Jong Won Kim, Chung-Sik Oh, Tae-Yop Kim","doi":"10.1097/EJA.0000000000002243","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002243","url":null,"abstract":"<p><strong>Background: </strong>The hyperanglulated videolaryngoscope blade may exert different forces on the larynx compared to the standard angle blade, potentially leading to haemodynamic changes, particularly in cardiac rhythm.</p><p><strong>Objective: </strong>This study aimed to investigate the impact of the hyperangulated blade on haemodynamic changes during tracheal intubation.</p><p><strong>Design: </strong>A prospective randomised controlled trial.</p><p><strong>Setting: </strong>Tertiary, university hospital, single centre.</p><p><strong>Patients: </strong>A total of 134 patients scheduled for general anaesthesia were included in the final analysis.</p><p><strong>Intervention: </strong>Tracheal intubation using either a standard angle videolaryngoscope blade (Standard group) or a hyperangulated blade (Hyperangulated group).</p><p><strong>Main outcome measures: </strong>The occurrence of a transient decrease in heart rate or a transient sinus pause during tracheal intubation was recorded.</p><p><strong>Results: </strong>The incidence of transient sinus pause was significantly higher in the Hyperangulated group compared to the Standard group (19% vs. 4%, respectively, P = 0.009). The percentage of the glottic opening score was significantly higher, and the incidence of backward, upward, and rightward pressure was significantly lower in the Hyperangulated group. The incidences of direct epiglottis lifting was significantly higher in the Hyperangulated group, and the total length of time of the blade in the mouth was significantly longer in the Hyperangulated group. Multivariate logistic analysis identified the use of a hyperangulated blade as an independent predictor of transient sinus pause during tracheal intubation (odds ratio = 5.73, 95% confidence interval = 1.53 to 21.53; P = 0.010).</p><p><strong>Conclusion: </strong>The hyperangulated videolaryngoscope blade is associated with a higher incidence of transient sinus pause than the standard angle blade during tracheal intubation.</p><p><strong>Trial registration: </strong>Clinical Research Information Service. Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare (Republic of Korea). (Identifier: KCT0006534). Online address: http://cris.nih.go.kr.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inefficiency of silica zeolite based scavenging of sevoflurane in a clinical practice setting.","authors":"David Bracco","doi":"10.1097/EJA.0000000000002242","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002242","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mean arterial pressure is all you need in a machine learning model for mean arterial pressure prediction.","authors":"Thomas Tschoellitsch, Sophie Kaltenleithner, Alexander Maletzky, Philipp Moser, Philipp Seidl, Carl Böck, Stefan Thumfart, Michael Giretzlehner, Sepp Hochreiter, Jens Meier","doi":"10.1097/EJA.0000000000002238","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002238","url":null,"abstract":"<p><strong>Background: </strong>Anaesthesiology and intensive care use monitoring to identify patients in danger of deterioration. Traditionally, trends and early warning scores allow clinicians to predict deterioration with moderate reliability. Reduced mean arterial blood pressure has been associated with complications, and models have been sought to predict its value. Machine learning methods with complex inputs have been used for predictive monitoring in hospital care.</p><p><strong>Objectives: </strong>This study evaluates whether machine learning can predict mean arterial pressure (MAP) from previous values.</p><p><strong>Design: </strong>This is a monocentre, retrospective, exploratory, observational cohort study using the MIMIC-III-WDB, VitalDB and an internal study centre dataset, training machine learning models on adult patients with invasively measured blood pressure (IBP) as input during an observation window up to 20 min before the prediction horizon (5 to 20 min).</p><p><strong>Setting: </strong>Kepler University Hospital, Linz, Austria.</p><p><strong>Participants: </strong>Two thousand three hundred and forty-six patients from the internal dataset, 4741 patients from MIMIC-III-WDB and 3357 patients from VitalDB were analysed.</p><p><strong>Main outcome measures: </strong>The primary endpoint was model performance in predicting whether MAP would fall below 65 mmHg in a given time frame. In a secondary analysis, we restricted the input set to stable patients with current MAP above 65 mmHg.</p><p><strong>Results: </strong>Models using the complete training data achieved receiver operating characteristic area under the curves (ROC AUCs) of 0.963, 0.946, 0.934 and 0.923 on the internal dataset for 5, 10, 15 and 20 min of prediction horizon, respectively, and 0.856, 0.837, 0.821 and 0.804 in the secondary analysis. The maximum difference of ROC AUC to baseline measurement (ROC AUC of last measured MAP as trivial estimator) was 0.006 for the complete training data and 0.051 for stable patients. The prediction of MAP may allow clinicians to intervene in time before MAP deterioration becomes clinically relevant.</p><p><strong>Conclusion: </strong>Predicting MAP below 65 mmHg within 5, 10, 15 and 20 min for patients with and without a MAP above 65 mmHg is possible and requires only MAP as input for machine learning models.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05471193).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalised analgesia/nociception index-guided opioid administration for abdominal surgery: A randomised trial.","authors":"Adrien Guyot, Pauline Rouxel, Samir Jaber, Bruno Pereira, Céline Lambert, Emmanuel Futier, Helene Beloeil","doi":"10.1097/EJA.0000000000002154","DOIUrl":"10.1097/EJA.0000000000002154","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 7","pages":"651-653"},"PeriodicalIF":6.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety and pain catastrophising: A systematic review and meta-analysis.","authors":"Juan R Castaño-Asins, Alberto Barceló-Soler, Estíbaliz Royuela-Colomer, Juan P Sanabria-Mazo, Vanesa García, Randy Neblett, Antonio Bulbena, Víctor Pérez-Solà, Antonio Montes-Pérez, Gerard Urrútia, Albert Feliu-Soler, Juan V Luciano","doi":"10.1097/EJA.0000000000002157","DOIUrl":"10.1097/EJA.0000000000002157","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that psychological interventions during the peri-operative period can help reduce the development of chronic postsurgical pain (CPSP); however, there is no evidence of their effects on other important pain-related variables.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis evaluated the effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety, stress and pain catastrophising.</p><p><strong>Study design: </strong>Systematic review of randomised controlled trials (RCTs) with meta-analyses (registration number: CRD42023403384). The search for studies was carried out in Web of Science, PsychINFO, MEDLINE and CINAHL up to March 2023.</p><p><strong>Eligibility criteria: </strong>RCTs comparing peri-operative psychological interventions with usual care or nonpsychological control interventions in adult patients with any type of surgery. The main outcome was pain intensity reduction after surgery. Secondary outcomes included patient-reported depression, anxiety, stress and pain catastrophising after surgery.</p><p><strong>Results: </strong>Twenty-seven RCTs (psychological intervention: 1462 patients; control: 1528 patients) were included in the systematic review and 17 studies for the meta-analysis. Random-effect models were used to combine the effect sizes of the studies. Compared with usual care or control interventions, psychological interventions reduced pain intensity, d = -0.45 95% CI, (-0.77 to -0.13) and anxiety, d = -0.33 95% CI, (-0.54 to -0.11) after surgery. Moderator analyses revealed that psychological interventions delivered by a psychologist were more effective than those delivered by other professionals. CBT seemed the most beneficial for surgical patients. The findings in other moderator analyses were heterogeneous.</p><p><strong>Conclusions: </strong>Moderate-quality evidence exists that peri-operative psychological interventions can significantly reduce pain intensity and anxiety postsurgery. However, results should be interpreted with caution because of the presence of a high risk of bias in many trials.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 7","pages":"609-625"},"PeriodicalIF":6.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waste and cost assessment of total intravenous anaesthesia in the context of environmental sustainability: Insights from a Dutch academic hospital.","authors":"Elisabeth A Rieff, Tom G Jacobs, Nicolaas H Sperna Weiland, Caroline van der Marel, Nicole Hunfeld","doi":"10.1097/EJA.0000000000002176","DOIUrl":"10.1097/EJA.0000000000002176","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"655-657"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pupillary dilation to monitor nociception in awake volunteers: A stimuli-randomised placebo-controlled study.","authors":"Nathalie M Malewicz-Oeck, Nic Skorupka, Felix Bartholmes, Adeline Dombrowski, Melanie Ebel, Peter K Zahn, Christine H Meyer-Frießem","doi":"10.1097/EJA.0000000000002143","DOIUrl":"10.1097/EJA.0000000000002143","url":null,"abstract":"<p><strong>Background: </strong>Pupillary reflex dilation (PRD) quantifies nociception in anaesthetised patients, enabling tailored opioid administration, which in turn reduces catecholamine levels and postoperative pain intensity. However, its utility in objectively assessing pain in awake individuals remains challenging.</p><p><strong>Objective: </strong>To investigate whether PRD can differentiate between painful and nonpainful stimuli in awake volunteers.</p><p><strong>Design: </strong>This was a randomised, placebo-controlled, stimuli-randomised study conducted after ethical approval and registration (DRKS00024791).</p><p><strong>Setting: </strong>This single-centre study was performed at BG University Hospital Bergmannsheil Bochum, Germany, between November 2021 and January 2022.</p><p><strong>Volunteers: </strong>Thirty healthy volunteers (25 ± 2 years, 50% male) were included in the study.</p><p><strong>Interventions: </strong>After a rest, the following stimuli were applied to one ventral forearm: an unannounced electric pain stimulus (UPS) and a randomised sequence of either an announced painful stimulus (APS), a placebo or a nonpainful stimulus (NPS).</p><p><strong>Main outcome measures: </strong>Pupil dilatation was measured as PRD (%) for 60 s during the experimental condition \"rest\", and during and after each stimulus application using an AlgiScan device. The participants rated stimulus pain intensity via a numeric rating scale (NRS: 0 = no pain, 10 = most intense pain imaginable). Statistics: Paired t -test, rmANOVA, Spearman's correlation and receiver operating characteristics (ROC), P  < 0.05.</p><p><strong>Results: </strong>The subjective pain intensity ratings were higher after APS (6.0 ± 1.9) than after UPS (5.5 ± 1.7, P  = 0.007), placebo (0.0 ± 0.0, P  = 0.027) and NPS (0.0 ± 0.0, P  = 0.001). Similarly, objective pupillary reaction to the stimuli measured using PRD was higher for APS: 13 (97.6% CI, 10.0 to 19.0)% vs. NPS 13 (97.6% CI, 7.0 to 20.0), P  = 0.024). UPS elicited the highest PRD of 25 (95.7% CI, 18.0 to 30.0)% vs. rest, P  < 0.001; significantly greater than placebo at 13.5 (96.4% CI, 10.0 to 22.0)%, P  < 0.001); and NPS at 13 (97.6% CI, 7.0 to 20.0)%, P  < 0.0001). However, no significant differences in PRD were observed between APS and UPS despite their electrical similarity. PRD correlated with pain intensity ( r  = 0.35, P  < 0.0001).</p><p><strong>Conclusions: </strong>In awake volunteers, PRD differentiates between painful and nonpainful stimuli and correlates with pain intensity. Noninvasive PRD measurement may be suitable for nociception monitoring in awake individuals.</p><p><strong>Trial registration: </strong>Prospectively DRKS00024791, March 2021.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"587-598"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat-dose dexamethasone to prevent pain relapse after total knee arthroplasty in high-pain-response patients: A randomised, double-blind, placebo-controlled superiority trial.","authors":"Anders H Springborg, Claus Varnum, Niklas I Nielsen, Lasse E Rasmussen, Per Kjærsgaard-Andersen, Lina Pleckaitiene, Kirill Gromov, Anders Troelsen, Henrik Kehlet, Nicolai B Foss","doi":"10.1097/EJA.0000000000002189","DOIUrl":"10.1097/EJA.0000000000002189","url":null,"abstract":"<p><strong>Background: </strong>Peri-operative glucocorticoids reduce pain after total knee arthroplasty, with evidence suggesting potential benefits of increased dosing in specific patient groups. However, the impact of repeat-dose glucocorticoids has not been studied in high-pain-response patients receiving pre-operative high-dose glucocorticoids.</p><p><strong>Objective: </strong>To investigate the effect on pain of an oral dose of dexamethasone after total knee arthroplasty in selected high-pain-response patients who had received a pre-operative high dose of intravenous dexamethasone (1 mg kg -1 ).</p><p><strong>Design: </strong>Randomised, double-blind, placebo-controlled superiority study.</p><p><strong>Setting: </strong>A multicentre study conducted at two major arthroplasty centres in Denmark from November 2021 to March 2024.</p><p><strong>Patients: </strong>One hundred and ten patients undergoing total knee arthroplasty who had received multimodal analgesia including pre-operative intravenous dexamethasone 1 mg kg -1 . Selection criteria included a Pain Catastrophising Scale score greater than 20 and moderate-to-severe pain (VAS >30) during walking 24 h postoperatively.</p><p><strong>Intervention: </strong>Patients were randomised to either oral dexamethasone 24 mg or placebo on postoperative day 1.</p><p><strong>Main outcome measures: </strong>The primary outcome was the proportion of patients experiencing moderate-to-severe pain during walking at 48 h postoperatively. Secondary outcomes included pain scores at various time points within 1 week postoperatively, rescue analgesics, quality of sleep, length of hospital stay and morbidity with follow-up at 30 days.</p><p><strong>Results: </strong>At 48 h postoperatively, 65% of patients in the dexamethasone group and 79% in the placebo group reported moderate-to-severe pain during walking: odds ratio 0.48 [95% confidence interval (CI), 0.20 to 1.16]; P  = 0.100. The mean ± SD Visual Analogue Scale (VAS) at 48 h during walking was 43 ± 21 in the dexamethasone group and 51 ± 22 in the placebo group ( P  = 0.051). There were no differences between the groups regarding secondary pain outcomes or the use of rescue analgesics.</p><p><strong>Conclusion: </strong>The administration of a high oral dose of dexamethasone following an initial pre-operative dose of 1 mg kg -1 intravenously in selected high-pain-response patients had no effect on postoperative pain following total knee arthroplasty.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT05563155.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"599-608"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CO 2 -equivalent emissions of a Bispectral Index electrode.","authors":"Sarah Saxena, Mia Gisselbaek, Joana Berger-Estilita, Alain F Kalmar","doi":"10.1097/EJA.0000000000002175","DOIUrl":"10.1097/EJA.0000000000002175","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"653-655"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}