Irish Journal of Medical Science最新文献

{"title":"Improving time to ECG in ambulatory chest pain: lessons from a larger Irish quality improvement cohort.","authors":"Joseph Anderson","doi":"10.1007/s11845-026-04681-9","DOIUrl":"https://doi.org/10.1007/s11845-026-04681-9","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rule-Out yield of the European society of cardiology 0/1-Hour troponin protocol in frail and non-frail octogenarians.","authors":"Ugur Durmus, Sebnem Zeynep Eke Kurt, Mustafa Sefa Isin, Asım Bedri Erdem, Erdem Kurt, Suphi Bahadirli","doi":"10.1007/s11845-026-04688-2","DOIUrl":"https://doi.org/10.1007/s11845-026-04688-2","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the rule-out yield of the European Society of Cardiology (ESC) 0/1-h high-sensitivity cardiac troponin I (hs-cTnI) algorithm for 30-day major adverse cardiac events (MACE) in emergency department (ED) patients aged ≥ 80 years, and explore whether frailty modifies performance.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included patients aged ≥ 80 undergoing 0/1-h hs-cTnI sampling for suspected acute coronary syndrome. Frailty was defined using the Clinical Frailty Scale (≥ 5). The prespecified primary outcome was the 30-day MACE miss rate in the rule-out stratum against a 1% threshold.</p><p><strong>Results: </strong>Of 1,136 screened encounters, 800 were analyzed (median age 83 years; 56.9% female); 312 (39.0%) were frail. Blinded re-abstraction of 80 records yielded kappa 0.82 (0.71-0.93) for frailty and agreement ≥ 0.71 across variables. The algorithm classified 120 patients (15.0%) as rule-out (prespecified target, 236); two had 30-day MACE (miss rate 1.7%; wide 95% Wilson CI, 0.5%-5.9%), an imprecise estimate whose upper bound exceeds the 1% threshold. A post hoc bounding analysis counting all 11 rule-out patients with incomplete nonfatal ascertainment as events raised the upper bound to 10.8% (6.4%-17.7%). Sensitivity was 99.0% and negative predictive value 98.3%. In prespecified exploratory analysis, no statistically significant independent association was observed between frailty and 30-day MACE (average marginal effect + 1.03 percentage points; 95% CI, -5.05 to + 7.20; p = 0.744).</p><p><strong>Conclusions: </strong>The ESC algorithm ruled out only 15% of octogenarians, potentially reflecting baseline age- and renal-related troponin elevations. Limited rule-out sample size, wide confidence intervals, and incomplete follow-up prevent a definitive safety conclusion.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond seropositivity: quantitative parietal cell antibody titers predict gastric intestinal metaplasia in a high helicobacter pylori prevalence setting.","authors":"İbrahim Durak, Bekir Ucun, Hayrettin Sever, Huseyin Alkim","doi":"10.1007/s11845-026-04686-4","DOIUrl":"https://doi.org/10.1007/s11845-026-04686-4","url":null,"abstract":"<p><strong>Purpose: </strong>Anti-gastric parietal cell antibody (APA) positivity is a recognized serological biomarker for autoimmune gastritis, but whether quantitative APA titer levels correlate with the severity of gastric intestinal metaplasia (GIM) in high Helicobacter pylori (H. pylori) prevalence settings remains unclear. This study aimed to evaluate the association between quantitative APA titer dilutions and histopathological GIM in a large endoscopic cohort.</p><p><strong>Methods: </strong>In this retrospective cohort study, medical records of adult patients who underwent APA testing at a tertiary referral center between November 2017 and November 2019 were reviewed. Of 1,104 screened patients, 453 met inclusion criteria after excluding those with repeated testing or missing data; following exclusion of 118 patients without gastroscopy or adequate biopsy sampling, 335 patients who underwent standardized topographical gastric biopsy mapping constituted the definitive analysis cohort. Associations between APA status/titer dilutions and histopathological findings were assessed using chi-squared tests and multivariate logistic regression.</p><p><strong>Results: </strong>GIM was present in 24.5% (n = 82) of the cohort. APA positivity was significantly associated with GIM (40.5% vs. 15.4% in APA-negative patients, p <0.001), with a titer-dependent dose-response relationship peaking at 50.0% in the 1:320 and >1:320 dilution subgroups. In multivariate analysis, each incremental step-up in APA titer dilution (OR 1.522, 95% CI 1.304-1.776) and advancing age (OR 1.043, 95% CI 1.021-1.066) independently predicted GIM, while active H. pylori infection was an independent negative predictor (OR 0.348, 95% CI 0.184-0.660).</p><p><strong>Conclusion: </strong>Quantitative APA titers, rather than binary positivity, demonstrate a clear dose-response relationship with histopathological GIM. Titers of 1:320 or greater identify a clinically actionable threshold that may guide prioritization of endoscopic evaluation with standardized topographical biopsy mapping.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators for community surgery in general practice / family medicine settings: a scoping review.","authors":"Ke Yi Lee, Nandakumar Ravichandran, John Broughan, Niall Maguire, Walter Cullen, Nia Clendennen, Kieran McCabe","doi":"10.1007/s11845-026-04684-6","DOIUrl":"https://doi.org/10.1007/s11845-026-04684-6","url":null,"abstract":"<p><strong>Background: </strong>Rising healthcare demand and costs have prompted policymakers to explore strategies for delivering appropriate care closer to patients. In Ireland, Sláintecare supports the transfer of suitable hospital activity to community-based providers, while the United Kingdom's Fit for the Future: 10-Year Health Plan promotes a shift towards community-based care. Community surgery may contribute to this transition, but successful implementation requires appropriate resources, training, governance, and collaboration. This scoping review aimed to synthesise existing evidence on barriers and facilitators influencing the delivery of community surgery in general practice.</p><p><strong>Methods: </strong>A scoping review was conducted following Levac's revision of Arksey and O'Malley's framework. Literature searches were performed in PubMed, Scopus, and Embase for studies published between January 2015 and May 2025, in line with PRISMA-ScR guidelines. Data were charted and analysed using thematic analysis guided by Braun and Clarke's framework.</p><p><strong>Results: </strong>Of 1,578 identified studies, 10 were included. Three key themes emerged: [1] operational implementation [2], GP practice dynamics, and [3] patient acceptability and engagement. Barriers included time constraints, limited resources, inconsistent training, limited collaboration between primary and secondary care, and low provider confidence. Facilitators included appropriate infrastructure, structured training, organisational support and collaboration across settings.</p><p><strong>Conclusion: </strong>Community surgery can be delivered safely in general practice, but implementation requires appropriate resourcing, training, governance, and collaboration. Community surgery may contribute to timely and equitable access to high-quality surgical care while reducing unnecessary demand on secondary care. Further research should explore stakeholder perspectives and long-term outcomes.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Association between postoperative arterial blood gas parameters and cognitive dysfunction following coronary artery bypass grafting: a prospective observational study\".","authors":"Fatima Ayyaz, Haris Khan, Ifza Zia","doi":"10.1007/s11845-026-04694-4","DOIUrl":"https://doi.org/10.1007/s11845-026-04694-4","url":null,"abstract":"","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder dysfunction in parkinson's disease: An updated review and guide for the urologist.","authors":"Daniel Peter McNicholas, Jaraspong Vuthiwong, Johan Gani","doi":"10.1007/s11845-026-04673-9","DOIUrl":"https://doi.org/10.1007/s11845-026-04673-9","url":null,"abstract":"<p><strong>Purpose: </strong>Bladder dysfunction(BD) is a common and debilitating manifestation of Parkinson's Disease(PD). However, guidelines for its management are lacking. We aim to address key bladder dysfunction issues that a urologist faces when managing PD patients.</p><p><strong>Methods: </strong>BD issues in PD patients were identified by expert opinion. We discussed the available literature and the recommended management for each of the identified issue.</p><p><strong>Results: </strong>Anticholinergics are traditionally first-line for overactive bladder (OAB) management; however, beta-3 agonists should instead be considered first-line therapy to reduce anticholinergic burden. Onabotulinum toxin-A is safe for PD patients, and we recommend a starting dose of 100IU. When comparing PD and Multiple System Atrophy (MSA), detrusor sphincter dyssynergia and high post void residual (PVR) strongly favour MSA, whereas detrusor overactivity with minimal PVR is more typical in PD. Surgery for bladder outflow obstruction is safe in PD patients, but should be avoided in MSA. Urodynamics should be considered prior to surgery. If diagnosis is unclear between PD and MSA, a neurologist should be consulted. Management of nocturia, functional incontinence and falls should include optimisation of PD management, environmental factors and standard OAB options. Orthostatic hypotension is common in PD and Midodrine, the treatment of choice, can cause bladder outlet obstruction(BOO). If this occurs, patients should consult their neurologist about an alternative medication. Alternatively, they can start 5-alpha reductase therapy, consider catheterisation or BOO surgery.</p><p><strong>Conclusion: </strong>Managing a PD patient's urological issues can be challenging. This article is an updated and comprehensive review of bladder dysfunction and its management in PD patients.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of ocular findings in pediatric patients with liver disease associated with metabolic dysfunction.","authors":"Elif Damar Güngör, Şükrü Güngör, Mete Güler, Nisa Kahraman, Adil Dogan","doi":"10.1007/s11845-026-04667-7","DOIUrl":"https://doi.org/10.1007/s11845-026-04667-7","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated fatty liver disease (MAFLD) is common in children and may affect extrahepatic organs through systemic metabolic and inflammatory mechanisms. The retina and choroid may be potential targets of these effects.</p><p><strong>Aims: </strong>To evaluate macular, peripapillary retinal nerve fiber layer (RNFL), and choroidal thickness in pediatric patients with MAFLD.</p><p><strong>Methods: </strong>Children diagnosed with MAFLD and hepatic steatosis between July 2018 and December 2020 were included. Fifty-four patients with MAFLD and 46 healthy controls underwent comprehensive ophthalmic examination, including measurements of macular, peripapillary RNFL, and choroidal thickness using spectral-domain optical coherence tomography (OCT) (Spectralis, Heidelberg Engineering, Germany; software version 6.3.4). OCT parameters were compared between groups.</p><p><strong>Results: </strong>The study included 54 patients with MAFLD and 46 healthy controls. All MAFLD patients had hepatic steatosis, and 15 (28%) were neither overweight nor obese. The groups were comparable in age. Weight, height, and BMI z-scores were significantly higher in the MAFLD group (p < 0.001, p = 0.026, and p < 0.001, respectively). No significant differences were observed in central macular thickness, global or nasal peripapillary RNFL thickness, subfoveal choroidal thickness, or temporal choroidal thickness at 500 µm from the fovea. However, temporal peripapillary RNFL, temporal choroidal thickness at 1500 µm, and nasal choroidal thicknesses at 500 and 1500 µm were thinner in the MAFLD group. Within the MAFLD group, the non-obese subgroup showed nominally lower Global RNFL (p = 0.005), NS RNFL (p = 0.012), and TI RNFL (p = 0.031) values.</p><p><strong>Conclusion: </strong>MAFLD may be associated with structural alterations in the peripapillary RNFL and choroid in pediatric patients.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hidden cost of hip fractures: a patient-caregiver perspective.","authors":"Gabriel Orhadje, Stephen Murphy, Colm Taylor, May Cleary","doi":"10.1007/s11845-026-04676-6","DOIUrl":"https://doi.org/10.1007/s11845-026-04676-6","url":null,"abstract":"<p><strong>Background: </strong>Older adults with hip fracture experience a profound change in health status which can be altered beyond the postoperative healing period resulting in increased care requirements post discharge from hospital. Few studies to date have described the severity of burden faced by caregivers in this cohort.</p><p><strong>Aims/objectives: </strong>The aim of this study is to characterize the degree of caregiver burden associated with hip fracture in Ireland and identify the factors potentially associated with it.</p><p><strong>Methods: </strong>A prospective pilot cohort study was conducted at a Major Trauma Centre in the Republic of Ireland (ROI). Patients aged 60 and over with an isolated hip fracture who underwent surgical fixation between April 7, 2025, and August 1, 2025 were invited to participate in the study with their primary caregiver. The main outcome of interest was caregiver burden at 3 months post discharge, measured using the Caregiver Strain Index (CSI) and the Zarit Burden Interview (ZBI).</p><p><strong>Results: </strong>16 patient-caregiver pairs participated in the present study. 11 out of 16 (69%) caregivers were the children of the hip fracture patients. 56% of caregivers were female, while 44% of caregivers were male. The median caregiver age was 60 years (IQR_25-75 51-70.5; range 25-83 years). 63% of caregivers were in employment while 37% were unemployed. The median CSI score at 3 months was 3.5 (IQR_25-75 2-7.75; range 0-11). The median ZBI score at 3 months was 14.5 (IQR_25-75 1-48; range 0-58). Five caregivers (31%) had a CSI score ≥ 7, and five caregivers reported ZBI scores 41-60. Frailty was shown to be associated with ZBI scores (p = 0.019), but not CSI scores (p = 0.366).</p><p><strong>Conclusion: </strong>While majority of caregivers reported minimal caregiver burden, 5 out of 16 caregivers reported moderate to severe burden. The primary caregiver was most commonly the daughter of the hip fracture patient. Frailty was associated with increased caregiver burden (ZBI). Future research is needed to clarify the extent of caregiver burden in this cohort and determine how multidisciplinary-based intervention can mitigate burden in at-risk patient-caregiver pairs.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The C-reactive protein-albumin-lymphocyte (CALLY) index as a predictor of mortality in patients undergoing carotid artery stenting.","authors":"Muhammed Keskin, Selami Doğan, Lütfi Öcal, Sinan Cerşit, Samet Yavuz, Bayram Öztürk, Hatice Işıl Dayı","doi":"10.1007/s11845-026-04660-0","DOIUrl":"https://doi.org/10.1007/s11845-026-04660-0","url":null,"abstract":"<p><strong>Background: </strong>Accurate risk stratification remains important in patients undergoing carotid artery stenting (CAS). The C-reactive protein-albumin-lymphocyte (CALLY) index integrates inflammatory, nutritional, and immunological parameters; however, data regarding its prognostic value after CAS remain limited.</p><p><strong>Objective: </strong>To evaluate the association between the CALLY index and 30-day all-cause mortality in patients undergoing CAS and to assess its discriminatory performance.</p><p><strong>Methods: </strong>This retrospective observational study included 436 patients who underwent CAS at a tertiary care center between January 1, 2022, and January 1, 2026. The CALLY index was calculated as albumin (g/dL) × lymphocyte count (10⁹/L) / C-reactive protein (mg/L) using preprocedural laboratory measurements. The primary outcome was 30-day all-cause mortality. CALLY-specific analyses were performed as complete-case analyses in 339 patients with available CALLY values. Discriminatory performance was assessed using receiver operating characteristic curve analysis. Because untransformed CALLY did not satisfy the linearity assumption for logistic regression, natural-log-transformed CALLY [ln(CALLY)] was used in a parsimonious multivariable model adjusted for creatinine.</p><p><strong>Results: </strong>Eleven of 436 patients (2.5%) died within 30 days. All 11 deaths had available CALLY values; therefore, CALLY-specific analyses included 339 patients (11 deaths and 328 survivors). The CALLY index yielded an area under the curve of 0.798 (95% CI, 0.642-0.953). The data-derived cutoff of CALLY ≤ 2.65 identified using the Youden index had a sensitivity of 72.73% (95% CI, 39.03%-93.98%) and a specificity of 81.71% (95% CI, 77.09%-85.74%). In multivariable analysis, ln(CALLY) was associated with 30-day all-cause mortality (OR, 0.379; 95% CI, 0.225-0.638; P<.001), whereas creatinine was not statistically significant (OR, 1.308; 95% CI, 0.636-2.690; P=.465). The model had an AUC of 0.804 and a McFadden R² of 0.175.</p><p><strong>Conclusion: </strong>Lower CALLY index values were associated with 30-day all-cause mortality after CAS and showed potentially useful discriminatory ability. However, only 11 deaths occurred, resulting in considerable uncertainty around the performance estimates. The findings should therefore be considered exploratory, and the prognostic performance and data-derived cutoff require validation in larger independent cohorts before clinical application.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the undergraduate airway \"Preparedness Gap\": a matched-pairs analysis of a trainee-led, scaffolding-based simulation curriculum.","authors":"Alice Meagher, Peter Burke, Dara Breslin","doi":"10.1007/s11845-026-04663-x","DOIUrl":"https://doi.org/10.1007/s11845-026-04663-x","url":null,"abstract":"<p><strong>Background: </strong>Traditional undergraduate airway training in Ireland relies heavily on passive and unstructured theatre-based observation. We hypothesised that this model may result in a \"preparedness gap\", where students lack safety-critical knowledge regarding airway management skills.</p><p><strong>Aims: </strong>Our study aimed to evaluate whether a Non Consultant Hospital Doctor (NCHD) led airway simulation circuit effectively remediates safety-focused knowledge deficits in airway management amongst medical students.</p><p><strong>Methods: </strong>A prospective pre-post study (n = 18) evaluated a four-station simulation circuit for medical students (Equipment, Bag-valve-mask (BVM), Endotracheal Tube Intubation (ETI), Supraglottic Airway Insertion (SGA)), designed and delivered by Anaesthesia NCHDs at St Vincent's University Hospital. Data were analysed using matched-pairs to evaluate objective knowledge and self-reported confidence among participants.</p><p><strong>Results: </strong>Objective safety knowledge improved from 2.72 to 4.83/5 (p < 0.001) among participants. Baseline recognition of nasopharyngeal airway contraindications rose from 38.9% to 100% (p = 0.001). Procedural confidence scores increased significantly across all domains (p < 0.001). Interestingly, fourteen of 18 participants (78%) reported increased interest in a career in anaesthesia after the workshop.</p><p><strong>Conclusion: </strong>NCHD-led simulation was associated with improved safety-focused knowledge and increased interest in anaesthesia as a career. Larger-scale evaluation is warranted.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}