Journal of Aerosol Medicine and Pulmonary Drug Delivery最新文献

{"title":"Comparative Efficacy of Two Inhalational Techniques when Using a Pressurized Meter Dose Inhaler with Valved Holding Chamber in Children with Asthma: A Randomized Controlled Trial.","authors":"Rashmi Ranjan Das, Amit Kumar Satapathy, Manoj Kumar Panigrahi","doi":"10.1177/19412711251360981","DOIUrl":"https://doi.org/10.1177/19412711251360981","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Inhaled medication delivered through a pressurized metered dose inhaler (pMDI) with a valved holding chamber (VHC) is the optimal treatment for asthma. The best technique is the breath-holding (BH) technique. Tidal breathing (TB) technique is also recommended by Global Initiative for Asthma (GINA) as an alternative. Clinical studies have shown variable results, but the scintigraphy study shows better lung deposition with the BH technique. The present study was designed to address the shortcomings in previous studies and to confirm the scintigraphy study findings by comparing the two techniques. <b><i>Methods:</i></b> This randomized controlled trial included children aged 5-14 years with nonsevere asthma not taking inhaled medications on entry to the study, but during the study, they were given inhaled medications by pMDI + VHC (according to GINA guidelines) over an 8-week period. Demography, clinical details, spirometry parameters, and asthma control were recorded/assessed. The primary outcome was change in spirometry parameters at 2 and 8 weeks. <b><i>Results:</i></b> Eighty-two children (mean age: 8.64 years, 46 boys) were included. There was no intergroup difference in the spirometry parameters and asthma control scores at any point in time (<i>p</i> > 0.05). A significant intragroup improvement was noted only for forced expiratory volume in the first second at 8 weeks (<i>p</i> < 0.05). Similarly, a significant intragroup improvement in asthma control score was noted at 8 weeks (<i>p</i> < 0.05). No adverse event was noted in either of the groups. <b><i>Conclusions:</i></b> The present study found no difference between the BH and the TB techniques while delivering aerosols through a pMDI with a VHC. Either the BH or the TB technique may be used in children (5-14 years) with nonsevere asthma. <b><i>Clinical trial registration number:</i></b> CTRI/2020/12/030078.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636998","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":"<i>Letter:</i> Comment on \"Association of Inhaled Corticosteroid Use with COVID-19 Severity and Hospitalization in Patients with and Without Respiratory Disease\".","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1177/19412711251360630","DOIUrl":"https://doi.org/10.1177/19412711251360630","url":null,"abstract":"","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626396","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":"<i>In Silico</i> Modeling of Resistances and Dosimetry in Sarcoidosis Patients with Airway Disease.","authors":"Matthew J Eden, Narges Mirdamadi, Daniel VanDerhoef, David M Perlman, Maneesh Bhargava, Jessica M Oakes","doi":"10.1089/jamp.2024.0004","DOIUrl":"10.1089/jamp.2024.0004","url":null,"abstract":"<p><p><b><i>Background:</i></b> Sarcoidosis is a multisystem granulomatous disease that often impacts the lungs with mucosal inflammation, cobblestoning of the central airways, obstruction, and small airway disease. Airway involvement is often under-reported and not well understood, despite likely having implications for the work of breathing and particle dosimetry. <b><i>Methods:</i></b> To shed light on sarcoidosis disease with airway involvement, we performed patient-specific computational fluid dynamics and particle transport simulations in three subjects, for a few generations of the large conducting airways, with various presentations of airway disease. While Patient A had peripheral obstruction as identified from pulmonary function tests (PFTs), airway models created from computed tomography (CT) scans highlighted lower left lobe central airway abnormalities. Patient B presented with airway obstruction and diffusive stenosis throughout all five lobes while Patient C had normal PFTs and CT scans. <b><i>Results:</i></b> Localized central airway remodeling in Patient A resulted in localized elevation in dosimetry but no changes in total dosimetry or airway resistances, as also seen in Patient C. The subject with diffusive remodeling had abnormally high airway resistances and central airway deposition within the 3D-modeled airways. <b><i>Conclusions:</i></b> Results from this pilot study suggest that patients with diffuse remodeling may have enhanced susceptibility to environmental pollutants due to increased aerosol dosimetry. For aerosol medication treatment, the subject with diffusive airway remodeling may not receive adequate therapeutic dose if the goal is to deliver medication to the lung periphery. This study provides the first glimpse of airflow, resistances, and particle dosimetry in sarcoidosis subjects. Future studies should focus on phenotyping airway abnormalities in a larger sarcoidosis cohort and performing whole lung dosimetry modeling.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618105","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":"Aerosol Delivery to an Adult Model via High-Flow Nasal Cannula with Inspiration-Synchronized Small-Particle Vibrating Mesh Nebulizer.","authors":"Jie Li, Osama Alanazi, James B Fink","doi":"10.1089/jamp.2025.0005","DOIUrl":"https://doi.org/10.1089/jamp.2025.0005","url":null,"abstract":"<p><p><b><i>Background:</i></b> Aerosol delivery via high-flow nasal cannula (HFNC) with an inspiration-synchronized vibrating mesh nebulizer (VMN) yielded higher inhaled doses than with a continuous VMN. Recently, a prototype VMN generating aerosol particles <3 µm improved aerosol delivery during invasive ventilation in adult and pediatric models, outperforming the conventional VMN. However, the effects of inspiration-synchronized small-particle VMN during HFNC remain unknown. <b><i>Methods:</i></b> An adult manikin was connected to a dual-chamber lung model driven by a ventilator to simulate spontaneous breathing. An HFNC system was utilized with gas flows at 15, 30, and 60 L/min with temperature at 37°C. Both small-particle and conventional VMNs were tested in inspiration-synchronized and continuous modes, with placements at the humidifier inlet and near the nasal cannula. Each experiment involved delivering 1 mL of albuterol (2.5 mg/mL) and was repeated five times. A collecting filter placed at the trachea captured aerosol, which was then eluted and assayed with UV spectrophotometry (276 nm). <b><i>Results:</i></b> When VMN was placed near the nasal cannula, inspiration-synchronized VMN consistently delivered greater inhaled doses compared with continuous VMN, regardless of aerosol particle sizes or HFNC flows (all <i>p</i> < 0.05). When positioned at the humidifier inlet, continuous VMN yielded higher inhaled doses than inspiration-synchronized VMN at 30 and 60 L/min but lower inhaled doses at 15 L/min (all <i>p</i> < 0.05). In the inspiration-synchronized mode, the small-particle VMN delivered greater inhaled doses at HFNC flows of 15 and 30 L/min than the conventional VMN, independent of nebulizer placements (all <i>p</i> < 0.05). The highest inhaled dose was observed with the inspiration-synchronized VMN placed near the nasal cannula and the continuous VMN placed at the humidifier inlet. <b><i>Conclusions:</i></b> In a model of adult transnasal aerosol delivery, the inspiration-synchronized VMN delivered a higher inhaled dose than the continuous VMN when placed near the nasal cannula. The small-particle VMN offers potential for further improvement in aerosol delivery.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560199","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":"Inhaled Volume as a Digital Biomarker Predicting Outcomes in Chronic Respiratory Disease.","authors":"Henry Chrystyn, Mark Milton-Edwards","doi":"10.1089/jamp.2024.0063","DOIUrl":"https://doi.org/10.1089/jamp.2024.0063","url":null,"abstract":"<p><p>Inhaler-based digital biomarkers can be objectively evaluated to indicate changes in response to therapeutic interventions. In chronic respiratory disease (CRD), measures of exhaled airflow play a central role in diagnosis and management, yet inhaled measures have not. Digital inhalers can passively collect inspiratory parameters such as inhaled volume (InhV) and peak inspiratory flow (PIF) during real-life patient use. Emphasis has been directed to the PIF, but little is known about the role of the InhV. InhV has now been observed to decrease prior to an exacerbation of asthma or chronic obstructive pulmonary disease and increase afterwards and be lower in uncontrolled asthma patients. These observations are consistent with the current understanding of the pathophysiology of CRD, whereby a strong correlation between InhV and forced expiratory volume in one second has been observed. Measurement of InhV has demonstrated accuracy and low variability, supporting the validity of interpreting individualized trends over time. After counseling, patient inhalation technique decays over time, and it is InhV that decreases more than PIF. Together, these findings suggest that InhV, captured by a digital inhaler, has utility as an effective digital biomarker to aid management of patients with CRD, with InhV being a major factor in the predictive value with respect to acute exacerbations.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553641","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":"A Randomized, Double-Blind Crossover Study of Change in Post-Dose Lung Function with Hydrofluoroolefin-1234ze, a Next-Generation Propellant for Metered Dose Inhalers, in Participants with Asthma.","authors":"Roy A Pleasants, Alan S Bell, Mandeep Jassal, John Xu, David Petullo, Ibrahim Raphiou, Magnus Aurivillius, Patrik Bondarov, Mehul Patel","doi":"10.1089/jamp.2024.0061","DOIUrl":"https://doi.org/10.1089/jamp.2024.0061","url":null,"abstract":"<p><p><b><i>Background:</i></b> Pressurized metered dose inhalers (pMDIs) currently contain propellants with relatively high global warming potential (GWP), such as hydrofluoroalkane-134a (HFA-134a). Hyrofluoroolefin-1234ze (HFO-1234ze) is a near-zero GWP propellant in development for use in future pMDIs. <b><i>Methods:</i></b> This Phase IIIb, multicenter, randomized, double-blind, single-dose crossover study aimed to assess post-dose lung function and clinical manifestations of bronchospasm following single doses of HFA-134a and HFO-1234ze via pMDI (four inhalations with no active drugs) in participants with well or partially controlled asthma. The primary endpoint was change from baseline in forced expiratory volume in one second area under the curve from 0 to 15 minutes (FEV₁ AUC_{0-15 minutes}) post-dose and was assessed using a linear mixed-effect model. Secondary endpoints included cumulative incidence of bronchospasm events (reduction in FEV₁ of >15% from baseline at 5 or 15 minutes post-dose with associated wheezing, shortness of breath, or cough). Safety and tolerability were also assessed. <b><i>Results:</i></b> Among 52 participants randomized to treatment, noninferiority of HFO-1234ze pMDI versus HFA-134a was established for change from baseline in FEV₁ AUC_{0-15 minutes} post-dose between treatments (least squares mean [LSM]; 95% confidence intervals [CI] change: HFO-1234ze pMDI, -0.014 [-0.033, 0.006] L; HFA-134a, -0.004 [-0.024, 0.015] L; LSM [95% CI] difference: -0.009 [-0.037, 0.018; <i>p</i> = 0.492]). No bronchospasm events were reported. Two patients (3.8%) in each group experienced ≥1 adverse event (AE). No serious AEs, AEs of special interest, or AEs leading to discontinuation were reported. <b><i>Conclusions:</i></b> HFO-1234ze pMDI was well tolerated in participants with well or partially controlled asthma. As with HFA-134a pMDI, no significant effects on lung function or bronchospasm events were observed. As HFO-1234ze pMDI has a near-zero GWP, it represents a compelling, environmentally conscious alternative propellant for use in pMDI devices for treatment of chronic respiratory disease. <b><i>Trial Registration:</i></b> NCT05850494.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475325","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":"Understanding the Effects of Body Mass Index and Inhaler Mouthpiece Size on Human Upper Airway Geometry.","authors":"Christopher Burchell, Agisilaos Kourmatzis, Xinyu Cai, Hanieh Gholizadeh, Taye Mekonnen, Sammy Diasinos, Hak-Kim Chan, Shaokoon Cheng","doi":"10.1089/jamp.2024.0046","DOIUrl":"https://doi.org/10.1089/jamp.2024.0046","url":null,"abstract":"<p><p><b><i>Background:</i></b> Understanding the geometries of the human upper airway and their impact on drug particle transport is important. This study investigates the impact of inhaler mouthpiece size on extrathoracic airway geometry across a diverse body mass index (BMI) range. <b><i>Methods and Materials:</i></b> Magnetic resonance imaging (MRI) was performed on 28 participants. Subjects were asked to bite on replicas of inhaler mouthpieces with incisal openings of 13.5 mm and 27 mm, and the effects of mouthpiece size on upper airway geometry were analysed. <b><i>Results:</i></b> Mouthpiece size affects the oral space, and the results show a significant linear correlation between oral space and BMI, with a reduction in the cross-sectional area (CSA) between the soft palate and the tongue of approximately 0.08 cm² per BMI unit increase. This trend contrasts with an increase in anterior-posterior (AP) length across three other pharyngeal regions of interest, with the largest increase observed in the oropharynx, where AP length increased by approximately 0.042 cm/(kg·m²). While the impact of device size was significant in the oral space across all participants, its effect in the oropharynx was significant only in the high BMI cohort. This group exhibited an expansion in the oropharynx when using the larger mouthpiece compared to the smaller one. <b><i>Conclusion:</i></b> These findings may have implications for inhaler design and prescription. The knowledge presented has the potential to improve inhaler efficacy in high BMI populations when accounting for mouthpiece size.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225492","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":"Limited Knowledge on Asthma and Pressurized Metered-Dose Inhaler Technique Among Health Care Professionals Attending Asthmatic Patients in Dar es Salaam, Tanzania.","authors":"Grace Ambrose Shayo, Aisha Awadh, Mwanaada Ahmed Kilima","doi":"10.1089/jamp.2024.0028","DOIUrl":"https://doi.org/10.1089/jamp.2024.0028","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Receiving wrong health education from health care professionals (HCPs) might contribute to patients' poor inhaler technique. We set out to investigate HCPs' knowledge on asthma and metered-dose inhaler technique in selected health facilities in Dar es Salaam, Tanzania. <b><i>Methods:</i></b> In a cross-sectional study done from August 2020 to February 2021, participant's demographics were recorded. The inhaler technique was assessed using a 12-step checklist. Participants had correct inhaler technique when all the steps were performed correctly; otherwise, the technique was poor. An 18-question questionnaire for health care professional knowledge was used to assess asthma knowledge. One point was awarded to each correctly answered question, whereas a zero point was given to a wrongly answered or unanswered question. Knowledge was adequate if the score was 13/18 or higher. Chi-square was used to compare categorical data, while analysis of variance was used for comparison of mean scores for asthma knowledge and inhaler technique. A <i>p</i> value ≤0.05 was considered significant. <b><i>Results:</i></b> A total of 114 participants were enrolled; 57% were medical officers, and 59.6% had work experience of <5 years. The majority (53.5%) had no training on inhaler technique, and 75% had inadequate knowledge on asthma. Good asthma knowledge was associated with age ≥40 years (<i>p</i> = 0.039) and being a medical specialist (<i>p</i> = 0.002). Only 4.4% of the participants did all the steps of inhaler technique correctly. <b><i>Conclusion:</i></b> Knowledge on asthma and inhaler use technique is generally lacking among health care professionals. In-service training on asthma and inhaler demonstration should be considered for HCPs in asthma clinics.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199186","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":"<i>N</i>-Acetylcysteine and Its Therapeutic Potential in an Animal Model of Allergic Asthma.","authors":"Lukáš Smieško, Jozef Mažerik, Eduard Gondáš, Matúš Dohál, Marta Jošková, Martina Šutovská, Soňa Fraňová","doi":"10.1089/jamp.2024.0049","DOIUrl":"10.1089/jamp.2024.0049","url":null,"abstract":"<p><p><b><i>Background:</i></b> <i>N</i>-acetylcysteine (NAC) is a classical mucolytic agent that, in addition to its mucolytic activity, also exhibits antioxidant activity. This could be beneficial in treating chronic inflammatory airway diseases, including asthma. <b><i>Background:</i></b> We evaluated the ability of NAC to modulate airway defense mechanisms, airway reactivity, inflammation, and remodeling after 10 days of administration [20 and 60 mg/(kg·d)] in an experimental guinea pig model of allergic inflammation. <b><i>Methods:</i></b> The concentrations of inflammatory cytokines (interleukins: IL-4, IL-5, IL-10, IL-12, and IL-13), granulocyte macrophage-colony stimulating factor (GM-CSF), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) were measured in bronchoalveolar lavage fluid using a multiplex detection method. The concentration of remodeling marker transforming growth factor beta-1 (TGF-β1) was measured in lung homogenates using enzyme-linked immunosorbent assay. <i>In vivo,</i> changes in specific airway resistance and number of cough efforts were determined. Tracheal smooth muscle reactivity was evaluated <i>in vitro</i>. Ciliary beat frequency (CBF) indicated mucociliary clearance. <b><i>Results:</i></b> A 10-day administration of NAC at a higher dosage led to a significant decrease in the regulatory cytokines IL-4, IL-5, and GM-CSF. NAC, in both dosing schedules, decreased the levels of TGF-β1. NAC at a higher dosage reduced the number of chemically induced cough reflexes and CBF. NAC did not affect airway hyperreactivity parameters. <b><i>Conclusion:</i></b> NAC is a multifactorial drug, and under our experimental conditions of allergic inflammation, it showed positive effects on the levels of regulatory cytokines and growth factors, which probably led to a reduction in the intensity of airway defense mechanisms.</p>","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":"118-126"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648657","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":"<i>Letter:</i> Respiratory Effectiveness Group Position Statement: Inhaler Choice: Balancing Personalized Health Care and Environmental Responsibility.","authors":"Omar S Usmani, Mona Al-Ahmad, Keith Allan, Antonio Anzueto, Fulvio Braido, Giorgio W Canonica, Trevor Lambert, Thérèse Lapperre, Alan Kaplan, Marc Miravitlles, Nikolaos G Papadopoulos, Chin Kook Rhee, Nicolas Roche, Joan B Soriano","doi":"10.1089/jamp.2024.0060","DOIUrl":"10.1089/jamp.2024.0060","url":null,"abstract":"","PeriodicalId":14940,"journal":{"name":"Journal of Aerosol Medicine and Pulmonary Drug Delivery","volume":" ","pages":"145-147"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730111","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}