Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

{"title":"Mind the Breath: Feasibility of Capnography-Assisted Learned Monitored (CALM) Breathing for Dyspnea Treatment.","authors":"Anna Norweg, Cheongeun Oh, Angela DiMango, Brittany Hofferber, Michael Spinner, Kimberly Stavrolakes, Marykay Pavol, Peter Lindenauer, Charles G Murphy, Naomi M Simon","doi":"10.1097/HCR.0000000000000939","DOIUrl":"10.1097/HCR.0000000000000939","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility and acceptability of Capnography-Assisted Learned Monitored (CALM) Breathing, a carbon dioxide (CO 2 ) biofeedback, and motivational interviewing intervention, to treat dyspnea and anxiety together.</p><p><strong>Methods: </strong>We randomized adults (n = 42) with chronic obstructive pulmonary disease (COPD) to a 4-week, 8-session intervention (CALM Breathing, n = 20) or usual care (n = 22). The CALM Breathing intervention consisted of tailored, slow nasal breathing exercises, capnography biofeedback, motivational interviewing, and a home breathing exercise program. The intervention targeted unlearning dysfunctional breathing behaviors. All participants were offered outpatient pulmonary rehabilitation (PR) in the second phase of the study. The primary outcomes were feasibility and acceptability of CALM Breathing. Exploratory secondary outcomes included respiratory and mood symptoms, physiological and exercise tolerance measures, quality of life, and PR uptake.</p><p><strong>Results: </strong>Attendance at CALM Breathing sessions was 84%, dropout was 5%, and home exercise completion was 90% and 73% based on paper and device logs, respectively. Satisfaction with CALM Breathing therapy was rated as \"good\" to \"excellent\" by 92% of participants. Significantly greater between-group improvements in secondary outcomes-respiratory symptoms, activity avoidance, oxygen saturation (SpO 2 ), end-tidal CO 2 , and breathing self-regulation (interoception)-were found post-intervention at 6 weeks in support of CALM Breathing compared with usual care. At 3 months (after PR initiation), statistically significant between-group differences in Borg dyspnea and SpO 2 post-6-minute walk test were identified also supporting CALM Breathing.</p><p><strong>Conclusions: </strong>Patient-centered CALM Breathing was feasible and acceptable in adults with COPD and dyspnea anxiety. A CALM Breathing intervention may optimize dyspnea treatment and complement PR.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"118-131"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 Cardiovascular Rehabilitation on Myocardial Perfusion and Functional Exercise Capacity in Patients With Stable Coronary Artery Disease and Myocardial Ischemia.","authors":"Guillermo Mazzucco, Leonardo Pilón, Rodrigo Torres-Castro, Ana Lista-Paz, Silvana López, Nicolás Chichizola, Gerardo Zapata, Jorge López, Alejandro Berenguel-Senén, Ane Arbillaga-Etxarri","doi":"10.1097/HCR.0000000000000924","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000924","url":null,"abstract":"<p><strong>Purpose: </strong>Myocardial ischemia is prevalent in chronic heart diseases. Cardiac rehabilitation (CR) offers non-pharmacological benefits to reduce hospitalization and mortality, yet its impact on coronary vascular changes remains unclear. We assessed the effects of CR on myocardial perfusion and exercise capacity in patients with stable coronary artery disease and exercise-induced ischemia.</p><p><strong>Methods: </strong>We conducted a retrospective observational study in individuals with stable coronary artery disease and myocardial ischemia enrolled in a CR program. Inclusion criteria required a minimum of 3 months of supervised CR and cardiac single-photon emission computed tomography (SPECT) imaging before and after the program. Blinded analysis and interpretation of the SPECT studies was carried out by nuclear cardiologists. The primary outcome was a change in myocardial perfusion via SPECT analysis. Secondary outcomes included changes in exercise capacity, electrocardiographic changes during treadmill stress tests, and evaluation of adverse effects during training. Cinecoronariographies reports were collected for further cardiac status assessment.</p><p><strong>Results: </strong>Of 394 patients, 22 with myocardial ischemia were analyzed (96% males, 61.5 ± 9.5 yr). Number of CR sessions ranged from 42 to 73. Stress-induced ischemia significantly decreased (P = .019), with improvements in exercise capacity, including absolute peak oxygen uptake (mL/min, P = .027), relative oxygen uptake (mL/kg/min, P = .044), maximum metabolic equivalent of task (P = .019), and exercise duration (P < .001). No adverse events occurred.</p><p><strong>Conclusion: </strong>After a structured CR program of at least 3 months in patients with stable coronary artery disease and exercise-induced ischemia, there was a notable reduction in stress-induced ischemia and enhancements in exercise capacity, highlighting the safety and efficacy of CR in improving myocardial perfusion and exercise tolerance.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"132-138"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation: Endorsed by the American College of Cardiology.","authors":"Todd M Brown, Quinn R Pack, Ellen A Beregg, LaPrincess C Brewer, Yvonne R Ford, Daniel E Forman, Emily C Gathright, Sherrie Khadanga, Cemal Ozemek, Randal J Thomas","doi":"10.1097/HCR.0000000000000930","DOIUrl":"10.1097/HCR.0000000000000930","url":null,"abstract":"<p><p>The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling. In addition, in recognition that high-quality cardiac rehabilitation programs regularly monitor their processes and outcomes and engage in an ongoing process of quality improvement, we introduce a new core component of program quality. High-quality program performance will be essential to improve widely documented low enrollment and adherence rates and reduce health disparities in cardiac rehabilitation access.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"E6-E25"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating for Health Equity in a Safety Net Hospital: Socioeconomic Status, Adherence, and Outcomes in Cardiac Rehabilitation.","authors":"Tulani Washington-Plaskett, Joshua P Gilman, Emily Quinn, Stephanie Zombeck, Gary Balady","doi":"10.1097/HCR.0000000000000927","DOIUrl":"10.1097/HCR.0000000000000927","url":null,"abstract":"<p><strong>Purpose: </strong>Uncovering the racial/ethnic health disparities that exist within cardiovascular medicine offers potential to mitigate treatment gaps that might affect outcomes. Socioeconomic status (SES) may be a more appropriate underlying factor to assess these disparities. We aimed to evaluate whether adherence, attendance, and outcomes in cardiac rehabilitation are associated with SES in a safety net hospital.</p><p><strong>Methods: </strong>We analyzed 542 patients in a retrospective cohort study of the Cardiac Rehabilitation Program at Boston Medical Center from 2016 to 2019. Enrollees had a mean age of 59.4 years, 34% were female, 42% Black, and 12% Hispanic. The zip codes of each enrollee were used to obtain their area deprivation index (ADI). The ADI reflects income, education, employment, and housing quality within a given zip code. Associations between ADI and adherence and attendance rate were evaluated while controlling for covariates. Secondary outcomes included associations of ADI with change in exercise capacity, low density lipoprotein cholesterol, weight, quality of life, nutrition, and depression scores.</p><p><strong>Results: </strong>We applied logistic regression to examine the association between adherence and ADI with adjustment on the covariates. The attendance rate was analyzed with negative binomial regression with percent of sessions attended as prescribed as a dependent variable and adjusted on the same covariates. The primary outcome revealed no association for ADI with adherence to cardiac rehabilitation (OR = 0.91: 95% CI, 0.74-1.12) or attendance rate (RR = 0.91: 95% CI, 0.80-1.04). Utilizing multiple linear regression, secondary outcomes improved among patients regardless of ADI.</p><p><strong>Conclusions: </strong>We found equity in our cardiac rehabilitation program outcomes despite SES.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"110-117"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Great Lakes Cardiac Rehabilitation Consortium: An International Perspective on Delivering Cardiac Rehabilitation in the Great Lakes Central Region.","authors":"Cayla N Wood","doi":"10.1097/HCR.0000000000000922","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000922","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"153-154"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Rate Index-An Alternative Exercise-Based Equation for Estimating Peak VO 2.","authors":"John R Wicks, Neil B Oldridge, Barry A Franklin","doi":"10.1097/HCR.0000000000000926","DOIUrl":"10.1097/HCR.0000000000000926","url":null,"abstract":"<p><strong>Purpose: </strong>Heart rate (HR)-derived variables (HR reserve [HR peak  - HR rest ], chronotropic indices [attenuated HR response to exercise], HR recovery [attenuated HR response to exercise recovery], and peak HR index [HR peak /HR rest ]) together with peak oxygen uptake (VO 2peak ) are potential prognostic variables for cardiovascular and all-cause mortality. However, heart rate index (HRI) has not been established as a surrogate for VO 2peak , whether measured (Meas) or estimated (Est), during cycle ergometry (CE) and/or treadmill testing (TT).</p><p><strong>Methods: </strong>HR-derived prognostic variables to assess cardiovascular outcomes were identified from 150 studies obtained from MEDLINE and Google Scholar searches. The Meas CE/TT-VO 2peak was reported in 81 studies (21 773 participants) and Est CE/TT-VO 2peak in 69 studies (331 435 participants). Using the HRI equation with metabolic equivalent (METs) = 6 × HRI - 5 (where HRI = peak HR/resting HR), HRI-VO 2peak was calculated from HR data reported in the 150 studies. The HRI-VO 2peak was then compared against group mean data for both Meas CE/TT-VO 2peak and Est CE/TT-VO 2peak .</p><p><strong>Results: </strong>The difference between Meas CE/TT-VO 2peak and HRI-VO 2peak was 1% (7.15 ± 3.25 METs vs 7.08 ± 3.02 METs [ P = .833], respectively). By comparison, the difference between Est CE/TT-VO 2peak and HRI-VO 2peak was 25.6% (8.94 ± 2.36 METs vs 7.12 ± 2.27 METs [ P < .001], respectively). Moreover, HRI equation estimation of VO 2peak showed greater overprediction for TT, 26.6%, than for CE, 11.9%.</p><p><strong>Conclusions: </strong>The Meas-VO 2peak and HRI-VO 2peak agreed closely. When compared with HRI-VO 2peak , Est-VO 2peak from currently used exercise-based equations shows significant overprediction. Use of HRI and/or Fitness Registry and the Importance of Exercise National Database (FRIEND) registry equations warrant consideration for more accurately estimating VO 2peak .</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"139-145"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More Rehab Is Better Rehab!","authors":"Richard A Josephson","doi":"10.1097/HCR.0000000000000942","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000942","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"77"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular and Risk Factor Outcomes for Ethnic Minorities From Cardiac Rehabilitation: A Systematic Review and Meta-Analysis.","authors":"Sarah Duggan, Robyn Gallagher, Ling Zhang, Gabriela Lima de Melo Ghisi, Dion Candelaria","doi":"10.1097/HCR.0000000000000936","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000936","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the benefits of cardiac rehabilitation (CR) among ethnic minorities for cardiovascular risk factors (systolic blood pressure [BP], exercise capacity, lipids, body fat), mortality, and morbidity, and compare outcomes to majority reference groups.</p><p><strong>Review methods: </strong>We searched electronic databases (Medline, EMBASE, CINAHL, Scopus, Cochrane Library) from inception until September 2023 for studies reporting CR outcomes of ethnic minorities. Meta-analyses were conducted for data that could be pooled using random effects model. Data that were not suitable for meta-analysis were synthesized and reported narratively.</p><p><strong>Summary: </strong>Thirteen studies with a total of 132 109 participants (10 494 from ethnic minorities [8% of total participants]) were included. Patients from ethnic minority groups made improvements in several outcomes post-CR. These outcomes were equivalent to majority groups for systolic BP (Mean Difference [MD] = -0.69: 95% CI, -1.62 to 0.24 mmHg), maximal exercise capacity (MD = -0.10: 95% CI, -0.63 to 0.44 metabolic equivalents of task), total cholesterol (MD = 0.16: 95% CI, -0.01 to 0.33 mmol/L), and low-density lipoprotein cholesterol (MD = 0.25: 95% CI, -0.04 to 0.54 mmol/L). However, ethnic minorities achieved less improvements than the majority for body mass index (MD = -0.31: 95% CI, -0.47 to -0.14 kg/m2) and waist circumference (MD = -1.50: 95% CI, -2.33 to -0.68 cm). Narrative synthesis indicated equivalent outcomes for minorities for all-cause mortality and mean cholesterol, with worse risk of hospitalization at 1 year. Patients from ethnic minorities attending CR achieve equivalent benefits to majority counterparts for multiple risk factors and potentially mortality and morbidity, therefore CR should be strongly promoted. Individual tailoring may be needed to address adiposity and exercise capacity.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 2","pages":"85-94"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Confirmatory Factory Analysis of the Exercise Sensitivity Questionnaire (ESQ).","authors":"Samantha G Farris, Mindy M Kibbey, Lilly Derby, Brittany Keller, Teresa M Leyro, Brandon L Alderman, Michael B Steinberg, Ana M Abrantes, Angelo M DiBello","doi":"10.1097/HCR.0000000000000933","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000933","url":null,"abstract":"<p><strong>Purpose: </strong>The Exercise Sensitivity Questionnaire (ESQ) is a self-report measure used to assess the extent to which different physical sensations of exercise elicit anxiety (ie, exercise sensitivity). The ESQ was developed for individuals with cardiovascular conditions and initially validated in a non-clinical sample. This study evaluates the factor structure and measurement invariance in a clinical sample of adults with various cardiovascular conditions.</p><p><strong>Methods: </strong>This was a cross-sectional study with retrospective chart review. Patients (N = 265; 73% male, mean age 67.8 ± 10.5 years) were attending an orientation for outpatient medically supervised exercise-based cardiac rehabilitation. The factor structure was examined using Confirmatory Factor Analysis, and tests of measurement invariance were evaluated by sex and advanced age (<65 years, >65 years). Internal consistency, descriptive characteristics, and correlates of ESQ scores and its factors were evaluated. Concurrent validity was evaluated in a subset of patients (N = 57) with elevated exercise sensitivity.</p><p><strong>Results: </strong>The Confirmatory Factor Analysis supported a 2-factor model, which was invariant, but not a 1-factor model, and reflected anxiety about (1) cardiopulmonary and (2) pain/weakness exercise sensations. Internal consistency of ESQ items was high. ESQ scores were associated with higher body mass index and shorter 6-Minute Walk Test distance, particularly the pain/weakness factor. ESQ scores evidenced preliminary concurrent validity with anxiety sensitivity and general anxiety but discriminant validity with depressive symptoms.</p><p><strong>Conclusions: </strong>There is support for the validity and reliability of ESQ scores as a 2-dimensional index of exercise sensitivity. The ESQ taps a psychological phenotype with relevance to exercise tolerance, and potentially cardiac rehabilitation participation, that warrants continued investigation.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Rural and Urban Differences in Geographic Proximity to Outpatient Stroke Rehabilitation Services in Tennessee.","authors":"Phoebe M Tran, Benjamin Fogelson, Robert E Heidel, Raj Baljepally","doi":"10.1097/HCR.0000000000000898","DOIUrl":"10.1097/HCR.0000000000000898","url":null,"abstract":"<p><strong>Purpose: </strong>Great travel distances and long travel times can be barriers to outpatient stroke rehabilitation services (OSR) receipt, but there is limited information on differences in proximity to specific OSR services between urban and potentially medically underserved rural areas. Accordingly, we compared travel distance and time to the nearest service for different OSR services between rural and urban counties in Tennessee.</p><p><strong>Methods: </strong>We conducted data scraping on Google Maps to locate Tennessee facilities offering any of the 13 American Heart Association recognized OSR services. We conducted manual validation by calling located facilities and visiting facility websites. We used the Wilcoxon rank sum test to examine if mean travel distance and time to a specific OSR service differed significantly between rural and urban counties.</p><p><strong>Results: </strong>All OSR services but audiology were available in Tennessee. In rural counties, social work had the highest median of mean travel distance (135.2 km), chaplaincy the highest median of mean travel time (113.5 min), and physical therapy the lowest distance (37.7 km) and time (36.3 min). Except for social work, rural counties had significantly higher travel distance and time than urban counties ( P < .01) for all OSR services.</p><p><strong>Conclusions: </strong>Rural Tennessee counties had significantly higher travel distance and time for almost all OSR services compared to urban areas. These findings from a largely rural state with high stroke risk factor prevalence suggest that additional focus on establishing maximum travel limits for OSR are warranted to overcome transportation barriers to enhance post-stroke services access in similar areas.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"65-71"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}