Journal of Cardiovascular Development and Disease最新文献

{"title":"Cerebral and Spinal Cord Protection Strategies in Aortic Arch Surgery.","authors":"Andrea Myers, Ciprian Nita, Guillermo Martinez","doi":"10.3390/jcdd12040130","DOIUrl":"https://doi.org/10.3390/jcdd12040130","url":null,"abstract":"<p><p>Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies have been put forward to ameliorate these complications; however, maintaining cerebral and spinal cord perfusion and reducing metabolic oxygen demand is the core principle of these strategies. Moderate hypothermia and selective ante-grade perfusion are the most promising methods that provide the best conditions for the competing requirements of both the brain and spinal cord. Intraoperative and postoperative monitoring is essential for early detection and intervention in delayed spinal cord ischaemia and stroke. In this article we aim to discuss the current methods of neuroprotection and spinal cord protection in aortic arch surgery and stenting.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Abdominal Artery Diameter in Patients Treated for Acute Aortic Dissection.","authors":"Marian Burysz, Radosław Litwinowicz, Mariusz Kowalewski, Jerzy Walocha, Jakub Batko","doi":"10.3390/jcdd12040129","DOIUrl":"https://doi.org/10.3390/jcdd12040129","url":null,"abstract":"<p><strong>Background: </strong>Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively.</p><p><strong>Methods: </strong>Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients.</p><p><strong>Results: </strong>In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (<i>p</i> < 0.001) and the renal arteries (<i>p</i> < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure.</p><p><strong>Conclusion: </strong>Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subtraction CT Angiography for the Evaluation of Lower Extremity Artery Disease with Severe Arterial Calcification.","authors":"Ryoichi Tanaka, Kunihiro Yoshioka","doi":"10.3390/jcdd12040131","DOIUrl":"https://doi.org/10.3390/jcdd12040131","url":null,"abstract":"<p><p>(1) Background: Peripheral arterial CT angiography (CTA) is an alternative to conventional angiography for diagnosing lower extremity artery disease (LEAD). However, severe arterial calcifications often hinder accurate assessment of arterial stenosis. This study evaluated the diagnostic performance of subtraction CTA with volume position matching compared to conventional CTA, using invasive digital subtraction angiography (DSA) as the gold standard. (2) Methods: Thirty-two patients with LEAD (mean age: 69.6 ± 10.8 years; M/F = 28:4) underwent subtraction CTA and DSA. The arterial tree was divided into 20 segments per patient, excluding segments with a history of bypass surgery. Subtraction was performed separately for each limb using volume position matching. Maximum intensity projections were reconstructed from both conventional and subtraction CTA data. Percent stenosis per arterial segment was measured using calipers and compared with DSA. Segments were classified as stenotic (>50% luminal narrowing) or not, with heavily calcified or stented segments assigned as incorrect. (3) Results: Of 640 segments, 636 were analyzed. Subtraction CTA and conventional CTA left 13 (2.0%) and 160 (25.2%) segments uninterpretable, respectively. Diagnostic accuracies (accuracy, precision, recall, macro F1 score) for subtraction CTA were 0.885, 0.884, 0.936, and 0.909, compared to 0.657, 0.744, 0.675, and 0.708 for conventional CTA. (4) Conclusions: Subtraction CTA with volume position matching is feasible and achieves high diagnostic accuracy in patients with severe calcific sclerosis.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Invasive Measurement of Hemodynamic Parameters via Whole-Body Impedance Cardiography Among Hospitalized Heart Failure Patients: An Effective Alternative to Invasive Right Heart Catheterization?","authors":"Felix Ausbuettel, Sabah Khwamurad, Murad Haj Abdo, Sebastian Kerber, Karin Nentwich, Martina Hautmann, Sebastian Barth","doi":"10.3390/jcdd12040128","DOIUrl":"https://doi.org/10.3390/jcdd12040128","url":null,"abstract":"<p><p>(1) Background: The measurement of hemodynamic parameters has proven to be crucial in the treatment of hospitalized heart failure patients, necessitating invasive measurement by right heart catheterization (RHC). The reliability of whole-body impedance cardiography (ICG) among this cohort has not been investigated to date; (2) Methods: The RHC and whole-body ICG examinations measured cardiac output (CO), the cardiac index (CI), total peripheral resistance (TPR), and pulmonary vascular resistance (PVR). To assess the accuracy of the whole-body ICG measurement, bias and precision were calculated as the mean difference and the twofold standard deviation between the average values of measurements; (3) Results: A total of 203 patients were analyzed. No significant bias was observed between the non-invasive CO and CI measurements when compared with the RHC measurements (-0.14 ± 2.56 L/min, <i>p</i> = 0.1; -0.09 ± 1.3 L/min/m², <i>p</i> = 0.06), but a significant bias occurred in the measurement of non-invasive TPR and non-invasive PVR (-1243 ± 3510 dyn × s^-1 × cm^-5, <i>p</i> = 0.001; -121 ± 504 dyn × s^-1 × cm^-5, <i>p</i> < 0.001); (4) Conclusions: CO and CI can be measured with whole-body ICG among hospitalized CHF patients with acceptable accuracy. The reliability of measuring TPR and PVR should be further investigated.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paravalvular Leak in Transcatheter Aortic Valve Implantation: A Review of Current Challenges and Future Directions.","authors":"Andreas Synetos, Nikolaos Ktenopoulos, Odysseas Katsaros, Konstantina Vlasopoulou, Maria Drakopoulou, Leonidas Koliastasis, Ioannis Kachrimanidis, Anastasios Apostolos, Sotirios Tsalamandris, George Latsios, Konstantinos Toutouzas, Ioannis Patrikios, Constantinos Tsioufis","doi":"10.3390/jcdd12040125","DOIUrl":"https://doi.org/10.3390/jcdd12040125","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary therapeutic modality for the management of severe aortic stenosis (AS), particularly in patients who are at high or prohibitive risk for surgical aortic valve replacement (SAVR). Over the past decade, extensive clinical evidence has expanded the indications for TAVI to include intermediate- and low-risk populations, which usually represent a population of younger age, in which the most common complications of TAVI, including paravalvular leak (PVL) and pacemaker implantation, should be avoided. This review focuses on the incidence and predictors of PVL in various types of TAVI implantation, its clinical implication, and the prevention strategies to tackle this complication.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty in Cardiac Surgery-Assessment Tools, Impact on Outcomes, and Optimisation Strategies: A Narrative Review.","authors":"Ashwini Chandiramani, Jason M Ali","doi":"10.3390/jcdd12040127","DOIUrl":"https://doi.org/10.3390/jcdd12040127","url":null,"abstract":"<p><strong>Background: </strong>Advancements in surgical care have made it possible to offer cardiac surgery to an older and frailer patient cohort. Frailty has been recognised as a prognostic indicator that impacts post-operative recovery and patient outcomes. The aim of this study is to identify frailty assessment tools, evaluate the impact of frailty on post-operative outcomes, and explore strategies to optimise care for frail patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>A comprehensive literature search was performed across PubMed, MEDLINE, and SCOPUS to identify articles reporting post-operative outcomes related to frail patients undergoing cardiac surgery.</p><p><strong>Results: </strong>Measurement tools such as gait speed, the Clinical Frailty Scale, Fried frailty phenotype, deficit accumulation frailty index and the Short Physical Performance Battery can be used to assess frailty. Frailty has been reported to increase the risk of post-operative morbidity and mortality. Multiple studies have also reported the association between frailty and an increased length of intensive care unit and hospital stays, as well as an increased risk of post-operative delirium. It is important to perform a comprehensive frailty assessment and implement perioperative optimisation strategies to improve outcomes in this patient population. Pre-operative strategies that can be considered include adequate nutritional support, cardiac prehabilitation, and assessing patients using a multidisciplinary team approach with geriatric involvement. Post-operatively, interventions such as early recognition and treatment of post-operative delirium, nutrition optimisation, early planning for cardiac rehabilitation, and occupational therapy can support patients' recovery and reintegration into daily activities.</p><p><strong>Conclusions: </strong>The early identification of frail patients during the perioperative period is essential for risk stratification and tailored management strategies to minimise the impact of frailty on outcomes following cardiac surgery.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Considerations, Anesthetic Management and Transesophageal Echocardiographic Evaluation of Patients Undergoing the Ross Procedure.","authors":"Giacomo Scorsese, Brandon Yonel, Eric Schmalzried, Alexandra Solowinska, Zhaosheng Jin, Jeremy Poppers","doi":"10.3390/jcdd12040126","DOIUrl":"https://doi.org/10.3390/jcdd12040126","url":null,"abstract":"<p><p>The Ross procedure introduced a new technique for aortic valve replacement by utilizing a pulmonary autograft to replace the diseased aortic valve. This approach provides a living, dynamic valve substitute capable of growth and adaptation to systemic pressures while addressing the limitations of mechanical valves, which require lifelong anticoagulation, and bioprosthetic valves, which lack durability and growth potential. The Ross procedure offers superior hemodynamic performance and freedom from anticoagulation. While initially popular, utilization declined due to its technical complexity and concerns regarding the potential for the failure of two valves, requiring additional operations. Advances in surgical techniques, such as reinforced autografts, improved myocardial protection, and better homograft preservation, coupled with evidence of favorable long-term outcomes, have renewed interest in the procedure. Preoperative imaging with echocardiography, cardiac magnetic resonance imaging, and computed tomography angiography ensures optimal patient selection and preparation. Intraoperatively, precise autograft harvesting, accurate implantation, and meticulous right ventricular outflow tract reconstruction are critical for success. Blood conservation techniques, such as acute normovolemic hemodilution and retrograde autologous priming, are employed to minimize transfusion-related complications. The anesthesiologist plays a critical role, including meticulous monitoring of myocardial function and hemodynamics, with intraoperative transesophageal echocardiography being essential for assessing valve integrity and ventricular function. Recent studies suggest that the Ross procedure can restore life expectancy in appropriately selected patients, reinforcing its value as a surgical option for managing aortic valve disease.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Systemic Impact of Congestion in Heart Failure: A Narrative Review of Multisystem Pathophysiology and Clinical Implications.","authors":"Daniela Mocan, Radu Jipa, Daniel Alexandru Jipa, Radu Ioan Lala, Florin Claudiu Rasinar, Iulia Groza, Ronela Sabau, Damaris Sulea Bratu, Diana Federica Balta, Sergiu Teodor Cioban, Maria Puschita","doi":"10.3390/jcdd12040124","DOIUrl":"https://doi.org/10.3390/jcdd12040124","url":null,"abstract":"<p><p>Congestion is a key clinical feature of heart failure (HF), contributing to hospitalizations, disease progression, and poor outcomes. While traditionally considered a hemodynamic issue, congestion is now recognized as a systemic process affecting multiple organs. Renal dysfunction arises from impaired perfusion and sodium retention, leading to maladaptive left ventricular remodeling. Hepatic congestion contributes to cholestatic liver injury, while metabolic disturbances drive anemia, muscle wasting, and systemic inflammation. Additionally, congestion disrupts the intestinal barrier and immune function, exacerbating HF progression. Given its widespread impact, effective congestion management requires a shift from a cardiovascular-centered approach to a comprehensive, multidisciplinary strategy. Targeted decongestive therapy, metabolic and nutritional optimization, and immune modulation are crucial in mitigating congestion-related organ dysfunction. Early recognition and intervention are essential to slow disease progression, preserve functional capacity, and improve survival. Addressing HF congestion through personalized, evidence-based strategies is vital for optimizing long-term care and advancing treatment paradigms.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable Devices for Quantifying Atrial Fibrillation Burden: A Systematic Review and Bayesian Meta-Analysis.","authors":"Ioannis Anagnostopoulos, Dimitrios Vrachatis, Maria Kousta, Sotiria Giotaki, Dimitra Katsoulotou, Christos Karavasilis, Gerasimos Deftereos, Nikolaos Schizas, Dimitrios Avramides, Georgios Giannopoulos, Theodore G Papaioannou, Spyridon Deftereos","doi":"10.3390/jcdd12040122","DOIUrl":"https://doi.org/10.3390/jcdd12040122","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common supraventricular arrhythmia and is associated with an impaired prognosis. Studies using implantable cardiac monitors suggest that this association is closely linked to AF burden, defined as the percentage of time spent in AF. Consequently, there is a growing need for affordable and comfortable alternative devices, such as wearables, capable of reliably monitoring AF burden in patients with AF.</p><p><strong>Methods: </strong>Major electronic databases were searched for studies comparing AF burden quantification using wearables and reference ECG monitoring methods. A Bayesian approach was adopted for the final analysis.</p><p><strong>Results: </strong>Six studies, including a total of 448 patients and 36,978 h of valid simultaneous recordings, were analyzed. Bayesian analysis revealed no statistically significant differences between wearables and reference methods in AF burden quantification. The mean error was 1% (95% CrIs: -4% to 7%). Similar findings were observed in the subgroup analysis of studies assessing only smartwatches. Between-study heterogeneity was low, and no evidence of publication bias was detected.</p><p><strong>Conclusion: </strong>Our analysis suggests that AF burden quantification using wearables is comparable to reference ECG monitoring methods. These findings support the potential role of wearables in clinical practice, particularly for research and prognostic purposes. However, more studies are needed to determine whether the observed statistical equivalence translates to clinical significance, thereby supporting the widespread use of wearables in the assessment of rhythm control therapeutic strategies.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 Pulmonary Vein Isolation for Atrial Fibrillation on Skin Sympathetic Nerve Activity in Association with Left Atrial Remodeling.","authors":"Yoichiro Nakagawa, Takashi Kusayama, Mayumi Morita, Yuta Nagamori, Kazutaka Takeuchi, Shuhei Iwaisako, Toyonobu Tsuda, Takeshi Kato, Soichiro Usui, Kenji Sakata, Kenshi Hayashi, Masayuki Takamura","doi":"10.3390/jcdd12040123","DOIUrl":"https://doi.org/10.3390/jcdd12040123","url":null,"abstract":"<p><p>Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). While it is known to affect the autonomic nervous system, the relationship between left atrial (LA) remodeling and PVI-mediated neuromodulation remains unclear. We aimed to assess the neuromodulatory effects of PVI using skin sympathetic nerve activity (SKNA). SKNA was recorded one day before and 2-3 days after PVI in 28 paroxysmal AF (PAF) and 33 persistent AF (PerAF) groups. Baseline low frequency to high frequency (LF/HF) ratio was higher in the PAF group (1.23 [interquartile range {IQR}: 0.79-1.76] vs. 0.74 [IQR: 0.49-1.38], <i>p</i> = 0.017). After PVI, the PAF group demonstrated significant reductions in burst amplitude (1.46 [IQR: 1.04-2.84] vs. 1.09 [IQR: 0.78-2.17] μV, <i>p</i> = 0.015) and LF/HF ratio (0.91 [IQR: 0.73-1.52] vs. 0.71 [IQR: 0.48-1.21], <i>p</i> = 0.012), whereas the PerAF group exhibited no such changes. A weak positive correlation was observed between the percentage change in LF/HF ratio and LA volume index in the PAF group (r = 0.572, <i>p</i> = 0.002). PVI significantly decreased SKNA in PAF patients but not in PerAF. LA remodeling may hinder the effectiveness of PVI-mediated neuromodulation.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12028141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}