Journal of Clinical Apheresis最新文献

{"title":"Antidote Worse Than the Poison? Emergent Therapeutic Plasma Exchange After Overzealous Intravenous Lipid Emulsion Infusion During Treatment of Local Anesthetic Systemic Toxicity","authors":"Brooke Yasgur,&nbsp;Ari Filip,&nbsp;Pratheepa Ravikumar,&nbsp;Logan Meurer,&nbsp;Gina Drobena","doi":"10.1002/jca.70025","DOIUrl":"https://doi.org/10.1002/jca.70025","url":null,"abstract":"<div>\u0000 \u0000 <p>This case report describes therapeutic plasma exchange as treatment for a rare instance of severe hypertriglyceridemia following high-dose intravenous lipid emulsion (ILE) therapy for bupivacaine-induced local anesthetic systemic toxicity (LAST). The patient received a cumulative ILE dose of 28.0 mL/kg to control seizures, exceeding the typical recommended maximum dose of 10 mL/kg. Clinical presentation included severe headache, visual disturbances, and photophobia, concerning for hyperviscosity syndrome. Laboratory findings revealed a markedly elevated serum triglyceride concentration (&gt; 10 350 mg/dL). Therapeutic plasma exchange with plasma was successfully employed to rapidly reduce serum triglycerides and alleviate symptoms. This case highlights the potential for severe iatrogenic hypertriglyceridemia associated with high-dose ILE therapy for LAST and emphasizes the importance of close clinical monitoring and timely intervention.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857110","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":"Therapeutic Plasma Exchange: Analysis of Practices and Compliance With International Guidelines","authors":"Davi Mesquita Miranda,&nbsp;Marina Vilela Pires Coelho,&nbsp;Márcia Torresan Delamain,&nbsp;Raquel A. Fabreti-Oliveira","doi":"10.1002/jca.70023","DOIUrl":"https://doi.org/10.1002/jca.70023","url":null,"abstract":"<div>\u0000 \u0000 <p>Therapeutic plasma exchange (TPE) is widely used in the treatment of autoimmune diseases and hematological emergencies. It is also applied in transplant patients for the desensitization of anti-HLA (human leukocyte antigen) antibodies and the management of antibody-mediated rejection. This study aims to assess the epidemiology of therapeutic plasmapheresis and evaluate whether indications for plasmapheresis align with the guidelines of the American Society for Apheresis (ASFA) and investigate the associated adverse effects. This retrospective observational study was conducted in hospitals in Belo Horizonte, Minas Gerais, and included 85 patients who underwent 493 TPE sessions between April 2021 and December 2023. The median age was 43 years, and 60% of the patients were women. The most common indications for TPE were neuromyelitis optica (24%) and acute rejection following kidney transplantation (21%). The replacement fluids used were primarily albumin (84%) and plasma frozen 24 h after phlebotomy (16%). Adverse events were reported in 5.88% of patients, including hypotension, vasovagal reflex, and one case of facial edema and urticaria. No procedure-related deaths were observed. TPE sessions were conducted in accordance with the guidelines of the ASFA, with 50% of procedures classified as Category I. There was no significant association between adverse events and patient diagnoses. The study demonstrated that TPE is effective and safe, with predominant indications for neuromyelitis optica and kidney transplant rejection, following ASFA guidelines. Adverse events were rare and manageable.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846167","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":"Incidence Rate of Therapeutic Apheresis: Analysis of a Therapeutic Apheresis Database to Use as a Benchmarking Tool","authors":"Joan Cid,&nbsp;Eva Rodríguez,&nbsp;Sandra Ortega,&nbsp;Anna M. Garcia,&nbsp;Jordi Comas,&nbsp;Paola Charry,&nbsp;Miquel Lozano,&nbsp;Rosa Ramos","doi":"10.1002/jca.70024","DOIUrl":"https://doi.org/10.1002/jca.70024","url":null,"abstract":"<div>\u0000 \u0000 <p>Benchmarking in apheresis medicine focuses on the collection of hematopoietic cells, where specific key performance indicators have been recommended to be used as an internal quality control of processes. The aim of this study was to collect data regarding the number of therapeutic apheresis procedures performed in Catalonia, Spain, and to compare this data with those from other countries. A database was created to collect therapeutic apheresis procedures from 2019 to 2023 in Catalonia, Spain. Similar articles about this topic were obtained using Medical Subject Headings in PubMed. To compare therapeutic apheresis performance among countries, the incidence rate of therapeutic apheresis was calculated as the number of therapeutic apheresis procedures per 1000 people per year. In a 5-year period, 26 897 therapeutic apheresis were performed in a 7.6 million population with an incidence rate of therapeutic apheresis of 0.71 per 1000 people per year. The incidence rate varied by as much as 10.1 times among the studies, from 0.07 in a USA study to 0.71 in the present study. When only European studies were compared, the incidence rate varied by as much as 1.65 times among the studies, from 0.43 in a Norwegian study to 0.71 in the present study. We report for the first time the therapeutic apheresis activity performed in Catalonia, Spain. Moreover, the incidence rate of therapeutic apheresis, calculated as the number of therapeutic apheresis procedures performed per 1000 people per year, is an objective indicator, easy to calculate, that can help in benchmarking therapeutic apheresis utilization.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831246","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":"Combined Treatment With Lipoprotein Apheresis and Hemodialysis in Patients With Severe Cardiovascular Disease, High Lipoprotein(a) and End Stage Renal Disease","authors":"Tilmann Röseler,&nbsp;Daniel Kayser,&nbsp;Georg Schlieper,&nbsp;Wanja M. Bernhardt","doi":"10.1002/jca.70020","DOIUrl":"https://doi.org/10.1002/jca.70020","url":null,"abstract":"<p>Elevated Lipoprotein(a) (Lp(a)) is a known independent cardiovascular risk factor. Lp(a) Lipoprotein Apheresis (LA) substantially reduces the number of cardiovascular events. The effect of LA treatment in hemodialysis (HD) patients remains unknown. Retrospective analysis of nine patients undergoing LA and HD. Cardiovascular risk factors and the efficacy of treatment were assessed. Adverse cardiac or vascular events (ACVE) were recorded. Median (range) years on HD were 4.2 (1.5 to 23.6) years and median years on LA were 4.0 (1.6 to 12.4) years. Before initiation of LA, median (range) Lp(a) level was 242.67 (164.0 to 400.10) nmol/L and mean LDL-C level (±SD) 2.49 (±1.14) mmol/L. Under treatment, mean acute reduction rates, comparing concentrations before and after LA sessions, were 64.15 (±5.45)% for Lp(a) and 57.26 (±7.93)% for LDL-C. Before initiation of LA, 14 ACVE occurred; after initiation, only 6 (57.2% reduction rate). In this small cohort, LA appears to be effective in reducing ACVE in patients on HD with elevated Lp(a) levels. Further studies are needed to evaluate the effect of LA on cardiovascular outcomes in dialysis patients.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822213","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":"Efficacy and Safety of Double Plasma Molecular Adsorption System at Different Therapeutic Doses During Regional Citrate Anticoagulation: A Pilot Study","authors":"Xiankun Sun,&nbsp;Yuan Zhao,&nbsp;Mingjin Dai,&nbsp;Fang Wang,&nbsp;Xinyu Chen,&nbsp;Zhongwei Zhang,&nbsp;Yuanji Ma,&nbsp;Ling Zhang,&nbsp;Yingying Yang","doi":"10.1002/jca.70019","DOIUrl":"https://doi.org/10.1002/jca.70019","url":null,"abstract":"<div>\u0000 \u0000 <p>This study aimed to assess the safety and therapeutic efficacy of increasing the dosage of the double plasma molecular adsorption system (DPMAS) in patients with liver failure during regional citrate anticoagulation (RCA). A prospective nonrandomized controlled trial was conducted. Three groups (3 L group, 4.5 L group, and 6 L group) of patients with liver failure receiving DPMAS treatment were created on the basis of various therapeutic plasma volumes. A total of 303 patients were included, with 110 in the 3 L group, 121 in the 4.5 L group, and 72 in the 6 L group. At the end of treatment, there was a statistically significant difference in the bilirubin clearance rate among the groups (<i>H</i> = 15.239, <i>p</i> &lt; 0.001). Pairwise comparisons revealed that only the difference in the bilirubin clearance rates between the 6 L group and the 3 L group was statistically significant (<i>p</i> &lt; 0.001). With the exception of base excess, no statistically significant differences were found between these three groups for any of the relevant laboratory indicators (<i>p</i> &gt; 0.05). The incidence of hypotension, hypocalcemia, acidosis, alkalosis, hypernatremia, hyperlactatemia, and allergic reactions did not differ significantly among these three groups (<i>p</i> &gt; 0.05). Furthermore, a statistically significant difference was found in clotting events among these three groups (<i>p</i> = 0.027), with a higher incidence observed in the 6 L group than in the 3 L group (<i>p</i> = 0.011). Increasing the therapeutic dose of RCA-DPMAS further removed bilirubin and did not increase the complications associated with citrate anticoagulation, but the coagulation risk is a concern.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809691","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":"Efficacy and Safety of Using Designed Auxiliary Lines in Standard CRRT Machines for DFPP Treatment","authors":"Fang Wang,&nbsp;Li Lin,&nbsp;Xiankun Sun,&nbsp;Xue Tang,&nbsp;Zhiwen Chen,&nbsp;Ling Zhang","doi":"10.1002/jca.70021","DOIUrl":"https://doi.org/10.1002/jca.70021","url":null,"abstract":"<div>\u0000 \u0000 <p>The demand for double-filtration plasmapheresis (DFPP) in clinical settings is growing steadily, yet the range and availability of specialized equipment designed to support DFPP are relatively limited. We aimed to assess the efficacy and safety of a designed auxiliary line for DFPP treatment using standard continuous renal replacement treatment (CRRT) machines. This prospective self-controlled study was conducted between May 2021 and April 2024. Patients who underwent DFPP treatment using both specialized DFPP machines and standard CRRT machines (using designed auxiliary line) were enrolled in the study. DFPP sessions were divided into the specialized DFPP machine group and the standard CRRT machine group. The rates of completed DFPP treatments, DFPP cost, circuit clotting, hypotension, anaphylaxis, hypocalcemia, and nurse operating time were compared. A total of 440 DFPP sessions were performed for 80 patients, with 330 (75.0%) sessions in the specialized DFPP machine group and 110 (25.0%) in the standard CRRT machine group. There were no statistically significant differences between the two groups in terms of the completed DFPP treatment rate (89.4% vs. 88.2%, <i>p</i> = 0.724), circuit clotting (8.2% vs. 7.3%, <i>p</i> = 0.760), anaphylaxis (12.7% vs. 11.8%, <i>p</i> = 0.803), hypotension (10.6% vs. 9.1%, <i>p</i> = 0.650), hypocalcemia (17.3% vs. 20.0%, <i>p</i> = 0.519), and nurse operation time (35.08 ± 2.27 min vs. 36.62 ± 1.94 min, <i>p</i> = 0.082). However, the cost per DFPP session in the standard CRRT machine group was lower than in the specialized DFPP machine (976.81 ± 14.38 $ vs. 1007.43 ± 35.30 $, <i>p</i> &lt; 0.001). Standard CRRT machines can effectively and safely perform DFPP treatment using a specially designed auxiliary line, which is more cost-effective. Even in primary hospitals without specialized DFPP machines, CRRT machines can be used to perform DFPP treatment.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786779","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":"Special Issue Abstracts from the American Society for Apheresis 46th Annual Meeting April 9–11, 2025","authors":"","doi":"10.1002/jca.70014","DOIUrl":"https://doi.org/10.1002/jca.70014","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 S1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786949","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":"Lipoprotein(a) Measurement in Lipoprotein Apheresis: Time to Change?","authors":"Carmen Corciulo,&nbsp;Beatrice Dal Pino,&nbsp;Francesco Sbrana,&nbsp;Federico Bigazzi","doi":"10.1002/jca.70018","DOIUrl":"https://doi.org/10.1002/jca.70018","url":null,"abstract":"<div>\u0000 \u0000 <p>The question of standardizing the measurement of lipoprotein(a) [Lp(a)] has been discussed for many years, but the unavailability of automated methods insensitive to the structural heterogeneity of Lp(a) and the transition to a new unit of measurement have delayed this process. The aim of this study is to compare, in subjects undergoing regular lipoprotein apheresis (LA) treatment (31 subjects, mean age 62 ± 11 years, female 7/31), Lp(a) measurements performed using routine polyclonal antibodies with a method that recognizes a single copy of apo(a) per molecule. This pilot study for adopting an assay insensitive to apo(a) size polymorphism showed a good match with the traditional method: correlations between pre-LA and post-LA measures show an <i>R</i>² of 0.89 and 0.76, respectively. Despite the interpretative problem caused by adopting different units of measurement, we believe that moving to an assay insensitive to the dimensional variation of apo(a) represents a necessary change to standardize, improve, and extend the accuracy and diagnostic power of Lp(a).</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770102","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 Descriptive 5-Year Analysis of the Demographics and Therapies for Patients With Immune Thrombotic Thrombocytopenic Purpura in the USA: A Multicenter Study of 390 Disease Episodes From 2017 to 2021","authors":"Jeremy W. Jacobs,&nbsp;Brian D. Adkins,&nbsp;Garrett S. Booth,&nbsp;Caroline G. Stanek,&nbsp;Elizabeth S. Allen,&nbsp;Brenda J. Grossman,&nbsp;Laura D. Stephens,&nbsp;Elizabeth P. Crowe,&nbsp;Laetitia Daou,&nbsp;Marisa B. Marques,&nbsp;Rance C. Siniard,&nbsp;Lisa R. Wallace,&nbsp;Chisa Yamada,&nbsp;Miriam Andrea Duque,&nbsp;Yanyun Wu,&nbsp;Omar Aljuboori,&nbsp;Thomas J. Harrington,&nbsp;Diana M. Byrnes,&nbsp;Quentin Eichbaum,&nbsp;Cristina A. Figueroa Villalba,&nbsp;Justin E. Juskewitch,&nbsp;Ellen Klapper,&nbsp;Ingrid Perez-Alvarez,&nbsp;Monica S. Klein,&nbsp;Fatima Aldarweesh,&nbsp;Rahaf Alkhateb,&nbsp;Meredith G. Parsons,&nbsp;Annette J. Schlueter,&nbsp;Christopher A. Tormey,&nbsp;Allison P. Wheeler,&nbsp;Amy A. Powers,&nbsp;Christopher B. Webb,&nbsp;Sean G. Yates,&nbsp;Evan M. Bloch,&nbsp;Jay S. Raval","doi":"10.1002/jca.70017","DOIUrl":"https://doi.org/10.1002/jca.70017","url":null,"abstract":"<p>Immune thrombotic thrombocytopenic purpura (iTTP) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and microvascular occlusion secondary to acquired ADAMTS13 deficiency. Contemporary data regarding iTTP treatment practices in the US, including the use of caplacizumab, are lacking. We aimed to characterize the demographics and therapies, including medications and apheresis practices, in patients with iTTP in the US. We retrospectively analyzed iTTP cases at 15 sites in the US that provide comprehensive care for patients with iTTP. The time-period assessed was from January 1, 2017 to December 31, 2021. Our primary objective was to analyze data by iTTP episode, inclusive of initial episodes and relapses. A total of 390 iTTP episodes were reported for 280 unique individuals (187 females, 93 males). Thirty-day mortality was 3.7% (14/374), and 6-month mortality was 7.4% (27/367). TPE details were reported for 343 episodes, among which 261 underwent at least one procedure (median 6, IQR 3–11). Among the 261 episodes with at least one therapeutic plasma exchange (TPE) performed, 82.0% (214/261) used only plasma. Caplacizumab was used either alone or in combination with other agents in 43 (11.0%) episodes. Management strategies for iTTP remain varied across centers in the US, with a variety of combinations for TPE replacement fluids and therapeutic agents, as well as limited use of caplacizumab. Further research and standardization of treatment regimens may further reduce mortality in this condition.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707372","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":"Effect of Therapeutic Plasma Exchange-Containing Regimens on Donor Specific Antibodies in Patients With Antibody Mediated Rejection of Pulmonary Transplant","authors":"Jasmine M. Velez,&nbsp;Coral Mansfield,&nbsp;Dongfeng Chen,&nbsp;John M. Reynolds,&nbsp;Grace M. Lee","doi":"10.1002/jca.70016","DOIUrl":"https://doi.org/10.1002/jca.70016","url":null,"abstract":"<div>\u0000 \u0000 <p>Prior studies examining therapeutic plasma exchange (TPE)-containing regimens in pulmonary transplant antibody-mediated rejection (AMR) have been limited by sample size and inconsistent application of TPE. In this single-center, retrospective study, patients with pulmonary transplant AMR who received a TPE-containing treatment regimen were examined. Mean fluorescence intensity (MFI) and Class distribution of DSAs were examined before/after 5 TPE and again after 8 TPE in the subset of patients who received an extended course of TPE. Fifty-two patients who completed 5 TPE were included. Testing of serum at 1:1 and 1:16 prior to initiation of TPE demonstrated that Class II DSAs occurred more frequently and at a higher MFI compared to Class I DSAs. After completing 5 TPE, for both 1:1 and 1:16 testing, the MFI of DSAs decreased significantly regardless of Class. For 4 patients with persistent DSAs, extending the course of TPE to 8 procedures did not cause an additional significant decline in the MFI of DSAs. Four patients developed de novo DSAs during the course of 5 TPE. Development of de novo DSAs was not associated with plasma exposure during TPE and was associated with high morbidity. In conclusion, completion of 5 TPE during treatment for pulmonary transplant AMR is associated with significant declines in DSAs regardless of HLA Class. Extending the course of TPE for DSAs which persist despite 5 TPE may be of limited benefit. De novo development of DSAs during the course of 5 TPE is associated with poor outcomes.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646091","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}