Journal of Clinical Neuroscience最新文献

{"title":"Developing aneurysm clipping capacity in Ghana through global neurosurgical collaboration: a case series from two global brainsurgery initiative mission trips","authors":"Teddy Totimeh ,&nbsp;Emmanuel K. Adjei Osei ,&nbsp;Irene Kweidjartey ,&nbsp;Kwadwo Darko ,&nbsp;Vincent Buckman ,&nbsp;Ulrick Sidney Kanmounye ,&nbsp;W. Elorm Yevudza ,&nbsp;Frederick Dogbe ,&nbsp;Nirali Patel ,&nbsp;Kwadwo Sarpong ,&nbsp;Hasan R. Syed ,&nbsp;Amjad Anaizi ,&nbsp;Daniel R. Felbaum ,&nbsp;Jean C. Walter","doi":"10.1016/j.jocn.2025.111607","DOIUrl":"10.1016/j.jocn.2025.111607","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of cerebral aneurysms in low- and middle-income countries (LMICs) faces significant barriers, including limited access to specialized neurosurgical care and equipment and dissipating human resources. Ghana’s inaugural experience with cerebral aneurysm clipping, facilitated by the Global Brainsurgery Initiative (GBI), represent an attempt to address these challenges through international collaboration.</div></div><div><h3>Methods</h3><div>This case series details the outcomes of six patients who underwent cerebral aneurysm clipping procedures at two neurosurgical centers. These cases were done in 2023 and 2024 by a team comprising local and international neurosurgeons. After a series of virtual case discussions, patients were selected. Case load was mainly limited by logistics and operative schedules. The preoperative planning; challenges encountered and strategies for capacity building are discussed.</div></div><div><h3>Results</h3><div>The patients were aged 15 to 63 years, predominantly female and presented with ruptured aneurysms at the internal carotid artery terminus, posterior communicating artery, and middle cerebral artery. All patients had their aneurysms clipped. There was an intraoperative rupture in one case and perioperative rupture with subsequent infarct in another. Most patients achieved good functional recovery, with mRS scores indicating minimal to moderate disability.</div></div><div><h3>Conclusion</h3><div>We outline the beginnings of a new global neurosurgery partnership. The GBI mission demonstrates that with appropriate planning and collaboration, neurosurgical care in low-resource settings can achieve appreciable outcomes. Continued investment in early diagnosis, advanced treatment modalities, and healthcare infrastructure is essential for scaling access to surgical aneurysm care in Ghana.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111607"},"PeriodicalIF":1.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996727","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":"Disparities in pediatric stroke-related mortality in the United States: Insights from the CDC WONDER database","authors":"Waleed Tariq ,&nbsp;Shahzaib Ahmed ,&nbsp;Sophia Ahmed ,&nbsp;Eeman Ahmad ,&nbsp;Neha Waseem ,&nbsp;Hoor Ul Ain ,&nbsp;Shkaib Ahmad","doi":"10.1016/j.jocn.2025.111592","DOIUrl":"10.1016/j.jocn.2025.111592","url":null,"abstract":"<div><h3>Objective</h3><div>Stroke is a rare but significant cause of mortality among the pediatric age group. Despite advances in treatment, disparities in stroke-related mortality persist. We aim to analyze stroke-related mortality among pediatric age groups in the US for over two decades. Methods: This retrospective cross-sectional study utilized the CDC WONDER database for stroke-related mortality in children (≤ 14 years). Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Annual percent changes (APC) with 95 % confidence intervals (CI) were determined from Joinpoint regression (Joinpoint Regression Program V 5.2.0). Results: From 1999 to 2020, a total of 15,512 deaths in the United States pediatric-stroke-related mortality were reported. An overall decrease in AAMR was observed, from 1.26 in 1999 to 1.02 in 2020. Males had higher AAMR (1.28) than females throughout the period (1.03). Across regions, the Midwest had the highest AAMR (1.24), followed by the South (1.23), the West (1.17), and the Northeast (0.95). Non-Hispanic (NH) Black or African American group had the highest AAMR (1.97) followed by Hispanic or Latinos (1.08), NH Whites (1.00), and NH Asian or Pacific Islanders exhibited the lowest AAMR (0.94). The CMR per 100,000 was noted to be the highest for the &lt;1 year age group (CMR: 8.14) while the 5–14 years group demonstrated the lowest crude rate (CMR: 0.56). Upon urbanization, the highest AAMR was observed in large central metro areas (1.23) while large fringe metro areas had the lowest AAMR (1.02). The highest AAMRs state-wise were observed in Alaska (1.79), South Dakota (1.77), and the District of Columbia (1.75). Conclusion: An increase in mortality trends was observed from 2012 onwards with males, infants, and African American children being the high-risk groups. A multifaceted approach, focusing on prevention, early recognition, and optimized management is required to mitigate pediatric-stroke-related mortality.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111592"},"PeriodicalIF":1.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988204","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":"Surgical resection of Wernicke’s area brain arteriovenous malformation via posterior Sylvian fissure: Two-dimensional video","authors":"Xingfen Su ,&nbsp;Jiakang Zhang ,&nbsp;Jianyu Zhu ,&nbsp;Jianping Song","doi":"10.1016/j.jocn.2025.111611","DOIUrl":"10.1016/j.jocn.2025.111611","url":null,"abstract":"<div><div>The brain arteriovenous malformation (BAVM) within language-eloquent area poses a significant surgical challenge, demanding meticulous planning to ensure both preservation of language function and curative resection. This report details the successful microsurgical resection of a Spetzler-Martin grade II BAVM located in Wernicke’s area in a 51-year-old male, ruptured three weeks ago and characterized by mild anomia. Following thorough discussion, the patient elected for microsurgery, providing informed consent, and the procedure was approved by the ethics committee. Given concerns regarding patient compliance during a prolonged procedure, the intravenous general anesthesia was favored over an awake craniotomy approach. Diffusion tensor imaging showed language-related neurofibers around the lesion. Functional magnetic resonance imaging was not employed due to potential inaccuracies arising from neurovascular uncoupling caused by BAVM hemodynamics[<span><span>1</span></span>]. Instead, intraoperative spatial–temporal functional mapping with cortico-cortical evoked potentials was implemented to delineate the language area, approximating the benefits of awake mapping[<span><span>2</span></span>,<span><span>3</span></span>]. After craniotomy, intraoperative inspection and spatial–temporal functional mapping elucidated the anatomical relationship between the BAVM and the language-eloquent cortex. The posterior Sylvian fissure was then sharply dissected to access the hematoma cavity and BAVM nidus, and the nidus was subsequently dissected and resected along its boundary with minimal disruption to the surrounding parenchyma. Intraoperative indocyanine green videoangiography and digital subtraction angiography confirmed restoration of normal hemodynamics and complete BAVM obliteration. Postoperatively, the patient exhibited no language function deterioration and demonstrated sustained symptomatic improvement at one-month follow-up. This case serves to highlight technical nuances relevant to the management of BAVMs within critical language areas.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111611"},"PeriodicalIF":1.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988205","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":"Feasibility and safety of the non-radial-specific 6 Fr FUBUKI XF guiding sheath for transradial neuroendovascular procedures","authors":"Daisuke Yamazaki ,&nbsp;Akifumi Yokota ,&nbsp;Daisuke Satoh ,&nbsp;Takehiro Yako ,&nbsp;Kazuo Kitazawa ,&nbsp;Tetsuyoshi Horiuchi ,&nbsp;Shigeaki Kobayashi","doi":"10.1016/j.jocn.2025.111609","DOIUrl":"10.1016/j.jocn.2025.111609","url":null,"abstract":"<div><div>The transradial approach (TRA) is gaining popularity in neuroendovascular therapy due to its safety and patient comfort, but its application in emergency settings with complex vascular anatomy remains technically demanding. This study assessed the feasibility and safety of using the 6 Fr FUBUKI XF long guiding sheath—a non-radial-specific device—for neuroendovascular procedures via TRA. Nineteen consecutive patients treated with the FUBUKI XF long guiding sheath between April 2024 and June 2025 were retrospectively reviewed and compared with a small cohort treated using the radial-specific Rist guiding sheath during the same period. The FUBUKI XF cohort had a mean age of 70.2 years, and 57.9 % were female. Most procedures (73.7 %) were for ruptured aneurysms. Anatomical challenges included type III aortic arch and aberrant right subclavian artery. Technical access success was achieved in 94.7 % of cases, with one case converted to transfemoral access. Median procedure time was 111.0 min (IQR, 72.0), median fluoroscopy time was 54.0 min (IQR, 35.3), and median DAP was 153.0 Gy·m² (IQR, 46.0). Intermediate catheters were employed in 94.7 % of procedures. One case of carotid dissection required stenting, but no major access-site complications occurred. The FUBUKI XF sheath’s atraumatic tip, flexible shaft, and high trackability enabled effective navigation and support. These findings suggest that the FUBUKI XF is a feasible and safe option for TRA-based neurointerventions, with performance comparable to radial-specific devices in complex anatomical scenarios.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111609"},"PeriodicalIF":1.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996726","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":"Expanding the research framework of isolated sleep paralysis: The need to consider environmental and behavioral variables","authors":"Christian Messina","doi":"10.1016/j.jocn.2025.111601","DOIUrl":"10.1016/j.jocn.2025.111601","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111601"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931645","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":"Critical gaps in evidence on intensive statins for acute ischemic stroke","authors":"Amisha Kumari ,&nbsp;Muddassir Khalid ,&nbsp;Archana Kumari ,&nbsp;Reena Kumari ,&nbsp;Fred Segawa","doi":"10.1016/j.jocn.2025.111600","DOIUrl":"10.1016/j.jocn.2025.111600","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111600"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931646","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":"Early exposure to neurosurgery: promoting early specialty interest through a single-day resident-driven neurosurgical course for preclinical students","authors":"Nicole A. Perez ,&nbsp;Zsombor T. Gal ,&nbsp;William Muñoz ,&nbsp;Brian Hsueh ,&nbsp;Pranav Nanda ,&nbsp;Bryan D. Choi ,&nbsp;Pamela Jones ,&nbsp;Christopher Stapleton ,&nbsp;Ganesh Shankar ,&nbsp;Jean Valery Coumans ,&nbsp;Brian Nahed","doi":"10.1016/j.jocn.2025.111612","DOIUrl":"10.1016/j.jocn.2025.111612","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Minimal exposure to neurosurgery in standard medical school curricula alongside a growing need for neurosurgical care necessitate early exposure programs that promote medical student retention in neurosurgery. Here, we evaluate preclinical students’ perceptions on a one-day, resident-designed introductory neurosurgical course.</div></div><div><h3>Methods</h3><div>Course curriculum involved hands-on and discussion-based elements split into three stations: (1) suturing/general information; (2) introduction to drilling/LPs/EVDs; and (3) case/clinical skills review. Anonymous online post-course surveys were administered immediately after the course and one year after the course following completion of clerkships.</div></div><div><h3>Results</h3><div>Ten medical students participated in the course, 70 % of which indicated desire to pursue neurosurgery at course onset. Nine students responded to an immediate post-survey, which revealed that, in students with a desire to pursue neurosurgery (n = 6) versus those undifferentiated in specialty interest (n = 3): the program was rated as having high versus moderate impacts on readiness and enthusiasm for surgical clerkships (readiness: avg 4 vs 3.67; enthusiasm: avg 4.3 vs 3.67), on fostering a sense of belonging within neurosurgery (avg 4.67 vs 3.33), and on clarifying specialty interests (avg 4.3 vs 3.3).</div><div>At 1-year, 75 % of participants (n = 6), including 100 % of students (n = 4) from minority backgrounds, noted a persistent desire to pursue neurosurgery. In participants with a continued interest in neurosurgery versus those planning to pursue different fields, the course was rated as having high versus moderate impacts on preparedness for surgery clerkship experiences (average 4.17 vs 3.5) and moderate impact on participant desire to pursue neurosurgery (3.67 vs 3).</div></div><div><h3>Conclusions</h3><div>Significant enthusiasm and sense of belonging fostered by the course, particularly amongst students with prior interests in neurosurgery, support that early specialty-specific exposure may promote retention of students in neurosurgery. High rates of persistent engagement in neurosurgery amongst minority students at 1-year post-course suggest that such courses may help to build a more representative neurosurgical workforce.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111612"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988203","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":"Choroidal melanoma missed on brain MRI: Small lesion, big consequences","authors":"Gökhan Tonkaz ,&nbsp;Cemre Akdeniz ,&nbsp;Mehmet Tonkaz ,&nbsp;Duygu Erkal Tonkaz","doi":"10.1016/j.jocn.2025.111593","DOIUrl":"10.1016/j.jocn.2025.111593","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111593"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932968","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":"Association between temporalis and masseter muscle thickness and dysphagia in patients with spontaneous intracerebral hemorrhage","authors":"Ya-Chu Hsu ,&nbsp;Ting-Ju Lai ,&nbsp;You-Lin Lu ,&nbsp;Hsing-Yu Chen ,&nbsp;Hsiao-Ting Tsai ,&nbsp;Tyng-Guey Wang ,&nbsp;Shu-Mei Yang ,&nbsp;Meng-Ting Lin","doi":"10.1016/j.jocn.2025.111598","DOIUrl":"10.1016/j.jocn.2025.111598","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study is to investigate the association between masticatory muscle thickness and dysphagia in intracerebral hemorrhage (ICH) patients.</div></div><div><h3>Materials &amp; methods</h3><div>This retrospective cohort study included patients with spontaneous ICH confirmed by brain computed tomography (CT) between June 2019 and June 2024 in a university-affiliated hospital. Temporal muscle thickness (TMT) and masseter muscle thickness (MMT) were measured on the initial brain CT. Dysphagia outcomes were assessed using NG tube retention and the Functional Oral Intake Scale (FOIS) at 1, 4, and 12 weeks post-ICH. Linear regression analyzed relationships between clinicodemographic factors, comorbidities, and TMT/MMT, while logistic regression assessed associations between TMT/MMT and dysphagia outcomes, adjusting for identified variables.</div></div><div><h3>Results</h3><div>A total of 412 patients (61.2 % male, mean age 63.5 years) were included in the study. The mean TMT and MMT were 5.78 ± 1.54 mm and 13.51 ± 2.67 mm, respectively. Younger age, male gender, and higher body mass index were associated with increased TMT, while similar factors, along with premorbid modified Rankin scale, were linked to higher MMT. Adjusted multivariate analysis revealed significant associations between TMT and FOIS scores at 1 and 4 weeks post-ICH, with adjusted odds ratios (ORs) of 0.54 (95 % CI 0.35–0.85) and 0.41 (95 % CI 0.2–0.82), respectively. TMT was also significantly associated with NG tube retention at 1 and 4 weeks, with adjusted odds ratios (ORs) of 0.54 (95 % CI 0.35–0.85) and 0.1 (95 % CI 0.01–0.99), respectively. No significant relationships were observed between MMT and dysphagia outcomes.</div></div><div><h3>Conclusion</h3><div>TMT may serve as a preliminary predictor of functional oral intake impairment in post-ICH population requiring prospective validation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111598"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931589","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":"Effect of glycemic control on outcomes after aneurysmal subarachnoid hemorrhage: A comprehensive analysis of stress-induced hyperglycemia and chronic glycemic status","authors":"Sapna Suresh ,&nbsp;Ajay Prasad Hrishi ,&nbsp;Karen Ruby Lionel ,&nbsp;Sravan Sreekumar ,&nbsp;Parvathy Dinesh","doi":"10.1016/j.jocn.2025.111604","DOIUrl":"10.1016/j.jocn.2025.111604","url":null,"abstract":"<div><h3>Background</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) frequently precipitates stress-induced hyperglycemia, yet the relationship between baseline glycemic control and clinical outcomes remains poorly understood. This study investigates the association between glycosylated hemoglobin (HbA1c) levels and clinical outcomes in aSAH patients, with a particular focus on stress-induced hyperglycemia(SIH) patterns.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled 155 consecutive aSAH patients aged ≥ 18 years. Patients were stratified based on admission HbA1c levels (&lt;6.0 % vs ≥ 6.0 %). Among patients with HbA1c values less than 6.0 %(i.e, without history of diabetes), stress hyperglycemia ratio (SHR)was calculated and further categorized into patients with low SHR (&lt;1.14) and high SHR (&gt;1.14). Primary outcomes included delayed cerebral ischemia (DCI) and functional outcomes at 3 months. Secondary outcomes encompassed in-hospital complications, length of stay, and mortality.</div></div><div><h3>Results</h3><div>Among 155 patients (mean age 55.4 ± 13.2 years), 116 (74.8 %) had HbA1c &lt; 6.0 % and 39 (25.2 %) had HbA1c ≥ 6.0 %. Patients with elevated HbA1c demonstrated significantly higher rates of DCI (46.2 % vs 24.1 %, p = 0.011), prolonged ICU stay (12.4 ± 8.7 vs 8.2 ± 6.4 days, p = 0.002), and poor functional outcomes (53.8 % vs 32.8 % with mRS 3–6, p = 0.026). SIH occurred more frequently in patients with normal HbA1c levels, and was associated with adverse outcomes independent of baseline glycemic control. Elevated HbA1c levels serve as an independent predictor of poor outcomes in aSAH patients. Among patients with normal baseline glycemic control who developed SIH, there was a significant association with adverse outcomes, including increased DCI rates (31.9 % vs 11.4 % in those without stress hyperglycemia, p = 0.021) and prolonged hospital stays.</div></div><div><h3>Conclusions</h3><div>Patients with elevated HbA1c demonstrated significantly higher rates of delayed cerebral ischemia (DCI), prolonged ICU stay, and poor functional outcomes. A high stress hyperglycemia ratio (SHR) &gt; 1.14 is associated with 3.6 times greater odds of developing DCI when compared to patients having a normal SHR in patients with normal baseline glycemic control.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111604"},"PeriodicalIF":1.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932967","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}