Journal of Heart and Lung Transplantation最新文献

{"title":"Loss of right ventricular outflow function in pulmonary hypertension.","authors":"Bruno R Brito da Rocha, Athiththan Yogeswaran, Bálint K Lakatos, Alexandra Fábián, Henning Gall, Hossein A Ghofrani, Nils C Kremer, Simon Schäfer, Werner Seeger, Daniel Zedler, Selin Yildiz, Zvonimir A Rako, Attila Kovács, Khodr Tello","doi":"10.1016/j.healun.2024.09.026","DOIUrl":"10.1016/j.healun.2024.09.026","url":null,"abstract":"<p><p>Right ventricular outflow tract (RVOT) function is not systematically quantified by three-dimensional (3D) echocardiography. We tested the hypothesis that loss of RVOT function in pulmonary hypertension (PH) is related to disease severity independently of other echocardiographic parameters. In this observational study, patients with PH, disease controls, and a matched healthy control group underwent 3D echocardiography and RVOT analysis using ReVISION software. The study included 43 patients (38 with PH, 5 disease controls) and 43 healthy controls. Median 3D RVOT-ejection fraction (EF) was 30.4% in the patients and 44.2% in the healthy controls (p < 0.001). Patients with low 3D RVOT-EF (<30.4%) were more frequently categorized in higher-risk groups and had a higher incidence of clinical worsening than those with high 3D RVOT-EF. Even in patients with RV-EF ≥35%, those with low 3D RVOT-EF had worse outcomes. Segmental RVOT analysis identifies high-risk patients even with normal overall RV function.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early stroke following durable left ventricular assist device (LVAD) implantation: An analysis of the Society of Thoracic Surgeons Intermacs National Database.","authors":"Ezequiel J Molina, Daniel Goldstein, Ryan S Cantor, Manreet K Kanwar, Dan Meyer, Ulrich Jorde, Omar Saeed, Katherine Wood, Rama Raju Rudraraju, Seth Lewis, James K Kirklin, Francis D Pagani, Arman Kilic","doi":"10.1016/j.healun.2024.09.031","DOIUrl":"10.1016/j.healun.2024.09.031","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a devastating complication of durable left ventricular assist device (LVAD) therapy. This study evaluated the incidence and risk factors for early stroke within 7 days following LVAD implantation investigating both traditional pre-implant and new intraoperative variables collected by The Society of Thoracic Surgeons (STS) Intermacs National Database.</p><p><strong>Methods: </strong>STS Intermacs was queried for patients undergoing implantation of a fully magnetically levitated centrifugal LVAD between November 25, 2020 and June 30, 2023. STS Intermacs stroke definitions were used to identify patients who suffered a stroke within the first 7 postoperative days (POD). A multivariable logistic regression model was created to generate adjusted odd ratios (OR) for variables associated with early stroke.</p><p><strong>Results: </strong>Among 6,950 patients in the study cohort, 5.9% (413/6950) developed a stroke after a median follow-up of 11 months, with 50% (205/413) of strokes occurring within 7 days after LVAD implantation. Of the strokes occurring during POD 0-7, 70% (144/205) occurred on POD 0-2. By multivariable analysis, the following factors were associated with early stroke: older age (70 vs 50; OR 1.4, p = 0.0129), white race (OR 1.5, p = 0.0078), pre-implant temporary mechanical circulatory support (MCS) bridge (temporary LVAD only: OR 1.6, extracorporeal membrane oxygenation [ECMO] only: OR 1.7, combination of both devices: OR 3.3; p = 0.0001) and presence of an unremoved left atrial clot (OR 8.0, p < 0.0001).</p><p><strong>Conclusions: </strong>A significant proportion of strokes occur within the first 7 days following LVAD implantation, particularly within the first 2 days. In addition to pre-implant variables, we identified modifiable intraoperative factors associated with stroke that provide an opportunity for further risk mitigation and improvement in quality of care.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of donation after circulatory death (DCD) and ex-vivo lung perfusion (EVLP) lung transplantation.","authors":"Selena S Li, Masaki Funamoto, Ruby Singh, Seyed A Rabi, Antonia Kreso, Eriberto Michel, Nathaniel B Langer, Asishana A Osho","doi":"10.1016/j.healun.2024.10.001","DOIUrl":"10.1016/j.healun.2024.10.001","url":null,"abstract":"<p><strong>Background: </strong>Donation after circulatory death (DCD) and ex-vivo lung perfusion (EVLP) have been adopted to expand the donor pool in lung transplantation, but outcomes data have been conflicting. This study explores outcomes of DCD and EVLP lung transplantation in the modern era.</p><p><strong>Methods: </strong>The United Network for Organ Sharing database was queried for adult lung transplants from January 1, 2015 to March 1, 2023. Loss to follow-up, multiorgan, and prior lung transplants were excluded. DCD versus donation after brain death (DBD) lung transplants were compared with subgroup analysis +/- EVLP. Outcomes were survival and postoperative complications.</p><p><strong>Results: </strong>The study included 1,103 DCD (221 with EVLP and 882 without) and 17,973 DBD lung transplants (524 with EVLP and 17,449 without). Median follow-up was 3 years. DCD donors were less likely to be CDC high risk (19.3% vs 24.1%, p < 0.001), have purulence on bronchoscopy (13.3% vs 18.3%, p < 0.001), or infiltrates on chest X-ray (66.7% vs 67.8%, p = 0.013). EVLP was more likely to be used for DCD transplants (20.0% vs 2.9%, p < 0.001). After transplant, DCD recipients were more likely to be reintubated (24.3% vs 18.5%, p < 0.001) and require ECMO within 72 hours (14.9% vs 7.8%, p < 0.001), and DCD donation was an independent risk factor for these complications on multivariable logistic regression. Overall survival did not differ significantly between DCD and DBD transplants on adjusted survival analysis in the early or modern era (p = 0.774 and p = 0.468, respectively). On subgroup analysis, the DCD+EVLP cohort had significantly worse survival in the modern era, which remained significant after adjusting for donor and recipient factors (p = 0.005). EVLP was an independent risk factor for graft failure in the DCD cohort (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.00-1.77, p = 0.047) but did not significantly affect DBD graft survival (p = 0.870). Risk factors for graft failure and mortality in the DCD+EVLP cohort included pulmonary hypertension (HR 77.5, 95% CI 6.15-979, p < 0.001), transfusion before transplant (HR 2.60, 95% CI 1.07-6.31, p = 0.035), elevated creatinine (HR 2.82, 95% CI 1.34-5.90, p = 0.006), and higher allocation score (HR 1.02, 95% CI 1.00-1.04, p = 0.017) CONCLUSIONS: Study findings suggest increased risks of mortality and perioperative complications following transplantation with DCD lungs that have undergone EVLP. DCD lung transplantation without EVLP confers equivalent survival but with some increase in perioperative complications. Further investigation and careful recipient selection are warranted to optimize the use of these extended criteria donors in the modern era.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loss of Nr4a1 ameliorates endothelial cell injury and vascular leakage in lung transplantation from circulatory-death donor.","authors":"Shinichi Kawana, Mikio Okazaki, Tomohisa Sakaue, Kohei Hashimoto, Kentaro Nakata, Haruki Choshi, Shin Tanaka, Kentaroh Miyoshi, Shinji Ohtani, Toshiaki Ohara, Seiichiro Sugimoto, Akihiro Matsukawa, Shinichi Toyooka","doi":"10.1016/j.healun.2024.09.028","DOIUrl":"10.1016/j.healun.2024.09.028","url":null,"abstract":"<p><strong>Background: </strong>Ischemia-reperfusion injury (IRI) stands as a major trigger for primary graft dysfunction (PGD) in lung transplantation (LTx). Especially in LTx from donation after cardiac death (DCD), effective control of IRI following warm ischemia (WIRI) is crucial to prevent PGD. This study aimed to identify the key factors affecting WIRI in LTx from DCD.</p><p><strong>Methods: </strong>Previously reported RNA-sequencing dataset of lung WIRI was reanalyzed to identify nuclear receptor subfamily 4 group A member 1 (NR4A1) as the immediate early gene for WIRI. Dynamics of NR4A1 expression were verified using a mouse hilar clamp model. To investigate the role of NR4A1 in WIRI, a mouse model of LTx from DCD was established using Nr4a1 knockout (Nr4a1^-/-) mice.</p><p><strong>Results: </strong>NR4A1 was located around vascular cells, and its protein levels in the lungs increased rapidly and transiently during WIRI. LTｘ from Nr4a1^-/- donors significantly improved pulmonary graft function compared to wild-type donors. Histological analysis showed decreased microvascular endothelial cell death, neutrophil infiltration, and albumin leakage. Evans blue permeability assay demonstrated maintained pulmonary microvascular barrier integrity in grafts from Nr4a1^-/- donors, correlating with diminished pulmonary edema. However, NR4A1 did not significantly affect the inflammatory response during WIRI, and IRI was not suppressed when a wild-type donor lung was transplanted into the Nr4a1^-/- recipient.</p><p><strong>Conclusions: </strong>Donor NR4A1 plays a specialized role in the positive regulation of endothelial cell injury and microvascular hyperpermeability. These findings demonstrate the potential of targeting NR4A1 interventions to alleviate PGD and improve outcomes in LTx from DCD.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A perspective on the added value of red blood cells during cardiac hypothermic oxygenated perfusion.","authors":"Mats T Vervoorn, Elisa M Ballan, Selma E Kaffka Genaamd Dengler, Veronique M F Meijborg, Saskia C A de Jager, Richard Van Wijk, Niels P van der Kaaij","doi":"10.1016/j.healun.2024.09.025","DOIUrl":"10.1016/j.healun.2024.09.025","url":null,"abstract":"<p><p>Hypothermic oxygenated perfusion (HOPE) is an emerging technique for donor heart preservation that is currently being studied in multiple clinical trials with promising results. When compared to HOPE for other organs, cardiac protocols involve red blood cell (RBC) supplementation, despite absence of comparative evidence for its benefits. In this perspective paper, we discuss the pros and cons of the addition of RBCs during cardiac HOPE. Although the current clinical results with RBC supplementation during HOPE seem promising, potential downsides of RBC supplementation cannot be ruled out. The impact of supplemented RBCs during cardiac HOPE requires further investigation to improve HOPE protocols, to optimize heart preservation using this promising technology.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The combination of postmortem sevoflurane ventilation and in situ topical cooling provides improved 6 hours lung preservation in an uncontrolled DCD porcine model.","authors":"Edson Ricardo Brambate Junior, Aizhou Wang, Rafaela Vanin Pinto Ribeiro, Erika L Beroncal, Khaled Ramadan, Vinicius Schenk Michaelsen, Manyin Chen, Aadil Ali, Yu Zhang, Prodipto Pal, Etienne Abdelnour, Gabriel Siebiger, Bruno Maineri Pinto, Tom Waddell, Ana C Andreazza, Shaf Keshavjee, Marcelo Cypel","doi":"10.1016/j.healun.2024.09.019","DOIUrl":"10.1016/j.healun.2024.09.019","url":null,"abstract":"<p><strong>Background: </strong>Recent clinical series on donation after uncontrolled cardiovascular death (uDCD) reported successful transplantation of lungs preserved by pulmonary inflation up to 3 hours postmortem. This study aims to investigate the additive effects of in situ lowering of intrathoracic temperature and sevoflurane preconditioning on lung grafts in a porcine uDCD model.</p><p><strong>Methods: </strong>After uDCD induction, donor pigs were allocated to one of the following groups: control-static lung inflation only (SLI); TC - SLI + continuous intrapleural topical cooling (TC); or TC+Sevo - SLI + TC + sevoflurane. Lungs were retrieved 6 hours postasystole and evaluated via ex vivo lung perfusion (EVLP) for 6 hours. A left single lung transplant was performed using lungs from the best performing group, followed by 4 hours of graft evaluation.</p><p><strong>Results: </strong>Animals that received TC achieved intrathoracic temperature <15°C within 1 hour after chest filling of coolant. Only lungs from donors that received TC and TC+Sevo completed the planned postpreservation 6 hours EVLP assessment. Despite similar early performance of the 2 groups on EVLP, the TC+Sevo group was superior-associated with overall lower airway pressures, higher pulmonary compliances, less edema development, and less inflammation. Transplantation was performed using lungs from the TC+Sevo group, and excellent graft function was observed postreperfusion.</p><p><strong>Conclusions: </strong>Preservation of uDCD lungs with a combination of static lung inflation, TC and sevoflurane treatment maintains good pulmonary function up to 6 hours postmortem with excellent early post lung transplant function. These interventions may significantly expand the clinical utilization of uDCD donor lungs.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of controlled DCDD lung transplantation after thoraco-abdominal vs abdominal normothermic regional perfusion: The Spanish experience.","authors":"Anna Minasyan, Mercedes de la Torre, Joel Rosado Rodriguez, Alberto Jauregui Abularach, Alejandra Romero Román, Nuria Novoa Valentin, Ivan Martínez Serna, Pablo Gámez García, Alilis Fontana, Gabriel Sales Badia, Francisco Javier González García, Angel Salvatierra Velazquez, Loreto Berjon, Roberto Mons Lera, Pedro Rodríguez Suarez, Elisabeth Coll, Eduardo Miñambres, Beatriz Domínguez-Gil, Jose Luis Campo-Cañaveral de la Cruz","doi":"10.1016/j.healun.2024.09.018","DOIUrl":"10.1016/j.healun.2024.09.018","url":null,"abstract":"<p><strong>Background: </strong>Thoraco-abdominal normothermic regional perfusion (TA-NRP) has emerged as a strategy for evaluating and recovering the heart in controlled donation after the circulatory determination of death (cDCDD). However, its impact on lung grafts remains largely unknown. We aimed to assess the impact of TA-NRP on the outcomes of recipients of cDCDD lungs.</p><p><strong>Methods: </strong>This is a retrospective, multicenter, nationwide study describing the outcomes of cDCDD lung transplants (LTs) performed in Spain from January 2021 to November 2023. Patients were divided in 2 groups based on the recovery technique: TA-NRP with the simultaneous recovery of the heart vs abdominal NRP (A-NRP) without simultaneous heart recovery. The primary endpoint was the incidence of Primary Graft Dysfunction (PGD) grade 3 at 72 hours. Secondary endpoints included the overall incidence of PGD, days on mechanical ventilation, intensive care unit (ICU) and hospital length of stay, early survival rates, and mid-term outcomes.</p><p><strong>Results: </strong>Two hundred and eighty three cDCDD LTs were performed during the study period, 28 (10%) using TA-NRP and 255 (90%) using A-NRP. No differences were observed in the incidence of PGD grade 3 at 72 hours between the TA-NRP and the A-NRP group (0% vs 7.6%; p = 0.231), though the overall incidence of PGD was significantly lower with TA-NRP (14.3% vs 41.5%; p = 0.005). We found no significant differences between the groups regarding other post-transplant outcome variables.</p><p><strong>Conclusions: </strong>TA-NRP allows the simultaneous recovery of both the heart and the lungs in the cDCDD scenario with appropriate LT outcomes comparable to those observed with the A-NRP approach.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation as a bridge to thoracic multiorgan transplantation.","authors":"Elbert E Heng, Aravind Krishnan, Stefan Elde, Alyssa Garrison, Moeed Fawad, Chawannuch Ruaengsri, Yasuhiro Shudo, Brandon A Guenthart, Y Joseph Woo, John W MacArthur","doi":"10.1016/j.healun.2024.09.015","DOIUrl":"10.1016/j.healun.2024.09.015","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) has emerged as a crucial tool in the care of patients with multiorgan failure and is increasingly utilized as a bridge to transplantation. While data on ECMO as a bridge to isolated heart and lung transplantation have been described, our emerging experience with ECMO as a bridge to thoracic multiorgan transplantation is not yet well understood.</p><p><strong>Methods: </strong>The United Network for Organ Sharing database was used to identify adult patients undergoing thoracic multiorgan transplantation between 1987 and 2022. Exclusion criteria were recipient age <18 and bridging with other non-ECMO mechanical circulatory support, Survival analysis was performed to compare outcomes between patients bridged to transplantation with ECMO and those who were not bridged.</p><p><strong>Results: </strong>Of 3,927 patients undergoing thoracic multiorgan transplantation, a total of 203 (5.2%) patients received ECMO as a bridge to transplantation. Among ECMO recipients, patients were most commonly bridged to heart-lung (45.8%), followed by heart-kidney (34.5%), and lung-kidney transplantation (11.8%). At a median follow-up of 35.5 months, unadjusted survival among patients bridged with ECMO was decreased versus multiorgan transplant recipients who were not bridged (p < 0.001). Among patients surviving past 30 days following transplantation, conditional long-term survival was similar between ECMO and non-ECMO patients (p = 0.82).</p><p><strong>Conclusions: </strong>ECMO is increasingly utilized as a bridge to thoracic multiorgan transplantation and is associated with increased 30 day mortality and decreased long-term survival. In select patients surviving to 30 days following transplantation, similar long-term survival is seen between patients bridged with ECMO and those not bridged.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vintage vitality: Embracing older donor lungs for transplants.","authors":"Sandra Lindstedt, Michael Perch, Anna Niroomand","doi":"10.1016/j.healun.2024.09.006","DOIUrl":"10.1016/j.healun.2024.09.006","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the Donor Pool: Sequential Double Lung then Heart Transplant Using Ex-Vivo Normothermic Perfusion","authors":"Hosam F. Ahmed MD PhD ,&nbsp;Don Hayes Jr, MD MS ,&nbsp;Marco Ricci MD ,&nbsp;Clifford Chin MD ,&nbsp;David L.S. Morales MD","doi":"10.1016/j.healun.2024.09.008","DOIUrl":"10.1016/j.healun.2024.09.008","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Pages 2046-2047"},"PeriodicalIF":6.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}