Journal of Perinatal Medicine最新文献

{"title":"Measurements of the fetal heart and prenatal biomarkers in children born with an isolated ventricular septum defect - a large, prospective, multicenter cohort study.","authors":"Cathrine Vedel, Christian Pihl, Finn Stener Jørgensen, Olav Bjørn Petersen, Line Rode, Karin Sundberg, Helle Zingenberg, Henning Bundgaard, Kasper Iversen, Anne-Sophie Sillesen, Anna Axelsson Raja, Niels Vejlstrup, Ann Tabor, Charlotte Kvist Ekelund","doi":"10.1515/jpm-2025-0167","DOIUrl":"https://doi.org/10.1515/jpm-2025-0167","url":null,"abstract":"<p><strong>Objectives: </strong>To compare 2nd-trimester cardiac and fetal biometries, 1st-trimester biomarkers, and obstetric outcome between children with an isolated ventricular septum defect (iVSD) and healthy children in a large cohort of children with neonatal echocardiography.</p><p><strong>Methods: </strong>The Copenhagen Baby Heart Study offered all neonates born in Copenhagen an echocardiography within the 60 days of life between 2016 and 2018. The mothers were recruited at the 2nd-trimester scan (18+0 to 22+6). The documentation from the 2nd-trimester anomaly scan was supplemented with the four-chamber view with Doppler flow, the sagittal view of the aortic arch, the mid-umbilical artery flow, and the ductus venosus flow. All prenatal images were evaluated and cardiac biometries measured by two blinded investigators. VSDs were classified as muscular or as \"other type\" (perimembranous, inlet, and outlet VSDs). We compared cardiac biometries, biomarkers, and pregnancy outcome between fetuses with a neonatally diagnosed iVSD and controls.</p><p><strong>Results: </strong>We included 25,556 neonates for an echocardiography, of which 9,155 fetuses were scanned in the period with extended cardiac imaging prenatally. We identified 294 fetuses with a postnatal VSD. Fetal measurements were similar between those with an iVSD compared to those without, and obstetric outcome were similar.</p><p><strong>Conclusions: </strong>Our results indicate that children diagnosed with an iVSD through neonatal echocardiography in an unselected population have an otherwise structurally normal heart prenatally and a normal pregnancy outcome.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707744","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":"Patient education materials: improving readability to advance health equity.","authors":"Amos Grünebaum, Susan L Pollet, Renee McLeod-Sordjan, Gloria Bachman, Frank A Chervenak","doi":"10.1515/jpm-2025-0368","DOIUrl":"https://doi.org/10.1515/jpm-2025-0368","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the readability of American College of Obstetricians and Gynecologists (ACOG) patient education pamphlets and evaluate changes over 25 years to determine their role as a social determinant of health affecting maternal health disparities.</p><p><strong>Methods: </strong>Cross-sectional descriptive analysis of 134 English-language ACOG patient pamphlets using five validated readability metrics (Flesch Reading Ease Score, SMOG Index, Gunning Fog Index, Coleman-Liau Index, and Bormuth Grade Placement). Materials were categorized into five groups: Pregnancy & Childbirth, Gynecologic Conditions, Other, Cancer & Screening, and Infections & STIs. A random subset of 20 pamphlets underwent quality assessment using the DISCERN tool. Results were compared with historical data from 1999.</p><p><strong>Results: </strong>The mean DISCERN score was 65.6/75, indicating excellent content quality. However, readability analysis revealed concerning accessibility barriers. The mean Flesch Reading Ease score was 58.4 ± 6.2, with only 35.1 % of pamphlets meeting plain language standards (≥60 score, equivalent to 8th grade or below). Most materials (57.5 %) required 10th-12th grade reading ability. Across all readability metrics, the average grade level was 9.5, with only 2.2-6.7 % of pamphlets meeting recommended standards (≤8th grade). Comparison with 1999 data showed worsening readability, with scores increasing 1.0-3.7 grade levels across all metrics.</p><p><strong>Conclusions: </strong>ACOG patient education materials consistently exceed recommended readability levels and have become more complex over 25 years. This inaccessibility perpetuates health disparities, particularly affecting marginalized populations with lower health literacy. Implementing plain language policies, AI-driven text simplification, and readability audits are essential for advancing maternal health equity and ensuring all patients can access comprehensible reproductive health information.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707745","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":"Fetal neurobehavior and consciousness: a systematic review of 4D ultrasound evidence and ethical challenges.","authors":"Mochammad Besari Adi Pramono, Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, I Nyoman Hariyasa Sanjaya, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak","doi":"10.1515/jpm-2025-0281","DOIUrl":"https://doi.org/10.1515/jpm-2025-0281","url":null,"abstract":"<p><strong>Introduction: </strong>Recent advancements in four-dimensional (4D) ultrasonography have enabled detailed observation of fetal behavior <i>in utero</i>, including facial movements, limb gestures, and stimulus responses. These developments have prompted renewed inquiry into whether such behaviors are merely reflexive or represent early signs of integrated neural function. However, the relationship between fetal movement patterns and conscious awareness remains scientifically uncertain and ethically contested.</p><p><strong>Content: </strong>A systematic review was conducted in accordance with PRISMA 2020 guidelines. Four databases (PubMed, Scopus, Embase, Web of Science) were searched for English-language articles published from 2000 to 2025, using keywords including \"fetal behavior,\" \"4D ultrasound,\" \"neurodevelopment,\" and \"consciousness.\" Studies were included if they involved human fetuses, used 4D ultrasound or functional imaging modalities, and offered interpretation relevant to neurobehavioral or ethical analysis. A structured appraisal using AMSTAR-2 was applied to assess study quality. Data were synthesized narratively to map fetal behaviors onto developmental milestones and evaluate their interpretive limits.</p><p><strong>Summary and outlook: </strong>Seventy-four studies met inclusion criteria, with 23 rated as high-quality. Fetal behaviors such as yawning, hand-to-face movement, and startle responses increased in complexity between 24-34 weeks gestation. These patterns aligned with known neurodevelopmental events, including thalamocortical connectivity and cortical folding. However, no study provided definitive evidence linking observed behaviors to conscious experience. Emerging applications of artificial intelligence in ultrasound analysis were found to enhance pattern recognition but lack external validation. Fetal behavior observed via 4D ultrasound may reflect increasing neural integration but should not be equated with awareness. Interpretations must remain cautious, avoiding anthropomorphic assumptions. Ethical engagement requires attention to scientific limits, sociocultural diversity, and respect for maternal autonomy as imaging technologies continue to evolve.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690579","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":"Maternal and perinatal outcomes in obese parturients with epidural analgesia: a systematic review.","authors":"Ewout C van der Wal, Johannes J Duvekot, Ilse J J Dons-Sinke, Robert J Stolker, Sanne E Hoeks, Caroline D van der Marel","doi":"10.1515/jpm-2024-0541","DOIUrl":"https://doi.org/10.1515/jpm-2024-0541","url":null,"abstract":"<p><strong>Objectives: </strong>Obesity in pregnancy is associated with several risks during vaginal delivery. Several guidelines advise early epidural placement. This systematic review summarizes evidence on the maternal and perinatal outcome of epidural analgesia (EA) for vaginal delivery in obese women.</p><p><strong>Methods: </strong>A systematic literature search was conducted to identify studies reporting EA during vaginal delivery in obese women. Study information, baseline characteristics, and outcomes were extracted.</p><p><strong>Results: </strong>Eleven studies (31,325 patients total) were included. Newcastle-Ottawa Scale quality scores ranged from 2/8 to 7/8. Studies varied in study group choice, baseline characteristics, and outcome measures. Five studies reported patient-oriented outcomes, nine reported technical outcomes regarding catheter placement. One study compared obese women with early vs. late vs. no EA and reported similar incidence of instrumental deliveries (5.3 vs. 1.8 % vs. 0 %, p=0.315) and similar Apgar scores (8.37 ± 1.17 vs. 8.43 ± 1.28 vs. 8.08 ± 2.02, p=0.519). Other studies used a comparison of obese with non-obese women, both receiving EA. Incidence of instrumental deliveries was similar, but the incidence of cesarean delivery and several other outcomes was increased in obese women.</p><p><strong>Conclusions: </strong>The selected literature predominantly reports on technical difficulties regarding EA. In many studies but one, we found a sub-optimal comparison of obese and non-obese women with EA. Side effects of EA in obese women are suggested in some studies, but we believe that the true influence of EA in obese parturients is insufficiently reported. To fully understand associated risks and benefits for these women, this population should be studied separately, and more evidence is needed.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637289","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":"Shaping the future: advancing maternal-fetal medicine through educational standards and innovations.","authors":"Ivica Zalud","doi":"10.1515/jpm-2025-0360","DOIUrl":"https://doi.org/10.1515/jpm-2025-0360","url":null,"abstract":"<p><p>The field of maternal-fetal medicine (MFM) stands at a transformative crossroads. Rising maternal morbidity and mortality in the United States, coupled with increasing clinical complexity driven by advanced maternal age, chronic diseases, and evolving reproductive technologies, demand a reimagining of MFM training. This review provides a comprehensive overview of current educational standards and innovations shaping MFM fellowship programs, drawing heavily from the frameworks of the American Board of Obstetrics and Gynecology (ABOG), the Accreditation Council for Graduate Medical Education (ACGME), and professional societies. Special attention is given to the MFM fellowship program in Hawai'i, which since its establishment in 2008, has emerged as a model of educational innovation, cultural responsiveness, and geographic adaptability. The integration of telemedicine, cultural competency, research, simulation, mentorship, and global health perspectives into MFM education is explored, culminating in a discussion on preparing the next generation of perinatal subspecialists for an evolving landscape of maternal and fetal health.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618677","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":"Impact of low dose nicotine on brain-derived neurotrophic factor after global hypoxia in newborn piglets.","authors":"Karianne B Vølstad, Maria Melheim, Marie H Iversen, Tom Stiris, Ola D Saugstad, Lars O Baumbusch, Jannicke H Andresen","doi":"10.1515/jpm-2025-0111","DOIUrl":"https://doi.org/10.1515/jpm-2025-0111","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to assess the effect of low-dose nicotine on the expression of brain-derived neurotrophic factor (BDNF) mRNA, its antisense alternative splice form brain-derived neurotrophic factor antisense (BDNF-AS), and its protein levels after global hypoxia in newborn piglets. This study also sought to explore the regulatory role of BDNF-AS on BDNF mRNA.</p><p><strong>Methods: </strong>41 newborn piglets were randomised after hypoxia to one of two different infusions of nicotine (18 or 46 μg/kg/h, respectively) or to a control group receiving saline. After 4 h of infusion, the piglets were euthanized and brain samples from the hippocampus and temporal cortex were collected for quantification of BDNF mRNA, BDNF-AS and BDNF protein.</p><p><strong>Results: </strong>In the hippocampus, significant lower expression of BDNF mRNA was observed in the animals treated with 46 μg/kg/h of nicotine compared to the group receiving 18 μg/kg/h (p=0.047) and the control group (p=0.017). The BDNF mRNA and BDNF-AS showed a strong correlation (r=0.63, p<0.001) in the hippocampus samples and moderate, but significant, correlation (r=0.36, p=0.021) in the samples from the cortex. We found no differences in BDNF mRNA between the groups in the cortex samples. Protein levels of BDNF were similar in all three groups in both the hippocampus and cortex samples.</p><p><strong>Conclusions: </strong>Our results suggest that low concentrations of nicotine might have a short-term effect on the expression of BDNF mRNA. However, the BDNF protein levels remained unchanged at the same time point and the long-term impact on the nervous system remains unclear.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591508","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":"Improved visualization of a fetal scalp cyst with B-mode and 3D ultrasound compared to magnetic resonance imaging.","authors":"Gilda Helena Arruda Sousa Pacheco, Pedro Teixeira Castro, Gustavo Yano Callado, Heron Werner, Edward Araujo Júnior","doi":"10.1515/jpm-2025-0271","DOIUrl":"https://doi.org/10.1515/jpm-2025-0271","url":null,"abstract":"","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591509","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":"Integrating KANET and Doppler indices to predict neurodevelopmental delays in high-risk pregnancies.","authors":"Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak","doi":"10.1515/jpm-2025-0051","DOIUrl":"https://doi.org/10.1515/jpm-2025-0051","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the predictive value of combining the Kurjak Antenatal Neurodevelopmental Test (KANET) with Doppler indices for early detection of neurodevelopmental delays in pregnancies of varying risk levels.</p><p><strong>Methods: </strong>A prospective study was conducted on 111 pregnant women (71 low-risk, 40 high-risk) between 28 and 36 weeks of gestation. KANET was performed using 4D ultrasound. Doppler assessments included resistance indices of the middle cerebral artery (MCA) and umbilical artery (UA), and ductus venosus (DV) velocity parameters: systolic (S), diastolic (D), and S/D ratio. High-risk cases with abnormal findings underwent repeat KANET. Postnatal neurodevelopment was evaluated at 3 and 6 months using the Denver Developmental Screening Test II (DDST II). Statistical analyses included regression and ROC curve analysis.</p><p><strong>Results: </strong>High-risk pregnancies showed significantly lower KANET scores (mean 13.4 ± 2.3) than low-risk pregnancies (mean 16.9 ± 1.5; p<0.001). Abnormal DV Doppler findings were present in 42 % of high-risk cases and correlated with lower KANET scores (r=0.82, p<0.01). Follow-up KANET identified progressive neurodevelopmental delays in 25 % of high-risk cases. The combined KANET-Doppler approach demonstrated superior predictive accuracy (AUC=0.89, p<0.001) compared to either method alone.</p><p><strong>Conclusions: </strong>Integrating KANET with Doppler indices, particularly DV parameters, offers an effective strategy for early identification of neurodevelopmental risks in high-risk pregnancies. This approach supports more targeted prenatal monitoring and early intervention strategies.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600831","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":"Factors influencing recurrence of preeclampsia in pregnant women with a history of preeclampsia and the establishment of a predictive model.","authors":"Hui Dong, Jie Song, Yanju Jia, Hongyan Cui, Xu Chen","doi":"10.1515/jpm-2024-0539","DOIUrl":"10.1515/jpm-2024-0539","url":null,"abstract":"<p><strong>Objectives: </strong>To establish and verify the prediction model of recurrent preeclampsia (PE) in pregnant women with a history of PE.</p><p><strong>Methods: </strong>Totally 130 pregnant women with a history of PE from Jan 2021 to Jan 2023 were selected retrospectively. The patients were randomly matched according to the proportion of 1:4 to establish a verification group (nasty 26) and a modeling group (nasty 104). The modeling patients were divided into two groups according to the occurrence of preeclampsia: recurrent group (nasty 50) and non-recurrent group (nasty 54). Multivariate logistic regression analysis of influencing factors was established. Calibration curve was performed to verify, decision curve analysis (DCA) was used to evaluate the clinical practicability of the prediction model, and ROC analysis was used to show the prediction value of the model.</p><p><strong>Results: </strong>Multivariate logistic regression analysis showed that there were significant differences in age, gestational age, gestational interval, systolic blood pressure and diastolic blood pressure of previous pregnancy. (p<0.05) According to the results of logistic regression analysis, a prediction model was constructed. Logit(P)=(0.910Age)+(0.987Age of onset of previous pregnancy)+(1.167Gestational interval)+(1.186Systolic blood pressure in previous pregnancy)+(0.970Diastolic blood pressure in previous pregnancy).The slope of the calibration curve was close to one in the training set and verification set. The results showed that the prediction of recurrent PE risk of pregnant women with history of eclampsia was consistent with the actual risk. ROC analysis showed that the area under curve was 0.991. The results of DCA analysis showed that the model had good clinical practicability.</p><p><strong>Conclusions: </strong>In this study, a prediction model is successfully established and verified according to the influencing factors.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591507","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":"Quo vadis neonatologia? Where is neonatology heading in the 21st century?","authors":"Milan Stanojević, Bożena Kociszewska-Najman, Amos Grünebaum, Frank Chervenak, Asim Kurjak","doi":"10.1515/jpm-2025-0339","DOIUrl":"https://doi.org/10.1515/jpm-2025-0339","url":null,"abstract":"<p><strong>Introduction: </strong>This comprehensive narrative review examines current paradigms, emerging trends, and future directions in neonatology through systematic analysis of contemporary literature, clinical practice patterns, and expert consensus. We synthesized evidence from recent publications, international guidelines, and clinical innovations to identify key transformation areas.</p><p><strong>Content: </strong>Several critical areas are reshaping neonatology. Gestational age has emerged as a lifelong health determinant with implications extending far beyond the neonatal period, affecting cardiovascular, metabolic, and neurodevelopmental outcomes throughout life. Global disparities in neonatal care remain unconscionably large, with survival rates for 28-week infants exceeding 90 % in high-income countries while similar infants in low-resource settings often die from preventable causes. Artificial intelligence applications are revolutionizing predictive analytics, real-time monitoring, and decision support systems, though implementation requires careful attention to bias, transparency, and human oversight. The neonatal microbiome's crucial role in immune development and long-term health has prompted interventions targeting healthy colonization. Salutogenic approaches emphasizing health promotion rather than disease treatment are gaining recognition. Most significantly, the systematic marginalization of mothers in neonatal care is being challenged, with growing recognition of the mother-infant dyad as the fundamental unit of care.</p><p><strong>Summary and outlook: </strong>Future neonatal care must balance technological advancement with humanistic values, addressing global disparities while maintaining scientific rigor. Success requires committing to global health equity, embracing ethical complexity at viability margins, recognizing maternal centrality, thoughtfully integrating emerging technologies, implementing salutogenic principles, and adopting lifelong health perspectives. The field's future depends on interdisciplinary collaboration, ethical reflection, and unwavering commitment to ensuring every newborn receives compassionate, high-quality care.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591510","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}