Korean Journal of Anesthesiology最新文献

{"title":"Nerve block for controlling posterior hip pain during hip surgery: clinical needs and evidence gaps.","authors":"Young-Suk Kwon","doi":"10.4097/kja.25515","DOIUrl":"10.4097/kja.25515","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"299-300"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584277","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":"Heterogeneity in meta-analyses: an unavoidable challenge worth exploring.","authors":"Geun Joo Choi, Hyun Kang","doi":"10.4097/kja.25001","DOIUrl":"10.4097/kja.25001","url":null,"abstract":"<p><p>Heterogeneity is a critical but unavoidable aspect of meta-analyses that reflects differences in study outcomes beyond what is expected by chance. These variations arise from differences in the study populations, interventions, methodologies, and measurement tools and can influence key meta-analytical outputs, including pooled effect sizes, confidence intervals, and overall conclusions. Systematic reviews and meta-analyses combine evidence from diverse studies; thus, a clear understanding of heterogeneity is necessary for reliable and meaningful interpretations of the results. This review examines the concepts, sources, measurement techniques, and implications of this heterogeneity. Statistical tools (e.g., Cochran's Q, I2, and τ2) quantify heterogeneity, whereas τ and prediction intervals, as they use the same units, aid in the intuitive understanding of heterogeneity. The choice between fixed- and random-effects models can also significantly affect the handling and interpretation of heterogeneity in meta-analyses. Effective management strategies include subgroup analyses, sensitivity analyses, and meta-regressions, which identify sources of variability and strengthen the robustness of the findings. Although heterogeneity complicates the synthesis of a single effect size, it offers valuable insights into patterns and differences among studies. Recognizing and understanding heterogeneity is vital for accurately synthesizing the evidence, which can indicate whether an intervention has consistent effects, benefits, or harms. Rather than viewing heterogeneity as inherently good or bad, researchers and clinicians should consider it a key component of systematic reviews and meta-analyses, allowing for a deeper understanding and more nuanced application of pooled findings. Addressing heterogeneity ultimately enhances the reliability, applicability, and overall impact of the conclusions of meta-analyses.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"301-314"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433402","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":"Bicarbonate-buffered solution versus Plasma-LyteTM in orthotopic adult liver transplantation: a pilot open-label, randomized, non-inferiority trial.","authors":"Fumitaka Yanase, Laurence Weinberg, Michael Jiang, Varun Peri, Rebecca Caragata, Jian Wen Chan, Lachlan F Miles, Shervin Tosif, Louise Ellard, Peter McCall, Brett Pearce, David A Story, Param Pillai, Antony Leaver, Hannah Perlman, Jinesh Patel, Glenn Eastwood, Dong Kyu Lee, Rinaldo Bellomo","doi":"10.4097/kja.24677","DOIUrl":"10.4097/kja.24677","url":null,"abstract":"<p><strong>Background: </strong>The ideal intravenous maintenance and resuscitation fluid for patients undergoing orthotopic liver transplantation (OLT) remains unknown. We aimed to determine whether bicarbonate-buffered solution was non-inferior to Plasma-LyteTM in preventing metabolic acidosis during OLT.</p><p><strong>Methods: </strong>We conducted a pilot single-center, open-label, randomized trial to compare the physiological effects of intravascular volume maintenance with a bicarbonate-buffered solution vs. Plasma-LyteTM in adults undergoing OLT. Non-inferiority was defined as a median difference in the standard base excess (SBE) of less than -2.5 mEq/L. The primary endpoint was the SBE at 5 minutes post-reperfusion. Quantile regression analysis was applied to confirm non-inferiority. Secondary endpoints included other forms of acid-base and electrolyte imbalances at pre-specified time points and postoperative complications.</p><p><strong>Results: </strong>We randomized 52 adults undergoing OLT. The median (Q1, Q3) volume infused was 5 000 (3 125, 7 000) ml in the bicarbonate-buffered solution group and 5 500 (4 000, 10 500) ml in the Plasma-LyteTM group (P = 0.37). The median (Q1, Q3) SBE at 5 minutes post-reperfusion was -4.857 (-6.231, -3.565) mEq/L in patients receiving bicarbonate-buffered solution and -4.749 (-7.574, -2.963) mEq/L amongst those in the Plasma-LyteTM group. The estimated median difference by quantile regression was -0.043 mEq/L (95% CI [-1.988 to 1.902] mEq/L; one-sided P = 0.015). There were no significant differences in the acid-base secondary outcomes, number of complications, or patient mortality. There were no reported adverse events or safety concerns associated with the use of either solution.</p><p><strong>Conclusions: </strong>A bicarbonate-buffered solution was non-inferior to Plasma-LyteTM for maintaining acid-base homeostasis post-reperfusion in OLT patients.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"369-381"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441285","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":"Comparison between conventional pleth variability index (PVI) and Rainbow PVI (RPVI) in non-cardiothoracic surgery: a retrospective study.","authors":"Chahyun Oh, Chan Noh, Sujin Baek, Sun Yeul Lee, Boohwi Hong","doi":"10.4097/kja.25307","DOIUrl":"https://doi.org/10.4097/kja.25307","url":null,"abstract":"<p><strong>Background: </strong>The rainbow pleth variability index (RPVI) is a newly introduced multiwavelength variant of the pleth variability index (PVI). However, the clinical data on RPVI remains limited. This study retrospectively compared PVI and RPVI in non-cardiothoracic surgery patients using pulse pressure variation (PPV) as a reference.</p><p><strong>Methods: </strong>Adult patients (≥20 years) who underwent non-cardiothoracic surgery under general anesthesia and had concurrent RPVI, PVI, and invasive arterial pressure monitoring were included. Repeated-measures correlation was used to evaluate the association with PPV. Agreement was assessed using nested Bland-Altman analysis, and receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive performance for detecting high PPV (>13%).</p><p><strong>Results: </strong>A total of 86 cases (195.3 h of data) were analyzed. The RPVI showed a stronger correlation with PPV than with PVI (r = 0.511 vs. r = 0.243). The Bland-Altman analysis revealed narrower limits of agreement for the RPVI, indicating greater precision. RPVI also demonstrated better predictive performance, with an area under the curve of 0.813 (95% CI, 0.804-0.821) compared to 0.663 (95% CI, 0.653-0.674) for PVI (P < 0.001). The optimal thresholds for detecting PPV >13% were 8.5 for RPVI and 13.5 for PVI.</p><p><strong>Conclusions: </strong>RPVI demonstrated superior performance compared with PVI, showing a stronger correlation and greater precision with respect to PPV, as well as an improved ability to detect states of elevated PPV. While not a direct substitute for PPV, RPVI may serve as a promising non-invasive index for fluid status assessment.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732043","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":"Role of frailty in predicting postoperative pulmonary complications in older patients undergoing major abdominal surgery: a retrospective cohort study.","authors":"Chun-Qing Li, Jia-Hui Ma, Zhen-Zhen Liu, Jun Li","doi":"10.4097/kja.24933","DOIUrl":"https://doi.org/10.4097/kja.24933","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine the association between frailty, as measured by the five-item modified frailty index (mFI-5), and postoperative pulmonary complications (PPCs) in older patients undergoing major abdominal surgery and to explore the predictive value of frailty beyond traditional PPC risk factors.</p><p><strong>Methods: </strong>In this retrospective cohort study, we collected baseline and perioperative data of older patients (aged ≥ 65 years) undergoing major abdominal surgery in a tertiary hospital. The association between the mFI-5 score and PPCs was examined using multivariate logistic regression analysis. Additionally, the predictive value of the mFI-5 beyond the four basic PPC risk models was estimated using discrimination (areas under receiver operating characteristic curve [AUROCs]; DeLong's test), calibration (Hosmer-Lemeshow test), goodness of fit (likelihood ratio χ2 test), explained variance (Nagelkerke R2), and reclassification (categorical and continuous net reclassification improvement [NRI] and integrated discrimination improvement [IDI]).</p><p><strong>Results: </strong>A total of 3,298 patients were included, of whom 351(10.6%) developed PPCs. After adjusting for confounding factors, higher mFI-5 scores were independently associated with an increased risk of PPCs compared with a score of 0 (all P < 0.05). Incorporating the mFI-5 score into the basic PPC risk models significantly improved the AUROC, goodness of fit, and risk reclassification (all P < 0.001); enhanced or maintained calibration (all P > 0.05); and increased explained variance.</p><p><strong>Conclusions: </strong>Frailty, measured using the mFI-5, was independently associated with an increased risk of PPCs and improved the predictive performance of conventional risk factors for PPCs in older patients undergoing major abdominal surgery.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675186","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 boundaries of simulation-based training: a narrative review of in situ simulation and its role in enhancing non-technical skills.","authors":"Christine Kang, Hannah Lee","doi":"10.4097/kja.25493","DOIUrl":"https://doi.org/10.4097/kja.25493","url":null,"abstract":"<p><p>Simulation-based training provides a psychologically and physically safe environment for health-care professionals to practice exercises repetitively without placing patients at risk. Furthermore, it allows them to rehearse rare or high-risk clinical scenarios that are rarely encountered in daily practice. In addition to technical procedures, anesthesiologists need to master non-technical skills (NTS), such as communication, teamwork, leadership, and decision-making. These cognitive and social abilities complement technical expertise, and their absence is a leading cause of errors in emergency situations. In situ simulation (ISS) training, which involves conducting realistic simulation training in actual clinical settings, is one of the most time-efficient and effective formats for training of both technical skills and NTS. ISS minimizes travel time and can be integrated into clinical workflows. In this review, we explore ISS training in terms of its definition and implementation, evidence of its effectiveness, its role in NTS training, and related emerging trends (e.g., virtual/augmented reality).</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591578","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 preoperative hyperglycemia and adverse cardiac events after non-cardiac surgery: a multicenter cohort study.","authors":"Byungjin Choi, Ah Ran Oh, Jungchan Park, Kwangmo Yang, Dong Yun Lee, Bumhee Park, Rae Woong Park","doi":"10.4097/kja.24854","DOIUrl":"https://doi.org/10.4097/kja.24854","url":null,"abstract":"<p><strong>Background: </strong>We conducted multicenter analyses of preoperative acute hyperglycemia to calculate the postoperative adverse cardiac events.</p><p><strong>Methods: </strong>Data from 10 hospitals were converted to the Observational Medical Outcomes Partnership Common Data Model and analyzed. We extracted the records of 318,119 adult patients who underwent non-cardiac surgery and had available blood glucose measurements less than 24 h before surgery. We defined acute hyperglycemia as at least one fasting blood glucose measurement > 140 mg/dl or random blood glucose level measurement > 180 mg/dl < 24 h before surgery. Risk of adverse cardiac events during the first year after surgery was analyzed.</p><p><strong>Results: </strong>After 1:2 propensity score matching (PSM), 40,340 patients with acute hyperglycemia and 70,770 patients without hyperglycemia were enrolled. Acute hyperglycemia was associated with an increased risk of adverse cardiac events (hazard ratio [HR], 1.26; 95% CI, 1.16-1.36; P < 0.001). In the subgroup analyses, the young age group (≤ 65 years) had a significantly higher risk (HR, 1.61; 95% CI, 1.40-1.85) than the older age group (HR, 1.13; 95% CI, 1.03-1.25; P for interaction < 0.001). A greater adverse cardiac events risk was observed in patients without hypertension (HR, 1.37; 95% CI, 1.24-1.52) but not in those with hypertension (HR, 1.09; 95% CI, 0.96-1.22; P for interaction = 0.003).</p><p><strong>Conclusions: </strong>Preoperative acute hyperglycemia was associated with adverse cardiac events during one year of follow up. Further investigation is warranted to determine whether acute glycemic control before non-cardiac surgery could prevent perioperative cardiac complications.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584275","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 age on volume kinetic parameters in healthy volunteers receiving Ringer's lactate solution.","authors":"Seong-Mi Yang, Junik Park, Junyoung Jo, Byung-Moon Choi","doi":"10.4097/kja.25109","DOIUrl":"https://doi.org/10.4097/kja.25109","url":null,"abstract":"<p><strong>Background: </strong>Understanding the effects of age and body weight on volume kinetics may provide practical guidance for fluid administration in clinical practice. This study aimed to quantify the effects of age and body weight on the volume kinetic parameters in healthy volunteers with varying ages and body weights.</p><p><strong>Methods: </strong>Eighteen healthy volunteers were enrolled in this study. These volunteers received 40 ml/kg of Ringer's lactate solution for 60 min; for safety reasons, volunteers aged > 65 years received 30 ml/kg. The maximum amount of administered fluid was limited to 3600 ml. Venous blood samples were collected at preset intervals to determine the hemoglobin concentrations and hematocrit percentage. NONMEM 7.5 (ICON PLC) was used to perform the population-based volume kinetic analysis.</p><p><strong>Results: </strong>A total of 122 plasma dilution data points were used from 18 volunteers to determine the pharmacokinetic characteristics of Ringer's lactate solution. Distribution and elimination could be well explained using a two-volume model. The central volume of distribution at baseline (Vc0) and the distributional clearance (kt) between the central and peripheral compartments decreased as age increased. A difference in elimination clearance (kr) was observed based on age, with a value of 60 years (≥ 60 y: 50.2 ml/min; < 60 y: 156 ml/min). Body weight was not a significant covariate for the volume kinetic parameters.</p><p><strong>Conclusions: </strong>These findings can serve as reference data for determining the appropriate amount of Ringer's lactate solution to administer to patients of different ages in clinical practice.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575795","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":"Human placental mesenchymal stem cell-derived exosomes carrying hsa-let-7i-5p mitigate lung injury in a murine model of aspiration pneumonia.","authors":"Ching-Wei Chuang, Hong-Phuc Nguyen Vo, Yen-Hua Huang, I-Lin Tsai, Chao-Yuan Chang, Chun-Jen Huang","doi":"10.4097/kja.25037","DOIUrl":"https://doi.org/10.4097/kja.25037","url":null,"abstract":"<p><strong>Background: </strong>Aspiration pneumonia (AP), which can be caused by gastric content inhalation into the lower airways, causes acute lung injury (ALI) through complex mechanisms, including inflammation, oxidative stress, and apoptosis. Here, we evaluated the efficacy of exosomes derived from human placental mesenchymal stem cells (hpMSCs) in mitigating ALI in a murine model of AP. We also investigated the role of hsa-let-7i-5p, the most abundant miRNA in hpMSC-derived exosomes, in this respect.</p><p><strong>Methods: </strong>Adult male C57BL/6 mouse AP models were administered hpMSC-derived exosomes (APExo group) or phosphate-buffered saline (AP group) intra-tracheally. After 48 h, the mice were euthanized and evaluated. The effects of hsa-let-7i-5p were assessed by specific inhibition or overexpression.</p><p><strong>Results: </strong>Compared with the APExo group, the AP group exhibited significantly greater ALI, as evidenced by histological damage, increased lung injury scores, impaired lung function, increased leukocyte infiltration, and elevated tissue edema (all P < 0.05). The untreated AP group also showed more inflammation, characterized by nuclear factor-κB upregulation, macrophage M1 polarization, and cytokine level elevation (tumor necrosis factor-α, interleukin-1β, and interleukin-6), as well as increased oxidation and activation of the apoptosis pathway (all P < 0.05). Notably, the therapeutic effects of hpMSC-derived exosomes were compromised by specific inhibition of hsa-let-7i-5p. Furthermore, engineered exosomes derived from genetically modified RAW264.7 overexpressing hsa-let-7i-5p demonstrated therapeutic effects against AP similar to those obtained with hpMSC-derived exosomes.</p><p><strong>Conclusions: </strong>In a murine AP model, intra-tracheal administration of hpMSC-derived exosomes has ALI-mitigating effects, involving inflammation, oxidation, and apoptosis modulation, with hsa-let-7i-5p playing a pivotal mediating role.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528568","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":"Accuracy of ultrasound-measured skin-to-hyoid bone distance for predicting difficult mask ventilation in patients with obesity: a prospective observational study.","authors":"Maha Mostafa, Israa ElGeneidi, Ahmed Hasanin, Mostafa Ali, Hanan Mostafa, Nader Noshy Naguib","doi":"10.4097/kja.25118","DOIUrl":"https://doi.org/10.4097/kja.25118","url":null,"abstract":"<p><strong>Background: </strong>The risk of difficult mask ventilation (DMV) is high in patients with obesity. Therefore, we evaluated the accuracy of ultrasound-measured skin-to-hyoid bone distance (SHD) for predicting DMV in such population.</p><p><strong>Methods: </strong>This prospective observational study included adult patients with obesity scheduled for elective surgery. Preoperative airway assessment included the modified Mallampati test, thyromental distance, sternomental distance, upper lip bite test, mouth opening, neck mobility, STOP-Bang score, and the SHD measured by a handheld ultrasound probe. The mask ventilation grade was evaluated using the 4-level Han score, and grades 3 and 4 were considered as DMV. The primary outcome was the ability of SHD to predict DMV using area under the receiver operating characteristic curve (AUC) analysis. A multivariate model including the STOP-Bang score, modified Mallampati test, upper lip bite test, and SHD was also assessed.</p><p><strong>Results: </strong>Data from 326 patients were analyzed. The DMV incidence was 22/326 (6.7%). Patients with DMV were predominantly male and had higher weight, STOP-Bang score, modified Mallampati grade, upper lip bite class, and SHD than did those with easy mask ventilation. The AUC (95% confidence interval) of the SHD for predicting DMV was 0.88 (0.84-0.92). An SHD > 1.9 cm had a negative-predictive value of 99%. Multivariate analysis revealed that the SHD was an independent predictor of DMV.</p><p><strong>Conclusions: </strong>In patients with obesity, SHD measured by a handheld ultrasound probe is an independent predictor of DMV and can accurately predict DMV. An SHD ≤ 1.9 cm can exclude DMV with 99% accuracy.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497462","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}