Neurocritical Care最新文献

{"title":"Safety of Peripherally Administered 23.4% Sodium Chloride.","authors":"Christian R Silva, Jessica Nagy, Andrew R Zullo, Rebecca A Greene","doi":"10.1007/s12028-025-02342-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02342-w","url":null,"abstract":"<p><strong>Background: </strong>For patients with increased intracranial pressure, prompt initiation of hyperosmolar therapy with 23.4% sodium chloride may minimize permanent neurological damage and prevent cerebral herniation. Placement of a central venous catheter can delay time to osmotherapy and may negatively impact patient outcomes. The objective of this study was to examine the safety of 23.4% sodium chloride administered through a peripheral intravenous (IV) catheter.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study conducted at a large academic health system. Patients were admitted to one 719-bed academic medical center and a level I trauma center or one 247-bed academic community hospital. Study participants were 18 years or older, admitted between March 29, 2015, and October 21, 2023, and received 23.4% sodium chloride through a peripheral IV. Patients who died within 24 h of 23.4% sodium chloride administration or were discharged less than 24 h after administration were excluded. All study participants received at least one 30 mL bolus of 23.4% sodium chloride administered through a peripheral IV catheter.</p><p><strong>Results: </strong>The primary outcome, defined as extravasation of peripherally administered 23.4% sodium chloride, was assessed using the Naranjo Adverse Drug Reaction Probability Scale and occurred in 56 of 863 administrations (6.4%). Secondary outcomes included incidence of tissue necrosis, interventions used to treat extravasations, and attributable risk factors for extravasation. There were no cases of tissue necrosis, no surgical interventions performed, and one case of medical intervention using hyaluronidase. Patients with a history of diabetes had a 2.39 times higher risk of experiencing a 23.4% sodium chloride extravasation event (95% CI 1.41-4.05, p = 0.001).</p><p><strong>Conclusions: </strong>Peripheral administration of 23.4% sodium chloride was associated with a low rate of extravasation and no significant injury in patients who did experience a possible or probable extravasation event. Diabetes mellitus was a possible risk factor for extravasation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesia, Sedation, and Neuromuscular Blockade in Pediatric Severe Traumatic Brain Injury: Secondary Analysis of the \"Approaches and Decisions in Acute Pediatric TBI Trial\" (ADAPT).","authors":"Jennifer Clancy Laws, Jaskaran Rakkar, Sandra D W Buttram, Michael Seth Wolf","doi":"10.1007/s12028-025-02336-8","DOIUrl":"10.1007/s12028-025-02336-8","url":null,"abstract":"<p><strong>Background: </strong>Sedative, analgesia, and neuromuscular blocking (NMB) medications may be necessary in the acute management of pediatric severe traumatic brain injury (sTBI), yet limited data exist to guide their use. We aimed to describe the use of continuous infusions of these medications in children with sTBI, to determine temporal trends during the first week of management, and to evaluate associations with in-hospital mortality.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial (NCT04077411, 2014-2017), a prospective multicenter observational study of patients < 18 years old with sTBI (Glasgow Coma Scale ≤ 8) who underwent intracranial pressure monitoring. Continuous analgesic, sedative, and NMB medication infusions administered in the first 7 days after sTBI were analyzed.</p><p><strong>Results: </strong>Data from 929 patients were analyzed with a median Glasgow Coma Scale of 6 (interquartile range 3-7), 14% hospital mortality. In the 7 days after intracranial pressure monitor placement, 866 (93%) patients received an opioid infusion, with 659 (71%) patients having received fentanyl. A total of 679 (73%) patients received benzodiazepine: 671 (72%) patients received midazolam. A total of 362 (39%) patients received NMB, with the most common being vecuronium, administered to 141 (15%) patients. Propofol was administered to 264 (28%) patients, alpha-2 agonist to 263 (28%) patients, and ketamine to 4 (0.43%) patients. The median number of infusions per patient was 2 (interquartile range 1-2), with the highest number on intensive care unit day 2. Morphine and dexmedetomidine infusions were used more often in survivors than nonsurvivors (33 vs. 16%, and 30 vs. 9%, respectively, p < 0.001).</p><p><strong>Conclusions: </strong>Fentanyl and midazolam were the most common analgesic and sedative continuous infusions during acute pediatric sTBI management. Propofol and dexmedetomidine were used less frequently. Opioid (specifically morphine) and dexmedetomidine infusions were associated with survival. Larger studies are needed to determine the safest and most effective analgesia, sedation, and NMB medication strategy for children with sTBI.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Red Blood Cell Transfusion on Cerebral Ischemia in Critically Ill Patients with Acute Brain Injury.","authors":"Timothée Ayasse, Emma Berthe, Ellington Barnes, Samuel Gaugain, Benjamin G Chousterman, Romain Barthélémy","doi":"10.1007/s12028-025-02333-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02333-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of Perihematomal Edema Mean Hounsfield Unit and Its Association with Clinical Outcome in Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.","authors":"Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Diego Incontri, Salil Soman, Magdy H Selim","doi":"10.1007/s12028-025-02337-7","DOIUrl":"https://doi.org/10.1007/s12028-025-02337-7","url":null,"abstract":"<p><strong>Background: </strong>Lower mean Hounsfield unit (mHU) values, indicating greater computed tomography (CT) hypodensity of perihematomal edema (PHE), have been proposed as a novel quantitative imaging marker in intracerebral hemorrhage (ICH). We explored its evolution and prognostic importance in a post hoc analysis of the Intracerebral Hemorrhage-Deferoxamine trial (NCT02175225).</p><p><strong>Methods: </strong>We included participants with primary supratentorial ICH who had available CT scans at baseline and follow-up after 72-96 h and 90-days and/or 180-days outcome data. The primary exposure variable was the mHU of PHE measured on the follow-up CT scan. We investigated (1) its change from baseline and (2) its association with unfavorable outcome (modified Rankin Scale score 3-6) in adjusted mixed-effects models, accounting for between-center and between-participant variability.</p><p><strong>Results: </strong>Among 273 of 293 Intracerebral Hemorrhage-Deferoxamine trial participants eligible for analysis (median age 61 years, 39% female), the median (interquartile range) mHU of PHE was 30.3 (28.3-32.7) at baseline and 26.9 (24.6-29.2) at follow-up. Τhe mHU of PHE decreased from baseline to follow-up scan by an average of 3.6 (95% confidence interval [CI] 3.2-4.0, p < 0.001). There was no association between the mHU of follow-up PHE with unfavorable outcome at 90 days (n = 273; odds ratio 1.05, 95% CI 0.95-1.17, p = 0.32), or at 180 days (n = 261; odds ratio 1.01, 95% CI 0.92-1.11, p = 0.81).</p><p><strong>Conclusions: </strong>Perihematomal edema after ICH tends to grow more hypodense on CT by day 3-4 compared with baseline. The degree of PHE hypodensity was not associated with long-term clinical outcomes in the setting of a multicenter randomized trial, challenging its utility as a radiological marker in ICH research.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov: NCT02175225.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Intracranial Pressure Prediction Using a Multimodal Ultrasound-Based Hemispheric Modeling Strategy: A Prospective Dual-Center Study.","authors":"Jun Qiu, Tong-Juan Zou, Dong-Mei Wang, Hai-Rong Luo, Hai-Tao Yu, Ling Lei, Wan-Hong Yin","doi":"10.1007/s12028-025-02339-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02339-5","url":null,"abstract":"<p><strong>Background: </strong>Accurate intracranial pressure (ICP) surveillance is a cornerstone of neurocritical care management, yet invasive monitoring still depends on neurosurgical expertise, specialized hardware, and continuous bedside resources-factors that restrict universal use even though insertion-related complications are relatively uncommon. Contemporary noninvasive ultrasound methods have limited predictive accuracy and seldom incorporate affected side information. We therefore preliminarily validated a multimodal, ultrasound-based hemispheric modeling approach that blends hemodynamic and structural indexes while emphasizing affected side specificity to enhance ICP prediction.</p><p><strong>Methods: </strong>In this prospective, dual-center study, 41 neurosurgical patients provided 216 paired ultrasound and invasive ICP measurements. Affected side and contralateral ultrasound parameters including pulsatility index, resistance index, optic nerve sheath diameter (ONSD), optic disk height, and ONSD-to-eyeball diameter ratio were analyzed. Linear mixed-effects models (LMMs) predicted continuous ICP, whereas generalized LMMs classified elevated ICP (≥ 20 mm Hg).</p><p><strong>Results: </strong>Affected side parameters showed consistently stronger ICP correlations than unaffected side parameters. An affected side five-parameter LMM (pulsatility index, resistance index, ONSD, ONSD-to-eyeball diameter ratio, and optic disk height) provided superior continuous ICP prediction (coefficient of determination [R²] = 0.618, root mean square error = 0.424), significantly outperforming contralateral models (R² = 0.338, root mean square error = 0.558). For binary classification, affected side ONSD demonstrated excellent accuracy (area under the receiver operating characteristic curve = 0.927, sensitivity = 91.4%, specificity = 79.5%), whereas the optimal affected side seven-parameter generalized LMM reached an area under the receiver operating characteristic curve of 0.829 (sensitivity = 80.8%, specificity = 75.8%).</p><p><strong>Conclusions: </strong>This study demonstrated the feasibility and potential advantages of a novel hemispheric (side-specific) modeling strategy for noninvasive ICP assessment. The multiparameter model constructed using affected side ultrasound parameters exhibited promising predictive accuracy, providing a potentially valuable and innovative noninvasive approach for ICP monitoring in neurocritical care patients that may serve as an adjunct when invasive monitoring is unavailable, although further validation is warranted.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interpretable Machine Learning Model for Predicting Early Neurological Deterioration Following Posttraumatic Acute Diffuse Brain Swelling.","authors":"Shilong Fu, Xianqun Wu, Guofeng Wang, Zongping Wu, Shousen Wang","doi":"10.1007/s12028-025-02340-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02340-y","url":null,"abstract":"<p><strong>Background: </strong>Diffuse brain swelling (DBS) significantly contributes to intracranial hypertension and poses a substantial risk of early neurological deterioration (END). This study aimed to develop and validate various machine learning (ML) models for predicting END in patients with traumatic DBS.</p><p><strong>Methods: </strong>Clinical data were retrospectively collected from 208 consecutive adult patients diagnosed with traumatic DBS on admission (within 6 h after injury) at two centers. END was assessed within 72 h of admission, and predictors for END were identified using least absolute shrinkage and selection operator regression and multivariate logistic regression analysis. Six ML algorithms were trained to develop prediction models. The performance of the ML models was evaluated by the area under the receiver operating characteristic curve (AUROC), Brier score, and decision curve analysis and was externally verified in the validation cohort. The optimal model was internally cross-validated, interpreted using Shapley Additive Explanations, and ultimately deployed as a Web-based risk calculator.</p><p><strong>Results: </strong>A total of 79 patients experienced END, with an incidence of 38.0%. The four confirmed predictors of END were subdural hemorrhage, severe traumatic subarachnoid hemorrhage, hemoglobin levels, and fibrinogen levels. The extreme gradient boosting model outperformed the other five models in discrimination, achieving an AUROC of 0.879, and had better calibration and clinical utility. This model had an acceptable generalizability, achieving mean AUROCs of 0.762 ± 0.033 and 0.770 ± 0.109 in fivefold and tenfold cross-validations, respectively, and an AUROC of 0.862 in the validation cohort.</p><p><strong>Conclusions: </strong>The developed ML model shows clinical promise in accurately predicting END following traumatic DBS. However, multicenter external validation remains essential before its widespread clinical application.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"N20-P25 Amplitude can Predict Awakening from Coma.","authors":"Li Huang, Zhi-Han Li, Mei-Lin Ai, Qi Liu, Qian-Yi Peng, Mi-Lin Peng, Chun-Guang Zhao, Li-Na Zhang","doi":"10.1007/s12028-025-02335-9","DOIUrl":"https://doi.org/10.1007/s12028-025-02335-9","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to evaluate the relationship between the N20-P25 amplitude of short-latency somatosensory evoked potentials (SSEPs) and neurologic outcomes in patients in a coma state.</p><p><strong>Methods: </strong>We retrospectively enrolled neurocritical patients who were older than 18 years; were admitted to the Department of Critical Medicine, Xiangya Hospital, Central South University, from January 2017 to January 2021 for 1-3 days; had a Glasgow Coma Scale score ≤ 8; had a body temperature ≥ 35 °C; and had SSEP records. Good outcome was defined as Cerebral Performance Category scores 1-3 at 1 year. The specificity and sensitivity of different SSEP patterns and amplitudes were calculated.</p><p><strong>Results: </strong>A total of 457 patients were included in this study. The N20-P25 amplitude can be used for predicting awakening for traumatic brain injury (TBI) (area under the curve [AUC] 0.70, p = 0.0077), aneurysmal subarachnoid hemorrhage (SAH) (AUC 0.69, p = 0.005), intracerebral hemorrhage (ICH) (AUC 0.69, p = 0.005), and cardiac arrest (CA) (AUC 0.72, p = 0.0077). An N20-P25 amplitude > 1.6 μV predicted awakening in CA, with a sensitivity of 100% (95% confidence interval [CI] 81.6-100%) and specificity of 46.7% (95% CI 30.9-60.9%). In SAH, an N20-P25 amplitude > 0.74 μV predicted the sensitivity and specificity of awakening were 100% (95% CI 93.8-100%) and 16% (95% CI 8.3-28.5%), respectively. In TBI, an N20-P25 amplitude > 1.20 μV predicted awakening with a sensitivity of 100% (95% CI 86.2-100%) and a specificity of 34.2% (95% CI 21.2-50.1%). An N20-P25 amplitude > 0.65 μV predicted the sensitivity and specificity of awakening in ICH were 100% (95% CI 91.0-100%) and 14.3% (95% CI 5.7-31.5%), respectively.</p><p><strong>Conclusions: </strong>N20-P25 amplitude can predict awakening in patients in a coma state at 1 year. Different diseases have different cutoff values for predicting awakening.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversal wave in cerebral artery in mechanical circulatory support-it is not what it seems.","authors":"Alessandro Bagliani, Angelo Guglielmi, Danila Katia Radolovich, Costanza Natalia Julia Colombo, Guido Tavazzi","doi":"10.1007/s12028-025-02322-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02322-0","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Pressure Reactivity and Cerebral Oximetry Indexes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Single-Center Pilot Study.","authors":"Yunseo Ku, Murad Megjhani, Tammam Alalqum, Soon Bin Kwon, Daniel Nametz, Bennett Weinerman, Angela Velazquez, Shivani Ghoshal, Sachin Agarwal, David J Roh, E Sander Connolly, Jan Claassen, Soojin Park","doi":"10.1007/s12028-025-02314-0","DOIUrl":"10.1007/s12028-025-02314-0","url":null,"abstract":"<p><strong>Background: </strong>Patient differences from optimal mean arterial pressure (MAP_OPT) derived by a cerebral oximetry index (COx_a) are associated with outcome, but the validity of COx_a-derived MAP_OPT remains in question due to the lack of agreement with pressure reactivity index (PRx)-derived MAP_OPT. The study aimed to elucidate the relationship between PRx and COx_a to justify the use of COx_a and COx_a-derived MAP_OPT in patients with aneurysmal subarachnoid hemorrhage (aSAH).</p><p><strong>Methods: </strong>This was a retrospective single-center study of six patients with aSAH with simultaneous near-infrared spectroscopy, intracranial pressure, and MAP monitoring. Repeated-measures Pearson correlation and Bland-Altman plot analysis were performed to compare PRx and COx_a and to compare PRx-derived MAP_OPT and COx_a-derived MAP_OPT. Coinciding changes in PRx and COx_a were compared, and the ability of COx_a to detect PRx-based autoregulation impairment was assessed over different time windows.</p><p><strong>Results: </strong>Repeated-measures Pearson correlation analysis showed no correlation between PRx and COx_a (r = 0.06, p < 0.01). The correlation between PRx- and COx_a-derived MAP_OPT over 388 h was r = 0.50 (p < 0.01). The bias and upper and lower limits of agreement were - 1.60, + 20.24, and - 23.43 mm Hg, respectively. The shift in the overall distribution of moving correlation to higher values as the time-window length increased was more pronounced for COx_a than PRx (COx_a: 0.09-0.41, PRx: 0.00-0.15). When using a typical PRx threshold of 0.3, COx_a was found to be ineffective in identifying impaired autoregulation across all time windows (area under the receiver operating characteristic curve: 0.494-0.527).</p><p><strong>Conclusions: </strong>The threshold applied to PRx should not be applied to COx_a. It is suggested to consider higher thresholds for COx_a than PRx in deriving the range for MAP_OPT calculations for continuous cerebral autoregulation assessment in aSAH. Further research is needed to optimize the MAP_OPT derived from PRx and COx_a based on specific monitoring targets.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it Time to Upgrade Neuromonitoring in ECPR Recipients to Evaluate Cerebral Perfusion Imbalances Adequately?","authors":"Alberto Marabotti, Giovanni Cianchi, Andrea Franci, Manuela Bonizzoli","doi":"10.1007/s12028-025-02331-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02331-z","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}