Neurology. Clinical practice最新文献

{"title":"Improving Folic Acid Supplementation for Women of Childbearing Age With Epilepsy.","authors":"Kimberly Anne Ndahayo, Teresa Connolly, Jennifer R Simpson, Ashley Baranoff, Jacob Pellinen","doi":"10.1212/CPJ.0000000000200485","DOIUrl":"10.1212/CPJ.0000000000200485","url":null,"abstract":"<p><strong>Background and objectives: </strong>Birth complications such as autism and neurodevelopmental disabilities have an increased incidence in women with epilepsy (WWE), associated with the use of antiseizure medications, which can be mitigated with folic acid supplementation. This quality improvement (QI) project aimed to increase folic acid prescription rates from 18% to 50% for WWE between ages 18 and 47 seen at a level 4 epilepsy center.</p><p><strong>Methods: </strong>Data from the electronic health record (EHR) were obtained for women meeting inclusion criteria and were analyzed using descriptive statistics and QI methods. Four Plan-Do-Study-Act cycles were conducted during the intervention phase including provider education, implementation of an EHR screening tool, introducing patient educational flyers into clinic rooms, and reporting provider data to improve awareness of prescribing barriers.</p><p><strong>Results: </strong>Baseline data were collected from January through June 2022, identifying 1,032 patients meeting inclusion criteria. Interventions began in July 2022 and concluded in March 2023 during which time 1,252 patients met inclusion criteria. Folic acid prescription rates for WWE of childbearing age were increased from a baseline of 17.37% to 35.03%. Folic acid prescribing increased throughout the intervention phases. Improving provider awareness of their own prescribing habits along with educational interventions had the largest impact on increasing prescribing rates. All providers effectively received the initial educational intervention.</p><p><strong>Discussion: </strong>This QI study demonstrated that increasing provider education and awareness of current clinical practice guidelines increases folic acid prescribing rates for WWE of childbearing age without negatively affecting clinical workflow. This highlights the importance of provider education and ongoing monitoring of folic acid prescribing rates to improve patient outcomes and identifies a series of interventions that can be replicated in a variety of clinical settings.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200485"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Role of Central Sensitization Syndrome in Patients With Autonomic Symptoms.","authors":"Peter Novak, Sadie P Marciano, Alexandra Witte","doi":"10.1212/CPJ.0000000000200490","DOIUrl":"10.1212/CPJ.0000000000200490","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200463.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200490"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Neurostimulation During Pregnancy for Treatment of Epilepsy and Tourette Syndrome: Maternal and Fetal Outcomes.","authors":"Anhmai Vu, Aisha Abdulrazaq, Brian Lundstrom, Lauren M Jackson, Jeffrey W Britton, William O Tatum, Cornelia Drees, Elizabeth A Coon, Linda M Szymanski, Gregory A Worrell, Kelsey M Smith","doi":"10.1212/CPJ.0000000000200498","DOIUrl":"10.1212/CPJ.0000000000200498","url":null,"abstract":"<p><strong>Background and objectives: </strong>Invasive neurostimulation is rapidly becoming an established option for treatment of neurologic disorders, particularly those that are refractory to pharmacologic treatment. However, there is limited information on the use of neuromodulation during pregnancy. This study explores the safety and clinical outcomes of invasive neuromodulation-specifically vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS)-in pregnant patients with epilepsy and movement disorders.</p><p><strong>Methods: </strong>Pregnant patients treated with VNS, DBS, or RNS were identified, and charts were reviewed to extract data on maternal epilepsy/movement disorder, treatment, and pregnancy.</p><p><strong>Results: </strong>A total of 14 patients (9 VNS, 3 DBS, 2 RNS) had 22 pregnancies. Neuromodulation indications included focal epilepsy (n = 6: 3 VNS, 2 RNS, 1 DBS), generalized epilepsy (n = 6: all VNS), and Tourette syndrome (n = 2: both DBS). The average age at implantation was 24.7 years for VNS, 29.6 years for DBS, and 28 years for RNS. Pregnancy complications included miscarriages (n = 4 pregnancies; 1 VNS, 2 DBS, 1 RNS), pre-eclampsia with fetal growth restriction (n = 3: 2 VNS, 1 DBS), and gestational diabetes (2 VNS). In addition, 10 pregnancies (8 VNS, 2 RNS) were complicated by seizure exacerbations. Delivery of eight of the pregnancies (5 VNS, 1 DBS, 2 RNS) was by cesarean section. There were no cases of maternal or neonatal mortality, and there were no major congenital malformations. Owing to exacerbated shortness of breath during the third trimester, 1 patient had her VNS turned off.</p><p><strong>Discussion: </strong>Pregnancy complications were consistent with previous reports of patients with neurologic disorders. Despite limitations in sample size and confounding factors related to medication use and neurologic diagnosis, our study suggests that implanted neuromodulation devices do not seem to pose a risk of neuromodulation-related teratogenicity. While these data are promising and may provide some reassurance for patient counseling regarding pregnancy, further studies with larger sample sizes are necessary.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200498"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection, Relapses, and Pseudo-Relapses in Individuals With Multiple Sclerosis.","authors":"Amber Salter, Samantha Lancia, Mudita Sharma, Gary R Cutter, Robert J Fox, Ruth Ann Marrie","doi":"10.1212/CPJ.0000000000200493","DOIUrl":"10.1212/CPJ.0000000000200493","url":null,"abstract":"<p><strong>Background and objectives: </strong>Infections are associated with an increased risk of relapse and pseudo-relapse in persons with multiple sclerosis (MS). However, the relationship with relapses and pseudo-relapses after SARS-CoV-2 infections (COVID) vs other infections in MS is poorly understood. Therefore, we compared the occurrence of relapse and pseudo-relapse after COVID and other infections with noninfected participants with MS.</p><p><strong>Methods: </strong>In spring 2023, we surveyed participants from the North American Research Committee on Multiple Sclerosis Registry regarding whether they had had a COVID infection, other infections, relapses, and pseudo-relapses. Recent infections, occurring in the 6 months before the survey, were used to categorize participants into groups: recent COVID, non-COVID infection (with no history of ever having COVID), COVID and non-COVID infections, or uninfected.</p><p><strong>Results: </strong>Of the 4,787 participants eligible for analysis, 2,927 participants were included, of whom 294 (10%) had a recent COVID infection; 853 (29.1%) had 1 recent infection other than COVID; 246 (8.4%) had a recent COVID and non-COVID infection; and 1,534 (52.4%) had no infection with COVID nor any infection within the past 6 months (uninfected). Compared with no infections, non-COVID infection was associated with a 39% increased likelihood of relapse (1.39, 95% CI [1.04-1.87]), whereas a recent COVID infection was associated with a decreased likelihood of relapse (0.45 [0.23, 0.87]), adjusting for covariates. All infection groups were associated with increased odds of pseudo-relapse compared with the uninfected group (non-COVID infections: 1.78 [1.44, 2.20]; COVID infection: 1.80 [1.32, 2.45]; COVID and non-COVID infection: 3.04 [2.24, 4.12]).</p><p><strong>Discussion: </strong>Because individuals with MS are at increased risk of infections, the association of infections with relapses and pseudo-relapses is clinically important. The high prevalence of acute worsening after infection, regardless of the type of infection, compared with those with no reported infection, needs to be considered in the management of persons with MS.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200493"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Herpes Zoster Infections With Multiple Sclerosis Disease-Modifying Therapies: A Real-World Pharmacovigilance Study.","authors":"Alexandra Balshi, Grace Leuenberger, John Dempsey, Nova Manning, Ursela Baber, Jacob A Sloane","doi":"10.1212/CPJ.0000000000200505","DOIUrl":"10.1212/CPJ.0000000000200505","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200462.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200505"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Analysis of Physician Communication During Brain Death Conversations: Dead With a Heartbeat.","authors":"Anoushka Rao, Jason X Shen, Paul Graham Fisher, David Magnus","doi":"10.1212/CPJ.0000000000200484","DOIUrl":"10.1212/CPJ.0000000000200484","url":null,"abstract":"<p><strong>Background and objectives: </strong>In recent decades, many legal cases have resulted from physicians ineffectively communicating to a family that their loved one is brain dead (brain dead/death by neurologic criteria [BD/DNC]). Although the definition of BD/DNC has recently undergone revision, little research has been conducted to establish optimal approaches in communicating BD/DNC status to families. The aim of this study was to characterize what highly experienced physicians perceive to be the best communication practices and language choices during BD/DNC conversations.</p><p><strong>Methods: </strong>In this qualitative study, we conducted semistructured, in-depth interviews with physician leaders in the field of BD/DNC between September 2023 and January 2024. All interviews were conducted through Zoom. Twenty expert physician participants were recruited from multiple institutions across the United States through convenience sampling. Participants were current or former attending physicians whose practices at academic institutions involved communication with families about BD/DNC in either the pediatric or adult setting. Participants completed a Qualtrics form containing questions about their demographic background and practice characteristics, including an estimate of the number of times they communicated BD/DNC to patient families. Semistructured interviews were conducted with each of the participants and included hypothetical scenarios and views about best practices.</p><p><strong>Results: </strong>Using 20 qualitative interview transcripts, we identified multiple areas of agreement and disagreement among expert physicians regarding best practices in communicating BD/DNC status. While physicians concurred on specific language to use and avoid, they differed on whether to use the word \"coma,\" on when to introduce the possibility of brain death, and on whether to analogize with cardiac death. There was strong agreement on the utility of visualization through imaging and family attendance at BD/DNC testing. Finally, physicians were in consensus that multiple family meetings with the same providers are crucial for successful BD/DNC communication.</p><p><strong>Discussion: </strong>This study described main convergences and divergences in physician language during BD/DNC conversations and used qualitative data to present a \"train journey\" theory of ideal physician communication with families. By investigating and improving physician communication styles during BD/DNC conversations, the medical community may ameliorate the legal and medical fallout that results from clinical miscommunication.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200484"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grounded in Evidence.","authors":"Lyell K Jones","doi":"10.1212/CPJ.0000000000200470","DOIUrl":"10.1212/CPJ.0000000000200470","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200470"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of an Electronic Medical Record Alert to Prevent Iatrogenic Interventions in Patients With Psychogenic Nonepileptic Seizures.","authors":"Serena Yin, Lydia Wolkiewicz, Bichun Ouyang, Adriana Bermeo-Ovalle","doi":"10.1212/CPJ.0000000000200457","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200457","url":null,"abstract":"<p><strong>Background and objectives: </strong>Seizures are a common presentation to the emergency department and the hospital setting. Psychogenic or functional seizures are often misdiagnosed as epileptic seizures or status epilepticus, and patients are subject to aggressive interventions including sedation, intubations, and prolonged hospital admissions. An electronic medical record (EMR) best practice alert (BPA) was implemented in 2016 for all patients with a confirmed diagnosis of psychogenic nonepileptic seizures (PNES) at Rush University Medical Center. It informs health care providers of the diagnosis and provides education on interacting with the patient's chart. This study evaluates the effectiveness of an EMR BPA in preventing iatrogenic interventions for patients with a diagnosis of PNES.</p><p><strong>Methods: </strong>A retrospective chart review was performed on all patients who presented to Rush University Medical Center between January 2017 and December 2019 and had a PNES BPA triggered. Data on emergency department (ED) visits and inpatient admissions for these patients from the year before and the year after the first BPA trigger were compared. A Wilcoxon signed-rank test and McNemar test were used for analysis.</p><p><strong>Results: </strong>A PNES BPA was triggered in 178 patients. One hundred and forty-three (80%) were female. The mean age was 41 (18-81) years. There was a decrease in the number of ED visits; hospital admissions; intensive care unit (ICU) admissions; and interventions such as intubations and rescue benzodiazepine use in the year after the BPA was first triggered compared with the previous year (<i>p</i> < 0.05). No adverse events were identified in relation to the BPA.</p><p><strong>Discussion: </strong>This study demonstrates that the use of an EMR BPA can be safe and effective in preventing potential iatrogenic interventions and reducing acute health care utilization in patients with PNES. These BPAs can also be used as an educational tool to communicate the presentation, risks, and needs of these patients within the hospital setting.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200457"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of 2HELPS2B Seizure Risk Score: A Cost-Effective Approach to Seizure Detection in the Intensive Care Units.","authors":"Fazila Aseem, Emily Fink, Chuning Liu, John Whalen, Jessica Werdel, Parin Nanavati, Fei Zou, Angela Wabulya, Casey Olm-Shipman, Suzette Maria LaRoche, Clio Rubinos","doi":"10.1212/CPJ.0000000000200464","DOIUrl":"10.1212/CPJ.0000000000200464","url":null,"abstract":"<p><strong>Background and objectives: </strong>Continuous EEG (cEEG) has become a standard for monitoring critically ill patients, but it is resource-intensive with limited availability. The 2HELP2B seizure risk score can help stratify seizure risk and aid in clinical decision making to optimize duration of monitoring. This study aimed to incorporate the 2HELPS2B score to inform cEEG duration and provide cost-effective care without compromising seizure detection.</p><p><strong>Methods: </strong>We conducted a quality improvement study that targeted clinical workflow and seizure risk stratification in the intensive care units of a tertiary academic hospital. The study included adult patients who underwent cEEG between June 2020 and December 2022 (n = 552), after excluding patients undergoing cEEG for management of status epilepticus, spell characterization, intracranial pressure monitoring, and post-cardiac arrest (n = 129). We performed a retrospective chart review to establish baseline cEEG volume, seizure incidence, and monitoring duration. We then introduced the 2HELPS2B risk score through multidisciplinary education and used published recommendations to suggest optimal cEEG duration. After the intervention, we analyzed the impact of integrating the 2HELPS2B score on cEEG duration and seizure detection rates.</p><p><strong>Results: </strong>Of 552 patients, most were low risk (n = 311, 56.3%), followed by moderate risk (n = 189, 34.2%) and high risk (n = 52, 9.4%). Before the intervention, cEEG duration was similar for all risk groups. After implementation of the 2HELPSB score, there was a significant reduction in cEEG duration for low-risk and moderate-risk patients (low 36.3 vs 23.8 hours; <i>p</i> < 0.0001, moderate 36.5 vs 29.3 hours; <i>p</i> = 0.01) and no significant change for the high-risk group (41.3 vs 40.4 hours; <i>p</i> = 0.92). Seizure detection was low except for the high-risk group (1.3% vs 7.9% vs 39.1%). Reduction in cEEG duration after implementation of the 2HELPS2B score did not lead to a significant change in seizure detection (0.6% vs 9% vs 37.9%).</p><p><strong>Discussion: </strong>Most critically ill patients had low or moderate seizure risk and, accordingly, a low incidence of seizures detected during cEEG. Implementing the 2HELPS2B seizure risk score allowed customization of cEEG duration for individual patients, applying the practice of precision medicine. This approach successfully improved cEEG utilization without compromising seizure detection. In conclusion, implementing seizure risk stratification can provide cost-effective monitoring and improve cEEG access.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200464"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Health Care Utilization for Individuals With Manifest Huntington Disease.","authors":"Amy C Ogilvie, Ryan M Carnahan, Adys Mendizabal, Stephanie Gilbertson-White, Aaron T Seaman, Elizabeth A Chrischilles, Jordan L Schultz","doi":"10.1212/CPJ.0000000000200471","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200471","url":null,"abstract":"<p><strong>Background and objectives: </strong>There is a need to understand how different factors influence health care utilization for patients with Huntington disease (HD) to maximize benefits of primary and specialty care while minimizing need for costly emergency visits or hospitalizations. The primary objective of this study was to characterize how settings where patients with HD in Northern America receive care change throughout the disease course and determine whether the likelihood of different types of service utilization is influenced by clinical, sociodemographic, and caregiver characteristics.</p><p><strong>Methods: </strong>Data from the Enroll-HD study and joinpoint regression were used to assess trends in neurology visits, general practitioner visits, emergency department visits, and inpatient stays over the disease course and as a function of total functional capacity. Generalized estimating equation models were then used to identify factors associated with use of these different services in the 6 months before their study visit.</p><p><strong>Results: </strong>Visits from 1,631 participants in the Northern America region from the Enroll-HD study were included in this study. Trends in neurology, emergency, and inpatient visits remained constant over most of the disease duration. For the general practitioner visits, there was an increasing trend in use throughout the course of disease. Clinical factors, such as psychiatric symptoms, functional ability, and comorbidities, were associated with use of multiple types of health care services. Sociodemographic and caregiver factors, such as race or ethnicity, urban or rural residence, and caregiver employment status, were also associated with use of multiple health care services.</p><p><strong>Discussion: </strong>Clinical, sociodemographic, and caregiver-related factors were all associated with outpatient, emergent, and inpatient care. This work identifies multiple avenues for future research on how to improve access to and quality of care for patients with HD, specifically relating to reducing the need for emergency visits and inpatient stays and promoting collaboration among primary and specialty clinicians.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200471"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}