Pediatric Cardiology最新文献

{"title":"Cardiogenic Shock Risk Score at Diagnosis of Multisystem Inflammatory Syndrome in Children: A Multicenter Study.","authors":"Saïd Bichali, Naïm Ouldali, Michaël Génin, Julie Toubiana, Alexandre Belot, Corinne Levy, Alexis Rybak, Nathan Giroux, Stéphane Béchet, Etienne Javouhey, François Angoulvant, François Godart, Ali Houeijeh, Stéphane Leteurtre","doi":"10.1007/s00246-025-03823-7","DOIUrl":"https://doi.org/10.1007/s00246-025-03823-7","url":null,"abstract":"<p><p>Severe cardiovascular involvement is associated with mortality in multisystem inflammatory syndrome in children (MIS-C). This study aimed to test a previously published cardiogenic shock risk score at diagnosis of MIS-C and build a new screening tool in a larger pediatric cohort. The first score published in a single-center cohort (age > 8 years, time to diagnosis ≥ 6 days, and NT-proBNP at diagnosis ≥ 11.10³ ng/L) was tested in a multicenter cohort of pediatric patients diagnosed with MIS-C from 2020 to 2023. In the multicenter cohort, the factors associated with the occurrence of cardiogenic shock were determined and a new score was built using a multivariate regression model. In 127 children with MIS-C, (median age [interquartile range] 8.6 [5.2; 11.5] years, 67 (53%) patients with cardiogenic shock), age > 8 years, time to treatment ≥ 6 days, dyspnea, altered mental status, general deterioration, gastrointestinal symptoms, ≤ 1 Kawasaki sign, absence of rhinopharyngitis signs, NT-proBNP ≥ 11.10³ ng/L, high C-Reactive Protein (CRP), and high leucocytes at diagnosis of MIS-C were associated with a high risk of cardiogenic shock. The new score was 0.128*Age(year) + 1.195*(1 if dyspnea, 0 otherwise) + 0.007*CRP(mg/L) - 2.6732. The sensitivity was 0.88 and negative likelihood ratio 0.23 (cutoff - 0.4761). The score correlated with the minimal left ventricular ejection fraction (ρ = 0.51, p < 0.001). In a multicenter cohort, each item of the previous score was associated with the occurrence of cardiogenic shock. The new score, combining age, dyspnea, and CRP at diagnosis of MIS-C, had a high sensitivity.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606085","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":"Evaluating Hospital Resource Utilization for Hypoplastic Left Heart Syndrome Through Linkage of a Clinical Registry and an Administrative Database.","authors":"Katherine E Bates, Li Huang, Colleen Mangeot, Jeffrey B Anderson, Samuel P Hanke, Sara K Pasquali, Kim Dalziel","doi":"10.1007/s00246-025-03814-8","DOIUrl":"https://doi.org/10.1007/s00246-025-03814-8","url":null,"abstract":"<p><p>Resource utilization estimates for hypoplastic left heart syndrome (HLHS) in early childhood are lacking. We linked the National Pediatric Cardiology Quality Improvement (NPC-QIC) clinical registry to the Pediatric Health Information Systems (PHIS) database to estimate hospital resource utilization for a contemporary HLHS cohort. All hospitals with both PHIS and NPC-QIC data available were eligible for inclusion. Patients discharged from their Norwood procedure 10/1/2009-9/30/2015 were linked using indirect identifiers. Estimated cost and length-of-stay data for all inpatient episodes across the first six years of life were calculated and reported per year of life. We linked 973/1175 (82.8%) unique patients from 33 centers. Complete costing records from birth to Fontan, transplant, or inpatient death < 6 years of age were available for 38%. For patients with complete cost estimate data, resource use was highest in the first year of life with an average cost of $450,124 (95% CI $397,094-$503,154) which corresponded to an average of 79 days (95% CI 72-86) in hospital. The total average cost in the first 6 years was $651,006 ($518,819-$783,193), with an average of 110 days (93-128) in hospital. Average hospitalization costs associated with each staged surgical procedure were $239,936 ($229,649-$250,223) for Norwood procedure, $143,292 ($126,383-$160,200) for stage 2 procedure, and $77,198 ($70,471-$83,925) for Fontan. Linking NPC-QIC clinical registry data to PHIS data to evaluate resource utilization is feasible. Resource utilization in HLHS is highest in the first year of life and remains high over the first six years of life.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606091","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":"Heart Rate Control with Landiolol Hydrochloride in Infants and Neonates During Cardiac Surgery.","authors":"Matthias Müller, Lukas Andreas Puschmann, Thomas Zajonz, Martin Unger, Jakob Ackerl, Olga Shatilova","doi":"10.1007/s00246-025-03824-6","DOIUrl":"https://doi.org/10.1007/s00246-025-03824-6","url":null,"abstract":"<p><p>Perioperative tachyarrhythmias are common in children undergoing cardiac surgery, contributing to significant mortality and morbidity. Landiolol, an ultrashort-acting beta-blocker, offers selective heart rate (HR) control in pediatric patients with tachycardia during cardiac surgery. The LANDI-cardioPed study assessed landiolol's safety and efficacy in children during cardiac surgery. The retrospective review included patients under 1 year of age with intraoperative tachycardia during cardiac surgery treated with landiolol hydrochloride (Rapibloc®) at the Pediatric Heart Center Giessen, Germany (June 2017-October 2022). The primary endpoint was the proportion of patients achieving a target HR (< 160 bpm) by surgery end. Among 24 patients (46% neonates, 54% infants; mean weight: 4.8 kg; preexisting heart failure in 71%), 83% achieved the target HR by surgery's end, with all patients reaching it during treatment. Median HR normalization time was 4.0 min and 75% of children reached it within 18.5 min. Landiolol demonstrated good hemodynamic stability. It reduced HR by 6% from baseline while maintaining stable blood pressure and HR/BP ratios, with no increased vasopressor use. The drug was titrated individually, with a mean initial dose of 23 µg/kg/min, the dose was 26 µg/kg/min upon reaching target HR, and the maximum dose of 49 µg/kg/min. The treatment duration averaged 10.5 h. Safety was favorable; three adverse events unrelated to landiolol were reported, and no dose interruptions occurred. Landiolol was effective and safe for HR control in neonates and infants with tachycardia during cardiac surgery, which aligns with current knowledge on its use in children.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597480","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":"Preoperative Oral Feeding in Infants with Congenital Heart Disease Within the First Month of Life is Associated with a Higher Likelihood of Freedom from Tube Feeding at Time of Postoperative Discharge.","authors":"Muhammad Irfan, Fatima Fazal","doi":"10.1007/s00246-025-03805-9","DOIUrl":"https://doi.org/10.1007/s00246-025-03805-9","url":null,"abstract":"","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586644","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":"Incidence and Risk Factors of Pulmonary Vein Stenosis After Orthotopic Heart Transplantation in Pediatric Patients.","authors":"Daiji Takajo, Paul J Critser, Benjamin S Mantell, Russel Hirsch","doi":"10.1007/s00246-025-03828-2","DOIUrl":"10.1007/s00246-025-03828-2","url":null,"abstract":"<p><p>Pulmonary vein stenosis (PVS) is a rare yet critical condition in children with a poor prognosis. The incidence and underlying risk factors of PVS following orthotopic heart transplantation (OHT) remain unclear. This study aimed to investigate the occurrence and predictors of PVS development post-OHT among pediatric recipients. This retrospective, single-center study was conducted at Cincinnati Children's Hospital Medical Center included patients who underwent OHT between 2014 and 2023. Demographics were compared between patients who developed PVS after OHT and those who did not. Cox regression analyses was used to identify predictors of PVS development. Among 114 patients (70 males, 61%) who underwent OHT at a median age of 11 years (IQR: 2-15), 12 were diagnosed with PVS (6 males, 50%) during a median follow-up of 29 months (IQR: 14-63). The median interval between OHT and diagnosis of PVS was 2 months (IQR: 1-8). All 12 PVS cases were associated with underlying congenital heart disease (12/69, 17.4%) including 2 patients with history of PVS at time of transplant. No patients with history of cardiomyopathy or myocarditis developed PVS. Among the 12 PVS patients, 3 (25%) had multivessel pulmonary vein disease and 4 patients (33%) died. Cox regression analysis, after excluding 2 patients with a prior history of PVS, identified age at OHT (Hazard ratio 0.86, p = 0.027) and partial or total anomalous pulmonary venous return (Hazard ratio 9.0, p = 0.002) as significant predictors of PVS development post-OHT. Prematurity, chronic lung disease, single ventricle physiology and donor-recipient size mismatch were not significantly associated with development of PVS post-OHT. The patients with PVS had significantly higher mortality compared to those without PVS (p = 0.025). This study highlights a low risk of PVS post-OHT in children with cardiomyopathy or myocarditis. PVS post-transplant is linked to congenital heart disease and early post-transplant period. Monitoring for PVS during the first year post-OHT is crucial, especially in children with congenital heart disease.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582359","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":"Benefits of Chronic Atrial Pacing in Fontan Physiology with Sinus Node Dysfunction and Preserved Ejection Fraction: Novel Therapeutic Approach for Failing Fontan.","authors":"Hideo Ohuchi, Keita Saku, Aya Miyazaki, Aki Mori, Yoshiaki Kato, Heima Sakaguchi, Isao Shiraishi, Kenichi Kurosaki","doi":"10.1007/s00246-025-03819-3","DOIUrl":"https://doi.org/10.1007/s00246-025-03819-3","url":null,"abstract":"<p><p>Increased heart rate (HR) can reduce central venous pressure (CVP) in patients with preserved ventricular systolic function. We aimed to investigate whether this theory works in failing Fontan physiology. Pacemaker implantation (PMI) was performed in six Fontan patients (age: 6-40 years) with sinus node dysfunction (SND) without junctional rhythm (JR). Baseline median (interquartile [IQR]) values of CVP, ventricular end-diastolic pressure (EDP), and ejection fraction (EF) were 12 (11-15) mmHg, 13 (10-16) mmHg, and 57% (53%-64%), respectively. Before PMI, the relationships among HR, cardiac index (L/min/m²), CVP, and EDP were evaluated using atrial pacing. Additionally, we assessed chronic changes in hemodynamics and hepatorenal function after PMI. During baseline catheterization, HR was 51 (40-58) bpm. Atrial pacing was initiated at 60 (60-63) bpm and increased to 85 (80-93) bpm. Reductions were observed in CVP (from 12 [11-15] to 9 [8-11] mmHg, p < 0.05), EDP (from 13 [10-16] to 8 [6-8] mmHg), and an increase in cardiac index (from 2.7 [2.3-3.0] to 3.4 [3.2-4.1] L/min/m²). After 1 year of PMI with HR of 80 (70-83) bpm, sustained improvements were observed, including reductions in CVP (from 12 [11-15] to 10 [9-11] mmHg, p < 0.05), EDP (from 13 [10-16] to 9 [4-9] mmHg, p = 0.06), and ventricular end-diastolic volume index (from 85 [76-98] to 67 [53-76] ml/m², p < 0.05). Total bilirubin levels and renal resistive index also decreased (both p = 0.06). In conclusion, chronic atrial pacing therapy reduced CVP and ventricular volume in Fontan patients with preserved EF and SND, even in the absence of JR. Proactive PMI may prevent the progression of Fontan-associated end-organ dysfunction in these selected Fontan patients.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573597","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":"Correlation of Liver Fibrosis on Ultrasound Elastography and Liver Biopsy After Fontan Operation: Is Non-invasive Always Better?","authors":"Yuen Lo Yau, John-Anthony Coppola, Dalia Lopez-Colon, Matthew Purlee, Himesh Vyas, David M Saulino, Dipankar Gupta","doi":"10.1007/s00246-025-03820-w","DOIUrl":"https://doi.org/10.1007/s00246-025-03820-w","url":null,"abstract":"<p><p>Fontan-associated liver disease (FALD) is a common complication after the Fontan procedure. A liver biopsy is the gold standard for assessing liver fibrosis. However, ultrasound (US) elastography has increasingly been used as a non-invasive method to diagnose and monitor liver fibrosis. Nonetheless, a clear correlation of severity of fibrosis between US elastography and liver biopsy in this population has not yet been established. In this single-center retrospective study, we included patients with Fontan physiology who had liver fibrosis evaluation between 2008 and 2022 with both US elastography and liver biopsy. Fibrosis was classified by US elastography and liver biopsy based on the METAVIR scoring system and congestive hepatic fibrosis score, respectively. Overall, 29 patients had both US elastography and liver biopsy with a median age of 17 years (IQR 13-27 years). The median time between Fontan operation and liver biopsy was 14 years (IQR 9-23). Nine patients underwent isolated heart transplantation (31%). The median shear wave elastography was 1.97 m/s (IQR 1.66-2.11) with 86% of patient's METAVIR score being > F2. There was no correlation in the severity of fibrosis between US elastography and liver biopsy (polycor = - 0.021). Findings on US elastography had weak correlation with histological fibrosis severity reported in liver biopsy. Further large-scale studies are necessary to assess optimal protocol for using US elastography for surveillance of FALD in Fontan patients.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586638","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":"Virtual Post Mortem in Fetuses and Newborns for the Verification of Congenital Heart Malformations.","authors":"Yishay Salem, Eitan Keizman, Jeffrey Jacobson, Orly Goitein, Eldad Katorza, Eran Kassif, David Mishali, Debora Kidron, Alain E Serraf, Eli Konen, Reuven Ahiron, Liat Gindes, Shai Tejman-Yardem","doi":"10.1007/s00246-025-03787-8","DOIUrl":"https://doi.org/10.1007/s00246-025-03787-8","url":null,"abstract":"<p><p>Post-mortem examinations of fetuses and newborns with congenital anomalies pose significant challenges, especially in cases of induced termination of pregnancy. To address this, we explored the use of virtual post-mortem examination (VPM) via computed tomography angiography (CTA) as a potential alternative. The study was conducted at Sheba Medical Center from January 2013 to June 2019. It focused on 20 cases involving severe congenital heart defects or lung malformations affecting the heart. VPM imaging was performed using CTA with contrast medium injected into the umbilical artery and vein. Prenatal sonographic diagnoses were fully concordant with VPM findings, confirmed by authorized invasive autopsies in 7 cases. The standardized injection protocol enabled accurate imaging of the systemic and pulmonary vessels, aiding in the identification of vascular anomalies and the cardiac structures. However, visualization of intra-cardiac anatomy was limited, possibly due to valve competence and post-mortem intra-ventricular Thrombi. Compared to MRI, CT scans this method offers higher spatial resolution at a lower cost, making it a feasible complement to standard medical practice. Despite limitations in visualizing cardiac chambers, VPM with umbilical vessel injection proved highly accurate, particularly in assessing the great vessels. Overall, the findings suggest that VPM may offer a less invasive and acceptable alternative for grieving parents, providing valuable insights into complex congenital cardiac anomalies, while respecting the sensitivity of post-mortem examinations in such cases.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573598","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 Predicting Early Outcome of Aortic Valve Neocuspidization in the Pediatric Population.","authors":"Sivakumar Sivalingam, Maruti Yamanappa Haranal, Woan Shiang See","doi":"10.1007/s00246-025-03808-6","DOIUrl":"https://doi.org/10.1007/s00246-025-03808-6","url":null,"abstract":"<p><p>Aortic valve reconstruction in the pediatric population presents significant surgical challenges as the ideal repair requires an individualized approach considering various factors. This study aims to analyze the factors influencing outcomes of aortic valve neocuspidization (AV Neo) in pediatric patients. A retrospective cohort study involving pediatric patients who underwent neocuspidization (congenital and acquired) between 2016 and 2023. Clinical outcomes assessed included mortality, reintervention, structural valve degeneration and infective endocarditis. Echocardiographic measurements included peak and mean gradient, indexed vena contracta jet width, annular diameter, and coaptation height. Freedom from events was analyzed using Kaplan-Meier analysis. Outcomes were compared based on congenital or acquired valve lesions. AV neo was performed in 53 patients with a mean age of 10.7 ± 3.91 years, of which 29 had congenital aortic valve disease. There was one early in-hospital mortality. At discharge, the mean coaptation height was 9.9 ± 1.0 mm, the peak gradient was 12.0 mmHg, and less than mild regurgitation was observed. The median follow up period was 27.4 months. Forty-four patients (83%) remained event-free. A Significant aortic annular growth was noted, with rheumatic etiology patients showed the most stable coaptation height over time. Truncus arteriosus patients demonstrated rapid growth of the annulus leading to accelerated truncal valve regurgitation progression. AV Neo is feasible with acceptable short-term results in pediatric patients with congenital and acquired etiology. The procedure allows significant physiological annular growth, particularly benefiting patients with rheumatic aortic valve disease, but less favorable among patients with truncal valve pathology.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557171","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":"Severity of Congenital Heart Defects Affects Long-Term Somatic Development.","authors":"Alexandra Kiess, Patricia Bimboese, Ruth Gausche, Christoph Beger, Christof Meigen, Mandy Vogel, Roland Pfäffle, Ingo Dähnert, Wieland Kiess","doi":"10.1007/s00246-025-03815-7","DOIUrl":"https://doi.org/10.1007/s00246-025-03815-7","url":null,"abstract":"<p><p>Treatment options and therefore general health in children with congenital heart defects (CHD) improved tremendously over the last decades. Growth is an important marker to evaluate healthy development, especially in patients with chronic diseases. This study aimed to evaluate growth in children with CHD compared to their healthy peers. A retrospective, longitudinal analysis of standardized measurements of height, weight, and head circumference of children with CHD aged 0 to 18 years (n = 18,591) was conducted based on data provided by the German pediatrician network CrescNet. These data were compared to the data of healthy children from the same region. Inclusion was based on the ICD-10 codes for CHD; patients with other growth-altering diseases or medications were excluded. CHD were grouped into mild, moderate, or severe according to their severity. The severity of the CHD influences the height, final height, weight, and head circumference of affected children at birth and in long-term growth. Children with more severe CHD are smaller (- 1 to - 0.7 SDS), lighter (- 1 SDS), and have smaller head circumferences (- 1 SDS) than their healthy peers and children with milder CHD. In a subgroup analysis of children with Down's syndrome (T21), children with T21 and CHD showed significantly smaller measurements than their peers without CHD. In this subgroup, only the presence but not the severity of the CHD mattered. Despite overall good outcomes and better survival rates, growth as a marker of healthy development in children with CHD may be still impacted and should be closely monitored to offer early intervention.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557389","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}