Pediatric Pulmonology最新文献

{"title":"Healthy Homes, Healthy Lungs: The Role of Home Insulation in Environmental Impact on People With Cystic Fibrosis.","authors":"Ceren Ayça Yıldız, Merve Selçuk Balcı, Derya Kocakaya, Caner Çınar, Almala Pınar Ergenekon, Ela Erdem Eralp, Yasemin Gökdemir, Bülent Karadağ","doi":"10.1002/ppul.71253","DOIUrl":"https://doi.org/10.1002/ppul.71253","url":null,"abstract":"<p><strong>Background: </strong>People with CF (pwCF) constantly strive for lung health, making environmental factors a crucial aspect of comprehensive care. This study investigated the impact of home insulation on the respiratory health of individuals with CF, focusing on dampness and mold as potential environmental factors. We hypothesize that improved living conditions, specifically adequate home insulation, have a positive impact on lung health in pwCF by reducing exposure to environmental risk factors such as dampness and mold.</p><p><strong>Methods: </strong>This cross-sectional survey involving 389 participants, was conducted between July and August 2023 using the computer assisted telephone interview (CATI) technique. Participants were asked about demographic features, dwelling house characteristics and medical conditions. The insulation status of the house and presence of mold were evaluated based on participant responses.</p><p><strong>Results: </strong>The study revealed that houses with insulation, constituting 72.8% of the sample, were associated with higher percent predicted forced expiratory volume in the first second (ppFEV₁) values (p = 0.028). Multivariate regression analysis demonstrated that insulation positively influenced ppFEV₁ (p = 0.005, B = 7.27), although it accounts for a modest portion of the variance in FEV₁ (adjusted R² = 0.254). Insulated houses showed lower rates of mold. Our study revealed an association between the absence of mold in the home and the absence of allergic bronchopulmonary aspergillosis (ABPA) in individuals, suggesting that environments free of mold may be associated with a lower occurrence of ABPA (p = 0.03).</p><p><strong>Conclusion: </strong>These findings suggest that insulation plays a role in reducing mold, contributing to improved respiratory health in pwCF. Despite limitations, the research underscores the potential of home modifications, specifically insulation, to enhance the well-being of individuals with CF.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71253"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964679","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":"Clinical Characteristics and Outcomes of Severe Non-HIV Related Pneumocystis jirovecii Pneumonia in the Pediatric Intensive Care Unit.","authors":"Kang An, Yali Han, Chengjuan Luo, Wenting Hu, Juan Qian","doi":"10.1002/ppul.71217","DOIUrl":"10.1002/ppul.71217","url":null,"abstract":"<p><strong>Background: </strong>Pneumocystis jirovecii is an important cause of opportunistic pneumonia in immunocompromised patients. The aim of this study was to investigate the clinical, laboratory, imaging characteristics, and prognosis of Pneumocystis jirovecii pneumonia (PJP) in immunocompromised non-HIV pediatric patients.</p><p><strong>Methods: </strong>This was a retrospective, observational study. Continuous variables were expressed as median and interquartile range and evaluated by Mann Whitney U test. Risk factors associated with 90-day all-cause mortality were evaluated by a logistic regression model.</p><p><strong>Results: </strong>Twenty-two patients (55%) had previously undergone transplantation; 19 (47.5%) liver transplants and 3 (7.5%) allogeneic hematopoietic stem cell transplants. The remaining 18 patients included 12 with acute lymphoblastic leukemia (30%) with 6 others (15%). Eight patients (20%) presented with shock on admission. Fifteen patients (37.5%) had received PJP prophylaxis before PJP onset. The median duration of hospitalization was 26 (20-34) days with a median saty of 18 (11-25) days in the pediatric intensive care unit (PICU). The 30 day all-cause mortality was 12.5% (5/40). The 90 day all-cause mortality was 22.5% (9/40). Compared with survivors, non-survivors had a significantly higher Pediatric Sequential Organ Failure Assessment Score (pSOFA) (11 vs 4; p < 0.01) and lower SpO2 at presentation (88% vs 90%; p = 0.046). Multivariate analysis showed that the pSOFA [95% CI 1.983 (1.183-3.325); p = 0.009)] was the only significant risk factor for mortality. Although there was no statistically significant difference, patients who received adjunctive glucocorticoid therapy had a shorter duration of mechanical ventilation compared to those who did not (12 vs. 15 days; p = 0.26).</p><p><strong>Conclusions: </strong>PJP remains life-threatening in immunocompromised pediatric patients. pSOFA was a significant risk factor for mortality.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71217"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799817","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":"Effectiveness of A Respiratory Care Protocol Including Less Invasive Surfactant Administration in ≥ 35 Weeks Gestational Age Infants.","authors":"Etze Chotzoglou, Arun Prasath, Riddhi Desai, Lebanon David, Nancy Ornelas, Patti Burchfield, Larry Steven Brown, David B Nelson, Venkatakrishna Kakkilaya","doi":"10.1002/ppul.71257","DOIUrl":"10.1002/ppul.71257","url":null,"abstract":"<p><strong>Background: </strong>In October 2018, a respiratory care protocol (RCP) including less invasive surfactant administration (LISA), was introduced for preterm infants admitted on continuous positive airway pressure (CPAP).</p><p><strong>Study design: </strong>We compared respiratory care practices and outcomes of ≥ 35-week gestational age (GA) infants between a pre-RCP (Jan 2016 to September 2018) and a post-RCP cohort (Oct 2018 to Dec 2021). Infants requiring < 24 h of CPAP and diagnosed with meconium aspiration syndrome were excluded.</p><p><strong>Results: </strong>Of the 260 infants meeting inclusion criteria, 126 belonged to the pre-RCP and 134 to post-RCP cohort. Compared to pre-RCP, a lower proportion of infants in the post-RCP received CPAP on admission but a higher proportion received surfactant therapy (8% vs 22%, p < 0.001). Notably, surfactant therapy was associated with lower FiO₂ requirement for 24 h and respiratory severity score for 48 h in the post-RCP cohort. However, there was no difference in any of the outcomes such as the need for mechanical ventilation, incidence of pneumothorax and length of hospital stay between two cohorts.</p><p><strong>Conclusions: </strong>Implementing an RCP increased surfactant use with associated improvement in oxygenation but did not improve outcomes. Further studies are necessary to evaluate the role of LISA in ≥ 35-week GA infants.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71257"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855993","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":"Comment on \"Evaluation of Intestinal Permeability in Children Diagnosed With Bronchiolitis in Pediatric Emergency Department: A Cross-Sectional Study\".","authors":"Rachana Mehta, Ranjana Sah","doi":"10.1002/ppul.71232","DOIUrl":"https://doi.org/10.1002/ppul.71232","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71232"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799818","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 Palivizumabe a Protective Factor for the Development of Asthma in Children? A Systematic Review With Metanalysis.","authors":"Mariana Bueno Manini, Natali Caroline da Silva, Rafaela Agra de Castro, Milena Baptistella Grotta, Adyleia A D Contrera Toro","doi":"10.1002/ppul.71242","DOIUrl":"https://doi.org/10.1002/ppul.71242","url":null,"abstract":"<p><strong>Introduction: </strong>Premature infants are at increased risk of developing chronic respiratory diseases, predisposing them to severe infections, such as those caused by respiratory syncytial virus (RSV). Palivizumab reduces the severity of RSV infections in high-risk children; however, its relationship with asthma development in premature infants remains unclear.</p><p><strong>Objective: </strong>This systematic review with meta-analysis aimed to review the literature and assess whether prophylaxis with palivizumab protects premature infants without congenital heart disease from developing asthma.</p><p><strong>Results: </strong>In total, 14 studies met the inclusion criteria, assessing 1,364,238 children; of these, 9232 received palivizumab. No significant difference in the chance of developing asthma between the groups (odds ratio (OR) of 0.84, 95% CI [0.62-1.13], p = 0.1968). Heterogeneity between studies was I² = 35.6%. Subgroup analysis for children with a family history of atopy showed no significant reduction in asthma risk (OR 0.78, 95% CI: 0.40-1.55, p = 0.3390). Sensitivity analysis confirmed result robustness. IgE levels were similar between the groups (standardized mean difference [SMD] -0.03 [95% CI: -0.30; 0.23], p = 0.8088). Children who received palivizumab were diagnosed younger (SMD -0.24 [95% CI: -0.38; -0.09], p = 0.0014), with lower gestational age (MD -0.75 [95% CI: -1.61; 0.12], p = 0.0915).</p><p><strong>Conclusions: </strong>Palivizumab prophylaxis does not reduce asthma risk in premature children without congenital heart disease. Its primary benefit lies in preventing severe RSV infections, with no direct impact on asthma developing.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71242"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964729","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":"Utility of Continuous Glucose Monitors for Improved Detection of Cystic Fibrosis-Related Diabetes.","authors":"Claire E Moore, Wenya Chen, Stacy Bichl, Alexis Wong, Carolyn Heyman, Sarayu Ratnam, Monica E Bianco","doi":"10.1002/ppul.71267","DOIUrl":"https://doi.org/10.1002/ppul.71267","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis-related diabetes (CFRD) can be associated with decline in pulmonary function and nutritional status. Earlier diagnosis of CFRD than offered by annual recommended oral glucose tolerance test (OGTT) and earlier initiation of insulin may help prevent clinical decline. This retrospective study investigates the utility of continuous glucose monitoring (CGM) for detection of hyperglycemia in patients with cystic fibrosis (CF).</p><p><strong>Methods: </strong>In this single-center, retrospective study, we analyzed data from 18 patients with CF over age 10 who had an abnormal OGTT and subsequently had at least 24 h of CGM data. EasyGV software was used to calculate multiple measures of CGM variability. Differences in OGTT and CGM measures were explored across four glucose-tolerance groups: indeterminate, fasting hyperglycemia, impaired glucose tolerance (with or without fasting hyperglycemia), and CFRD.</p><p><strong>Results: </strong>Multiple CGM measures correlated with components of the OGTT. Across glucose-tolerance groups, significant differences were observed for the OGTT 2-h glucose (p = 0.002), mean of daily differences from CGM (p = 0.03), and standard deviation from CGM (p = 0.02). Approaching significance was the lability index (p = 0.05) from the CGM data. Glucose management indicator (GMI), continuous overlapping net glycemic action (CONGA), glycemic risk assessment in diabetes equation (GRADE), and average daily risk range (ADRR) showed negative correlations with change in forced expiratory volume over 1 s (FEV1) over the year before OGTT.</p><p><strong>Conclusion: </strong>Markers of glycemic variability may be important variables distinguishing between degrees of abnormal glucose tolerance, including CFRD. This area warrants further research with a larger sample size.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71267"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964788","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":"Rigid and Flexible Bronchoscopy for Foreign Body Removal in Children: Complications, Risk Factors and Anesthetic Management.","authors":"Oliver Keil, Yehor Huzhva, Vanessa Rigterink, Nils Dennhardt, Dietmar Boethig, Katja Nickel, Julia Carlens, Anna-Maria Dittrich, Ruth Grychtol, Martin Wetzke, Gesine Hansen, Nicolaus Schwerk, Katharina Schütz, Christiane E Beck","doi":"10.1002/ppul.71261","DOIUrl":"https://doi.org/10.1002/ppul.71261","url":null,"abstract":"<p><strong>Background: </strong>Foreign body (FB) aspiration is a typical emergency experienced by young children and associated with significant morbidity and mortality unless diagnosed early and treated adequately. Data on anesthetic management, applicability, complications and risk factors in the context of foreign body removal (FBR) is scarce, especially for flexible techniques, which are increasingly being used.</p><p><strong>Aim: </strong>Analyzation of the complication rate and risk factors of two different techniques (rigid vs. flexible) as well as the anesthetic management for FBR in children.</p><p><strong>Method: </strong>This is a retrospective single center analysis of 160 cases who underwent bronchoscopy for suspected FB aspiration under general anesthesia between January 2014 and January 2022 at a tertiary hospital.</p><p><strong>Results: </strong>An FB was detected in 67 patients (median age 1.8 years). The preferred anesthesia regimes were total intravenous anesthesia (91.9%) and laryngeal mask (95%) for flexible bronchoscopy. Flexible bronchoscopy was used in 52.2%, rigid bronchoscopy in 31.3%, and both techniques were used in 16.4% of cases. The complication rate was 2.19 versus 1.29/patient in rigid versus flexible bronchoscopy, respectively. Independent risk factors for severe complications were rigid bronchoscopy (OR 11.6, p < 0.01) and airway infections (OR 4.1, p < 0.01). We observed flexible bronchoscopy being increasingly used for FBR during the observational period.</p><p><strong>Conclusion: </strong>FBR can result in serious complications that require experienced pediatric anesthetic management. In our series, the use of a rigid bronchoscope and pre-existing airway infection were independent risk factors for severe complications. Flexible bronchoscopy was shown to be a safe, fast and successful tool for FBR with secured laryngeal mask airway and total intravenous anesthesia with fewer adverse events compared to rigid bronchoscopy.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71261"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964803","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":"Prediction of Bronchopulmonary Dysplasia by Diaphragmatic Ultrasound in Preterm Infants: A Prospective Pilot Study.","authors":"Chiara Poggi, Monica Fusco, Giovanni Sassudelli, Iuri Corsini, Carlo Dani","doi":"10.1002/ppul.71243","DOIUrl":"https://doi.org/10.1002/ppul.71243","url":null,"abstract":"<p><strong>Background: </strong>Diaphragmatic ultrasound showed significant differences between patients with established bronchopulmonary dysplasia (BPD) and healthy controls. The aim of this study was to assess whether diaphragmatic ultrasound could predict the development of BPD in preterm infants < 32 weeks of gestational age.</p><p><strong>Methods: </strong>Diaphragmatic ultrasound was performed on day 3 of life (T₀), and at 7 ± 1 (T₁), 14 ± 1 (T₂), and 21 ± 2 (T₃) days of life. Diaphragmatic excursion (DE), diaphragmatic thickness at end of inspiration (DT_ins) and expiration (DT_exp), inspiratory and expiratory peak velocities (I-peak and E-peak) and their ratio to body surface area (BSA), and diaphragmatic thickness fraction (DTF) were measured. Logistic regression and ROC curve analyses were performed to evaluate possible role of these variables as predictive factors for BPD and their accuracy for the prediction of BPD.</p><p><strong>Results: </strong>DE/BSA, DT_ins/BSA, DT_exp/BSA, and DTF did not differ between patients who developed or did not developed BPD. I-peak/BSA and E-peak/BSA were significantly higher in patients who developed BPD at all timings. I-peak/BSA at T₂ and E-peak/BSA at T₀ and T₁ were independent predictive factors for BPD after adjustment for gestational age and respiratory support. At T₁ I-peak/BSA > 18 cm/s/m² and E-peak/BSA > 17.1 cm/s/m² accurately predict BPD with sensitivity of 92% and specificity of 92%, and sensitivity of 99% and specificity of 79%, respectively.</p><p><strong>Conclusions: </strong>I-peak/BSA and E-peak/BSA are independent risk factors for the development of BPD. They can early and accurately predict the risk for BPD in very preterm infants contributing to targeted treatment of patients at higher risk of BPD.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71243"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822257","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":"Upcoming events of interest.","authors":"","doi":"10.1002/ppul.71239","DOIUrl":"https://doi.org/10.1002/ppul.71239","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71239"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799847","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":"Preliminary Estimates of the Diagnostic Accuracy of Video Clips for Obstructive Sleep Apnea in Children.","authors":"Sherri L Katz, Taylor Barwell, Vid Bijelić, Nicholas Barrowman, Henrietta Blinder, Naomi Dussah, Roya Shamsi, Alexa R Leitman, Refika Ersu","doi":"10.1002/ppul.71228","DOIUrl":"https://doi.org/10.1002/ppul.71228","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing obstructive sleep apnea (OSA) in children is challenging, with long wait times for polysomnography (PSG). This study assessed the diagnostic accuracy of home-recorded video clips for OSA compared to PSG.</p><p><strong>Methods: </strong>Children (2-18 years) referred for PSG for suspected OSA were enrolled. Parents recorded video clips of their child sleeping and completed the Pediatric Sleep Questionnaire (PSQ). Blinded clinicians scored videos using the Monash Obstructive Sleep Apnea score (MS). Participants underwent PSG, and outcomes included obstructive apnea-hypopnea index (OAHI) and oximetry metrics (i.e., McGill Oximetry Score [MOS]; 3% Oxygen Desaturation Index [ODI3]). Diagnostic characteristics of MS, PSQ, MOS, and ODI3 were compared for detection of any (OAHI ≥ 1.5 events/h) and moderate-severe OSA (OAHI ≥ 5 events/h).</p><p><strong>Results: </strong>Forty-one children (age 7.0 years, 49% female) participated. Median OAHI was 0.6 events/h (IQR 0.3, 3.1); 16 (39%) had OAHI ≥ 1.5 events/h, 5 (12%) had OAHI ≥ 5 events/h. PSQ identified 36 (88%) participants with a score ≥ 0.33. One child had MOS ≥ 2; ODI3 was ≥ 4.3 in 8 (20%) and > 7 in 6 (15%). Mean MS was 3.6 (SD 2.1). MS had 81.2% sensitivity and 52.0% specificity for any OSA and 100% sensitivity and 44.4% specificity for moderate-severe OSA. A combination of MS and ODI3 improved diagnostic accuracy with an AUC of 98.3.</p><p><strong>Conclusion: </strong>MS demonstrated high sensitivity but low specificity for the detection of moderate-severe OSA. Video scores outperformed PSQ but were less accurate than oximetry. Combining MS and ODI3 yielded the strongest diagnostic characteristics. Video scores may aid in pediatric OSA screening.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 8","pages":"e71228"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964684","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}