Saudi Journal of Anaesthesia最新文献

{"title":"Association of high thoracic erector spinae plane block and serratus posterior superior intercostal plane block for postoperative analgesia in rib removal surgery.","authors":"Paolo Scimia, Massimiliano L D'Agostino, Antonio De Cato, Luca Gentili","doi":"10.4103/sja.sja_819_25","DOIUrl":"https://doi.org/10.4103/sja.sja_819_25","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"476-477"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779834","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":"Effectiveness of dexmedetomidine versus fentanyl on postoperative pain and recovery after pediatric tonsillectomy: A retrospective cohort study.","authors":"Mohammad Jallad, Bander AlAnazi, Abdulaziz Aloqbawi, Muneera Albuthi, Ahmed Haroun M Mahmoud, Muhammad Imran Khan, Abdullah AlDhuwaihy, Faisal Alzuhayri, Mostafa Nagy","doi":"10.4103/sja.sja_788_25","DOIUrl":"https://doi.org/10.4103/sja.sja_788_25","url":null,"abstract":"<p><strong>Background: </strong>Pediatric tonsillectomy is commonly associated with significant postoperative pain. Opioids remain a mainstay for perioperative analgesia but carry risks of respiratory depression and prolonged recovery, especially in patients with obstructive sleep apnea (OSA). Dexmedetomidine, an alpha-2 adrenergic agonist, provides sedation and analgesia with minimal respiratory depression.</p><p><strong>Objective: </strong>To compare intraoperative induction with fentanyl versus dexmedetomidine and their effects on postoperative pain, post-anesthesia care unit (PACU) length of stay, and opioid consumption in children undergoing tonsillectomy.</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of pediatric patients aged 3-16 years, who underwent tonsillectomy at King Abdullah Specialized Children's Hospital between January 2024 and December 2024. Patients were grouped by intraoperative induction regimen: fentanyl or dexmedetomidine. Outcomes included PACU pain scores, postoperative opioid use, PACU stay, adverse events, and hospital stay. Shapiro-Wilk was used to test normality; Mann-Whitney U was used when comparing continuous variables, and chi-square/Fisher was used when comparing categorical variables. Controlled logistic and linear regressions were used to adjust for the age, weight, and duration of a surgery. The analyses were conducted using Python 3.10.</p><p><strong>Results: </strong>A total of 250 patients were analyzed (dexmedetomidine <i>n</i> = 125; fentanyl <i>n</i> = 125). PACU pain scores did not differ significantly between groups (<i>P</i> = 0.154). Postoperative morphine use was not significantly different (<i>P</i> = 0.316). Median PACU stay was longer in the dexmedetomidine group (<i>P</i> = 0.002). Adverse event rates were lower in the adjusted analysis (OR: 0.11; 95% CI: 0.014-0.926). Hospital stay was comparable.</p><p><strong>Conclusion: </strong>Dexmedetomidine induction provides comparable analgesia to fentanyl while reducing adverse events, although it is associated with longer PACU stay. It may represent a safe opioid-sparing option in pediatric tonsillectomy, particularly in high-risk children.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"245-248"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779914","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":"Refractory cardiac arrest during epidural anesthesia for caesarean section in a patient with supra-systemic pulmonary hypertension rescued by VA ECMO.","authors":"Nisar A Soomro, Raed S Altowairki, Riaz N Ahmed, Wesam I Kurdi","doi":"10.4103/sja.sja_899_25","DOIUrl":"https://doi.org/10.4103/sja.sja_899_25","url":null,"abstract":"<p><p>Patients with severe pulmonary arterial hypertension (PAH) tolerate the hemodynamic changes of pregnancy poorly and should be referred early to an experienced expert multidisciplinary team (MDT) in a tertiary care center early in pregnancy. Idiopathic pulmonary arterial hypertension, which is PAH without a known cause, is classified under group 1 of WHO classification of pulmonary hypertension. Current consensus guidelines and expert opinion recommend scheduled caesarean section under epidural anesthesia or combined low dose spinal-epidural anesthesia as the preferred mode of delivery and anesthesia in patients with PAH. However severe hemodynamic instability secondary to pulmonary hypertensive crises (PHC) or right ventricular failure can occur during the perioperative period and can precipitate refractory cardiac arrest. In this situation, timely institution of veno-arterial extracorporeal membrane oxygenation (VAECMO) can be lifesaving. Here we report the case of a patient with severe idiopathic PAH, who developed pulmonary hypertensive crisis, catecholamine-resistant hypotension and refractory cardiac arrest during establishment of epidural anesthesia for elective caesarean section, who was successfully rescued with VA ECMO.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"470-472"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780186","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 novel technique of peripheral nerve blocks and sedation as primary anesthetic technique for adult emergency hip fracture surgery: A retrospective propensity matched study.","authors":"Angelina Low, David Bettan, Sean Jeffries, Avinash Sinha, Eric Pelletier, Oliver Cafferty, Pascal Laferriere-Langlois, Michel Malo, Thomas M Hemmerling","doi":"10.4103/sja.sja_891_25","DOIUrl":"https://doi.org/10.4103/sja.sja_891_25","url":null,"abstract":"<p><strong>Background: </strong>No study has evaluated peripheral nerve block as the primary anesthetic technique in adult hip fracture surgery. This retrospective cohort study compares peri-operative outcomes between spinal anesthesia and peripheral nerve block with sedation (block-sedation) in adult emergency hip fracture surgery.</p><p><strong>Methods: </strong>Adult patients who underwent hip fracture repair at Fleury Hospital between 2018 and 2025 were screened (<i>n</i> = 503). Of these, patients receiving planned spinal anesthesia (<i>n</i> = 238) or block-sedation (<i>n</i> = 230) were identified. Primary outcome was the success rate of block-sedation in emergency hip fracture surgery, defined as the proportion of patients in whom block-sedation was used without conversion to another anesthetic technique. Secondary outcomes included peri-operative opioid requirement (MME), postoperative pain, intra-operative anesthetic requirements (i.e., ketamine, midazolam, propofol), post-anesthesia care unit (PACU) stay, hospital length of stay, and intra-operative hypotension requiring inotropes.</p><p><strong>Results: </strong>Block-sedation was successful without conversion in 98.1% of patients; four patients (1.9%) required conversion to general anesthesia and were excluded from peri-operative outcomes. Median PACU stay was longer in the spinal group (54 min, IQR 42-72) compared with block-sedation (36 min, IQR 27-53; <i>P</i> < 0.001) The incidence of hypotension requiring inotropes was higher in the spinal group (53.0%) compared with the block-sedation group (19.4%; <i>P</i> < 0.001). Postoperative pain scores were comparable between groups (<i>P</i> = 0.126), and postoperative hospital length of stay was also similar (<i>P</i> = 0.416).</p><p><strong>Conclusion: </strong>In this propensity-matched cohort study, block-sedation was feasible and safe for MIS hip fracture surgeries, with a high success rate (>98%) and low conversion to general anesthesia.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"332-338"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779699","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":"Cadaveric dissection studies in regional anesthesia - A comprehensive bibliographic analysis.","authors":"Abhijit S Nair, P M Navveen, Reshma Nath, Sandeep Diwan","doi":"10.4103/sja.sja_724_25","DOIUrl":"https://doi.org/10.4103/sja.sja_724_25","url":null,"abstract":"<p><p>The anatomical basis and safety optimization of regional anesthesia techniques are supported by cadaveric studies. However, the development of this field of study has not been thoroughly documented. To map publication trends, collaborative networks, and emerging themes in cadaveric studies on regional anesthesia, we conducted a bibliometric analysis. A Scopus database search using the keywords 'cadaveric studies' and 'regional anesthesia' revealed 298 articles from inception till May 2025. The comma-separated values (CSV) file was uploaded to the VOS viewer and CiteSpace software for analyzing various bibliometric parameters like bibliographic coupling, citation, co-authorship, co-occurrence, and co-citation. The results revealed that most of the work was done and published in high-income countries (the United States, the United Kingdom, and Canada), in established universities (University of Toronto, Canada), and in high-impact journals (Regional Anesthesia and Pain Medicine). Future studies should prioritize multicenter, cross-cultural cadaveric validations, standardized anatomical nomenclature, and stronger collaboration among anatomists and anesthesiologists to translate cadaveric insights into clinical protocols and enhance patient safety.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"418-425"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779805","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":"Anesthetic considerations in smokers: A scoping review.","authors":"Ahad N Yamani, Abdulrahman Almazrooa","doi":"10.4103/sja.sja_576_25","DOIUrl":"https://doi.org/10.4103/sja.sja_576_25","url":null,"abstract":"<p><p>Tobacco smoking is a well-established modifiable risk factor that significantly influences perioperative outcomes through complex physiological and pharmacological mechanisms. Despite widespread awareness of its long-term health consequences, a considerable proportion of surgical patients continue to smoke at the time of their procedures. The objective of this review is to synthesize current evidence regarding the impact of smoking on anesthetic management. Smoking induces chronic inflammation and structural changes in the respiratory tract, which may increase the risk of intraoperative hypoxemia, bronchospasm, and postoperative pulmonary complications. Cardiovascular risks are similarly elevated due to smoking-related endothelial dysfunction, increased sympathetic activity, and impaired myocardial oxygen balance. Moreover, nicotine and other components of tobacco smoke alter drug metabolism, particularly via hepatic enzyme induction, affecting the pharmacokinetics of commonly used anesthetics and analgesics. Smokers also exhibit altered pain perception and increased opioid requirements postoperatively, complicating analgesic strategies. In conclusion, an in-depth understanding of the multifaceted effects of smoking on anesthetic care is essential for optimizing outcomes and reducing perioperative morbidity in this high-risk group.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"399-404"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779807","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":"Evaluating the pain management among postoperative patients in Saudi Arabia: A cross-sectional study.","authors":"Rothana M Aljehani, Yara Alorfi, Lama Alharbi, Haneen Alharbi, Sadeem Alharbi, Miad Alhamrani, Mohammed Almarjan","doi":"10.4103/sja.sja_806_25","DOIUrl":"https://doi.org/10.4103/sja.sja_806_25","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain is one of the most common and distressing consequences of surgery, with inadequate pain management contributing to delayed recovery, increased morbidity, and reduced patient satisfaction. Despite advances in analgesic techniques, patients in many healthcare systems continue to report poor outcomes. This study aimed to evaluate pain management practices and patient satisfaction among postoperative patients in Saudi Arabia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from June to September 2025 across multiple hospitals in Saudi Arabia. A total of 688 adult patients who had undergone surgery within the previous 1-4 weeks participated. Data were collected using a structured, bilingual questionnaire covering demographics, surgical type, pain experience, methods of pain assessment, management strategies, satisfaction levels, and cultural influences on pain expression. Statistical analyses included descriptive statistics, Chi-square tests, independent <i>t</i>-tests, and one-way analysis of variance (ANOVA), with significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>Of the 688 participants, 52.8% were female, and the majority (95.3%) were Saudi nationals. Most respondents were treated in government hospitals (63.5%) and underwent general (26.9%) or obstetric/gynecological surgery (19.5%). The mean postoperative pain score was 5.29 (SD: 2.94), with 76.2% reporting pain. Pain assessment was inconsistent; 39.4% reported being assessed using numeric scales, while an equal proportion indicated no assessment. The most common management methods were intravenous analgesics (52.2%) and oral medications (44.6%), with nonpharmacological approaches rarely used (1.5%). Overall satisfaction was moderate to high, with 78.8% reporting being satisfied or very satisfied.</p><p><strong>Conclusion: </strong>Postoperative pain remains prevalent and often under-assessed in Saudi Arabia. Although satisfaction levels were generally favorable, significant disparities exist across sex, age, and surgical type. Standardizing pain assessment tools and implementing tailored, multimodal management strategies could improve patient outcomes and overall satisfaction.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"302-308"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780020","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":"Pulse pressure variation versus central venous pressure guided fluid management therapy in kidney transplant recipients: A single-blinded prospective randomized control study.","authors":"Saurabh Gupta, Divesh Arora","doi":"10.4103/sja.sja_915_25","DOIUrl":"https://doi.org/10.4103/sja.sja_915_25","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease (ESRD) necessitates renal transplantation, where precise fluid management is essential for graft perfusion and function. Central venous pressure (CVP) is traditionally used, but the optimal strategy is uncertain. Pulse pressure variation (PPV), a dynamic index, may better predict fluid responsiveness. This randomized trial compared PPV- versus CVP-guided fluid therapy in kidney transplant recipients.</p><p><strong>Methods: </strong>Fifty ESRD patients undergoing renal transplantation were randomly divided into two groups (n = 25 each). Group A received intraoperative fluid therapy guided by PPV, while Group B followed CVP-guided fluid therapy. The primary outcome was total intraoperative fluid administered. Secondary outcomes included total urine output, time to onset of diuresis, incidence of hypotensive episodes, and post-reperfusion lactate levels. Data were analyzed with independent t-tests or Mann-Whitney tests for continuous variables and Fisher's exact test for categorical variables; <i>P</i> < 0.05 denoted significance.</p><p><strong>Results: </strong>Total fluid administration was significantly lower in the PPV group (1862 ± 327 mL) than in the CVP group (2480 ± 355 mL; <i>P</i> < 0.0001). Intraoperative urine output was higher with PPV guidance (996 ± 348 mL vs. 820 ± 141 mL; <i>P</i> = 0.026). The time to diuresis was shorter in the PPV group (median 1 min [IQR 1-2] vs. 2 min [IQR 1-3]; <i>P</i> = 0.0008). Incidence of hypotension and lactate levels post clamp release did not differ between groups.</p><p><strong>Conclusion: </strong>PPV-guided therapy reduced fluid requirements and accelerated diuresis without increasing hypotension or lactate levels, supporting dynamic over static preload indices for optimizing graft perfusion.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"369-374"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780123","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":"The Hennepin double tube technique: A breakthrough in airway management for tracheal tumor removal.","authors":"Paramitha P Hapsari, Muhammad R Aditya, Maya A Saphira","doi":"10.4103/sja.sja_628_25","DOIUrl":"https://doi.org/10.4103/sja.sja_628_25","url":null,"abstract":"<p><p>A 47-year-old man was diagnosed with a tracheal mass with a narrowed airway at the level of vertebrae thoracalis 2-4 (T2 - T4). He was scheduled for sternotomy. The patient's clinical condition was considered ASA III. We used fiberoptic bronchoscopy (FOI) to visualize the tumor's location and employed double endotracheal tubes to manage the airway difficulties. The first endotracheal tube was inserted orally into the trachea until it passed the tumor to provide primary airway control. Once the ventilator was connected, the second tube was repositioned below the tumor to maintain airway patency. After the surgery, the patient was transferred to the intensive care unit (ICU) for close monitoring of maintaining respiratory stability and preventing complications. The patient recovered well with stable vital signs and effective pain control.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"449-451"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779462","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":"Effect of e-health literacy on preoperative anxiety in patients undergoing gynecologic surgery: A cross-sectional study.","authors":"Merve B Yediyıldız, İrem Durmuş, Kübra Taşkın, Esra Keleş, Ayşe Demirden, Hülya Y Ak, Murat Api","doi":"10.4103/sja.sja_715_25","DOIUrl":"https://doi.org/10.4103/sja.sja_715_25","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety (PA) is a common condition that can negatively affect surgical outcomes. As digital health resources become more integrated into patient care, e-health literacy (eHL) is gaining importance as a determinant of surgical readiness and emotional well-being. This study aimed to evaluate the relationship between eHL and PA in patients undergoing elective gynecologic surgery.</p><p><strong>Methods: </strong>This cross-sectional study was conducted at a tertiary hospital between June and November 2024. Patients scheduled for elective gynecologic surgery were included. Participants completed the sociodemographic form, eHealth Literacy Scale (eHEALS), and the State-Trait Anxiety Inventory (STAI-I and STAI-II) during their preoperative anesthesia consultation.</p><p><strong>Results: </strong>A total of 325 patients scheduled for elective gynecologic surgery were included. The mean eHEALS score was 35.1 ± 8.4, with 47.7% of patients classified as having high eHL. Patients with higher eHL were significantly younger (<i>P</i> < 0.05), had lower BMI (<i>P</i> < 0.05), and had higher educational attainment (<i>P</i> < 0.05). High eHL was associated with lower state anxiety scores (38.3 ± 8.6 vs. 47.2 ± 7.7, <i>P</i> < 0.05) and trait anxiety scores (42.2 ± 7.7 vs. 49.4 ± 8.2, <i>P</i> < 0.05). Patients with higher eHL reported lower postoperative pain scores and were more likely to perceive themselves as well-informed about their surgery (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>Higher eHL is significantly associated with lower PA in patients undergoing gynecologic surgery. These findings highlight the importance of digital health competencies in surgical preparedness.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"20 2","pages":"249-254"},"PeriodicalIF":1.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779883","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}