Seminars in Dialysis最新文献

{"title":"Clinical Analysis of Heparin-Induced Thrombocytopenia due to Therapeutic Plasmapheresis With Heparin Anticoagulation.","authors":"Chenling Lv, Hongtao Liang, Fei Tian, Gang Liu, Weibi Chen, Yan Zhang","doi":"10.1111/sdi.13259","DOIUrl":"https://doi.org/10.1111/sdi.13259","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the clinical characteristics and treatment outcomes of heparin-induced thrombocytopenia (HIT) following therapeutic plasma exchange (TPE) with heparin anticoagulation in patients with neurological autoimmune diseases.</p><p><strong>Methods: </strong>Clinical data were prospectively collected from 158 patients (79 males, 79 females; mean age 37.49 ± 16.95 years) with neurological autoimmune diseases who underwent TPE in the neuro-intensive care unit between January 2016 and June 2024. For patients with continuous platelet decline after TPE, the 4Ts score was determined, and platelet factor 4 (PF4) antibody tests were performed. Their platelet counts, clinical complications (thrombosis and bleeding), treatment plans, outcomes, and prognoses before and after TPE were analyzed.</p><p><strong>Results: </strong>One hundred thirty-nine patients experienced at least one significant decrease in platelet count during TPE (average decrease 36.75 ± 19.63%), and the average 4Ts score was 3.55 ± 1.87 points. PF4 antibody testing was conducted on 23 patients with continuous platelet decline and 4Ts scores ≥ 4. Four PF4-positive patients were diagnosed with type II HIT and developed deep vein thrombosis. After heparin withdrawal, the platelet count gradually normalized after intravenous immunoglobulin (IVIG), nonheparin TPE, or argatroban/fondaparinux anticoagulant therapy (mean recovery time 8.17 ± 3.54 days). The platelet counts spontaneously recovered for the remaining 116 patients (mean recovery time 3.88 ± 2.66 days).</p><p><strong>Conclusion: </strong>Platelet counts should be dynamically monitored throughout TPE with heparin anticoagulation. Patients with continually decreasing platelet counts and an intermediate to high 4Ts score should be monitored for HIT. Heparin should be discontinued immediately for patients with type II HIT, and nonheparin anticoagulants, IVIG, or nonheparin TPE may be administered.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151870","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":"On the Cusp-A Questionnaire-Based Assessment of Implementing PIVOTAL Into UK Practice.","authors":"Sebastian Spencer, Samantha Hunter, Sunil Bhandari","doi":"10.1111/sdi.13250","DOIUrl":"10.1111/sdi.13250","url":null,"abstract":"<p><strong>Background: </strong>Anemia is a common occurrence in people with chronic kidney disease and end-stage kidney disease. Intravenous administration of iron is standard treatment for people undergoing maintenance hemodialysis. However, until the recent PIVOTAL randomized control trial, there was uncertainty around clinically effective regimens. This study found that among incident, people receiving hemodialysis in the first year, a proactive high-dose intravenous iron regimen was superior to reactive low-dose regimen, leading to reduced mortality and cardiac events. Our study investigated whether the research and guidelines have been successfully implemented into clinical care across the United Kingdom, identified barriers experienced, and explored our local hemodialysis population's awareness of the treatment they are receiving.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey using a convenient sample of UK-based kidney physicians working in the NHS and local people receiving hemodialysis. Two preconceived, standardized questionnaires were designed.</p><p><strong>Results: </strong>Forty physicians responded. Of these, 40% had implemented a proactive iron protocol, whereas 37.5% had not. Respondents acknowledged concerns about doses of iron and the need for local protocols. Thirty-seven patients responded to the patient questionnaire within our own hemodialysis unit. Fifty-one percent of patients reported to be receiving iron supplementation, of which 84% stated it was intravenous through their dialysis machine.</p><p><strong>Conclusions: </strong>We have not observed a paradigm shift in clinical practice and identified poor patient understanding of their treatment. Strategies to overcome barriers are necessary to introduce treatments that offer both clinical advantages and cost savings. Eliminating futile practice is challenging due to departmental prioritization and economic considerations. Traditionally, efforts to improve care are targeted towards newer therapies; however, there is an opportunity to improve implementation of current evidence.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"214-220"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568065","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":"Kinetic Modeling Programs for Hemodialysis Adequacy Focusing on Urea, Creatinine, Phosphate, and Beta-2-Microglobulin.","authors":"John T Daugirdas","doi":"10.1111/sdi.13252","DOIUrl":"10.1111/sdi.13252","url":null,"abstract":"<p><p>Here we describe six kinetic modeling programs that allow quantification of removal of urea, creatinine, phosphate, and beta-2-microglobulin. They can be used with asymmetric dialysis treatment schedules ranging from one to seven times per week. Once downloaded, the programs can be run locally from a personal computer without requiring connection to the internet. They have been designed to analyze solute removal in a single patient or in thousands of patients. Each program is contained in a single JavaScript-HTML text file, and all of the assumptions and equations used are easily accessible in uncompressed text format and are accompanied by comments and annotations. Inputs are in the form of comma-delimited files which can be imported from spreadsheets. Outputs appear in the form of web pages or as comma-delimited files that can be exported into spreadsheets for graphing and further analysis. This perspective focuses on describing the potential utility of these programs (two pertaining to urea, two to creatinine, one to phosphate, and one to beta-2-microglobulin) as well as two helper calculators, one that computes dialyzer mass transfer area coefficient for urea (K0A) from dialyzer specification chart urea clearance data, and another that can be used to calculate the phosphate binder equivalent dose.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"161-165"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights Into Peritoneal Dialysis Outcomes: An Approach Using Competing Risks Analysis.","authors":"Ana Cunha, Beatriz Gil Braga, Sofia Sousa, António Inácio, Yulia Shilyaeva, Joana Tavares, Maria João Carvalho, Isabel Fonseca, Anabela Rodrigues, Laetitia Teixeira","doi":"10.1111/sdi.13255","DOIUrl":"https://doi.org/10.1111/sdi.13255","url":null,"abstract":"<p><p>Peritoneal dialysis (PD) outcomes analysis presents challenges due to heterogeneous outcomes. Our study aims to evaluate mortality, transition to hemodialysis (HD), and kidney transplant (KT) rates and investigate potential baseline patient characteristics influencing these outcomes. We conducted an observational retrospective registry-based single-center cohort study involving 722 incident adult PD patients admitted between 1985 and 2022. Follow-up duration extended from PD initiation to the first occurrence of death (n = 143), transfer to HD (n = 313), or KT (n = 202). Utilizing competitive risks analysis, we calculated cumulative incidence (CI) functions and applied a Fine and Gray model to baseline variables to understand their impact. The majority of patients were female (n = 401; 55.54%), with an average age of 49.64 ± 15.80 years. Transfer to HD had the highest probability (CI of 0.38 at 60 months), followed by KT (CI of 0.27 at 60 months) and death (CI of 0.19 at 60 months). Diabetes correlated solely with death (HR 1.71 (0.18); p = 0.004). PD-first was associated with a lower risk of HD transfer (HR 0.76 (0.13); p = 0.036) and positively influenced KT (HR 1.73 (0.16); p < 0.01). Vascular access as the reason for PD selection was associated with death (HR 2.16 (0.19); p < 0.001). The main risk for PD patients is transitioning to HD, unaffected by baseline patient characteristics. PD-first option positively influences KT access, and mortality rates remain low and unaffected by this option, ensuring the safety of the technique. Vascular access-related PD initiations correlate with increased mortality, potentially due to comorbidities.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"207-213"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022517","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":"Two Cases of Acquired Reactive Perforating Collagenosis in Hemodialysis Patients.","authors":"Min Xu, Fale Cao, Shumei Shi","doi":"10.1111/sdi.13244","DOIUrl":"10.1111/sdi.13244","url":null,"abstract":"<p><p>Acquired reactive proliferating collagen (ARPC), usually associated with systemic diseases, is a rare skin disease characterized by the elimination of altered dermal collagen through the epidermis. Here, we report two cases of ARPC in maintenance hemodialysis patients, one of which is combined with type 2 diabetes, chronic renal failure, and hypertension and the other is combined with chronic renal failure and hypothyroidism. Two patients were treated with oral thalidomide and ebastine, local application of fluticasone propionate cream, and enhanced dialysis. After treatment, the itching and the rash significantly improved. We report for the first time that ARPC in patients with hemodialysis could be improved by oral thalidomide and antihistamines and local application of steroid. This report provides reference for guiding the understanding of ARPC and the new treatment of ARPC in hemodialysis patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"225-228"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391588","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":"Impact of the Causes of Arteriovenous Fistula Stenosis on the Patency Rate of Arteriovenous Fistula Following Percutaneous Transluminal Angioplasty.","authors":"Min Xia, Qi-En He, Wen-Jing Zhou, Zhu-Jun Wang, Yi-Shu Bao, Xue-Lin He","doi":"10.1111/sdi.13258","DOIUrl":"https://doi.org/10.1111/sdi.13258","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate the impact of the causes of arteriovenous fistula (AVF) stenosis on the 1-year primary patency rate of AVF following percutaneous transluminal angioplasty (PTA) and to identify the independent risk factors that affect vascular access patency post-PTA.</p><p><strong>Methods: </strong>In this investigation, we analyzed the clinical data of 78 patients who underwent successful PTA for dysfunctional autologous AVF in the Nephrology Department of our hospital between January 2020 and September 2022. The primary focus of this study was to observe the postoperative patency rate of AVF in these patients. Subsequently, the patients were categorized based on primary diseases, Charlson comorbidity index (CCI), AVF typing, and causes of AVF stenosis. The postoperative patency rates of AVF were then compared among the respective groups. To further analyze the relevant risk factors influencing vascular access patency following PTA, the Cox proportional hazard model was employed.</p><p><strong>Results: </strong>A total of 78 eligible patients who underwent PTA were included in this study revealing patency rates of 93%, 85%, 80%, and 72% at 3, 6, 9, and 12 months postoperatively, respectively. Analysis using the Kaplan-Meier curve indicated no significant association between the presence of diabetic nephropathy (p = 0.313) and AVF stenosis typing (p = 0.195) with post-PTA patency of AVF. However, the 1-year patency rate demonstrated notable differences, with higher rates observed in the CCI < 7 group compared with the CCI ≥ 7 group and similarly in the simple AVF stenosis group compared with the intimal hyperplasia group (p < 0.001). Furthermore, based on multivariate survival analysis (Cox regression model), the causes of AVF stenosis and CCI index were identified as independent risk factors influencing AVF patency following PTA (p < 0.05).</p><p><strong>Conclusion: </strong>Patients with intimal hyperplasia were found to have a higher likelihood of AVF restenosis compared with those with simple stenosis. Similarly, individuals with a high CCI were more prone to AVF restenosis than those with low CCI. The causes of AVF stenosis and CCI were identified as independent risk factors influencing vascular access patency following PTA.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"201-206"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044499","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":"One Nation-One Dialysis: Breaking Barriers, Empowering Lives.","authors":"Sourabh Sharma, Vivek Kute, Narayan Prasad, Sanjay Kumar Agarwal","doi":"10.1111/sdi.13253","DOIUrl":"10.1111/sdi.13253","url":null,"abstract":"<p><p>The objective of India's One Nation One Dialysis (ONOD) program is to remove the barriers that end-stage kidney disease patients face in accessing consistent, quality dialysis services across the nation. A unified and standardized dialysis care approach is what ONOD aims to achieve at a national level. The objective of ONOD is to improve access to, affordability of, and quality in dialysis services for economically weaker segments of society and those living in remote areas of the country by providing dialysis services through public-private partnerships. The ONOD program places a lot of emphasis on the infrastructure development, funding support, skill development, regulatory reforms, and technological integration of dialysis services. By implementing ONOD, India can improve patient outcomes, close the supply-demand gaps for end-stage kidney disease kidney replacement therapy, and create a more balanced and sustainable kidney healthcare ecosystem.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"166-175"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711215","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":"The Multidimensional Impact of Expanded Hemodialysis: A Comprehensive Review.","authors":"Georges Kosmadakis, Aura Necoara, Julien Baudenon, Clemence Deville, Ioana Enache, Elena Chelaru","doi":"10.1111/sdi.13257","DOIUrl":"https://doi.org/10.1111/sdi.13257","url":null,"abstract":"<p><p>Expanded hemodialysis (HDx) represents a transformative innovation in renal replacement therapy, addressing the limitations of conventional hemodialysis and high-flux modalities. By employing medium cut-off (MCO) membranes, HDx ensures efficient clearance of middle- and large-molecular-weight uremic toxins, such as β₂-microglobulin and cytokines, while selectively retaining vital proteins like albumin. This comprehensive review examines the clinical efficacy, safety, and broader implications of HDx, highlighting its potential to improve outcomes for patients with chronic kidney disease (CKD). The review synthesizes findings from comparative studies, emphasizing HDx's superior toxin removal capabilities, particularly for solutes implicated in systemic inflammation and cardiovascular complications. Key mechanisms, including the internal filtration-backfiltration process, contribute to hemodynamic stability and enhanced toxin clearance. HDx demonstrates significant reductions in inflammatory biomarkers, improved arterial compliance, and better cardiovascular outcomes compared with traditional methods. Patient-reported outcomes further underscore HDx's benefits, with shorter recovery times, enhanced quality of life, and reduced intradialytic complications. While albumin loss remains a consideration, studies confirm its clinical acceptability and minimal impact on nutritional status. HDx's economic viability, reduced infrastructure requirements, and compatibility with existing systems position it as a cost-effective alternative, especially in resource-limited settings. Despite promising evidence, the review identifies gaps in long-term data, particularly regarding mortality and sustained quality-of-life improvements. Future directions include refining membrane technologies and incorporating personalized medicine approaches to optimize HDx protocols. By bridging these gaps, HDx has the potential to redefine renal replacement therapy, offering a safer, more effective, and scalable solution for CKD management.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"176-186"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022589","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":"Comparative Outcomes of Tunneled and Non-Tunneled Catheters as Bridge to Arteriovenous Fistula Creation in Incident Hemodialysis Patients.","authors":"Himansu Sekhar Mahapatra, Muthukumar B, Chandra Krishnan, Tanvi Thakker, Lalit Pursnani, Renju Binoy, Beauty Suman, Md Mahboob Alam, Abhishek Jha, Vipul Gupta, Sutanay Bhattacharyya, Rajesh Tarachandani, Preeti Chaudhary","doi":"10.1111/sdi.13256","DOIUrl":"https://doi.org/10.1111/sdi.13256","url":null,"abstract":"<p><strong>Background: </strong>This study compares the outcomes of tunneled catheters (TCs) and non-tunneled catheters (NTCs) in incident hemodialysis patients undergoing early arteriovenous fistula (AVF) creation.</p><p><strong>Methods: </strong>Adult incident ESKD patients were randomized in two catheter groups (TC and NTC) for hemodialysis initiation and were followed for 12 weeks from March 2021 in a 3-year study period. Catheter salvage was attempted in both the groups until AVF maturation in cases of catheter-related bloodstream infection (CRBSI) or mechanical dysfunction. Catheter insertion and removal dates, infection episodes, and mechanical dysfunction events were recorded. CRBSI rates, dysfunction rates, and catheter survival were compared.</p><p><strong>Results: </strong>A total of 133 patients were randomized into TC (65) and NTC (68) groups. Seventy-six patients developed symptoms of CRBSI, of whom eight patients required catheter removal (TC: 2, NTC: 6). CRBSI episodes per 1000 catheter days were 15.14 for TCs and 16.85 for NTCs, but mechanical dysfunction rates were 0.96 and 1.68, respectively. By 6 weeks, one catheter was removed in the TC group (AVF maturation), and eight in the NTC group were removed (four due to AVF maturation, three due to CRBSI, and one due to mechanical dysfunction). Kaplan-Meier analysis showed significantly longer catheter survival for TCs compared to NTCs (66.9 vs. 57.9 days, p = 0.001).</p><p><strong>Conclusion: </strong>CRBSI rates and catheter patency were comparable between TCs and NTCs at 6 weeks, but TCs demonstrated better survival beyond this period. When early AVF creation is ensured, NTCs may serve as a viable short-term vascular access option, particularly in resource-limited settings.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"187-193"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029798","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":"Comparison of the Effects of Hemodialysis and Peritoneal Dialysis on Exhaled Nitric Oxide in Renal Replacement Therapy.","authors":"Buğra Kerget, Alperen Aksakal, İbrahim Ethem Doğdu, Can Sevinç, Edip Erkuş","doi":"10.1111/sdi.13254","DOIUrl":"10.1111/sdi.13254","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) and hemodialysis (HD) form the basis of renal replacement therapy (RRT) in patients with end-stage renal disease. Both methods have advantages, and in our study, we aimed to examine the effect of both methods on exhaled nitric oxide (FeNO) levels.</p><p><strong>Methods: </strong>Our study included RRT patients between 18 and 65 who our hospital's nephrology clinic followed up for at least 2 years. A total of 100 patients, 35 patients from both RRT groups and 30 healthy control groups, were included in our study. Echocardiography (ECHO) and FeNO measurements were performed.</p><p><strong>Results: </strong>In the comparison of the groups' mean pulmonary arterial pressure (PAP) and pre-RRT FeNO levels, it was observed that both levels were higher in HD patients compared to PD patients (p = 0.04, < 0.001, respectively). The control group observed that both predialysis and postdialysis FeNO levels in HD patients showed a statistically significant difference compared to the control group (p ≤ 0.001, 0.01, respectively). It was observed that mean arterial pressure (MAP) levels were higher in HD patients compared to PD patients before RRT (p = 0.01). FeNO positively correlated with age and gamma-glutamyl transferase (GGT) level (R = 0.542, p = 0.01, R = 0.629, p = 0.01, respectively).</p><p><strong>Conclusion: </strong>FeNO is known as an essential indicator of oxidative stress and inflammation. The higher FeNO level in HD patients compared to PD and its positive correlation with oxidative stress markers such as GGT suggest that PD may be more suitable for the physiological structure.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"194-200"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764953","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}