Seminars in Dialysis最新文献

{"title":"Creatinine Kinetic Modeling to Estimate Residual Kidney Creatinine Clearance in Patients Being Hemodialyzed Once or Twice Per Week.","authors":"John T Daugirdas, Piergiorgio Bolasco","doi":"10.1111/sdi.70009","DOIUrl":"https://doi.org/10.1111/sdi.70009","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of residual kidney function is potentially useful in patients receiving hemodialysis for risk stratification, adjusting the dialysis prescription, and early identification of renal function recovery. However, periodic urine collection is problematic. We examined the potential of predicting residual kidney creatinine (water) clearance (KrCrW) without urine collection using a creatinine kinetic model, which allows KrCrW to be estimated based on previously measured or anthropometrically estimated creatinine generation rate (GCr), volume of distribution (VdCr), and measured predialysis serum creatinine.</p><p><strong>Methods: </strong>Studies were done in 12 patients receiving once weekly hemodialysis and 12 other patients being dialyzed twice a week in whom KrCrW was measured by collection of urine. GCr and VdCr were taken either from the modeling outputs or were estimated from anthropometric values.</p><p><strong>Results: </strong>The mean modeled GCr was 1091 ± 377 (SD) mg/day, similar to the value predicted by an anthropometric equation suggested by Ix et al. (1198 ± 304). The mean kinetically modeled VdCr was 22.7 ± 2.4 L, somewhat lower than expected. The KrCrW from urine collection was 7.43 ± 4.07 mL/min. Predicted KrCrW from modeled GCr, modeled VdCr, and measured predialysis serum creatinine was similar (7.35 ± 4.01, r² = 0.987) with an average error less than 1%. When anthropometric estimates of GCr and VdCr were used as inputs, the mean modeled KrCrW was somewhat higher (8.66 ± 4.27, y = 1.09x, R² = 0.585) and the mean error was 1.23 ± 2.6 mL/min.</p><p><strong>Conclusions: </strong>Residual kidney creatinine clearance (KrCrW) can be estimated in patients receiving one or two dialysis treatments weekly based on creatinine kinetic modeling. Using anthropometric estimates of GCr and VdCr in the modeling equations yields similar values of KrCrW to those when modeled GCr and VdCr inputs are used, but with a substantial error. A strategy of using a baseline modeled values of GCr and VdCr for future KrCrW change prediction may be promising, but the stability of GCr over time needs to be confirmed.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213642","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":"Comparing Concurrent and Countercurrent Dialysate Flow in Hemodialysis: A Pilot Study on Hyponatremic Patients.","authors":"Amandeep Singh, Lalit Pursnani, Himansu Sekhar Mahapatra, Muthukumar Balakrishna, Manoj Prabhakaran, Abhishek Gautam, Anubhav Chakraborty","doi":"10.1111/sdi.70008","DOIUrl":"https://doi.org/10.1111/sdi.70008","url":null,"abstract":"<p><strong>Background: </strong>In hyponatremic patients, concurrent dialysate flow during hemodialysis may be an ideal option to mitigate complications such as osmotic demyelination syndrome (ODS).</p><p><strong>Methods: </strong>Present randomized controlled trial enrolled dialysis-requiring chronic kidney disease (CKD) and acute kidney injury (AKI) patients with serum sodium levels < 125 mEq/L during January 2020 over 16 months. Hemodynamically unstable patients, as well as those with a history of seizures and neurological conditions, were excluded. All were randomized to concurrent and countercurrent dialysate flow groups during two-h dialysis session. Hydration status was evaluated by Body Composition Monitor BCMTM and hourly sodium was estimated to guide ultrafiltration. Comparative analysis of sodium correction rates (meq/L/h) during dialysis, neurological deterioration via Mini-Mental State Examination (MMSE) scores, and ODS during 1 week and 1 month in both groups was done. Two-way repeated measures ANOVA was used to compare sodium correction trends.</p><p><strong>Results: </strong>A total of 44 hyponatremic patients of AKI (17.39%), CKD (56.52%) and acute on CKD (26.09%) were randomized to concurrent (n = 23) and countercurrent (n = 21) dialysate groups. Postdialysis sodium correction rate was nonsignificantly slower in the concurrent group (45.45%) vs. the countercurrent group (36.36% group, p = 0.44). Neurological deterioration, measured via MMSE scores, and ODS incidence were absent in both groups. The concurrent group exhibited a higher proportion of patients without neurological deterioration (73.91%) compared to the countercurrent group (57.14%, p = 0.241). Comparable survival between the two groups was seen at 10, 20, and 30 days. No significant risk factors for mortality were identified in either group.</p><p><strong>Conclusion: </strong>Concurrent dialysate flow demonstrates a slower but nonsignificant rate of sodium correction, making it a safer alternative for managing severe hyponatremia during hemodialysis by reducing the risk of rapid neurological shifts.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016185","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":"Effects of Insulin Dosage Adjustment on Hemodialysis Day for Blood Glucose Levels, Glycated Albumin, Interleukin-6, and TNF-α in Patients With Type 2 Diabetes Mellitus and End-Stage Renal Disease.","authors":"Hendra Zufry, Krishna Wardhana Sucipto, Agustia Sukri Ekadamayanti, Sarah Firdausa, Maulina Debbyousha","doi":"10.1111/sdi.70007","DOIUrl":"https://doi.org/10.1111/sdi.70007","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggested adjusting insulin doses during hemodialysis to reduce intra- and post-hemodialysis hypoglycemia. However, the impact of insulin adjustment on cardiovascular morbidity and mortality in diabetic patients with end-stage renal disease (ESRD) remains unclear. Although reducing hypoglycemia is a well-documented benefit of insulin dose modification in this population, the broader metabolic and inflammatory consequences-particularly those related to cardiovascular risk-are not well understood. This study aimed to investigate the effects of a 25% reduction in total daily insulin dose on hemodialysis days in T2DM patients with ESRD, focusing on daily blood glucose profiles, glycated albumin, IL-6, and TNF-α.</p><p><strong>Methods: </strong>A multicenter study with clinical trials was designed in five hemodialysis centers. It was a 4-week clinical trial involving 17 eligible type 2 diabetic patients with ESRD on insulin therapy and regular hemodialysis. Self-monitoring blood glucose was performed seven times a day before, during, and 1 month after the intervention. Blood samples were collected before and after the intervention. The Wilcoxon test was used to assess differences in daily glucose profiles, glycated albumin, IL-6, and TNF-α before and after insulin dose adjustment.</p><p><strong>Results: </strong>After 1 month of adjusting total daily insulin dose during hemodialysis, no statistically significant difference was observed in daily blood glucose, IL-6, and TNF-α levels. However, glycated albumin levels increased both before and after the insulin dosage modification.</p><p><strong>Conclusions: </strong>Reducing the total daily insulin dose by 25% during hemodialysis day effectively reduces hypoglycemia incidence intra- and post-hemodialysis in T2DM patients with ESRD without impacting pro-inflammatory factors IL-6 and TNF-α, which are associated with increased cardiovascular morbidity and mortality risk.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967340","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":"Adrenal Insufficiency in Dialysis Patients.","authors":"Stéphane Roueff, Hélène Lazareth, Julien Riancho, Laurence Amar","doi":"10.1111/sdi.70004","DOIUrl":"10.1111/sdi.70004","url":null,"abstract":"<p><p>The aim of this review is to summarize the literature on the pathophysiology, diagnosis, and etiology of adrenal insufficiency (AI) in dialysis patients. The prevalence of AI in dialysis patients is unknown, and AI appears to be an uncommon complication associated with dialysis. Data in the literature on the impact of chronic kidney disease and dialysis on adrenal function give conflicting results. Patients with end-stage renal disease are at risk of hypercortisolism due to loss of the nychthemeral cortisol cycle. Dialysis itself may lead to a rebound in cortisol synthesis at the end of dialysis session. Nevertheless, it has recently been suggested that dialysis vintage was associated with loss of adrenal function and with the onset of AI, and that among chronically hypotensive dialysis patients, the prevalence of AI may be as high as 20%. In dialysis patients, adrenal function is preserved, and AI is rare. AI is difficult to diagnose and often goes unnoticed, as symptoms are nonspecific and diminish with dialysis, which partially corrects them. Diagnosis is therefore delayed and often occurs during an adrenal crisis. For hemodialysis patients, diagnosis is based on blood cortisol measurements before and after an ACTH stimulation test, which are performed at the start of dialysis, regardless of the dialysis session schedule. Salivary cortisol measurements can be used instead of blood cortisol measurements for peritoneal dialysis patients to avoid venipunctures. Situations suggestive of AI in dialysis patients include history or current low-dose corticosteroid therapy, unexplained chronic arterial hypotension, recurrent hypoglycemia, and unexplained hypercalcemia.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"261-266"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761201","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":"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":"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":"267-275"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","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":"The Effects of Glucose-Containing Dialysate on Cardiovascular and Cerebrovascular Outcome Events in Hemodialysis Patients.","authors":"Mengyu Wu, Yang Li, Xiangyu Hou, Wenqiang Zhang, Zunsong Wang","doi":"10.1111/sdi.70005","DOIUrl":"10.1111/sdi.70005","url":null,"abstract":"<p><p>For patients with end-stage renal failure, hemodialysis is a crucial renal replacement therapy, which is meaningful to alleviate patients' symptoms and prolong survival. The principle of hemodialysis is to exchange the substances in the blood and dialysis solution through a semipermeable membrane and to discharge the excess water, metabolic waste, and electrolytes into the dialysis solution, which can balance the water, electrolytes, and acid-base. However, patients on maintenance hemodialysis are at high risk of developing cardiovascular and cerebrovascular diseases. Therefore, the composition of dialysis fluid has been widely studied, and the use of sugar-containing dialysis fluid can reduce the incidence of hypoglycemia, hypotension, and cardiovascular and cerebrovascular complications in hemodialysis patients. This article reviews the effects of current glucose-containing dialysate on cardiovascular and cerebrovascular outcome events in hemodialysis patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"231-236"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795304","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 Heparin Hemodialysis Catheter Lock on Partial Thromboplastin Time Assays in Inpatients on Therapeutic Intravenous Heparin.","authors":"Thomas S Tuggle, Lama Noureddine, Ryan A Hobbs","doi":"10.1111/sdi.13260","DOIUrl":"10.1111/sdi.13260","url":null,"abstract":"<p><strong>Objective: </strong>Multiple in vitro and in vivo studies indicate that there is a significant amount of dialysis catheter lock leak with tunneled and nontunneled dual lumen hemodialysis (HD) catheters. The impact of heparin 1000 unit/mL HD catheter lock on outcomes in patients on therapeutic heparin has not been previously reported.</p><p><strong>Methods: </strong>Twenty-nine patients with 42 patient events on HD or continuous renal replacement therapy (CRRT) via double lumen catheters were retrospectively analyzed. Study patients received heparin 1000 unit/mL HD catheter lock while on therapeutic intravenous heparin. All patients had stable activated partial thromboplastin times (PTT) prior to catheter locking and had a PTT drawn within 6 h after administration of the heparin HD catheter lock.</p><p><strong>Results: </strong>The average prelock PTT was 56 s and postlock PTTs increased on average to 85 s (p < 0.0001). PTTs were significantly higher when drawn closer to the administration time of the heparin catheter lock. Major bleeding occurred in many surgical patients after heparin HD catheter lock administration.</p><p><strong>Conclusion: </strong>Citrate or saline HD catheter lock may be preferable to heparin HD catheter lock in patients on intravenous heparin infusions, especially in high-bleed-risk surgical patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"282-285"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235064","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":"Method for Predict Stenosis of Arteriovenous Fistula Patients Based on Machine Learning.","authors":"Yunghsin Chen, Wei-Tse Hsu, Christopher Chen, Wei-Ta Chen","doi":"10.1111/sdi.70001","DOIUrl":"10.1111/sdi.70001","url":null,"abstract":"<p><strong>Objectives: </strong>Arteriovenous fistula (AVF) is the most ideal vascular access for hemodialysis. People with AVF have a longer vascular access survival rate and a lower complication rate. Thrombosis and stenosis are the most common complications of AVF. The annual thrombosis event rate is 10%-50%. Appropriate identification of AVF stenosis and management could reduce the risk of thrombosis and access loss. Guidelines recommended physical examinations as the first line of AVF stenosis monitoring. However, even for health professionals, the diagnosis rate by hearing the bruit varied. The sound waves of AVF can be recorded by electronic stethoscopes and the analysis of the digitalized signal may help predict stenosis of AVF and trigger the next step of management.</p><p><strong>Methods: </strong>From January 1, 2019, to December 31, 2019, all dialysis patients with AVF referred to our angiography laboratory for AVF angiography were enrolled. Significant stenosis was defined as stenosis severity > 70% on angiography. The stenosis severities were measured before and after the angioplasty. Before and after the angioplasty/angiography, the sounds of AVF were digitally recorded by an electrical stethoscope. Two sections longer than 10 s were obtained at different sites for each recording. Seventy percent of all the data was used to train the machine learning algorithm. The other 30% was used for testing. For the output of the algorithm, the AVF stenosis severity was classified into significant stenosis or non-significant stenosis.</p><p><strong>Results: </strong>One hundred ninety-nine patients were enrolled. Ninety-six patients were with significant stenotic AVF and the other 103 patients were with insignificant stenosis. One hundred eighty-nine recording sections for significant stenosis and 511 recording sections for insignificant stenosis were obtained. The machine learning artificial intelligence can classify the input sound waves as significant or insignificant stenosis with a 94.1% sensitivity rate and an 81.7% specificity rate.</p><p><strong>Conclusions: </strong>Artificial intelligence can help predict AVF stenosis by analyzing the digitalized sound waves of AVF. This analysis is convenient and non-invasive. Moreover, this technique can help the development of a remote monitor of AVF stenosis, which is especially important in the era of the COVID-19 pandemic.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"276-281"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542159","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 Intervention Effect of Digital Health Technology on Anxiety, Depression, and Treatment Adherence in Maintenance Hemodialysis Patients: A Meta-Analysis.","authors":"Yiting Wang, Hua Kang, Fan Yang, Huiyu Hu","doi":"10.1111/sdi.70002","DOIUrl":"10.1111/sdi.70002","url":null,"abstract":"<p><p>A systematic assessment was conducted to evaluate the effectiveness of digital health technology interventions on anxiety, depression, and treatment adherence in maintenance hemodialysis patients. A computerized search of 10 databases of randomized controlled trials of digital health technologies on anxiety, depression, and treatment adherence in maintenance hemodialysis patients was conducted for the period from database construction to December 5, 2024, and a meta-analysis of the included literature was performed using RevMan 5.4 and Stata 15.0 software to evaluate the level of evidence-based on GRADE. A total of 13 papers were included with 1063 maintenance hemodialysis patients. Meta-analysis results showed that digital health technology could reduce anxiety and depression and improve treatment adherence of maintenance hemodialysis patients. Digital health technology has a positive effect on anxiety, depression, and treatment adherence in maintenance hemodialysis patients. However, due to the limitations of the quality and quantity of included studies, as well as the heterogeneity of the findings, further validation of the results is necessary through the inclusion of more high-quality studies.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"250-260"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683029","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":"Peritoneal Dialysis Catheter Breaks-Do Not Let It Break Your Heart!","authors":"Veenaa Manjari S, Rajeevalochana Parthasarathy, Sanjeev Nair, Anwin Tom Thomas, Suwetha T","doi":"10.1111/sdi.70003","DOIUrl":"10.1111/sdi.70003","url":null,"abstract":"<p><p>PD catheter breaks are rare and can occur spontaneously or traumatically. Breaks may cause peritonitis due to wet contamination. We describe the management of three unique cases of catheter breaks without interruption of treatment. We salvaged two PD catheters with breaks that were proximal to the exit site with minimally invasive procedures. Even though one patient required removal of the catheter, a new catheter was exchanged over a guidewire and used immediately. PD therapy was continued without any complications. Out of the box thinking and repair of PD catheter breaks prevents removal and extends its life.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"295-298"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761202","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}