Stroke最新文献

{"title":"Proteinopathies and the Neurodegenerative Aftermath of Stroke: Potential Biomarkers and Treatment Targets.","authors":"Josh Allen, Charlotte M Ermine, Runxuan Lin, Geoffrey C Cloud, Sandy R Shultz, Pablo M Casillas-Espinosa","doi":"10.1161/STROKEAHA.124.049279","DOIUrl":"10.1161/STROKEAHA.124.049279","url":null,"abstract":"<p><p>Stroke remains a predominant cause of death and long-term disability among adults worldwide. Emerging evidence suggests that proteinopathies, characterized by the aggregation and accumulation of misfolded proteins, may play a significant role in the aftermath of stroke and the progression of neurodegenerative disorders. In this review, we explore preclinical and clinical research on key proteinopathies associated with stroke, including tau, Aβ (amyloid-β), TDP-43 (TAR DNA-binding protein 43), α-synuclein, and UCH-L1 (ubiquitin C-terminal hydrolase-L1). We focus on their potential as biomarkers for recovery management and as novel treatment targets that may enhance neuronal repair and mitigate secondary neurodegeneration. The involvement of these proteinopathies in various aspects of stroke, including neuroinflammation, oxidative stress, neuronal damage, and vascular dysfunction, underscores their potential. However, further investigations are essential to validate the clinical utility of these biomarkers, elucidate the mechanisms connecting proteinopathies to poststroke neurodegeneration, and develop targeted interventions. Identifying specific protein signatures associated with stroke outcomes could facilitate the advancement of precision medicine tailored to individual patient needs, significantly enhancing the quality of life for stroke survivors.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1600-1611"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvenous Approach for the Treatment of Cerebral Arteriovenous Malformations: A Randomized Comparison With Transarterial Embolization.","authors":"Jean Raymond, Tim E Darsaut, Suzana Saleme, Aymeric Rouchaud, Daniela Iancu, Daniel Roy, Alain Weill, Leonardo Olijnyk, Roland Jabre, Michel W Bojanowski, Chiraz Chaalala, David Roberge, Kamel Boubagra, Olivier Heck, Jeremy L Rempel, Chrysanthi Papagiannaki, Xavier Barreau, Gaultier Marnat, Jean-Christophe Gentric, Julien Ognard, Lorena Nico, Marc Bintner, Pascale Gauthier Lasalarie, Jean-Brice Veyrieres, Michel Piotin, Simon Escalard, Vitor M Pereira, Daniel G Abud, Justine Zehr, Miguel Chagnon, Thanh N Nguyen, David Mathieu, Guylaine Gevry, Ruby Klink, Emmanuelle Lorian, Charbel Mounayer","doi":"10.1161/STROKEAHA.124.049109","DOIUrl":"10.1161/STROKEAHA.124.049109","url":null,"abstract":"<p><strong>Background: </strong>Transvenous embolization (TVE) is a new treatment of brain arteriovenous malformations (AVMs). The safety and efficacy of TVE have not been compared with transarterial embolization (TAE). The primary hypothesis of this trial was that TVE would increase the proportion of AVM occlusion from 40% to 80%.</p><p><strong>Methods: </strong>The TATAM (Transvenous Approach for the Treatment of Cerebral AVMs) was an investigator-initiated, multicenter, prospective, phase 2, open-label, controlled randomized trial comparing TVE versus TAE alone (1:1). Patients with symptomatic or asymptomatic AVMs considered curable with 2 endovascular sessions were reviewed by a case selection committee. Participating centers were experienced (>20 cases) or proctored by experts. The primary outcome was complete occlusion of the AVM, confirmed by catheter angiography at 3 to 6 months. There was no blinding. Primary analyses were intent-to-treat.</p><p><strong>Results: </strong>From May 2019 to April 2023, 77 patients were recruited in 7 French and 2 Canadian centers. After exclusions, results from 69 patients were analyzed; 35 were allocated TVE and 34 TAE. The mean age of participants was 43.3 years; 29 of 69 (42%) were female. There were 2 crossovers. The primary outcome was reached in 29 of 35 patients with TVE (83% [95% CI, 67%-92%]) compared with 20 of 34 patients allocated TAE (59% [95% CI, 42%-74%]; <i>P</i>=0.036). Poor outcomes (modified Rankin Scale score >2 at 3-6 months) occurred in 7 of 35 patients with TVE (20% [95% CI, 10%-36%]) and 9 of 34 patients with TAE (27% [95% CI, 15%-43%]; <i>P</i>=0.578) and related serious adverse events in 12 of 35 patients with TVE (34% [95% CI, 21%-51%]) and 14 of 34 patients with TAE (41% [95% CI, 26%-58%]; <i>P</i>=0.624).</p><p><strong>Conclusions: </strong>TVE was more effective than TAE in terms of angiographic results at 3 to 6 months. Morbidity was similar but high for both groups. More studies are needed to determine the role of curative embolization in managing patients with brain AVM.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03691870.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1396-1403"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Extracellular Vesicles From Hypoxia-Neuron Maintain Blood-Brain Barrier Integrity.","authors":"Wei Chen, Yousheng Wu, Ying Liang, Xuanlin Su, Man Ke, Die Deng, Jiankun Zang, Jielin Zhu, Hongcheng Mai, Anding Xu, Dan Lu","doi":"10.1161/STROKEAHA.124.048446","DOIUrl":"10.1161/STROKEAHA.124.048446","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke disrupts communication between neurons and blood vessels in penumbral areas. How neurons and blood vessels cooperate to achieve blood-brain barrier repair remains unclear. Here, we reveal crosstalk between ischemic penumbral neurons and endothelial cells (ECs) mediated by circular RNA originating from oxoglutarate dehydrogenase (CircOGDH).</p><p><strong>Methods: </strong>We analyzed clinical data from patients with acute ischemic stroke to explore the relationship between CircOGDH levels and hemorrhagic transformation events. In addition, a middle cerebral artery occlusion and reperfusion mouse model with neuronal CircOGDH suppression was used to assess endothelial permeability. ECs with increased CircOGDH expression were analyzed for changes in COL4A4 (collagen type IV alpha 4) levels, and in vitro coculture experiments were conducted to examine small extracellular vesicle-mediated CircOGDH transfer between neurons and ECs.</p><p><strong>Results: </strong>Clinical data indicated that reduced CircOGDH levels were correlated with increased hemorrhagic transformation in patients with acute ischemic stroke. In the middle cerebral artery occlusion and reperfusion model, neuronal CircOGDH suppression impaired the restoration of endothelial permeability. ECs with increased CircOGDH expression exhibited higher COL4A4 levels, which helped maintain vascular stability. In vitro, hypoxic neurons transferred CircOGDH to ECs via small extracellular vesicles, leading to elevated COL4A4 expression and enhanced endothelial integrity.</p><p><strong>Conclusions: </strong>Our findings highlight the significance of CircOGDH in neuron-EC crosstalk via small extracellular vesicles in the ischemic penumbra, emphasizing the need for balanced intervention strategies in acute ischemic stroke management.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1569-1580"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ARISE II Consensus on the Management of Intracranial Atherosclerotic Disease.","authors":"Stavropoula I Tjoumakaris, Joanna M Roy, Sepideh Amin-Hanjani, Fady T Charbel, Guilherme Dabus, Marc Fisher, Matthew Gounis, Brian L Hoh, David S Liebeskind, Italo Linfante, Edgar A Samaniego, Gabor Toth, Osama O Zaidat, Pervinder Bhogal, Adam Arthur, Ajay K Wakhloo","doi":"10.1161/STROKEAHA.124.050336","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050336","url":null,"abstract":"<p><p>Intracranial atherosclerotic disease (ICAD) is one of the leading causes of ischemic stroke worldwide. Despite advances in its diagnosis and management, there is no clear consensus on best practices to manage ICAD. This report summarizes the ARISE II (Roundtable Discussion With Industry and Stroke Experts) consensus in treating ICAD. The consensus underscored the importance of lifestyle modification and medical management in patients with ICAD. Patients who fail medical management are candidates for endovascular treatment. Open surgery is not recommended in patients who lack demonstrated hemodynamic insufficiency. The consensus also identified gaps in knowledge about the optimal duration of antithrombotics, the effect of the CYP2C19 genotype on medical management, the need for newer devices, and the standardization of antithrombotic protocols before stenting in an acute setting. Optical coherence tomography requires additional clinical data before defining its role in the diagnosis of ICAD.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 6","pages":"1636-1641"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroids for Focal Cerebral Arteriopathy: The Jury Is Still Out.","authors":"E Steve Roach","doi":"10.1161/STROKEAHA.125.051400","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051400","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 6","pages":"1469-1470"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spot Sign in Cerebral Venous Sinus Thromboses-Associated Intracerebral Hemorrhage.","authors":"Praveen Kesav, Syed Irteza Hussain, Seby John","doi":"10.1161/STROKEAHA.125.051217","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051217","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 6","pages":"e155-e156"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Ischemic Core Hypodensity With Thrombectomy Treatment Effect in Large Core Stroke: A Secondary Analysis of the SELECT2 Randomized Controlled Trial.","authors":"Vignan Yogendrakumar, Bruce C V Campbell, Hannah T Johns, Leonid Churilov, Felix C Ng, Clark W Sitton, Ameer E Hassan, Michael G Abraham, Santiago Ortega-Gutierrez, M Shazam Hussain, Michael Chen, Scott E Kasner, Gagan Sharma, Prodipta Guha, Deep K Pujara, Faris Shaker, Maarten G Lansberg, Lawrence R Wechsler, Thanh N Nguyen, Johanna T Fifi, Michael D Hill, Marc Ribo, Mark W Parsons, Stephen M Davis, James C Grotta, Gregory W Albers, Amrou Sarraj","doi":"10.1161/STROKEAHA.124.048899","DOIUrl":"10.1161/STROKEAHA.124.048899","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine whether extensive severe computed tomography (CT) hypodensity, representing blood-brain barrier injury, would be associated with a reduced benefit of endovascular therapy (EVT) in patients presenting with large core stroke.</p><p><strong>Methods: </strong>This study is an exploratory analysis of SELECT2 (Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke), a randomized controlled trial of EVT versus medical management in patients with large ischemic core who presented to 31 comprehensive stroke centers across the United States, Canada, Europe, Australia, and New Zealand. Visible CT hypodensity was outlined, and a threshold of severe CT hypodensity was defined as the lower 99% CI of contralateral thalamic gray matter in Hounsfield units (HU). The association between the volume of severe CT hypodensity and modified Rankin Scale (mRS) score of 0 to 3 was evaluated using logistic regression models, with adjustment for age, National Institutes of Health Stroke Scale, total noncontrast CT core volume, and a volume-by-treatment interaction. The relationship between severe CT hypodensity volume and the probability of an mRS score of 0 to 3 was used to select clinically relevant volume cut points for further evaluation. The treatment effect of EVT versus medical management on independent ambulation and hemicraniectomy was assessed in 2 subgroups based on these volume cut points.</p><p><strong>Results: </strong>In 322 patients, the median CT density was 31 HU (interquartile range, 28-34). The selected threshold of severe CT hypodensity was 26 HU. The volume of ischemic core ≤26 HU (per 1 mL increase) was associated with lower odds of mRS score of 0 to 3 after EVT (adjusted odds ratio [aOR], 0.96 [95% CI, 0.94-0.99]), but not medical management (aOR, 1.01 [95% CI, 0.98-1.03]; <i>P</i>interaction<0.01). In 101 patients with ≥26 mL of severe CT hypodensity, EVT, compared with medical management, was not associated with mRS score of 0 to 3 (aOR, 0.98 [95% CI, 0.33-2.88]) and was associated with hemicraniectomy (≥26 mL: aOR, 3.45 [95% CI, 1.09-10.86] versus <26 mL: aOR, 0.74 [95% CI, 0.31-1.75]; <i>P</i>interaction=0.03), whereas among 221 patients with <26 mL of severe hypodensity EVT was associated with mRS score of 0 to 3 (aOR, 7.20 [95% CI, 3.55-15.47]; <i>P</i>interaction<0.01).</p><p><strong>Conclusions: </strong>Severe hypodensity within large ischemic regions modifies the thrombectomy treatment effect and increases the likelihood of hemicraniectomy, independent of lesion volume.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03876457.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1366-1375"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of White Matter Hyperintensities on Nonverbal Cognition Through Structural Disconnections in Poststroke Aphasia.","authors":"Ida Rangus, Natalie Busby, Alex Teghipco, Rebecca W Roth, Janina Wilmskoetter, Chris Rorden, Argye E Hillis, Dirk-Bart den Ouden, Roger Newman-Norlund, Julius Fridriksson, Leonardo Bonilha","doi":"10.1161/STROKEAHA.124.049058","DOIUrl":"10.1161/STROKEAHA.124.049058","url":null,"abstract":"<p><strong>Background: </strong>Nonverbal cognitive deficits in poststroke aphasia remain poorly understood. They may result from direct stroke damage or disconnections of preserved cortical regions due to white matter injury, which may be worsened by white matter hyperintensities (WMH). Here, we examined the prevalence of nonverbal cognitive deficits in chronic poststroke aphasia and whether WMH-related disconnections contribute to these deficits beyond those caused by stroke lesions.</p><p><strong>Methods: </strong>Individuals with chronic left hemisphere ischemic or hemorrhagic stroke were enrolled between 2012 and 2021. Nonverbal cognition was assessed using the Matrix Subtest of the Wechsler Adult Intelligence Scale Version IV, the Pyramids and Palm Trees Test, and the Kissing and Dancing Test. Stroke lesions and WMH masks were derived from structural magnetic resonance imaging scans. Disconnection severity from stroke lesions and WMH was quantified across association, commissural, and projection fibers using the Lesion Quantification Toolbox. Hierarchical regression models examined whether WMH-related disconnections explained additional variance in nonverbal cognitive deficits.</p><p><strong>Results: </strong>Among 73 participants (mean age, 59.1±11.9 years; 61.6% men; mean time poststroke, 47.3±52.4 months), nonverbal cognitive deficits were common (Wechsler Adult Intelligence Scale, 27/58 [46.6%]; Pyramids and Palm Trees Test, 44/73 [60.3%]; Kissing and Dancing Test, 32/61 [52.5%]). Lesion-related commissural disconnections were associated with worse Kissing and Dancing Test performance (<i>r</i>[61]=-0.378; <i>P</i>=0.004), whereas WMH-related disconnections across all fiber types were linked to lower Pyramids and Palm Trees Test scores (<i>r</i>[73]=-0.392 to -0.462; <i>P</i><0.001). Interestingly, disconnection severity from stroke lesions was a weak predictor of nonverbal cognitive deficits, but adding disconnection severity from WMH significantly improved the prediction of nonverbal semantic memory as measured by the Pyramids and Palm Trees Test (<i>R</i>² increase from 0.111 to 0.338; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Disconnections from WMH contribute to nonverbal cognitive deficits, particularly in semantic memory, among individuals with poststroke aphasia. Considering WMH in poststroke aphasia research and rehabilitation may improve the understanding and treatment of cognitive impairments in this population.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1471-1482"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spot Sign in Intracerebral Hemorrhage: Critical Reappraisal and Future Clinical Implications.","authors":"Umberto Pensato, Dar Dowlatshahi, David Rodriguez-Luna, Johanna M Ospel, Andrea Morotti, Koji Tanaka, Vignan Yogendrakumar, Javier M Romero, H Bart Brouwers, Stephen M Davis, Nawaf Yassi, Matthew L Flaherty, David J Gladstone, Richard I Aviv, Joshua N Goldstein, Andrew M Demchuk","doi":"10.1161/STROKEAHA.125.050637","DOIUrl":"10.1161/STROKEAHA.125.050637","url":null,"abstract":"<p><p>Hematoma expansion (HE) is a common occurrence affecting around 10% to 30% of patients with acute intracerebral hemorrhage within the initial hours from symptom onset and is the only modifiable factor associated with poor clinical outcomes. The detection of contrast extravasation on computed tomography (CT) angiography, known as the spot sign, was initially embraced as a promising radiological marker for predicting HE that could aid patient selection for acute interventions aimed at minimizing HE. However, the initial enthusiasm waned as clinical studies failed to show clear clinical benefits of hemostatic treatments when patients were selected based on the presence of this imaging marker. In this narrative review, we provide a comprehensive summary of the pathophysiology, definitions, imaging protocols, and predictive performance of the spot sign, along with the clinical studies that have selected and treated patients based on its presence. Finally, we delve into some nuances of the spot sign that can enhance its predictive performance and help stratify HE risk with greater precision. These features include static findings observed on single-phase CT angiography (ie, number, volume, CT density, and colocalization with hypodensities), as well as dynamic findings identified on multiphase/dynamic CT angiography (ie, timing of appearance, volume increase, volume decrease for tissue dispersion, and CT density changes). In this reappraisal of the spot sign, we aim to reinvigorate research on advanced neuroimaging in intracerebral hemorrhage that could lead to a more accurate HE prediction. This could facilitate better selection for therapies aimed at preventing HE or surgical approaches to address the bleeding source.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1612-1624"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coil Embolization of an Infraoptic Anterior Cerebral Artery Aneurysm.","authors":"Miao Li, Jiayin Zhang, Yue Yin, Hanlin Chen, Yiming Deng","doi":"10.1161/STROKEAHA.125.050832","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050832","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 6","pages":"e153-e154"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}