Transfusion最新文献

{"title":"An agnostic study of donor and component factors associated with transfusion-related changes in laboratory markers.","authors":"Lucas D Ekström, Mark Clements, Nareg Roubinian, Jingcheng Zhao, Torsten Dahlén, Michael P Busch, Gustaf Edgren","doi":"10.1111/trf.18249","DOIUrl":"10.1111/trf.18249","url":null,"abstract":"<p><strong>Background: </strong>Donor and red blood cell (RBC) component factors may affect patient outcomes after RBC transfusions, but data on the magnitude and consequences of these associations are limited.</p><p><strong>Study design and methods: </strong>In this retrospective cohort study, we analyzed associations between 10 donor and component factors-including donor age, hemoglobin, parity, sex, and component storage time-and changes in 55 clinical laboratory markers measured within 24 h before and after RBC transfusions. Primary analyses used data from the Swedish SCANDAT3-S database, with findings replicated in the U.S. REDS-III database. The primary outcome was the transfusion-related change in pre- and post-transfusion values of the laboratory markers, normalized per RBC unit transfused.</p><p><strong>Results: </strong>After adjusting for the false discovery rate, 33 significant associations were identified, with 20 replicated in the SCANDAT replication sample or the REDS-III cohort after Bonferroni corrections, and 18 remaining after visual assessment. Higher donor hemoglobin concentration consistently led to greater increases in recipient hemoglobin and measures of RBC mass. Extended component storage times were associated with elevated recipient bilirubin and carboxyhemoglobin levels. Differences in recipient hemoglobin response between the SCANDAT3-S and REDS-III cohorts suggest potential variations in transfusion efficacy across populations and practices.</p><p><strong>Discussion: </strong>These findings suggest that considering donor hemoglobin and RBC component storage duration could enhance transfusion efficacy, providing avenues for personalized transfusion strategies to improve patient outcomes.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"886-896"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive model for optimizing prehospital transfusions in an urban EMS system.","authors":"Bo Zeng, Joshua Brown, Zhengsong Lu, Jonathan McMahon, Leonard Weiss, Bopaya Bidanda, Mark Yazer","doi":"10.1111/trf.18209","DOIUrl":"10.1111/trf.18209","url":null,"abstract":"<p><strong>Background: </strong>Prehospital transfusions might provide a survival benefit for injured patients. Because blood products are a scarce resource, their optimal deployment requires careful consideration. A computer model was built to explore different deployment scenarios for two blood-carrying ambulances (mobile blood banks, MBBs) in the City of Pittsburgh.</p><p><strong>Study design and methods: </strong>Mixed integer programs were used to determine the optimal locations for the bases of the two MBBs from amongst the City's 14 ambulance bases. Then, a discrete-event simulation of dispatching MBBs to attend to patients who would have qualified for prehospital transfusions due to having hypotension following injury was performed using data from one year of calls to the City's emergency services hotline (911 calls).</p><p><strong>Results: </strong>Over the one-year period, there were 238 ambulance dispatches to injured patients with hypotension for their age. The average time to transfusion was significantly lower when the MBB attended to the patient compared with receiving their transfusion at the hospital (average 7.2 ± 0.1 min vs. 36.7 ± 0.2 min, respectively). However, there were diminishing returns when more than four deployed MBBs were simulated; with two MBBs, up to 73% of qualifying patients could be serviced, and when four MBBs were deployed, up to 95% of patients could be serviced. Deploying >4 MBBs did not increase the number of serviced eligible patients. There was minimal improvement in MBB efficiency when the restocking and cleaning time after patient delivery was reduced from 40 to 15 min.</p><p><strong>Conclusion: </strong>Computer modeling can help optimize resources when planning prehospital transfusion programs.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S23-S29"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel anticoagulant-preservative solution maintained the hemostatic function of cold stored whole blood for 56 days.","authors":"K M Reddoch-Cardenas, J A Cancelas, S Nestheide, N Rugg, K Peña, C S McIntosh, J Ferdin, J Talackine, J Parker, L A Jensen, R Gonzales, J R Hess, M Zia","doi":"10.1111/trf.18207","DOIUrl":"10.1111/trf.18207","url":null,"abstract":"<p><strong>Background: </strong>Whole blood (WB) is an efficient product for field medical resuscitation because of its unitary composition, tolerance for storage on ice and in field refrigerators, and simplicity of use. We measured quality parameters of a novel 8-week WB storage system.</p><p><strong>Study design and methods: </strong>Here, 500 mL of WB from healthy donors was collected in 70 mL of CPDA-1, leukoreduced with a platelet-sparing filter, pooled into ABO-compatible two-unit pools, and split into matched pairs of equal volume designated as Test or Control units. Test units received an additional 50 mL of a novel WB preservative solution (APEX units, Hemerus Medical, St Paul, MN). A total of 15 paired WB units were evaluated at Day 0 (D0) and periodically up to Day 56 (D56) of storage at 1-6°C across two centers. Quality testing included cellularity, ATP concentrations, hemolysis, blood gases, metabolites, coagulation factor levels, thromboelastography (TEG), and bacterial culture.</p><p><strong>Results: </strong>At D56, APEX units displayed higher RBC ATP concentration (3.14 vs. 2.18 μmol/gHb, p = 0.001), pH (6.53 vs. 6.50, p = 0.01), and higher bicarbonate reserve (8 vs. 5.4, p < 0.0001). D56 APEX units had greater platelet contribution to TEG clot strength (p < 0.01) and better preservation of red cell ATP (p < 0.001). Activities of fibrinogen, factor VIII, factor V, and protein S activity in APEX units remained within the reference levels on D56. No bacterial contamination was detected at the end of storage.</p><p><strong>Discussion: </strong>These findings suggest that APEX preserves RBCs effectively and maintains platelet and plasma coagulation functions for up to 56 days.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S185-S192"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do we leverage implementation science to support and accelerate uptake of clinical practice guidelines in transfusion medicine.","authors":"Jacob Crawshaw, Jeannie Callum, Sophie Chargé, Fabiana Lorencatto, Justin Presseau, Sheharyar Raza, Nicole Relke, Abby Wolfe, Simon Stanworth","doi":"10.1111/trf.18234","DOIUrl":"10.1111/trf.18234","url":null,"abstract":"<p><strong>Background: </strong>Developing and disseminating clinical practice guidelines is a common strategy used to inform practice and address evidence-to-practice gaps that are prominent in transfusion medicine. Despite a highly systematic method for synthesizing evidence into guideline recommendations, comparatively little attention is paid to the real-world implementation of the recommendations in routine practice. A more scientific approach drawing on learnings from the field of implementation science is therefore warranted.</p><p><strong>Study design and methods: </strong>In this article, we propose a methodological roadmap to embed implementation science principles, frameworks, and methods to facilitate the development and uptake of transfusion medicine guidelines. We draw upon research undertaken in partnership with the International Collaboration of Transfusion Medicine Guidelines (ICTMG) to illustrate the roadmap in action.</p><p><strong>Results: </strong>The methodological roadmap constitutes five steps which have been matched to existing processes for developing and implementing clinical practice guidelines: (1) environmental scan; (2) detailing who needs to do what differently, per guideline recommendation; (3) barriers and enablers assessment; (4) tailoring implementation strategies to identified barriers and enablers; and (5) implementation and evaluation of implementation strategies. For each step, we define the key concepts and methods involved, and share examples from work done with ICTMG to support transfusion medicine guideline implementation.</p><p><strong>Discussion: </strong>We intend this methodological roadmap for clinicians, researchers, and organizations involved in supporting clinical practice guideline use. Informed by principles, frameworks, and methods from implementation science, the roadmap can provide a more structured, transparent, and replicable approach to improve the implementation of guideline recommendations in transfusion medicine.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"799-813"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of nonspecific reactivity rates across three immunohematology testing platforms with assessment of subsequent specific alloantibody development.","authors":"Nalan Yurtsever, Gabrielle Carmichael, Ryan Malonis, Matthew Z Madden, Numan Isik, Muhammad U Ahmed, Laurie Bizzario, Bhushan Shah, Christopher A Tormey, Edward S Lee","doi":"10.1111/trf.18256","DOIUrl":"10.1111/trf.18256","url":null,"abstract":"<p><strong>Background: </strong>Gel and solid-phase testing platforms are commonly used for pretransfusion testing but are also prone to nonspecific reactivities (NSP) compared to tube testing. This study aims to characterize the features of NSPs in these platforms and how frequently NSPs precede specific antibody detection.</p><p><strong>Methods: </strong>All antibody screens and identification panels performed between 5/2021-4/2023 by two automated and one manual platforms at a single institution were analyzed with IRB approval: solid-phase (Immucor, Norcross, GA), automated gel (Grifols, Los Angeles, CA), and manual gel (Ortho Diagnostics, Raritan, NJ). Testing platform, antibody identification, strength of reactivity, number of reactive reagent red cells, and RBC antibody history were extracted from chart review. Differences in reactivity strength were compared using the Kruskal-Wallis test, and differences in the number of cells used to establish diagnoses of NSPs were compared using two-way ANOVA.</p><p><strong>Results: </strong>During the 24-month study period, a total of 156,247 antibody screens were performed with 5491 positive screens, and NSP was identified on 358/5491 panels (6.6%). 271/5491 (4.9%) panels had NSP detected on non-tube platforms: 95 on solid-phase, 123 on automated gel, and 53 on manual gel. The mean strength of reactivity by agglutination for NSP was 1.7, 0.5, and 1.4, respectively (p < .001). In addition, 9/271 (3.3%) of all panels with NSP on gel or solid-phase were associated with the detection of specific alloantibodies in subsequent panels.</p><p><strong>Conclusion: </strong>Nonspecific reactions differ by platforms in specificity and strength. Solid-phase shows stronger reactivity, while automated gel has higher rates of positivity.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"978-984"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding beyond trauma: Characterizing low titer group O whole blood (LTOWB) use in children requiring massive transfusion protocol activation.","authors":"Erin V Feeney, Elissa Abou Khalil, Barbara A Gaines, Philip C Spinella, Christine M Leeper","doi":"10.1111/trf.18203","DOIUrl":"https://doi.org/10.1111/trf.18203","url":null,"abstract":"<p><strong>Introduction: </strong>Data regarding low titer group O whole blood (LTOWB) use for hemostatic resuscitation is largely derived from trauma cohorts; studies regarding its use in uninjured pediatric patients are lacking.</p><p><strong>Methods: </strong>The blood bank database from a single academic pediatric hospital with a massive transfusion protocol (MTP) allowing the use of LTOWB for any severe bleeding etiology was queried between 2016 and 2023. Pediatric (age <18 years) recipients of LTOWB were included; injured children were excluded. Data recorded included demographics, bleeding etiology, blood volumes, mortality (24-h and in-hospital), organ dysfunction, and, when available, posttransfusion biochemical markers of hemolysis.</p><p><strong>Results: </strong>Of 112 recipients of LTOWB, 16 met inclusion criteria. Median (IQR) age was 13 years (8-16) and 8/16 (50%) were male. MTP was most often activated on the day of admission (median (IQR) = day 0 (0-1)), and the bleeding etiology was variable, including perioperative (8/16; 50%), gastrointestinal bleed (5/16; 31%), and extracorporeal membrane oxygenation (ECMO) cannulation (3/16; 19%). The median (IQR) weight-adjusted volume of LTOWB transfused was 19 (10-26) mL/kg, and most children (13/16; 81%) received component blood products in addition to LTOWB. The 24-h mortality rate was 25% (4/16) and in-hospital mortality was 44% (7/16). The most common complication was AKI (10/16; 63%). There were no significant differences in biochemical hemolysis markers between group O (n = 7) and non-group O (n = 9) LTOWB recipients at any time point (p = .07-.99).</p><p><strong>Conclusions: </strong>LTOWB use was feasible in the resuscitation of children with various bleeding etiologies requiring massive transfusion. Larger prospective investigations are needed to inform guidelines for optimal use in this cohort.</p><p><strong>Level of evidence: </strong>Retrospective Observational Study.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":"65 Suppl 1 ","pages":"S173-S180"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-evaluating the role of arginine vasopressin (AVP) in damage control resuscitation for combat casualties in hemorrhagic shock.","authors":"Joseph Rhee, Mason H Remondelli, Cole W Crandall, Jonathan C Wang, Patrick F Walker, Matthew J Bradley, Patrick J Coleman","doi":"10.1111/trf.18222","DOIUrl":"https://doi.org/10.1111/trf.18222","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":"65 Suppl 1 ","pages":"S140-S145"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From shortages to solutions: Liquid plasma as a practical alternative to whole blood for prehospital trauma resuscitation.","authors":"Aashish Rajesh, Randall M Schaefer, Jon R Krohmer, Eric A Bank, John B Holcomb, Donald H Jenkins","doi":"10.1111/trf.18183","DOIUrl":"10.1111/trf.18183","url":null,"abstract":"<p><p>Trauma-induced hemorrhagic shock remains a leading cause of preventable mortality, necessitating timely and effective resuscitation strategies. While low-titer O whole blood (LTOWB) is the preferred choice for prehospital resuscitation due to its balanced composition and ease of use, overall widespread implementation is hindered by persistent supply chain issues and daily logistical challenges of access and deployment. Platelets, containing plasma as a component, are considered the next best alternative to LTOWB but are constrained by their short shelf life and ongoing scarcity, and ongoing storage compliance, rendering their use impractical. This review evaluates plasma-based alternatives, particularly liquid plasma (LP), as a viable and cost-effective substitute therapeutic modality. LP offers a 26-day refrigerated shelf life compared to the 5-day limit of thawed fresh frozen plasma (FFP) and eliminates the challenges associated with freezing and thawing while maintaining clinical efficacy. Preliminary economic analyses further underscore the advantages of LP, demonstrating reduced wastage and lower costs compared to LTOWB, especially when partnering with a hospital system. Acknowledging the barriers in implementing prehospital blood transfusion programs due to blood supply and costs, we advocate for emergency medical service (EMS) adoption of LP, highlighting its availability, comparable efficacy to LTOWB, and cost-effectiveness. Until LTOWB becomes more accessible, LP should be prioritized in prehospital care to optimize outcomes for trauma patients in hemorrhagic shock.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S288-S296"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of whole blood stored in room temperature for up to 5 days.","authors":"Sanna Susila, Tuukka Helin, Lotta Joutsi-Korhonen, Jouni Lauronen, Minna Ilmakunnas","doi":"10.1111/trf.18133","DOIUrl":"10.1111/trf.18133","url":null,"abstract":"<p><strong>Background: </strong>Non-refrigerated whole blood can be used for bleeding emergencies when cold-stored whole blood is unavailable. Storage time in room temperature is usually limited to 24 h although there is little evidence supporting this practice. We studied the quality of whole blood stored in room temperature for 5 days to investigate the effects of prolonged storage time.</p><p><strong>Study design and methods: </strong>Non-leukoreduced whole blood in CPDA-1 from 10 group O or A RhD positive male donors was stored in +22°C for 120 h. Samples were taken daily to assess blood cultures, blood count and metabolic parameters. Platelet function and blood coagulation were evaluated with multiple electrode aggregometry, viscoelastic tests (sonorheometry and rotational thromboelastometry), thrombin generation assay and measurements of individual clotting factors.</p><p><strong>Results: </strong>Blood cell counts remained stable during storage. Metabolic changes were similar to those previously reported in cold-stored blood products. Most coagulation factor levels, including FVIII, decreased during storage but remained within physiological range. Thrombin generation remained mostly intact during storage. In viscoelastic tests, clotting times prolonged, but clot strength remained stable. Platelet function in multiple electrode aggregometry impaired along with storage. No bacterial growth was detected in any sample.</p><p><strong>Conclusion: </strong>Whole blood stored in room temperature for 5 days seems bacteriologically safe and retains most of its metabolic and hemostatic function. These results suggest that whole blood stored in room temperature may be usable for longer than the currently recommended 24 h.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S193-S203"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal trauma resuscitation: Successful use of low-titer O+ whole blood in a 4-day-old infant with hemorrhagic shock.","authors":"Renee W Green, Bryan A Cotton","doi":"10.1111/trf.18233","DOIUrl":"10.1111/trf.18233","url":null,"abstract":"<p><strong>Background: </strong>Neonatal trauma resuscitation is particularly challenging in cases of profound hemorrhagic shock. Low-titer group O+ whole blood (LTOWB+) has emerged as a potentially effective option in pediatric trauma, but its use in neonates is debated due to risks such as D-alloimmunization. In life-threatening emergencies, decisions must carefully balance immediate survival benefits against long-term risks.</p><p><strong>Study design and methods: </strong>We present a case report of a 4-day-old neonate transported as a Level 1 trauma following a dog attack to the head, resulting in hemorrhagic shock and cardiac arrest. Upon arrival to the trauma bay, the patient was pulseless, with unsuccessful intraosseous and intravenous vascular access attempts. Access was eventually achieved using an umbilical venous catheter, enabling administration of LTOWB+.</p><p><strong>Results: </strong>Administration of LTOWB+ resulted in the return of spontaneous circulation, improved perfusion, and hemodynamic stabilization. The patient remained alive at the 6-month follow-up. LTOWB+ facilitated rapid correction of hemorrhagic shock with no immediate complications observed.</p><p><strong>Discussion: </strong>This case underscores the challenges of neonatal trauma resuscitation, including vascular access and the use of LTOWB+. LTOWB+ proved lifesaving, enabling rapid correction of acidosis and an improved outcome. Although concerns persist regarding LTOWB+ administration, the immediate survival benefits outweigh the risks, supported by evidence demonstrating its efficacy and safety. This case highlights the need for adaptability and a systematic approach to managing complex neonatal trauma scenarios. We argue that LTOWB+ is poised to become a pillar of pediatric resuscitation, providing a lifesaving, efficient, and safe option even in the newborn.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":"S181-S184"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}