Clinical Practice and Cases in Emergency Medicine最新文献

{"title":"Stridor and Dysphagia Unmasking an Aberrant Right Subclavian Artery in a Toddler.","authors":"Masato Yasuda, Tomoya Ito","doi":"10.5811/cpcem.61391","DOIUrl":"10.5811/cpcem.61391","url":null,"abstract":"<p><strong>Case presentation: </strong>A one-year-old girl presented with acute-onset dyspnea persistent for two days and recurrent choking episodes. Physical examination revealed stridor and sub-costal retractions. Despite initial treatment with inhaled nebulized epinephrine, stridor persisted. Lateral chest radiography finding indicated tracheal stenosis. Contrast-enhanced neck and chest computed tomography (CT) showed an aberrant right subclavian artery compressing the esophagus posteriorly, causing esophageal stenosis with associated food residue accumulation. The proximally dilated portion of the esophagus caused mass effect with compression of the trachea, resulting in tracheal stenosis. Despite medical management, the patient experienced recurrent stridor and could only swallow liquids. Therefore, surgical translocation of the right subclavian artery to the right common carotid artery was performed. Postoperatively, the patient swallowed age-appropriate food, and the stridor resolved.</p><p><strong>Discussion: </strong>The most common cause of stridor in children is viral croup, which is typically treated with nebulized epinephrine and corticosteroids in moderate to severe cases. However, recurrent or persistent stridor with dysphagia should raise concern for vascular anomalies (eg, aberrant right subclavian artery), bacterial tracheitis, epiglottitis, retropharyngeal abscess, foreign body aspiration, mediastinal tumors, or other compressive pathologies. Early symptomatic presentation with dysphagia and stridor in young children is unusual, as aberrant right subclavian artery symptoms typically develop after age 40. When clinical presentation deviates from typical croup, particularly if associated with dysphagia, ultrasound, magnetic resonance imaging, or contrast-enhanced CT can identify vascular anomalies. Surgical intervention is indicated for symptomatic aberrant right subclavian artery when symptoms persist despite medical management (nutrition monitoring, feeding support, airway support, and growth assessment).</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"411-413"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Novel Agitated Behavior Score and Its Association with Code Violet Activation: A Case Series.","authors":"Negin Ceraolo, Julianna Sandine, Bethany Crouse, Jessica Krizo, Erin Simon","doi":"10.5811/cpcem.62328","DOIUrl":"10.5811/cpcem.62328","url":null,"abstract":"<p><strong>Introduction: </strong>Agitation in the emergency department (ED) poses a significant safety concern for staff and patients. Multidisciplinary responses, such as Code Violet activations, are common but resource-intensive. Early identification and intervention may reduce escalation, but ED-specific data are limited. The objective of the study was to evaluate the implementation of a novel agitated behavior score (ABS) and assess whether higher ABS scores are associated with increased risk of Code Violet activation.</p><p><strong>Case series: </strong>This prospective observational study included adult patients admitted to a behavioral health unit in a community teaching hospital ED. Trained staff administered a novel 25-point ABS incorporating altered mentation, verbal agitation, and motor agitation. The primary outcome was Code Violet activation; secondary outcomes included pharmacologic interventions and substance use. Among 83 patients, 27 (33%) experienced ≥ 1 Code Violet activation. And those patients with Code Violet activation had higher initial ABS scores (mean 10.9 [6.35] versus 4.6 [4.43]; P <.001). Overall rates of psychotropic medication use were similar between groups; however, time to first medication was longer in the Code Violet group (4.0 versus 2.7 hours). Patients with Code Violet activations more frequently received parenteral medications, whereas those without the code activation more commonly received oral agents.</p><p><strong>Conclusion: </strong>The agitated behavior score was associated with Code Violet activation and may help identify patients at greater risk of behavioral escalation. While it measures current agitation rather than predicting future agitation, its structured format may facilitate early recognition and management of agitation.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"238-242"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Mental Status in Emergency Department Patient with Cerebral Septic Emboli from Infective Endocarditis: Case Report.","authors":"Andrew G Theophanous, Rebecca G Theophanous","doi":"10.5811/cpcem.62214","DOIUrl":"10.5811/cpcem.62214","url":null,"abstract":"<p><strong>Introduction: </strong>Infective endocarditis (IE) is associated with high mortality (30%). Patients with structural cardiac disease or implanted hardware have higher risk for IE (23-47%). Diagnosis per the 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria is by pathological confirmation or the major/minor criteria. Major criteria include ≥ 2 positive blood culture sets, echocardiography or computed tomography vegetation visualization, and surgical visualization. Septic emboli symptoms (which complicate 25% of IE cases) include neurological deficits or shortness of breath. Early intravenous antimicrobial therapy within one hour for patients who meet sepsis criteria is recommended per Infectious Diseases Society of America guidelines.</p><p><strong>Case report: </strong>A middle-aged male with recent IE and aortic valve prosthesis presented to the emergency department with altered mental status and hypoglycemia. He had right basilar lung rales but no heart murmur, leg swelling, or jugular venous distension. He met sepsis criteria with leukocytosis and hypothermia. Computed tomography head was performed due to his altered mental status and revealed a right parietal-occipital hypodense lesion concerning for an abscess with edema and mass effect. Given his history of IE and ill appearance, three blood culture sets were drawn and intravenous antibiotics initiated. The patient was admitted to the hospital with magnetic resonance imaging confirming brain abscess; and neurosurgery performed a craniotomy with brain abscess evacuation. Intravenous antibiotics were continued for four weeks for septic brain emboli from recent IE.</p><p><strong>Conclusion: </strong>Clinicians should keep a broad differential for altered mental status patients. Sepsis patients should have antimicrobials initiated within one hour. Expedited diagnosis with three sets of blood cultures, echocardiography, and surgical consult should be completed in patients with suspected infective endocarditis for improved patient outcomes. Finally, clinicians should evaluate for septic emboli symptoms such as neurological deficits or respiratory symptoms.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"403-407"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent and Progressive Exfoliative Dermatitis: A Case Report.","authors":"Jennifer Boukouris, Sherif Elsherif","doi":"10.5811/cpcem.53897","DOIUrl":"10.5811/cpcem.53897","url":null,"abstract":"<p><strong>Introduction: </strong>Exfoliative dermatitis, also known as erythroderma, represents an infrequent clinical presentation in emergency departments (ED) and often contributes to considerable diagnostic uncertainty. The differential diagnosis is broad, and the condition may arise from a wide variety of etiologies. We report a case of severe exfoliative dermatitis characterized by gradual progression and resistance to multiple therapeutic interventions over several weeks, ultimately resulting in significant systemic complications and marked hematological abnormalities.</p><p><strong>Case report: </strong>A 57-year-old man presented to the ED with severe pain, pruritus, and widespread skin peeling involving more than 90% of his body surface area. The patient developed a rash following a trip to Korea about six months prior to presentation, which progressively worsened despite multiple prior diagnoses and treatments including corticosteroids, immunosuppressive therapy, and biologic agents. On presentation, the patient met systemic inflammatory response syndrome criteria and was found to have profound leukopenia, thrombocytopenia, hypoalbuminemia, and Staphylococcus aureus bacteremia. Subsequent evaluation confirmed crusted scabies complicated by secondary bacterial infection.</p><p><strong>Conclusion: </strong>The case demonstrates the complexity of assessing generalized rash in emergency settings and underscores the importance of a thorough history and physical, as well as maintaining a broad differential diagnosis. It shows both the physical and psychological effects of diagnostic uncertainty on treatment adherence, emphasizes early recognition, and notes systemic complications arising from multifactorial etiologies.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"370-373"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penetrating Neck Injury in a Child Presenting as a Simple Laceration: A Case Report.","authors":"Brian Davitt, Eric Quinn","doi":"10.5811/cpcem.52830","DOIUrl":"10.5811/cpcem.52830","url":null,"abstract":"<p><strong>Introduction: </strong>Penetrating neck injury is rare in children, but it can have devastating consequences due to the vital structures in the neck. Having a high index of suspicion is crucial for detection and management of such injuries. Superficial-appearing wounds can mask underlying injury. In this case report, we present a case of penetrating neck injury in a patient who presented with what appeared to be a simple laceration to his neck.</p><p><strong>Case report: </strong>A three-year-old male presented with a laceration to his neck caused by a piece of shattered glass. On evaluation, he had normal vital signs and no hard or soft signs of penetrating neck injury. During bedside examination, a track was found extending beyond the platysma. The patient developed hoarseness in his voice, prompting computed tomography (CT). The CT revealed three foreign bodies lodged between the right common carotid artery and tracheal wall, abutting the wall. The patient underwent open exploration with removal of the foreign bodies. No significant damage to vital structures was found.</p><p><strong>Conclusion: </strong>While rare, this case exemplifies the importance of having a high index of suspicion for penetrating neck injury in children presenting with even superficial-appearing neck lacerations, especially if caused by glass. Because the neck is typically uncovered, it carries an increased risk for foreign body penetration. Glass is generally radiopaque, but detection may be limited by the surrounding tissue, fragment size, and glass composition. Patients demonstrating hard signs of penetrating neck injury require operative management, while those with soft signs should undergo assessment with CT.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"284-287"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Popliteal Artery Aneurysm Thrombosis Diagnosed with Point-of-Care Ultrasound.","authors":"Andrew Gonedes, Brian Kohen, Alfa Diallo, Mark McKenna, Robert Farrow, Eric Boccio","doi":"10.5811/cpcem.52832","DOIUrl":"10.5811/cpcem.52832","url":null,"abstract":"<p><strong>Case presentation: </strong>A 62-year-old male presented to the emergency department with a three-day history of right knee, calf, and foot pain following a bout of prolonged crouching while gardening. The physical examination revealed a cold and pale foot with absent pulses. A point-of-care ultrasound (POCUS) performed at bedside revealed a thrombosed popliteal artery aneurysm. A heparin infusion was initiated, and vascular surgery was consulted. Subsequent imaging confirmed the diagnosis of a thrombosed popliteal artery aneurysm with thrombus extension into the superficial femoral artery. The patient underwent a femoropopliteal bypass, resulting in successful revascularization of the limb.</p><p><strong>Discussion: </strong>While POCUS is a well-established imaging modality for the diagnosis of deep vein thrombosis, its utility in diagnosing acute peripheral arterial pathologies is less well-known. This case demonstrates how prompt bedside POCUS evaluation can circumvent potential delays associated with traditional imaging such as computed tomography angiography, allowing for expedited surgical consultation and timely therapeutic and procedural intervention. This case highlights the potential role of POCUS in the rapid diagnosis of acute limb ischemia from arterial thrombosis in the acute care setting.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"419-420"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VenoArterial Extracorporeal Membrane Oxygenation in Cardiac Arrest Suspected due to Massive Pulmonary Embolism: A Case Report.","authors":"Tananshi Chopra, Lea Dahlke, Nancy Salinas, Moizza Shabbir, Tyler Gunn, Sam Torbati","doi":"10.5811/cpcem.52963","DOIUrl":"10.5811/cpcem.52963","url":null,"abstract":"<p><strong>Introduction: </strong>High-risk pulmonary embolism (PE) is an uncommon but potentially reversible cause of out-of-hospital cardiac arrest, frequently presenting as pulseless electrical activity (PEA). Early identification and multidisciplinary intervention are critical, yet confirmatory imaging is often delayed. Current guidelines recommend consideration of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in specialized centers when high-risk PE is suspected and the patient presents with cardiogenic shock or cardiac arrest.</p><p><strong>Case report: </strong>We describe a 50-year-old woman with a remote history of deep vein thrombosis who arrested after acute-onset dyspnea. Emergency medical services documented PEA arrest and initiated advanced cardiac life support. On arrival to the emergency department (ED), the patient remained in PEA arrest without cardiac motion on point-of-care ultrasound. Pulmonary embolism was strongly suspected but could not be confirmed, and VA-ECMO was initiated within 42 minutes of arrest. Pulmonary angiography confirmed massive bilateral PE, followed by mechanical thrombectomy using a catheter-directed device. Extracorporeal membrane oxygenation support continued for four days before successful decannulation, and the patient was discharged on hospital day 17 to a rehabilitation facility with a Cerebral Performance Category score 1, indicating excellent neurological function.</p><p><strong>Conclusion: </strong>This case illustrates the potential for favorable neurologic and functional outcomes in cardiac arrest associated with high-risk PE when VA-ECMO is implemented early as a bridge to definitive therapy. In resource-rich settings, rapid ED-based activation of extracorporeal cardiopulmonary resuscitation protocols and access to catheter-directed thrombectomy may represent an optimal strategy for improving survival and neurologic recovery in patients with PEA arrest that may be related to high-risk PE.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"358-362"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Etiology and Presentation for Hyperkalemia-Dialysis Access Recirculation: A Case Report.","authors":"Joseph L Kim, Joshua M Glazer, Amaka Edeani Achufusi, Ryan E Tsuchida","doi":"10.5811/cpcem.50879","DOIUrl":"10.5811/cpcem.50879","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperkalemia is a common and potentially life-threatening complication of end-stage renal disease, often producing nonspecific symptoms but profound cardiac effects. While nonadherence and dietary indiscretion are typical precipitants, clinicians must also consider the adequacy and effectiveness of dialysis.</p><p><strong>Case report: </strong>We report a patient with end-stage renal disease on thrice-weekly hemodialysis who presented with significant bradycardia and altered mental status. Initial prehospital electrocardiogram (ECG) was suspicious for acute coronary syndrome after automated ECG interpretation suggested anterior ST-segment elevation. In the emergency department, the patient was in a junctional escape rhythm with diffuse peaked T-waves. Serum potassium was 7.8 millimoles per liter with concomitant uremia. Despite administration of potassium-shifting therapies bradycardia persisted, and temporary pacing attempts failed. An epinephrine infusion was initiated while arranging for emergent hemodialysis. Following dialysis, the potassium normalized, cardiac conduction returned to sinus rhythm, and the patient's mental status improved. In the absence of missed dialysis sessions, increased potassium intake, or access site dysfunction, nephrology determined the likely etiology to be dialysis access recirculation from improper cannulation.</p><p><strong>Conclusion: </strong>Dialysis recirculation is an uncommon but important cause of inadequate clearance leading to life-threatening hyperkalemia. Clinicians should consider this mechanism when confronted with otherwise unexplained electrolyte derangements in compliant dialysis patients.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"273-276"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Case of Spontaneous Pneumothorax Presenting as Right Lower Quadrant Pain: A Case Report.","authors":"Timothy P Crowe, Patrick P Cheatle","doi":"10.5811/cpcem.53014","DOIUrl":"10.5811/cpcem.53014","url":null,"abstract":"<p><strong>Introduction: </strong>Primary spontaneous pneumothorax generally presents with symptoms of chest pain and shortness of breath. Progression to a tension pneumothorax results in a medical emergency. Rare presentations with abdominal pain are possible and must be considered to expedite appropriate treatment of pneumothorax.</p><p><strong>Case report: </strong>We report a case of a 21-year-old male with primary spontaneous pneumothorax who initially presented to the emergency department with right lower quadrant abdominal pain. History and physical exam were suggestive of acute appendicitis. A large right pneumothorax was incidentally found on computed tomography.</p><p><strong>Conclusion: </strong>This case highlights unusual presentations of pneumothorax. Emergency physicians should consider atypical presentations of chest pathology such as pneumothorax in patients presenting with symptoms consistent with an acute abdomen.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"252-254"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13517968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental Diagnosis of ST-Elevation Myocardial Infarction on Computed Tomography in a Burn Patient: A Case Report.","authors":"Maria Jose Araujo, Eknoor Sandhu, Angel Romero, Jugraj Randhawa, Rachel O'Donnell","doi":"10.5811/cpcem.53234","DOIUrl":"10.5811/cpcem.53234","url":null,"abstract":"<p><strong>Introduction: </strong>ST-elevation myocardial infarctions (STEMI) represent complete occlusion of a coronary artery. An electrocardiogram (ECG) is a method of diagnosis; however, on rare occasions clues of myocardial infarction are first noted on imaging. This is a case of myocardial infarction first noted on computed tomography (CT).</p><p><strong>Case report: </strong>A 62-year-old man was brought to the emergency department after being found unresponsive with multiple burns. An ECG performed on arrival did not show changes consistent with myocardial ischemia. Due to reported trauma, a CT incidentally found a heterogeneous low-attenuation area in the posterior wall of the left ventricle of the heart. A repeat ECG subsequently showed an inferior STEMI.</p><p><strong>Conclusion: </strong>Computed tomography of the chest obtained in the evaluation of trauma may demonstrate evidence of myocardial ischemia. This case highlights the ability of CT to detect cardiac hypoperfusion. The role of CT in myocardial infarction diagnosis remains limited; however, given that the timing of contrast injection depends on the clinical question, it may not reliably assess the hypoperfusion.</p>","PeriodicalId":31975,"journal":{"name":"Clinical Practice and Cases in Emergency Medicine","volume":"10 3","pages":"385-387"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}