Critical Pathways in Cardiology最新文献

{"title":"Utility of N-Terminal Pro-B-Type Natriuretic Peptide -to-Troponin and BNP-to-Troponin Ratios for Differentiating Type 1 from Type 2 Myocardial Infarction: A HIGH-US Sub-Study.","authors":"Muhammad Memon, Robert H Christenson, Gordon Jacobsen, Fred S Apple, Adam J Singer, Alexander T Limkakeng, William F Peacock, Christopher R deFilippi, Joseph B Miller, James McCord","doi":"10.1097/HPC.0000000000000399","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000399","url":null,"abstract":"<p><strong>Background: </strong>Differentiating type 1 myocardial infarction (T1-MI) from type 2 MI (T2-MI) remains a diagnostic challenge, even with the availability of high-sensitivity cardiac troponin assays. This study explored whether NT-proBNP, BNP, and their respective ratios to troponin could enhance the ability to distinguish between these MI subtypes.</p><p><strong>Methods: </strong>As a HIGH-US sub-study, we examined data from 280 patients diagnosed with non-ST elevation myocardial infarction (172 with T1-MI and 108 with T2-MI). We assessed NT-proBNP, BNP, hs-cTnI, and their ratios as potential discriminative biomarkers. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>NT-proBNP levels were markedly elevated in T2-MI patients compared to those with T1-MI (mean 10,327±12,923 vs 4,675±11,740 ng/L; P=0.006). Conversely, hs-cTnI concentrations were higher in T1-MI (1.4±5.1 vs 0.5±1.1 ng/L; P=0.030). Notably, the NT-proBNP-to-troponin ratio was more than three times greater in T2-MI cases (94,880±152,648 vs 24,209±78,727; P=0.007). NT-proBNP alone demonstrated fair discriminatory capacity (AUC 0.717, 95% CI 0.578-0.856), closely matching the NT-proBNP-to-troponin ratio (AUC 0.720, 95% CI 0.566-0.873). In contrast, BNP and the BNP-to-troponin ratio offered lower diagnostic values. Mean BNP levels were 505.4 ±576.6 ng/L for those with T2-MI and 437.1 ±738.8 ng/L for patients with T1-MI. BNP-to-troponin ratio showed a poor discrimination for the 2 MI types (AUC, 0.660; 95% CI, 0.532-0.789).</p><p><strong>Conclusions: </strong>Both NT-proBNP and its ratio to troponin show potential in differentiating T1-MI from T2-MI, reflecting distinct underlying pathophysiological processes. Given its comparable performance to the ratio, NT-proBNP alone may serve as a practical and cost-effective standalone marker. These findings support the hypothesis that incorporating NT-proBNP testing into routine clinical workflows may better informs the management of patients with suspected MI.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining the Undergraduate Medical Education Systems-Based Course: an example for the Cardiovascular System.","authors":"David E Winchester","doi":"10.1097/HPC.0000000000000401","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000401","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the experience and results of adopting evidence-based teaching strategies in a cardiovascular system course for undergraduate medical students.</p><p><strong>Material and methods: </strong>Evidence-based methods for teaching undergraduate medical students was combined with feedback from students to inform and implement several changes to the course structure, content, and teaching methods.</p><p><strong>Results and conclusions: </strong>The course was restructured with new learning objectives, \"mini-tracks\", 30-minute lectures, and purposeful repetition. Active learning was increased to 32 of 101 learning activities AL (31.7%). The overall approval rating for the course substantially increased after changes were made. Course directors should periodically review their learning activities for opportunities to adopt evidence-based educational techniques.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSESSING THE UTILITY OF THE HEART SCORE IN THE ERA OF HIGH-SENSITIVITY TROPONIN.","authors":"Ethan F Kramer, Jonathan Van Name, Rogina Rezk, Nicolas J Abchee, Emily P Meisel, Michelle Waples, Reece Frechette, Brandon R Allen, Mohammed Ruzieh","doi":"10.1097/HPC.0000000000000400","DOIUrl":"10.1097/HPC.0000000000000400","url":null,"abstract":"<p><p>There is uncertainty in the clinical utility of the HEART score, given its incorporation of an older generation of troponin assay. We sought to determine whether high-sensitivity troponin I (Hs-TnI) alone can effectively stratify cardiovascular risk in patients presenting to the emergency department (ED) with moderate or high HEART score by analyzing the management and outcomes of adults presenting to our ED with chest pain, moderate or high HEART score, and Hs-TnI below the 99th percentile. For this population, we calculated the negative predictive value (NPV) of Hs-TnI in ruling out a major adverse cardiac event (MACE; defined as myocardial infarction or death from a cardiovascular or unknown cause) at 30 days. The average HEART score was 5.1, and 1224 patients (92.0%) had a moderate HEART score (4-6) and 107 patients (8.0%) had a high HEART score (7+). The average age of patients was 59.0 years and 52.7% were women. The incidence of 30-day MACE was 0.2%. Overall, in this cohort of patients with moderate or high HEART score, Hs-TnI below the 99th percentile had an NPV of 99.8% (95% CI: 99.6% - 100.0%) in ruling out MACE at 30 days. Given the low event rate, a moderate or high HEART score should not be the sole determinant for admission when Hs-Tnl is not elevated.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Outcomes of Over-Expanding Versus Conventional Sizing in transcatheter aortic valve replacement for Borderline Aortic Annulus: A Meta-Analysis.","authors":"Ahmad Mustafa, Ryan Kaple, Chapman Wei, Yuriy Dudiy, Sung-Han Yoon, Perry Wengrofsky, Vladimir Jelnin, George Batsides, Rachel Spallone, Elie Elman, Mark Anderson, David Landers, Craig Basman","doi":"10.1097/HPC.0000000000000392","DOIUrl":"10.1097/HPC.0000000000000392","url":null,"abstract":"<p><p>Approximately 20-40% of patients that present for transcatheter aortic valve replacement (TAVR) with a balloon-expandable (BE) transcatheter heart valve (THV) fall into a borderline aortic annulus size (BAAS). There are potential benefits to over-expanding an under-sized THV (OE-THV) in such cases that include reduced electrical disturbances and annular injury at the expense of increased paravalvular leak (PVL). We conducted a meta-analysis of data comparing conventional sized vs OE-THV strategy for BAAS and review the literature for BE-THV in such cases. 9 non-randomized studies that compared a conventional strategy to OE-THV in patients with BAAS were included in our study. Our findings suggest that there is no difference in mortality, stroke, mean gradient or significant PVL. There was a trend towards less pacemakers in patients receiving an OE-THV. Borderline aortic annulus measurements are common in patients undergoing TAVR and there appears to be equipoise between conventional sizing vs OE-THV. Future detailed studies are required to evaluate short- and long-term outcomes amongst strategies.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The QRS Interval After Pacemaker Implant: An Independent Mortality Risk Factor.","authors":"Gabriel Vanerio","doi":"10.1097/HPC.0000000000000385","DOIUrl":"10.1097/HPC.0000000000000385","url":null,"abstract":"<p><strong>Background: </strong>We have been pacing the right ventricular apex, creating an artificial left bundle branch block (LBBB) for more than 4 decades. We learned that some patients would develop dys-synchronization and hence heart failure due to QRS widening. If the lead is implanted in the left bundle area and a narrow QRS is achieved, those patients with LBBB will improve after implant, but those with non-LBBB morphologies might not benefit from QRS narrowing. However, there is not enough information regarding patients with narrow or wide QRS with different types of atrioventricular block that could also benefit from QRS narrowing.</p><p><strong>Objectives: </strong>Demonstrate that a narrow-paced QRS is a significant determinant of mortality in patients receiving a permanent pacemaker despite the previous QRS morphology.</p><p><strong>Patients and methods: </strong>We analyzed 204 patients from our pacemaker database. We attempted to implant the lead in the septal area. In our lab, we utilized standard lead electrodes. The criteria for appropriate implant were an electrogram with injury potential, an acceptable lead positioning in the right anterior oblique and left anterior oblique, and a ventricular bipolar threshold less or equal to 1.0 V @ 0.5 ms. QRS duration was assessed according to the global QRS method (from the earliest onset of the QRS in any of the 12 simultaneously recorded standard leads). A QRS interval of 135 ms was determined as a cutoff point using a receiver operator curve (mortality).</p><p><strong>Results: </strong>The first implants were performed in March 2008 and ended in March 2024. A narrow QRS (<135 ms) was observed in 140 subjects (140/204, 68%). The primary endpoint (death from cardiovascular cause) was met in 10 (4.9%) patients. LBBB was present before implant in 29 patients and a QRS <135 ms was measured in 12/29 (41%). We did not observe more complications compared with the conventional technique. The survival curve using Kaplan-Meier analysis comparing the 2 groups was significantly different with a significant mortality reduction in the narrow QRS group.</p><p><strong>Conclusions: </strong>A narrow-paced QRS is an independent variable associated with increased survival rates.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0385"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Outcomes of Coronary Artery Aneurysms: A Patient-Level Systematic Review.","authors":"Daler Rahimov, Nayeem Nasher, Danial Ahmad, Rohinton J Morris, Anjali Upadhyaya, Colin Yost, Daniella Wong, Preeyal Patel, Alec Vishnevsky, Nicholas J Ruggiero, John W Entwistle, Vakhtang Tchantchaleishvili","doi":"10.1097/HPC.0000000000000381","DOIUrl":"10.1097/HPC.0000000000000381","url":null,"abstract":"<p><strong>Background: </strong>Data are lacking to guide standardized management of coronary artery aneurysms (CAAs). We sought to analyze the available evidence in a quantitative manner.</p><p><strong>Methods: </strong>An electronic search identified 431 case reports or case series on CAA, comprising 488 patients. Patient-level data were extracted. Subgroups of CAA with fistulous connections (CAAF) and CAA without fistulous connections (CAAO) were analyzed separately.</p><p><strong>Results: </strong>Fistulous connection was present in 24.0% (117/488) of patients with CAA. Angina was a presenting symptom in 64.7% (301/465), with higher preponderance in the CAAO group [CAAO: 71.1% (249/350) versus CAAF: 45.2% (52/115); P < 0.01]. The median largest aneurysm diameter was higher in the CAAF group [CAAO: 3.0 (1.5-5.0) cm versus CAAF: 5.0 (3.0-7.0) cm; P < 0.01], and rupture was more frequently observed in the CAAF group [CAAO: 3.1% (11/353) versus CAAF: 13.8% (16/116); P < 0.01]. For any given diameter, CAAF had a higher risk of rupture compared with CAAO. Surgery was the most common management strategy, particularly in patients with CAAF [CAAO: 50.9% (189/371) versus CAAF: 75.2% (88/117); P < 0.01]. The Kaplan-Meier analysis showed a trend toward more favorable survival in CAAF. The hazard of mortality was associated with aneurysm diameter in both subsets but was higher in the CAAO group independent of surgical versus interventional management.</p><p><strong>Conclusions: </strong>CAAF appears to have a higher risk of rupture but may be associated with better survival than CAAO. Management for patients with CAA differs based on the presence or absence of a fistula; however, both surgical and interventional modes of management result in similar survival.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0381"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Embolic Protection in Percutaneous Coronary Intervention Without Saphenous Venous Graft Lesions in ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis: Erratum.","authors":"Maisha Maliha, Vikyath Satish, Kuan Yu Chi, Diego Barzallo Zeas, Amrin Kharawala, Nishat Shama, Nathaniel Abittan, Sneha Nandy, Anita Osabutey, Nidhi Madan, Prabhjot Singh, Eleonora Gashi","doi":"10.1097/HPC.0000000000000389","DOIUrl":"10.1097/HPC.0000000000000389","url":null,"abstract":"","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0376"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rewarding 20-Year Experience With Initial and Repeat EKG and Echocardiographic Screening for Prevention of Sudden Death in Detecting Abnormal Findings.","authors":"Sharon Bates, Mohammad Reza Movahed","doi":"10.1097/HPC.0000000000000382","DOIUrl":"10.1097/HPC.0000000000000382","url":null,"abstract":"<p><strong>Background: </strong>To further analyze the impacts, findings, and modalities of multiple cardiac screenings to answer the question, are multiple screens necessary and useful in youth?</p><p><strong>Methods: </strong>Over 20 years, the Anthony Bates Foundation (ABF) has offered free and low-cost cardiac screenings to youth and their families nationwide. The volunteer force has provided blood pressure and ultrasound tests to participants throughout the 20 years. After year 7, electrocardiograms were added to the screening.</p><p><strong>Results: </strong>Over the 20 years, ABF abnormal findings held steady between 10% and 13%, with potential life-threatening findings at 2.5%. The participants who have experienced multiple screening tests on average would repeat within 2.5 years and have abnormal findings at 31.84%, potential life-threatening at 11.43%, and total echocardiography-related abnormal findings at 16.82%. The variance between male and female attendance by age is also noted during the review of ABF repeat screened data. Male attendance was at 59.65% and female 40.35%. The abnormality rate of males for the first visit was 10.9% followed by the second visit of 18.80%. The abnormality rate of females for the first visit was 12.22% followed by the second visit of 17.09%. A detailed analysis of abnormal findings is presented in this article.</p><p><strong>Conclusions: </strong>Cardiac screening involving multiple repeated screenings appears to be effective in detecting increasing numbers of abnormal findings that can be lifesaving.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0382"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Aortic Valve Implantation in Brazilian Public Health System: A Single-Center Experience.","authors":"Guilherme Pinheiro Machado, Pedro Castilhos Crivelaro, Gustavo Neves de Araujo, Alan Pagnoncelli, Julia Carvalho da Silva, Camila Porto Cardoso, Wagner Tadeu Azeredo Azevedo, Rodrigo Petersen Saadi, Eduardo Keller Saadi, Orlando Wender, Marco Wainstein, Felipe Costa Fuchs","doi":"10.1097/HPC.0000000000000387","DOIUrl":"10.1097/HPC.0000000000000387","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) has been established as the treatment of choice for severe aortic stenosis in high-risk patients as well as patients above 75 years old in all risk spectrums. Despite its worldwide adoption, implementation in lower-middle-income countries such as the Brazilian public health system (SUS, acronym in Portuguese) is incipient.</p><p><strong>Objectives: </strong>This study aimed to evaluate TAVI exclusively within SUS patients.</p><p><strong>Methods: </strong>This was a prospective cohort study in a public tertiary hospital in southern Brazil. All patients who underwent TAVI between 2018 and 2024 were included. The cohort was divided into 2 temporal periods: from July 2018 to December 2022 (n = 60) and January 2023 to October 2024 (n = 65). The clinical and procedural characteristics and in-hospital, as well as 1 year of outcomes, were evaluated according to Valve Academic Research Consortium-2 (VARC-2) criteria.</p><p><strong>Results: </strong>During the study period, 125 patients underwent TAVI. The average age was 80 years (± 10), and 49.6% were male. The mean aortic valve area was 0.76 cm² and the mean gradient was 45 (±13) mm Hg. The mean STS predicted risk of mortality (STS-PROM) score was 4.6% (±3.6). Device success was achieved in 119 patients (95.2%). In-hospital mortality was 2 (1.6%). A new permanent pacemaker was required in 16 (12.8%). Demographic and clinical characteristics between the first and the second periods were similar.</p><p><strong>Conclusions: </strong>The mortality and complications rate of TAVI performed within the scope of the Brazilian public health system were consistent with the clinical experience of other international registries.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0387"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Anthropometrics and HbA1c Levels, but not Dyslipidemia, Are Associated With Elevated hs-CRP Levels in Middle-aged Adults: A Population-based Analysis.","authors":"Laith Ashour, Layan Ayesh, Zeid Jarrar, Areen Mishleb, Danah Alenezi, Moath Fateh, Rawan Almejaibal, Nicola Hanna Madani, Muath Mohammad Dabas, Sama Samer Abu Monshar, Samar Hamdan","doi":"10.1097/HPC.0000000000000378","DOIUrl":"10.1097/HPC.0000000000000378","url":null,"abstract":"<p><p>Population-based studies of cardiovascular disease markers, such as high-sensitivity C-reactive protein (hs-CRP), are crucial. However, studies exploring the effect of metabolic indices on hs-CRP while controlling for confounding variables adequately in middle-aged adults are limited. Using Wave 5 public-use biomarkers data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined the impact of various metabolic indices on hs-CRP in adults aged 32-42, controlling for eight allergic and infectious factors that may elevate hs-CRP levels. We used multiple linear regression analysis to determine which factors predict hs-CRP levels after the log transformation of the dependent variable. The total number of participants was N = 1839 (weighted N = 1,390,763), with a mean age of 38.1 (SD = 2.0) and 46.4% having obesity. Among the controlled variables, recent surgery was the only confounder to significantly predict increased hs-CRP levels [ P = 0.029; exponentiated estimate (EE) = 1.61; 95% confidence interval (Cl), 1.31-1.91]. Notably, current smoking and altered low-density lipoprotein levels did not show a significant association with hs-CRP levels ( P > 0.05). However, a significant increase in hs-CRP levels was observed in females compared with males ( P < 0.001; EE = 1.43; 95% Cl, 1.35-1.51). Similar findings were noted for diabetic HbA1c levels ( P = 0.001; EE = 1.6; 95% CI, 1.42-1.78), high waist circumference ( P = 0.015; EE = 1.25; 95% CI, 1.15-1.35), and stage 3 obesity ( P = 0.006; EE = 7.62; 95% CI, 2.86-12.38). Although not statistically significant, hs-CRP levels exhibited a gradual increase with rising body mass index after controlling for other variables. These findings will improve the clinical application of hs-CRP in predicting coronary artery disease, especially in younger adults.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0378"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476566","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}