CJC Open最新文献

{"title":"Takotsubo T Waves---a Diagnostically Useful Electrocardiographic Pattern in 10 Case Presentations","authors":"Everglad Mugutso MBChB, MSc , Brent M. McGrath MD, MSc, PhD, FACC, FSCAI, FRCPC, DRCPSC","doi":"10.1016/j.cjco.2025.06.010","DOIUrl":"10.1016/j.cjco.2025.06.010","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1198-1200"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061779","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":"Complete Heart Block Due to High Vagal Tone in Pregnancy","authors":"Ella Maria Cockburn BCS, MD , Jessica Yao BBMed, MD , Robert Anderson BMedSci (Hons), MBBS (Hons), PhD, FRACP","doi":"10.1016/j.cjco.2025.06.001","DOIUrl":"10.1016/j.cjco.2025.06.001","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1263-1265"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061757","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":"Human-Centred Design & Development of a Shared Decision Aid for Patients with Chronic Kidney Disease Facing Treatment for Coronary Heart Disease","authors":"Julie Babione MSc ,&nbsp;Denise Kruger II RTR ,&nbsp;Pantea Javaheri MSc ,&nbsp;Todd Wilson PhD ,&nbsp;Winnie Pearson (Patient Partner) ,&nbsp;Wayne Gerber (Patient Partner) ,&nbsp;Loretta Lee (Patient Partner) ,&nbsp;Krystina B. Lewis PhD, RN, CCN(C) ,&nbsp;Michelle M. Graham MD, FRCPC, FCCS ,&nbsp;Stephen B. Wilton MD, MSc ,&nbsp;Matthew T. James MD, PhD, FRCPC","doi":"10.1016/j.cjco.2025.06.004","DOIUrl":"10.1016/j.cjco.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery disease (CAD) commonly accompanies chronic kidney disease (CKD) and carries unique management considerations for people with CKD. Shared decision-making (SDM) is a collaborative approach in which patients and physicians make decisions together based on a shared understanding of the health condition, treatment options and attributes, patient values and preferences, and risk tolerance. Our objective was to support SDM by creating a decision aid for patients with CKD and physicians addressing invasive vs conservative CAD treatment options, which included personalized risk estimates for treatment option attributes, and identification of patient values and preferences.</div></div><div><h3>Methods</h3><div>Applying human-centred design, informed by the International Patient Decision Aid Standard and Ottawa Decision Support Framework, we created a personalized <em>shared</em> decision aid. A concurrent mixed-methods study involved patients and physicians evaluating content, features, implementation contexts, and guided design. Survey data analysis used descriptive statistics, and interview transcripts were analyzed using deductive content analysis.</div></div><div><h3>Results</h3><div>Thirty-two patients (47% aged &lt; 65 years; 47% women) and 18 physicians (72% aged &lt; 50 years; 22% women) evaluated successive decision-aid iterations, providing design and implementation perspectives. Most received decision-aid content positively, and the design was refined over 3 development iterations. Overarching development-informing themes were as follows: (i) facilitating patient-physician interactions and knowledge-sharing to enable SDM; (ii) responding to contextual end-user needs for decision-making; and (iii) supporting flexible workflow use and integration. The decision aid is available at: <span><span>https://myheartandckd.ca</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusions</h3><div>Human-centred design processes effectively guided creation of a decision aid for patients with CKD and physicians making shared CAD treatment decisions. Findings will inform future clinical implementation strategies.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1244-1262"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061756","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":"Adiposity and Cardiometabolic Health Among Inuit of Nunavik: A 13-Year Follow-Up Study","authors":"Fannie Lajeunesse-Trempe MD-PhD ,&nbsp;Marie-Eve Piché MD-PhD ,&nbsp;Paul Poirier MD-PhD ,&nbsp;Sarah O’Connor PhD ,&nbsp;André Tchernof PhD ,&nbsp;Pierre Ayotte PhD","doi":"10.1016/j.cjco.2025.05.016","DOIUrl":"10.1016/j.cjco.2025.05.016","url":null,"abstract":"<div><h3>Background</h3><div>Obesity (body mass index [BMI] ≥ 30 kg/m²) is a major determinant of cardiometabolic health, yet the clinical impact of weight changes on cardiometabolic health in the Canadian Inuit population remains unclear.</div></div><div><h3>Methods</h3><div>Data were collected from 302 individuals (107 men and 195 women) who participated in the <em>Qanuippitaa?</em> 2004 and <em>Qanuilirpitaa?</em> 2017 Nunavik Inuit health surveys. Anthropometric indices (weight, BMI, waist circumference, and waist-to-height ratio, percentage of body fat, and fat-freemass), metabolic biomarkers, and hemodynamics were measured. Anthropometric characteristics and cardiometabolic risk factors were compared between 2017 and 2004 using Student paired <em>t</em> tests or the χ² test, adjusted for medication. The impact of adiposity changes on cardiometabolic risk factors (blood pressure, lipid profile, and glucose homeostasis parameters) was assessed using adjusted multivariate linear regression analysis.</div></div><div><h3>Results</h3><div>Inuit men and women (mean baseline age: 37.1 and 36.4 years) showed a significant increase in age-standardized percentage of body fat, despite having similar BMI in 2004 and 2017. Inuit women had significant rises in age-standardized waist circumference and waist-to-height ratio (<em>P</em> &lt; 0.05), whereas men’s remained stable. Increased abdominal fat was linked to adverse changes in some lipid (high-density lipoprotein cholesterol [HDL-C], total cholesterol/HDL-C ratio, apolipoprotein B) and glucose homeostasis (Homeostatic Model Assessment of Insulin Resistance) parameters (<em>P</em> &lt; 0.05), but not low-density lipoprotein cholesterol, triglycerides, non-HDL-C, fasting glucose, or blood pressure.</div></div><div><h3>Conclusions</h3><div>Adiposity phenotypes and cardiometabolic risk factors are evolving among Nunavik Inuit, but increased abdominal fat is not linked to certain lipid parameters, fasting glucose, or blood pressure. Further research is needed to understand ethnicity-specific traits and improve management of weight-related complications.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1226-1235"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061753","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 Self-Expanding Valve with a Dual Purpose—Exclusion of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa and Treatment of Aortic Stenosis","authors":"Antonio Tondo MD ,&nbsp;Alessandro Cafaro MD ,&nbsp;Miriam Albanese MD ,&nbsp;Marco Mussardo MD ,&nbsp;Alessandro Mandurino-Mirizzi MD ,&nbsp;Luca Quarta MD ,&nbsp;Francesco Rizzo MD ,&nbsp;Francesco Germinal RN ,&nbsp;Dionigi Fischetti MD ,&nbsp;Giuseppe Colonna MD","doi":"10.1016/j.cjco.2025.05.019","DOIUrl":"10.1016/j.cjco.2025.05.019","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1266-1270"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061758","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":"From Wrist to Precision: Enhanced Atrial Flutter Detection with Modified Smartwatch Single-Lead Electrocardiogram Placement","authors":"Yuval Avidan MD ,&nbsp;Amir Aker MD ,&nbsp;Razi Khoury MD ,&nbsp;Sameha Zahra MD ,&nbsp;Nissan Ben Dov MD ,&nbsp;Jorge E. Schliamser MD ,&nbsp;Asaf Danon MD, MSc","doi":"10.1016/j.cjco.2025.05.015","DOIUrl":"10.1016/j.cjco.2025.05.015","url":null,"abstract":"<div><h3>Background</h3><div>Smartwatches, such as the Apple Watch (AW), are well-established tools for detecting atrial fibrillation (AF). We hypothesize that atrial flutter (AFL) is frequently misdiagnosed using traditional single-lead electrocardiogram configurations and that modified device positioning could substantially improve diagnostic accuracy.</div></div><div><h3>Methods</h3><div>Standard smartwatch lead-I (AW-I) recordings were obtained from 75 patients, including 25 with AFL, 25 with AF, and 25 with sinus rhythm. Additionally, modified lead-II (AW-II) recordings were collected for all AFL cases, resulting in a total of 100 tracings. Twenty blinded physicians from 4 different specialties independently analyzed all recordings.</div></div><div><h3>Results</h3><div>Physicians’ ability to detect AFL using the AW-I lead was poor, with only 11.6% of cases correctly identified (<em>P</em> = 0.362). AFL was most often misdiagnosed as AF (55.6%), undetermined (21%), or sinus rhythm (11.8%). Diagnostic accuracy improved significantly with the AW-II lead, exceeding 80% among electrophysiologists, cardiologists, and primary care physicians (<em>P</em> = 0.001). Variable atrioventricular conduction was associated strongly with correct diagnosis exclusively through the AW-II lead (odds ratio 1.85, 95% confidence interval 1.14-3.0, <em>P</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>The standard lead-I configuration used by smartwatches is prone to misclassifying AF as AFL, particularly in the setting of variable conduction. A simple modification to lead-II positioning significantly enhances diagnostic accuracy. This adjustment may be especially valuable during post–pulmonary vein isolation surveillance and in broader clinical scenarios in which precise rhythm identification can influence therapeutic decision-making.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1149-1156"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060784","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":"Patient- and Family-Centered Care Recommendations in Cardiology Guidelines: An AI-Driven Systematic Review","authors":"Sarah A. Beydoun BSc, MSc (candidate) ,&nbsp;Catherine Gagné BSc ,&nbsp;Noah S. Neubarth BSc ,&nbsp;Jean-Pierre Abdallah BSc, MSc ,&nbsp;Jillian Kifell BSc, MSc ,&nbsp;Michael Goldfarb MD, MSc","doi":"10.1016/j.cjco.2025.05.017","DOIUrl":"10.1016/j.cjco.2025.05.017","url":null,"abstract":"<div><h3>Background</h3><div>Patient- and family-centred care (PFCC) is recognized as a critical component of cardiovascular care, but its integration into cardiology society guidelines has not been described. The objective of this study is to review PFCC language use and recommendations within major cardiology society guidelines.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of guidelines and statements from the American College of Cardiology (ACC), the American Heart Association (AHA), the Canadian Cardiovascular Society (CCS), and the European Society of Cardiology (ESC) for the period 2013-2023. PFCC-related key terms were identified using an artificial intelligence–based natural language processing algorithm, and recommendations were categorized into 8 dimensions of PFCC. The inclusion of PFCC recommendations across societies and trends over time were examined.</div></div><div><h3>Results</h3><div>A total of 260 guidelines and statements were analyzed. The most frequent PFCC dimensions overall were Health Transitions (23.5 per 100 pages), Shared Decision-Making (11.1 per 100 pages), and Care Access (9.9 per 100 pages). The least commonly identified dimensions across all journals were Care Coordination (6.5 per 100 pages), Emotional Support (4.0 per 100 pages), and Familial Support (1.0 per 100 pages). The CCS, ACC, and AHA had more recommendations using PFCC key terms than the ESC per 100 pages (17.3, 12.0, 10.3 vs 4.6, respectively, <em>P</em> &lt; 0.01). PFCC language usage increased markedly over the 10-year period for the ACC, AHA, and ESC, but it decreased for the CCS (all <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>PFCC language and recommendations are being included increasingly in cardiology society guidelines. Differences exist in PFCC language use across these societies. Future research is needed to evaluate the impact of these guideline recommendations on clinical practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1218-1225"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061752","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":"Incidence, Predictors, and Prognostic Impact of Left Ventricular Outflow Tract Obstruction Following Transcatheter Aortic Valve Replacement","authors":"Yuta Kobayashi MD, PhD ,&nbsp;Yusuke Enta MD ,&nbsp;Masaki Nakashima MD ,&nbsp;Makoto Saigan MD ,&nbsp;Natsuko Satomi MD ,&nbsp;Yung Teng MD ,&nbsp;Daishi Tazawa MD ,&nbsp;Yoshiko Munehisa MD, PhD ,&nbsp;Masataka Taguri PhD ,&nbsp;Masaki Hata MD ,&nbsp;Norio Tada MD, PhD","doi":"10.1016/j.cjco.2025.05.020","DOIUrl":"10.1016/j.cjco.2025.05.020","url":null,"abstract":"<div><h3>Background</h3><div>Dynamic left ventricular outflow tract obstruction (LVOTO) following transcatheter aortic valve replacement (TAVR) is a potential complication that can cause severe hemodynamic instability. However, limited evidence is available regarding the incidence and predictors of LVOTO post-TAVR. This study aimed to clarify the incidence and identify the predictors of LVOTO following TAVR and to investigate whether LVOTO is associated with clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective, single-centre study analyzed 2068 consecutive patients with aortic stenosis who underwent TAVR between January 2014 and December 2023. Transthoracic echocardiography was performed both before and after TAVR. LVOTO was defined as a peak pressure gradient exceeding 30 mm Hg.</div></div><div><h3>Results</h3><div>LVOTO occurred in 25 of 1963 patients (1.3%), with 6 patients developing acute hemodynamic compromise immediately after TAVR. Least absolute shrinkage and selection operator-penalized regression analysis identified the left ventricular outflow tract dimension (LVOTD), interventricular septum (IVS) thickness, transvalvular velocity, LVOT maximum velocity (V_max), and aortic annulus-to-LVOT area ratio (A/L ratio) as independent predictors of LVOTO following TAVR. Kaplan-Meier analysis revealed no association between LVOTO following TAVR and all-cause mortality or rehospitalization for heart failure.</div></div><div><h3>Conclusions</h3><div>The incidence of LVOTO after TAVR was 1.27%. Predictors of LVOTO were the IVS thickness, transvalvular velocity, LVOTD, LVOT V_max, and A/L ratio. Notably, LVOTO following TAVR was not associated with the composite outcome of all-cause mortality or heart failure hospitalization.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1236-1243"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061754","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":"Longitudinal Changes in Multiple Cardiac Biomarkers in Transthyretin Amyloidosis Cardiomyopathy Patients Treated Vs Untreated with Tafamidis","authors":"Karan Shahi MSc ,&nbsp;Robert J.H. Miller MD ,&nbsp;Steven Dykstra PhD ,&nbsp;Yuanchao Feng PhD ,&nbsp;Jonathan G. Howlett MD ,&nbsp;Victor Jimenez-Zepeda MD ,&nbsp;Jan Veenhuyzen RN, BScN ,&nbsp;James A. White MD ,&nbsp;Nowell M. Fine MD, SM","doi":"10.1016/j.cjco.2025.05.012","DOIUrl":"10.1016/j.cjco.2025.05.012","url":null,"abstract":"<div><h3>Background</h3><div>Tafamidis is an oral transthyretin stabilizer that improves survival in transthyretin amyloidosis cardiomyopathy (ATTR-CM), but only limited real-world data describe serial cardiac biomarker changes following treatment initiation. The primary objective of this study was to characterize longitudinal changes across multiple cardiac biomarker domains in tafamidis-treated ATTR-CM patients, to describe how these parameters evolve over time in routine clinical practice. We also report the same outcomes in untreated patients to reflect the natural disease history in a modern real-world cohort.</div></div><div><h3>Methods</h3><div>Clinical, biochemical, and cardiac imaging parameters were serially assessed at baseline and 1-year follow-up for 145 ATTR-CM patients, both those treated and those untreated with tafamidis.</div></div><div><h3>Results</h3><div>The median age was 80 years (range: 73-86), and 80 patients (55%) received tafamidis. At baseline, the treated group was younger and exhibited less advanced disease, relative to the untreated group. Treatment with tafamadis was associated with stabilization in N-terminal pro-B-type natriuretic peptide (NTproBNP) level, troponin-T level, and New York Heart Association functional class at 1-year follow-up, whereas the untreated group demonstrated worsening (all comparisons <em>P</em> &lt; 0.05). Tafamidis treatment status was not significantly associated with National Amyloidosis Center or Mayo Clinic disease stage.</div></div><div><h3>Conclusions</h3><div>NTproBNP level, troponin-T level, and New York Heart Association functional class remain stable over 1 year in a real-world cohort of tafamidis-treated ATTR-CM patients. These results may help inform therapeutic monitoring strategies in clinical practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1190-1197"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061778","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":"Consequences of Right Heart Disease for Cardiac Electrophysiology and Arrhythmias: Cellular and Structural Mechanisms","authors":"Orlane Neuilly MSc ,&nbsp;Ngoc Anh Lisa Le MSc ,&nbsp;Paul Khairy MD, PhD ,&nbsp;Roddy Hiram PhD","doi":"10.1016/j.cjco.2025.06.013","DOIUrl":"10.1016/j.cjco.2025.06.013","url":null,"abstract":"<div><div>Conditions provoking the electrical and structural-functional remodelling of the myocardium can lead to the development of heart rhythm disorders, including atrial fibrillation (AF) and ventricular tachyarrhythmias that can cause sudden cardiac death. Right heart disease (RHD) causes progressive structural and functional remodelling of the right heart responsible for right ventricular and atrial dysfunction and arrhyhmias. Conditions contributing to the development of RHD include left heart disease, pulmonary arterial hypertension, congenital heart disease, right-sided myocardial infarction due to coronary artery occlusion, and amyloidosis. In adult patients with RHD associated with pulmonary arterial hypertension, the prevalence of AF is about 20%, and in adult patients with arrhythmogenic right ventricular cardiomyopathy, it is 14%. A study has suggested that compared to non patients without congenital heart disease, AF appears 30 years earlier in adult patients with congenital heart disease, with a 10-20-fold-higher incidence. This narrative review article aims to review knowledge about the pathophysiology of RHD associated with cardiac arrhythmia. Evidence is reported about the mechanisms underlying the initiation and maintenance of the arrhythmogenic substrate in RHD. We summarize the available experimental approaches to study RHD associated with cardiac arrhythmia, including <em>in vitro</em> models (isolated cardiomyocytes, fibroblasts) and <em>in vivo</em> models (monocrotaline, pulmonary artery banding, Sugen/hypoxia). In addition, we discuss potential future strategies targeting myocardial inflammation and fibrosis in the prevention of cardiac arrhythmia in RHD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1170-1189"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061777","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}