Acute and Critical Care最新文献

{"title":"Reply to the Letter to the Editor: \"Duration of antibiotic therapy: with or without biomarkers?\": applying the double-trigger approach at the bedside.","authors":"Goncalo Sequeira Guerreiro, Joao Manuel Ferreira Fustiga, Pedro Manuel Sarmento Rodrigues Povoa","doi":"10.4266/acc.008190","DOIUrl":"https://doi.org/10.4266/acc.008190","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184952","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 effects of intravenous glutamine supplementation in critically ill patients: a systematic review and meta-analysis.","authors":"Jae Gil Lee, In Gyu Kwon, Seung Min Baik","doi":"10.4266/acc.002132","DOIUrl":"https://doi.org/10.4266/acc.002132","url":null,"abstract":"<p><strong>Background: </strong>Studies evaluating intravenous (IV) glutamine supplementation in critically ill patients have shown inconsistent results. This study aimed to evaluate the effects of IV glutamine on mortality, infectious complications, length of stay, and duration of mechanical ventilation.</p><p><strong>Methods: </strong>A systematic search of Ovid Medline, Embase, the Cochrane Central Register of Controlled Trials, and KoreaMed was conducted from inception through October 2023 and updated in April 2025. Randomized controlled trials comparing IV glutamine supplementation with standard care in critically ill adults were included. Pooled estimates were calculated using random-effects models.</p><p><strong>Results: </strong>A total of 10 randomized trials involving 1,593 critically ill patients were included in the analysis. IV glutamine supplementation was not associated with reduced overall mortality (risk ratio [RR], 0.93; 95% CI, 0.77-1.13) or overall infection rates (RR, 0.86; 95% CI, 0.63-1.18). No mortality benefit was observed in either non-surgical or surgical/trauma subgroups. Glutamine supplementation was associated with reduced pneumonia incidence (RR, 0.65; 95% CI, 0.49-0.87) and shorter mechanical ventilation duration (mean difference, -0.97 days; 95% CI, -1.62 to -0.32); however, these findings were based on a limited number of small studies. Intensive care unit and hospital length of stay were longer in the glutamine group.</p><p><strong>Conclusions: </strong>IV glutamine supplementation was not associated with improved survival or overall infection rates in critically ill adults. Current evidence does not support routine IV glutamine supplementation in unselected critically ill patients.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185062","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":"Comment on \"Duration of antibiotic therapy: with or without biomarkers?\": applying the double-trigger approach at the bedside.","authors":"Faruk Yıldız, Volkan İnal","doi":"10.4266/acc.007748","DOIUrl":"https://doi.org/10.4266/acc.007748","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184926","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":"Clinical characteristics and risk factors for intensive care unit admission and mortality in rapid response team-activated ward patients: a retrospective cohort study at a tertiary hospital in South Korea.","authors":"Sumin Gwon, Bumin Kim, Gaeun Kim","doi":"10.4266/acc.002782","DOIUrl":"https://doi.org/10.4266/acc.002782","url":null,"abstract":"<p><strong>Background: </strong>Factors driving intensive care unit (ICU) transfer decisions and mortality after rapid response team (RRT) activation remain unclear. We identified independent predictors of ICU admission, 28-day mortality, and in-hospital mortality in RRT-activated ward patients.</p><p><strong>Methods: </strong>This retrospective cohort study included adults with first RRT activation from September 2023 to August 2025 at a Korean tertiary hospital (n=549). Multivariable logistic regression with backward elimination was used.</p><p><strong>Results: </strong>Of 549 patients, 191 (34.8%) were transferred to the ICU. ICU admission was independently predicted by procalcitonin >0.5 ng/ml (adjusted odds ratio [aOR], 2.833; P=0.021) and lower hemoglobin (aOR, 0.808 per g/dl; P=0.040), whereas solid tumor was associated with lower transfer likelihood (aOR, 0.142; P<0.001). Mortality did not differ significantly between ICU and ward groups at 28 days (27.7% vs. 27.7%, P=0.937) or during hospitalization (46.1% vs. 40.2%, P=0.162). Declining peripheral oxygen saturation (SpO₂)/fraction of inspired oxygen (FiO₂) ratio, rising lactate, and hyperkalemia predicted both mortality outcomes. Lower platelet count uniquely predicted 28-day mortality, whereas solid tumor, chronic kidney disease, and deep learning-based continuous cardiac arrest risk score (DeepCARS) additionally predicted in-hospital mortality. ICU admission itself was not independently associated with mortality.</p><p><strong>Conclusions: </strong>ICU transfer after RRT activation appears to reflect acute reversibility, clinical trajectory, and possible at/after-activation goals-of-care processes rather than severity alone. Mortality was more closely associated with oxygenation failure, hypoperfusion, and electrolyte instability than with disposition.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184966","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":"Brachial artery reactivity in sepsis and septic shock patients in the intensive care unit: a prospective exploratory study in an Indian population.","authors":"Karrothu Trimurthulu, Afzal Azim, Banani Poddar, Mohan Gurjar, Zafar Neyaz","doi":"10.4266/acc.001508","DOIUrl":"https://doi.org/10.4266/acc.001508","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is increasingly recognized as a state of profound endothelial dysfunction triggered by infection, leading to microvascular injury and multi-organ failure. Non-invasive assessment of brachial artery reactivity using ultrasound following transient ischemia provides an indirect yet practical tool for evaluating endothelial dysfunction. This study aimed to determine the association between brachial artery reactivity indices and intensive care unit (ICU) mortality in sepsis and septic shock patients.</p><p><strong>Methods: </strong>In this prospective analysis, 120 participants were enrolled, with 40 in each group (sepsis, septic shock, and healthy controls). Within 24 hours of ICU admission, baseline and post-deflation arterial diameters and velocity time integral (VTI) were measured using ultrasonography after three minutes of cuff occlusion at 50 mm Hg above systolic pressure and compared. Subgroup analysis was performed to compare survivors and non-survivors, correlating with Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores.</p><p><strong>Results: </strong>Flow mediated dilation (FMD), hyperemic VTI, and change in VTI (ΔVTI) were significantly reduced (P<0.001) in sepsis and septic shock compared with controls. Non-survivors (n=38) had significantly lower hyperemic VTI (53.40 cm/cardiac cycle [interquartile range, 40.28-65.95] vs. 61.30 [48.18-84.85], P=0.041) and lower ΔVTI (35.80 [20.3-43.66] vs. 44.65 [30.95-57.23], P=0.011) than survivors. Receiver operating characteristic analysis showed ΔVTI (cutoff, 43.07 cm/cardiac cycle) had higher specificity (59.5% vs. 54.8%) than hyperemic VTI (cutoff, 60.15), while both showed equal sensitivity (71.1%) for discriminating ICU mortality.</p><p><strong>Conclusions: </strong>Brachial artery reactivity indices were impaired in sepsis and septic shock. Hyperemic VTI and ΔVTI may have potential as complementary bedside prognostic markers requiring further validation in larger multicenter studies.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799158","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":"Right ventricular strain assessed by two-dimensional speckle tracking echocardiography and mortality in acute respiratory distress syndrome: a systematic review and meta-analysis.","authors":"Eleni Xourgia, Dimitrios E Katsaros, Ilias I Siempos, Anastasia Kotanidou, Christina Routsi","doi":"10.4266/acc.006025","DOIUrl":"10.4266/acc.006025","url":null,"abstract":"<p><strong>Background: </strong>We investigated differences in right ventricular cardiac strain between survivor and non-survivor acute respiratory distress syndrome (ARDS) patients as measured by speckle tracking echocardiography.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed and Scopus for relevant articles reporting data on all-cause mortality and right cardiac speckle tracking echocardiography in ARDS patients. We considered studies published up to May 4, 2025. The primary objectives of the meta-analysis were right ventricular global and free-wall strain. A random effects model was used.</p><p><strong>Results: </strong>We included six studies with a total population of 359 individuals. While right ventricular global longitudinal strain of intubated ARDS patients (mean difference [95% CI], -2.30 [-4.13 to -0.47], P=0.01) was greater among non-survivors, free-wall strain (mean difference [95% CI], -2.78 [-6.83 to 1.27], P=0.18) was similar among groups. Among classic right ventricular echocardiographic indices, S prime and fractional area of change were lower among non-survivors, while still within normal range, while tricuspid annular plane systolic excursion was similar between groups. When exploring heterogeneity, we observed that removing outlier studies indicated consistently worse baseline right ventricular function among both strain and non-strain parameters.</p><p><strong>Conclusions: </strong>Although right ventricular function appears to be worse among non-survivor ARDS patients, results vary due to high heterogeneity among published studies. The role of right ventricular speckle tracking echocardiography as a non-invasive bedside means of quantifying myocardial dysfunction and predicting patient outcomes remains to be explored further in future trials.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"578-587"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279182","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":"Prognostic value of initial hemoglobin levels for neurological outcomes in patients with out-of-hospital cardiac arrest in South Korea.","authors":"Jihun Keum, Kyung Hun Yoo, Yongil Cho, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko, Juncheol Lee","doi":"10.4266/acc.005075","DOIUrl":"10.4266/acc.005075","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest that lower hemoglobin (Hb) levels are associated with adverse outcomes after out-of-hospital cardiac arrest (OHCA). However, most of these were limited by small sample sizes and single-center designs. We aimed to evaluate the association between initial Hb levels and clinical outcomes after OHCA using a large multicenter registry.</p><p><strong>Methods: </strong>This retrospective observational study analyzed prospectively collected multicenter registry data. Hb levels measured at emergency department arrival were analyzed as continuous variables with restricted cubic spline (RCS) models, which flexibly characterize dose-response relationships with unfavorable neurological outcomes and in-hospital mortality. Generalized estimating equations with a logit link were used to account for within-hospital clustering and to adjust for clinically relevant covariates.</p><p><strong>Results: </strong>Lower Hb levels were independently associated with higher adjusted odds of unfavorable neurological outcomes and in-hospital mortality. RCS analyses showed a statistically significant overall association between Hb levels and both outcomes after multivariable adjustment (overall P<0.001). The adjusted odds of adverse outcomes increased progressively with decreasing Hb levels. Cluster-adjusted analyses using generalized estimating equations yielded consistent results.</p><p><strong>Conclusions: </strong>Initial Hb levels were independently associated with neurological outcomes and in-hospital mortality after OHCA. Modeling Hb as a continuous variable showed a graded association across the Hb spectrum. These findings highlight the prognostic relevance of baseline Hb levels.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"588-597"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279223","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":"Korean clinical practice guidelines for rehabilitation in critically ill patients and post-intensive care syndrome.","authors":"Chi Ryang Chung, Hye Ju Yeo, Jong Geol Do, Yoonju Na, Eunjeong Choi, Jiyeon Kang, Jeong-Yi Kwon, Hyun Jung Kim, Jinyoung Park, Hak-Jae Lee, Myung Hun Jang, Seung-Tak Kang, Kyung Hyup Koo, Young Seok Kim, Won Kim, Tae-Yoon Kim, Jiyoun Park, Jaewon Beom, Kyung Cheon Seo, Hyun-Woo Sun, Woochul Son, Myung-Jun Shin, So Young Ahn, Song I Lee, Min-Hyung Rhee, Yu Hui Won, Myungeun Yoo, Yu Jin Im, Sun Ju Chang, Ye Rim Chang, Mi-Kyeong Jeon, Jin Hee Jung, Yumi Ha, Sung Eun Hyun, Suk-Kyung Hong, Gee Young Suh","doi":"10.4266/acc.006630","DOIUrl":"10.4266/acc.006630","url":null,"abstract":"<p><strong>Background: </strong>Survivors of critical illness commonly experience persistent physical, cognitive, and psychological impairments, collectively known as post-intensive care syndrome. Although intensive care unit (ICU) rehabilitation is now recognized as an important part of recovery after critical illness, rehabilitation practices remain inconsistent, and clinical practice guidelines adapted to the Korean healthcare context have not been available.</p><p><strong>Methods: </strong>These clinical practice guidelines were developed de novo by a multidisciplinary panel comprising critical care physicians, rehabilitation specialists, nurses, and allied health professionals. The panel prioritized 15 key clinical questions addressing adult, pediatric, and neonatal ICU (NICU) rehabilitation. Systematic literature searches were conducted in Medline via PubMed, Embase, the Cochrane Library, and KoreaMed, and the final searches for all 15 questions were completed by November 30, 2024. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Final recommendations were approved through a structured consensus process requiring at least 70% panel agreement.</p><p><strong>Results: </strong>The panel issued 15 recommendations across major rehabilitation domains, including early structured rehabilitation, criteria for withholding or discontinuing therapy, adjunctive modalities, rehabilitation frequency, inspiratory muscle training, swallowing rehabilitation, cognitive and occupational therapy, nutritional support, neonatal and pediatric ICU rehabilitation, and post-ICU follow-up care. Thirteen recommendations were conditional, whereas two were strong, mainly because they addressed patient safety.</p><p><strong>Conclusions: </strong>These guidelines provide evidence-informed recommendations for rehabilitation in critically ill patients across adult, pediatric, and NICUs in Korea. They are designed to standardize practice, improve patient safety, support patient-centered functional recovery beyond survival, and identify priorities for future research.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"439-465"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931628","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":"Predictors of delayed extubation post-coronary artery bypass graft and its relationship with length of stay and in-hospital mortality in Jordan.","authors":"Mohannad Eid Aburuz, Fatma Refaat Ahmed, Haya Ibrahim Ali Abu Maloh, Elham Othman, Ahmed Abdel Hafez, Rawia Gamil, Ahmad Rajeh Saifan","doi":"10.4266/acc.003432","DOIUrl":"10.4266/acc.003432","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass graft (CABG) surgery is an invasive procedure done to resolve symptoms and improve quality of life in patients with coronary artery disease. However, it is a major operation that has its own complications and risks. Delayed extubation (DE) after surgery has been associated with higher-than-average rates of morbidity and mortality. The objective of this study was to determine the incidence and most important predictors of DE following CABG surgery.</p><p><strong>Methods: </strong>This prospective observational study was conducted on 300 adult patients who underwent non-urgent CABG. Data were collected from 4 hospitals in Alexandria, Egypt, by trained research assistants and were analyzed using logistic regression, independent t-test, and Fisher's exact test.</p><p><strong>Results: </strong>Seventy-five participants (25%) developed DE. Patients with age ≥60 years, operation time ≥7 hours, cardiopulmonary bypass time ≥120 minutes, or body mass index ≥28 kg/m2 had a 1.71, 1.88, 2.25, or 2.33 times higher risk of developing DE than those in the counterpoint groups. The only protective variable was the ejection fraction (EF). Patients with EF ≥50% were 21% less likely to develop DE than those with EF less than 50%. Participants who developed DE stayed longer in the intensive care unit (mean±standard deviation [SD], 7.9±1.60 vs. 3.1±1.2; P<0.001) and in the hospital (mean±SD, 22.6±3.1 vs. 15.1±2.9; P<0.001) than those who did not develop DE.</p><p><strong>Conclusions: </strong>Performing CABG as early as possible, controlling body mass index, shortening the operation and cardiopulmonary bypass times, and enhancing EF might decrease the occurrence of postoperative DE and its associated mortality.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"692-700"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279155","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":"Vasoactive-inotropic score as a predictor of clinical deterioration in pediatric patients undergoing venovenous extracorporeal membrane oxygenation: a preliminary single-center study in South Korea.","authors":"Joung-Hee Byun, Young A Kim, Hye Jin Baek, Hyungtae Kim, Jae Hong Lee, Kwang Ho Choi","doi":"10.4266/acc.008840","DOIUrl":"10.4266/acc.008840","url":null,"abstract":"<p><strong>Background: </strong>Venovenous (VV) extracorporeal membrane oxygenation (ECMO) supports pediatric patients with severe respiratory failure; however, some experience clinical deterioration requiring conversion to venoarterial (VA) ECMO or resulting in mortality. The prognostic role of the vasoactive-inotropic score (VIS) at VV ECMO cannulation remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed pediatric patients who underwent VV ECMO between 2010 and 2024 at a single center. Baseline VIS was calculated from vasoactive infusion rates documented immediately prior to cannulation. The primary composite outcome was conversion to VA ECMO or in-hospital mortality. Associations between VIS and outcomes were assessed using correlation, univariable logistic regression, and receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Twenty patients underwent VV ECMO. Five (25.0%) required VA conversion, seven (35.0%) died, and nine (45.0%) met the composite outcome. Baseline VIS was not significantly associated with isolated mode change (r=0.13, P=0.589) and showed a borderline association with mortality (r=0.43, P=0.062). Logistic regression demonstrated a consistent direction of association between higher baseline VIS and the composite outcome (odds ratio, 1.04; 95% CI, 1.00-1.09; P=0.078). Correlation analysis also suggested an association (r=0.54, P=0.014). ROC analysis demonstrated an area under the curve of 0.79, suggesting potential discriminative ability, with an exploratory cutoff of 25.</p><p><strong>Conclusions: </strong>Baseline VIS showed a possible association with clinical deterioration in this pilot cohort. These findings are exploratory and require validation in larger prospective multicenter studies.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"654-660"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799219","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}