Neurohospitalist最新文献

{"title":"Evaluating Treatment Dynamics in Refractory Status Epilepticus: A Retrospective Observational Cohort Study.","authors":"Megan Barra, Henrikas Vaitkevicius, Salia Farrokh, Sri Saikumar, Saloni Shah, Dushyant Katariya, Eva Rybak","doi":"10.1177/19418744261444521","DOIUrl":"https://doi.org/10.1177/19418744261444521","url":null,"abstract":"<p><strong>Background and purpose: </strong>Status epilepticus (SE) is a life-threatening emergency associated with high morbidity and mortality. Limited guidance exists on optimal therapy for refractory SE (RSE), which may include administration of repeat second-line IV-antiseizure medications (IV-ASMs) or escalation to IV-anesthesia (IVA). This study examined real-world treatment dynamics and outcomes of hospitalized patients with RSE in the United States.</p><p><strong>Methods: </strong>A retrospective, cross-sectional analysis of hospitalized patients with SE between 2018-2022 was performed using PINC AI™ Healthcare Database. Patient encounters for RSE were categorized into RSE-no IVA (≥2 IV-ASMs without IVA) and RSE-IVA (≥1 IV-ASMs with IVA and concomitant mechanical ventilation). RSE-no IVA episodes were further stratified by exposure to 2 IV-ASMs and ≥3 IV-ASMs.</p><p><strong>Results: </strong>Across 140 538 SE episodes in 113 229 unique patients, 44% were RSE. IV-ASM and IVA exposure, as well as time to escalation varied widely across SE episodes. Compared to RSE-no IVA episodes (59%), RSE-IVA episodes (41%) were associated with increased ICU length of stay (LOS; 5 vs 3 days), hospital LOS (9 vs 6 days), and in-hospital mortality (25% vs 12%). Compared to patients with RSE-no IVA administered 2 IV-ASMs, those administered ≥3 IV-ASMs had increased ICU admission (73% vs 62%), longer ICU LOS (4 vs 2 days), and hospital LOS (9 vs 5 days).</p><p><strong>Conclusions: </strong>Heterogeneity in RSE treatments management is prominent, with variation in IV-ASM treatment sequencing and escalation timing. Both increased IV-ASM utilization and IVA exposure were associated with similarly worse outcomes and healthcare utilization. Rapidly effective anti-SE treatments remain an urgent unmet need in this patient population.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261444521"},"PeriodicalIF":0.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822302","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":"Navigating Uncertain Outcomes: A Case Study on Preference-Sensitive Decision-Making in Neurocritical Care.","authors":"Beatrix Göcking, Sophie Gloeckler, Andrea Glässel, Giovanna Brandi, Nikola Biller-Andorno","doi":"10.1177/19418744261444468","DOIUrl":"https://doi.org/10.1177/19418744261444468","url":null,"abstract":"<p><strong>Background: </strong>Navigating health-related decisions after severe acute brain injury (SABI) can be challenging, especially when the patient's preferences and the prognosis remain unclear. This uncertainty adds a layer of complexity for surrogates and medical teams striving to make treatment choices.</p><p><strong>Purpose: </strong>To address these challenges, this article presents an interview study examining decisions that were retrospectively relevant for a surrogate decision-maker.</p><p><strong>Study design: </strong>Key moments for shared decision-making and advance care planning were identified and compared to a theoretical decision model, providing valuable insights for decision-making in the context of SABI given time-pressure, prognostic uncertainties, and the patient's neurological impairment.</p><p><strong>Study sample: </strong>A semi-structured interview was conducted with the 31-year-old daughter of a 53-year-old woman who had experienced an aneurysmal subarachnoid hemorrhage.</p><p><strong>Analysis and results: </strong>The interview was thematically analyzed, and eight preference-sensitive decision moments were identified and visualized within a timeline: bleeding event, emergency treatment, intensive care unit treatment (general), severe complication, long-term life-sustaining surgical interventions, admission to rehabilitation, further severe complication, and palliation.</p><p><strong>Conclusion: </strong>In conclusion, this case study supports an iterative evaluation of treatment preferences and suggests well-suited moments for reevaluation of medical treatment goals and shared decision-making within a timeline. This framework may serve to facilitate shared decision-making by identifying key preference-sensitive junctures and providing a basis for designing tools that incorporate deliberate timing.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261444468"},"PeriodicalIF":0.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784885","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":"Radiographic Stability to Guide Initiation of Pharmacologic Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.","authors":"Andrea Loggini, Faddi G Saleh Velez, Adnan I Qureshi, Amir Ghafarian, Muaaz Wajahath, Awni D Shahait","doi":"10.1177/19418744261445689","DOIUrl":"https://doi.org/10.1177/19418744261445689","url":null,"abstract":"<p><strong>Background: </strong>Optimal timing of pharmacologic venous thromboembolism (VTE) prophylaxis after spontaneous intracerebral hemorrhage (ICH) remains uncertain due to concerns regarding hematoma expansion. Prior studies have primarily relied on arbitrary time thresholds rather than physiological markers of hemorrhage stability.</p><p><strong>Objectives: </strong>To summarize the literature on the safety and efficacy of pharmacologic VTE prophylaxis initiated after radiographic confirmation of hematoma stability in patients with spontaneous ICH.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of studies assessing heparinoids prophylaxis following repeat neuroimaging demonstrating hemorrhage stability. Three databases were searched: PubMed, Embase, Cochrane Central. The meta-analysis was registered in PROSPERO (CRD420261282903). The primary outcome was new or worsening intracranial hemorrhage, including hematoma expansion or new bleeding. Secondary outcomes included deep vein thrombosis and pulmonary embolism. Random-effects models were applied. <i>P</i> value was set at 0.05.</p><p><strong>Results: </strong>Four observational studies comprising 935 patients met inclusion criteria. Comparative meta-analysis demonstrated no significant association between pharmacologic prophylaxis after radiographic stability and intracranial bleeding risk (OR: 1.24, 95% CI: 0.80-1.94, <i>P</i> = 0.33), with negligible heterogeneity (I² = 0%). Sensitivity analysis restricted to parenchymal hematoma expansion showed similar results (OR 2.37, 95% CI: 0.42-13.43, <i>P</i> = 0.33). Thromboembolic outcomes trended in favor of pharmacological prophylaxis without reaching statistical significance (OR: 0.63, 95% CI: 0.33-1.22, <i>P</i> = 0.17).</p><p><strong>Conclusions: </strong>Pharmacologic VTE prophylaxis initiated after radiographic confirmation of hematoma stability does not increase intracranial hemorrhage risk and may reduce thromboembolic complications. These findings support further investigation into imaging-guided, individualized strategies for pharmacologic VTE prophylaxis after ICH.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261445689"},"PeriodicalIF":0.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785062","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":"Prolonged Agitation and Hypotonia due to Baclofen and Tizanidine Overdose Followed by Withdrawal: A Case Report.","authors":"Samuele Bonomi, Giorgio Guido, Ashley M Jones, Savannah Seupaul, Michael E Mullins","doi":"10.1177/19418744261444530","DOIUrl":"https://doi.org/10.1177/19418744261444530","url":null,"abstract":"<p><p>We describe a unique case of combined baclofen and tizanidine overdose followed by dual withdrawal syndromes, highlighting overlapping and contrasting clinical features that may complicate diagnosis and management. A 26-year-old man with paraplegia from cervical spinal cord injury, prescribed baclofen and tizanidine for spasticity, was found unresponsive at home next to partially empty medication bottles. Clinical evaluation included laboratory testing, neuroimaging, continuous monitoring, and serial neurologic and cardiopulmonary assessments. On admission, the patient exhibited CNS depression, hypotension, bradycardia, hypothermia, and subsequent episodes of severe psychomotor agitation. Supportive care with fluids, vasopressors, and sedation was required, including 2 subsequent intubations for airway protection. Within 24 hours, fever, tachycardia, and worsening agitation developed, consistent with withdrawal. Reintroduction of home baclofen and tizanidine alongside benzodiazepines and dexmedetomidine led to gradual resolution of symptoms, and the patient was discharged at neurologic baseline with psychiatric follow-up. This case underscores the diagnostic and therapeutic challenges of overlapping baclofen and tizanidine toxicity and withdrawal. Recognizing key bedside features-such as hypotonia vs tremor and mydriasis vs miosis-is essential. Sedation and bradycardia may be more severe in combined overdose than in overdose of either agent alone. Clinicians should anticipate withdrawal even in the setting of persistent toxicity. Early recognition and tailored supportive care are the cornerstone of management.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261444530"},"PeriodicalIF":0.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13091903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729904","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":"Dengue-Associated Acute Necrotizing Encephalopathy: A Case Report and Review of the Literature.","authors":"Muhammad Aslam Rind, Maria Nazir, Zehra Fatima, Sahir Bansari, Mahek Bansari, Sehar Hashim, Farina Fatima Siddiqui, Muhammad Momin Khan, Asma Subhan, Fiza Batool Rajput","doi":"10.1177/19418744261440439","DOIUrl":"10.1177/19418744261440439","url":null,"abstract":"<p><p>Dengue virus infection is increasingly recognized as a cause of neurological complications, though severe parenchymal involvement such as acute necrotizing encephalitis remains exceptionally rare in adults. We report a 35-year-old woman presenting with fever, seizures, and altered consciousness. Laboratory tests confirmed dengue virus infection, while cerebrospinal fluid analysis revealed normal protein and glucose, no pleocytosis, and positive dengue IgM. Brain MRI demonstrated bilateral thalamic hyperintensities with central hypointense cores, the characteristic \"double-doughnut\" sign, along with additional involvement of the brainstem, cerebellum, and occipital lobe, consistent with ANE. Despite prompt initiation of high-dose intravenous methylprednisolone, the patient developed persistent akinetic mutism, highlighting the poor prognosis in adult-onset cases. This case underscores the dissociation between severe radiological findings and relatively unremarkable CSF, emphasizes the diagnostic utility of MRI, and illustrates the therapeutic challenges in resource-limited settings. Early recognition and context-appropriate management are critical to improving outcomes.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261440439"},"PeriodicalIF":0.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610427","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":"Family Perceptions of End-of-Life Care Quality in Patients With Stroke: A Descriptive and Comparative Survey Study.","authors":"Celso Suárez Huelga, Carmen García-Cabo Fernández, Antía López Peleteiro, Manuel Díaz Castela, Andrea Vargas Mendoza, Marina Lanero Santos, Lourdes Sánchez Miranda, Beatriz Napal Cuerno, Juan Dinis Afonso Agüera, Lorena Benavente Fernández, María Rico Santos, Montserrat González Delgado, María Castañón Apilánez, Davinia Larrosa Campo, Elena López-Cancio Martínez, Sergio Calleja Puerta","doi":"10.1177/19418744261432021","DOIUrl":"10.1177/19418744261432021","url":null,"abstract":"<p><strong>Background and objetives: </strong>End-of-life (EOL) care in acute stroke is complex. Understanding family experiences is essential to improve care quality and promote a dignified death. This study aimed to assess family members perceptions of EOL care in patients who died after stroke and to identify factors associated with perceived dignified death.</p><p><strong>Methods: </strong>A cross-sectional survey of relatives of deceased stroke patients during 1 year was conducted. Of 111 eligible cases, 68 questionnaires were returned (61.3%). Following the descriptive analysis, we compared relatives who perceived the death as dignified with those who did not. Survey responses were then integrated with clinical data regarding treatment history and place of death.</p><p><strong>Results: </strong>Most relatives (82.4%) considered that the patient died with dignity. Perceived dignified death was significantly associated with adequate and comprehensible prognostic information, respectful communication, respect for patient and family preferences, adequate symptom control, being accompanied at the time of death, and empathetic staff attitudes (all <i>P</i> < 0.05). No significant associations were observed with room type, religious variables, clerical visits, expectedness of death, continuous sedation, IV fluids, antibiotics, enteral nutrition, or location of death; symptom control ratings did not differ between sedated and non-sedated patients.</p><p><strong>Conclusions: </strong>Most relatives perceived the death as dignified and they were generally satisfied with EOL care. Dignity was primarily linked to communication, respect for preferences, emotional support, and humane care rather than specific medical interventions.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261432021"},"PeriodicalIF":0.7,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487814","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":"Hypercoagulable Workup in Cryptogenic Stroke: What to Test, and When.","authors":"Saman Zafar, Sushma Helagalli Paramashivaiah, Aparna Prabhu, Muskaan Uppal, Gabriel Levis-Lahti, Sridhara Yaddanapudi","doi":"10.1177/19418744261434353","DOIUrl":"10.1177/19418744261434353","url":null,"abstract":"<p><p>There is a significant percentage of ischemic strokes, particularly in younger people, with etiologies that remain elusive despite standard workup. One dilemma in managing such patients is deciding whether they may have an underlying hypercoagulable condition that would lead to consideration of anticoagulation. Previous guidelines have focused on primary thrombophilia, but acquired conditions exceed genetic causes, and a stepwise approach to exclude such conditions before pursuing primary thrombophilia testing is important to improve diagnostic accuracy. To date, we have not encountered any algorithm in the medical literature that advises exclusion of secondary prothrombotic states prior to considering primary hypercoagulable disorders. This report proposes a methodical approach to screening the basic stroke workup for acquired hypercoagulable states before consideration of primary thromboembolic conditions. These recommendations are informed by the authors' experience at tertiary stroke centers and the current literature.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261434353"},"PeriodicalIF":0.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12979215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469592","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":"Quantitative EEG to Detect a Late-Onset Vasospasm After Subarachnoid Hemorrhage due to Basilar Artery Aneurysm: A Case Report.","authors":"Mustafa Tansel Kendirli, Lucas Lozano-Garcia, Maria Bruzzone Giraldez","doi":"10.1177/19418744261430474","DOIUrl":"10.1177/19418744261430474","url":null,"abstract":"<p><p>Delayed cerebral ischemia remains a major cause of morbidity and mortality following subarachnoid hemorrhage. Early detection is crucial for improving outcomes, yet traditional imaging modalities may fail to identify evolving ischemic changes in real time. We report the case of a 44-year-old female who presented with a sudden severe headache. Initial computed tomography revealed a subarachnoid hemorrhage secondary to a serpentine aneurysm of a tortuous basilar artery. Continuous EEG (cEEG) monitoring demonstrated progressive hemispheric asymmetry and frequency slowing preceding clinical deterioration, consistent with evolving delayed cerebral ischemia (DCI). This case underscores the value of cEEG as a sensitive and noninvasive tool for the early detection of cerebral ischemia, allowing timely therapeutic intervention before irreversible injury occurs.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261430474"},"PeriodicalIF":0.7,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345179","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":"Clinical Problem Solving: A 68-Year-Old Woman With Acute Apraxic Agraphia, Constructional Apraxia, and Finger Agnosia.","authors":"Alexis Giff, Agostinho Pinheiro, Tamara Kaplan, Ugonma Chukwueke, Alexis Roy, Sarah Conway","doi":"10.1177/19418744261430081","DOIUrl":"10.1177/19418744261430081","url":null,"abstract":"<p><p>A 68-year-old left-handed woman with a history of hypertension presented with writing difficulties initially affecting numbers and then progressing to include letters. She described an inability to form the shape of numbers and found her hand drifting towards incorrect keys on her phone despite knowing what she wanted to select. Neurological examination revealed fluent but mildly slowed speech without paraphasic errors, intact comprehension and naming, and mild temporal disorientation, where she often stated the wrong year. Her writing was characterized by hesitation, poor spatial planning, and irregular letter and number formation. She also demonstrated constructional apraxia when attempting to draw cubes and finger agnosia. Oral calculation, bedside language functions, and reading were intact. MRI revealed multifocal enhancing lesions in the corpus callosum and left inferior frontal lobe, after which brain biopsy confirmed primary CNS lymphoma. This case illustrates how isolated disturbances of writing and praxis can arise from multifocal lesions involving visuospatial-motor integration networks.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261430081"},"PeriodicalIF":0.7,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345185","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":"High Stakes, High Dose? Retrospective Treatment Outcomes of Coccidioidal Meningitis Treated With Steroids.","authors":"Harneet Dhillon, Hannah Theodora Pescaru, Shefali Dujari, Victoria Ding, Manisha Desai, Kristin Galetta","doi":"10.1177/19418744261424934","DOIUrl":"10.1177/19418744261424934","url":null,"abstract":"<p><strong>Background and objectives: </strong>Coccidioidal vasculitis is a serious complication of coccidioidal infection. Prior studies suggest that steroids may reduce the risk of secondary vasculitis in coccidioidal meningitis (CM), but data on optimal dosing are limited. This study compared the characteristics and outcomes of CM patients with vasculitis who received different steroid doses.</p><p><strong>Methods: </strong>The Stanford Research Data Repository was used to identify adult patients diagnosed with coccidioidal meningitis from 1992 to 2024. Patients were divided into those who received no steroids, low or medium dose steroids, and high dose steroids. Characteristics at admission were compared by steroid use category, and their association with clinical outcomes were assessed.</p><p><strong>Results: </strong>A total of 65 patients with CM were identified, with mean (standard deviation) age 45 (17) and 35% female. A higher percentage of patients not treated with steroids had a better modified Rankin score (mRS) of 2 or lower on admission compared to patients who were treated with steroids (standardized mean difference [SMD] = 0.67). Compared to patients who received a low/medium dose, those who received a high dose were 32% (95% CI 0.12, 3.61; <i>P</i> = 0.65) less likely to experience death or vasculitis.</p><p><strong>Discussion: </strong>There is a complex relationship between the use of steroids and outcomes among patients with CM. Among steroid recipients, those who received high dose steroids may achieve better long-term outcomes. A larger study is needed to validate these findings.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744261424934"},"PeriodicalIF":0.7,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144114","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}