Indian Journal of Critical Care Medicine最新文献

{"title":"Author Response: Can Early Use of High-flow Nasal Cannula with Improved Study Design Make a Statistically Significant Difference in the Rate of Intubation in Patients with Post-traumatic Lung Contusion?","authors":"Farouk Kamaleldeen","doi":"10.5005/jp-journals-10071-24951","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24951","url":null,"abstract":"<p><p><b>How to cite this article:</b> Kamaleldeen F. Author Response: Can Early Use of High-flow Nasal Cannula with Improved Study Design Make a Statistically Significant Difference in the Rate of Intubation in Patients with Post-traumatic Lung Contusion? Indian J Crit Care Med 2025;29(4):398-399.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"398-399"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054122","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":"Acute Hemodynamic Changes Induced by Physiotherapy in Critically Ill Patients: A Prospective Observational Study.","authors":"K J Priyanka, Dipali A Taggarsi, Bhuvana Krishna, Shiva K Narayan","doi":"10.5005/jp-journals-10071-24956","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24956","url":null,"abstract":"<p><strong>Background: </strong>The potential benefits of safe physiotherapy are immense, which may mitigate the devastating functional impairments caused by critical illness. However, there is sparse data on its safety with respect to hemodynamic changes, including the level of vasopressor therapy at which physiotherapy is deemed safe.</p><p><strong>Materials and methods: </strong>The hemodynamic parameters were recorded before, after, and every 5 minutes during physiotherapy in a total of 107 patients. Cardiac output was measured by Doppler ultrasound. Based on the type of physiotherapy, the study participants were grouped into active and passive groups. The frequencies of predefined adverse events were captured.</p><p><strong>Results: </strong>Of the 107 study participants, 65 received active physiotherapy (Group I) and 42 passive physiotherapy (Group II), with 29% on noradrenaline infusion. There was an increasing trend in each of the hemodynamic parameters after physiotherapy, as compared to rest. The mean changes in parameters before and after physiotherapy were heart rate 6.04/min; respiratory rate 3.9/min; systolic blood pressure 5 mm Hg; diastolic blood pressure 3.3 mm Hg; mean arterial pressure 3.4 mm Hg, cardiac output 0.752 L/min; and SpO₂ 0.44%. Despite being statistically significant, the small changes after physiotherapy lack clinical significance. Subgroup analysis between the active and passive physiotherapy groups was also done. The incidence of adverse events was 10.2%.</p><p><strong>Conclusion: </strong>Physiotherapy may be well tolerated in critically ill patients, even when there is a requirement for vasopressor support. Transient hemodynamic changes likely reflect physiological compensation for increased oxygen demand during physiotherapy, with low adverse event rates highlighting its safety in the intensive care unit (ICU).(CRTI Registration number: CTRI/2022/09/045766).</p><p><strong>How to cite this article: </strong>Priyanka KJ, Taggarsi DA, Krishna B, Narayan SK. Acute Hemodynamic Changes Induced by Physiotherapy in Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(4):363-369.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"363-369"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024935","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":"Incidence Risk Factors and Drug Resistance Patterns of Bacterial Isolates in Patients with Catheter-associated Urinary Tract Infections.","authors":"Tushar Jha, Mayuri Khaparde, Tejas S Parkhe, Bharat Purandare, Rutika Lavate","doi":"10.5005/jp-journals-10071-24932","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24932","url":null,"abstract":"<p><strong>Introduction: </strong>Catheter-associated urinary tract infections (CAUTIs) account for 80% of nosocomial UTIs and 40% of hospital-acquired infections, making them the most common healthcare-associated infections globally. Despite the rise of quinolone-resistant <i>Escherichia coli</i> and extended-spectrum β-lactamase-producing gram-negative bacteria, fluoroquinolones remain a common empirical treatment. Understanding antimicrobial resistance (AMR) associated with CAUTIs is critical.</p><p><strong>Methods: </strong>A prospective observational study was conducted from November 2023 to July 2024 at Deenanath Mangeshkar Hospital, Maharashtra, India. The study included catheterized patients in the intensive care unit (ICU) with a duration of over 48 hours showing UTI symptoms, including fever, suprapubic discomfort, urgency, or dysuria. Among 80 patients (mean age 56.75 ± 23.65 years; 53% male), bacterial isolates, resistance patterns, and risk factors were analyzed.</p><p><strong>Results: </strong>Catheter-associated UTIs developed in 59 patients (73.75% prevalence; 83.1 per 1,000 catheter days). Patients aged over 60, hospitalized for more than 10 days, or with comorbidities like diabetes (51.3%), hypertension (HTN) (37.5%), or chronic kidney disease (10%) were at higher risk. <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> were the most common pathogens (34.14%), with gram-negative bacilli constituting 84.74% of isolates. <i>Candida</i> species, particularly <i>C. tropicalis</i> (34.78%) and <i>C. auris</i> (26%), were also significant.</p><p><strong>Conclusion: </strong>This study identifies <i>E. coli</i>, <i>K. pneumoniae</i>, and <i>Candida</i> species as major CAUTI pathogens, with substantial multidrug resistance among gram-negative bacteria. Regular AMR surveillance and targeted infection control strategies are essential to combat CAUTI-related challenges and improve clinical outcomes.</p><p><strong>How to cite this article: </strong>Jha T, Khaparde M, Parkhe TS, Purandare B, Lavate R. Incidence Risk Factors and Drug Resistance Patterns of Bacterial Isolates in Patients with Catheter-associated Urinary Tract Infections. Indian J Crit Care Med 2025;29(4):338-344.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"338-344"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989755","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":"The Novel \"RISC\" Score as a Risk-prediction Model of Carbapenem-resistant Hospital-acquired Infections in Adult Sepsis Patients - A Prospective Observational Study.","authors":"Abhilash B Mareguddi, Souvik Chaudhuri, Sagar M Shanmukhappa, Vishwas Parampalli, Margiben T Bhatt, Roshan Fernandes, Shwethapriya Rao, Poornima S Birajdar","doi":"10.5005/jp-journals-10071-24953","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24953","url":null,"abstract":"<p><strong>Aim and background: </strong>Antimicrobial sensitivity (AMS) reports are often available after 72 hours of identification of gram-negative (GN) hospital-acquired infection (HAI). Prediction of carbapenem-resistant infection (CRI) among GN strains is important even before AMS reports are available, for judicious use of empirical antibiotics. We aimed to study the predictors of CRI in patients with HAI.</p><p><strong>Materials and methods: </strong>We conducted a single-center prospective observational study between April 2023 and September 2024 on patients of GN sepsis with HAI. The use of empirical carbapenem antibiotics, organ dysfunction scores, the modified nutritional risk in critically ill (mNUTRIC) score, blood-count-derived inflammation indices, type of HAI, AMS reports, and in-hospital mortality were noted.</p><p><strong>Results: </strong>A total of 935 sepsis patients with HAI were screened, and there were 195 patients with GN infection. Among the 195 patients, 145 (74.4%) had CRI and 50 (25.6%) had non-CRI. Multivariable logistic regression revealed that the length of intensive care unit (ICU) stay before the day of HAI (<i>p</i> = 0.009, adjusted odds ratio (OR) 1.155, 95% confidence interval (CI) 1.037-1.286), presence of ventilator-associated pneumonia (VAP) (<i>p</i>-value < 0.001, adjusted OR 4.170, 95% CI: 1.858-9.361), empirical carbapenem antibiotics before the day of HAI (<i>p</i>-value = 0.004, adjusted OR 3.164, 95% CI: 1.439-6.957), and septic shock on the day of HAI (<i>p</i>-value 0.012, adjusted OR 4.162, 95% CI: 1.366-12.677) were the independent risk factors of CRI.</p><p><strong>Conclusion: </strong>In GN sepsis patients with HAI, respiratory infection (VAP), length of ICU stay prior to HAI, septic shock, and empirical carbapenem antibiotic administration are risk factors of CRI.</p><p><strong>How to cite this article: </strong>Mareguddi AB, Chaudhuri S, Shanmukhappa SM, Parampalli V, Bhatt MT, Fernandes R, <i>et al</i>. The Novel \"RISC\" Score as a Risk-prediction Model of Carbapenem-resistant Hospital-acquired Infections in Adult Sepsis Patients - A Prospective Observational Study. Indian J Crit Care Med 2025;29(4):352-362.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"352-362"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018521","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":"Validity of Blood Urea Nitrogen to Serum Albumin Ratio as an Independent Biomarker to Predict Severity and Mortality of Community-acquired Pneumonia.","authors":"Abdeali Ginwala, Sanjay Pujari, Deepak Phalgune, Vihita Kulkarni, Arun Bahulikar","doi":"10.5005/jp-journals-10071-24926","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24926","url":null,"abstract":"<p><strong>Background and objective: </strong>Certain serum biomarkers have been reported to predict the severity and mortality of community-acquired pneumonia (CAP). There is a dearth of studies on this subject in the Indian population in patients with CAP. The present prospective observational study was conducted to find the utility of the blood urea nitrogen (BUN)/serum albumin (B/A) ratio as a biomarker to predict the severity and mortality in patients with CAP.</p><p><strong>Materials and methods: </strong>All 90 patients aged ≥ 18 years of either sex, with a new radiographic infiltrate, were included. Various biochemical parameters such as BUN, serum albumin, and procalcitonin were tested. The serum B/A ratio was calculated. A chest radiograph was obtained. Patients were followed up for the duration of their stay in hospital till discharge or death.</p><p><strong>Results: </strong>The sensitivity and specificity of the B/A ratio at the optimum cut-off value of 10.66 to predict the severity of CAP was about 79.0%, whereas the sensitivity and specificity of the procalcitonin at the optimum cut-off value of 1.50 ng/dL to predict the severity of CAP were 71.15 and 84.21%, respectively. The sensitivity and specificity of the B/A ratio at the optimum cut-off value of 19.8 to predict the mortality of CAP was about 99.0%, whereas the sensitivity and specificity of the procalcitonin at the optimum cut-off value of 5.55 ng/dL to predict the mortality of CAP was about 92.0%.</p><p><strong>Conclusion: </strong>The B/A ratio and procalcitonin are simple but independent predictors of mortality and severity of CAP.</p><p><strong>How to cite this article: </strong>Ginwala A, Pujari S, Phalgune D, Kulkarni V, Bahulikar A. Validity of Blood Urea Nitrogen to Serum Albumin Ratio as an Independent Biomarker to Predict Severity and Mortality of Community-acquired Pneumonia. Indian J Crit Care Med 2025;29(4):333-337.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"333-337"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990949","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":"Author Response: Muscle Wasting in ICU Patients is Multifactorial and Requires thorough Workup.","authors":"Kiran Rajagopal","doi":"10.5005/jp-journals-10071-24954","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24954","url":null,"abstract":"<p><p><b>How to cite this article:</b> Rajagopal K. Author Response: Muscle Wasting in ICU Patients is Multifactorial and Requires thorough Workup. Indian J Crit Care Med 2025;29(4):395.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"395"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006648","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":"Enhancing Advance Care Planning in India through a 12-step Pathway.","authors":"Anuja Damani, Arun Ghoshal, Krithika Rao, Shreya Nair, Roop Gursahani, Srinagesh Simha, Raj Kumar Mani, Naveen Salins","doi":"10.5005/jp-journals-10071-24938","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24938","url":null,"abstract":"<p><strong>Background: </strong>Advanced care planning (ACP) and advance medical directives (AMDs) are vital for aligning medical decisions with patient preferences, particularly for end-of-life care. The 2018 Supreme Court judgment in India established the legality of AMDs, enabling patients to exercise their autonomy. Recent amendments in 2023 simplified procedural requirements, replacing judicial magistrate approval with a streamlined two-tier medical board system. This article proposes a culturally sensitive and practical 12-step framework for implementing ACP and AMDs in India.</p><p><strong>Materials and methods: </strong>A structured and consensus-driven process was undertaken by experts in palliative medicine, neurology, critical care, and geriatrics, supported by key medical organizations. The development process included multiple iterations, public consultations, and feedback from legal and medical stakeholders. The framework integrates legal, ethical, and cultural considerations to address procedural and systemic challenges in ACP implementation.</p><p><strong>Results: </strong>The proposed 12-step pathway focuses on three phases: creating living wills, periodic reviews and updates, and executing AMDs. Key components include initiating discussions, identification and appointment of surrogate decision-makers, ensuring legal compliance through simplified procedures, and providing guidance for withholding or withdrawing life-sustaining treatments. Implementation strategies emphasize public awareness, provider training, and institutional policies to normalize ACP. Simplified legal requirements introduced in 2023 facilitate broader adoption and reduce procedural barriers.</p><p><strong>Conclusion: </strong>This framework provides a practical, culturally relevant model for ACP in India, ensuring patient-centered, ethical, and transparent end-of-life care. By integrating simplified legal procedures and addressing misconceptions through education and policy initiatives, the proposed approach empowers individuals, families, and healthcare providers to make informed decisions, fostering dignity and autonomy in medical care.</p><p><strong>How to cite this article: </strong>Damani A, Ghoshal A, Rao K, Nair S, Gursahani R, Simha S, <i>et al</i>. Enhancing Advance Care Planning in India through a 12-step Pathway. Indian J Crit Care Med 2025;29(4):301-307.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"301-307"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018584","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":"Planning for a Dignified Death with a Living Will.","authors":"Jigeeshu V Divatia","doi":"10.5005/jp-journals-10071-24958","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24958","url":null,"abstract":"<p><p><b>How to cite this article:</b> Divatia JV. Planning for a Dignified Death with a Living Will. Indian J Crit Care Med 2025;29(4):283-284.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"283-284"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021964","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":"Should We Scope? Or is there a Scope for the Probe?","authors":"Mahesha Padyana, Sunil Karanth","doi":"10.5005/jp-journals-10071-24950","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24950","url":null,"abstract":"<p><p><b>How to cite this article:</b> Padyana M, Karanth S. Should We Scope? Or is there a Scope for the Probe? Indian J Crit Care Med 2025;29(4): 287-288.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"287-288"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054176","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":"Correlation of Ultrasound Examination with FOB for Airway Assessment in Burn Patients with Inhalational Injury: A Prospective Observational Study.","authors":"Heena Garg, Savita Agarwal, Amit Kumar, Shailendra Kumar, Vanlal Darlong, Lokesh Kashyap, Maneesh Singhal, Shivangi Saha","doi":"10.5005/jp-journals-10071-24936","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24936","url":null,"abstract":"<p><strong>Aim/background: </strong>Fiberoptic bronchoscopy (FOB) is the gold standard for assessing airway involvement in burn patients but is invasive. Ultrasound (USG) has not been previously used to evaluate the airway in burn patients. Our study evaluated the feasibility of using USG to assess airway involvement in inhalational burn injury and correlated its efficacy with FOB.</p><p><strong>Materials and methods: </strong>This prospective observational study was conducted in the burns intensive care unit (ICU) of a tertiary care hospital. Bedside airway USG was performed to evaluate vocal cord (VC) width for edema and other airway parameters, including tongue thickness, pre-epiglottis space depth, inter-arytenoid distance, epiglottis-to-midpoint of VC, distance between the true VCs, distance between the false VCs, tracheal wall thickness, and tracheal air column width. Fiberoptic bronchoscopy was then performed to assess airway involvement, and findings were correlated with USG at the VC level.</p><p><strong>Results: </strong>About 51 patients were included. Airway USG assessment was able to predict the VC edema, correlating with FOB findings in 30 patients. Ultrasound showed a sensitivity and specificity of 85.2 and 81.3%, respectively, with a positive and negative predictive value of 90.9 and 72.2%, respectively, for assessing airway edema at the level of VC. The mean right and left VC widths were 21.15 ± 9.52 mm and 22.03 ± 9.52 mm, respectively, in patients with VC edema. The pre-epiglottis space in patients with (<i>n</i> = 33) vs without VC edema (<i>n</i> = 18) was found to be statistically significant (14.5± 5.64 mm vs 10.87 ± 4.36 mm; <i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>Ultrasound can be used as a reliable, non-invasive bedside predictor of airway involvement in patients with suspected inhalational injury.</p><p><strong>How to cite this article: </strong>Garg H, Agarwal S, Kumar A, Kumar S, Darlong V, Kashyap L, <i>et al</i>. Correlation of Ultrasound Examination with FOB for Airway Assessment in Burn Patients with Inhalational Injury: A Prospective Observational Study. Indian J Crit Care Med 2025;29(4):314-319.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"314-319"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057298","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}