The journal of extra-corporeal technology最新文献

{"title":"Evaluating the need for magnesium administration following cardioplegic arrest with del Nido cardioplegia solution.","authors":"Carrie Whittaker Striker, James A Reagor","doi":"10.1051/ject/2024033","DOIUrl":"10.1051/ject/2024033","url":null,"abstract":"<p><strong>Background: </strong>del Nido cardioplegia (dNC) solution is widely used in pediatric and congenital cardiac surgery. In 2014, Cincinnati Children's Hospital Medical Center (CCHMC) changed from Mee cardioplegic solution to dNC. Since Mee solution does not contain magnesium, magnesium was administrated post cross-clamp removal, at a dose of 25 mg/kg up to 1 g, to abate hypomagnesemia. This practice remained in place with the use of dNC. We postulated that patients may experience hypermagnesemia under this protocol.</p><p><strong>Methods: </strong>To determine if exogenous magnesium is necessary post-clamp removal in our practice, a study examining serum magnesium levels during cardiopulmonary bypass (CPB) was completed from January 2022 through October 2023 (IRB #2021-0816). One hundred patients undergoing CPB with cross-clamp, ranging from infants to adults, were consented. Two magnesium samples were collected. Draw 1 (D1) was collected post cardioplegia administration and 30 min prior to cross-clamp removal. Draw 2 (D2) was collected post-cross-clamp removal and 10 ± 2 min following magnesium administration.</p><p><strong>Results: </strong>Both samples demonstrated magnesium levels > 1.6 mg/dL or higher (normal magnesium range at CCHMC, 1.6-2.6 mg/dL). A Wilcoxon rank sum test demonstrated statistical significance for D1, comparing the number of samples that fell above 2.6 mg/dL vs. those that fell within the normal range (p < 0.001). D2 demonstrated values above the normal range for all but one sample, which does not satisfy the criteria of the Wilcoxon rank sum test for demonstrating significance (p = 0.089); however, ninety-nine samples displayed hypermagnesemia.</p><p><strong>Conclusion: </strong>This study demonstrates that exogenous magnesium administration may not be necessary in the setting of our practice at CCHMC and dNC cardioplegic arrest.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"9-13"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575726","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":"Pediatric cardiac patients with pulmonary hemorrhage supported on ECMO: An ELSO registry study.","authors":"Pilar Anton-Martin, Caroline Young, Hitesh Sandhu, Shilpa Vellore","doi":"10.1051/ject/2024038","DOIUrl":"10.1051/ject/2024038","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary Hemorrhage (PH) is a rare but potentially devastating condition and pediatric cardiac patients are at increased risk for. ECMO may be used to safely support these patients, but data is limited.</p><p><strong>Methods: </strong>Observational retrospective cohort study from the ELSO registry database in pediatric cardiac patients from birth to 18 years old with PH supported on ECMO from January 2011 through December 2020. The objectives of the study were to characterize pediatric cardiac patients with PH before ECMO and to describe factors associated with improved survival.</p><p><strong>Results: </strong>A total of 161 cardiac neonates and children with PH supported on ECMO were analyzed. Median age and weight were 40 days (IQR 7.3-452) and 4.06 kg (IQR 3-9.36), respectively. Congenital heart disease accounted for 77% of diagnoses. Survival to hospital discharge was 35.8%. Before ECMO cannulation, most patients were ventilated in conventional modes (79.7%), followed by high-frequency oscillatory (HFOV) ventilation (11%). There was a significantly higher use of HFOV pre-cannulation in survivors compared to non-survivors (24.4% vs 2.8%, p < 0.001). Multivariable logistic regression demonstrated that HFOV before ECMO (OR 28.44, p < 0.001) and the absence of hemorrhagic (OR 3.51, p 0.031) and renal (OR 3.50, p 0.027) complications were independent predictors for survival to hospital discharge.</p><p><strong>Conclusion: </strong>Utilization of HFOV before cannulation to ECMO seems to be associated with improved survival in pediatric cardiac patients with acute pulmonary hemorrhage. A prospective assessment of mechanical ventilation practices before ECMO may improve outcomes in this medically complex population.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"2-8"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575792","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":"Development and validation of a checklist for cardiopulmonary bypass.","authors":"Valdir Assis Dos Reis Filho, Karina Aparecida Antonelli Novello, Mariana Leticia Matias","doi":"10.1051/ject/2024030","DOIUrl":"10.1051/ject/2024030","url":null,"abstract":"<p><strong>Introduction: </strong>Risk prevention protocols related to patient care have been developed to reduce the incidence of adverse events in health care services. Cardiopulmonary bypass (CPB) can trigger several complications, including physiological problems, electrical, mechanical, and human failures, or defective components. In order to promote patient safety and the identification of failures before they can cause damage, it is necessary to the use of a checklist for all surgeries.</p><p><strong>Objective: </strong>To prepare and validate a checklist for cardiopulmonary bypass.</p><p><strong>Methodology: </strong>A consensus validation methodology is applied in this study, in which the Delphi technique was structured for the instrument's development. Five perfusion experts, with at least five years of experience, had an active participation in this research. First, a questionnaire was structured, based on a comprehensive review of the relevant literature. Then, two rounds of assessments were conducted, allowing for the collection of experts' opinions.</p><p><strong>Results: </strong>In the first moment, a 42-item list was prepared and sent to the five experts for analysis. Based on participant's responses, certain elements were accepted, excluded, and suggested. After that, a second 37-item list was assessed by the experts, resulting in all 37 items having an average assessment of ≥4 and a standard deviation ≤1.0 of acceptance. Based on these results, a 41-element checklist was developed, and these elements were considered crucial and relevant for the concerned analysis.</p><p><strong>Conclusion: </strong>The use of specific checklists for cardiopulmonary bypass comes into view as a highly proficient strategy, capable of promoting substantial improvements in the procedure safety and quality. The implementation and approval of this checklist should be considered.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"18-23"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576089","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":"Variability in triggers for mechanical left ventricular unloading in VA-ECMO: A literature search.","authors":"Anthony Calhoun, Min-Ho Lee, Dominic V Pisano, Alexandros Karavas, Jamel Ortoleva","doi":"10.1051/ject/2024031","DOIUrl":"10.1051/ject/2024031","url":null,"abstract":"<p><strong>Background: </strong>Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a means of supporting the lungs or the heart and lungs in patients with hemodynamic compromise that is refractory to conventional measures. VA-ECMO is most commonly deployed in a percutaneous fashion with femoral arterial and venous access. While VA-ECMO, particularly in a femoral-femoral configuration, provides both hemodynamic and ventilatory support, it also causes increased afterload on the left ventricle (LV) which in turn may result in LV distension (LVD). LV thrombus formation, ventricular arrhythmias, pulmonary edema, and pulmonary hemorrhage are clinical manifestations of LVD. LV unloading is a means of preventing LVD and its sequelae. If less invasive methods fail to achieve adequate LV unloading, invasive mechanical methods are pursued such as intra-aortic balloon pump counter-pulsation, atrial septostomy, surgical venting, left atrial cannulation, and percutaneous transvalvular micro-axial pump placement.</p><p><strong>Methods: </strong>We sought to review indicators of LVD, thresholds, and options for mechanical venting strategies. A Pubmed search was performed to identify current literature about LV unloading for VA ECMO. This was categorized and summarized to determine commonly reported thresholds for mechanical LV unloading.</p><p><strong>Results: </strong>Multiple physiologic and radiographic indicators were reported without uniformity. Common indicators included increased pulmonary artery catheter pressures, decreased Aortic Line Pulse Pressure, as well as multiple Echocardiographic, and radiographic indicators.</p><p><strong>Conclusion: </strong>Although there has been significant interest in the topic, there is currently limited uniformity in thresholds for when to initiate and escalate mechanical LV unloading. While the method of LV unloading is an active area of investigation, the threshold for which to initiate invasive venting strategies is largely unexplored.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"24-31"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575815","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":"Infection as an indicator and additional factor for consideration of ECMO circuit change-out: A call for further research.","authors":"Salman Pervaiz Butt, Stephanie Thomas, Salman Abdulaziz","doi":"10.1051/ject/2024034","DOIUrl":"10.1051/ject/2024034","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"56-57"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575728","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 feasibility of centralized application services for perfusion education programs.","authors":"Blaine Johnson","doi":"10.1051/ject/2024040","DOIUrl":"10.1051/ject/2024040","url":null,"abstract":"<p><p>The perfusion profession has recently experienced significant advancements in education and practice. Despite competition from other healthcare professions, the demand for perfusionists continues to grow. This work explores the evolving landscape of perfusion education programs in the United States over the past three decades, highlighting the growing number of accredited programs and rising applicant interest. Additionally, this letter further examines the potential benefits of implementing a centralized application service for perfusion education programs, which could streamline the application process and reduce associated costs for prospective students. By analyzing current trends, including a significant rise in the number of Certified Clinical Perfusionists and enrollment in perfusion education programs, this work underscores the importance of enhancing admission mechanisms to meet the future challenges of the profession. These findings suggest that adopting centralized application services may improve accessibility and efficiency in the application process, ultimately supporting the continued growth of the perfusion profession.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"50-52"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575773","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 ECMO support in a pediatric patient with complex cardiac conditions during wartime in Kyiv, Ukraine.","authors":"Daniel Rusnak, Ignazio Condello, Valerii Dohtiar, Serhii Varbanets, Kristina Alieksieieva, Serhii Luhovkin, Vladyslav Palokha, Vadym Zhoha, Neonila Bukhnei, Lesia Krashevska, Olha Kutsenko, Nataliia Kupina, Oleksii Vnukov","doi":"10.1051/ject/2025004","DOIUrl":"10.1051/ject/2025004","url":null,"abstract":"<p><strong>Background: </strong>In the conflict-affected setting of Kyiv, Ukraine, managing complex medical interventions presents significant challenges, especially for critically ill pediatric patients. This case report describes the prolonged use of extracorporeal membrane oxygenation (ECMO) in a 12-year-old girl with severe congenital heart disease, including critical aortic stenosis and myocarditis. In the absence of a transplant system and with limited resources, alternative solutions were explored to balance the high risk of complications and maintain ECMO support over an extended period.</p><p><strong>Methods: </strong>The patient received ECMO support for a total of 259 days, utilizing both VV-ECMO and VA-ECMO configurations. Due to wartime supply issues, polypropylene fiber oxygenators, specifically the Quadrox-i and Terumo Fx15 models, were used despite not being indicated for long-term use. Eleven oxygenators were employed, with a total of ten replacements due to thrombosis and technical malfunctions. Oxygenator models included EUROSETS Alone, Maquet PLS, Paragon, Terumo Fx15, and Quadrox-i. Frequent adjustments to ECMO parameters, infection control, and daily rehabilitation efforts were essential components of care. Weaning tests consistently indicated no recovery of cardiac function.</p><p><strong>Results: </strong>Despite rigorous management, the oxygenators faced performance declines over time, including clotting, reduced oxygen exchange, and lower CO₂ removal efficiency, necessitating frequent replacements, with a total of ten changes across the ECMO course. Oxygenator usage durations were as follows: EUROSETS (10, 32, 88, and 26 days), Paragon (78 days), Maquet PLS (14 days), Terumo Fx15 (5, 1, 3, and 2 days), and Quadrox-i (1 day). Notably, EUROSETS nr 3 achieved the longest duration of 88 days, while the Paragon oxygenator provided stable support for 78 days. In contrast, the Maquet PLS oxygenator lasted 14 days, and the Terumo Fx15 and Quadrox-i models required rapid replacement within 1-5 days due to accelerated wear and reduced efficacy. Ultimately, ECMO support was discontinued due to irreversible heart failure, with limited options for heart-lung transplantation in Ukraine's conflict-impacted healthcare system. The patient passed away following the cessation of ECMO support due to severe multi-organ dysfunction and complications.</p><p><strong>Conclusions: </strong>This case underscores the extraordinary challenges of prolonged ECMO use in a pediatric patient within a war zone, highlighting the resilience and adaptability required of healthcare teams in resource-limited settings. The logistical constraints imposed by a lack of suitable biomedical devices and the necessity to use suboptimal models due to supply shortages emphasize the need for international support and resource mobilization to sustain advanced medical care in conflict-affected regions.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"42-49"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575806","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 feasibility of a national matching service for perfusion education program applicants.","authors":"Blaine Johnson","doi":"10.1051/ject/2024039","DOIUrl":"10.1051/ject/2024039","url":null,"abstract":"<p><p>The perfusion profession is experiencing rapid advancement, creating an array of new opportunities for professional growth and educational expansion. However, this increase in demand is juxtaposed with a concerning limitation in the availability of positions for prospective students and may leave many qualified applicants without admission. This letter explores how implementing a national matching service alongside a centralized application service could streamline the application process for perfusion education programs in the United States. Over the last two decades, the number of available positions in perfusion education programs has surged significantly. This growth presents new challenges in recruitment due to varying requirements and timelines, often resulting in unstable matches. A national matching service could standardize acceptances, mitigate unfair practices, and enhance applicants' and program decision-making. By ensuring a fair and efficient system, the national matching service could support the growing need for qualified healthcare perfusionists and promote the perfusion profession's advancement.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"53-55"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575769","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":"A case of intraoperative arrest & mobile ECMO.","authors":"Rodrigo Alejandro Díaz Gómez, Catalina Alvarado Neves, Carmen Gloria Karlezi de la Fuente, Gabriela Cecilia Bejarano Alva, Dafna Garcia Gomez, Luisa Fernanda Rodas García","doi":"10.1051/ject/2025003","DOIUrl":"10.1051/ject/2025003","url":null,"abstract":"<p><p>Over the past two decades, extracorporeal membrane oxygenation (ECMO) has been increasingly used to support critical patients with cardiac and respiratory failure who fail to respond to conventional management. In refractory cardiac arrest, ECMO can restore perfusion in patients who meet specific criteria designed to maximize survival benefit and good neurological outcomes. In recent literature, there is no report of mobile ECMO in a case of prolonged cardiac arrest with direct cardiac massage. We describe our experience with a 34-year-old man with multiple traumatic injuries following a motor vehicle collision. He was treated in a trauma center hospital in the same city as our center. He was initially in stable condition (spontaneous ventilation with FiO2 0.21, no vasoactive drugs, Glasgow 15, no acute kidney injury or other organ dysfunction). One week after admission, a retained left hemopneumothorax required surgical intervention, as previous drainage was ineffective. Computed tomography imaging was also concerning for parencyhmal injury by the thoracotomy tube. Intraoperatively, when the patient was placed in lateral position, he experienced cardiac arrest, presumed to be secondary to pulmonary embolism. After 18 min, we were asked to rescue this patient with ECMO, as he had no contraindications to support. After 81 min of advanced life support, including direct cardiac massage, return of spontaneous circulation was achieved seconds after ECMO was initiated. He was then transported to our hospital. The patient achieved a favorable neurological outcome (Glasgow Coma Scale score of 15 at 24 h) and was discharged after a 2 month stay. This case highlights the potential benefits of prolonged cardiopulmonary resuscitation and ECMO in patients with refractory in-hospital cardiac arrest. In this case, proper ACLS and CPR allowed time for mobile ECMO support to be initiated from a remote center.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"38-41"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576087","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":"Limiting the gamble: Risk and predictability for renal replacement therapy in patients receiving mechanical circulatory support★.","authors":"Kelsey Gore, Dean Linder, Juan José Martinez Duque, Junxi Wang, Brett Wester, Tiffany Otero, Shaun Yockelson, Adrian Alexis Ruiz, Bobby D Nossaman","doi":"10.1051/ject/2024041","DOIUrl":"10.1051/ject/2024041","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving mechanical circulatory support (MCS) frequently require renal replacement therapy (RRT). Examining risk factors for requiring RRT in patients receiving MCS may allow improved understanding of these comorbidities and enhance patient outcomes.</p><p><strong>Methods: </strong>Following IRB approval, patient characteristics, comorbidities, and the need for RRT were studied in 129 patients who received MCS from January 2017 to October 2023. The clinical variables underwent machine learning to examine their relationships to the outcome of interest, the need for RRT.</p><p><strong>Results: </strong>In this study, the incidence of RRT was 36% with a 95% confidence interval ranging from 29% to 44%. Following machine learning, patients with a history of immunologic therapy or having a pacemaker or internal cardiac defibrillator (ICD) were associated with the need for RRT (χ² = 44, P = 0.0003). The c-index statistic for this model was 0.81. The anticoagulation therapy administered in these two groups was also analyzed. Patients in these two groups receiving unfractionated heparin were observed to have a higher incidence (44%) in the need for RRT.</p><p><strong>Conclusion: </strong>The incidence of RRT was high in this patient population. The novel associations in patients requiring MCS who have received prior immunologic therapy or have pre-existing pacemaker/ICDs suggest that an increased systemic inflammatory state exists that escalates the need for RRT. Unfractionated heparin appears to provide minimal protection from the need for RRT in patients requiring MCS. These findings suggest that other options for systemic anticoagulation in patients requiring MCS should be considered. Further investigation into how these background inflammatory conditions contribute to the need for RRT in patients requiring MCS is warranted.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"57 1","pages":"14-17"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575729","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}