The journal of extra-corporeal technology最新文献

{"title":"Challenges and opportunities in ECMO monitoring: A mixed-methods appraisal.","authors":"Wei Yin, Alisa Permessur, George Pittas, Shiffoni Sukhlal, Nicholas Chow, Steven Pinheiro, Andrew Cobos, Giancarlo Sabetta, Jan Cahill, Saleem Zaidi, Jon Longtin, Jonathon Schwartz","doi":"10.1051/ject/2026022","DOIUrl":"10.1051/ject/2026022","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) provides heart/lung support for critically ill patients. While advances in research have improved the overall design and performance of ECMO circuits, complications such as hemolysis and thrombosis persist, and the dysfunction of the ECMO machine itself can pose significant risk to patients. Many parameters need to be closely monitored during an ECMO run, and it is often labor and resource-intensive. Currently, there are few commercially available automated ECMO circuit monitoring systems that can provide continuous, holistic monitoring for ECMO circuit health and provide real-time clinical recommendations. This mixed-methods review (through literature review and customer discovery interviews) discussed key parameters relevant to ECMO circuits and monitoring, including bleeding, thrombosis, hemolysis, flow and pressure conditions, and gas exchange. Their importance in ECMO monitoring, current practices, and available technologies were highlighted. In addition, a customer discovery study, supported by the New York regional I-Corps program, was conducted to identify the \"pain points\" in ECMO circuit monitoring through interviews with healthcare professionals and other stakeholders experienced in ECMO care/use. Findings from both the literature review and the customer discovery study indicated that ECMO monitoring and management require significant resources, due to the variability and complexity of patients' conditions, challenges in collecting patient and ECMO circuit data, and the need for a comprehensive understanding of the entire patient-ECMO ecosystem. Improvements in understanding complex ECMO data, incorporating new sensors into the monitoring system, and establishing comprehensive ECMO data pipelines represent key steps towards developing \"smart\" ECMO monitoring that can serve as a clinical decision support system.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"280-294"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979209","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":"From arrest to circuit: Mapping twenty years of progress and pitfalls in ECPR implementation, patient selection, and initiation timing☆.","authors":"Nousjka P A Vranken, Patrick W Weerwind, Raymond K Wong","doi":"10.1051/ject/2026019","DOIUrl":"10.1051/ject/2026019","url":null,"abstract":"<p><strong>Background: </strong>Although the literature on extracorporeal cardiopulmonary resuscitation (ECPR) has grown substantially, coherent integrative paradigms remain limited. This study synthesizes two decades of research to elucidate knowledge gaps and orient future inquiry.</p><p><strong>Methods: </strong>A mapping review of studies from 2004 to 2024 was performed via PubMed and EMBASE. Only studies comparing ECPR to conventional cardiopulmonary resuscitation were included. Data were extracted and synthesized thematically.</p><p><strong>Results: </strong>A total of twenty studies were included, the majority being retrospective and observational design, including three interventional studies. Mortality rates following ECPR remain high and more or less constant, up to 86%. To improve chances of survival, several factors need to be considered. First is patient selection: age limit, initial cardiac rhythm, bystander resuscitation with sufficient efficacy, and maximum low-flow time are common criteria, although inconsistently applied. Some studies suggest higher ECPR survival rates in specific clinical scenarios, but none of the previous studies have yet succeeded in formulating an algorithm that facilitates the identification of the most suitable candidates. The second factor affecting outcomes is the pathophysiologic processes during ECPR. This is largely unexplored territory, with current knowledge limited to observational studies of low-flow injury. Most studies do not report on factors including temperature management during support, pump flow, target mean arterial pressures, and oxygenation strategies. Lastly, and potentially most significantly, is the timing of ECPR initiation. Timely restoration and maintenance of circulation and oxygenation halt the accumulation of oxygen debt and commence oxygen debt repayment. To date, data on optimal initiation timing thresholds remains undetermined.</p><p><strong>Conclusion: </strong>Current ECPR literature lacks knowledge across three interdependent domains that require an integrated approach: validated selection criteria, a mechanistic understanding of ischemia-reperfusion injury, and precise initiation-timing strategies. A multidisciplinary research agenda is needed to unlock the true value of ECPR in cardiac arrest care.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"267-279"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979267","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":"Optimizing cardiac surgery outcomes in morbid obesity: Surgical, anesthetic, perfusion, and critical care considerations, a narrative review.","authors":"Salman Pervaiz Butt, Salman Abdulaziz, Nabeel Razzaq, Rhea Anand, Nilesh Srivatav, Yasir Saleem, Olga Lender, Mairead Griffin, Azreen Afzal, Vivek Kakar, Fazil Ashiq, Arun Kumar, Arshad Ghori, Jehad Ramahi, Mitesh Badiwala, Umer Darr, Gopal Bhatnagar","doi":"10.1051/ject/2026021","DOIUrl":"10.1051/ject/2026021","url":null,"abstract":"<p><strong>Introduction: </strong>The global prevalence of morbid obesity is increasing, presenting challenges in cardiac surgery. Morbid obesity (body mass index ≥40 kg/m²) is associated with a high burden of cardiometabolic comorbidities and obesity-specific physiological alterations that increase perioperative risk and complicate surgical, anesthetic, and cardiopulmonary bypass management. As the number of obese patients presenting for cardiac surgery rises, a synthesis of current evidence and perioperative strategies is needed to optimize outcomes in this high-risk population.</p><p><strong>Methods: </strong>This narrative review identified relevant literature through targeted searches of PubMed and Google Scholar, supplemented by screening the reference lists of key articles. Search terms included combinations of \"cardiac surgery,\" \"morbid obesity,\" \"obesity,\" \"cardiopulmonary bypass,\" \"anesthesia,\" \"perfusion,\" \"postoperative complications,\" and \"critical care.\" Studies were mapped to perioperative domains, including anesthesia and respiratory management, surgical and wound-related considerations, perfusion and cardiopulmonary bypass strategy, intensive care unit (ICU) outcomes, renal complications, atrial fibrillation, bleeding, thromboembolism, and mortality. The evidence base was predominantly observational and review-based, with limited randomized evidence.</p><p><strong>Discussion: </strong>Obesity poses multifactorial challenges in cardiovascular surgery by altering cardiac morphology, hemodynamics, and perioperative outcomes. Associated comorbidities such as diabetes, obstructive sleep apnea, and pulmonary hypertension increase operative risk and complicate anesthetic and perfusion management. Obese patients demonstrate altered pharmacokinetics, reduced pulmonary compliance, and heightened inflammation, requiring individualized strategies. Available evidence suggests that lean body mass-informed perfusion, selected off-pump CABG, and early extubation may reduce complications, although high-quality randomized evidence remains limited.</p><p><strong>Conclusion: </strong>Cardiac surgery in morbidly obese patients requires a coordinated, physiology-driven perioperative strategy to address obesity-specific anatomical and functional challenges. Tailored anesthetic, perfusion, and surgical approaches, supported by close multidisciplinary collaboration, are central to optimizing outcomes. Further research is needed to refine perioperative protocols, improve risk stratification beyond BMI, and clarify long-term cardiovascular outcomes following surgery in this population.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"301-312"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979022","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":"Real-world outcomes of unfractionated heparin plus antithrombin concentrate versus bivalirudin in adult patients undergoing extracorporeal membrane oxygenation.","authors":"Amanda Arenella, Jiani Zhou, Joshua Oh, Michael Calloway, Reuben Howden, Stephen O Bader","doi":"10.1051/ject/2026015","DOIUrl":"10.1051/ject/2026015","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) provides life support to patients undergoing cardiopulmonary surgeries when other interventions are ineffective. Unfractionated heparin (UFH) is routinely used during ECMO due to the increased risk of thrombosis. However, in some cases, like antithrombin deficiency, UFH is not efficacious, and heparin resistance (HR) can develop. There is considerable confusion about HR and what additional management strategies should be taken.</p><p><strong>Objectives: </strong>This study compared clinical and economic outcomes associated with antithrombin concentrate (ATc) + UFH versus bivalirudin in adult patients undergoing ECMO.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the 2014-2023 TriNetX database and the 2018-2021 Premier Healthcare Database. Adult patients treated with ATc + UFH or bivalirudin within 3 days of ECMO initiation who did not undergo cardiopulmonary bypass (CPB) or coronary artery bypass grafting (CABG) during their ECMO hospital stay were identified. Propensity score matching was performed to balance the groups. Thromboembolic events, bleeding events, heparin-induced thrombocytopenia, hospital mortality, length of stay, and total hospital cost were compared.</p><p><strong>Results: </strong>A total of 1601 patients (276 ATc + UFH, and 1352 bivalirudin) were identified from TriNetX, and 1592 (264 ATc + UFH, and 1528 bivalirudin) from Premier. ATc + UFH was associated with lower odds of thrombotic and bleeding events compared to bivalirudin only. Length of stay and total hospital costs trended lower for patients prescribed antithrombin and UFH.</p><p><strong>Conclusions: </strong>Antithrombin + UFH may be a preferable option for managing ECMO patients, particularly those with heparin resistance.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"237-245"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979193","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":"Introduction of modified blood priming technique in the neonatal and infant populations undergoing congenital heart surgery.","authors":"Kailey Fuegmann, Kevin Charette, Amy Falconer, Navriti Sharma, Brian Perfette, Moore Phillips, Lyubomyr Bohuta","doi":"10.1051/ject/2026018","DOIUrl":"10.1051/ject/2026018","url":null,"abstract":"<p><strong>Background: </strong>Allogenic blood product transfusion has well-documented risks and adverse outcomes. To limit perioperative transfusions for neonates and infants undergoing cardiac surgery, our institution launched a blood conservation program in May, 2021. Over the past several years, our standard has changed from blood priming the cardiopulmonary bypass (CPB) circuit for most patients ≤12 kilograms (kg) to administering an asanguinous prime to all patients with an adequate baseline hematocrit (HCT), regardless of weight. For those requiring transfusion, the technique of modified blood priming (MBP), introduced herein, presents an intermediate solution between a clear and standard blood prime, with the goal of administering the minimum amount of packed red blood cells (PRBC) to maintain safe oxygen-carrying capacity while on CPB.</p><p><strong>Methods: </strong>The crystalloid prime in the core of the CPB circuit (venous reservoir, arterial pump boot, and oxygenator) is displaced with a pre-calculated amount of PRBC to maintain an on-bypass HCT of ≥24%. In addition, the crystalloid in the arterial and venous lines is replaced with patient blood volume via retrograde and venous autologous priming (RAP and VAP). Once CPB is established, the remaining crystalloid in the ultrafiltration (UF) and cardioplegia (CPG) circuits is displaced into a syringe with circulating blood to minimize any further hemodilution.</p><p><strong>Results: </strong>We have applied MBP to 26 patients weighing less than 7 kg. The mean amount of PRBC these patients received during CPB, including in the prime, was half the amount when compared to the initial amount of PRBC we include in our institution's standard blood prime alone.</p><p><strong>Conclusion: </strong>The MBP technique allows safe initiation of CPB in the subset of neonates and infants with a post-dilutional hematocrit (PDHCT) calculated at less than 24% while avoiding excessive transfusion of exogenous blood products.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 3","pages":"313-317"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978860","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":"Estimation of hemoglobin concentration at the initiation of cardiopulmonary bypass using support vector regression.","authors":"Harutoyo Hirano, Shun Takahashi, Tetsuya Kamei, Makoto Hibiya","doi":"10.1051/ject/2025071","DOIUrl":"10.1051/ject/2025071","url":null,"abstract":"<p><strong>Background: </strong>Hemodilution during cardiopulmonary bypass (CPB) is a standard perfusion strategy used to reduce blood viscosity and enhance microcirculatory flow. The hemodilution rate, expressed as hemoglobin (Hb) concentration, is a key control index in CPB and is currently estimated from total blood volume (TBV). The objective of this study was to propose a novel formula to accurately predict Hb concentration at the initiation of CPB (Hb_CPB) by incorporating circulating blood volume, laboratory data, physical measurements, and patient history.</p><p><strong>Methods: </strong>We retrospectively analyzed 577 adult patients who underwent elective CPB at Fujita Health University Hospital from January 2016 to December 2020. Thirty-six preoperative variables - including demographics, laboratory data, circuit parameters, and indices such as TBV and ideal weight - were standardized. Categorical variables underwent one-hot encoding. We compared generalized linear models (GLM), support vector regression (SVR), and multilayer perceptron (MLP). Model performance was evaluated using the coefficient of determination (R²), mean squared error (MSE), and Bland-Altman analysis (bias and 95% limits of agreement [LoA]). Predictions from two conventional TBV-based formulas were used as benchmarks.</p><p><strong>Results: </strong>Of 993 screened cases, 577 met inclusion criteria (447 males, mean age 66.8 ± 11.7 years; 130 females, 69.5 ± 10.6 years). SVR on standardized predictors achieved the highest accuracy (R² = 0.498, MSE = 0.517), outperforming GLM (R² = 0.429, MSE = 0.797) and MLP (R² = 0.332, MSE = 0.669). Conventional formulas showed lower performance (R² = 0.325, MSE ≥ 1.48). Bland-Altman analysis for SVR demonstrated minimal bias (-0.0028 g/dL) and narrower LoA (-1.42 to 1.41 g/dL) than conventional methods (bias -1.33 g/dL; LoA -3.49 to 0.83 g/dL).</p><p><strong>Conclusion: </strong>These findings suggest that an SVR-based model improves prediction of Hb_CPB over conventional approaches, supporting optimized transfusion management and reduced hemodilution-related risks.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"128-138"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280694","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":"Understanding pressure excursions in extracorporeal technologies: The role of shear stress and hematologic predisposition.","authors":"Youssef El Dsouki, Chiara Cirullo, Assunta D'Alessandro, Ignazio Condello","doi":"10.1051/ject/2026003","DOIUrl":"10.1051/ject/2026003","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"205-207"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280769","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":"Corrigendum to: High pressure excursion in a radial design oxygenator.","authors":"Ashley Svec, Tyler Eadie, Brandon D'Aloiso, Peter Arlia","doi":"10.1051/ject/2025054","DOIUrl":"10.1051/ject/2025054","url":null,"abstract":"","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"208"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280713","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":"Learning from a pitfall: Atrial septostomy in LV failure under VA-ECMO for pulmonary hypertension.","authors":"Camille Wirth, Pierre De Normandie, Sebastien Hascoet, Elie Fadel, François Stephan","doi":"10.1051/ject/2026001","DOIUrl":"10.1051/ject/2026001","url":null,"abstract":"<p><strong>Background: </strong>Atrial septostomy has been successfully used in patients with pulmonary hypertension and in those supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) complicated by pulmonary congestion.</p><p><strong>Case description: </strong>We report a patient on VA-ECMO for decompensated pulmonary hypertension who subsequently developed stress-induced cardiomyopathy and pulmonary congestion. An atrial septostomy was performed, which led to worsening respiratory status due to the creation of a right-to-left shunt, and hemodynamic deterioration resulting from increased left ventricular preload.</p><p><strong>Conclusion: </strong>The implications of atrial septostomy should be carefully considered prior to decompression, as there may be situations, especially if right-sided pressures are less than left-sided pressures, where patients may still benefit.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"180-183"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280716","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":"Ventricular assist device simulation to improve staff confidence and knowledge when caring for patients supported with the Berlin heart☆.","authors":"Laura Valido, Vicky Duffy, Erica Rey, Matt Deitemyer, Tracy Heard, Jaqueline Pleiman, Richard Fernandez","doi":"10.1051/ject/2025058","DOIUrl":"10.1051/ject/2025058","url":null,"abstract":"<p><strong>Background: </strong>Rapid growth of our mechanical cardiac support program, coupled with limited experience among bedside nursing staff in the care of patients supported with the Berlin Heart (BH VAD), created the need for a targeted educational intervention. We designed an educational module combining didactic sessions with high-fidelity simulation of a patient supported with a BH VAD.</p><p><strong>Methods: </strong>A novel, high-fidelity BH VAD simulator was designed and tested by our team. Members of the cardiothoracic intensive care unit (CICU) staff participated in didactic sessions and high-fidelity simulations. Pre- and post-experience surveys were administered to gauge staff confidence and basic knowledge regarding caring for a patient supported with a BH VAD. Follow-up surveys were administered 6-8 weeks after the educational module was completed.</p><p><strong>Results: </strong>82 total staff members participated in the simulation. There were significant improvements in feelings of being prepared to care for a patient supported with a BH VAD [pre-participation median response 3 (range 2-4), post-participation median 4 (range 3-4), p < 0.001]. There were also significant improvements in knowledge assessment before and after the educational module [median number of questions answered pre-participation correctly: 2 (range 0-3); median answered post-participation correctly: 3 (range 2-3); p < 0.001]. These gains were maintained at a 6-8-week follow-up.</p><p><strong>Conclusions: </strong>High-fidelity simulation with a novel BH VAD simulator, coupled with focused didactics, led to significant improvements in staff confidence and knowledge. This combination of training methods resulted in sustained improvements at 6-8-week follow-up. This approach to staff training can build and solidify knowledge of mechanically supported patients for the nursing staff in a CICU.</p>","PeriodicalId":519952,"journal":{"name":"The journal of extra-corporeal technology","volume":"58 2","pages":"195-201"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280774","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}