Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Methanol poisoning outbreak in a northwestern Moroccan town: report of 22 cases treated with hemodialysis.","authors":"Amal Zniber, Selim Benhadda, Narjis Badrane, Meryem Ennafiri, Hanane Chaoui, Mohammed Yassir Tahri, Khalid Ouhman, Zainab Kaouiri, Ali Kettani, Houda Sefiani, Loubna Benamar, Tarik Bouattar, Naima Ouzeddoun","doi":"10.1080/15563650.2025.2525410","DOIUrl":"https://doi.org/10.1080/15563650.2025.2525410","url":null,"abstract":"<p><strong>Introduction: </strong>Methanol poisoning, a serious healthcare problem in resource-poor countries, is usually caused by unintentional ingestion. Early diagnosis and optimal treatment are crucial to prevent morbidity and mortality.</p><p><strong>Methods: </strong>We report our experience with hemodialysis in patients with methanol poisoning from consumption of adulterated alcoholic beverages.</p><p><strong>Results: </strong>Of 202 patients admitted to provincial and regional hospitals with methanol poisoning, the overall mortality rate was 5%. A total of 22 patients underwent hemodialysis, none of whom died. Most were male (86.4%), with a median [IQR] age of 32 years [22-39 years]. Patients typically presented with inebriation, vomiting, blurred vision, and/or decreased visual acuity. The median [IQR] bicarbonate concentration was 10 mmol/L [8.3-19.6 mmol/L] and the median [IQR] arterial pH was 7.1 [6.9-7.13]. Methanol blood concentrations ranged from 40-1,830 mg/L before hemodialysis. Nineteen patients made a full recovery, but permanent blindness developed in three. Blood methanol concentrations were significantly higher in patients with permanent blindness (<i>P</i> = 0.02).</p><p><strong>Discussion: </strong>The optimal treatment of patients with methanol poisoning requires early recognition and initiation of effective therapy. Fomepizole is a safe and preferred antidote but is costly and currently unavailable in Morocco. We opted for oral ethanol therapy in combination with hemodialysis. Oral ethanol was well tolerated, and no adverse effects were observed.</p><p><strong>Conclusion: </strong>Despite the severity of the methanol poisoning cases received in our department, no fatalities were recorded. We believe that the implementation of a standardized clinical protocol issued by health authorities, timely initiation of hemodialysis, and the use of oral ethanol contributed to good patient outcomes.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two fatalities from sodium azide ingestion: delayed enhanced elimination was not effective.","authors":"Nicholas Husak, Alexander Sidlak, Rachael Westover, Stanislaw Haciski, Michael Abesamis","doi":"10.1080/15563650.2025.2528995","DOIUrl":"https://doi.org/10.1080/15563650.2025.2528995","url":null,"abstract":"<p><strong>Background: </strong>Ingestion of sodium azide can lead to severe toxicity, including the development of refractory shock. No antidote has been identified. Enhanced elimination has demonstrated variable outcomes in prior reports.</p><p><strong>Case reports: </strong>We present two fatal cases of sodium azide toxicity. The first patient, a 27-year-old man, ingested approximately 5 g of sodium azide and developed hypotension 1 h after ingestion. Orogastric lavage was performed, and vasopressors were started. Hemodialysis was performed 13 h after ingestion. Despite stabilization, he developed recurrent cardiac arrest and died. The second patient, a 19-year-old man, presented 2 h after the intentional ingestion of 40 mL of 5% (2 g) sodium azide. This patient was started on vasopressors and had plasma exchange performed, after which vasopressor requirements were reduced. Shortly after, however, the patient experienced recrudescence of shock and ultimately succumbed to toxicity.</p><p><strong>Discussion: </strong>Despite aggressive supportive measures, decompensation refractory to supportive measures occurred in both patients. Enhanced elimination techniques were attempted, albeit not immediately, and the delay in initiating hemodialysis and plasma exchange may have limited any potential benefit.</p><p><strong>Conclusions: </strong>Enhanced elimination did not appear to alter the course of toxicity in these two patients who ingested at least 2 g of sodium azide.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing a regional drug profile in Newfoundland and Labrador, Canada, using data from acute drug deaths.","authors":"Syed Z Raza, Cindy Whitten, Allyson Summers, Shane Randell, Nash Denic","doi":"10.1080/15563650.2025.2529017","DOIUrl":"https://doi.org/10.1080/15563650.2025.2529017","url":null,"abstract":"<p><strong>Introduction: </strong>Drug deaths are rising in Canada and are driven by polydrug toxicity (that is toxicity resulting from multiple drugs belonging to different drug classes). Addressing polydrug toxicity requires the establishment of regional drug profiles so that appropriate harm reduction policies can be implemented.</p><p><strong>Methods: </strong>Using toxicology data from individuals who died from acute drug toxicity, we established regional drug profiles for the Canadian province of Newfoundland and Labrador. Medical examiners determined which drugs contributed to each acute death. Counts were described to establish the most common drugs and classes.</p><p><strong>Results: </strong>Between 2018 and 2023, 222 individuals died from unintentional acute drug toxicity, and a majority of deaths were from polydrug toxicity. Stimulants and opioids were the most frequent drug class combinations in the sample. Cocaine was the most frequent drug contributing to death and was involved in a majority of stimulant-related deaths. Opioid-related deaths involved many drugs, and deaths resulting from non-pharmaceutical opioids and opioid agonists used in opioid depen-dence treatment rose sharply in the later years of the study.</p><p><strong>Discussion: </strong>Stimulants, especially cocaine, disproportionately contributed to stimulant-related deaths, reinforcing the need for stimulant-specific harm reduction measures in the region. Among opioids, the sharp rise in deaths from opioid agonists used in opioid depen-dence treatment requires policy attention, and the emergence of non-pharmaceutical opioids presents an opportunity to implement policies that have shown success in other regions. Policy impacts and suggestions are discussed, including the need for drug-checking services so that drug profiles can be established more quickly and reflect drug use that is not specific to toxicity.</p><p><strong>Conclusions: </strong>A total of 222 individuals died from unintentional acute drug toxicity in Newfoundland and Labrador between 2018 and 2023, with polydrug toxicity comprising a majority (55.4%) of these fatalities. Stimulants and opioids were the most prevalent drug classes, with cocaine implicated in most stimulant-related deaths and various types of opioids involved in opioid-related deaths.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two analytically confirmed cases of vegetable-induced methemoglobinemia.","authors":"Margaux Gaschignard, Anna Manfredi, Marion Grimaud, Sandra Sinno-Tellier, Hervé Laborde-Casterot, Mehdi Oualha, Pascal Houze, Dominique Vodovar","doi":"10.1080/15563650.2025.2524612","DOIUrl":"https://doi.org/10.1080/15563650.2025.2524612","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/15563650.2025.2538387","DOIUrl":"https://doi.org/10.1080/15563650.2025.2538387","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1"},"PeriodicalIF":3.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characterisation of the novel benzodiazepine bromazolam-data from the ASSIST (A Surveillance Study of Illicit Substance Toxicity) study.","authors":"Lisa C Dunlop, Vicki Craik, Nicole Jarvie, Simon Hudson, Matthew Walters, James W Dear, David J Lowe","doi":"10.1080/15563650.2025.2524078","DOIUrl":"https://doi.org/10.1080/15563650.2025.2524078","url":null,"abstract":"<p><strong>Introduction: </strong>Scotland has a drug death crisis. In 2023, 58% of drug-related deaths involved benzodiazepines. Novel benzodiazepines, predominantly bromazolam, are found in the drug \"street valium\", commonly used in Scotland. This study describes features of analytically confirmed bromazolam use.</p><p><strong>Methods: </strong>This observational study was conducted at the Queen Elizabeth University Hospital, Glasgow between 17 August 2022 and 16 February 2024. The study used data from a larger surveillance study (A Surveillance Study of Illicit Substance Toxicity, clinicaltrials.gov, NCT05329142). Emergency department attendances with moderate to severe illicit substance toxicity and positive detection of bromazolam were included. Toxicological analysis was performed on anonymised samples in the Laboratory of the Government Chemist Assure laboratory using ultra performance liquid chromatography interfaced with Thermofisher Q-Exactive Orbitrap high resolution accurate mass systems. The study has full ethical approval (West of Scotland Research Ethics Committee 22/WS/0047).</p><p><strong>Results: </strong>Of 1,188 adult attendances with illicit drug toxicity, 653 qualified for toxicological analysis. Two-hundred ninety-nine (45.8%) of these involved bromazolam with increasing rates seen within this study from 22.7% in quarter 1 to 58.3% in quarter 6. The median age was 42 years (IQR: 34-50 years) and 214 (71.6%) were male. The median number of illicit substances detected in samples with bromazolam was seven (IQR: five to nine). The most common clinical feature was reduced consciousness (238 patients, 79.6%) and 37 patients (12.4%) required critical care admission.</p><p><strong>Discussion: </strong>Rates of bromazolam detection increased within the population studied, aligning with Scottish drug death figures. Though clinical features presented in this study cannot be fully attributed to bromazolam alone due to high substance co-use, reduced consciousness was frequent.</p><p><strong>Conclusion: </strong>High rates of substance co-use inhibit our ability to fully understand specific features of bromazolam toxicity, however, this study highlights its prevalence in this population and identifies clinical features in positive detections.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":3.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse reactions of liquorice consumed in the diet: a 10-year retrospective study of poison centres in France.","authors":"Weniko Caré, Guillaume Grenet, Corinne Schmitt, Luc De Haro, Jérôme Langrand, Gaël Le Roux, Dominique Vodovar","doi":"10.1080/15563650.2025.2514643","DOIUrl":"https://doi.org/10.1080/15563650.2025.2514643","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to describe the symptoms, patient demographics, and trends over time of adverse effects related to liquorice consumed in the diet reported to French poison centres.</p><p><strong>Methods: </strong>We performed a retrospective study of data from French poison centres of cases of adverse effects of liquorice consumed in the diet, with a high causality score, between 2012 and 2021 (10 years).</p><p><strong>Results: </strong>Sixty-four cases were included. The annual number of cases ranged from three to nine, with no significant variation over the study period. Liquorice-induced reactions were very rare (0.008% of all cases with symptoms reported to French poison centres). The products consumed were non-alcoholic beverages (non-alcoholic pastis, liquorice-based Antésite^®, and liquorice syrup), alcoholic beverages of the pastis type (10.9%), confectionery containing liquorice (12.5%), confectionery made with liquorice extract only (9.4%), herbal teas (12.5%) and food supplements (4.7%). Consumption was commonly chronic (67.2%) and non-compliant (70.3%). Chronic users presented with symptoms suggestive of pseudohyperaldosteronism, the severity of which seemed to correlate with the amount of glycyrrhizin ingested. Severity was high in 43.8% of cases. When the outcome was known (56.3%), it was favourable in almost all cases (94.4%), often after inpatient care, particularly in an intensive care unit. One patient had sequelae due to a stroke, and one fatality was reported. Severe cases were observed with all types of products, except liquorice syrup and food supplements, and more frequently with beverages (pastis with or without alcohol, and Antésite^®).</p><p><strong>Discussion: </strong>Due to significant variability in response to glycyrrhizin, some patients presented signs and symptoms suggestive of pseudohyperaldosteronism such as hypokalaemia, salt and water retention, and hypertension despite consuming the product as directed.</p><p><strong>Conclusions: </strong>Liquorice-induced effects were rarely reported to French poison centres, but their severity was high. Most patients were adults with chronic and non-compliant consumption, especially of soft drinks, with a clinical presentation suggestive of pseudohyperaldosteronism.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xylazine detection in urine of fentanyl-positive patients from a single academic center.","authors":"Andrea Leal Lopez, Kenichi Tamama","doi":"10.1080/15563650.2025.2529016","DOIUrl":"https://doi.org/10.1080/15563650.2025.2529016","url":null,"abstract":"<p><strong>Introduction: </strong>Xylazine has increasingly been used as an additive in illicit drugs, leading to severe health consequences. The current study aims to define the total xylazine-positive cases since 2010 and to analyze the trends and clinical implications of xylazine-positive cases at the University of Pittsburgh Medical Center from 2020 to 2024.</p><p><strong>Methods: </strong>This cross-sectional academic laboratory-based study analyzed the mass spectrometry dataset, including the normalized peak sizes of xylazine and fentanyl in xylazine-positive urine comprehensive drug screening cases, along with their clinical information. The laboratory information system was also queried to obtain the total number of xylazine detections in urine comprehensive drug screening since 2010.</p><p><strong>Results: </strong>A total of 351 xylazine-positive adult cases in urine comprehensive drug screening were examined to identify trends in urine xylazine and fentanyl relative concentrations between 1 April 2020 and 31 March 2024. After excluding outpatient cases, the urine xylazine and fentanyl relative concentrations were also correlated with clinical features for the remaining 249 cases. Xylazine-positive cases have increased since 2016, with a sharp rise between 2019 and 2021. Urine xylazine relative concentrations showed a minimal decline, while urine fentanyl relative concentrations modestly decreased. Patients with skin wounds and infections, but not with coma or post-cardiac arrest, had significantly higher urine xylazine relative concentrations than the entire cohort.</p><p><strong>Discussion: </strong>The number of xylazine-positive and fentanyl-positive cases has increased over time, even as the relative concentrations of urine xylazine and fentanyl have gradually declined. This inverse trend suggests an increasing prevalence of xylazine and fentanyl exposure at progressively lower concentrations. Our data also indicated the association of urine xylazine concentrations with skin wounds and infections, but not with coma or post-cardiac arrest.</p><p><strong>Conclusions: </strong>The findings of this study highlight the increasing prevalence of xylazine in illicit drug use, particularly in combination with fentanyl, at our institution over time. More research is needed to elucidate the roles of xylazine on opioid intoxication.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence and quantity of ingredients in sports supplements purportedly containing the orchid <i>Eria jarensis</i>.","authors":"Pieter A Cohen, Radek Abarca, Alia Sovereign, Mikayla Joyce Gonzaga, Roy Gerona","doi":"10.1080/15563650.2025.2515242","DOIUrl":"https://doi.org/10.1080/15563650.2025.2515242","url":null,"abstract":"<p><strong>Introduction: </strong>The orchid <i>Eria jarensis</i>, purported to be a major source of <i>N,N</i>-dimethylphenethylamine, is promoted as a novel botanical ingredient in sport supplements.</p><p><strong>Objective: </strong>To determine the presence and quantity of ingredients found in <i>Eria jarensis</i> sports supplements.</p><p><strong>Methods: </strong>Supplements were purchased online in the United States, and each product was analyzed using liquid chromatography-quadrupole time-of-flight mass spectrometry.</p><p><strong>Results: </strong>None of the 12 <i>Eria jarensis</i> supplements analyzed were accurately labeled. The products contained inaccurately labeled quantities of caffeine, theobromine, hordenine, yohimbine, <i>N,N</i>-dimethylphenethylamine, and synephrine. Products that listed caffeine on the label contained quantities ranging from 0.1 to 665 mg/serving size. Nine of 12 products either listed an ingredient on the label that was not detected in the product or contained a stimulant not listed on the label. Four of 12 products contained an undeclared stimulant. In addition, two of these products contained the United States Food and Drug Administration-prohibited stimulant 1,4-dimethylamylamine.</p><p><strong>Discussion: </strong>The United States Food and Drug Administration does not evaluate the safety or quality of supplements prior to market introduction, and our findings reflect the consequences of this regulatory framework.</p><p><strong>Conclusion: </strong>Sports supplements labeled as containing <i>Eria jarensis</i> that we tested were inaccurately labeled and contained high quantities of caffeine and undeclared stimulants.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the reproducibility and validity of the use of the causality assessment method for poisonings designed and applied by the French poison control centres.","authors":"Sandra Sinno-Tellier, Dorian Délepine, Dominique Vodovar, Coralie Bragança, Marie Sponga, Emmanuel Puskarczyk, Ingrid Blanc-Brisset, Fanny Pelissier, Ismaïl Ahmed, Jacques Manel, Juliette Bloch, Alexis Descatha","doi":"10.1080/15563650.2025.2515239","DOIUrl":"https://doi.org/10.1080/15563650.2025.2515239","url":null,"abstract":"<p><strong>Introduction: </strong>French poison control centres have developed and use a standardised causality assessment method based on a decision tree for poisoning cases involving a wide range of xenobiotics, which includes five ascending levels (I0-I4) and six determinants. This study was designed to evaluate inter-rater reliability and the validity of using this method.</p><p><strong>Methods: </strong>A reference group of toxicologists identified five categories of cases - based on the route of exposure with two circumstances for the oral route - recorded in the French National Database of Poisonings. The reference group assessed by consensus the level of causality of each randomly selected case as the reference level. Toxicologists from poison centres, not belonging to the reference group, were selected as raters. Inter-rater reliability was assessed using weighted Light's kappa. The results of raters were compared against the reference to test the validity of the method. A subgroup analysis of inter-rater reliability was also performed according to rater experience, case category, and causality determinant.</p><p><strong>Results: </strong>Nineteen raters reviewed the 86 cases selected by the reference group. Kappa was equal to 0.55 (moderate agreement). Sensitivity was 0.90 and specificity was 0.62 when comparing I0 versus I1-I4 classes. The agreement between raters increased with experience except for the most experienced group. Ocular route of exposure had the highest kappa (0.70) among the five case categories. Kappa for the causality determinants varied from 0.31 (exposure) to 0.54 (bibliographical references).</p><p><strong>Discussion: </strong>The causality assessment of poisonings was carried out on real-life cases. Our results are close to those of studies on causality methods in pharmacovigilance and nutrivigilance, despite a wider scope of application.</p><p><strong>Conclusion: </strong>Causality assessment method employed by French poison control centres is useful, although coding of some determinants should be improved. Further refinement of the causality assessment method will also further enhance its utility.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}