Journal of Hospital Infection最新文献

{"title":"The complexity of Staphylococcus epidermidis molecular epidemiology in neonatal intensive care units (NICU) as revealed by genomic approaches","authors":"R.F. Rampelotto ,&nbsp;N.A. Faria ,&nbsp;R. Hörner ,&nbsp;M. Miragaia","doi":"10.1016/j.jhin.2025.04.011","DOIUrl":"10.1016/j.jhin.2025.04.011","url":null,"abstract":"<div><div>Bloodstream infections caused by <em>Staphylococcus epidermidis</em> are among the most frequent and serious infections in neonatal intensive care units (NICU), being responsible for high rates of morbidity and mortality. However, how <em>S. epidermidis</em> prevails, disseminates and evolves to cause outbreaks in NICU is poorly understood. We aimed to understand what is the genomic basis of <em>S. epidermidis</em> outbreaks in NICU to provide guidelines for a better infection control.</div><div>We collected all <em>S. epidermidis</em> isolated from newborn blood cultures admitted to a hospital NICU in Brazil over one-year and compared their genomes.</div><div>The <em>S. epidermidis</em> infection incidence rate was 1.17 per baby-year. 83,64% of <em>S. epidermidis</em> were resistant to methicillin (MRSE) and 84,5% belonged to sequence type 2 (ST2) or related, carrying the staphylococcal cassette chromosome <em>mec</em> (SCC<em>mec</em>) type III or IVa. Single nucleotide polymorphisms (SNPs) analysis showed that <em>S. epidermidis</em> infections resulted from the co-existence of three ST2 transmission chains originating from distinct endemic sources (&lt;50 SNPs). Each transmission chain was characterized by specific antibiotic resistance and virulence profile and content in staphylococcal cassette chromosome elements (SCC<em>mec</em>, SCC non-<em>mec</em> and ACME). During transmission, other mobile genetic elements were acquired/lost and mutations emerged in genes involved in adhesion, signal transduction, general metabolism, replication, recombination and repair.</div><div>Tracking <em>S. epidermidis</em> transmission chains in the NICU will require a deep genomic analysis, combining bacterial genetic background and accessory genome. This study highlighted the need for the integration of whole genome sequencing as a key surveillance tool for infection control in NICUs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 148-158"},"PeriodicalIF":3.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative in-vitro antimicrobial activity of silver- and minocycline–rifampin–chlorhexidine-coated needle-free connectors","authors":"Y. Truong,&nbsp;J. Rosenblatt,&nbsp;B. Gerges,&nbsp;Y. Jiang,&nbsp;I. Raad","doi":"10.1016/j.jhin.2025.04.012","DOIUrl":"10.1016/j.jhin.2025.04.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Needle-free connectors (NFCs) are widely used to access vascular infusion circuits. Despite their safety benefits, NFCs still present risks for colonization and vascular ingress by pathogenic microbes. Antimicrobial NFCs present one approach to prevent microbial colonization over all colonizable surfaces of NFCs, with the advantage of potentially protecting all vulnerable internal and external NFC surfaces.</div></div><div><h3>Methods</h3><div>This study compared a commercially available silver-coated NFC with a novel minocycline–rifampin–chlorhexidine (MRC)-coated NFC in an in-vitro model posing a severe microbial challenge following 1 and 7 days of elution in a 50% serum solution to simulate clinical use of the NFCs. Microbial challenges were performed against clinical isolates of meticillin-resistant <em>Staphylococcus aureus</em> (MRSA), multi-drug-resistant <em>Pseudomonas aeruginosa</em> and <em>Candida albicans</em> as representative of the major classes of highly virulent bloodstream infectious pathogens.</div></div><div><h3>Results</h3><div>Results following 1 day of elution showed colonization of uncoated NFCs of 4.45 x 10⁶ colony-forming units (CFU)/NFC for MRSA, 5.20 x 10⁶ CFU/NFC for <em>C. albicans</em> and 3.68 x 10⁷ CFU/NFC for <em>P. aeruginosa</em>. The silver NFC presented approximately a 1 log₁₀ reduction for <em>P. aeruginosa</em> and similar colonization densities as the control for MRSA and <em>C. albicans</em>. In contrast, the MRC NFC showed no colonization by any of the challenge pathogens. Similar results were obtained following 7 days of elution.</div></div><div><h3>Conclusions</h3><div>The differences between the MRC and silver NFCs were significant (<em>P</em>&lt;0.005). The MRC NFC has potential to reduce line infections, and therefore merits further in-vivo and clinical testing.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 114-118"},"PeriodicalIF":3.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand disinfections per patient-day in relation to use of unsterile gloves per patient-day: a comparator for the appropriate use of unsterile gloves in the clinical setting?","authors":"A Ambrosch","doi":"10.1016/j.jhin.2025.04.014","DOIUrl":"10.1016/j.jhin.2025.04.014","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personal protective equipment stewardship across 112 medical facilities: a preliminary survey in Japan","authors":"T. Ohishi ,&nbsp;S. Shinomiya ,&nbsp;Y. Tsuda ,&nbsp;H. Kurosu ,&nbsp;T. Yoshikawa","doi":"10.1016/j.jhin.2025.03.016","DOIUrl":"10.1016/j.jhin.2025.03.016","url":null,"abstract":"<div><h3>Background</h3><div>The stewardship of personal protective equipment (PPE) is crucial in preventing healthcare-associated infections by safeguarding healthcare workers.</div></div><div><h3>Aim</h3><div>To comprehensively elucidate the selection process and current status of PPE stewardship in Japanese medical facilities and gather evidence that will contribute to the qualitative enhancement of PPE stewardship in the country.</div></div><div><h3>Methods</h3><div>A survey on PPE stewardship was conducted at 200 Japanese medical facilities between February and March 2024.</div></div><div><h3>Findings</h3><div>The response rate was 56.0% (112/200). While 99.1% of the responding facilities had documented protocols for PPE use and provided comprehensive training (including practical skills), only 3.8% extended this training to outsourced staff. Multiple sizes of surgical mask were available in 58.0% of the facilities, and 58.9% were equipped to conduct fit testing for N95 respirators. Moreover, 58.9% of the facilities monitored and evaluated PPE stewardship in conjunction with environmental rounds and hand hygiene assessments.</div></div><div><h3>Conclusion</h3><div>Despite the limited sample size, this study is the first large-scale survey of PPE use in Japan. Our findings provide a basis for future surveys and evidence for establishing optimal PPE-related protocols. They may also contribute to the advancement of healthcare-associated infection control.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 135-139"},"PeriodicalIF":3.9,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A \"SWIFT\" response to wound healing.","authors":"Melissa Rochon, Giles Bond-Smith","doi":"10.1016/j.jhin.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.04.006","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial contamination of ultrasound probes in emergency departments: A multicentre observational study.","authors":"Takahiro Yamanaka, Ryo Yamamoto, Keitaro Yajima, Ikutaro Yamashita, Tomohiro Kurihara, Dai Kujirai, Kazunori Moritani, Hanae Kamikura, Hidefumi Koh, Junichi Sasaki","doi":"10.1016/j.jhin.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.03.017","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound is frequently used in emergency departments (ED) for patient evaluation and diagnosis. Despite the risk of probe contamination from body fluids and blood, the rate of such contamination remains unclear.</p><p><strong>Aim: </strong>This study aimed to evaluate bacterial contamination of ultrasound probes in EDs, focusing on hospital types and reprocessing methods.</p><p><strong>Methods: </strong>A multicentre prospective observational study was conducted at a university hospital, a non-academic tertiary hospital, and a regional hospital in 2023. Samples were collected from probes used on ED patients. Reprocessing methods included water-moistened wipes alone, water-moistened wipes with ethanol wipes, quaternary ammonium wipes alone, and quaternary ammonium wipes with ethanol or hypochlorite wipes. Outcomes included the level of bacterial contamination, measured by colony-forming units (CFU) per total surface area of each probe, and resistant bacterial strains.</p><p><strong>Findings: </strong>The median CFU was 10 (IQR: 0-50) at the university hospital, 40 (10-135) at the non-academic tertiary hospital, and 30 (1-95) at the regional hospital. By reprocessing method, the median CFU was 20 (1-90) for water-moistened wipes alone, 10 (0-20) for water-moistened wipes and additional ethanol wipe, 90 (40-180) for quaternary ammonium wipes alone, and 20 (1-50) for quaternary ammonium wipe and additional ethanol or hypochlorite wipe. Resistant bacterial strains were found on 18.2% of probes.</p><p><strong>Conclusion: </strong>High levels of bacterial contamination, including resistant strains, were observed on ultrasound probes in EDs, regardless of facility type and reprocessing method.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of airborne bacteria in rooms with turbulent mixing ventilation vs unidirectional airflow during the preparation of surgical instruments – an experimental study","authors":"E. Torbjörnsson ,&nbsp;C. Olivecrona ,&nbsp;A. Lööf Ngo ,&nbsp;A. Tammelin","doi":"10.1016/j.jhin.2025.04.005","DOIUrl":"10.1016/j.jhin.2025.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Surgical instruments could act as carriers of pathogens causing surgical site infections. Different types of ventilation systems in operating theatres are used to prevent contamination of sterile fields and instruments by airborne bacteria. The results are inconclusive concerning which ventilation system creates the best conditions.</div></div><div><h3>Aim</h3><div>To investigate levels of airborne bacteria during the preparation of surgical instruments in preparation rooms with turbulent mixing ventilation (TMV) and unidirectional airflow (UDAF).</div></div><div><h3>Methods</h3><div>This study was conducted in a newly built operating theatre at Södersjukhuset, Stockholm, Sweden. Colony-forming units (CFU)/m³ were measured in a preparation room with TMV with an intake of air of either 700 L/s or 1200 L/s, and a preparation room with UDAF with an intake of air of 700 L/s.</div></div><div><h3>Findings</h3><div>Mean CFU/m³ air ranged from 0 to 104.5 in the preparation room with TMV and airflow of 700 L/s. When airflow was adjusted to 1200 L/s, mean CFU/m³ air ranged from 0 to 5.5. In the preparation room with UDAF, mean CFU/m³ air ranged from 0 to 7. With airflow of 700 L/s, the difference between the two rooms was significant (<em>P</em>&lt;0.006). When the airflow in the preparation room with TMV was increased to 1200 L/s, there was no significant difference between TMV and UDAF (<em>P</em>=0.443).</div></div><div><h3>Conclusion</h3><div>This experimental study of the differences in levels of airborne bacteria in preparation rooms during preparation of surgical instruments showed that, with airflow of 700 L/s, the preparation room with UDAF had significantly lower CFU/m³ air than the preparation room with TMV.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 13-18"},"PeriodicalIF":3.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disinfection efficacy and safety of 222-nm ultraviolet C compared with 254-nm ultraviolet C: systematic review and meta-analysis","authors":"Q. Liu ,&nbsp;X. Wang ,&nbsp;L. Jiang,&nbsp;Y. Fan,&nbsp;F. Gao,&nbsp;Y. Wu,&nbsp;L. Xiong","doi":"10.1016/j.jhin.2025.04.004","DOIUrl":"10.1016/j.jhin.2025.04.004","url":null,"abstract":"<div><div>Some studies have indicated that disinfection with 222-nm ultraviolet C (UVC) is more effective than that with 254-nm UVC; however, other studies have reported the opposite. Moreover, additional studies have reported that 222-nm UVC exposure is safe for the skin and eyes. This study aimed to identify and quantitatively synthesize all studies evaluating the disinfection efficacy and safety of 222-nm UVC compared with 254-nm UVC. We conducted a systematic review and meta-analysis. Web of Science, SCOPUS, Medline, Ovid Embase, and the Cochrane Library were searched through November 2024 for studies that evaluated the disinfection efficacy and safety of 222-nm UVC compared with 254-nm UVC. We identified 25 eligible publications including 15 publications providing data only on the efficacy, seven only on the safety, and the remaining three on both efficacy and safety. The pooled odds ratio for studies comparing the efficacy of 222-nm UVC with that of 254-nm UVC was 1.382 (95% CI: 1.153–1.656, <em>N</em> = 18 publications with 87 studies), indicating that 222-nm UVC is more effective for disinfection. The pooled risk difference for studies evaluating the safety of 222-nm UVC radiation was -0.211 (95% CI: -0.245, -0.177; <em>N</em> = 10 publications with 29 studies), which indicates that the proportion of normal cells producing cyclobutane pyrimidine dimers via 222-nm UVC is 21.1% less than that via 254-nm. Compared with 254-nm UVC, 222-nm UVC not only exhibits comparable or potentially superior efficacy in disinfecting diverse micro-organisms but also causes less DNA damage to the mammalian cells.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 55-67"},"PeriodicalIF":3.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time investigation of a Burkholderia cenocepacia bacteraemia outbreak in a Vietnamese intensive care unit","authors":"A.T.K. Nguyen ,&nbsp;V.K. Phuong Linh ,&nbsp;D.T. Huong ,&nbsp;P.T. Kieu ,&nbsp;V.V. Phat ,&nbsp;H.T. Tuyen ,&nbsp;Q. Nguyen ,&nbsp;N.H. Hien ,&nbsp;N.T. Diem Trinh ,&nbsp;H.N. Hon ,&nbsp;N.T. Binh ,&nbsp;P.T. Phuong Thao ,&nbsp;T. Quang ,&nbsp;N.T. Thu Van ,&nbsp;P.T. Ngoc Lan ,&nbsp;Y. Mo ,&nbsp;D.L. Paterson ,&nbsp;G. Thwaites ,&nbsp;L. Thwaites ,&nbsp;P.T. Duy","doi":"10.1016/j.jhin.2025.04.003","DOIUrl":"10.1016/j.jhin.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>The <em>Burkholderia cepacia</em> complex (Bcc), a group of environmentally ubiquitous bacteria, are inherently resistant to antiseptics and antibiotics. Bcc can proliferate in pharmaceutical products, resulting in nosocomial outbreaks. However, Bcc is often dismissed as blood culture contaminants, and precise identification of Bcc species remains challenging in resource-limited settings, leading to under-treatment and delay in outbreak detection. This paper reports the first identified Bcc bacteraemia outbreak in a Vietnamese intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>In June 2023, a Bcc bacteraemia outbreak was acknowledged by the hospital authorities after examination of clinical and microbiological evidence. A comprehensive investigation was performed, encompassing epidemiological and clinical review, environmental sampling, whole-genome sequencing (WGS), and implementation of enhanced infection prevention and control (IPC) measures.</div></div><div><h3>Results</h3><div>The bacteraemia outbreak involved 19 ICU patients between May and August 2023. The causative bacteria were identified as <em>B</em>. <em>cenocepacia</em> belonging to a novel sequence type, and did not carry any acquired antimicrobial resistance genes. Although these organisms were susceptible to the commonly used antibiotics, the outbreak was associated with a high case fatality rate. Three <em>B. cenocepacia</em> isolates were also found in used syringes for drug infusion in three cases, exhibiting a genomic link to the outbreak cluster. Enhanced IPC measures targeting aseptic techniques in handling intravenous medications resulted in termination of the outbreak.</div></div><div><h3>Conclusions</h3><div>WGS plays a crucial role in outbreak control, particularly for under-studied opportunistic pathogens. This work also highlights key gaps in IPC measures, species identification, and treatment of Bcc infections, warranting further research to improve hospital prevention and treatment strategies.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 74-82"},"PeriodicalIF":3.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contamination and control of environmental surfaces and personal protective equipment in dental clinics: a multi-centre study","authors":"J. Ding ,&nbsp;M. Huang ,&nbsp;Y. Shen ,&nbsp;H. Dong ,&nbsp;T. Yuan ,&nbsp;Y. Jin ,&nbsp;L. Li ,&nbsp;X. Gui ,&nbsp;R. Shen ,&nbsp;M. Tang ,&nbsp;Y. Zhang ,&nbsp;Y. Shen ,&nbsp;H. Huang ,&nbsp;H. Ban ,&nbsp;Y. Yang ,&nbsp;E. Lu","doi":"10.1016/j.jhin.2025.03.015","DOIUrl":"10.1016/j.jhin.2025.03.015","url":null,"abstract":"<div><h3>Background</h3><div>Dental procedures are associated with the production of aerosols, blood, and saliva splashes. However, the extent of blood contamination on surfaces during dental procedures remains largely unknown.</div></div><div><h3>Aim</h3><div>To evaluate the contamination of environmental surfaces and personal protective equipment (PPEs) in dental clinics and effects of subsequent disinfection measures.</div></div><div><h3>Methods</h3><div>The study was conducted in five dental clinics in Shanghai. The contamination on environmental surfaces around dental chairs, gloves, and face shields was quantified using occult blood detection and adenosine triphosphate (ATP) bioluminescence analysis. Results of ATP tests are displayed in relative light units (RLU). Further analysis was conducted following the implementation of standardized cleaning and disinfection protocols.</div></div><div><h3>Findings</h3><div>The presence of occult blood on gloves was most frequent during tooth extraction (67.65%), while the highest RLU values were observed for crown and brace procedures (median: 3214; interquartile range (IQR): 18.00–5371.00). The positive rate of occult blood on face shields was 24.00% (median RLU: 59; IQR: 14.75–206.75). Environmental surfaces most severely contaminated with occult blood were dental chair sink (87.00%), handpiece handle (48.00%), and saliva ejector handle (36.00%). Disinfection measures significantly reduced contamination levels at all sites, with both methods demonstrating substantial reductions in contamination for the dental chair sink, saliva ejector handle, and handpiece handle.</div></div><div><h3>Conclusion</h3><div>This study identified high-risk contamination sites and procedures in dental clinics. Disinfection is effective against surface contamination with blood.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 44-51"},"PeriodicalIF":3.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}