American Journal of the Medical Sciences最新文献

{"title":"The TyG index correlation with invasive ventilator in critically ill patients: A retrospective analysis of the MIMIC-IV database","authors":"Jie Hu MD ,&nbsp;Jie Min MD ,&nbsp;Dan Zong BS","doi":"10.1016/j.amjms.2025.03.009","DOIUrl":"10.1016/j.amjms.2025.03.009","url":null,"abstract":"<div><h3>Background</h3><div>Insulin resistance is common in critically ill patients. It is not known whether it is associated with the use of invasive ventilation. This study investigated the relationship between the triglyceride glycemic index (TyG) and the risk of invasive ventilator use in critically ill patients admitted to the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>The study utilized the Medical Information Mart for Intensive Care-IV database. All patients were divided into three groups according to the TyG index. The study employed univariable and multivariable logistic regression analysis, competing risk analysis, and 4-knot multivariate restricted cubic spline regression. ROC curves were used to determine if the TyG index improves the predictive value of disease scores.</div></div><div><h3>Results</h3><div>Out of 2196 participants, 51.9 % had invasive ventilation. Multivariable logistic regression analyses and competing risk analyses revealed that the risk of Invasive ventilator use was significantly higher in the highest quartile of the TyG index. Meanwhile, the RCS analysis indicated S-typed relationships between the TyG index and invasive ventilator use, with inflection points at 9.40, respectively. The TyG index had an incremental effect on the AUC of existing severity of illness scores to predict invasive ventilation.</div></div><div><h3>Conclusions</h3><div>This study shows that an increased TyG index is a significant risk factor for invasive ventilation in patients in the ICU.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 6","pages":"Pages 664-670"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial disparity among Native Americans in coronary artery bypass grafting: An analysis of national inpatient sample from 2015 to 2020","authors":"Renxi Li BS,&nbsp;Deyanira J. Prastein MD,&nbsp;Brian G. Choi MD, MBA, FACC","doi":"10.1016/j.amjms.2024.12.004","DOIUrl":"10.1016/j.amjms.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Disparities have been shown in the outcomes of coronary artery bypass grafting (CABG) in racial minorities. Although Native Americans are known to have a higher risk for cardiovascular diseases, the current literature on CABG outcomes for Native Americans remains notably limited, probably due to their limited population size. Thus, this study aimed to investigate racial disparities in CABG outcomes among Native Americans.</div></div><div><h3>Methods</h3><div>Patients who underwent CABG were identified in National Inpatient Sample database from last quarter of 2015 to 2020. A 1:2 propensity score matching was conducted between Native Americans and Caucasians to address preoperative differences in demographics, socioeconomic status, comorbidity, and hospital characteristics. In-hospital outcomes, length of stay (LOS), time from admission to operation, and total hospital charge were compared.</div></div><div><h3>Results</h3><div>There were 905 (0.54 %) Native Americans and 125,983 (74.91 %) Caucasians, where 1,838 Caucasians were matched to all the Native Americans. The in-hospital mortality rate was elevated in Native Americans but was not statistically different (2.87 % vs. 2.23 %, <em>p</em> = 0.43). However, Native Americans had a higher risk of cardiogenic shock (8.51 % vs. 6.2 %, <em>p</em> = 0.03). There was no difference in time from admission to operation (2.55 ± 0.11 vs. 2.73 ± 0.08 days, <em>p</em> = 0.20), LOS (9.82 ± 0.23 vs. 9.95 ± 0.20 days, <em>p</em> = 0.65), or the total hospital charge between the two groups (205,594 ± 5192.8 vs. 213,961 ± 4150.9 US dollars, <em>p</em> = 0.20).</div></div><div><h3>Conclusion</h3><div>Native Americans had a significantly higher risk of cardiogenic shock after CABG. However, in-house mortality and other parameters were not affected. These disparities highlight challenges that Native Americans encounter and emphasize the need for targeted interventions to ensure health equity.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 6","pages":"Pages 657-663"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing paradigms in asthma management","authors":"Charles E. Grogan MD,&nbsp;Marlee Wadsworth MD,&nbsp;Gailen D. Marshall Jr. MD, PhD.","doi":"10.1016/j.amjms.2024.12.008","DOIUrl":"10.1016/j.amjms.2024.12.008","url":null,"abstract":"<div><div>Asthma is a complex clinical syndrome characterized by airway inflammation that can cause variable, usually reversible airway obstruction and bronchial hyperreactivity. This illness has a spectrum from intermittent to persistent that has mild, medium or severe intensity. As our understanding of the underling inflammatory pathway grows, so too does our catalogue of advanced treatments (such as monoclonal antibodies), opening the path for treatment individually curated for patients.</div><div>The current approved therapies are directed against IgE, interleukin (IL)-5, IL-5 receptor, IL-4 receptor subunit-α and most recently thymic stromal lymphopoietin (TSLP). These therapies all have demonstrated efficacies that make them variably effective in patients with moderate to severe persistent disease. More recently, other inflammatory molecules have been therapeutically targeted and are currently under clinical investigation for future potential use.</div><div>However, a significant concern remains: the high financial costs for these advanced therapies continues to pose a significant burden both to patients and the healthcare system. Novel uses of long-acting bronchodilator-corticosteroids inhalers may reduce the use of highly priced biologics in many patients with comparatively less severe disease. Furthermore, the variability in patient response demands further research into to identify which patients will best respond to which specific therapy.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 6","pages":"Pages 653-656"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facial metastasis of Esophageal squamous cell carcinoma","authors":"Sen-Ei Shai M.D. PhD. ,&nbsp;Hung-Ju Kuo M.D. ,&nbsp;Yi-Ling Lai M.S. ,&nbsp;Chi-Wei Hsieh M.D.","doi":"10.1016/j.amjms.2025.02.003","DOIUrl":"10.1016/j.amjms.2025.02.003","url":null,"abstract":"<div><div>Esophageal squamous cell carcinoma (SCC) is a highly lethal malignancy with a low survival rate, often presenting at an advanced stage. Cutaneous metastasis from esophageal SCC is exceedingly rare, affecting less than 1 % of cases, and is associated with a poor prognosis. This review particularly focuses on facial metastasis and discusses the clinical presentation, diagnostic challenges, and management of cutaneous metastases. The variability in clinical presentation often leads to misdiagnosis, delaying appropriate treatment. Histopathological examination and immunohistochemical staining are crucial for accurate diagnosis. Management involves a combination of local and systemic therapies, tailored to the patient's overall health and disease extent. This topic emphasizes the need for vigilance and thorough diagnostic workups in patients with unusual skin lesions and highlights the importance of multidisciplinary care in optimizing treatment outcomes for patients with advanced esophageal cancer.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 6","pages":"Pages 745-750"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of the conicity index as an indicator of abdominal obesity in predicting cardiovascular disease and all-cause mortality risk in patients with diabetes based on NHANES data from 1999-2018","authors":"Peng Ning MD ,&nbsp;Jiali Huang MM ,&nbsp;Hong Ouyang MM ,&nbsp;Qiu Feng MM ,&nbsp;Hongyi Cao MM ,&nbsp;Fan Yang MD ,&nbsp;Jie Hou MD","doi":"10.1016/j.amjms.2025.04.014","DOIUrl":"10.1016/j.amjms.2025.04.014","url":null,"abstract":"<div><h3>Objective</h3><div>The mortality risk among patients with diabetes is increasingly severe, yet the relationship between obesity and mortality risk in these patients remains controversial. This study evaluated the Conicity index (C-index), an indicator of abdominal obesity, to determine its value in predicting cardiovascular disease (CVD) and all-cause mortality in patients with diabetes.</div></div><div><h3>Methods</h3><div>This cross-sectional study utilized NHANES 1999–2018 data. Patients were grouped into quartiles based on the C-index. The relationship between the C-index and mortality risk was assessed using Cox proportional hazards regression models and restricted cubic spline (RCS) analysis.</div></div><div><h3>Results</h3><div>A total of 7694 patients with diabetes were included in the study. The obesity rate was 55.7 %, with an average follow-up duration of 88 months. During this period, 588 CVD deaths and 2094 all-cause deaths occurred. Higher C-index quartiles were associated with increased mortality risks, with hazard ratios for all-cause mortality ranging from 1.00 to 2.29 and for CVD mortality from 1.00 to 2.23. Unadjusted RCS analysis showed a linear positive correlation between the C-index and mortality risks. After adjusting for confounding factors, a non-linear positive correlation was observed between the C-index and all-cause mortality risk, particularly when the C-index exceeded 1.40. Subgroup analysis revealed that the relationship between the C-index and all-cause mortality was more significant in men and nonobese patients.</div></div><div><h3>Conclusions</h3><div>The C-index is a valuable predictor of mortality in patients with diabetes. A C-index above 1.40, being male, and being nonobese are associated with a more significant risk of all-cause mortality.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 1","pages":"Pages 74-82"},"PeriodicalIF":2.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Refeeding hypophosphatemia is a common cause of delirium in critically ill patients: A retrospective study” [The American Journal of the Medical Sciences 369 (2025) 62–70]","authors":"Ying Xu MD ,&nbsp;Yajun Qian Ph.D. ,&nbsp;Pei Liang MD ,&nbsp;Ning Liu MD ,&nbsp;Danjiang Dong MD ,&nbsp;Qin Gu MD ,&nbsp;Jian Tang MD","doi":"10.1016/j.amjms.2025.04.012","DOIUrl":"10.1016/j.amjms.2025.04.012","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 1","pages":"Page 103"},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncommon cases of crescentic glomerulonephritis with preserved renal function at diagnosis: A retrospective case series from a single center","authors":"Yanyan Zhang MD, PhD ,&nbsp;Wei Wang MD, PhD ,&nbsp;Guisen Li MD, PhD ,&nbsp;Shasha Chen MD, PhD","doi":"10.1016/j.amjms.2025.04.011","DOIUrl":"10.1016/j.amjms.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study is to investigate the clinicopathologic characteristics, treatment and prognosis of crescentic glomerulonephritis (Crescentic GN) in patients with normal renal function at diagnosis, and compare to those with impaired renal function.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients with renal biopsy proven Crescentic GN at our center and divided them into normal eGFR group (eGFR≥60 ml/min/1.73 m²) and low eGFR group (eGFR &lt;60 ml/min/1.73 m²). Clinical and renal pathological findings at diagnosis and renal outcomes were compared between the two groups using t-test, Wilcoxon rank sum test or Kruskal-Wallis H test.</div></div><div><h3>Results</h3><div>From Jan 2010 to Dec 2021, 90 Crescentic GN patients with normal eGFR were included, in which clinicopathological diagnoses were LN (lupus nephritis) (60 cases, 66.77 %), IgAN (IgA nephropathy) (9 cases, 10 %), HSPN (Henoch-Schnlein purpura nephritis) (14 cases, 15.6 %) and AAV (ANCA-associated GN) (7 cases, 7.8 %). Compared with the low eGFR group (<em>n</em> = 300), the following characteristics were observed in the normal eGFR group: younger age (<em>p</em> &lt; 0.001), female predominance (<em>p</em> &lt; 0.001), longer time from onset to biopsy (<em>p</em> &lt; 0.001), lower hypertension rate (<em>p</em> &lt; 0.001), lower rate of oliguria (<em>p</em> &lt; 0.001), and anemia (<em>p</em> &lt; 0.001), lower levels of C3 (<em>p</em> &lt; 0.001), C4 (<em>p</em> &lt; 0.001) and Urine RBC (<em>p</em> &lt; 0.001), higher titers of ANA (<em>p</em> &lt; 0.001) and ds-DNA (<em>p</em> = 0.002), lower positive rate of ANCA (&lt;0.001) and GBM (<em>p</em> = 0.02), less extra-renal involvement (<em>p</em> &lt; 0.05), lower proportions of crescents (56.3(51.8–62.7) % vs 66.7 (56.3–81.3) %, <em>p</em> &lt; 0.001) and glomerular sclerosis (<em>p</em> &lt; 0.001), less severe tubulointerstitial lesion (<em>p</em> &lt; 0.001) and interstitial inflammation (<em>p</em> &lt; 0.001), higher degree of immune complex deposition of IgA, IgM, C3, C4 and C1q by Immunofluorescence. Normal eGFR group received lower frequency of intravenous methylprednisolone pulse therapy (71.2 % vs 89 %, <em>p</em> = 0.044) and dialysis treatment (0 % vs 53.7 %, <em>p</em> &lt; 0.001). The 5- and 10-year cumulative renal survival rates from ESRD were 90.7 % vs 45.5 % and 58.3 % vs 43.7 %, respectively in normal and low eGFR group.</div></div><div><h3>Conclusion</h3><div>Crescentic GN may present with normal renal function, which has poor renal outcomes and may benefit from intensive immunosuppressive treatment. This often occurs in patients with abnormal immunological indicators and systemic autoimmune disease. Shorter time from onset to biopsy may help better management and improve long-term outcomes in these cases. Renal biopsy remains the diagnostic gold standard when urinary abnormalities are present in nephritis.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 1","pages":"Pages 47-53"},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond pressure and volume: mechanical power levels in a cohort of intensive care unit patients","authors":"Jacob Harder MD, PhD,&nbsp;Kenneth Iwuji MD, PhD,&nbsp;Kenneth Nugent MD, PhD","doi":"10.1016/j.amjms.2025.04.004","DOIUrl":"10.1016/j.amjms.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Several ventilator parameters can be used to evaluate gas exchange and mechanical properties of the respiratory system in acute respiratory failure patients. The calculation of mechanical power (MP), a critical parameter that summarizes the energy transferred from the ventilator to the patient’s lungs, is not routinely made in these patients.</div></div><div><h3>Methods</h3><div>This study analyzed the distribution of MP in a cohort of 70 patients requiring mechanical ventilation and investigated its association with clinical outcomes.</div></div><div><h3>Results</h3><div>This study included 39 men and 31 women with a mean age of 57.7 ± 15.1 years. The mean MP index decreased significantly from 10.4 J/min ± 5.65 on day 2 of mechanical ventilation to 8.3 J/min ± 4.1 on day 4 (<em>p</em> = 0.045). The mean length of mechanical ventilation was 5.2 <span><math><mrow><mo>±</mo><mspace></mspace><mn>6.5</mn><mrow><mspace></mspace><mtext>days</mtext></mrow><mo>.</mo></mrow></math></span> Mechanical power measured on day 2 (<em>r</em> = 0.317, <em>p</em> = 0.052) and day 4 (<em>r</em> = 0.352, <em>p</em> = 0.030) positively correlated with the duration of mechanical ventilation. There were no differences in MP between survivors and non-survivors on both day 2 (<em>p</em> = 0.458) and day 4 (<em>p</em> = 0.373).</div></div><div><h3>Conclusions</h3><div>This study analyzed the distribution of MP levels in mechanically ventilated patients in an ICU. Mechanical power measured on days 2 and 4 of mechanical ventilation had a positive correlation with the duration of ventilation, but it was not a significant predictor of ICU mortality.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 1","pages":"Pages 54-58"},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential role of SGLT2 inhibitors in the management of amyloidosis","authors":"Bülent Özlek MD","doi":"10.1016/j.amjms.2025.04.008","DOIUrl":"10.1016/j.amjms.2025.04.008","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"370 1","pages":"Pages 100-102"},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of HIF-1α for left ventricular remodeling following an anterior ST-segment elevation myocardial infarction","authors":"Jun Wan MM ,&nbsp;Feng Xu MM ,&nbsp;Chunlin Yin MD ,&nbsp;Yang Jiang MM ,&nbsp;Cai Chen MM ,&nbsp;Yulin Wang MM ,&nbsp;Heping Zuo MM ,&nbsp;Jinglin Cheng MM ,&nbsp;He Li MD","doi":"10.1016/j.amjms.2024.11.009","DOIUrl":"10.1016/j.amjms.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Hypoxia-inducible factor-1α (HIF-1α) has an essential role in ventricular remodeling processes involving myocardial fibrosis and hypertrophy, but the clinical significance of HIF-1α levels in the early period after ST-segment elevation myocardial infarction (STEMI) for the prediction of left ventricular remodeling (LVR) has yet to be fully elucidated.</div></div><div><h3>Objective</h3><div>To investigate the predictive value of HIF-1α for LVR after STEMI based on the echocardiographic parameters.</div></div><div><h3>Methods</h3><div>In this prospective observational study, plasma samples were collected within 12 hours of onset from 183 patients with a first reperfused anterior ST-segment elevation myocardial infarction (STEMI), and HIF-1α levels were measured using enzyme-linked immunosorbent assay (ELISA). At baseline and 12 months after discharge, all patients underwent repeat echocardiography. The changes of echocardiography parameters from baseline to 12 months were used to reflect the changes of ventricular structure and function. An increase in end-diastolic volume of ≥20 % was defined as LVR.</div></div><div><h3>Results</h3><div>The levels of HIF-1α were highly correlated with the changes of echocardiography parameters (ΔLVEF, ΔLVEDD, as well as ΔLVEDV). During the follow-up period, patients with higher HIF-1α concentrations had higher incidence of LVR, poorer ventricular function, and a lower MACE-free survival. Multivariate analysis showed the single-point HIF-1α was an independent predictor of LVR (odds ratio[OR]: 4.813; 95 % CI: 1.553 to 14.918; P = 0.006). The HIF-1α levels predicted LVR with an AUC of 0.7905 (95 % CI: 0.7067 to 0.8744; P &lt; 0.0001). The combination of HIF-1α and N-terminal probrain natriuretic peptide (NT-proBNP) yielded a favorable increase in AUC to 0.8121 (95 % CI: 0.7345 to 0.8896; P &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>These results demonstrate that serum HIF-1α levels can predict LVR after STEMI independently.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 479-484"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}