American Journal of Emergency Medicine最新文献

{"title":"Trends in mental health-related pediatric emergency visits among New York City students","authors":"Juan Echenique PhD ,&nbsp;Amy Ellen Schwartz PhD ,&nbsp;Kevin Konty PhD ,&nbsp;Sophia Day MA ,&nbsp;Argelinda Baroni MD ,&nbsp;Cheryl R. Stein PhD ,&nbsp;Kira Argenio MPH ,&nbsp;Brian Elbel PhD, MPH","doi":"10.1016/j.ajem.2025.07.045","DOIUrl":"10.1016/j.ajem.2025.07.045","url":null,"abstract":"<div><h3>Background and objective</h3><div>Recent studies highlight an increase in pediatric mental health disorders, amplified by COVID-19. This study examines changes in mental health-related emergency department visits among New York City public school students across the pandemic timeline.</div></div><div><h3>Methods</h3><div>We employed logistic regression to examine changes in the probability of a student's emergency department visit being mental health-related, and as a secondary outcome, we analyzed the difference in same-day discharge rates between mental health-related visits and other visits. For this analysis, we used the New York City Student Population Health Registry to link public school students' records to emergency department visit data.</div></div><div><h3>Results</h3><div>No significant linear trends were observed in the average monthly probability of a mental health-related visit before March 2020. From March 2020 through June 2021 there was an increase for all groups except male elementary school students. Female middle and high school students experienced the largest increase (0.031 (CI = [0.027, 0.034])) compared to pre-pandemic (0.103 (CI = [0.103, 0.104])). Post-June 2021, all groups experienced a lower probability except for female middle and high school students, who had a 0.009 (CI = [0.007, 0.011]) higher probability than during the pandemic.</div><div>Compared to the pre-pandemic period and non-mental health-related visits, a 0.043 (CI = [0.029, 0.057]) lower probability of same-day discharge was observed for mental health-related visits during the pandemic period.</div></div><div><h3>Conclusions</h3><div>The COVID-19 pandemic correlated with a significant increase in mental health-related emergency department visits and longer stays, particularly among female middle and high school students.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 152-158"},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713149","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":"Intravenous tranexamic acid in gastrointestinal bleeding: A systematic review and meta-analysis of randomized controlled trials","authors":"Tarek Djoudjou MBBS ,&nbsp;Osama Alamri ,&nbsp;Abdulrahman Aljuwayr ,&nbsp;Anas Fakieh ,&nbsp;Ahmad Aljared MBBS ,&nbsp;Amanee Almalik ,&nbsp;Laale Khan ,&nbsp;Mohammed Al-Nahari ,&nbsp;Yazeed Alsanad ,&nbsp;Renad Alabdulrahman ,&nbsp;Lara Aljohny ,&nbsp;Thana Ali Algarni ,&nbsp;Abdullah Alturki ,&nbsp;Faheem Mohammed Saleh","doi":"10.1016/j.ajem.2025.07.050","DOIUrl":"10.1016/j.ajem.2025.07.050","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastrointestinal bleeding is a critical condition associated with high morbidity and mortality, necessitating effective management strategies. Tranexamic acid (TXA), an anti-fibrinolytic agent, has been proposed as a therapeutic option to reduce bleeding complications. However, recent randomized controlled trials (RCTs) have produced conflicting results regarding its efficacy and safety.</div></div><div><h3>Method</h3><div>This systematic review and meta-analysis followed PRISMA guidelines and included RCTs evaluating the use of intravenous TXA in adult patients with gastrointestinal bleeding. Comprehensive searches were conducted in PubMed and Google Scholar, yielding 518 publications, with 7 RCTs meeting inclusion criteria. Data were synthesized using mainly a random-effects model to assess outcomes, including mortality, rebleeding, failure to control bleeding, thromboembolic events, and blood transfusion requirements.</div></div><div><h3>Result</h3><div>The analysis included 7 RCTs of 13,608 participants, revealing that IV TXA was statistically significant in reducing rebleeding rates (OR 0.64; 95 % CI: 0.45–0.91, <em>P</em> = 0.01) and failure to control bleeding (OR 0.55; 95 % CI: 0.45–0.91, <em>P</em> = 0.03). However, there was no significant reduction in mortality (OR 0.77; 95 % CI: 0.56–1.07, <em>P</em> = 0.12) or blood transfusion requirements (OR 0.94;95 % CI: 0.61–1.43, <em>P</em> = 0.76). While thromboembolic events showed no significant difference in the random-effects model (OR 1.28; 95 % CI: 0.51–4.51, <em>P</em> = 0.46), fixed-effect analysis suggested a statistical significance (OR 1.28; 95 % CI: 1.07–1.55, <em>P</em> = 0.009).</div></div><div><h3>Conclusion</h3><div>Intravenous TXA appears to be an effective adjunctive therapy for managing gastrointestinal bleeding, particularly in reducing rebleeding and failure to control bleeding. However, it does not significantly affect mortality rates, and caution is warranted regarding potential thromboembolic risks. Further research is needed to optimize TXA use and identify high-risk populations to enhance patient outcomes in gastrointestinal bleeding management.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 175-182"},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749896","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":"Multilayer spinal hemorrhage in a patient on long-term warfarin: A case report.","authors":"Charakrit Pankongngam, Pawaruj Rirermsoonthorn, Borwon Wittayachamnankul","doi":"10.1016/j.ajem.2025.07.046","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.07.046","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord hemorrhages are very rare conditions. It can be categorized into four types based on its anatomical location: epidural, subdural, subarachnoid, and intramedullary. The incidence of spinal hematomas remains undetermined due to limited data. Early detection and prompt management are critical for better outcomes in terms of morbidity and mortality.</p><p><strong>Case report: </strong>A 65-year-old Southeast Asian female with a history of mechanical valve replacement and long-term warfarin use presented with progressive back pain following a mild back pain after riding a speedboat. She later developed sudden bilateral lower limb weakness and urinary retention. Magnetic resonance imaging (MRI) revealed multiple spinal cord hematomas: intramedullary from T4 to the conus medullaris, epidural from T8 to L1, and subdural from T2 to T7. She underwent T10-T12 laminectomy for epidural hematoma evacuation. Anticoagulation therapy with warfarin was resumed under close monitoring of international normalized ratio.</p><p><strong>Conclusion: </strong>Spinal hemorrhage involving multiple spinal cord layer is a very rare condition. It should be considered in patients with acute back pain and neurological symptoms. MRI is the imaging modality of choice, with early decompression within 12 h of symptom onset improving outcomes. Prompt correction of coagulopathy is crucial to prevent hematoma expansion. Proper warfarin management is essential to prevent the recurrence of bleeding events while ensuring cardiovascular protection.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735551","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":"Inter-rater reliability of ultrasound quality assurance review of FAST examinations: A cross-sectional study","authors":"Elizabeth Dearing MD ,&nbsp;Sarah E. Frasure MD ,&nbsp;Kaitlen Howell MD ,&nbsp;Megan M. Leo MD ,&nbsp;Matthew Lipton MD ,&nbsp;Michael Gottlieb MD ,&nbsp;Martin Demant MD ,&nbsp;Bret P. Nelson MD ,&nbsp;Yiju T. Liu MD ,&nbsp;Keith Boniface MD","doi":"10.1016/j.ajem.2025.07.053","DOIUrl":"10.1016/j.ajem.2025.07.053","url":null,"abstract":"<div><h3>Background</h3><div>Point-of-care ultrasound (POCUS), an integral part of patient care in the Emergency Department, requires a robust Quality Assurance (QA) program for credentialing and providing ongoing feedback to providers. However, there are no set guidelines for QA and the agreement between providers is unknown.</div></div><div><h3>Objective</h3><div>This study sought to evaluate the inter-rater reliability of QA for POCUS.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, eight emergency ultrasound faculty members from eight different institutions completed QA on a total of 25 Focused Assessment with Sonography in Trauma (FAST) exams. The exams were graded on overall quality of image acquisition as well as accuracy of interpretation (true positive, true negative, false positive, false negative, incomplete, and technically limited study). The studies were assessed as to whether they met minimal criteria for credentialing. The overall agreement in meeting this minimal requirement as well as the quality scores alone were each compared between participants using Fleiss' kappa.</div></div><div><h3>Results</h3><div>Inter-rater reliability for whether studies met the minimum criteria for credentialing was slight (Fleiss' κ = 0.058; 95 % CI: −0.016 to 0.132). Image quality grading (scores of 1 and 2 versus 3, 4 and 5) also showed slight agreement (κ = 0.199; 95 % CI: 0.125 to 0.275). There was also no correlation between years in clinical practice and QA review.</div></div><div><h3>Conclusions</h3><div>This pilot study found there is only slight agreement in QA grading between emergency ultrasound faculty for both overall competency assessment and in image acquisition alone. Developing a tool to standardize QA may improve the inter-rater reliability and create more uniformity for POCUS feedback and credentialing.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 170-174"},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723634","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 analysis of APUA, APUA-RO₂, and CURB-65 scores for mortality risk in hospitalized pneumonia patients","authors":"Abdullah Algin ,&nbsp;Serdar Özdemir ,&nbsp;Mustafa Ahmet Afacan ,&nbsp;Kaan Yusufoglu ,&nbsp;Abuzer Özkan","doi":"10.1016/j.ajem.2025.07.054","DOIUrl":"10.1016/j.ajem.2025.07.054","url":null,"abstract":"<div><h3>Background</h3><div>Early identification of patients at high risk of mortality in community-acquired pneumonia (CAP) is critical for clinical decision-making. While the CURB-65 score is widely used, simplified tools such as APUA and APUA-RO₂ have been proposed to improve risk stratification by incorporating fewer and more accessible parameters.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included adult patients (≥18 years) hospitalized with CAP between January 2023 and December 2024. The APUA, APUA-RO₂, and CURB-65 scores were calculated based on admission data. The primary outcome was 30-day in-hospital mortality. The predictive performances of the scores were compared using receiver operating characteristic (ROC) curve analysis, and AUCs were statistically compared using the DeLong test.</div></div><div><h3>Results</h3><div>A total of 348 patients were included; the in-hospital mortality rate was 32.5 %. The area under the curve (AUC) for APUA-RO₂ was 0.716 (95 % CI, 0.657–0.774), for CURB-65 was 0.716 (95 % CI, 0.662–0.770), and for APUA was 0.658 (95 % CI, 0.596–0.719). APUA-RO₂ showed significantly better discriminatory ability than APUA (<em>P</em> &lt; .001). No significant difference was observed between APUA-RO₂ and CURB-65 (<em>P</em> = .976).</div></div><div><h3>Conclusion</h3><div>Both APUA-RO₂ and CURB-65 demonstrated moderate and comparable accuracy in predicting 30-day mortality in hospitalized CAP patients. The APUA-RO₂ score may be a practical alternative to existing tools, offering a balance between simplicity and prognostic utility.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 136-139"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711879","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":"Evaluation of an influenza vaccine administration program in the emergency department","authors":"Jason J. Bischof MD ,&nbsp;Erin M. Reichert PharmD ,&nbsp;Jillian Maitland MBA, RN ,&nbsp;Jessica M. Queen BS ,&nbsp;Chelsea Cobranchi MTDA ,&nbsp;Mark J. Conroy MD ,&nbsp;Eric Adkins MD ,&nbsp;Daniel R. Martin MD ,&nbsp;Michael S. Lyons MD, MPH","doi":"10.1016/j.ajem.2025.07.038","DOIUrl":"10.1016/j.ajem.2025.07.038","url":null,"abstract":"<div><h3>Background</h3><div>The Emergency Department (ED) offers the opportunity to expand vaccine prevention interventions. However, the processes, outcomes, and sustainability of ED influenza vaccination remain largely uncharacterized. We report the outcomes of a low-intensity, electronic health record (EHR) facilitated, ED influenza vaccination initiative.</div></div><div><h3>Methods</h3><div>This retrospective evaluation of an ED influenza vaccination program used existing EHR records of ED encounters from 2019 to 2023 at two affiliated urban EDs. The ED influenza vaccination program launched September 2020 and continued during annual influenza seasons. Nurses assessed eligibility and administered vaccine by protocol based on passive electronic health record best practice advisories (BPAs). Implementation efforts were limited to BPA programming with email and staff meeting announcements. Descriptive statistics were used to compute the primary outcome of the number of ED influenza vaccine administrations by year.</div></div><div><h3>Results</h3><div>After vaccinating 18 individuals in the year prior to launch, the program vaccinated 271 individuals (225 year 1; 41 year 2; 5 year 3). In the 3-year evaluation period, nurses acknowledged 10,558 (8.9 %) BPAs, of which 116 (1.1 %) were excluded due to contraindications, 10,000 (94.7 %) were documented as “vaccine offer declined”, and 442 (4.2 %) agreed to vaccination.</div></div><div><h3>Conclusion</h3><div>A nursing driven ED influenza vaccination protocol may enable vaccination, but successful ED influenza vaccination was minimal in this experience featuring limited implementation procedures. The passive BPA was most often not acknowledged and when acknowledged resulted in a high refusal rate possibly due to erroneous documentation. A program of research in ED care processes, staff motivation, and health policy is required to leverage EDs as vaccination sites.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 131-135"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711881","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":"Ultrasound guidance compared to anatomic landmark approach for thoracentesis: A systematic review and meta-analysis","authors":"Rukaiyah Lakkadghatwala MD ,&nbsp;Alexander Wilson MD ,&nbsp;Vikram Sabhaney MD ,&nbsp;Michael Gottlieb MD ,&nbsp;Ye Shen ,&nbsp;Colleen Pawliuk ,&nbsp;Justin S. Ahn ,&nbsp;Daniel J. Kim","doi":"10.1016/j.ajem.2025.07.049","DOIUrl":"10.1016/j.ajem.2025.07.049","url":null,"abstract":"<div><h3>Background</h3><div>Although thoracentesis has traditionally been performed with anatomic landmarking, ultrasound guidance is increasingly used. The primary objective of this systematic review and meta-analysis is to determine the difference in success rates between ultrasound guidance versus anatomic landmark technique. Secondary outcomes include assessing the effects of ultrasound guidance on complication rates.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, LILACS, Web of Science Core Collection, Google Scholar, and the grey literature were searched for prospective randomized trials or cluster randomized trials comparing the success rate of ultrasound-guided to anatomic landmark thoracentesis in patients of all ages from inception to February 2024. Two investigators independently completed study screening, data extraction, and quality evaluations using the Cochrane Risk of Bias and GRADE tools. Outcomes were analyzed using random effects meta-analysis using generalized linear mixed effects models and corresponding 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Three papers met inclusion criteria (<em>n</em> = 417 patients). Overall, ultrasound-guided thoracentesis was successful in 195 of 202 patients (96.5 %), and anatomic landmark thoracentesis was successful in 189 of 215 patients (87.9 %). Ultrasound-guidance trended towards higher success rates (OR 3.99, 95 % CI 0.60–26.50) and lower complication rates (OR 0.18, 95 % CI 0.01–3.07). Only two of the three studies evaluated post-procedure pneumothorax: in sum, 1/99 of the ultrasound group versus 20/113 in the anatomic landmark group were complicated by pneumothorax.</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis of randomized trials found that ultrasound guidance for thoracentesis trended towards increased success and lower complication rates compared to anatomic landmark technique.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 159-164"},"PeriodicalIF":2.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722000","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":"Evaluation of atomized tranexamic acid (TXA) for pediatric epistaxis.","authors":"Kayla White, David Rodriguez, Kara Quaney","doi":"10.1016/j.ajem.2025.07.051","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.07.051","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762435","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":"Urgent need for reversal agents for xylazine and other imidazolines in illicit fentanyl","authors":"Michael E. Mullins MD ,&nbsp;Donna L. Seger MD","doi":"10.1016/j.ajem.2025.07.042","DOIUrl":"10.1016/j.ajem.2025.07.042","url":null,"abstract":"<div><div>The epidemic of illicit fentanyl use continues in the United States. Xylazine, a veterinary tranquilizer closely related to clonidine, is now a widespread adulterant in illicit fentanyl. More recently medetomidine (racemic version of dexmedetomidine) has appeared with increasing frequency in the fentanyl supply. Specific reversal agents for xylazine and medetomidine such as atipamezole and tolazoline have decades of approved use in animals and favorable experimental use in humans. However, an expert panel in 2024 opined that research into human use of alpha-adrenergic agonist was neither “necessary nor worthwhile”. We disagree. We outline the unmet need for reversal agents for xylazine and medetomidine, discuss their human evidence of effectiveness, and suggest the path forward as the fentanyl epidemic continues to evolve.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages 129-130"},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711882","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":"Posterior circulation infarction with sudden deafness as a clinical manifestation.","authors":"Chunxiang Chen, Lili Shan, Mingfeng He, Yan Han","doi":"10.1016/j.ajem.2025.07.047","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.07.047","url":null,"abstract":"<p><p>Hearing loss caused by stroke must be taken seriously, as it is a treatable condition that highly depends on timely intervention. This case report presents a rare case of a 75-year-old female with a history of hypertension who visited the Emergency Department of Otolaryngology due to sudden left-sided deafness accompanied by vertigo and vomiting, and magnetic resonance imaging (MRI) demonstrated acute posterior circulation cerebral infarction.In the Emergency Department setting, for middle-aged and elderly patients with vascular risk factors, hearing loss may serve as an early warning sign of vertebrobasilar artery ischemic stroke. Immediate stroke screening should always be prioritized, as acute antithrombotic and acute revascularization treatments may be necessary.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735552","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}