American Journal of Emergency Medicine最新文献

{"title":"Ultrasound accuracy in acute diverticulitis: A systematic review and Meta-analysis","authors":"Hamid Shokoohi MD, MPH ,&nbsp;Gary D. Peksa PharmD, MBA ,&nbsp;Ainsley Hutchison BS ,&nbsp;Nour Al Jalbout MD ,&nbsp;Kristofer Montoya MD ,&nbsp;Jennifer C. Westrick MSLIS, AHIP ,&nbsp;Andrew Goldsmith MD, MBA ,&nbsp;Peiman Nazerian MD ,&nbsp;Michael Gottlieb MD","doi":"10.1016/j.ajem.2025.03.002","DOIUrl":"10.1016/j.ajem.2025.03.002","url":null,"abstract":"<div><h3>Objectives</h3><div>The utility of ultrasound for diagnosing diverticulitis, especially in high-risk cases with complicated diverticulitis, remains debated. This study aimed to provide contemporary quantitative data synthesis of the diagnostic accuracy of ultrasound in patients with suspected diverticulitis.</div></div><div><h3>Methods</h3><div>Scopus, PubMed, Google Scholar, and CENTRAL were searched from January 1st,1990 to September 15th, 2023, for potentially relevant articles. Selected studies evaluated and reported estimates of diagnostic accuracy of ultrasound for the diagnosis of acute diverticulitis using CT as the gold standard. Subgroup analyses were conducted for simple versus complicated diverticulitis, and for point-of-care ultrasound (POCUS) versus radiology-performed ultrasound (RADUS). Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Diagnostic odds ratios, sensitivity, specificity, likelihood ratio, and area under the receiver operating characteristic curve with 95 % confidence intervals (CI) were reported.</div></div><div><h3>Results</h3><div>A total of 12 diagnostic studies (<em>n</em> = 2056 patients) were identified. Ultrasound showed a sensitivity of 92.5 % (95 % CI 86.9 %–95.8 %) and specificity of 87.7 % (95 % CI 75.7 %–94.2 %) for detecting acute diverticulitis. The positive likelihood ratio (LR+) was 8.28 (95 % CI 4.74–14.45) and negative likelihood ratio (LR-) was 0.08 (95 % CI 0.05–0.15). For complicated diverticulitis ultrasound had a sensitivity of 58.3 % (95 % CI 46.1 %–69.8 %) and specificity of 98.2 % (95 % CI 96.4–99.2). The LR+ was 31.86 (95 % CI 15.61–65.06) and LR- was −0.42 (95 % CI 0.32–0.56)). Subgroup analysis showed POCUS had 94.1 % (95 % CI 91.4 %–95.9 %) sensitivity and 89.8 % (95 % CI 77.6 %–95.7 %) specificity, while RADUS had 83.2 % (95 % CI 68.3 %–91.9 %) sensitivity and 88.7 % (95 % CI 76.1 %–95.1 %) specificity for detecting acute diverticulitis.</div></div><div><h3>Conclusions</h3><div>Ultrasound had high accuracy for diagnosing acute diverticulitis with greater sensitivity when performed by emergency physicians and surgeons at the bedside. For complicated diverticulitis, the overall sensitivity was lower, while the specificity was higher.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 96-103"},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619443","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":"Syncope among adolescents and young adults seeking treatment for cannabis-related injuries","authors":"Bart Hammig PH.D., MPH,&nbsp;Abigail Bordelon","doi":"10.1016/j.ajem.2025.03.003","DOIUrl":"10.1016/j.ajem.2025.03.003","url":null,"abstract":"<div><h3>Importance</h3><div>The legalization of cannabis for both recreational and medicinal purposes in numerous states across the United States has resulted in increased accessibility and usage rates. With Tetrahydrocannabinol (THC) potency in cannabis products on the rise, concerns regarding associated health implications, including syncope, have emerged.</div></div><div><h3>Objective</h3><div>This study aims to explore the prevalence and characteristics of cannabis-associated syncope among adolescents and young adults presenting to emergency departments (EDs).</div></div><div><h3>Design, setting and participants</h3><div>Utilizing data from the National Electronic Injury Surveillance System (NEISS) from 2019 to 2022, a cross sectional study was employed.</div><div>The sample consisted of adolescents and young adults aged 15–24 years presenting with cannabis-associated injuries, and also screened for syncope.</div></div><div><h3>Main outcomes and measures</h3><div>Cases of cannabis-associated injuries were identified, and those presenting with syncope were analyzed. Epidemiological analyses were conducted to estimate prevalence ratios (PR).</div></div><div><h3>Results</h3><div>Among the study sample of individuals aged 15–24, 24,922 presented with cannabis-associated injuries, with 5400 of those also screening positive for syncope. The majority of injuries treated were to the head and neck, with falls being the most prevalent mechanism of injury. Comparisons between syncopal and non-syncopal injuries revealed distinct clinical profiles, with approximately 21.7 % of cannabis-associated injuries accompanied by syncope. Moreover, the prevalence of syncope among cannabis users was found to be significantly elevated compared to non-cannabis users (PR = 8.6, 95 % CI 7.1–10.2).</div></div><div><h3>Conclusions and relevance</h3><div>Syncope is a prevalent condition among adolescents and young adults seeking treatment in emergency departments for cannabis-associated injuries. The clinical relevance of cannabis associated syncope as it pertains to cardiovascular anomalies needs further study. As cannabis legislation, usage patterns, and products continue to evolve, a well informed medical care community will be essential.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 109-113"},"PeriodicalIF":2.7,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628914","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":"Can the Alvarado score predict complicated acute appendicitis? A systematic review and meta-analysis.","authors":"Wenhan Wu, Shijian Zhang, Jia He","doi":"10.1016/j.ajem.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.015","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617893","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":"Development of SARS-CoV-2 vaccination and therapeutics: Population-level impact during the early pandemic.","authors":"Yui Okamura, Emerald O'Brien, Hiroshi Ito, Takumi Sato","doi":"10.1016/j.ajem.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.016","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671904","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":"Imaging trends and surgical outcomes for nephrolithiasis in the pediatric emergency department","authors":"Vidya R. Raghavan MD,&nbsp;John J. Porter MBA,&nbsp;Michael C. Monuteaux ScD,&nbsp;Mark I. Neuman MD, MPH,&nbsp;Kyle A. Nelson MD, MPH","doi":"10.1016/j.ajem.2025.03.014","DOIUrl":"10.1016/j.ajem.2025.03.014","url":null,"abstract":"<div><h3>Objectives</h3><div>There has been a marked rise in the incidence of pediatric nephrolithiasis over the past two decades. Although computed tomography (CT) is the gold standard for the diagnosis of nephrolithiasis, efforts to reduce minimize childhood exposure to ionizing radiation remain important. This study aims to assess current imaging trends and rates of surgical intervention for nephrolithiasis at the hospital level.</div></div><div><h3>Methods</h3><div>A multicenter, cross-sectional analysis was conducted using the Pediatric Health Information System, which included children treated in the emergency department (ED) and diagnosed with nephrolithiasis using ICD 9/10 codes from 2010 to 2021. The analysis involved a hospital-level examination where hospitals were grouped into quartiles based on their rates of CT use. Logistic regression was employed to evaluate the association between hospital-level CT utilization and rates of surgery, while accounting for demographic characteristics and treatments administered including opioids, intravenous fluids, and antibiotics.</div></div><div><h3>Results</h3><div>We analyzed 15,979 ED visits (median age 15 years, 59 % female) across 29 hospitals. There was significant variation in CT utilizations across hospitals (range 13–91 %). Surgery rates at the index visit ranged from 5.3 to 7.5 % and rates of surgery within 6 months ranged from 15.1 to 19.1 % across hospital CT quartiles. After adjusting for demographic characteristics and treatment administered, odds of surgery occurring during the index hospitalization or within 180 days did not differ based upon hospital-level CT utilization (p-trend = 0.19 and 0.26, respectively).</div></div><div><h3>Conclusions</h3><div>In this hospital-level study of imaging and surgical intervention for pediatric nephrolithiasis, we found no significant association between CT utilization and rates of surgery either during the index visit or within 180 days of the ED visit. These findings suggest there are opportunities to further reduce CT usage in children presenting with nephrolithiasis.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 104-108"},"PeriodicalIF":2.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619444","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":"No more kids jumping on the bed-emergency departments visits, 2013–2022","authors":"Colby E.N. Walton MD ,&nbsp;Richard W. Hussey MD ,&nbsp;Patrick T. Reeves MD","doi":"10.1016/j.ajem.2025.03.013","DOIUrl":"10.1016/j.ajem.2025.03.013","url":null,"abstract":"<div><div>Jumping on the bed has been long regarded as an unsafe practice in the home. Anecdotally, this pastime has been associated with injury for children, however there is a literature gap surrounding injuries sustained by jumping on beds. The United States consumer product injury database was queried for emergency department visits concerning bed-related injuries by children which included narrative data containing “jump.” Bed-related jump injuries were most common in younger males [61 %; median age 3.5 years] at home. Fourteen percent of injuries resulted in concussion. Three percent of all bed injuries resulted in an escalation of care. When comparing injury patterns of bunk beds to single beds, injuries from bunk beds were twice as likely to require escalation of care. Injury data from this study may be used to guide anticipatory guidance for parents.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 161-164"},"PeriodicalIF":2.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674882","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 effectiveness of supination-flexion and hyperpronation maneuvers in radial head subluxation: A systematic review and meta-analysis","authors":"Gökhan Aksel MD ,&nbsp;Şeref Kerem Çorbacıoğlu MD ,&nbsp;Haldun Akoğlu MD ,&nbsp;Mehmet Muzaffer İslam MD","doi":"10.1016/j.ajem.2025.03.011","DOIUrl":"10.1016/j.ajem.2025.03.011","url":null,"abstract":"<div><h3>Study objective</h3><div>Radial head subluxation (RHS) is a frequent upper extremity injury in preschool children. Although the supination-flexion method is traditionally used for reduction, the 2017 Cochrane Review systematic review has shown that the hyperpronation maneuver is more successful. Despite the Cochrane Review suggesting that hyperpronation could be the preferred first-line technique in clinical practice, the studies analyzed have been deemed to carry a high risk of bias due to various methodological issues. This systematic review and meta-analysis aimed to reevaluate the evidence by including both prior and recently published randomised controlled trials (RCTs) comparing the two techniques.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Web of Science databases were searched and reviewed from 1980 to 2024 using specific search criteria without any language restriction. This systematic review and meta-analysis focused on randomised controlled trials (RCTs) that compared supination/flexion techniques to hyperpronation techniques for reducing radial head subluxation in children aged 0 to 6 years. The risk of bias in all included studies was assessed using the Revised Cochrane Risk of Bias tool (ROB-2). The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.</div></div><div><h3>Results</h3><div>A total of 11 studies met the inclusion criteria, with ten assessed as high risk of bias and one as low risk. The pooled data demonstrated that hyperpronation had significantly lower first-attempt failure rates compared to supination-flexion (9.42 % vs. 25 %). Pain levels during the maneuvers were comparable, with slight advantages for hyperpronation noted in a few subjective assessments.</div></div><div><h3>Conclusion</h3><div>Despite the predominance of low-quality evidence, the findings suggest hyperpronation as the preferred technique for RHS reduction due to its higher success rates and simplicity.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 68-78"},"PeriodicalIF":2.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611509","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":"Lactate levels and the modified age-adjusted quick sequential organ failure assessment (qSOFA) score are fair predictors of mortality in critically ill pediatric patients","authors":"Ying Wang ,&nbsp;Qiaowei Wu ,&nbsp;Xi Zhu ,&nbsp;Xiaobo Wu ,&nbsp;Pengwei Zhu","doi":"10.1016/j.ajem.2025.03.010","DOIUrl":"10.1016/j.ajem.2025.03.010","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the predictive accuracy of baseline lactate levels and the modified age-adjusted quick Sequential Organ Failure Assessment (qSOFA) score in forecasting mortality in critically ill pediatric patients.</div></div><div><h3>Methods</h3><div>A retrospective single-center analysis was conducted on patients aged ≤18 years admitted to the intensive care unit (ICU) between January 1, 2019, and December 31, 2023. The predictive performance of lactate levels at baseline and that of the modified age-adjusted qSOFA score were compared in terms of mortality.</div></div><div><h3>Results</h3><div>Among 1156 patients (median age: 20.2 months; mortality rate: 6.2 %), non-survivors exhibited significantly higher baseline lactate levels (3.7 [2.4–4.9] vs. 2.1 [1.4–3.4] mmol/L, *p* &lt; 0.01) and modified age-adjusted qSOFA scores (3 (Bulgarelli et al., 2020; Filho et al., 2016a; Issa et al., 2021) vs. 1 [0–2], *p* &lt; 0.01) compared to survivors. The baseline lactate level exhibited a predictive value of 0.699(sensitivity: 59.7 %; specificity: 74.9 %). The modified age-adjusted qSOFA score showed greater predictive capability than baseline lactate levels in critically ill pediatric patients; nevertheless, it is constrained by limited specificity. The predictive value of baseline lactate level paired combined with the modified age-adjusted qSOFA score was similar to that of the modified age-adjusted qSOFA score alone. Specifically, when the area under the Receiver Operating Characteristic (ROC) curve reached 0.836, the specificity enhanced with the integration of these two indicators. However, lactate levels and the modified age-adjusted qSOFA score did not influence clinical decision-making in critically ill pediatric patients, as demonstrated by subgroup analysis according to different baseline lactate concentrations.</div></div><div><h3>Conclusion</h3><div>Baseline lactate and the modified age-adjusted qSOFA score had a low-accuracy ability to predict mortality in critically ill children. Although the combination of lactate and the modified age-adjusted qSOFA score appears to enhance predictive ability, it remains an insufficient predictor for making definitive clinical decisions in critically ill children.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 85-90"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611508","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":"Treatment of gastritis and gastroparesis symptoms with erector spinae plane block in the emergency department.","authors":"Richard J Gawel, Michael Gottlieb, Frances S Shofer, Michael Shalaby","doi":"10.1016/j.ajem.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.03.007","url":null,"abstract":"<p><p>Flares of gastritis and gastroparesis are commonly encountered in the emergency department (ED) and can often be distressing for patients. These conditions can be difficult to symptomatically manage with conventional therapies, including acid reducing medications, analgesics, and pro-motility agents. We describe two patients with acute gastritis and three patients with gastroparesis flares who reported considerable symptom improvement after a unilateral thoracic ultrasound-guided erector spinae plane block (ESPB). One gastritis patient was admitted to the hospital for endoscopy but did not require any opioids until she was sedated for the procedure, while the other gastritis patient reported complete symptom relief and elected to be discharged from the ED. All three patients with gastroparesis flares reported considerable improvement in their symptoms and were able to be discharged home rather than be admitted for continued symptom management. The ESPB may be an effective tool for emergency physicians to manage acute gastritis and gastroparesis flares in the ED.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588378","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":"Impact of phenobarbital when used in combination with benzodiazepines for the treatment of alcohol withdrawal syndrome: A retrospective analysis","authors":"Xian Jie Cindy Cheng PharmD ,&nbsp;Juri Chung PharmD ,&nbsp;Noah Yoo PharmD ,&nbsp;Meredith Akerman MS ,&nbsp;Michael Bender MD ,&nbsp;Kathryn Chan PharmD ,&nbsp;Erin Meier MD ,&nbsp;Mark Nunnally MD","doi":"10.1016/j.ajem.2025.03.008","DOIUrl":"10.1016/j.ajem.2025.03.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>Alcohol withdrawal syndrome (AWS) is a serious complication of alcohol use disorder. Although benzodiazepines are the mainstay of treatment, some patients may be resistant to them, requiring rapidly escalating doses. Phenobarbital has emerged as an effective adjunct therapy in severe alcohol withdrawal, but studies have yielded inconsistent results and carry safety risks. The purpose of our study was to examine the effectiveness and the potential harm of phenobarbital in AWS.</div></div><div><h3>Methods</h3><div>In this multi-center, retrospective cohort study, patients who were admitted for AWS and received phenobarbital with benzodiazepine were compared to patients who received benzodiazepine monotherapy. The primary outcome was time to AWS resolution. Other secondary and safety outcomes included length of stay (LOS), rate of mechanical ventilation, and incidence of aspiration pneumonia.</div></div><div><h3>Results</h3><div>The phenobarbital group received significantly higher doses of benzodiazepines compared to the benzodiazepine monotherapy group (660 mg vs 340 mg, <em>p</em> &lt; 0.0001). After adjustment, the use of phenobarbital was associated with significantly reduced time to AWS resolution (141.65 h vs 165.72 h, <em>p</em> &lt; 0.0001). However, the use of phenobarbital was associated with the likelihood of mechanical ventilation (19.42 %vs. 0.96 %, p &lt; 0.0001), aspiration pneumonia (22.33 % vs 5.77 %, <em>p</em> = 0.0006), and increased hospital LOS (8 days vs. 6 days, <em>p</em> = 0.0197). In the combination group, earlier phenobarbital initiation (within 24 h) was associated with significantly lower cumulative benzodiazepine dose (530 mg vs 887.50 mg, <em>p</em> = 0.002) and hospital LOS (6 days vs 10 days, <em>p</em> = 0.0017).</div></div><div><h3>Conclusion and relevance</h3><div>In our study, patients who received phenobarbital in combination with benzodiazepines had a quicker resolution of AWS but also had a higher incidence of mechanical ventilation, prolonged hospital LOS, and an increased risk of aspiration pneumonia. For patients at high risk of severe alcohol withdrawal, earlier initiation of phenobarbital appeared to yield the most optimal benefit.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"92 ","pages":"Pages 79-84"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600809","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}