Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

{"title":"Assessment of residual gastric volume by ultrasound prior to upper endoscopy: a prospective cohort study.","authors":"Emanuella F A Pinto, Mariana L S Bastos, Cassiana G Prates, Guilherme B Sander, Daniela B Bumaguin, Airton Bagatini","doi":"10.1007/s12630-024-02885-0","DOIUrl":"10.1007/s12630-024-02885-0","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary aspiration is an adverse event with high morbidity and mortality. Despite fasting for > 8 hr, some patients still have residual gastric volume and are thus at risk of aspiration. We aimed to determine the accuracy of gastric ultrasound in assessing residual gastric content in patients undergoing upper gastrointestinal endoscopy.</p><p><strong>Methods: </strong>In a prospective cohort study, we performed gastric ultrasound immediately before upper gastrointestinal endoscopy in a sample of 294 patients. We categorized the ultrasound results as high risk of aspiration when the fluid volume was > 1.5 mL·kg^-1 or when there was thick/solid content. We applied Spearman's test to determine the correlation between aspirated volume and ultrasound-estimated volume using three mathematical models. We assessed the method's accuracy by calculating its sensitivity and specificity.</p><p><strong>Results: </strong>We included 282 patients in the analysis. The incidence of residual gastric contents was 5%. There were no aspiration events. Prokinetic use (relative risk [RR], 7.5; 95% confidence interval [CI], 1.9 to 29.1; P < 0.01), previous stroke (RR, 4.0; 95% CI, 1.2 to 13.6; P = 0.02), and male sex (RR, 3.3; 95% CI, 1.2 to 9.4; P = 0.02) were significantly more frequent among those with residual gastric content. The ultrasonography's specificity and sensitivity to predict gastric content at risk of aspiration were 100% and 77%, respectively, with a positive predictive value of 100% and a negative predictive value of 99%.</p><p><strong>Conclusion: </strong>Ultrasonography was an effective way to assess residual gastric content, which can help improve patient safety.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"233-241"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840370","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":"Exploration of the optimal programmed intermittent epidural bolus volume with the dural puncture epidural technique for labour analgesia: a biased-coin up-and-down sequential allocation study.","authors":"Yujie Song, Yingcai Song, Zhihao Sheng, Qingsong Zhao, Wei Liu, Yujie Li, Yu Zang, Zhendong Xu, Zhiqiang Liu","doi":"10.1007/s12630-024-02855-6","DOIUrl":"10.1007/s12630-024-02855-6","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the optimal programmed intermittent epidural bolus (PIEB) volume for providing effective analgesia in 90% of patients (EV₉₀) during the first stage of labour using the dural puncture epidural (DPE) technique to initiate labour analgesia.</p><p><strong>Methods: </strong>We conducted a biased-coin up-and-down sequential allocation study. We included 40 nulliparous women requiring epidural labour analgesia. We used a 25G Whitacre spinal needle to puncture the dural mater and then administered a loading dose of 12 mL of ropivacaine 0.1% and sufentanil 0.3 μg·mL^-1. Subsequently, the PIEB pump delivered boluses with an identical solution at a fixed 40-min interval, starting 1 hr after epidural initiation. The bolus volume for the first patient was 7 mL and was adjusted for subsequent patients according to the study protocol (bolus volume, 7-12 mL). The primary endpoint was effective analgesia, indicated by no need for patient-controlled or manual boluses within 6 hr after analgesia initiation or until complete cervical dilation, whichever came first. Outcome evaluators assessed the patients' pain ratings, Bromage scores, sensory blockade level, and maternal blood pressure hourly.</p><p><strong>Results: </strong>Using the truncated Dixon and Mood method, the estimated EV₉₀ was 9.2 mL (95% confidence interval [CI], 8.5 to 9.9) whereas the isotonic regression method yielded a value of 8.8 mL (95% CI, 8.6 to 9.8). None of the patients experienced a motor block. Two patients experienced hypotension without the need for vasopressors.</p><p><strong>Conclusions: </strong>The estimated PIEB EV₉₀ for ropivacaine 0.1% and sufentanil 0.3 μg·mL^-1 approached 9 mL when DPE was combined with a fixed 40-min interval.</p><p><strong>Study registration: </strong>ChiCTR.org.cn ( ChiCTR2300067281 ); first submitted 3 January 2023.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"254-261"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481872","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 clinical comparison of the effects of six disposable cardiopulmonary bypass circuits on bleeding and coagulation: a quality assurance project.","authors":"Sunpreet Takhar, Selene Martinez-Perez, Brian Beairsto, Raphael Derman, Cyril Serrick, Margarita Otalora-Esteban, Cielo Bingley, Stuart A McCluskey, Keyvan Karkouti, Justyna Bartoszko","doi":"10.1007/s12630-024-02903-1","DOIUrl":"10.1007/s12630-024-02903-1","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiac surgery requiring cardiopulmonary bypass (CPB) is frequently complicated by excessive bleeding because of coagulopathy. Contact of blood with the CPB circuit is a major contributor. While several Health Canada-approved disposable circuits are available for purchase, there is no existing direct comparative data. Our objective was to conduct a quality assurance project to provide clinical data on the bleeding and coagulation effects of six disposable CPB circuits in a cohort of cardiac surgery patients.</p><p><strong>Methods: </strong>We compared the effects of six different circuits on bleeding and coagulation in 872 consecutive patients who underwent various types of cardiac surgery over 12 months at Toronto General Hospital (Toronto, ON, Canada). Generalized estimating equations accounting for clustering by surgeon were used to assess the impact of each circuit group on the following: 1) at least moderate bleeding as defined by the Universal Definition of Perioperative Bleeding Score after separation from bypass through the first postoperative day; 2) total allogeneic blood product transfusion within seven days of surgery; and 3) hemostatic therapy administration within seven days of surgery. Changes in coagulation tests before and after bypass were recorded.</p><p><strong>Results: </strong>We included 872 patients. There were no major differences between the six types of circuit in prebypass compared with postbypass coagulation tests. Nevertheless, when accounting for surgeon, patient, and procedural characteristics, significant differences between circuit types emerged for all primary and secondary outcomes.</p><p><strong>Conclusion: </strong>The findings of this quality assurance project suggest that current Health Canada-approved CPB circuits may have differential effects on coagulation and bleeding. This should be further verified in randomized controlled trials.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"319-333"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451031","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":"Effect of total intravenous anesthesia versus sevoflurane anesthesia on intraoperative facial nerve monitoring: a randomized controlled trial.","authors":"Yu Jeong Bang, Sang Hyun Lee, Yeon Woo Jeong, Ji Won Choi, Hyun Joo Ahn, Boram Park, Jin Kyoung Kim","doi":"10.1007/s12630-024-02864-5","DOIUrl":"10.1007/s12630-024-02864-5","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative facial nerve monitoring (IFNM) facilitates effective nerve preservation during ear and head and neck surgeries. Quantitative differences in the timely feasibility of IFNM during total intravenous anesthesia (TIVA) vs sevoflurane anesthesia have not been investigated.</p><p><strong>Methods: </strong>We conducted a randomized controlled trial in which 98 patients undergoing ear surgery were allocated to either the TIVA or sevoflurane group. We used quantitative neuromuscular monitoring of train-of-four (TOF) responses to assess achievements of IFNM-feasible conditions, and recorded the TOF count (TOFC) or TOF ratio of T4/T1 (TOFR). The primary outcome was the time interval between a TOFR of 0.25 and 0.75 (recovery index). The most important secondary outcome was the time to reach a TOFR of 0.25. We also recorded the quality of IFNM, intubation condition, patient-ventilator dyssynchrony, surgeon's satisfaction, and postoperative analgesic and antiemetic requirements.</p><p><strong>Results: </strong>Ninety-two patients completed the study. The median [interquartile range] recovery index was significantly shorter in the TIVA group (9 [7-11] min) than in the sevoflurane group (34 [24-53] min), with a difference in medians of 25 min (95% confidence interval, 20 to 31; P < 0.001). Before IFNM requests, the time to TOFR of 0.25 was achieved earlier in the TIVA group (34 [29-41] min) than in the sevoflurane group (51 [43-77] min) (P < 0.001). Both groups achieved neuromuscular recovery in time for IFNM without a need for reversal agents.</p><p><strong>Conclusions: </strong>Intraoperative facial nerve monitoring was feasible earlier and faster under TIVA than under sevoflurane anesthesia. We suggest that TIVA may be a preferable choice over sevoflurane to meet a surgeon's request for an earlier IFNM.</p><p><strong>Study registration: </strong>CRIS.nih.go.kr ( KCT0006676 ); first submitted 7 October 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"262-272"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741654","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 a patient-oriented transfer tool for transition from the intensive care unit to the ward: a mixed methods study.","authors":"Jariya Sereeyotin, Hayley Robinson, Michael E Detsky, Christine Soong, Erin Kennedy, Catherine Eta-Ndu, Lisa Burry, Sumesh Shah, Sangeeta Mehta","doi":"10.1007/s12630-024-02890-3","DOIUrl":"10.1007/s12630-024-02890-3","url":null,"abstract":"<p><strong>Purpose: </strong>The use of patient/family-centred written summaries to supplement verbal information may be useful to improve knowledge and reduce anxiety related to patient transfer from the intensive care unit (ICU) to a hospital ward. We aimed to identify essential elements to include in an ICU-specific patient-oriented discharge summary tool (PODS-ICU).</p><p><strong>Methods: </strong>We conducted a mixed methods study. Participants were ICU patients who were transitioning to a hospital ward and clinicians. We used a validated questionnaire to measure the relocation stress of patients, and standardized questions to qualitatively explore patients' needs during the transition, as well as perspectives of clinician stakeholders. Inductive thematic analysis was used for the qualitative analysis.</p><p><strong>Results: </strong>We recruited 22 participants, including ten patients and 12 clinician stakeholders. Of ten patients, 50-100% reported positive experiences during the transition and 10-30% reported negative experiences. From all participants' perspectives, we identified the following essential elements for the PODS-ICU: the reason for transition, a summary of the ICU course, a clinical update, destination ward details, medication reconciliation, a future care plan, and the planned follow-up by the ICU outreach team. Family presence and earlier notification of an upcoming transfer were identified as support needs to help patients prepare mentally and reduce transfer anxiety. Moreover, using positive communication with patients when providing transfer details and using the brief standardized transfer tool were recommended to improve transition care.</p><p><strong>Conclusions: </strong>We identified informational gaps in patient and family knowledge at the time of transfer from the ICU to a ward, which informed essential elements for the PODS-ICU. The PODS-ICU may reduce transfer anxiety and improve care during the transition from the ICU.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"334-344"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928796","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":"The association of right ventricular function with outcomes after cardiac surgery: a systematic review.","authors":"Neeki Alavi, Wilton Van Klei, Kwame Agyei, Amir Zabida, Mosana Abraha, Marcus Salvatori, Azad Mashari, Justyna Bartoszko","doi":"10.1007/s12630-024-02898-9","DOIUrl":"10.1007/s12630-024-02898-9","url":null,"abstract":"<p><strong>Purpose: </strong>Assessment of right ventricular (RV) function is recommended as part of a comprehensive echocardiography exam, including before and after cardiac surgery. Nevertheless, the prognostic implications of various measures of RV function in patients undergoing cardiac surgery are not well characterized. Our goal was to conduct a focused systematic review to assess the association of quantitative parameters of RV function with postoperative outcomes in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>We conducted a systematic review of randomized controlled trials or observational studies in adult (≥ 18 yr) patients undergoing cardiac surgery with a reported echocardiogram within six months of surgery, intraoperatively, or shortly after surgery. We excluded case reports and case series. Databases included PubMed® and MEDLINE, and papers published from 1 January 1990 to 22 April 2024 were searched for. The primary predictors of interest were quantitative RV function parameters. The primary outcome of interest was postoperative mortality up to five years. The secondary outcome was all major adverse cardiac events (MACE).</p><p><strong>Results: </strong>We identified 7,187 potentially relevant studies, 27 of which were included; all of these were observational studies. Right ventricular fractional area change (RVFAC) was the most commonly reported parameter, but was inconsistently associated with mortality and MACE. Tricuspid annular plane systolic excursion (TAPSE) and strain were consistently associated with mortality. The most consistent predictor of MACE was RV myocardial performance index (MPI) across studies.</p><p><strong>Conclusion: </strong>Pre- and perioperative assessment of RV function using at least two quantitative echocardiographic parameters may offer prognostic information in patients undergoing cardiac surgery. Right ventricular FAC, TAPSE, strain, and RV MPI have been frequently studied; however, further research is needed to delineate the role of echocardiographic RV quantification for perioperative prognostication.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42023387383 ); first submitted 23 December 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"285-318"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411054","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":"Addressing ageism in anesthesiology: valuing older physicians and enhancing their sense of belonging.","authors":"Julie K Silver","doi":"10.1007/s12630-024-02851-w","DOIUrl":"10.1007/s12630-024-02851-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"219-225"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360697","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":"Transcutaneous carbon dioxide monitoring in children undergoing rigid bronchoscopy: a prospective blinded observational study.","authors":"Martina Bordini, Julia M Olsen, Jennifer M Siu, Jason Macartney, Nikolaus E Wolter, Evan J Propst, Clyde T Matava","doi":"10.1007/s12630-024-02862-7","DOIUrl":"10.1007/s12630-024-02862-7","url":null,"abstract":"<p><strong>Purpose: </strong>Anesthetic management during rigid bronchoscopy in children can be challenging, and continuous end-tidal carbon dioxide (EtCO₂) monitoring is often unachievable. Transcutaneous carbon dioxide (TcCO₂) monitoring is strongly correlated with the partial pressure of carbon dioxide (PaCO₂) and EtCO₂. We aimed to investigate the incidence of hypercapnia in children undergoing rigid bronchoscopy.</p><p><strong>Methods: </strong>We enrolled patients aged < 18 yr scheduled for rigid bronchoscopy in a prospective observational study. We recorded TcCO₂ values from anesthesia induction to the postanesthesia care unit (PACU) stay. We ended monitoring when TcCO₂ reached values ≤ 50 mm Hg. The operating room (OR) team was blinded to the TcCO₂. The outcome of primary interest was the incidence of hypercapnia (TcCO₂ > 50 mm Hg) in the OR. Other outcomes were the incidences of hypercapnia in the PACU and severe hypercapnia (TcCO₂ > 90 mm Hg), factors possibly related to hypercapnia (patient, surgery, or anesthesia factors), and the incidence of perioperative adverse events.</p><p><strong>Results: </strong>A total of 30 patients were enrolled. The median [interquartile range (IQR)] age was 3.5 [1.5-8.0] yr. The incidence of hypercapnia was 100% in the OR and 60% in the PACU. Five cases (17%) presented with severe hypercapnia in the OR. The highest median [IQR] TcCO₂ was 69 [61-79] mm Hg. The most common adverse event was oxygen desaturation (57%, 17/30). Patients with severe hypercapnia had long stays in the PACU.</p><p><strong>Conclusion: </strong>Hypercapnia was a frequent event in children undergoing rigid bronchoscopy and severe hypercapnia was associated with a long PACU stay. Further studies are needed to assess the utility of TcCO₂ monitoring in guiding ventilatory interventions during these cases.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"273-284"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481875","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":"Simulation-based ultrasound-guided regional anesthesia education: a national survey of Canadian anesthesiology residency training programs.","authors":"Pooyan Sekhavati, Reva Ramlogan, Jonathan G Bailey, Jason W Busse, Sylvain Boet, Yuqi Gu","doi":"10.1007/s12630-024-02818-x","DOIUrl":"10.1007/s12630-024-02818-x","url":null,"abstract":"<p><strong>Purpose: </strong>Simulation-based education in ultrasound-guided regional anesthesia (UGRA) improves knowledge, skills, and patient outcomes. Nevertheless, it is not known how simulation-based UGRA education is used across Canada. We aimed to characterize the current use of simulation-based UGRA education in Canadian anesthesiology residency training programs.</p><p><strong>Methods: </strong>We developed and distributed a structured national survey to simulation leads of all 17 Canadian anesthesiology residency training programs. The survey inquired about program demographics, simulation modalities, facilitators and barriers to simulation use, use for assessment, and beliefs around simulation-based UGRA education. We gathered data from August to November 2023 and summarized our findings descriptively.</p><p><strong>Results: </strong>Fifteen programs (88%) responded to our survey. Eight programs (53%) used UGRA simulation for technical training and nine programs (60%) for nontechnical training. The most common simulators used were live model scanning (13 programs, 87%) and gel phantom models (7 programs, 47%). Five programs (33%) mandated simulation-based UGRA in their curriculum. We found that deliberate practice and improved patient safety were most valued in simulation training while lack of funding and faculty availability were the most common barriers to implementation. Most respondents agreed that formative simulation-based education would improve trainee skills and called for greater standardization. Nevertheless, there were mixed responses regarding summative UGRA simulation and the need for simulation proficiency before clinical practice.</p><p><strong>Conclusions: </strong>Our findings show significant variations in simulation implementation and views on UGRA simulation-based education among Canadian anesthesiology residency training programs. Future studies should explore avenues to overcome barriers and improve knowledge translation in UGRA.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"173-180"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899022","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":"Intraoperative diaphragmatic stimulation by a cardiac resynchronization therapy defibrillator presenting as hiccups.","authors":"Hüseyin Aybar","doi":"10.1007/s12630-024-02880-5","DOIUrl":"10.1007/s12630-024-02880-5","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"211-213"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820235","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}