American Journal of Cardiology最新文献

{"title":"Machine Learning-Based Algorithm to Predict Procedural Success in a Large European Cohort of Hybrid Chronic Total Occlusion Percutaneous Coronary Interventions","authors":"Alice Moroni MD ,&nbsp;Andrea Mascaretti PhD ,&nbsp;Jo Dens MD, PhD ,&nbsp;Paul Knaapen MD, PhD ,&nbsp;Alexander Nap MD, PhD ,&nbsp;Yvemarie B.O. Somsen MD ,&nbsp;Johan Bennett MD, PhD ,&nbsp;Claudiu Ungureanu MD ,&nbsp;Yoann Bataille MD ,&nbsp;Steven Haine MD, PhD ,&nbsp;Patrick Coussement MD ,&nbsp;Peter Kayaert MD, PhD ,&nbsp;Alexander Avran MD, PhD ,&nbsp;Jeroen Sonck MD, PhD ,&nbsp;Carlos Collet MD, PhD ,&nbsp;Stéphane Carlier MD, PhD ,&nbsp;Giovanni Vescovo MD ,&nbsp;Giacomo Avesani MD ,&nbsp;Mohaned Egred MD ,&nbsp;James C. Spratt MD, PhD ,&nbsp;Carlo Zivelonghi MD, PhD, MSc","doi":"10.1016/j.amjcard.2025.04.001","DOIUrl":"10.1016/j.amjcard.2025.04.001","url":null,"abstract":"<div><div>CTOs are frequently encountered in patients undergoing invasive coronary angiography. Even though technical progress in CTO-PCI and enhanced skills of dedicated operators have led to substantial procedural improvement, the success of the intervention is still lower than in non-CTO PCI. Moreover, the scores developed to appraise lesion complexity and predict procedural outcomes have shown suboptimal discriminatory performance when applied to unselected cohorts. Accordingly, we sought to develop a machine learning (ML)-based model integrating clinical and angiographic characteristics to predict procedural success of chronic total occlusion (CTO)-percutaneous coronary intervention(PCI). Different ML-models were trained on a European multicenter cohort of 8904 patients undergoing attempted CTO-PCI according to the hybrid algorithm (randomly divided into a training set [75%] and a test set [25%]). Sixteen clinical and 16 angiographic variables routinely assessed were used to inform the models; procedural volume of each center was also considered together with 3 angiographic complexity scores (namely, J-CTO, PROGRESS-CTO and RECHARGE scores). The area under the curve (AUC) of the receiver operating characteristic curve was employed, as metric score. The performance of the model was also compared with that of 3 existing complexity scores. The best selected ML-model (Light Gradient Boosting Machine [LightGBM]) for procedural success prediction showed an AUC of 0.82 and 0.73 in the training and test set, respectively. The accuracy of the ML-based model outperformed those of the conventional scores (J-CTO AUC 0.66, PROGRESS-CTO AUC 0.62, RECHARGE AUC 0.64, p-value &lt;0.01 for all the pairwise comparisons). In conclusion, the implementation of a ML-based model to predict procedural success in CTO-PCIs showed good prediction accuracy, thus potentially providing new elements for a tailored management. Prospective validation studies should be conducted in real-world settings, integrating ML-based model into operator decision-making processes in order to validate this new approach.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Pages 50-57"},"PeriodicalIF":2.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906229","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":"Distal Radial Artery Approach for Invasive Blood Pressure Monitoring in Intensive Cardiac Care Unit","authors":"Luca Cumitini MD ,&nbsp;Ailia Giubertoni MD ,&nbsp;Lidia Rossi MD ,&nbsp;Giuseppe Patti MD","doi":"10.1016/j.amjcard.2025.04.005","DOIUrl":"10.1016/j.amjcard.2025.04.005","url":null,"abstract":"<div><div>Distal radial artery (dRA) is a novel vascular access site in interventional cardiology. We evaluated the use of dRA as alternative approach to standard forearm radial artery (fRA) for invasive blood pressure monitoring in Intensive Cardiac Care Unit (ICCU). This is a single-center, randomized, noninferiority trial. Patients admitted in ICCU needing invasive blood pressure monitoring were randomly allocated to dRA or fRA access site (1:1 ratio). Primary endpoint was noninferiority of dRA in the final catheterization success rate. Secondary endpoints were: first attempt success rates; arterial catheterization time; catheterization-related quality of pain; incidence of complications. A total of 250 patients were enrolled (125 in each arm). Final success rate was 95.2% in the dRA group versus 96.8% in the fRA arm (p &lt;0.001 for noninferiority). First attempt success rates were 59.2% with dRA and 70.4% with fRA (p = 0.12). There was no difference in arterial catheterization time and catheterization-related quality of pain between the 2 arms. Entry-site complications were reduced with dRA (6.7% vs 17.4% in the fRA group; p = 0.013); this was mainly driven by decreased incidence of hematoma (0.8% vs 6.6%; p = 0.020). A numerically lower occurrence of arterial occlusion was observed with dRA (0.8% vs 4.9%; p = 0.06). In conclusion, in ICCU patients, the use of dRA to invasively monitor blood pressure is noninferior to fRA for catheterization success rates and may reduce entry-site bleeding.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Pages 16-22"},"PeriodicalIF":2.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891628","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":"Endovascular Treatment of Infrainguinal Peripheral Artery Disease With Stent Versus Nonstent Strategies in the XLPAD Registry","authors":"Subhash Banerjee MD ,&nbsp;David Fernandez Vazquez MD ,&nbsp;Yu-Lun Liu PhD ,&nbsp;Sameh Sayfo MD ,&nbsp;Minseob Jeong MD ,&nbsp;Zachary P. Rosol MD ,&nbsp;Anand Gupta MBBS, MPH ,&nbsp;Blake M. Bruneman BS ,&nbsp;Sarah G. Weideman BS ,&nbsp;Kennedy S. Adelman BS ,&nbsp;Shirling Tsai MD ,&nbsp;Shuaib Abdullah MD ,&nbsp;Hung B. Chu MD, RPVI ,&nbsp;Bertram L. Smith MD ,&nbsp;Bradley R. Grimsley MD ,&nbsp;Stephen E. Hohmann MD ,&nbsp;Javier Vasquez Jr MD ,&nbsp;Chris Metzger MD ,&nbsp;Christopher L. Henry MD ,&nbsp;Mujtaba M. Ali MD ,&nbsp;John F. Eidt MD","doi":"10.1016/j.amjcard.2025.04.002","DOIUrl":"10.1016/j.amjcard.2025.04.002","url":null,"abstract":"<div><div>Anatomic location of infrainguinal peripheral arteries has continually challenged endovascular revascularization strategies based on the use of stent vs. nonstent strategies. The objective of our study is to compare stent vs. nonstent outcomes of patients enrolled in the multicenter, core laboratory adjudicated XLPAD registry (NCT01904851) between 2005 and 2023. We analyzed 12-month cumulative incidence of major adverse cardiac and vascular events (MACVE), a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, lower limb revascularization and any amputation in patients treated with clinically indicated stent or nonstent interventions, analyzed within a competing risk framework; group differences assessed using the Gray’s test. To minimize confounding bias, we also implemented propensity score matching. About 5,067 patients (5,876 lesions), mean age 67.2 ± 10.3 years, underwent stent (<em>n</em> = 2,571) or nonstent (<em>n</em> = 2,496) predominantly femoropopliteal artery (68%) interventions. 42.8% were current smokers, 57.3% diabetic; 17% had chronic kidney disease and 56.5% coronary artery disease. 50.7% presented with Rutherford class (II-III) symptoms, with mean ankle-brachial index 0.64 ± 0.24. 61% lesions in stent group and 38.6% in the nonstent group had chronic total occlusions (p &lt;0.001). Significantly greater calcified (36.6% vs. 33%; p = 0.004) and longer lesions (142.9 ± 96.5 mm vs. 115.8 ± 91.3 mm; p &lt;0.001) were treated in the stented group. Drug-coated balloon and atherectomy use were 18% and 34.2%, respectively. Procedural success was higher in the stent group (96.9% vs. 89.5%; p &lt;0.001). Peri-procedural period flow-limiting dissections were higher in the stent (2.7% vs. 0.3%; p &lt;0.001), and any amputation in the nonstent (3.0% vs. 4.4%; p = 0.008). 12-month MACVE was higher in the stent group (22.2% vs. 19.2%, p = 0.009) mainly driven by greater need for repeat endovascular revascularization (13.1% vs. 10.4%, p = 0.003), and this was consistent even after adjusting for chronic limb threatening ischemia presentation (adjusted odds ratio [OR], 1.193; 95% confidence interval [CI], 1.039 to 1.370; p = 0.013). The stented group had 29.6% increased odds of MACVE compared to nonstent (adjusted OR, 1.296, 95% CI: 1.115 to 1.506, p = 0.001), even after adjusting for residual confounders with propensity matching. Stent-based interventions are used to treat more complex infrainguinal PAD, with greater procedural success, but higher 12-month MACVE compared with nonstent interventions.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Pages 58-66"},"PeriodicalIF":2.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906098","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":"Key Concepts in Cardiovascular Secondary Prevention: A Case-Based Review","authors":"Shruti Revankar MD ,&nbsp;Nezar Shakra BS ,&nbsp;John Michael DiMaio MD ,&nbsp;Anandita Agarwala MD","doi":"10.1016/j.amjcard.2025.03.035","DOIUrl":"10.1016/j.amjcard.2025.03.035","url":null,"abstract":"<div><div>Atherosclerotic cardiovascular disease (ASCVD) continues to be a growing global health concern with ischemic heart disease and stroke as leading causes of years of life lost. While aging is a major ASCVD risk factor, recent trends show a concerning rise in its incidence among younger adults driven, in part, by increased rates of risk factors such as hypertension and diabetes. These individuals with ASCVD are at elevated risk of recurrence years following their initial event, further underscoring the need for aggressive implementation of secondary prevention strategies to reduce morbidity and mortality. This case-based review discusses evidence-based pharmacological approaches to ASCVD secondary prevention—focusing on the roles of antiplatelets, lipid lowering therapies, antihypertensive medications, and glucose lowering treatments, in practical clinical settings.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Pages 32-40"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794419","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 Outcomes of Physiological Ventricular Rhythm Resetting With AV Node Ablation and Left Bundle Branch Pacing in Patients With AF-Induced Cardiomyopathy: A Prospective Cohort Study","authors":"Wen Yang MD,&nbsp;Zhixin Jiang MD,&nbsp;Shengchan Wang MD,&nbsp;Chun Chen MD,&nbsp;Xiujuan Zhou MD,&nbsp;Qijun Shan MD, PHD","doi":"10.1016/j.amjcard.2025.03.044","DOIUrl":"10.1016/j.amjcard.2025.03.044","url":null,"abstract":"<div><div>The mechanism of AF-induced cardiomyopathy (AF-CM) is still unclear. Expect for heart rate, atrial contraction lost and ventricular rhythm irregularity are believed as possible contributors to AF-CM. This study aimed to investigate ventricular rhythm irregularity effects on AF-CM. The AF-CM patients underwent the physiological ventricular rhythm resetting (PVRR) with atrioventricular node ablation combined with left bundle branch pacing or pharmacological therapy. To avoid heart rate effects, the heart rate (HR) setting according to preoperative Holter averages heart rate for each patient in the PVRR group. The primary endpoint was the echocardiographic response rate, defined as an absolute increase of left ventricular ejection fraction (LVEF) &gt; 5%. Secondary endpoints included heart failure (HF) rehospitalization and worsening HF. Finally, 71 patients (mean age 65 ± 11 years, 36 PVRR and 35 no-PVRR group) were enrolled this study. Compared with no-PVRR group, the PVRR without changed pre-and postprocedure HR significantly enhance echocardiographic response rate (86.1% vs 31.4%, p &lt;0.001), improve LVEF (12.0% ± 6.6% vs 4.0% ± 8.1%, p &lt;0.001), and shorten left ventricular end-diastolic diameter, and left ventricular end-systolic diameter (−4.6 ± 4.1 mm vs −1.7 ± 5.5 mm, p &lt;0.05; −6.8 ± 3.8 mm vs −2.4 ± 6.3 mm, p &lt;0.01, respectively) in 13.1 ± 6.6 months follow-up. Furthermore, HF rehospitalization and worsening HF rates were significantly lower in the PVRR group (5.6% vs 31.4%, p &lt;0.01). In conclusion, the ventricular rhythm irregularity is an important reversible contributor for AF-CM. The PVRR significantly enhances cardiac function, lowers HF rehospitalization and worsening HF rates. The PVRR could become a promising therapeutic strategy for AF-CM patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Pages 42-49"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794421","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 Unanswered Questions in Hemolysis Following SAPIEN 3 Ultra RESILIA Valve Implantation","authors":"Ashfaq Ahmad ,&nbsp;Ayesha Ahmad ,&nbsp;Javed Iqbal ,&nbsp;Arej iltaf ,&nbsp;Ayesha Parvaiz Malik","doi":"10.1016/j.amjcard.2025.03.040","DOIUrl":"10.1016/j.amjcard.2025.03.040","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"247 ","pages":"Pages 55-56"},"PeriodicalIF":2.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787522","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":"Large Bore Sheath Technology and Hemostasis Efficacy After Transfemoral Transcatheter Aortic Valve Implantation","authors":"Fortunato Iacovelli MD, PhD ,&nbsp;Alessandro Cafaro MD ,&nbsp;Antonio Pignatelli MD ,&nbsp;Osvaldo Burattini MD ,&nbsp;Francesco Spione MD ,&nbsp;Luigi Salemme MD ,&nbsp;Angelo Cioppa MD ,&nbsp;Armando Pucciarelli MD ,&nbsp;Grigore Popusoi MD ,&nbsp;Eugenio Stabile MD, PhD ,&nbsp;Tullio Tesorio MD","doi":"10.1016/j.amjcard.2025.03.045","DOIUrl":"10.1016/j.amjcard.2025.03.045","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"247 ","pages":"Pages 41-43"},"PeriodicalIF":2.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787523","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":"Rural/Urban Disparities in Cardiovascular Disease in the US—What Can be Done to Improve Outcomes for Rural Americans?","authors":"Jacob B. Pierce MD, MPH ,&nbsp;Spencer M. Ng MD ,&nbsp;Joy A. Stouffer MD ,&nbsp;Clark A. Williamson MD, MPH ,&nbsp;George A. Stouffer MD","doi":"10.1016/j.amjcard.2025.03.033","DOIUrl":"10.1016/j.amjcard.2025.03.033","url":null,"abstract":"<div><div>For the last forty years in the United States, there has been a progressively widening disparity in cardiovascular disease (CVD) morbidity and mortality between rural and urban areas known as the “rural mortality penalty.” Drivers of rural-urban disparities in CVD are multifactorial, including differences in demographics, education, economic opportunity, access to care, and healthcare quality. Because of the complex and heterogenous nature of rural areas in the United States, definitions of rural vary significantly, leading to challenges in quantifying disparities and targeting interventions. Potential solutions to increase access to cardiovascular care in rural areas include initiatives to expand the primary care and cardiology workforces, build partnerships between rural healthcare providers and academic medical centers (AMC), establish more outreach clinics in underserved or poorly resourced rural communities, develop rural provider training programs, expand and improve telemedicine offerings, develop community wide CVD prevention programs, expand health insurance coverage in rural areas, continue government support of rural hospitals and address social determinants of health as rural populations often face higher rates of poverty, food insecurity, unemployment, housing instability, and limited access to education, all of which exacerbate health disparities.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Pages 10-15"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787525","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":"Comments: Impact of Prereperfusion Left Ventricle Unloading on ST-Segment Elevation Myocardial Infarction According to the Onset-to-Unloading Time","authors":"Jayadevan Sreedharan PhD,&nbsp;Anshul Yadav MBBS,&nbsp;Neelesh Gupta MD,&nbsp;Rajeev Gupta DM","doi":"10.1016/j.amjcard.2025.03.030","DOIUrl":"10.1016/j.amjcard.2025.03.030","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Page 41"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778757","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":"Prognostic Value of Resting Heart Rate and Heart Rate Variability in the 12-lead Electrocardiogram: Mortality Data from the CODE Database","authors":"Diego N. Moraes MD, MSc ,&nbsp;Bruno R. Nascimento MD, MSc, PhD, FACC, FESC ,&nbsp;Magda C. Pires BSc, PhD ,&nbsp;Gabriela Miana de M. Paixão MD, MSc, PhD ,&nbsp;Peter W. MacFarlane DSc ,&nbsp;Antonio Luiz P. Ribeiro MD, PhD","doi":"10.1016/j.amjcard.2025.03.038","DOIUrl":"10.1016/j.amjcard.2025.03.038","url":null,"abstract":"<div><div>Resting heart rate (HR) and heart rate variability (HRV) reflect cardiovascular autonomic control and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a tele-ECG cohort network. We assessed unique 12-lead ECGs recorded from patients ≥16 years, from a tele-ECG database in Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Four Cox models were adjusted to evaluate the association between HR and HRV and the outcomes of interest (all-cause and cardiovascular mortality, assessed by ICD codes from death certificates): model (1) Unadjusted; (2) Adjusted for sex and age; (3) Model 2 + risk factors and clinical comorbidities; (4) Model 3 + adjustment for HRV or HR, respectively. At total 992,611 individuals were included, median age of 55 years. In 6 years, there were 33,292 (3.37%) deaths, 21% due to cardiovascular causes. After adjustments (model 4), all HR quartiles were independently associated with a progressively increased risk of all-cause mortality, being 88% higher for the fourth quartile (HR = 1.88, 95% CI 1.77 to 1.89). Similarly, the first and second HRV quartiles remained associated with increased all-cause mortality (first quartile [HR] = 1.42, 95% CI 1.37 to 1.47) in the final model. HR (fourth quartile: [HR] = 1.77, 95% CI 1.65 to 1.91) and HRV (first quartile: [HR] = 1.33, 95% CI 1.23 to 1.44) were also independent predictors (model 4) of cardiovascular mortality. In conclusion, in a large cohort of Brazilian adults, baseline HR and HRV were independent predictors of all-cause and cardiovascular mortality, even when adjusted for each other.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"248 ","pages":"Pages 23-31"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778761","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}