Annals of Intensive Care最新文献

{"title":"Utility of fibrinolysis enhanced viscoelastic assays to evaluate fibrinolysis disorders in critically ill adults with severe infection: a scoping review.","authors":"Matthew Self, Lucy A Coupland, Anders Aneman","doi":"10.1186/s13613-025-01528-x","DOIUrl":"10.1186/s13613-025-01528-x","url":null,"abstract":"<p><strong>Background: </strong>Acutely infected critically ill patients develop coagulopathies and perturbations to the fibrinolysis system that manifest as immunothrombosis. Whole blood viscoelastic testing, using an exogenous fibrinolytic agent to enhance fibrinolysis (FE-VET) can assess both processes of coagulation and fibrinolysis at the bedside. This scoping review aimed to illustrate clinical applicability, knowledge gaps and unmet needs for this emerging technology.</p><p><strong>Methods: </strong>A systematic search of bibliographic databases and the grey literature was performed between the 10th October 2024 and the 14th January 2025 using a pre-published protocol and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline for scoping reviews (PRISMA-ScR). Studies reporting FE-VET to investigate fibrinolysis in acutely infected patients admitted to the intensive care unit were assessed, including associations with disease severity and clinical outcomes.</p><p><strong>Results: </strong>The search identified 297 studies with 24 included in this review. Fifteen studies were observational (12 prospective, 3 retrospective), 4 case reports and series, 2 validation studies, 2 letters, and 1 poster abstract. No randomised controlled trials were identified. Most studies used varying concentrations of tissue plasminogen activator (tPA) to enhance fibrinolysis, with FE-VET performed at a single time point and the lysis time to achieve 50% reduction of maximum clot firmness being the most frequently reported variable. Fibrinolysis resistance was the prevailing state reported in acute sepsis or COVID-19 infections and associated with increased disease severity and worse clinical outcomes.</p><p><strong>Conclusion: </strong>Viscoelastic testing using a fibrinolysis enhancing agent demonstrated a spectrum of fibrinolysis resistance in acutely infected critically ill patients, associated with increased disease severity and mortality. Standardisation of the concentrations of fibrinolysis enhancing agents and the reporting of clot lysis parameters across testing devices are needed to establish reference values. This would improve future clinical studies of fibrinolysis, including trials of fibrinolytic therapies using a personalised medicine approach.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"110"},"PeriodicalIF":5.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolomic stratification of shock: pathophysiological insights for personalized critical care.","authors":"Frederic Sangla, Karim Bendjelid, Federico Aletti, Vicente Ribas, Antoine Herpain, Bernardo Bollen Pinto, David Legouis","doi":"10.1186/s13613-025-01532-1","DOIUrl":"10.1186/s13613-025-01532-1","url":null,"abstract":"<p><strong>Background: </strong>Shock, encompassing septic and cardiogenic etiologies, is a life-threatening condition associated with systemic inflammation, metabolic dysregulation, and high mortality in intensive care units. Traditional clinical markers often fail to capture the complexity of this syndrome, limiting personalized therapeutic approaches. Advances in metabolomics enable comprehensive analysis of metabolic disruptions, providing novel insights into shock pathophysiology. This study aimed to cluster critically ill patients with shock into metabolic phenotypes and investigate their associations with clinical severity.</p><p><strong>Results: </strong>We analyzed metabolomic profiles from 60 critically ill patients with shock at ICU admission using Uniform Manifold Approximation and Projection (UMAP) for dimensionality reduction and Density-Based Spatial Clustering of Applications with Noise (DBSCAN) for clustering. Three distinct clusters were identified: Cluster 1 (n = 13) exhibited the highest severity (median APACHE II: 29) and mortality (54%), with elevated biogenic amines, sugars, and sphingolipids, reflecting intense metabolic activation. Cluster 2 (n = 24), despite having low initial severity (median APACHE II: 25), demonstrated high mortality (38%) and was characterized by elevated glycerophospholipids and sphingolipids as in cluster 1, without enhanced biogenic amines and sugars, indicating inadaptive metabolic responses. Cluster 3 (n = 23) showed the lowest severity (median APACHE II: 22) and mortality (9%), with uniformly reduced metabolite levels, suggesting an adaptive metabolic profile.</p><p><strong>Conclusions: </strong>Shock patients exhibit distinct metabolic phenotypes associated with clinical severity and outcomes. Metabolomic profiling offers a promising avenue for precision medicine in critical care by uncovering pathophysiological insights. Future research should validate these findings, identify practical biomarkers, and explore therapeutic interventions tailored to specific metabolic profiles.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"109"},"PeriodicalIF":5.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining thresholds and timing in V/Q matching assessment during prone positioning in ARDS.","authors":"Nan Xiong, Yinde Huang","doi":"10.1186/s13613-025-01530-3","DOIUrl":"10.1186/s13613-025-01530-3","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"108"},"PeriodicalIF":5.5,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12297046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding the new vascular reactivity index to norepinephrine.","authors":"Enrique Monares-Zepeda, Christopher Barrera-Hoffmann","doi":"10.1186/s13613-025-01519-y","DOIUrl":"10.1186/s13613-025-01519-y","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"107"},"PeriodicalIF":5.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness, knowledge and practices related to intra-abdominal hypertension and abdominal compartment syndrome among intensive care providers: a systematic scoping review.","authors":"ZhiRu Li, FangYan Lu, JingYun Wu, YanHong Dai, Yan Wang, Li Zheng, HuaFen Wang","doi":"10.1186/s13613-025-01521-4","DOIUrl":"10.1186/s13613-025-01521-4","url":null,"abstract":"<p><strong>Objectives: </strong>To provide a comprehensive overview of current research on intensive care providers' awareness, knowledge, and practices regarding IAP/IAH/ACS, as well as barriers to IAP measurement.</p><p><strong>Methods: </strong>This scoping review was guided by the framework of Arksey and Malley. Eight databases were searched to identify research published after 2007, including MEDLINE Complete, EMBASE, Web of Science, Cochrane Library, CINAHL Complete, ProQuest Health & Medical Complete, CNKI, and WANFANG. Two researchers reviewed and screened potentially relevant studies based on title and abstract. Full-text articles were independently assessed for eligibility based on predefined inclusion criteria.</p><p><strong>Results: </strong>Nineteen articles were included. Overall, pediatric intensive care providers demonstrated a lower awareness and knowledge of IAH/ACS compared to adult intensive care providers, particularly regarding the consensus definitions of IAH/ACS in critically ill children. IAP measurement has not been adequately integrated into clinical practice, with 18.0-73.0% of intensive care providers reporting they have never measured it. The frequency of IAP measurements and the criteria for determining which patients necessitate such measurements exhibited significant variability across different hospitals. The most frequently mentioned barriers to IAP measurement include a lack of knowledge regarding IAP measurement among adult intensivists, an overreliance on physical examination among pediatric intensivists, uncertainty in interpreting IAP data among adult intensive care nurses, and challenges in identifying populations at high risk of IAH among pediatric intensive care nurses. Diuretics were mentioned most often in the management of IAH/ACS, followed by administration of vasopressors and inotropes, decompressive laparotomy, and judicious administration of fluids and blood products. 37.0-66.3% of adult intensivists would choose a decompressive laparotomy in cases of ACS, whereas pediatric intensivists were less inclined to opt for the same approach.</p><p><strong>Conclusions: </strong>Since the publication of the WSACS consensus in 2007, there has been an improvement in awareness and knowledge regarding IAP/IAH/ACS among intensive care providers. Nevertheless, the understanding of the consensus definitions regarding IAH/ACS remains inadequate, particularly among pediatric intensive care providers. It is imperative to advocate for the implementation of WSACS guidelines in hospitals through targeted training programs and to promote the routine practice of IAP measurement in clinical settings.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"106"},"PeriodicalIF":5.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiotensin II, conventional vasopressor therapy, and mortality in shock: a large, multicenter, propensity score-weighted analysis.","authors":"Laurence W Busse, Caitlin Ten Lohuis, Han Xu, Cooper Jannuzzo, Robert H Lyles, J Pedro Teixeira, Ishan Mehta, Yuan Liu","doi":"10.1186/s13613-025-01522-3","DOIUrl":"10.1186/s13613-025-01522-3","url":null,"abstract":"<p><strong>Background: </strong>Angiotensin II (Ang II) is typically used in addition to adrenergic agents and vasopressin (conventional therapy) in patients with shock, but whether its use improves outcomes is unknown.</p><p><strong>Research question: </strong>We evaluated whether Ang II, when added to conventional therapy at different norepinephrine equivalent (NE) doses, was associated with mortality.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 811 patients admitted to four centers in a single healthcare system who received vasopressors for shock, including 275 who received Ang II plus conventional therapy and 536 who received only conventional therapy. Age, gender, sequential organ failure assessment score, serum lactate, background NE dose, corticosteroid use, pre-morbid angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and Charlson Comorbidity Index were calculated at initiation of Ang II or at an equivalent point of acuity in the conventional therapy cohort. We used propensity scores with inverse probability of treatment weighting (IPTW) to achieve covariate balance and multivariable logistic regression to compare 30-day mortality, further stratifying patients by 0.10 mcg/kg/min NE increments.</p><p><strong>Results: </strong>Overall 30-day mortality was 56.4%. Groups statistically differed by all baseline variables. In multivariable logistic regression, Ang II treatment was associated with lower 30-day mortality compared to conventional therapy alone (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.45-0.95, p = 0.025). After IPTW, Ang II use was independently associated with lower mortality (OR 0.74, 95% CI 0.55-0.99, p = 0.040). When stratifying by increments of background NE dose, Ang II initiation was associated with lower 30-day mortality compared to conventional therapy alone in patients on background NE doses > 0.4, > 0.5, and ≤ 0.6 mcg/kg/min. Ang II use in patients on background NE dose > 0.6 was not significantly associated with mortality.</p><p><strong>Conclusions: </strong>Ang II administration was associated with a lower risk of death in unadjusted and adjusted analyses. This effect was preserved only with patients receiving NE at doses ranging from 0.4 to 0.6 mcg/kg/min. Though additional prospective studies are required, these findings suggest that Ang II may be beneficial across a specific range of background vasopressor doses.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"104"},"PeriodicalIF":5.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the Venous Excess Ultrasound (VExUS) score and acute kidney injury in critically ill patients with sepsis: a multicenter prospective observational study.","authors":"Jia Song, Gongze Chen, Detian Lai, Li Zhong, Haozhe Fan, Weihang Hu, Minjia Wang, Caibao Hu, Wenwei Chen, Ziqiang Ming, Shijin Gong, Qiancheng Luo","doi":"10.1186/s13613-025-01529-w","DOIUrl":"10.1186/s13613-025-01529-w","url":null,"abstract":"<p><strong>Background: </strong>Venous congestion is associated with adverse clinical outcomes in critically ill patients, yet its assessment remains challenging. Recently, the Venous Excess Ultrasound (VExUS) score has shown great potential as a non-invasive tool for assessing venous congestion in cardiac patients. However, the relationship between VExUS and clinical outcomes in patients with sepsis remains understudied. This study aims to evaluate the incidence of venous congestion based on VExUS assessment within the first 5 days of intensive care unit (ICU) admission in critically ill patients with sepsis, and to investigate the association between VExUS and clinical outcomes.</p><p><strong>Methods: </strong>We conducted a prospective, observational study in four ICUs, enrolling adult patients with sepsis who stayed in the ICU for at least 24 h. VExUS assessments were performed on days 1 (within 24 h), 3 (48-72 h), and 5 (96-120 h) following ICU admission. Patients were classified according to VExUS score ≥ 2 or < 2. The primary outcome was the prevalence of acute kidney injury (AKI) during ICU stay, while secondary outcomes included 30-day mortality, ICU mortality, and requirement for renal replacement therapy (RRT).</p><p><strong>Results: </strong>Among the 108 patients included, 18% (19 patients) showed VExUS score ≥ 2 on day 1 of ICU admission, and the prevalence progressively decreased to 15% (15 patients) by day 3 and 6% (6 patients) by day 5. The VExUS score ≥ 2 was not associated with AKI (OR 1.82, 95% CI 0.62-5.31, p = 0.274), 30-day mortality (OR 0.82, 95% CI 0.28-2.4, p = 0.711), ICU mortality (OR 1.12, 95% CI 0.41-3.04, p = 0.82), or requirement for RRT (OR 2.29, 95% CI 0.68-7.64, p = 0.179). There was no significant correlation between VExUS and central venous pressure (coefficient: - 0.019, 95% CI -0.01 to 0.05, p = 0.204).</p><p><strong>Conclusion: </strong>In critically ill patients with sepsis, approximately 20% exhibit early (within 24 h of ICU admission) venous congestion, with the prevalence progressively decreasing over the subsequent 5 days. Venous congestion assessed by VExUS was not associated with the occurrence of AKI or with mortality.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2200066987. Registered 22 December 2022, https://www.chictr.org.cn/.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"105"},"PeriodicalIF":5.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers to guide sepsis management.","authors":"Vasiliki Bourika, Evangelia-Areti Rekoumi, Evangelos J Giamarellos-Bourboulis","doi":"10.1186/s13613-025-01524-1","DOIUrl":"10.1186/s13613-025-01524-1","url":null,"abstract":"<p><strong>Background: </strong>Sepsis remains a major cause of morbidity and mortality. Precision therapeutics are now regarded as a novel prospective to improve outcome. This approach relies on biomarkers to identify a pathway of pathogenesis which prevails and directs the best available therapeutic option to modulate this pathway. This review provides the most recent findings on biomarkers for bacterial or viral sepsis. These biomarkers provide guidance for prompt diagnosis and management tailored to specific needs.</p><p><strong>Main body: </strong>Keywords relative to sepsis management (early recognition, antibiotic administration, selection of fluids, vasopressors and immunotherapy) were searched across PubMed database. Published evidence the last five years exists for heparin-binding protein (HBP), monocyte distribution width (MDW), interleukin-10 (IL-10), presepsin, procalcitonin and C-reactive protein (CRP) for early sepsis diagnosis; procalcitonin is the most well-studied biomarker for antibiotic guidance. Endothelial and cardiac biomarkers have been explored as tools to tailor circulatory support in sepsis, including fluid therapy, and the targeted use of vasopressors for vascular tone optimization.</p><p><strong>Conclusion: </strong>This review explored how biomarkers can optimize immunomodulatory therapies, guide vasopressor initiation, inform antibiotic stewardship, and aid in fluid resuscitation decisions, ultimately improving patient outcomes.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"103"},"PeriodicalIF":5.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How should spontaneous breathing trials be performed in the light of recent literature?","authors":"Arnaud W Thille, Gonzalo Hernández","doi":"10.1186/s13613-025-01507-2","DOIUrl":"10.1186/s13613-025-01507-2","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"102"},"PeriodicalIF":5.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal replacement therapy in an intensive care unit: guidelines from the SRLF-GFRUP consensus conference.","authors":"Mercè Jourdain, Ines Gragueb Chatti, Brahim Housni, Pierre Jaquet, Mélissa Jezequel, Oumar Kane, Béatrice La Combe, Mickael Landais, Mehdi Marzouk, Etienne de Montmollin, Guillaume Mortamet, Mai-Anh Nay, Charlotte Salmon-Gandonnière, Sophie Perinel-Ragey, Jérôme Rambaud, Joanna Schmitt, Marie Simon, Julie Starck, Arnaud W Thille, Pierre-François Dequin","doi":"10.1186/s13613-025-01517-0","DOIUrl":"10.1186/s13613-025-01517-0","url":null,"abstract":"<p><strong>Background: </strong>Although largely used, the place of extracorporeal renal replacement therapy (RRT) in acute kidney injury (AKI) in intensive care unit (ICU) patients has yet to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Pediatric Group of Intensive Care and Emergency (Groupe Francophone de Réanimation et d'Urgence Pédiatrique, GFRUP) organized a consensus conference in November 2024.</p><p><strong>Methods: </strong>A committee, without any conflict of interest (CoI) on the subject, defined seven generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Eighteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 14 critical-care medicine physicians and a nurse) and the public. The jury then met for 48 h to write out and vote on its recommendations.</p><p><strong>Results: </strong>The panel provided 45 statements addressing seven questions. In patients, adults or children, admitted to the ICU with AKI (1) What are the indications for RRT, when should it be initiated, and within what timeframe? (2) What are the advantages/disadvantages of the different RRT modalities in ICU, and based on what criteria should they be chosen? (3) Which dose of dialysis should be prescribed for ICU patients? (4) How to prescribe, adjust and monitor each RRT technique? (5) Which vascular access technique should be preferred (insertion site, catheter type and length)? (6) How to prevent circuit thrombosis? (7) What are the criteria to consider weaning from RRT and how can it be achieved?</p><p><strong>Conclusions: </strong>These recommendations should optimize the prescription and use of RRT during AKI in ICUs for both adult and pediatric patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"100"},"PeriodicalIF":5.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}