Therapeutic advances in pulmonary and critical care medicine最新文献

{"title":"Ventilator-Associated Pneumonia: An Update on the Role of Lung Ultrasound in Adult, Pediatric, and Neonatal ICU Practice.","authors":"Diana Adrião, Francesco Mojoli, Rebeca Gregorio Hernandez, Daniele De Luca, Belaid Bouhemad, Silvia Mongodi","doi":"10.1177/29768675251349632","DOIUrl":"10.1177/29768675251349632","url":null,"abstract":"<p><p>Ventilator-associated pneumonia (VAP) remains one of the most common and challenging intensive care unit (ICU)-acquired infections, significantly contributing to mortality, morbidity, and healthcare costs. The diagnosis relies on quantitative analysis of a deep microbiological sample; a combination of clinical and radiological signs is commonly used to raise VAP suspicion in clinical practice. Traditional imaging methods such as chest radiography and computed tomography have limitations in critically ill patients under mechanical ventilation. Lung ultrasound (LUS) has emerged in the last years as a valuable tool in the assessment and monitoring of critically ill patients, including for diagnosis and management of VAP, due to its noninvasive bedside applicability and absence of radiation exposure. This last quality is of particular interest in the specific population of children and newborns, where radiation exposure should be further avoided. LUS allows for daily monitoring of lung aeration and provides a quantitative assessment through the LUS aeration score; an unexpected increase of LUS aeration score may raise the suspicion of superinfection. Key ultrasonographic findings, such as subpleural consolidations and consolidations with dynamic linear-arborescent air bronchogram, improve diagnostic specificity for VAP. Similarly to what happens with traditional radiology, the Ventilator-associated Pneumonia Lung Ultrasound Score (VPLUS) combines ultrasound signs with clinical parameters like purulent secretions to enhance diagnostic accuracy. Furthermore, LUS aeration score plays a crucial role in monitoring the response to treatment, enabling assessment of lung reaeration over time. It helps differentiate between treatment responders and nonresponders, guiding therapy adjustments and identifying complications. This review highlights the evolving role of LUS in the early diagnosis, monitoring, and treatment of VAP across various ICU settings, including its application in adult, pediatric, and neonatal care.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"20 ","pages":"29768675251349632"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers in Cardiac Arrest: A Narrative Review.","authors":"Rohin Singla, Chelsey Sidaras, Jignesh K Patel","doi":"10.1177/29768675251346014","DOIUrl":"10.1177/29768675251346014","url":null,"abstract":"<p><p>Inflammatory, neurologic, and cardiac biomarkers appear to have varying significance in the prognostication of patients with cardiac arrest. Post-cardiac arrest syndrome is a condition characterized by systemic ischemia with reperfusion injury, neurologic damage, and myocardial dysfunction. The relative significance of these biomarkers remains unclear and is an area of active investigation. In this narrative review, we aim to describe what is currently known about the role of inflammatory, neurologic, and cardiac biomarkers in cardiac arrest. A PubMed review was performed for relevant articles. Articles that studied inflammatory, neurologic, and cardiac biomarkers in adult cardiac arrest were included. This narrative review determined that biomarkers play a key role in facilitating prognostication of patients with cardiac arrest. The release of inflammatory, neurologic, and cardiac biomarkers mediates inflammation, ischemic brain injury, and myocardial dysfunction. Inflammatory and neurologic biomarkers appear to have more clinical utility than cardiac biomarkers. When combined with physical exam, imaging and electroencephalograph findings, blood biomarkers can be useful in making predictions of patient outcomes post-cardiac arrest. Despite this utility, no single biomarker has sufficient power to predict patient outcomes independently. Ongoing research investigating these biomarkers remains an area of strong clinical interest. In conclusion, inflammatory, neurologic, and cardiac biomarkers all play a role in understanding both the short-term and long-term outcomes in patients with cardiac arrest. To date, no single parameter has been shown to reliably predict outcome in cardiac arrest patients. Such biomarkers remain an area of active investigation.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"20 ","pages":"29768675251346014"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Dynamic Cause of Cardiogenic Shock Identified on Point-of-Care Ultrasound: A Case Report.","authors":"Akhilesh Gonuguntla, Thomas M Ruli, David N Maynard, Steven Fox","doi":"10.1177/29768675251344037","DOIUrl":"10.1177/29768675251344037","url":null,"abstract":"<p><p>Dynamic left ventricular outflow tract obstruction (dLVOTO) is an important cause of cardiogenic shock to consider as its management differs from garden-variety cardiogenic shock from systolic dysfunction. It is best suited for serial evaluation by point-of-care ultrasound (POCUS) as its dynamic nature may cause it to be missed on routine echocardiograms. We present a case of a 95-year-old male who presented for constipation and went into cardiac arrest after manual disimpaction. After intubation and advanced cardiovascular life support with eventual return of spontaneous circulation, the patient developed cardiogenic shock. He developed persistent lactic acidosis, increasing ventilator requirements, and worsening renal function despite diuresis and escalating epinephrine and norepinephrine requirements. POCUS revealed left ventricular systolic dysfunction with apical hypokinesis and basal hyperkinesis suspicious for stress-induced cardiomyopathy. Moreover, systolic anterior motion of the mitral valve on M-mode ultrasound and a left ventricular outflow tract pressure gradient of 46 mm Hg on spectral Doppler were noted, consistent with dLVOTO. On recognition of dLVOTO, epinephrine and norepinephrine were weaned after adding vasopressin and phenylephrine. The patient's clinical status drastically improved thereafter and he was weaned off vasopressors and the ventilator within 48 hours. POCUS techniques that are often excluded from basic critical care ultrasound exams are required to identify the characteristic features of hemodynamically significant dLVOTO. These features are important to recognize in cardiogenic shock as inotropes and diuresis can lead to paradoxical worsening of the dLVOTO. Instead, these patients should be managed with pure vasopressors and measures to increase left ventricular preload (beta blockers and intravenous fluids).</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"20 ","pages":"29768675251344037"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Adherence to the 2023 Canadian Thoracic Society Chronic Obstructive Pulmonary Disease Pharmacotherapy Guidelines: A Hospital-Based Study.","authors":"Mathieu D Saint-Pierre","doi":"10.1177/29768675251336660","DOIUrl":"https://doi.org/10.1177/29768675251336660","url":null,"abstract":"<p><strong>Background: </strong>A previous study at Montfort Hospital (Ottawa, Ontario, Canada) found that only one-fifth of patients treated in 2022 for a severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were prescribed the appropriate inhaled therapy at discharge. The revised 2023 Canadian Thoracic Society (CTS) COPD pharmacotherapy guidelines now recommend inhaled triple therapy as initial maintenance treatment in patients at high risk of AECOPD.</p><p><strong>Objectives: </strong>The primary objective of this study was to determine if adherence to the CTS guidelines significantly improved following the publication of the 2023 statement. A secondary objective was to review the proportion of patients receiving appropriate optimization based on whether they were treated exclusively in the emergency department (ED) or required hospitalization.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Methods: </strong>Subjects treated for AECOPD in the first 12 months after the publication of the 2023 guidelines were reviewed. Patient characteristics and inhaled therapy were charted. Adherence to the guidelines was compared to the prior cohort from 2022.</p><p><strong>Results: </strong>A total of 169 patients were treated for AECOPD. After excluding individuals who died in the hospital and those who were maintained on inhaled triple therapy, 74 were candidates for review of their inhaled therapy. 27% received recommended medication optimization at discharge compared to 20% in 2022 (P = 0.25). Adherence to the guidelines significantly improved for hospitalized patients (51% vs 27%, P = 0.02). Only 5% of subjects treated exclusively in the ED received appropriate inhaler optimization. The most common deviations from the guidelines were the continued use of prior therapy (35%) and the lack of any long-acting medication (22%).</p><p><strong>Conclusions: </strong>Adherence to the CTS COPD pharmacotherapy guidelines remained very low in ED-treated patients. The findings highlight the need for structured COPD care plans.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"20 ","pages":"29768675251336660"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Functional Impairment in Severe COVID-19 Patients Two Months After Discharge.","authors":"Antoine El Kik, Hind Eid, Nabil Nassim, Karim Hoyek, Albert Riachy, Bassem Habr, Ghassan Sleilaty, Moussa Riachy","doi":"10.1177/29768675241305102","DOIUrl":"10.1177/29768675241305102","url":null,"abstract":"<p><strong>Background: </strong>The Post-COVID-19 Functional Status (PCFS) scale is a validated tool used to measure the functional status of patients discharged from the hospital.</p><p><strong>Objectives: </strong>To describe the functional limitations of hospitalized COVID-19 patients at the time of discharge and two months afterward, and to identify risk factors associated with functional impairment.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Methods: </strong>A total of 540 patients were included in this monocentric study. The functional status assessment using the PCFS scale and ventilatory needs were recorded at discharge and two months later. Univariate and multivariate analyses were performed in order to identify the risk factors of a high PCFS score.</p><p><strong>Results: </strong>Two months after discharge, the PCFS grade was 0 in 60,6% of the survivors, 1 in 24.5%, 2 in 6.9%, 3 in 2.8%, and 4 in 5.3%. The identified risk factors of a high PCFS scale were: age, arterial hypertension, diabetes mellitus, immunosuppression, cardiovascular disease, high need for oxygen and high News2 score at admission, a high percentage of ground glass at chest CT scan performed at admission or during follow-up, elevated leukocytes, neutrophils, LDH, D-dimers, procalcitonin, and serum creatinine levels. During the hospital stay, treatment with steroids, tocilizumab, longer duration of hospitalization, ICU admission and prolonged stay, and the occurrence of thromboembolic or hemorrhagic events were also significantly associated with a higher PCFS. Multivariate analysis identified that only age and a high News2 score at admission were independent risk factors of a low PCFS score.</p><p><strong>Conclusion: </strong>Multiple risk factors for a higher PCFS score were identified, but only age and a high News2 score at admission were found to be independent risk factors.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"19 ","pages":"29768675241305102"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review of Invasive Candidiasis in the Intensive Care Unit.","authors":"Elnè Noppè, Julian Robert Paul Eloff, Sean Keane, Ignacio Martin-Loeches","doi":"10.1177/29768675241304684","DOIUrl":"10.1177/29768675241304684","url":null,"abstract":"<p><p><i>Candida</i> species is the most common cause of invasive fungal infection in the critically ill population admitted to the intensive care unit (ICU). Numerous risk factors for developing invasive candidiasis (IC) have been identified, and some, like the breach of protective barriers, abound within the ICU. Given that IC carries a significant mortality, morbidity, and healthcare cost burden, early diagnosis and treatment have become an essential topic of discussion. Several expert panels and task forces have been established to provide clear guidance on the management of IC. Unfortunately, IC remains a diagnostic and therapeutic challenge attributable to the changing fungal ecology of <i>Candida</i> species and the emergence of multidrug-resistant strains. This narrative review will focus on the following: (1) the incidence, outcomes, and changing epidemiology of IC globally; (2) the risk factors for developing IC; (3) IC risk stratification tools and their appropriate use; (4) diagnosis of IC; and (5) therapeutic agents and regimens.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"19 ","pages":"29768675241304684"},"PeriodicalIF":0.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchiectasis-COPD Overlap Syndrome: A Comprehensive Review of its Pathophysiology and Potential Cardiovascular Implications.","authors":"Mohammad Ajaz Alam, Padmavathi Mangapuram, Fremita Chelsea Fredrick, Bhupinder Singh, Amishi Singla, Avi Kumar, Rohit Jain","doi":"10.1177/29768675241300808","DOIUrl":"10.1177/29768675241300808","url":null,"abstract":"<p><p>Bronchiectasis-Chronic Obstructive Pulmonary Disease Overlap Syndrome (BCOS) is a complex pulmonary condition that merges bronchiectasis and chronic obstructive pulmonary disease (COPD), presenting unique clinical challenges. Patients with BCOS typically exhibit a range of symptoms from both conditions, including a chronic productive cough, reduced lung function, frequent exacerbations, and diminished exercise tolerance. The etiology of BCOS involves multiple factors such as genetic predisposition, respiratory infections, tobacco smoke, air pollutants, and other inflammatory mediators. Accurate diagnosis requires a comprehensive approach, incorporating pulmonary function tests to evaluate airflow limitation, radiographic imaging to identify structural lung abnormalities, and blood eosinophil counts to detect underlying inflammation. Treatment strategies are tailored to individual symptom profiles and severity, potentially including bronchodilators, inhaled corticosteroids, and pulmonary therapy to improve lung function and quality of life. Patients with BCOS are also at an increased risk for cardiovascular complications, such as stroke, ischemic heart disease, and cor pulmonale. Additionally, medications like beta-agonists and muscarinic antagonists used in COPD treatment can further affect cardiac risk by altering heart rate. This paper aims to provide a thorough understanding of BCOS, addressing its development, diagnosis, treatment, and associated cardiovascular complications, to aid healthcare providers in managing this multifaceted condition and improving patient outcomes.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"19 ","pages":"29768675241300808"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Effects of Diaphragmatic Breathing and Pursed-lip Breathing Exercises on the Sleep Quality of Elderly Patients with Chronic Obstructive Pulmonary Disease (COPD): A Clinical Trial Study.","authors":"Zahra Dodange, Azar Darvishpour, Mohamad Javad Ershad, Bahare Gholami-Chaboki","doi":"10.1177/29768675241302901","DOIUrl":"10.1177/29768675241302901","url":null,"abstract":"<p><strong>Background: </strong>Sleep-related disorders are common among older adults with chronic obstructive pulmonary disease (COPD). Breathing exercises, a key component of pulmonary rehabilitation programs, may improve sleep quality. However, there is a paucity of research on the impact of breathing exercises on sleep quality in elderly patients with COPD.</p><p><strong>Objective: </strong>This study aimed to compare the effects of diaphragmatic breathing (DB) and pursed-lip breathing (PLB) exercises on sleep quality in elderly patients with COPD.</p><p><strong>Design: </strong>Crossover clinical trial.</p><p><strong>Methods: </strong>In this study, 60 elderly patients with COPD were randomly assigned to two groups: DB followed by PLB (Group 1) and PLB followed by DB (Group 2). Each exercise was performed for 4 weeks. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Abbreviated Mental Test Score (AMTS), and COPD Assessment Test (CAT) questionnaires before training. Data were analyzed using descriptive and inferential statistics in SPSS version 21, with a significance level of 0.05.</p><p><strong>Results: </strong>Both DB and PLB exercises significantly improved sleep quality in elderly patients with COPD (<i>P</i> < 0.05). No significant difference was found between the two exercises. However, the sequence of exercises in Group 1 (DB followed by PLB) resulted in greater improvement in average sleep quality compared to Group 2.</p><p><strong>Conclusion: </strong>This study demonstrates that DB and PLB exercises enhance sleep quality in elderly patients with COPD. These exercises are recommended as an effective non-pharmacological approach to improve sleep quality in this population.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"19 ","pages":"29768675241302901"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple life-threatening complications in a patient who received lung transplantation due to cystic fibrosis and their management.","authors":"Gizem Kececi Ozgur, Ali Ozdil, Pervin Korkmaz, Tevfik İlker Akcam","doi":"10.1177/29768675241302903","DOIUrl":"10.1177/29768675241302903","url":null,"abstract":"<p><p>Cystic fibrosis patients may be considered for lung transplantation. Although these patients may experience more successful outcomes and survival rates compared to others, various complications can arise. In particular, infectious complications and septic deaths may be more prevalent in cystic fibrosis patients compared to other lung transplant indications. Considering all these factors, recognizing and managing complications that may arise during the postoperative period in this patient group are of critical importance. In this article, multiple life-threatening complications occurring in the post-transplant period in a patient who underwent lung transplantation due to cystic fibrosis are chronologically presented, and their management is discussed.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"19 ","pages":"29768675241302903"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence for Mechanical Ventilation: A Transformative Shift in Critical Care.","authors":"Giovanni Misseri, Matteo Piattoli, Giuseppe Cuttone, Cesare Gregoretti, Elena Giovanna Bignami","doi":"10.1177/29768675241298918","DOIUrl":"https://doi.org/10.1177/29768675241298918","url":null,"abstract":"<p><p>With the large volume of data coming from implemented technologies and monitoring systems, intensive care units (ICUs) represent a key area for artificial intelligence (AI) application. Despite the last decade has been marked by studies focused on the use of AI in medicine, its application in mechanical ventilation management is still limited. Optimizing mechanical ventilation is a complex and high-stake intervention, which requires a deep understanding of respiratory pathophysiology. Therefore, this complex task might be supported by AI and machine learning. Most of the studies already published involve the use of AI to predict outcomes for mechanically ventilated patients, including the need for intubation, the respiratory complications, and the weaning readiness and success. In conclusion, the application of AI for the management of mechanical ventilation is still at an early stage and requires a cautious and much less enthusiastic approach. Future research should be focused on AI progressive introduction in the everyday management of mechanically ventilated patients, with the aim to explore the great potentiality of this tool.</p>","PeriodicalId":94361,"journal":{"name":"Therapeutic advances in pulmonary and critical care medicine","volume":"19 ","pages":"29768675241298918"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}