Pub Date : 2025-02-01DOI: 10.1053/j.jvca.2025.01.043
John Levasseur, Justin Tabah, John Bishop, Saleh Alotaibi, Nakul Kumar, Chase Donaldson
{"title":"A Rare Cause of Shock After Orthotopic Heart Transplant.","authors":"John Levasseur, Justin Tabah, John Bishop, Saleh Alotaibi, Nakul Kumar, Chase Donaldson","doi":"10.1053/j.jvca.2025.01.043","DOIUrl":"https://doi.org/10.1053/j.jvca.2025.01.043","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1053/j.jvca.2024.08.023
Mitchell Lippy MD , Brady Still MD , Richa Dhawan MD, MPH , Ingrid Moreno-Duarte MD , Hiroto Kitahara MD
{"title":"Stepwise Mechanical Circulatory Support in a Pediatric Patient With Respiratory Failure Facilitating Mobilization and Recovery","authors":"Mitchell Lippy MD , Brady Still MD , Richa Dhawan MD, MPH , Ingrid Moreno-Duarte MD , Hiroto Kitahara MD","doi":"10.1053/j.jvca.2024.08.023","DOIUrl":"10.1053/j.jvca.2024.08.023","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 538-545"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1053/j.jvca.2024.10.041
Eric Bain MD, Roopa Rao MD, Maya Guglin MD
Introduction
Spinal cord infarction (SCI) or ischemia is a rare but devastating complication of venoarterial extracorporeal membrane oxygenation (VA ECMO). The natural course and outcomes are poorly studied.
Methods
We completed a literature review on ischemic spinal cord injury in patients on VA ECMO and analyzed the published case reports and case series with individual patient characteristics. We also added 3 previously unpublished cases from our own experience.
Results
The final sample included 30 adult patients on VA ECMO for cardiogenic shock secondary to various etiologies. The mean age was 47.7 ± 17.8 years with equal distribution between men and woman. The total duration on ECMO ranged from 3 to 47 days with a median of 10 days. In all patients, ECMO was placed peripherally via an arterial cannula in the femoral artery. All 30 patients developed either paraplegia (27/90%) or weakness (3/10%) of both lower extremities. Magnetic resonance imaging of the spine was consistent with infarction in 88.5% and ischemia in the rest. On follow-up, there were no cases of complete recovery. Partial recovery with significant limitations of mobility was noted in half of them. The remaining half had no signs of neurological recovery. Survival to discharge was reported in 24 cases. Of these cases, 17/70.8% survived and 7/29.2% died.
Conclusion
Spinal infarction/ischemia on VA ECMO typically presents with paraplegia of lower extremities with low potential for even partial recovery. Because no treatment is currently available, the efforts should be focused on prevention. Several strategies have been proposed, but they need further testing under controlled settings.
{"title":"Spinal Cord Injury Following Venoarterial Extracorporeal Membrane Oxygenation: A Scoping Review","authors":"Eric Bain MD, Roopa Rao MD, Maya Guglin MD","doi":"10.1053/j.jvca.2024.10.041","DOIUrl":"10.1053/j.jvca.2024.10.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal cord infarction (SCI) or ischemia is a rare but devastating complication of venoarterial extracorporeal membrane oxygenation (VA ECMO). The natural course and outcomes are poorly studied.</div></div><div><h3>Methods</h3><div>We completed a literature review on ischemic spinal cord injury in patients on VA ECMO and analyzed the published case reports and case series with individual patient characteristics. We also added 3 previously unpublished cases from our own experience.</div></div><div><h3>Results</h3><div>The final sample included 30 adult patients on VA ECMO for cardiogenic shock secondary to various etiologies. The mean age was 47.7 ± 17.8 years with equal distribution between men and woman. The total duration on ECMO ranged from 3 to 47 days with a median of 10 days. In all patients, ECMO was placed peripherally via an arterial cannula in the femoral artery. All 30 patients developed either paraplegia (27/90%) or weakness (3/10%) of both lower extremities. Magnetic resonance imaging of the spine was consistent with infarction in 88.5% and ischemia in the rest. On follow-up, there were no cases of complete recovery. Partial recovery with significant limitations of mobility was noted in half of them. The remaining half had no signs of neurological recovery. Survival to discharge was reported in 24 cases. Of these cases, 17/70.8% survived and 7/29.2% died.</div></div><div><h3>Conclusion</h3><div>Spinal infarction/ischemia on VA ECMO typically presents with paraplegia of lower extremities with low potential for even partial recovery. Because no treatment is currently available, the efforts should be focused on prevention. Several strategies have been proposed, but they need further testing under controlled settings.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 526-531"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1053/j.jvca.2024.11.027
Jordan Holloway MD, Jennifer Yee DO, Scott Holliday MD, Michael Essandoh MD
{"title":"Virtual Reality in Procedural Learning: An Underutilized Toolbox in Medical Education","authors":"Jordan Holloway MD, Jennifer Yee DO, Scott Holliday MD, Michael Essandoh MD","doi":"10.1053/j.jvca.2024.11.027","DOIUrl":"10.1053/j.jvca.2024.11.027","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 554-555"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To summarize anesthetic and perioperative considerations in patients undergoing the convergent procedure for atrial fibrillation (AF).
Design
Retrospective observational study.
Setting
A single quaternary teaching hospital.
Participants
Adult patients with AF undergoing the convergent procedure before January 2024.
Interventions
Retrospective chart review.
Measurements/Main Results
The study cohort comprised 40 patients, including 35 patients with persistent longstanding AF. The mean age was 64 (SD, 6) years, and 33 patients (83%) were male. Common comorbidities included obesity (n = 27; 68%), obstructive sleep apnea (n = 29; 73%), history of tachycardia-mediated cardiomyopathy (n = 10; 25%), and significant alcohol use (n = 10; 25%). Sixteen of the 40 patients (40%) had a history of prior endocardial ablation, and 37 patients (93%) had required a cardioversion in the past. In all, 39 patients (98%) were receiving anticoagulation, and 38 (95%) were on at least 1 antiarrhythmic medication prior to the procedure. All patients received general anesthesia, inhalational in 39 patients (98%) and total intravenous in 1 patient (3%), with regional analgesia adjuncts in 36 patients (88%). All patients required lung isolation, arterial line, central venous access, and transesophageal echocardiographic monitoring. While cardiopulmonary bypass (CPB) was on standby and ready to be initiated for every patient, only 3 patients (8%) required CPB (1 planned, 2 emergent). Thirty seven of the 40 patients (93%) were extubated in the operating room, and 11 patients (28%) required intensive care unit (ICU) admission (planned or unplanned). The median ICU and hospital length of stay were 1 day and 4 days, respectively.
Conclusions
This retrospective analysis of medical records showed that many patients with recurrent AF presenting for convergent procedure carry a burden of multiple comorbidities (eg, obesity, obstructive sleep apnea), and history of unsuccessful ablations. Multistage multidisciplinary convergent procedure might be lengthy and potentially complicated and requires meticulous preparation (eg, endotracheal intubation, lung isolation, advanced cardiac monitoring, central venous access) to ensure optimal outcomes. Anesthesiologists and perioperative physicians should tailor their approach to this multimorbid population while anticipating perioperative respiratory events, rapid hemodynamic shifts, blood loss, and the possibility of CPB.
{"title":"Anesthetic and Perioperative Considerations for Convergent Procedure for Atrial Fibrillation: A Retrospective Observational Cohort Study","authors":"Sarvie Esmaeilzadeh MBBCh , Arman Arghami MD, MPH , Ammar Killu MBBS , Kyle Bohman MD , George Gilkey MD , Gabor Bagameri MD , Elena Swan MD, PhD","doi":"10.1053/j.jvca.2024.11.009","DOIUrl":"10.1053/j.jvca.2024.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>To summarize anesthetic and perioperative considerations in patients undergoing the convergent procedure for atrial fibrillation (AF).</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>A single quaternary teaching hospital.</div></div><div><h3>Participants</h3><div>Adult patients with AF undergoing the convergent procedure before January 2024.</div></div><div><h3>Interventions</h3><div>Retrospective chart review.</div></div><div><h3>Measurements/Main Results</h3><div>The study cohort comprised 40 patients, including 35 patients with persistent longstanding AF. The mean age was 64 (SD, 6) years, and 33 patients (83%) were male. Common comorbidities included obesity (n = 27; 68%), obstructive sleep apnea (n = 29; 73%), history of tachycardia-mediated cardiomyopathy (n = 10; 25%), and significant alcohol use (n = 10; 25%). Sixteen of the 40 patients (40%) had a history of prior endocardial ablation, and 37 patients (93%) had required a cardioversion in the past. In all, 39 patients (98%) were receiving anticoagulation, and 38 (95%) were on at least 1 antiarrhythmic medication prior to the procedure. All patients received general anesthesia, inhalational in 39 patients (98%) and total intravenous in 1 patient (3%), with regional analgesia adjuncts in 36 patients (88%). All patients required lung isolation, arterial line, central venous access, and transesophageal echocardiographic monitoring. While cardiopulmonary bypass (CPB) was on standby and ready to be initiated for every patient, only 3 patients (8%) required CPB (1 planned, 2 emergent). Thirty seven of the 40 patients (93%) were extubated in the operating room, and 11 patients (28%) required intensive care unit (ICU) admission (planned or unplanned). The median ICU and hospital length of stay were 1 day and 4 days, respectively.</div></div><div><h3>Conclusions</h3><div>This retrospective analysis of medical records showed that many patients with recurrent AF presenting for convergent procedure carry a burden of multiple comorbidities (eg, obesity, obstructive sleep apnea), and history of unsuccessful ablations. Multistage multidisciplinary convergent procedure might be lengthy and potentially complicated and requires meticulous preparation (eg, endotracheal intubation, lung isolation, advanced cardiac monitoring, central venous access) to ensure optimal outcomes. Anesthesiologists and perioperative physicians should tailor their approach to this multimorbid population while anticipating perioperative respiratory events, rapid hemodynamic shifts, blood loss, and the possibility of CPB.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 398-405"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1053/j.jvca.2024.11.019
Skye A. Buckner Petty MPH , Gwendolyn Raynor MD , Ricardo Verdiner MD, MPH , Elizabeth H. Stephens MD, PhD , Osezele Oboh BS , Tiffany Williams MD, PhD , Linda Shore-Lesserson MD , Adam J. Milam MD, PhD
Objectives
To evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients.
Design
A retrospective cohort study.
Setting
A large academic medical system comprising four sites.
Participants
A total of 6,856 patients who underwent cardiac surgery with cardiopulmonary bypass and received intraoperative methadone between 2018 and 2023 were included. Patients were divided into two groups: those who received both methadone and ketamine (Group M+K; n = 5,696) and those who received methadone alone (Group M; n = 1,160).
Interventions
Intraoperative administration of methadone with or without ketamine. Some patients also received additional opioids such as hydromorphone and fentanyl.
Measurements and Main Results
The primary outcomes were daily total oral morphine equivalents (OMEs) until postoperative day (POD) 7 and the time to first postoperative opioid administration. The secondary outcome was daily postoperative pain scores until POD 7. Exploratory outcomes included delirium and intensive care unit length of stay. The median time to first postoperative opioid administration was longer in Group M+K (7.2 hours) compared with Group M (5.0 hours) (hazard ratio = 0.88, 95% confidence interval: [0.82, 0.95]). Total OMEs were significantly lower in Group M+K on POD 0 (ß = –2.24; 95% confidence interval: [–3.2, –1.3]), with no significant differences beyond POD 0. No significant differences were found in pain scores or exploratory outcomes.
Conclusions
Adding ketamine to methadone prolonged the time to first opioid consumption postoperatively but showed no benefits beyond POD 0. Future studies should consider protocolized dosing to optimize pain control.
{"title":"The Use of Methadone and Ketamine for Intraoperative Pain Management in Cardiac Surgery: A Retrospective Cohort Study","authors":"Skye A. Buckner Petty MPH , Gwendolyn Raynor MD , Ricardo Verdiner MD, MPH , Elizabeth H. Stephens MD, PhD , Osezele Oboh BS , Tiffany Williams MD, PhD , Linda Shore-Lesserson MD , Adam J. Milam MD, PhD","doi":"10.1053/j.jvca.2024.11.019","DOIUrl":"10.1053/j.jvca.2024.11.019","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients.</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting</h3><div>A large academic medical system comprising four sites.</div></div><div><h3>Participants</h3><div>A total of 6,856 patients who underwent cardiac surgery with cardiopulmonary bypass and received intraoperative methadone between 2018 and 2023 were included. Patients were divided into two groups: those who received both methadone and ketamine (Group M+K; n = 5,696) and those who received methadone alone (Group M; n = 1,160).</div></div><div><h3>Interventions</h3><div>Intraoperative administration of methadone with or without ketamine. Some patients also received additional opioids such as hydromorphone and fentanyl.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcomes were daily total oral morphine equivalents (OMEs) until postoperative day (POD) 7 and the time to first postoperative opioid administration. The secondary outcome was daily postoperative pain scores until POD 7. Exploratory outcomes included delirium and intensive care unit length of stay. The median time to first postoperative opioid administration was longer in Group M+K (7.2 hours) compared with Group M (5.0 hours) (hazard ratio = 0.88, 95% confidence interval: [0.82, 0.95]). Total OMEs were significantly lower in Group M+K on POD 0 (ß = –2.24; 95% confidence interval: [–3.2, –1.3]), with no significant differences beyond POD 0. No significant differences were found in pain scores or exploratory outcomes.</div></div><div><h3>Conclusions</h3><div>Adding ketamine to methadone prolonged the time to first opioid consumption postoperatively but showed no benefits beyond POD 0. Future studies should consider protocolized dosing to optimize pain control.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 414-419"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multimodality Imaging to Redefine the Diagnosis in a Rare Case of Double Outlet Both Ventricles for Surgical Correction","authors":"Divya Jacob MD, DM , Saravana Babu-MS MD, DM, FICACC , Shrinivas V Gadhinglajkar MD, PDCC , Prasanta Kumar Dash MD, PDCC , Baiju S Dharan MS, MCh , Anoop Ayyappan MD, PDCC","doi":"10.1053/j.jvca.2024.11.015","DOIUrl":"10.1053/j.jvca.2024.11.015","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 551-552"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1053/j.jvca.2024.11.012
Megan Rose McClain MD , Kathirvel Subramaniam MD, MPH , Roshni Cheema MD, Danielle R. Lavage MA, Hsing-Hua Sylvia Lin MS, PhD, Ibrahim Sultan MD, Senthilkumar Sadhasivam MD, MPH, MBA, Kimberly Howard-Quijano MD, MS
Objectives
To evaluate the effect of intraoperative intravenous methadone within a standardized enhanced recovery after cardiac surgery pathway on the perioperative corrected QT interval (QTc).
Design
Retrospective cohort study.
Setting
Cardiac surgical patients from a tertiary academic medical institution.
Participants
Eligible 1,040 adult patients undergoing elective cardiac surgery from July 2020 through July 2023 using validated institutional electronic medical record data
Interventions
Patients were administered intravenous methadone (0.1 mg/kg) or received analgesics other than intravenous methadone as part of an enhanced recovery after cardiac surgery pathway.
Measurements and Main Results
The primary outcomes were change in QTc and the percent QTc change between preoperative QTc and postoperative QTc upon intensive care unit admission. Secondary outcomes include postoperative ventricular arrhythmias, postoperative atrial fibrillation, intensive care unit length of stay, 30-day mortality, 1-year mortality, and mortality days from surgery. Out of a total of 1,040 patients, 423 received intraoperative methadone and 617 did not receive methadone. Methadone QTc mixed models demonstrated that QTc is prolonged immediately postoperatively and normalized 24 hours after surgery in both methadone and nonmethadone groups. There were no significant differences in baseline QTc, immediate postoperative QTc, changes in QTc, or percent change in QTc between the methadone and nonmethadone groups. There were no significant differences in ventricular or atrial arrhythmias, 30-day mortality, 1-year mortality, or days to death.
Conclusions
A single intraoperative intravenous methadone dose did not prolong the QTc significantly or increase the incidence of arrhythmias and may be safe in adult cardiac surgical patients.
{"title":"Intraoperative Methadone in Adult Cardiac Surgical Patients and Risks for Postoperative QTc Prolongation","authors":"Megan Rose McClain MD , Kathirvel Subramaniam MD, MPH , Roshni Cheema MD, Danielle R. Lavage MA, Hsing-Hua Sylvia Lin MS, PhD, Ibrahim Sultan MD, Senthilkumar Sadhasivam MD, MPH, MBA, Kimberly Howard-Quijano MD, MS","doi":"10.1053/j.jvca.2024.11.012","DOIUrl":"10.1053/j.jvca.2024.11.012","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the effect of intraoperative intravenous methadone within a standardized enhanced recovery after cardiac surgery pathway on the perioperative corrected QT interval (QTc).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Cardiac surgical patients from a tertiary academic medical institution.</div></div><div><h3>Participants</h3><div>Eligible 1,040 adult patients undergoing elective cardiac surgery from July 2020 through July 2023 using validated institutional electronic medical record data</div></div><div><h3>Interventions</h3><div>Patients were administered intravenous methadone (0.1 mg/kg) or received analgesics other than intravenous methadone as part of an enhanced recovery after cardiac surgery pathway.</div></div><div><h3>Measurements and Main Results</h3><div>The primary outcomes were change in QTc and the percent QTc change between preoperative QTc and postoperative QTc upon intensive care unit admission. Secondary outcomes include postoperative ventricular arrhythmias, postoperative atrial fibrillation, intensive care unit length of stay, 30-day mortality, 1-year mortality, and mortality days from surgery. Out of a total of 1,040 patients, 423 received intraoperative methadone and 617 did not receive methadone. Methadone QTc mixed models demonstrated that QTc is prolonged immediately postoperatively and normalized 24 hours after surgery in both methadone and nonmethadone groups. There were no significant differences in baseline QTc, immediate postoperative QTc, changes in QTc, or percent change in QTc between the methadone and nonmethadone groups. There were no significant differences in ventricular or atrial arrhythmias, 30-day mortality, 1-year mortality, or days to death.</div></div><div><h3>Conclusions</h3><div>A single intraoperative intravenous methadone dose did not prolong the QTc significantly or increase the incidence of arrhythmias and may be safe in adult cardiac surgical patients.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 2","pages":"Pages 406-413"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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