Adherence is an important factor contributing to the effectiveness of pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). However, there appears to be a lack of reliable and validated measures to assess adherence in PR.
Objective
The purpose of this study was to systematically review and analyze existing PR adherence assessment tools, describe their application effects in different contexts, and explore the scientific validity and applicability of each assessment method.
Methods
MEDLINE, PubMed, Web of Science and other data sources were searched for target articles. To ensure all pertinent papers were included, reference lists from articles that met the inclusion criteria were reviewed. A combination of EndNote 21 software and manual screening of the literature was used for quality assessment, employing the JBI Critical Appraisal Checklist. Both researchers conducted the entire process independently, without interfering with each other.
Results
Three studies were included, reporting three tools in three different countries. The quality and validity of these three articles are high. Two of the tools were developed specifically for the COPD population, one tool was developed initially for athlete participant but used to assess the adherence of PR in patients with COPD.
Conclusion
The results show a gap in the literature for well-developed tools that capture adherence for PR of patients with COPD.
背景：依从性是影响慢性阻塞性肺疾病（COPD）患者肺康复（PR）有效性的重要因素。目的：本研究旨在系统地回顾和分析现有的PR依从性评估工具，描述其在不同情境下的应用效果，并探讨每种评估方法的科学有效性和适用性。方法：检索MEDLINE、PubMed、Web of Science等数据库，检索目标文章。为了确保所有相关论文都被纳入，我们审查了符合纳入标准的文章的参考文献列表。结合EndNote 21软件和人工筛选文献进行质量评估，采用JBI关键评估清单。两位研究人员独立完成了整个过程，互不干扰。结果：纳入了三项研究，报告了三个不同国家的三种工具。这三件商品的质量和有效性都很高。其中两个工具是专门为COPD人群开发的，一个工具最初是为运动员参与者开发的，但用于评估COPD患者的PR依从性。结论：研究结果表明，文献中关于COPD患者PR依从性的完善工具存在空白。
{"title":"Adherence to pulmonary rehabilitation in COPD patients: A systematic review of measurement tools","authors":"Fangrong Jia , Chantra Promnoi , Chuleeporn Prompahakul , Waraporn Kongsuwan","doi":"10.1016/j.rmed.2026.108696","DOIUrl":"10.1016/j.rmed.2026.108696","url":null,"abstract":"<div><h3>Background</h3><div>Adherence is an important factor contributing to the effectiveness of pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). However, there appears to be a lack of reliable and validated measures to assess adherence in PR.</div></div><div><h3>Objective</h3><div>The purpose of this study was to systematically review and analyze existing PR adherence assessment tools, describe their application effects in different contexts, and explore the scientific validity and applicability of each assessment method.</div></div><div><h3>Methods</h3><div>MEDLINE, PubMed, Web of Science and other data sources were searched for target articles. To ensure all pertinent papers were included, reference lists from articles that met the inclusion criteria were reviewed. A combination of EndNote 21 software and manual screening of the literature was used for quality assessment, employing the JBI Critical Appraisal Checklist. Both researchers conducted the entire process independently, without interfering with each other.</div></div><div><h3>Results</h3><div>Three studies were included, reporting three tools in three different countries. The quality and validity of these three articles are high. Two of the tools were developed specifically for the COPD population, one tool was developed initially for athlete participant but used to assess the adherence of PR in patients with COPD.</div></div><div><h3>Conclusion</h3><div>The results show a gap in the literature for well-developed tools that capture adherence for PR of patients with COPD.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108696"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119661","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}
Pub Date : 2026-03-01Epub Date: 2026-02-07DOI: 10.1016/j.rmed.2026.108707
Dominick Roto, Deborah Haight, Kyle Norton, R James White, Daniel Lachant
Introduction
Disability after acute pulmonary embolism is common. Functional testing is not routinely performed in early follow-up and typically occurs only when symptoms persist after three months of anticoagulation.
Methods
This pilot study was a single center, prospective, observational study as part of a larger rehabilitation clinical trial. We recruited patients hospitalized for intermediate or high risk acute pulmonary embolism. Baseline (within 2 weeks of discharge) and follow up (3 months later) testing included 6-min walk test with metabolic monitoring, Cardiac Effort (number of heart beats used/walk distance), two weeks of actigraphy, and PE-mb Quality of Life Questionnaire. Non-parametric and mixed method repeated measures regression were performed.
Results
Twenty-five participants completed paired 6-min walk testing after acute PE. No safety concerns emerged when performing the walk test. There was significant improvement in walk distance, +58 m (29, 108), and Cardiac Effort, −0.2 beats/m (−0.4, −0.1), at 3-month follow up. Metabolic monitoring showed improvement in oxygen consumption, +1.8 ml/kg/min (0.8, 4.9), and respiratory efficiency, −2.9 (−7.7, −0.5). Actigraphy showed increased moderate activity time, +10 min/day (4, 21), and quality of life improved, −20% (−24, −7). Both 6-min walk distance and actigraphy parameters were associated with metabolic parameters.
Conclusion
For a group of participants that were asymptomatic at 3 months after hospitalization for acute pulmonary embolism, early functional assessments that can be obtained and repeated in an office setting demonstrated recovery in function and physiology (gas exchange and heart rate). Early testing could help better characterize recovery after acute pulmonary embolism.
{"title":"Functional recovery after pulmonary embolism: A pilot study using metabolic monitoring during the 6-minute walk test","authors":"Dominick Roto, Deborah Haight, Kyle Norton, R James White, Daniel Lachant","doi":"10.1016/j.rmed.2026.108707","DOIUrl":"10.1016/j.rmed.2026.108707","url":null,"abstract":"<div><h3>Introduction</h3><div>Disability after acute pulmonary embolism is common. Functional testing is not routinely performed in early follow-up and typically occurs only when symptoms persist after three months of anticoagulation.</div></div><div><h3>Methods</h3><div>This pilot study was a single center, prospective, observational study as part of a larger rehabilitation clinical trial. We recruited patients hospitalized for intermediate or high risk acute pulmonary embolism. Baseline (within 2 weeks of discharge) and follow up (3 months later) testing included 6-min walk test with metabolic monitoring, Cardiac Effort (number of heart beats used/walk distance), two weeks of actigraphy, and PE-mb Quality of Life Questionnaire. Non-parametric and mixed method repeated measures regression were performed.</div></div><div><h3>Results</h3><div>Twenty-five participants completed paired 6-min walk testing after acute PE. No safety concerns emerged when performing the walk test. There was significant improvement in walk distance, +58 m (29, 108), and Cardiac Effort, −0.2 beats/m (−0.4, −0.1), at 3-month follow up. Metabolic monitoring showed improvement in oxygen consumption, +1.8 ml/kg/min (0.8, 4.9), and respiratory efficiency, −2.9 (−7.7, −0.5). Actigraphy showed increased moderate activity time, +10 min/day (4, 21), and quality of life improved, −20% (−24, −7). Both 6-min walk distance and actigraphy parameters were associated with metabolic parameters.</div></div><div><h3>Conclusion</h3><div>For a group of participants that were asymptomatic at 3 months after hospitalization for acute pulmonary embolism, early functional assessments that can be obtained and repeated in an office setting demonstrated recovery in function and physiology (gas exchange and heart rate). Early testing could help better characterize recovery after acute pulmonary embolism.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108707"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149991","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}
Pub Date : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.rmed.2026.108712
C Raina MacIntyre , Adriana Notaras , Noor Bari , Con Doolan , Mohamed Mahmoud Abdelkareem Mahmoud , Damian Honeyman , Andre Fellipe Vilanova de Araujo Aquino , Ian Seppelt , Mark Nicholls , Stuart Turville , Anupriya Aggarwal , Mohana Kunasekaran , Rebecca Gresham , Gregory Walker , Andrea Sevendal , William Rawlinson , Isla E. Emmen , Shelby L. O'Connor , David H. O'Connor , Charitha de Silva
Rationale
Nosocomial transmission of SARS-CoV-2 is multifactorial and may vary between clinical sites.
Objectives
To measure SARS-CoV-2 in the air and on surfaces within the Intensive Care Unit (ICU) and Emergency Department (ED).
Methods
We conducted an air and surface-sampling study of SARS-CoV-2 in the ED and ICU of a hospital in Sydney.
Measurements
We sampled air, patient equipment, and personal protective equipment during two community COVID-19 epidemics. SARS-CoV-2 was detected using quantitative reverse transcription polymerase chain reaction (RT-qPCR). Carbon dioxide (CO2) was measured simultaneously, with <800 ppm indicating good air quality.
Main results
SARS-CoV-2 genetic material was detected in 39% of 51 aerosol samples, with mean CO2 levels consistently <800 ppm for positive samples. The ED had more detections than the ICU (80% vs. 20%; p < 0.0027) and a higher mean CO2 level than the ICU (669 ppm vs. 522 ppm; p < 0.05). The ED waiting room, acute ward, and ICU staff tearoom showed higher detection rates than the ICU ward area. SARS-CoV-2 was detected in air samples in the ED a week before an outbreak was declared, and both inside and outside a COVID-19 patient's negative-pressure ICU room, where high-flow nasal prongs and a glove tested positive.
Conclusion
During community epidemics, SARS-CoV-2 genetic material is detected in hospital air despite good ventilation. Enhanced protection with masks, vaccines, and portable air purifiers, especially in high-risk areas, may mitigate nosocomial transmission, including among staff. Air sampling can provide an early warning of an outbreak and help identify areas that need enhanced infection control.
理由：SARS-CoV-2的医院传播是多因素的，可能因临床地点而异。目的：测量重症监护室（ICU）和急诊科（ED）空气和表面上的SARS-CoV-2。方法：对悉尼一家医院急诊科和重症监护室的SARS-CoV-2进行空气和表面采样研究。测量方法：在两次社区COVID-19流行期间，我们对空气、患者设备和个人防护设备进行了采样。采用定量逆转录聚合酶链反应（RT-qPCR）检测SARS-CoV-2。同时测量了二氧化碳（CO2）， < 800 ppm表示空气质量良好。主要结果：51份气溶胶样本中有39%检测到SARS-CoV-2遗传物质，平均CO2水平与ICU一致（669 ppm比522 ppm， p < 0.05）。急诊科候诊室、急症病房和ICU工作人员茶室检出率高于ICU病房区。在宣布疫情爆发前一周，在急诊科的空气样本中检测到SARS-CoV-2，在一名COVID-19患者的负压ICU病房内外，高流量鼻尖和手套的检测结果均为阳性。结论：在社区流行期间，即使通风良好，医院空气中仍检测到SARS-CoV-2遗传物质。加强口罩、疫苗和便携式空气净化器的保护，特别是在高风险地区，可能会减轻院内传播，包括工作人员之间的传播。空气采样可以提供疫情的早期预警，并有助于确定需要加强感染控制的地区。
{"title":"Detection of SARS-CoV-2 in aerosol and surface samples in high acuity hospital settings during community epidemic waves – implications for risk-based infection control","authors":"C Raina MacIntyre , Adriana Notaras , Noor Bari , Con Doolan , Mohamed Mahmoud Abdelkareem Mahmoud , Damian Honeyman , Andre Fellipe Vilanova de Araujo Aquino , Ian Seppelt , Mark Nicholls , Stuart Turville , Anupriya Aggarwal , Mohana Kunasekaran , Rebecca Gresham , Gregory Walker , Andrea Sevendal , William Rawlinson , Isla E. Emmen , Shelby L. O'Connor , David H. O'Connor , Charitha de Silva","doi":"10.1016/j.rmed.2026.108712","DOIUrl":"10.1016/j.rmed.2026.108712","url":null,"abstract":"<div><h3>Rationale</h3><div>Nosocomial transmission of SARS-CoV-2 is multifactorial and may vary between clinical sites.</div></div><div><h3>Objectives</h3><div>To measure SARS-CoV-2 in the air and on surfaces within the Intensive Care Unit (ICU) and Emergency Department (ED).</div></div><div><h3>Methods</h3><div>We conducted an air and surface-sampling study of SARS-CoV-2 in the ED and ICU of a hospital in Sydney.</div></div><div><h3>Measurements</h3><div>We sampled air, patient equipment, and personal protective equipment during two community COVID-19 epidemics. SARS-CoV-2 was detected using quantitative reverse transcription polymerase chain reaction (RT-qPCR). Carbon dioxide (CO<sub>2)</sub> was measured simultaneously, with <800 ppm indicating good air quality.</div></div><div><h3>Main results</h3><div>SARS-CoV-2 genetic material was detected in 39% of 51 aerosol samples, with mean CO<sub>2</sub> levels consistently <800 ppm for positive samples. The ED had more detections than the ICU (80% vs. 20%; p < 0.0027) and a higher mean CO<sub>2</sub> level than the ICU (669 ppm vs. 522 ppm; p < 0.05). The ED waiting room, acute ward, and ICU staff tearoom showed higher detection rates than the ICU ward area. SARS-CoV-2 was detected in air samples in the ED a week before an outbreak was declared, and both inside and outside a COVID-19 patient's negative-pressure ICU room, where high-flow nasal prongs and a glove tested positive.</div></div><div><h3>Conclusion</h3><div>During community epidemics, SARS-CoV-2 genetic material is detected in hospital air despite good ventilation. Enhanced protection with masks, vaccines, and portable air purifiers, especially in high-risk areas, may mitigate nosocomial transmission, including among staff. Air sampling can provide an early warning of an outbreak and help identify areas that need enhanced infection control.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108712"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202499","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}
Pub Date : 2026-03-01Epub Date: 2026-01-29DOI: 10.1016/j.rmed.2026.108693
Amit K. Mahajan , Duy K. Duong , Johanna Cortes , Krish Bhadra
Purpose
Robotic-assisted bronchoscopy (RAB) with embedded digital tomosynthesis (DT) provides real-time, intraoperative nodule localization. This study examines the performance of RAB with embedded DT and integrated AF to achieve tool-in-lesion (TIL) confirmation via cone beam computer tomography (CBCT).
Methods
This was a prospective, bicentric, single-arm, non-randomized observational trial. Thirty-one patients with peripheral pulmonary nodules underwent RAB with embedded DT. Navigation was guided by DT and augmented fluoroscopy (AF). Primary endpoints were successful navigation to target lesions and successful TIL as confirmed by CBCT. Secondary endpoints included diagnostic yield based on the strict Delphi consensus definition of diagnostic yield along with serious device or procedure-related adverse events.
Results
Thirty-one patients were enrolled across two sites. Thirty-one lung nodules were successfully biopsied. The mean lesion size measured by longest cross-sectional diameter was 16 mm (±6.7 mm). DT demonstrated TIL in 30 of 31 nodules (96.7 %), with one case resulting in tool-touching-lesion (TTL). Of the 30 nodules demonstrating TIL by DT, TIL was confirmed in 29 nodules by CBCT (concordance rate of 96.7 %). Overall TIL confirmed by CBCT was 29 of 31 nodules (93.5 %). A diagnosis was obtained in 30 of 31, resulting in a 96.7 % diagnostic yield by strict definition. Pneumothorax occurred in 1 of 31 cases (3 %).
Conclusions
RAB with embedded DT demonstrated a high rate of TIL confirmed by CBCT. The strong concordance between the DT with AF and CBCT demonstrates the reliability of DT and AF for real-time intraprocedural guidance.
{"title":"The match 2 study: Robotic assisted bronchoscopy with integrated imaging with assessment of digital tomosynthesis (DT) and augmented fluoroscopy (AF): Three-Dimensional accuracy as confirmed by cone beam computed tomography (CBCT)","authors":"Amit K. Mahajan , Duy K. Duong , Johanna Cortes , Krish Bhadra","doi":"10.1016/j.rmed.2026.108693","DOIUrl":"10.1016/j.rmed.2026.108693","url":null,"abstract":"<div><h3>Purpose</h3><div>Robotic-assisted bronchoscopy (RAB) with embedded digital tomosynthesis (DT) provides real-time, intraoperative nodule localization. This study examines the performance of RAB with embedded DT and integrated AF to achieve tool-in-lesion (TIL) confirmation via cone beam computer tomography (CBCT).</div></div><div><h3>Methods</h3><div>This was a prospective, bicentric, single-arm, non-randomized observational trial. Thirty-one patients with peripheral pulmonary nodules underwent RAB with embedded DT. Navigation was guided by DT and augmented fluoroscopy (AF). Primary endpoints were successful navigation to target lesions and successful TIL as confirmed by CBCT. Secondary endpoints included diagnostic yield based on the strict Delphi consensus definition of diagnostic yield along with serious device or procedure-related adverse events.</div></div><div><h3>Results</h3><div>Thirty-one patients were enrolled across two sites. Thirty-one lung nodules were successfully biopsied. The mean lesion size measured by longest cross-sectional diameter was 16 mm (±6.7 mm). DT demonstrated TIL in 30 of 31 nodules (96.7 %), with one case resulting in tool-touching-lesion (TTL). Of the 30 nodules demonstrating TIL by DT, TIL was confirmed in 29 nodules by CBCT (concordance rate of 96.7 %). Overall TIL confirmed by CBCT was 29 of 31 nodules (93.5 %). A diagnosis was obtained in 30 of 31, resulting in a 96.7 % diagnostic yield by strict definition. Pneumothorax occurred in 1 of 31 cases (3 %).</div></div><div><h3>Conclusions</h3><div>RAB with embedded DT demonstrated a high rate of TIL confirmed by CBCT. The strong concordance between the DT with AF and CBCT demonstrates the reliability of DT and AF for real-time intraprocedural guidance.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108693"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097155","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}
Pub Date : 2026-03-01Epub Date: 2026-02-04DOI: 10.1016/j.rmed.2026.108701
Jiahui Han , Yibo Yan , Zhongye Du , Haizhu Huang , Xuexin Yan , Chuanlin Zhou , Yanmei Lei , Shaochu Zheng , Chongxi Bao , Yun Jiang , Xiaopu Wu , Wei Lu , Yue Zhou , Liangmin Zhang , Rongquan He , Gang Chen , Jin Luo , Jinliang Kong
Background
Bronchiectasis is a chronic airway disease characterized by persistent inflammation and structural damage, with substantial clinical and etiologic heterogeneity. Although previous studies have identified associations between blood cells and bronchiectasis, the causal relationships remain unclear. Moreover, the mechanisms underlying blood cell perturbation responses and their potential mediation by immune cells in disease progression are largely unexplored.
Methods
Two-sample Mendelian randomization (MR) analysis was used to explore genetically predicted associations among immune cell traits, blood cell perturbation response phenotypes, and bronchiectasis, based on genome-wide association study summary data. Mediation MR analysis was further applied to assess whether immune cells mediate these associations. Multiple sensitivity analyses, including tests for heterogeneity and horizontal pleiotropy, were performed to evaluate the validity and robustness.
Results
Five blood cell perturbation response phenotypes and twenty-nine immune cell traits showed significant genetically predicted associations with bronchiectasis. Mediation analysis showed that natural killer (NK) cell absolute count partially mediated the causal effect between the eosinophil perturbation response and bronchiectasis, with a mediation proportion of 9.626%. CD38 on transitional B cells mediated the causal effect between the monocyte perturbation response and bronchiectasis, with a mediation proportion of 10.580%. Additionally, CD45 on NK cells played a mediating role in the association between the white blood cell perturbation response and bronchiectasis, with a mediation proportion of 10.651%.
Conclusion
This study systematically explores genetically predicted associations between blood cell perturbation responses and bronchiectasis and highlights potential immune-mediated pathways. These exploratory findings provide novel genetic insights into the pathogenesis of bronchiectasis and identify potential therapeutic targets for future strategies.
{"title":"Genetically predicted associations between blood cell perturbation responses and bronchiectasis through immune mediation: A Mendelian Randomization study","authors":"Jiahui Han , Yibo Yan , Zhongye Du , Haizhu Huang , Xuexin Yan , Chuanlin Zhou , Yanmei Lei , Shaochu Zheng , Chongxi Bao , Yun Jiang , Xiaopu Wu , Wei Lu , Yue Zhou , Liangmin Zhang , Rongquan He , Gang Chen , Jin Luo , Jinliang Kong","doi":"10.1016/j.rmed.2026.108701","DOIUrl":"10.1016/j.rmed.2026.108701","url":null,"abstract":"<div><h3>Background</h3><div>Bronchiectasis is a chronic airway disease characterized by persistent inflammation and structural damage, with substantial clinical and etiologic heterogeneity. Although previous studies have identified associations between blood cells and bronchiectasis, the causal relationships remain unclear. Moreover, the mechanisms underlying blood cell perturbation responses and their potential mediation by immune cells in disease progression are largely unexplored.</div></div><div><h3>Methods</h3><div>Two-sample Mendelian randomization (MR) analysis was used to explore genetically predicted associations among immune cell traits, blood cell perturbation response phenotypes, and bronchiectasis, based on genome-wide association study summary data. Mediation MR analysis was further applied to assess whether immune cells mediate these associations. Multiple sensitivity analyses, including tests for heterogeneity and horizontal pleiotropy, were performed to evaluate the validity and robustness.</div></div><div><h3>Results</h3><div>Five blood cell perturbation response phenotypes and twenty-nine immune cell traits showed significant genetically predicted associations with bronchiectasis. Mediation analysis showed that natural killer (NK) cell absolute count partially mediated the causal effect between the eosinophil perturbation response and bronchiectasis, with a mediation proportion of 9.626%. CD38 on transitional B cells mediated the causal effect between the monocyte perturbation response and bronchiectasis, with a mediation proportion of 10.580%. Additionally, CD45 on NK cells played a mediating role in the association between the white blood cell perturbation response and bronchiectasis, with a mediation proportion of 10.651%.</div></div><div><h3>Conclusion</h3><div>This study systematically explores genetically predicted associations between blood cell perturbation responses and bronchiectasis and highlights potential immune-mediated pathways. These exploratory findings provide novel genetic insights into the pathogenesis of bronchiectasis and identify potential therapeutic targets for future strategies.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108701"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126275","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}
Pub Date : 2026-03-01Epub Date: 2026-02-04DOI: 10.1016/j.rmed.2026.108699
Xiu-zhi Xu , Xi Chen , Rong Zheng , Guo-hong Huang , Zhu-zhu Wang , Xiao-qing Lv , Min Huang , Jing-fang Hong
Purpose
The aim of this study was to identify perceived cognitive impairment and its associated factors in patients newly diagnosed with lung cancer.
Methods
This cross-sectional analysis utilized pretreatment data sourced from an ongoing multicenter longitudinal investigation (registration: ChiCTR2300076232). A total of 340 participants were enrolled between September 2023 and March 2024 from two public hospitals in Anhui Province, China. The well-validated Chinese version of the FACT-Cog was used to collect the information of perceived cognitive function. Data on sociodemographic and clinical characteristics, as well as cancer-related symptoms were obtained through structured questionnaires and medical records.
Results
170 Patients newly diagnosed with lung cancer and 170 non-cancer controls matched in age and gender. Patients scored significantly lower on the FACT-Cog and four subscales than controls (all P < 0.05). The prevalence of perceived cognitive impairment in patients was 15.3%, which was significantly higher than 6.5% in controls (P = 0.009). Multivariate regression analysis revealed that fatigue [(95% CI: −2.527 ∼ −1.701); P < 0.001], gender [(95% CI: −15.722 ∼ −4.670); P < 0.001], age [(95% CI: −0.711 ∼ −0.082); P = 0.014] and depression [(95% CI: 0.222 ∼ 1.963); P = 0.014] emerged as significant predictors of perceived cognitive impairment, explaining 54.5% of the total variance (P < 0.001).
Conclusions
Patients newly diagnosed with lung cancer exhibited a significant decrement in cognitive function compared to controls. Healthcare professionals ought to provide prompt attention and implement early rehabilitative interventions to prevent further cognitive decline subsequent to the initiation of systemic treatment.
{"title":"Perceived cognitive impairment in patients newly diagnosed with lung cancer: a cross-sectional study","authors":"Xiu-zhi Xu , Xi Chen , Rong Zheng , Guo-hong Huang , Zhu-zhu Wang , Xiao-qing Lv , Min Huang , Jing-fang Hong","doi":"10.1016/j.rmed.2026.108699","DOIUrl":"10.1016/j.rmed.2026.108699","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to identify perceived cognitive impairment and its associated factors in patients newly diagnosed with lung cancer.</div></div><div><h3>Methods</h3><div>This cross-sectional analysis utilized pretreatment data sourced from an ongoing multicenter longitudinal investigation (registration: ChiCTR2300076232). A total of 340 participants were enrolled between September 2023 and March 2024 from two public hospitals in Anhui Province, China. The well-validated Chinese version of the FACT-Cog was used to collect the information of perceived cognitive function. Data on sociodemographic and clinical characteristics, as well as cancer-related symptoms were obtained through structured questionnaires and medical records.</div></div><div><h3>Results</h3><div>170 Patients newly diagnosed with lung cancer and 170 non-cancer controls matched in age and gender. Patients scored significantly lower on the FACT-Cog and four subscales than controls (all <em>P</em> < 0.05). The prevalence of perceived cognitive impairment in patients was 15.3%, which was significantly higher than 6.5% in controls (<em>P</em> = 0.009). Multivariate regression analysis revealed that fatigue [(95% CI: −2.527 ∼ −1.701); <em>P</em> < 0.001], gender [(95% CI: −15.722 ∼ −4.670); <em>P</em> < 0.001], age [(95% CI: −0.711 ∼ −0.082); <em>P</em> = 0.014] and depression [(95% CI: 0.222 ∼ 1.963); <em>P</em> = 0.014] emerged as significant predictors of perceived cognitive impairment, explaining 54.5% of the total variance (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Patients newly diagnosed with lung cancer exhibited a significant decrement in cognitive function compared to controls. Healthcare professionals ought to provide prompt attention and implement early rehabilitative interventions to prevent further cognitive decline subsequent to the initiation of systemic treatment.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108699"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132639","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}
Pub Date : 2026-03-01Epub Date: 2026-02-05DOI: 10.1016/j.rmed.2026.108706
Wen Luo , Zhenzhen Yu , Yongcai Zhang , Dingnan Lin , Wanyu Wang , Chen Wang
Background
Systemic inflammation, nutritional depletion, and immune dysregulation are common in asthma, yet no composite indicator has been prospectively linked to long-term survival; accordingly, the association between the C-Reactive Protein-Albumin-Lymphocyte (CALLY) index and all-cause mortality in U.S. adults with asthma was examined.
Methods
We analyzed 3887 asthma participants aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 1999–2010, linked to the National Death Index (NDI) through December 2019. Cox regression estimated hazard ratios (HR) per CALLY quartile and per one-unit increase in In-transformed CALLY, adjusting for sociodemographic, lifestyle and comorbidity covariates. Non-linearity was assessed with restricted cubic splines; subgroup analyses tested effect consistency.
Results
During a median 157 months, 729 deaths occurred (18.8% mortality). Higher CALLY was associated with younger age, lower BMI and fewer comorbidities. After full adjustment, each unit increase in CALLY conferred a 19% lower mortality risk (HR 0.81, 95 % CI 0.76–0.86). The dose-response gradient remained linear across the entire distribution, and the inverse association was consistently observed across all predefined strata.
Conclusion
In this cohort, a higher CALLY index was independently associated with lower all-cause mortality among adults with asthma; prospective studies are warranted to confirm this association.
背景：全身性炎症、营养消耗和免疫失调在哮喘中很常见，但目前还没有与长期生存相关的综合指标；因此，研究了美国成人哮喘患者c反应蛋白-白蛋白淋巴细胞（CALLY）指数与全因死亡率之间的关系。方法：我们分析了1999-2010年国家健康与营养调查（NHANES）中3887名年龄≥18岁的哮喘参与者，该调查与截至2019年12月的国家死亡指数（NDI）相关。Cox回归估计了每个CALLY四分位数的风险比（HR）和转化后的CALLY每增加一个单位的风险比（HR），调整了社会人口统计学、生活方式和合并症协变量。用受限三次样条评价非线性；亚组分析检验了效果的一致性。结果：中位157个月期间，发生729例死亡（死亡率18.8%）。较高的CALLY与更年轻、更低的BMI和更少的合并症有关。完全调整后，CALLY每增加一个单位，死亡风险降低19% （HR 0.81, 95% CI 0.76-0.86）。剂量-响应梯度在整个分布中保持线性，并且在所有预定义的地层中一致观察到反向关联。结论：在该队列中，较高的CALLY指数与成人哮喘患者较低的全因死亡率独立相关；有必要进行前瞻性研究来证实这种联系。
{"title":"The C-Reactive Protein-Albumin-Lymphocyte (CALLY) index and all-cause mortality in adults with Asthma: A cohort study using NHANES 1999–2010","authors":"Wen Luo , Zhenzhen Yu , Yongcai Zhang , Dingnan Lin , Wanyu Wang , Chen Wang","doi":"10.1016/j.rmed.2026.108706","DOIUrl":"10.1016/j.rmed.2026.108706","url":null,"abstract":"<div><h3>Background</h3><div>Systemic inflammation, nutritional depletion, and immune dysregulation are common in asthma, yet no composite indicator has been prospectively linked to long-term survival; accordingly, the association between the C-Reactive Protein-Albumin-Lymphocyte (CALLY) index and all-cause mortality in U.S. adults with asthma was examined.</div></div><div><h3>Methods</h3><div>We analyzed 3887 asthma participants aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 1999–2010, linked to the National Death Index (NDI) through December 2019. Cox regression estimated hazard ratios (HR) per CALLY quartile and per one-unit increase in In-transformed CALLY, adjusting for sociodemographic, lifestyle and comorbidity covariates. Non-linearity was assessed with restricted cubic splines; subgroup analyses tested effect consistency.</div></div><div><h3>Results</h3><div>During a median 157 months, 729 deaths occurred (18.8% mortality). Higher CALLY was associated with younger age, lower BMI and fewer comorbidities. After full adjustment, each unit increase in CALLY conferred a 19% lower mortality risk (HR 0.81, 95 % CI 0.76–0.86). The dose-response gradient remained linear across the entire distribution, and the inverse association was consistently observed across all predefined strata.</div></div><div><h3>Conclusion</h3><div>In this cohort, a higher CALLY index was independently associated with lower all-cause mortality among adults with asthma; prospective studies are warranted to confirm this association.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108706"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137807","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}
Amikacin (AMK) is a widely used therapeutic drug monitoring (TDM)-recommended treatment for nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its optimal dosage and TDM target remain unclear. In this study, we aimed to clarify the relationship between AMK exposure, ototoxicity, and efficacy.
Methods
Patients with NTM-PD treated with AMK at Fukujuji Hospital were retrospectively included in this study. The correlation between AMK exposure, measured by peak and trough levels and the area under the concentration-time curve (AUC), ototoxicity, and culture conversion was analyzed using the Mann–Whitney U test and Cox regression analysis. A population pharmacokinetic/pharmacodynamic (PPK/PD) model was developed to predict ototoxicity using TDM measurements.
Results
A total of 185 patients were enrolled. The median AMK dose and observation period were 500 (interquartile range [IQR], 500–600) mg/day and 45.8 (IQR, 31.3–76.5) months, respectively. Ototoxicity and culture conversion were observed in 39% and 54% of the enrolled patients, respectively, after initiating AMK. The median time to the development of ototoxicity was 69 (IQR; 43–97) days. Neither ototoxicity nor culture conversion was associated with pharmacokinetic parameter of AMK exposure, including its minimum inhibitory concentration. However, the cumulative AUC was significantly higher in patients who developed ototoxicity (P < 0.001) than in those without ototoxicity. The developed PPK/PD model enabled calculation of cumulative AUC from TDM data and prediction of ototoxicity onset.
Conclusion
Cumulative AMK exposure was associated with ototoxicity, and our findings allow prediction of ototoxicity onset using AMK TDM data.
{"title":"Amikacin exposure and its association with ototoxicity and efficacy in nontuberculous mycobacterial pulmonary disease treatment","authors":"Fumiya Watanabe , Tatsuya Kodama , Masashi Ito , Koji Furuuchi , Keiji Fujiwara , Keisuke Kamada , Takashi Ohe , Eriko Hachikawa , Kazuhiko Hanada , Kozo Morimoto","doi":"10.1016/j.rmed.2026.108708","DOIUrl":"10.1016/j.rmed.2026.108708","url":null,"abstract":"<div><h3>Purpose</h3><div>Amikacin (AMK) is a widely used therapeutic drug monitoring (TDM)-recommended treatment for nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its optimal dosage and TDM target remain unclear. In this study, we aimed to clarify the relationship between AMK exposure, ototoxicity, and efficacy.</div></div><div><h3>Methods</h3><div>Patients with NTM-PD treated with AMK at Fukujuji Hospital were retrospectively included in this study. The correlation between AMK exposure, measured by peak and trough levels and the area under the concentration-time curve (AUC), ototoxicity, and culture conversion was analyzed using the Mann–Whitney <em>U</em> test and Cox regression analysis. A population pharmacokinetic/pharmacodynamic (PPK/PD) model was developed to predict ototoxicity using TDM measurements.</div></div><div><h3>Results</h3><div>A total of 185 patients were enrolled. The median AMK dose and observation period were 500 (interquartile range [IQR], 500–600) mg/day and 45.8 (IQR, 31.3–76.5) months, respectively. Ototoxicity and culture conversion were observed in 39% and 54% of the enrolled patients, respectively, after initiating AMK. The median time to the development of ototoxicity was 69 (IQR; 43–97) days. Neither ototoxicity nor culture conversion was associated with pharmacokinetic parameter of AMK exposure, including its minimum inhibitory concentration. However, the cumulative AUC was significantly higher in patients who developed ototoxicity (<em>P</em> < 0.001) than in those without ototoxicity. The developed PPK/PD model enabled calculation of cumulative AUC from TDM data and prediction of ototoxicity onset.</div></div><div><h3>Conclusion</h3><div>Cumulative AMK exposure was associated with ototoxicity, and our findings allow prediction of ototoxicity onset using AMK TDM data.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108708"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143329","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}
Adherence to inhaled therapy remains a persistent challenge in asthma management and continues to compromise disease control in routine clinical practice. Although data from Greece are limited, international evidence indicates that a substantial proportion of patients do not use their inhalers consistently or as prescribed. Suboptimal adherence is associated with avoidable exacerbations, loss of lung function, increased healthcare utilization, and inappropriate escalation of therapy, including early introduction of biologic agents. This narrative review examines recent evidence on behavioral, treatment-related, and healthcare-system factors influencing adherence to inhaled therapy in asthma, with particular attention to the Greek healthcare environment. Findings from clinical trials, meta-analyses, and real-world studies published between 2018 and 2025 are synthesized to identify determinants of adherence, methods of assessment, and strategies that support sustained treatment engagement. Across studies, adherence rates typically range between 30% and 60%, with major barriers including limited understanding of asthma as a chronic condition, concerns about inhaled corticosteroids, complex dosing regimens, and persistent inhaler technique errors. These challenges are often compounded by system-level constraints such as brief consultations and fragmented follow-up. Simplified treatment strategies, particularly once-daily inhaled corticosteroid/long-acting β2-agonist regimens and single maintenance and reliever therapy approaches, are consistently associated with more regular medication use. Pharmacist-led interventions improve inhaler technique and daily adherence, while digital inhaler technologies support early identification of non-adherence, although their implementation in Greece remains limited. Improving adherence requires coordinated, patient-centered care that integrates behavioral support, appropriate inhaler selection, simplified regimens, and targeted use of digital monitoring within existing healthcare pathways.
{"title":"Optimizing adherence to inhaled therapy in asthma: Behavioral and digital strategies with insights from the Greek healthcare context","authors":"Christelos Kapatais , Andriana I. Papaioannou , Evangelia Fouka , Konstantinos Samitas , Stavros Tryfon , Konstantinos Porpodis , Katerina M. Antoniou , Eleftherios Zervas , Petros Bakakos , Stylianos Loukides , Nikoletta Rovina","doi":"10.1016/j.rmed.2026.108709","DOIUrl":"10.1016/j.rmed.2026.108709","url":null,"abstract":"<div><div>Adherence to inhaled therapy remains a persistent challenge in asthma management and continues to compromise disease control in routine clinical practice. Although data from Greece are limited, international evidence indicates that a substantial proportion of patients do not use their inhalers consistently or as prescribed. Suboptimal adherence is associated with avoidable exacerbations, loss of lung function, increased healthcare utilization, and inappropriate escalation of therapy, including early introduction of biologic agents. This narrative review examines recent evidence on behavioral, treatment-related, and healthcare-system factors influencing adherence to inhaled therapy in asthma, with particular attention to the Greek healthcare environment. Findings from clinical trials, meta-analyses, and real-world studies published between 2018 and 2025 are synthesized to identify determinants of adherence, methods of assessment, and strategies that support sustained treatment engagement. Across studies, adherence rates typically range between 30% and 60%, with major barriers including limited understanding of asthma as a chronic condition, concerns about inhaled corticosteroids, complex dosing regimens, and persistent inhaler technique errors. These challenges are often compounded by system-level constraints such as brief consultations and fragmented follow-up. Simplified treatment strategies, particularly once-daily inhaled corticosteroid/long-acting β<sub>2</sub>-agonist regimens and single maintenance and reliever therapy approaches, are consistently associated with more regular medication use. Pharmacist-led interventions improve inhaler technique and daily adherence, while digital inhaler technologies support early identification of non-adherence, although their implementation in Greece remains limited. Improving adherence requires coordinated, patient-centered care that integrates behavioral support, appropriate inhaler selection, simplified regimens, and targeted use of digital monitoring within existing healthcare pathways.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108709"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146181953","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}
Pub Date : 2026-03-01Epub Date: 2026-01-30DOI: 10.1016/j.rmed.2026.108673
Ziad T. Baki , Mustafa A. Alameri , Sushil K. Singhi
Purpose
Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea, but adherence remains suboptimal. Subjective symptoms such as excessive daytime sleepiness may influence motivation to maintain therapy. This study examined whether baseline Epworth Sleepiness Scale (ESS) scores predict early CPAP adherence compared with objective measures such as the Apnea-Hypopnea Index (AHI).
Methods
We conducted a retrospective observational study of 400 adults with Obstructive Sleep Apnea prescribed CPAP between 2021 and 2023. Thirty days of CPAP adherence data was downloaded and categorized into five ordinal groups ranging from very low to very high adherence. Associations between ESS and adherence were assessed using chi-square tests, Goodman and Kruskal's gamma, and ordinal logistic regression adjusted for AHI, age, sex, and body mass index.
Results
Higher ESS scores were significantly associated with greater adherence (χ2 = 28.7, P = 0.026; gamma = 0.199). Ordinal regression showed each 1-point increase predicted 7.4% higher odds of being in a greater adherence category (OR 1.072, 95% CI 1.027–1.117, P < 0.001). Age modestly predicted adherence (OR 1.010, P = 0.019). AHI, body mass index, and sex were not significant predictors. Patients with severe daytime sleepiness had the highest rates of excellent adherence (>90%).
Conclusion
Although causality cannot be inferred from a retrospective design, higher subjective sleepiness, measured by ESS, was associated with higher early adherence. Incorporating ESS into routine evaluation may identify patients at risk for nonadherence and guide targeted interventions.
目的：持续气道正压通气（CPAP）治疗是阻塞性睡眠呼吸暂停的金标准治疗，但依从性仍不理想。主观症状如白天过度嗜睡可能影响维持治疗的动机。本研究考察了基线Epworth嗜睡量表（ESS）评分与呼吸暂停低通气指数（AHI）等客观指标相比，是否能预测早期CPAP依从性。方法：我们对2021年至2023年间400名患有阻塞性睡眠呼吸暂停的成年人进行了回顾性观察研究。下载30天的CPAP依从性数据，并将其分为从非常低到非常高依从性的五个顺序组。采用卡方检验、Goodman和Kruskal伽玛，并根据AHI、年龄、性别和体重指数调整有序逻辑回归，评估ESS与依从性之间的关系。结果：ESS评分越高，依从性越高（χ2=28.7， P=0.026; gamma=0.199）。序数回归显示，每增加1点，进入更强依从性类别的几率将增加7.4% （OR 1.072, 95% CI 1.027-1.117, P90%）。结论：虽然不能从回顾性设计中推断出因果关系，但ESS测量的较高的主观困倦与较高的早期依从性相关。将ESS纳入常规评估可以识别有不依从风险的患者，并指导有针对性的干预措施。
{"title":"Association between Epworth Sleepiness Scores and CPAP compliance in patients with obstructive sleep apnea","authors":"Ziad T. Baki , Mustafa A. Alameri , Sushil K. Singhi","doi":"10.1016/j.rmed.2026.108673","DOIUrl":"10.1016/j.rmed.2026.108673","url":null,"abstract":"<div><h3>Purpose</h3><div>Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea, but adherence remains suboptimal. Subjective symptoms such as excessive daytime sleepiness may influence motivation to maintain therapy. This study examined whether baseline Epworth Sleepiness Scale (ESS) scores predict early CPAP adherence compared with objective measures such as the Apnea-Hypopnea Index (AHI).</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of 400 adults with Obstructive Sleep Apnea prescribed CPAP between 2021 and 2023. Thirty days of CPAP adherence data was downloaded and categorized into five ordinal groups ranging from very low to very high adherence. Associations between ESS and adherence were assessed using chi-square tests, Goodman and Kruskal's gamma, and ordinal logistic regression adjusted for AHI, age, sex, and body mass index.</div></div><div><h3>Results</h3><div>Higher ESS scores were significantly associated with greater adherence (χ<sup>2</sup> = 28.7, P = 0.026; gamma = 0.199). Ordinal regression showed each 1-point increase predicted 7.4% higher odds of being in a greater adherence category (OR 1.072, 95% CI 1.027–1.117, P < 0.001). Age modestly predicted adherence (OR 1.010, P = 0.019). AHI, body mass index, and sex were not significant predictors. Patients with severe daytime sleepiness had the highest rates of excellent adherence (>90%).</div></div><div><h3>Conclusion</h3><div>Although causality cannot be inferred from a retrospective design, higher subjective sleepiness, measured by ESS, was associated with higher early adherence. Incorporating ESS into routine evaluation may identify patients at risk for nonadherence and guide targeted interventions.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"253 ","pages":"Article 108673"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100446","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}
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