Pub Date : 2025-05-08DOI: 10.1016/j.paed.2025.04.002
Wei Yen Evelyn Chia
Vascular access in children is often challenging, especially in difficult intravenous access (DIVA) patients. Identifying the vascular access needed and planning insertion points carefully to maximize success and minimize patient distress is key. Although some alternative treatment options are available, a wide array of treatment care pathways are reliant on vascular access. Choosing the right vascular access device, its size and insertion point to fit the needs and condition of the patient adds complexity to decision making for the clinician. This article discusses tips for and the practicalities of obtaining and maintaining vascular access in paediatric patients, with a special focus on ultrasound-guided vascular access.
{"title":"Managing difficult intravenous access: obtaining and maintaining paediatric vascular access","authors":"Wei Yen Evelyn Chia","doi":"10.1016/j.paed.2025.04.002","DOIUrl":"10.1016/j.paed.2025.04.002","url":null,"abstract":"<div><div>Vascular access in children is often challenging, especially in difficult intravenous access (DIVA) patients. Identifying the vascular access needed and planning insertion points carefully to maximize success and minimize patient distress is key. Although some alternative treatment options are available, a wide array of treatment care pathways are reliant on vascular access. Choosing the right vascular access device, its size and insertion point to fit the needs and condition of the patient adds complexity to decision making for the clinician. This article discusses tips for and the practicalities of obtaining and maintaining vascular access in paediatric patients, with a special focus on ultrasound-guided vascular access.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 6","pages":"Pages 188-195"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute kidney injury (AKI) and chronic kidney disease (CKD) are significant concerns in paediatric intensive care units (PICUs), with AKI affecting up to 50% of critically ill children. Renal replacement therapy (RRT) is essential for managing these conditions, with available modalities including intermittent haemodialysis (IHD), continuous renal replacement therapy (CRRT), and peritoneal dialysis (PD). This article defines AKI and CKD based on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and outlines the key indications for RRT, such as severe electrolyte abnormalities, fluid overload exceeding 10%, metabolic acidosis and toxin clearance. The fundamental principles of solute clearance in RRT—including diffusion, ultrafiltration, convection, and adsorption—are explained. Additionally, the article reviews essential considerations such as vascular access, anticoagulation strategies and the unique challenges of RRT in neonates and children requiring extracorporeal life support (ECLS). CRRT allows precise and gradual solute and fluid removal, making it ideal for haemodynamically unstable patients. However, it requires an extracorporeal circuit, large-bore vascular access and anticoagulation which can pose challenges, particularly in neonates. In contrast, PD can be initiated quickly via a percutaneous catheter, avoiding the risks associated with central venous access (thrombosis and bleeding). Conversely PD solute and fluid clearance rates are less effective than CRRT, and it is unsuitable for patients with recent abdominal surgery or congenital anomalies. The choice of RRT modality depends on the child's clinical condition, available resources, and institutional expertise. This review highlights the need for individualised RRT strategies to improve outcomes and survival in critically ill children.
{"title":"Renal replacement therapy in the paediatric intensive care unit","authors":"Rajalakshmi Iyer, Nalaayeni Kanesan, Oluwaseun Ajayi, Arun Ghose","doi":"10.1016/j.paed.2025.04.006","DOIUrl":"10.1016/j.paed.2025.04.006","url":null,"abstract":"<div><div>Acute kidney injury (AKI) and chronic kidney disease (CKD) are significant concerns in paediatric intensive care units (PICUs), with AKI affecting up to 50% of critically ill children. Renal replacement therapy (RRT) is essential for managing these conditions, with available modalities including intermittent haemodialysis (IHD), continuous renal replacement therapy (CRRT), and peritoneal dialysis (PD). This article defines AKI and CKD based on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and outlines the key indications for RRT, such as severe electrolyte abnormalities, fluid overload exceeding 10%, metabolic acidosis and toxin clearance. The fundamental principles of solute clearance in RRT—including diffusion, ultrafiltration, convection, and adsorption—are explained. Additionally, the article reviews essential considerations such as vascular access, anticoagulation strategies and the unique challenges of RRT in neonates and children requiring extracorporeal life support (ECLS). CRRT allows precise and gradual solute and fluid removal, making it ideal for haemodynamically unstable patients. However, it requires an extracorporeal circuit, large-bore vascular access and anticoagulation which can pose challenges, particularly in neonates. In contrast, PD can be initiated quickly via a percutaneous catheter, avoiding the risks associated with central venous access (thrombosis and bleeding). Conversely PD solute and fluid clearance rates are less effective than CRRT, and it is unsuitable for patients with recent abdominal surgery or congenital anomalies. The choice of RRT modality depends on the child's clinical condition, available resources, and institutional expertise. This review highlights the need for individualised RRT strategies to improve outcomes and survival in critically ill children.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 6","pages":"Pages 196-202"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.paed.2025.02.001
Elizabeth Liew, William P Whitehouse
Headache in children has a wide differential, from benign, tension-type headaches to secondary headache caused by a brain tumour. We review the categories of primary and secondary headache disorders, and discuss practical approaches to the history, examination, and when to request further investigations such as brain imaging. Approaches to treatment especially of migraine and other primary headache disorders are discussed, as is service configuration. We have signposted useful resources such as NICE guidelines and quality standards, the International Headache Society's International Classification of Headache Disorders, the Migraine Trust charity, and a review of new and emerging therapies. Headache can be a terrible burden for children and worry for parents, but is a fascinating and generally rewarding field to work in.
{"title":"How to assess and manage headache in children: the basics","authors":"Elizabeth Liew, William P Whitehouse","doi":"10.1016/j.paed.2025.02.001","DOIUrl":"10.1016/j.paed.2025.02.001","url":null,"abstract":"<div><div>Headache in children has a wide differential, from benign, tension-type headaches to secondary headache caused by a brain tumour. We review the categories of primary and secondary headache disorders, and discuss practical approaches to the history, examination, and when to request further investigations such as brain imaging. Approaches to treatment especially of migraine and other primary headache disorders are discussed, as is service configuration. We have signposted useful resources such as NICE guidelines and quality standards, the International Headache Society's International Classification of Headache Disorders, the Migraine Trust charity, and a review of new and emerging therapies. Headache can be a terrible burden for children and worry for parents, but is a fascinating and generally rewarding field to work in.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 125-133"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.paed.2025.02.005
Alison Skippen, Rohini Rattihalli
Over the last year, new Medicines and Healthcare products Regulatory Agency (MHRA) regulations for the use of sodium valproate in females and males have had a significant impact on clinical practice. This article uses a case as an anchor, to understand what these regulations mean in clinical practice. We highlight that knowledge about the regulations, together with a holistic view of the patient is important to choose the most effective and tolerated medication. Professional guidelines which offer valuable support with the practicalities are highlighted in the further reading sections.
{"title":"Beyond valproate: considerations for the general paediatrician","authors":"Alison Skippen, Rohini Rattihalli","doi":"10.1016/j.paed.2025.02.005","DOIUrl":"10.1016/j.paed.2025.02.005","url":null,"abstract":"<div><div>Over the last year, new Medicines and Healthcare products Regulatory Agency (MHRA) regulations for the use of sodium valproate in females and males have had a significant impact on clinical practice. This article uses a case as an anchor, to understand what these regulations mean in clinical practice. We highlight that knowledge about the regulations, together with a holistic view of the patient is important to choose the most effective and tolerated medication. Professional guidelines which offer valuable support with the practicalities are highlighted in the further reading sections.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 152-154"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.paed.2025.02.002
Vijay Palanivel, Tim Grove, Melanie Burrough
The field of paediatric neurorehabilitation is undergoing significant transformation, driven by evolving care pathways, innovative technologies, and a growing emphasis on addressing health disparities. Children and young people (CYP) with acquired brain injuries (ABI) benefit from rehabilitation that optimizes their participation in daily life across home, school, and community settings. This paper explores the changing landscape of paediatric neurorehabilitation and changing patterns of causes of brain injury in children. The discussion extends to health inequalities that affect access to care, underscoring the need for system-wide reforms to bridge disparities linked to socioeconomic, geographic, and cultural factors. The development of seamless, end-to-end service pathways, from acute care to specialist tertiary neurorehabilitation and onward community services, demonstrates the potential for integrated care to improve outcomes for CYP transitioning from hospital to home. Central to effective rehabilitation is personalized goal setting and high-intensity treatments, which enhance physical, cognitive, and social outcomes. Technological advancements, including virtual reality, robotics, and electrical muscle stimulation, are reshaping therapeutic approaches, increasing engagement, and fostering neuroplasticity. Findings advocate for ongoing research, investment in community services, and equitable application of emerging technologies. By prioritizing personalized care and addressing systemic barriers, the future of paediatric neurorehabilitation holds promise for improved long-term functional outcomes for children with ABI.
{"title":"Revolutionizing paediatric neurorehabilitation: integrating innovation and contemporary practice","authors":"Vijay Palanivel, Tim Grove, Melanie Burrough","doi":"10.1016/j.paed.2025.02.002","DOIUrl":"10.1016/j.paed.2025.02.002","url":null,"abstract":"<div><div>The field of paediatric neurorehabilitation is undergoing significant transformation, driven by evolving care pathways, innovative technologies, and a growing emphasis on addressing health disparities. Children and young people (CYP) with acquired brain injuries (ABI) benefit from rehabilitation that optimizes their participation in daily life across home, school, and community settings. This paper explores the changing landscape of paediatric neurorehabilitation and changing patterns of causes of brain injury in children. The discussion extends to health inequalities that affect access to care, underscoring the need for system-wide reforms to bridge disparities linked to socioeconomic, geographic, and cultural factors. The development of seamless, end-to-end service pathways, from acute care to specialist tertiary neurorehabilitation and onward community services, demonstrates the potential for integrated care to improve outcomes for CYP transitioning from hospital to home. Central to effective rehabilitation is personalized goal setting and high-intensity treatments, which enhance physical, cognitive, and social outcomes. Technological advancements, including virtual reality, robotics, and electrical muscle stimulation, are reshaping therapeutic approaches, increasing engagement, and fostering neuroplasticity. Findings advocate for ongoing research, investment in community services, and equitable application of emerging technologies. By prioritizing personalized care and addressing systemic barriers, the future of paediatric neurorehabilitation holds promise for improved long-term functional outcomes for children with ABI.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 134-139"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.paed.2025.02.004
Yoshua C. Collins-Sawaragi, Evangeline Wassmer
Childhood demyelination is a condition that all paediatricians will see either presenting as encephalopathy from Acute Disseminated Encephalomyelitis (ADEM) or neurological deficits such as with optic neuritis (ON) or transverse myelitis (TM) amongst other presentations. We discuss the various types of demyelinating conditions including MOG antibody disease (MOGAD), NMO spectrum disorder (NMOSD) and Paediatric onset Multiple Sclerosis (POMS) and how these conditions present, how these should be investigated, the differentials to consider when faced with a patient with acute neurological deficit and the acute and long-term management for paediatric patients with demyelinating conditions.
{"title":"Acute neurological deficit: is it demyelination? Review of demyelinating disorders of the central nervous system","authors":"Yoshua C. Collins-Sawaragi, Evangeline Wassmer","doi":"10.1016/j.paed.2025.02.004","DOIUrl":"10.1016/j.paed.2025.02.004","url":null,"abstract":"<div><div>Childhood demyelination is a condition that all paediatricians will see either presenting as encephalopathy from Acute Disseminated Encephalomyelitis (ADEM) or neurological deficits such as with optic neuritis (ON) or transverse myelitis (TM) amongst other presentations. We discuss the various types of demyelinating conditions including MOG antibody disease (MOGAD), NMO spectrum disorder (NMOSD) and Paediatric onset Multiple Sclerosis (POMS) and how these conditions present, how these should be investigated, the differentials to consider when faced with a patient with acute neurological deficit and the acute and long-term management for paediatric patients with demyelinating conditions.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 146-151"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.paed.2025.02.007
Ogechukwu Okpala, Manali Chitre
Epileptic encephalopathies (EE) and developmental and epileptic encephalopathies (DEE) are a group of severe brain disorders in which epileptic electrical discharge contributes to progressive psychomotor dysfunction. These include rare but important conditions such as neonatal epileptic encephalopathy, West, Dravet, Lennox Gastaut and Landau Kleffner syndromes. These conditions result in a characteristic cluster of clinical, EEG and aetiological features which together, help us understand the condition, use more targeted therapies and prognosticate with regards to progression with age. Electroencephalography (EEG) is crucial in determining the causative epilepsy syndrome. Since the availability of next generation sequencing, genetic testing has assumed increasing importance in the diagnosis of specific syndromes. Multidisciplinary support from medical, nursing and therapy teams is essential in helping these children reach the best of their abilities, skills and to optimize their long-term outcomes. In this article we describe some of the more commonly seen EE/DEE and discuss management and prognosis of these.
{"title":"Developmental and epileptic encephalopathies: the clinical approach to investigation and management","authors":"Ogechukwu Okpala, Manali Chitre","doi":"10.1016/j.paed.2025.02.007","DOIUrl":"10.1016/j.paed.2025.02.007","url":null,"abstract":"<div><div>Epileptic encephalopathies (EE) and developmental and epileptic encephalopathies (DEE) are a group of severe brain disorders in which epileptic electrical discharge contributes to progressive psychomotor dysfunction. These include rare but important conditions such as neonatal epileptic encephalopathy, West, Dravet, Lennox Gastaut and Landau Kleffner syndromes. These conditions result in a characteristic cluster of clinical, EEG and aetiological features which together, help us understand the condition, use more targeted therapies and prognosticate with regards to progression with age. Electroencephalography (EEG) is crucial in determining the causative epilepsy syndrome. Since the availability of next generation sequencing, genetic testing has assumed increasing importance in the diagnosis of specific syndromes. Multidisciplinary support from medical, nursing and therapy teams is essential in helping these children reach the best of their abilities, skills and to optimize their long-term outcomes. In this article we describe some of the more commonly seen EE/DEE and discuss management and prognosis of these.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 163-170"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.paed.2025.02.008
Nee Na Kim, Asthik Biswas, Cheryl Hemingway
Inherited white matter disorders (IWMDs), otherwise known as leukodystrophies, represent a group of rare and heterogenous neurological conditions affecting the white matter of the central nervous system (CNS). With a wide range of differential diagnoses and associated medical complexities, they often pose a diagnostic challenge to clinicians. Rapid technological advancement including the availability of genetic investigations such as whole genome sequencing (WGS) is leading to an increasing number of patients with a confirmed genetic diagnosis. For the majority of IWMDs there is no specific treatment, and the focus of clinical management remains symptomatic and involves a multidisciplinary team and holistic approaches. Up until recently, only natural history trials were available, but now the focus is shifting to novel targeted therapies. Early diagnosis and prompt referral to specialized IWMD centers is crucial for optimum management of affected children or asymptomatic affected siblings. Collaborative efforts are needed to achieve two important goals 1) to establish international patient registries for long term natural history and recruitment to new treatment trials and 2) to encourage wider newborn screening programmes for early detection of these rare diseases at the asymptomatic stage. In this review, we aim to summarise the common clinical presentations, diagnostic investigations, management and prognosis of the more commonly encountered inherited white matter disorders in children.
{"title":"Inherited white matter disorders in children","authors":"Nee Na Kim, Asthik Biswas, Cheryl Hemingway","doi":"10.1016/j.paed.2025.02.008","DOIUrl":"10.1016/j.paed.2025.02.008","url":null,"abstract":"<div><div>Inherited white matter disorders (IWMDs), otherwise known as leukodystrophies, represent a group of rare and heterogenous neurological conditions affecting the white matter of the central nervous system (CNS). With a wide range of differential diagnoses and associated medical complexities, they often pose a diagnostic challenge to clinicians. Rapid technological advancement including the availability of genetic investigations such as whole genome sequencing (WGS) is leading to an increasing number of patients with a confirmed genetic diagnosis. For the majority of IWMDs there is no specific treatment, and the focus of clinical management remains symptomatic and involves a multidisciplinary team and holistic approaches. Up until recently, only natural history trials were available, but now the focus is shifting to novel targeted therapies. Early diagnosis and prompt referral to specialized IWMD centers is crucial for optimum management of affected children or asymptomatic affected siblings. Collaborative efforts are needed to achieve two important goals 1) to establish international patient registries for long term natural history and recruitment to new treatment trials and 2) to encourage wider newborn screening programmes for early detection of these rare diseases at the asymptomatic stage. In this review, we aim to summarise the common clinical presentations, diagnostic investigations, management and prognosis of the more commonly encountered inherited white matter disorders in children.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 171-179"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.paed.2025.02.006
Hanna Richardson, Rachel Gwynn, Parisha Chadha, Penny Andreou, Karen Ray, Clare Rapier, Catherine Swales, Sarah Aylett
Neurocutaneous syndromes are rare, genetically derived conditions which show characteristic dermatological and neurological features, the most common being Neurofibromatosis type 1, Tuberous Sclerosis Complex and Sturge Weber syndrome. These conditions are medically complex, often involving a number of bodily systems, but are also often associated with developmental differences. Medical and developmental care often involves a large number of professionals. Maintaining a holistic overview of care and ensuring clear communication between teams are essential to ensure that the needs of the child or young person are met in an appropriate and timely way. In this article, we present an approach to the multidisciplinary care of a child and young person with a neurocutaneous condition, taking into account both medical and developmental needs.
{"title":"Neurocutaneous syndromes: a multidisciplinary team approach","authors":"Hanna Richardson, Rachel Gwynn, Parisha Chadha, Penny Andreou, Karen Ray, Clare Rapier, Catherine Swales, Sarah Aylett","doi":"10.1016/j.paed.2025.02.006","DOIUrl":"10.1016/j.paed.2025.02.006","url":null,"abstract":"<div><div>Neurocutaneous syndromes are rare, genetically derived conditions which show characteristic dermatological and neurological features, the most common being Neurofibromatosis type 1, Tuberous Sclerosis Complex and Sturge Weber syndrome. These conditions are medically complex, often involving a number of bodily systems, but are also often associated with developmental differences. Medical and developmental care often involves a large number of professionals. Maintaining a holistic overview of care and ensuring clear communication between teams are essential to ensure that the needs of the child or young person are met in an appropriate and timely way. In this article, we present an approach to the multidisciplinary care of a child and young person with a neurocutaneous condition, taking into account both medical and developmental needs.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 155-162"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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