Toxic epidermal necrolysis (TEN) can lead to various extracutaneous complications, including respiratory involvement. We present a case of a patient who developed bronchiolitis obliterans (BO) after the acute phase of TEN, with computed tomography (CT) bronchography revealing bronchial tree structural changes.
Case Presentation
A 60-year-old woman presented with a rash and hoarseness 2 days after taking ibuprofen and was diagnosed with TEN. While her cutaneous symptoms improved by day 20, the flow-volume loop indicated obstructive respiratory failure. CT bronchography revealed bead-like changes and mural irregularities in the bronchi; thus, BO was diagnosed. Despite treatment with bronchodilators and steroids, she required long-term mechanical ventilation with persistent bronchial alterations.
Conclusion
Extracutaneous complications of TEN are crucial, particularly in BO development following the acute phase. In this case, CT bronchography showed treatment-refractory bead-like changes and mural irregularities in the bronchioles.
背景中毒性表皮坏死溶解症（TEN）可导致各种皮肤外并发症，包括呼吸系统受累。我们报告了一例在 TEN 急性期后发展为阻塞性支气管炎（BO）的患者，其计算机断层扫描（CT）支气管造影显示支气管树结构发生了变化。 病例介绍 一位 60 岁的妇女在服用布洛芬 2 天后出现皮疹和声音嘶哑，被诊断为 TEN。虽然她的皮肤症状在第 20 天时有所改善，但血流-容积循环显示她出现了阻塞性呼吸衰竭。CT 支气管造影显示支气管内有珠状改变和壁状不规则，因此诊断为 BO。尽管使用了支气管扩张剂和类固醇治疗，她仍需要长期机械通气，支气管病变持续存在。 结论 TEN 的皮肤外并发症至关重要，尤其是在急性期后出现 BO 时。在该病例中，CT 支气管造影显示了难治性珠状改变和支气管壁不规则。
{"title":"Bronchiolitis obliterans due to toxic epidermal necrolysis with structural evaluation using computed tomography bronchography: A case report","authors":"Hidemasa Kudo, Ken Katsuta, Shigeki Kushimoto","doi":"10.1002/ams2.70046","DOIUrl":"https://doi.org/10.1002/ams2.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Toxic epidermal necrolysis (TEN) can lead to various extracutaneous complications, including respiratory involvement. We present a case of a patient who developed bronchiolitis obliterans (BO) after the acute phase of TEN, with computed tomography (CT) bronchography revealing bronchial tree structural changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 60-year-old woman presented with a rash and hoarseness 2 days after taking ibuprofen and was diagnosed with TEN. While her cutaneous symptoms improved by day 20, the flow-volume loop indicated obstructive respiratory failure. CT bronchography revealed bead-like changes and mural irregularities in the bronchi; thus, BO was diagnosed. Despite treatment with bronchodilators and steroids, she required long-term mechanical ventilation with persistent bronchial alterations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Extracutaneous complications of TEN are crucial, particularly in BO development following the acute phase. In this case, CT bronchography showed treatment-refractory bead-like changes and mural irregularities in the bronchioles.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Community-acquired pneumonia is an acute lung infection in patients without recent healthcare exposure that can progress to severe sepsis. Despite the well-established influence of miRNAs on inflammation, their specific roles in pneumonia-associated sepsis remain underexplored. In this pilot study, we aimed to provide insights into the pathogenesis of community-acquired pneumonia-associated sepsis by performing an integrative mRNA–miRNA analysis to identify key cellular signaling pathways and potential molecular targets for future research and treatment development.
Methods
We conducted a prospective, observational, single-center study including 14 critically ill patients with community-acquired pneumonia-associated sepsis and 15 healthy controls (median age: 78 [interquartile range 67.3–83.5] and 55 [interquartile range 40.5–59.0] years, respectively).
Results
Eleven patients required ventilatory support, and six met the diagnostic criteria for septic shock. All patients survived. RNA sequencing revealed 1209 upregulated and 1461 downregulated differentially expressed genes for mRNAs (false discovery rate < 0.05, |log2 fold change| >1.2), 51 upregulated and 21 downregulated genes for miRNAs, and 646 upregulated and 1274 downregulated for mRNA related to miRNAs. Canonical pathway analysis revealed activation of the programmed death-1/programmed death-ligand-1 cancer immunotherapy pathway and suppression of the Th1 pathway, indicating T-cell exhaustion in the acute phase of community-acquired pneumonia-associated sepsis.
Conclusion
This study provides valuable insights into the molecular mechanisms underlying CAP-associated sepsis, confirming the occurrence of immune dysregulation, particularly T-cell exhaustion. Our findings suggest that specific miRNAs and signaling pathways identified here may serve as potential therapeutic targets or biomarkers.
{"title":"mRNA–miRNA integration analysis of T-cell exhaustion in sepsis from community-acquired pneumonia","authors":"Sayaka Oda, Hisatake Matsumoto, Yuki Togami, Jumpei Yoshimura, Hiroshi Ito, Shinya Onishi, Arisa Muratsu, Yumi Mitsuyama, Daisuke Okuzaki, Hiroshi Ogura, Susumu Tanaka, Jun Oda","doi":"10.1002/ams2.70054","DOIUrl":"https://doi.org/10.1002/ams2.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Community-acquired pneumonia is an acute lung infection in patients without recent healthcare exposure that can progress to severe sepsis. Despite the well-established influence of miRNAs on inflammation, their specific roles in pneumonia-associated sepsis remain underexplored. In this pilot study, we aimed to provide insights into the pathogenesis of community-acquired pneumonia-associated sepsis by performing an integrative mRNA–miRNA analysis to identify key cellular signaling pathways and potential molecular targets for future research and treatment development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective, observational, single-center study including 14 critically ill patients with community-acquired pneumonia-associated sepsis and 15 healthy controls (median age: 78 [interquartile range 67.3–83.5] and 55 [interquartile range 40.5–59.0] years, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven patients required ventilatory support, and six met the diagnostic criteria for septic shock. All patients survived. RNA sequencing revealed 1209 upregulated and 1461 downregulated differentially expressed genes for mRNAs (false discovery rate < 0.05, |log<sub>2</sub> fold change| >1.2), 51 upregulated and 21 downregulated genes for miRNAs, and 646 upregulated and 1274 downregulated for mRNA related to miRNAs. Canonical pathway analysis revealed activation of the programmed death-1/programmed death-ligand-1 cancer immunotherapy pathway and suppression of the Th1 pathway, indicating T-cell exhaustion in the acute phase of community-acquired pneumonia-associated sepsis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides valuable insights into the molecular mechanisms underlying CAP-associated sepsis, confirming the occurrence of immune dysregulation, particularly T-cell exhaustion. Our findings suggest that specific miRNAs and signaling pathways identified here may serve as potential therapeutic targets or biomarkers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carbon monoxide (CO), produced endogenously by heme oxygenase-1, plays a crucial role in the immune system by mitigating cellular damage under stress. However, the significance of carboxyhemoglobin (COHb) levels after out-of-hospital cardiac arrest (OHCA) is not well understood. This study aimed to explore the association between COHb levels at hospital arrival and within the first 24 h post-arrival with 30-day mortality and neurological outcomes in patients who experienced OHCA.
Methods
This single-center, retrospective study analyzed data from adult patients who experienced OHCA seen at Okayama University Hospital from 2019 to 2023. The patients were assigned to one of two study groups based on COHb levels (0.0% or ≥0.1%) upon hospital arrival. The primary outcome was 30-day mortality.
Results
Among the 560 eligible patients who experienced OHCA, 284 (50.7%) were in the COHb 0.0% group and 276 (49.3%) were in the COHb ≥ 0.1% group. The 30-day mortality was significantly higher in the COHb 0.0% group compared to the COHb ≥ 0.1% group (264 [92.9%] vs. 233 [84.4%]). Multivariable logistic regression showed that the COHb 0.0% group was associated with 30-day mortality (adjusted ORs: 2.24, 95% CIs: 1.10–4.56). Non-survivors at 30 days who were admitted to the intensive care unit had lower COHb levels at hospital arrival (0.0% vs. 0.2%) and lower mean COHb levels during the first 24 h post-arrival (0.7% vs. 0.9%) compared to survivors.
Conclusions
COHb levels of 0.0% were linked to worse outcomes in patients experiencing OHCA, warranting further research on the prognostic implications of COHb in this context.
{"title":"Association of blood carboxyhemoglobin levels with mortality and neurological outcomes in out-of-hospital cardiac arrest","authors":"Takashi Hongo, Tetsuya Yumoto, Hiromichi Naito, Tomohiro Hiraoka, Yuya Murakami, Takafumi Obara, Tsuyoshi Nojima, Toshiyuki Aokage, Atsunori Nakao","doi":"10.1002/ams2.70053","DOIUrl":"https://doi.org/10.1002/ams2.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Carbon monoxide (CO), produced endogenously by heme oxygenase-1, plays a crucial role in the immune system by mitigating cellular damage under stress. However, the significance of carboxyhemoglobin (COHb) levels after out-of-hospital cardiac arrest (OHCA) is not well understood. This study aimed to explore the association between COHb levels at hospital arrival and within the first 24 h post-arrival with 30-day mortality and neurological outcomes in patients who experienced OHCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective study analyzed data from adult patients who experienced OHCA seen at Okayama University Hospital from 2019 to 2023. The patients were assigned to one of two study groups based on COHb levels (0.0% or ≥0.1%) upon hospital arrival. The primary outcome was 30-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 560 eligible patients who experienced OHCA, 284 (50.7%) were in the COHb 0.0% group and 276 (49.3%) were in the COHb ≥ 0.1% group. The 30-day mortality was significantly higher in the COHb 0.0% group compared to the COHb ≥ 0.1% group (264 [92.9%] vs. 233 [84.4%]). Multivariable logistic regression showed that the COHb 0.0% group was associated with 30-day mortality (adjusted ORs: 2.24, 95% CIs: 1.10–4.56). Non-survivors at 30 days who were admitted to the intensive care unit had lower COHb levels at hospital arrival (0.0% vs. 0.2%) and lower mean COHb levels during the first 24 h post-arrival (0.7% vs. 0.9%) compared to survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>COHb levels of 0.0% were linked to worse outcomes in patients experiencing OHCA, warranting further research on the prognostic implications of COHb in this context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID-19). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID-19 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes.
Methods
We analyzed data from the J-RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID-19 between January and September 2020. The patients were categorized into lymphopenia (LP) (<800 cells/μL) and non-lymphopenia (NL) (≥800 cells/μL) groups based on the lymphocyte counts between days 1 and 4 post-onset. They were further divided into “persistent,” “recovered,” “exacerbated,” and “stable” groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in-hospital mortality. The Cox proportional hazard regression was used for the analysis.
Results
Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in-hospital mortality (hazard ratio [HR] 2.32, [95% CI 1.39 to 3.87], p-value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10 days—categorized as the “persistent” and “exacerbated” groups—was associated with in-hospital mortality (HR 4.65, [95% CI 2.07 to 10.47], p-value <0.001, and HR 5.59, [95% CI 2.24 to 13.97], p-value <0.001, respectively).
Conclusions
Early lymphopenia is predictive of poor prognosis in patients with COVID-19. A declining lymphocyte count trend post-onset further indicates disease deterioration.
淋巴细胞减少症被认为是预测冠状病毒病（COVID-19）预后的生物标志物。然而，观测它的最佳时间仍然不确定。我们研究了早期淋巴细胞减少与COVID-19预后的关系，以及淋巴细胞计数趋势与疾病结局的关系。方法我们分析了J-RECOVER研究的数据，这是一项日本的多中心回顾性队列研究，包括2020年1月至9月期间的COVID-19患者。根据发病后第1 ~ 4天淋巴细胞计数将患者分为淋巴细胞减少（LP）组（≤800个细胞/μL）和非淋巴细胞减少（NL）组（≥800个细胞/μL）。根据第7天至第10天的淋巴细胞计数，他们被进一步分为“持续”、“恢复”、“恶化”和“稳定”组。主要终点是住院死亡率。采用Cox比例风险回归进行分析。结果995例入组患者中，LP组212例（21.3%）。LP与住院死亡率显著相关（危险比[HR] 2.32, [95% CI 1.39 ~ 3.87]， p值0.001）。在LP组和NL组中，7 - 10天内较低的淋巴细胞计数（被归类为“持续性”组和“加重”组）与住院死亡率相关（相对危险度4.65,[95% CI 2.07 - 10.47]， p值<；0.001；相对危险度5.59,[95% CI 2.24 - 13.97]， p值<；0.001）。结论早期淋巴细胞减少可预测COVID-19患者预后不良。发病后淋巴细胞计数下降趋势进一步表明疾病恶化。
{"title":"Early lymphopenia as a predictor of COVID-19 outcomes: A multicenter cohort study","authors":"Kazuhiro Okada, Takashi Tagami, Takanobu Otaguro, Mineji Hayakawa, Kazuma Yamakawa, Akira Endo, Takayuki Ogura, Atsushi Hirayama, Hideo Yasunaga, Yoshiaki Hara","doi":"10.1002/ams2.70044","DOIUrl":"https://doi.org/10.1002/ams2.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID-19). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID-19 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the J-RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID-19 between January and September 2020. The patients were categorized into lymphopenia (LP) (<800 cells/μL) and non-lymphopenia (NL) (≥800 cells/μL) groups based on the lymphocyte counts between days 1 and 4 post-onset. They were further divided into “persistent,” “recovered,” “exacerbated,” and “stable” groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in-hospital mortality. The Cox proportional hazard regression was used for the analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in-hospital mortality (hazard ratio [HR] 2.32, [95% CI 1.39 to 3.87], <i>p</i>-value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10 days—categorized as the “persistent” and “exacerbated” groups—was associated with in-hospital mortality (HR 4.65, [95% CI 2.07 to 10.47], <i>p</i>-value <0.001, and HR 5.59, [95% CI 2.24 to 13.97], <i>p</i>-value <0.001, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early lymphopenia is predictive of poor prognosis in patients with COVID-19. A declining lymphocyte count trend post-onset further indicates disease deterioration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 1-year-old boy with Down syndrome visited the emergency department of our hospital with complaints of displeasure and suspicion of pharyngeal foreign body obstruction. The parents noticed that a clothing price tag was missing at home. At the time of the initial examination, no foreign bodies were detected in the oral cavity of the patient. In addition, computed tomography did not reveal any foreign bodies (Figure 1A). The patient was referred to our department the next day. Endoscopic examination revealed a plastic foreign body at the posterior pharyngeal wall (Figure 1B). We could observe the foreign body from the oral cavity, and the foreign body was removed from the oral cavity using forceps, avoiding the huge tongue (Figure 1C).
Pharyngeal foreign body obstruction usually manifests as dysphagia, vomiting, and drooling.1 Typical pharyngeal foreign bodies include food, toys, balloons, and plastic bags. The patient had Down syndrome, and consequently, his enlarged tongue posed difficulties for oral observation. The foreign body was plastic and transparent, and it is difficult to see the foreign body in the emergency department. This case was characterized by the difficulty of diagnosis due to the presence of a transparent plastic foreign body and a large tongue, and there was a risk of the foreign body blocking and moving to the larynx. It was suggested that this case showed the need for early intervention by an otolaryngologist in the emergency outpatient department and the importance of performing an endoscopy as soon as possible. In addition, we should consider the possibility of performing an endoscopy before a CT scan to avoid radiation exposure.
None.
The authors declare no conflicts of interest.
Approval of the research protocol: N/A.
Informed consent: Informed consent was obtained from the patient's family.
Registry and the registration number of the study/trial: N/A.
{"title":"Pediatric pharyngeal foreign body with a difficult diagnosis","authors":"Hisataka Ominato, Tomoki Yoshizaki, Yui Hirata-Nozaki, Shota Sakaue, Miki Takahara","doi":"10.1002/ams2.70052","DOIUrl":"https://doi.org/10.1002/ams2.70052","url":null,"abstract":"<p>A 1-year-old boy with Down syndrome visited the emergency department of our hospital with complaints of displeasure and suspicion of pharyngeal foreign body obstruction. The parents noticed that a clothing price tag was missing at home. At the time of the initial examination, no foreign bodies were detected in the oral cavity of the patient. In addition, computed tomography did not reveal any foreign bodies (Figure 1A). The patient was referred to our department the next day. Endoscopic examination revealed a plastic foreign body at the posterior pharyngeal wall (Figure 1B). We could observe the foreign body from the oral cavity, and the foreign body was removed from the oral cavity using forceps, avoiding the huge tongue (Figure 1C).</p><p>Pharyngeal foreign body obstruction usually manifests as dysphagia, vomiting, and drooling.<span><sup>1</sup></span> Typical pharyngeal foreign bodies include food, toys, balloons, and plastic bags. The patient had Down syndrome, and consequently, his enlarged tongue posed difficulties for oral observation. The foreign body was plastic and transparent, and it is difficult to see the foreign body in the emergency department. This case was characterized by the difficulty of diagnosis due to the presence of a transparent plastic foreign body and a large tongue, and there was a risk of the foreign body blocking and moving to the larynx. It was suggested that this case showed the need for early intervention by an otolaryngologist in the emergency outpatient department and the importance of performing an endoscopy as soon as possible. In addition, we should consider the possibility of performing an endoscopy before a CT scan to avoid radiation exposure.</p><p>None.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Informed consent was obtained from the patient's family.</p><p>Registry and the registration number of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143632901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Skin and soft tissue infection (SSTI) is classified as necrotizing fasciitis (NF) or cellulitis based on the invasion depth of the lesion. Cellulitis has a good prognosis and improves with conservative treatment, whereas NF has a poor prognosis with rapid progression requiring prompt debridement of the wound and intensive care control. Therefore, they should be differentiated quickly and accurately; however, a useful diagnostic method, except for the surgical test incision, remains to be established. This study aimed to verify the usefulness of near-infrared spectroscopy (NIRS) to measure regional oxygen saturation (rSO2) in diagnosing SSTI.
Methods
This was a single-center, retrospective, observational study. SSTI cases from October 2019 to April 2024 (4.5 years) were selected from medical records, and their characteristics, rSO2 levels, computed tomography findings, and Laboratory Risk Indicator for Necrotizing Fasciitis scores were collected. The primary endpoint was the rSO2 between cellulitis and NF lesions measured using NIRS, and the affected and unaffected sides in the same patient were compared.
Results
Eighteen patients were included: six with NF and 12 with cellulitis. There were no significant differences in patient characteristics between the groups. The primary endpoint of NIRS on the affected/unaffected side was significantly lower in patients with NF (0.6 [interquartile range, 0.5–0.7] vs. 1.4 [1.2–1.6]; p < 0.01).
Conclusion
NIRS has the potential to be a non-invasive and quantitative diagnostic tool for SSTI.
{"title":"Efficacy of near-infrared spectroscopy in diagnosing skin and soft tissue infections: A single-center retrospective study","authors":"Marina Oi, Takaaki Maruhashi, Yasushi Asari","doi":"10.1002/ams2.70041","DOIUrl":"https://doi.org/10.1002/ams2.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Skin and soft tissue infection (SSTI) is classified as necrotizing fasciitis (NF) or cellulitis based on the invasion depth of the lesion. Cellulitis has a good prognosis and improves with conservative treatment, whereas NF has a poor prognosis with rapid progression requiring prompt debridement of the wound and intensive care control. Therefore, they should be differentiated quickly and accurately; however, a useful diagnostic method, except for the surgical test incision, remains to be established. This study aimed to verify the usefulness of near-infrared spectroscopy (NIRS) to measure regional oxygen saturation (rSO2) in diagnosing SSTI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center, retrospective, observational study. SSTI cases from October 2019 to April 2024 (4.5 years) were selected from medical records, and their characteristics, rSO2 levels, computed tomography findings, and Laboratory Risk Indicator for Necrotizing Fasciitis scores were collected. The primary endpoint was the rSO2 between cellulitis and NF lesions measured using NIRS, and the affected and unaffected sides in the same patient were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen patients were included: six with NF and 12 with cellulitis. There were no significant differences in patient characteristics between the groups. The primary endpoint of NIRS on the affected/unaffected side was significantly lower in patients with NF (0.6 [interquartile range, 0.5–0.7] vs. 1.4 [1.2–1.6]; <i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NIRS has the potential to be a non-invasive and quantitative diagnostic tool for SSTI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143602530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Akira Suekane, Wataru Takayama, Koji Morishita, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda, the Save-J II Study Group
Aim
Retrospective analysis of clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) requiring extracorporeal membrane oxygenation (ECMO) reinsertion or not.
Methods
Data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in the Japan II database were reviewed. Patients who received ECPR after OHCA between January 2015 and July 2021 and underwent ECPR weaning were divided into reinsertion and no-reinsertion groups. The primary outcome was the 30-day survival rate.
Results
Data from 1011 patients who underwent ECMO weaning ≥1 time and survived were analyzed (12 [1.2%], reinsertion; 999 [98.8%] no-reinsertion). The reinsertion group had a longer time to first ECMO weaning (median [interquartile range, IQR]: 3.0 [2.0–5.0] vs. 4.5 [3.2–6.8] days; p = 0.02). The survival rates at 30 days (25.0% vs. 55.1%; p = 0.08) and favorable neurological outcomes at discharge (8.3% vs. 30.5%; p = 0.18) tended to be lower in the reinsertion group. Among patients who died within 30 days, medical costs were significantly higher in the reinsertion group (median [IQR]: $36,628.2 [26,012.9–45,885.6] vs. $16,456.6 [9341.2–24,880.6]; p < 0.01). Intensive care unit (ICU) stay and mechanical ventilation duration were significantly longer in the reinsertion group.
Conclusion
Patients requiring ECMO reinsertion tended to have poor clinical outcomes and higher healthcare costs, highlighting the need for large-scale studies to develop ECPR protocols and optimize clinical benefits and resource allocation.
目的回顾性分析院外心脏骤停（OHCA）患者行体外心肺复苏（ECPR）治疗是否需要体外膜氧合（ECMO）的临床特点和结局。方法对日本ⅱ数据库中室性颤动体外循环晚期生命支持研究资料进行回顾性分析。2015年1月至2021年7月期间，OHCA后接受ECPR并进行ECPR脱机的患者分为重新插入组和未重新插入组。主要观察指标为30天生存率。结果分析了1011例接受ECMO脱机≥1次并存活的患者的数据(12例[1.2%]，重新插入；999例（98.8%）无插拔)。重新插入组到首次ECMO脱机的时间更长(中位数[四分位数间距，IQR]: 3.0 [2.0-5.0] vs. 4.5[3.2-6.8]天；p = 0.02)。30天存活率(25.0% vs. 55.1%；P = 0.08)和出院时良好的神经预后(8.3% vs. 30.5%；P = 0.18)，再插入组有降低的趋势。在30天内死亡的患者中，重新插入组的医疗费用明显更高(中位数[IQR]: 36,628.2美元[26,012.9-45,885.6美元]vs. 16,456.6美元[9341.2-24,880.6美元]；p < 0.01)。重插组重症监护病房（ICU）住院时间和机械通气时间均明显延长。结论需要重新置入ECMO的患者往往临床结果较差，医疗费用较高，需要进行大规模的研究来制定ECPR方案，优化临床效益和资源分配。
{"title":"Clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest treated by repeated extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study","authors":"Akira Suekane, Wataru Takayama, Koji Morishita, Akihiko Inoue, Toru Hifumi, Tetsuya Sakamoto, Yasuhiro Kuroda, the Save-J II Study Group","doi":"10.1002/ams2.70051","DOIUrl":"https://doi.org/10.1002/ams2.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Retrospective analysis of clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) requiring extracorporeal membrane oxygenation (ECMO) reinsertion or not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in the Japan II database were reviewed. Patients who received ECPR after OHCA between January 2015 and July 2021 and underwent ECPR weaning were divided into reinsertion and no-reinsertion groups. The primary outcome was the 30-day survival rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 1011 patients who underwent ECMO weaning ≥1 time and survived were analyzed (12 [1.2%], reinsertion; 999 [98.8%] no-reinsertion). The reinsertion group had a longer time to first ECMO weaning (median [interquartile range, IQR]: 3.0 [2.0–5.0] vs. 4.5 [3.2–6.8] days; <i>p</i> = 0.02). The survival rates at 30 days (25.0% vs. 55.1%; <i>p</i> = 0.08) and favorable neurological outcomes at discharge (8.3% vs. 30.5%; <i>p</i> = 0.18) tended to be lower in the reinsertion group. Among patients who died within 30 days, medical costs were significantly higher in the reinsertion group (median [IQR]: $36,628.2 [26,012.9–45,885.6] vs. $16,456.6 [9341.2–24,880.6]; <i>p</i> < 0.01). Intensive care unit (ICU) stay and mechanical ventilation duration were significantly longer in the reinsertion group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients requiring ECMO reinsertion tended to have poor clinical outcomes and higher healthcare costs, highlighting the need for large-scale studies to develop ECPR protocols and optimize clinical benefits and resource allocation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chie Tanaka, Takahiro Kinoshita, Yohei Okada, Kasumi Satoh, Yosuke Homma, Kensuke Suzuki, Shoji Yokobori, Jun Oda, Yasuhiro Otomo, Takashi Tagami, Special Committee on the Utilization of Advanced Technology in Emergency Medicine, Japanese Association for Acute Medicine
Aim
In Japan, emergency ambulance dispatches involve minor cases requiring outpatient services, emphasizing the need for improved public guidance regarding emergency care. This study evaluated both the medical plausibility of the GPT model in aiding laypersons to determine the need for emergency medical care and the laypersons' interpretations of its outputs.
Methods
This cross-sectional study was conducted from December 10, 2023, to March 7, 2024. We input clinical scenarios into the GPT model and evaluated the need for emergency visits based on the outputs. A total of 314 scenarios were labeled with red tags (emergency, immediate emergency department [ED] visit) and 152 with green tags (less urgent). Seven medical specialists assessed the outputs' validity, and 157 laypersons interpreted them via a web-based questionnaire.
Results
Experts reported that the GPT model accurately identified important information in 95.9% (301/314) of red-tagged scenarios and recommended immediate ED visits in 96.5% (303/314). However, only 43.0% (135/314) of laypersons interpreted those outputs as indicating urgent hospital visits. The model identified important information in 99.3% (151/152) of green-tagged scenarios and advised against immediate visits in 88.8% (135/152). However, only 32.2% (49/152) of laypersons considered them routine follow-ups.
Conclusions
Expert evaluations revealed that the GPT model could be highly accurate in advising on emergency visits. However, laypersons frequently misinterpreted its recommendations, highlighting a substantial gap in understanding AI-generated medical advice.
{"title":"Medical validity and layperson interpretation of emergency visit recommendations by the GPT model: A cross-sectional study","authors":"Chie Tanaka, Takahiro Kinoshita, Yohei Okada, Kasumi Satoh, Yosuke Homma, Kensuke Suzuki, Shoji Yokobori, Jun Oda, Yasuhiro Otomo, Takashi Tagami, Special Committee on the Utilization of Advanced Technology in Emergency Medicine, Japanese Association for Acute Medicine","doi":"10.1002/ams2.70042","DOIUrl":"https://doi.org/10.1002/ams2.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In Japan, emergency ambulance dispatches involve minor cases requiring outpatient services, emphasizing the need for improved public guidance regarding emergency care. This study evaluated both the medical plausibility of the GPT model in aiding laypersons to determine the need for emergency medical care and the laypersons' interpretations of its outputs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study was conducted from December 10, 2023, to March 7, 2024. We input clinical scenarios into the GPT model and evaluated the need for emergency visits based on the outputs. A total of 314 scenarios were labeled with red tags (emergency, immediate emergency department [ED] visit) and 152 with green tags (less urgent). Seven medical specialists assessed the outputs' validity, and 157 laypersons interpreted them via a web-based questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Experts reported that the GPT model accurately identified important information in 95.9% (301/314) of red-tagged scenarios and recommended immediate ED visits in 96.5% (303/314). However, only 43.0% (135/314) of laypersons interpreted those outputs as indicating urgent hospital visits. The model identified important information in 99.3% (151/152) of green-tagged scenarios and advised against immediate visits in 88.8% (135/152). However, only 32.2% (49/152) of laypersons considered them routine follow-ups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Expert evaluations revealed that the GPT model could be highly accurate in advising on emergency visits. However, laypersons frequently misinterpreted its recommendations, highlighting a substantial gap in understanding AI-generated medical advice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Out-of-hospital cardiac arrest (OHCA) remains an important health care issue. Considering the importance of such a time course after cardiac arrest, detailed evaluation of the prehospital time (i.e., time from EMS contact to a patient to hospital arrival) is essential to improve the mortality and neurologic outcome of OHCA. In this study, we aimed to evaluate the impact of prehospital time on neurological outcomes in patients with OHCA.
Methods
This retrospective observational study included adult non-traumatic OHCA patients who were transported to 2 emergency centers in Tokyo from January 2015 to December 2020. The following data were obtained retrospectively from medical records.
Results
Of the 3120 OHCA patients who were transported during the study period, 2215 patients were evaluated via the inclusion and exclusion criteria. Sixty-nine patients were alive at hospital discharge with a good neurological outcome (i.e., CPC 1 or 2). The multivariate logistic regression model showed that prehospital time (time from EMS contact to hospital arrival) was an independent predictor for hospital discharge with good neurological outcome, in addition to age, bystander CPR, initial rhythm, and cause of cardiac arrest. The GAM plot showed that the adjusted odds ratio of prehospital time for the good neurological outcome was decreased linearly according to time, and the threshold was approximately 30 min.
Conclusion
The threshold of allowable prehospital time, including field activity and transport, for OHCA patients might be 30 min at least in a Japanese urban setting.
{"title":"Association between neurological outcomes and prehospital time in patients with out-of-hospital cardiopulmonary arrest","authors":"Kazuhide Yoshikawa, Akira Endo, Wataru Takayama, Tomohisa Shoko, Yasuhiro Otomo, Koji Morishita","doi":"10.1002/ams2.70025","DOIUrl":"https://doi.org/10.1002/ams2.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Out-of-hospital cardiac arrest (OHCA) remains an important health care issue. Considering the importance of such a time course after cardiac arrest, detailed evaluation of the prehospital time (i.e., time from EMS contact to a patient to hospital arrival) is essential to improve the mortality and neurologic outcome of OHCA. In this study, we aimed to evaluate the impact of prehospital time on neurological outcomes in patients with OHCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study included adult non-traumatic OHCA patients who were transported to 2 emergency centers in Tokyo from January 2015 to December 2020. The following data were obtained retrospectively from medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 3120 OHCA patients who were transported during the study period, 2215 patients were evaluated via the inclusion and exclusion criteria. Sixty-nine patients were alive at hospital discharge with a good neurological outcome (i.e., CPC 1 or 2). The multivariate logistic regression model showed that prehospital time (time from EMS contact to hospital arrival) was an independent predictor for hospital discharge with good neurological outcome, in addition to age, bystander CPR, initial rhythm, and cause of cardiac arrest. The GAM plot showed that the adjusted odds ratio of prehospital time for the good neurological outcome was decreased linearly according to time, and the threshold was approximately 30 min.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The threshold of allowable prehospital time, including field activity and transport, for OHCA patients might be 30 min at least in a Japanese urban setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Japan, emergency medical service personnel often have difficulty obtaining hospitals' acceptance of emergency cases owing to congestion in the emergency unit; such cases are called difficult-to-transport cases. Increased difficult-to-transport cases at a regional level may be associated with the prognosis of out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the association between the proportion of difficult-to-transport cases at a regional level and neurological outcomes in patients with OHCA, using the nationwide Utstein database linked to ambulance records in Japan.
Methods
In this retrospective cohort study from 2017 to 2021 in Japan, the proportion of difficult-to-transport cases was calculated as the number of difficult-to-transport cases divided by the number of emergency calls in each district on each day. Patients with OHCA were categorized into no, low, and high difficult-to-transport cases groups. The primary outcome was a Cerebral Performance Category 1 or 2 at 1 month. The secondary outcome was transportation time intervals. Multivariate regression analyses were conducted to assess the association between difficult-to-transport cases and patient outcomes.
Results
Among 592,021 eligible patients, the no, low, and high difficult-to-transport case groups included 282,747 (48%), 155,167 (26%), and 154,107 (26%) patients, respectively. The high difficult-to-transport cases group was associated with decreased favorable neurological outcomes (adjusted odds ratio, 0.91; 95% confidence interval, 0.86–0.95) and longer total transportation time (difference, 4.1 min; 95% confidence interval, 3.8–4.4).
Conclusion
A higher proportion of difficult-to-transport cases was associated with poorer neurological outcomes and longer total transportation times in patients with OHCA.
{"title":"Difficult-to-transport cases and neurological outcomes of out-of-hospital cardiac arrest: A population-based nationwide study in Japan","authors":"Azusa Taguchi, Shotaro Aso, Hiroshi Yamagami, Hideo Yasunaga","doi":"10.1002/ams2.70050","DOIUrl":"https://doi.org/10.1002/ams2.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In Japan, emergency medical service personnel often have difficulty obtaining hospitals' acceptance of emergency cases owing to congestion in the emergency unit; such cases are called difficult-to-transport cases. Increased difficult-to-transport cases at a regional level may be associated with the prognosis of out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the association between the proportion of difficult-to-transport cases at a regional level and neurological outcomes in patients with OHCA, using the nationwide Utstein database linked to ambulance records in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study from 2017 to 2021 in Japan, the proportion of difficult-to-transport cases was calculated as the number of difficult-to-transport cases divided by the number of emergency calls in each district on each day. Patients with OHCA were categorized into no, low, and high difficult-to-transport cases groups. The primary outcome was a Cerebral Performance Category 1 or 2 at 1 month. The secondary outcome was transportation time intervals. Multivariate regression analyses were conducted to assess the association between difficult-to-transport cases and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 592,021 eligible patients, the no, low, and high difficult-to-transport case groups included 282,747 (48%), 155,167 (26%), and 154,107 (26%) patients, respectively. The high difficult-to-transport cases group was associated with decreased favorable neurological outcomes (adjusted odds ratio, 0.91; 95% confidence interval, 0.86–0.95) and longer total transportation time (difference, 4.1 min; 95% confidence interval, 3.8–4.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A higher proportion of difficult-to-transport cases was associated with poorer neurological outcomes and longer total transportation times in patients with OHCA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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