{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T22:37:46Z","timestamp":1776292666694,"version":"3.50.1"},"reference-count":43,"publisher":"Walter de Gruyter GmbH","issue":"6","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jtim-2025-0053_s_013\">\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Catecholamine-dependent acute obstructive suppurative cholangitis (CD-AOSC) is a severe form of cholangitis characterized by refractory hypotension. This study aimed to investigate its underlying pathogenic mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jtim-2025-0053_s_014\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective case-control study involving 345 patients with biliary infections treated at Tongji Hospital, Tongji University, between 2012 and 2022. Patients were divided into three groups: chronic cholecystitis (CC; negative control), acute obstructive suppurative cholangitis (AOSC; positive control), and CD-AOSC (case group). Clinical and laboratory data were analyzed. Endotoxin levels in subcutaneous adipose tissue were measured, and transcriptomic analysis was performed to explore potential mechanisms. A rat model of cholangitis was used to validate findings related to hypotension in CD-AOSC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jtim-2025-0053_s_015\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with CD-AOSC exhibited slower endotoxin clearance from adipose tissue (1\n                      <jats:sup>st<\/jats:sup>\n                      week\n                      <jats:italic>vs<\/jats:italic>\n                      . 2\n                      <jats:sup>nd<\/jats:sup>\n                      week: 72.7 \u00b1 4.0 EU\/g\n                      <jats:italic>vs<\/jats:italic>\n                      . 23.3 \u00b1 3.2 EU\/g) and milder inflammation (Immune cell count: 665.4 \u00b1 179.1, Immunodeconv analysis: 0.3 \u00b1 0.1) compared to AOSC patients (1\n                      <jats:sup>st<\/jats:sup>\n                      week\n                      <jats:italic>vs<\/jats:italic>\n                      . 2\n                      <jats:sup>nd<\/jats:sup>\n                      week: 9.7 \u00b1 2.6 EU\/g\n                      <jats:italic>vs<\/jats:italic>\n                      . 2.6 \u00b1 0.7 EU\/g, Immune cell count: 1344.0 \u00b1 599.3, Immunodeconv analysis: 0.6 \u00b1 0.1). This slower clearance of endotoxin allowed adipose tissue to function as an endotoxin reservoir. Persistent endotoxin release resulted in prolonged activation of the interleukin-18 (IL-18)\/IL-18 receptor accesary protein (IL-18RAP) pathway, thereby sustaining inflammation and contributing to extended hypotension. The rat model confirmed the role of the interleukin-1\u03b2 (IL-1\u03b2) inhibitor in decelerating endotoxin release and maintaining activation of the IL-18\/IL-18RAP\/interferon-\u03b3 (IFN-\u03b3) pathway.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jtim-2025-0053_s_016\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Persistent hypotension in CD-AOSC appears to result from sustained activation of the IL-18\/IL-18RAP pathway, driven by prolonged endotoxin release from adipose tissue. These findings highlight the potential of \"Hours Exchanged Against (severity) Loss (HEAL)\" strategy, in which early modulation of endotoxin release from adipose tissue by IL-1\u03b2 inhibition during the initial phase of sepsis in cholangitis may improve patient survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jtim-2025-0053","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T16:03:12Z","timestamp":1766419392000},"page":"537-558","source":"Crossref","is-referenced-by-count":1,"title":["Endotoxin retention in adipose tissue leading to persistent hypotension in catecholamine-dependent acute obstructive suppurative cholangitis"],"prefix":"10.1515","volume":"13","author":[{"given":"Kun","family":"Li","sequence":"first","affiliation":[{"name":"General Surgery Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"},{"name":"Department of General Surgery, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sibo","family":"Zhu","sequence":"additional","affiliation":[{"name":"MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun","family":"Ye","sequence":"additional","affiliation":[{"name":"General Surgery Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Ding","sequence":"additional","affiliation":[{"name":"General Surgery Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiangxi","family":"Liu","sequence":"additional","affiliation":[{"name":"General Surgery Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yufeng","family":"Wang","sequence":"additional","affiliation":[{"name":"General Surgery Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyong","family":"Wang","sequence":"additional","affiliation":[{"name":"Surgery Department, Chongyi County People's Hospital , Ganzhou , Jiangxi Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenfeng","family":"Li","sequence":"additional","affiliation":[{"name":"Surgery Department, Chongyi County People's Hospital , Ganzhou , Jiangxi Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DongHua","family":"Yang","sequence":"additional","affiliation":[{"name":"Administrative Dean, New York College of Traditional Chinese Medicine , New York, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Ultrasound Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3197-9798","authenticated-orcid":false,"given":"Rui","family":"Lin","sequence":"additional","affiliation":[{"name":"General Surgery Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"},{"name":"Surgery Department, Chongyi County People's Hospital , Ganzhou , Jiangxi Province , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9042-1701","authenticated-orcid":false,"given":"Baomin","family":"Shi","sequence":"additional","affiliation":[{"name":"General Surgery Department, Tongji Hospital, School of Medicine, Tongji University , Shanghai , China"},{"name":"Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai , China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"2025122216030787318_j_jtim-2025-0053_ref_001","doi-asserted-by":"crossref","unstructured":"Pillay SP, Hardie IR. Acute obstructive suppurative cholangitis. Med J Aust 1984;140:332-336.","DOI":"10.5694\/j.1326-5377.1984.tb104086.x"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_002","doi-asserted-by":"crossref","unstructured":"Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:17-30.","DOI":"10.1002\/jhbp.512"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_003","unstructured":"Mok CS, Vanessa L. Isolated hypotension after the induction of general anesthesia refractory to fluids and vasopressors: an indicator of anaphylaxis. Med J Malaysia 2021;76:267-269."},{"key":"2025122216030787318_j_jtim-2025-0053_ref_004","doi-asserted-by":"crossref","unstructured":"Li SY, Chen XJ, Lin XM. Refractory hypotension under neuraxial anesthesia for cesarean delivery. Chin Med J (Engl) 2019;132:1509-1511.","DOI":"10.1097\/CM9.0000000000000250"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_005","doi-asserted-by":"crossref","unstructured":"Memon MB, Chadda N, Dahhan A, Krystofiak M, Thakore S. Refractory hypotension: a detailed case discussion and current literature review. Cureus 2022;14:e29558.","DOI":"10.7759\/cureus.29558"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_006","doi-asserted-by":"crossref","unstructured":"Hojo T, Shibuya M, Kimura Y, Otsuka Y, Fujisawa T. Refractory hypotension during general anesthesia despite withholding telmisartan. Anesth Prog 2020;67:86-89.","DOI":"10.2344\/anpr-67-02-02"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_007","doi-asserted-by":"crossref","unstructured":"Lu YC, Yeh WC, Ohashi PS. LPS\/TLR4 signal transduction pathway. Cytokine 2008;42:145-151.","DOI":"10.1016\/j.cyto.2008.01.006"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_008","doi-asserted-by":"crossref","unstructured":"Mierzchala-Pasierb M, Krzystek-Korpacka M, Lesnik P, Adamik B, Placzkowska S, Serek P, et al. Interleukin-18 serum levels in sepsis: Correlation with disease severity and inflammatory markers. Cytokine 2019;120:22-27.","DOI":"10.1016\/j.cyto.2019.04.003"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_009","doi-asserted-by":"crossref","unstructured":"Ihim SA, Abubakar SD, Zian Z, Sasaki T, Saffarioun M, Maleknia S, et al. Interleukin-18 cytokine in immunity, inflammation, and autoimmunity: Biological role in induction, regulation, and treatment. Front Immunol 2022;13:919973.","DOI":"10.3389\/fimmu.2022.919973"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_010","doi-asserted-by":"crossref","unstructured":"Kanai T, Watanabe M, Okazawa A, Sato T, Yamazaki M, Okamoto S, et al. Macrophage-derived IL-18-mediated intestinal inflammation in the murine model of Crohn\u2019s disease. Gastroenterology 2001;121:875-888.","DOI":"10.1053\/gast.2001.28021"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_011","doi-asserted-by":"crossref","unstructured":"Kojima H, Aizawa Y, Yanai Y, Nagaoka K, Takeuchi M, Ohta T, et al. An essential role for NF-\u03baB in IL-18-induced IFN-\u03b3 expression in KG-1 cells. J Immunol 1999;162:5063-5069.","DOI":"10.4049\/jimmunol.162.9.5063"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_012","doi-asserted-by":"crossref","unstructured":"Chen W, Song TB, Zou F, Xia YQ, Xing J, Yu WM, et al. Prognostic and immunological roles of IL18RAP in human cancers. Aging 2023;15:9059-9085.","DOI":"10.18632\/aging.205017"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_013","doi-asserted-by":"crossref","unstructured":"Ma J, Lam IKY, Lau CS, Chan VSF. Elevated interleukin-18 receptor accessory protein mediates enhancement in reactive oxygen species production in neutrophils of systemic lupus erythematosus patients. Cells 2021;10:964.","DOI":"10.3390\/cells10050964"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_014","doi-asserted-by":"crossref","unstructured":"Li XL, Shang BX, Li YN, Shi YF, Shao CS. IFN\u03b3 and TNF\u03b1 synergistically induce apoptosis of mesenchymal stem\/stromal cells via the induction of nitric oxide. Stem Cell Res Ther 2019;10:18.","DOI":"10.1186\/s13287-018-1102-z"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_015","doi-asserted-by":"crossref","unstructured":"Rap\u00f4so C, Luna RL, Nunes AKS, Thom\u00e9 R, Peixoto CA. Role of iNOS-NO-cGMP signaling in modulation of inflammatory and myelination processes. Brain Res Bull 2014;104:60-73.","DOI":"10.1016\/j.brainresbull.2014.04.002"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_016","doi-asserted-by":"crossref","unstructured":"Liu R, Kang YL, Chen L. Activation mechanism of human soluble guanylate cyclase by stimulators and activators. Nat Commun 2021;12:5492.","DOI":"10.1038\/s41467-021-25617-0"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_017","doi-asserted-by":"crossref","unstructured":"Kopra K, Sharina I, Martin E, H\u00e4rm\u00e4 H. Homogeneous single-label cGMP detection platform for the functional study of nitric oxide-sensitive (soluble) guanylyl cyclases and cGMP-specific phosphodiesterases. Sci Rep 2020;10:17469.","DOI":"10.1038\/s41598-020-74611-x"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_018","doi-asserted-by":"crossref","unstructured":"Ataei Ataabadi E, Golshiri K, J\u00fcttner A, Krenning G, Danser AHJ, Roks AJM. Nitric oxide-cGMP signaling in hypertension: current and future options for pharmacotherapy. Hypertension 2020;76:1055-1068.","DOI":"10.1161\/HYPERTENSIONAHA.120.15856"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_019","doi-asserted-by":"crossref","unstructured":"Sallusto F. Heterogeneity of human CD4+ T cells against microbes. Annu Rev Immunol 2016;34:317-334.","DOI":"10.1146\/annurev-immunol-032414-112056"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_020","doi-asserted-by":"crossref","unstructured":"Mosmann TR, Coffman RL. TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol 1989;7:145-173.","DOI":"10.1146\/annurev.iy.07.040189.001045"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_021","doi-asserted-by":"crossref","unstructured":"Lin R, Wang YF, Chen QN, Liu ZY, Xiao S, Wang BY, et al. TRPM2 promotes the proliferation and invasion of pancreatic ductal adenocarcinoma. Mol Med Report 2018;17:7537-7544.","DOI":"10.3892\/mmr.2018.8816"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_022","doi-asserted-by":"crossref","unstructured":"Lin R, Bao XX, Wang H, Zhu SB, Liu ZY, Chen QN, et al. TRPM2 promotes pancreatic cancer by PKC\/MAPK pathway. Cell Death Dis 2021;12:585.","DOI":"10.1038\/s41419-021-03856-9"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_023","doi-asserted-by":"crossref","unstructured":"Eloseily EM, Weiser P, Crayne CB, Haines H, Mannion ML, Stoll ML, et al. Benefit of anakinra in treating pediatric secondary hemophagocytic lymphohistiocytosis. Arthritis Rheumatol 2020;72:326-334.","DOI":"10.1002\/art.41103"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_024","doi-asserted-by":"crossref","unstructured":"Durand M, Troyanov Y, Laflamme P, Gregoire G. Macrophage activation syndrome treated with anakinra. J Rheumatol 2010;37:879-880.","DOI":"10.3899\/jrheum.091046"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_025","doi-asserted-by":"crossref","unstructured":"Faulkner L, Cooper A, Fantino C, Altmann DM, Sriskandan S. The mechanism of superantigen-mediated toxic shock: not a simple Th1 cytokine storm. J Immunol 2005;175:6870-6877.","DOI":"10.4049\/jimmunol.175.10.6870"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_026","doi-asserted-by":"crossref","unstructured":"De Benedetti F, Gattorno M, Anton J, Ben-Chetrit E, Frenkel J, Hoffman HM, et al. Canakinumab for the treatment of autoinflammatory recurrent fever syndromes. N Engl J Med 2018;378:1908-1919.","DOI":"10.1056\/NEJMoa1706314"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_027","doi-asserted-by":"crossref","unstructured":"Garlanda C, Dinarello CA, Mantovani A. The interleukin-1 family: back to the future. Immunity 2013;39:1003-1018.","DOI":"10.1016\/j.immuni.2013.11.010"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_028","doi-asserted-by":"crossref","unstructured":"Martinon F, P\u00e9trilli V, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 2006;440:237-241","DOI":"10.1038\/nature04516"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_029","doi-asserted-by":"crossref","unstructured":"Netea MG, Kullberg BJ, Verschueren I, Van Der Meer JW. Interleukin-18 induces production of proinflammatory cytokines in mice: no intermediate role for the cytokines of the tumor necrosis factor family and interleukin-1beta. Eur J Immunol 2000;30:3057-3060.","DOI":"10.1002\/1521-4141(200010)30:10<3057::AID-IMMU3057>3.0.CO;2-P"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_030","doi-asserted-by":"crossref","unstructured":"Shimizu M, Yokoyama T, Yamada K, Kaneda H, Wada H, Wada T, et al. Distinct cytokine profiles of systemic-onset juvenile idiopathic arthritis-associated macrophage activation syndrome with particular emphasis on the role of interleukin-18 in its pathogenesis. Rheumatology 2010;49:1645-1653.","DOI":"10.1093\/rheumatology\/keq133"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_031","doi-asserted-by":"crossref","unstructured":"Seymour CW, Kennedy JN, Wang S, Chang CH, Elliott CF, Xu ZY, et al. Derivation, validation, and potential treatment implications of novel clinical phenotypes for sepsis. JAMA 2019;321:2003-2017.","DOI":"10.1001\/jama.2019.5791"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_032","doi-asserted-by":"crossref","unstructured":"Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:2063.","DOI":"10.1056\/NEJMc1312359"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_033","doi-asserted-by":"crossref","unstructured":"Dellinger RP, Bagshaw SM, Antonelli M, Foster DM, Klein DJ, Marshall JC, et al. Effect of targeted polymyxin B hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level. Jama 2018;320:1455.","DOI":"10.1001\/jama.2018.14618"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_034","doi-asserted-by":"crossref","unstructured":"Fisher CJ, Dhainaut JF, Opal SM, Pribble JP, Balk RA, Slotman GJ, et al. Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomized, double-blind, placebo-controlled trial. Phase III rhIL-1ra Sepsis Syndrome Study Group. JAMA 1994;271:1836-1843.","DOI":"10.1001\/jama.1994.03510470040032"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_035","doi-asserted-by":"crossref","unstructured":"Shakoory B, Carcillo JA, Winn Chatham W, Amdur RL, Zhao H, Dinarello CA, et al. Interleukin-1 receptor blockade is associated with reduced mortality in sepsis patients with features of macrophage activation syndrome: reanalysis of a prior phase III trial. Crit Care Med 2016;44:275-281.","DOI":"10.1097\/CCM.0000000000001402"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_036","doi-asserted-by":"crossref","unstructured":"Oh YS, Kwak MK, Kim K, Cho EH, Jang SE. Development and application of an antibody that binds to interleukin-1\u03b2 of various mammalian species for the treatment of inflammatory diseases. Biochem Biophys Res Commun 2020;527:751-756.","DOI":"10.1016\/j.bbrc.2020.04.073"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_037","doi-asserted-by":"crossref","unstructured":"Thomas MG, Bayliss C, Bond S, Dowling F, Galea J, Jairath V, et al. Trial summary and protocol for a phase II randomised placebo-controlled double-blinded trial of Interleukin 1 blockade in Acute Severe Colitis: the IASO trial. BMJ Open 2019;9:e023765.","DOI":"10.1136\/bmjopen-2018-023765"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_038","doi-asserted-by":"crossref","unstructured":"Abbate LM, Perman SM, Clambey ET, Van Pelt RE, Ginde AA. Age modifies the association between obesity and mortality in individuals hospitalized with severe sepsis. J Am Geriatr Soc 2016;64:882-883.","DOI":"10.1111\/jgs.14047"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_039","doi-asserted-by":"crossref","unstructured":"Arabi YM, Dara SI, Tamim HM, Rishu AH, Bouchama A, Khedr MK, et al. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Crit Care 2013;17:R72.","DOI":"10.1186\/cc12680"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_040","doi-asserted-by":"crossref","unstructured":"Nguyen AT, Tsai CL, Hwang LY, Lai D, Markham C, Patel B. Obesity and mortality, length of stay and hospital cost among patients with sepsis: a nationwide inpatient retrospective cohort study. PLoS One 2016;11:e0154599.","DOI":"10.1371\/journal.pone.0154599"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_041","doi-asserted-by":"crossref","unstructured":"Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, et al. Being overweight or obese is associated with decreased mortality in critically ill patients: a retrospective analysis of a large regional Italian multicenter cohort. J Crit Care 2012;27:714-721.","DOI":"10.1016\/j.jcrc.2012.08.013"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_042","doi-asserted-by":"crossref","unstructured":"Wacharasint P, Boyd JH, Russell JA, Walley KR. One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response. Crit Care 2013;17:R122.","DOI":"10.1186\/cc12794"},{"key":"2025122216030787318_j_jtim-2025-0053_ref_043","doi-asserted-by":"crossref","unstructured":"Yeo HJ, Kim TH, Jang JH, Jeon K, Oh DK, Park MH, et al. Obesity paradox and functional outcomes in sepsis: a multicenter prospective study. Crit Care Med 2023;51:742-752.","DOI":"10.1097\/CCM.0000000000005801"}],"container-title":["Journal of Translational Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jtim-2025-0053\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jtim-2025-0053\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T16:03:56Z","timestamp":1766419436000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jtim-2025-0053\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":43,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,10,16]]},"published-print":{"date-parts":[[2025,12,22]]}},"alternative-id":["10.1515\/jtim-2025-0053"],"URL":"https:\/\/doi.org\/10.1515\/jtim-2025-0053","relation":{},"ISSN":["2224-4018"],"issn-type":[{"value":"2224-4018","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}