Clinical Toxicology最新文献

{"title":"Elevated osmol gaps in patients with alcoholic ketoacidosis.","authors":"Chelsea V Hayman, Kyle D Pires, Emily T Cohen, Rana Biary, Mark K Su, Robert S Hoffman","doi":"10.1080/15563650.2024.2397053","DOIUrl":"10.1080/15563650.2024.2397053","url":null,"abstract":"<p><strong>Introduction: </strong>The use of the osmol gap as a surrogate marker of toxic alcohol poisoning is common. Unfortunately, many patients with alcoholic ketoacidosis have elevated osmol gaps and are misdiagnosed with toxic alcohol poisoning. We aimed to characterize the range of osmol gaps in patients with alcoholic ketoacidosis.</p><p><strong>Methods: </strong>This was a retrospective poison center study. Data from 24 years were reviewed using the following case definition of alcoholic ketoacidosis: (1) documented alcohol use disorder; (2) presence of urine or serum ketones or an elevated blood beta-hydroxybutyrate concentration; (3) an anion gap ≥14 mmol/L. Potential cases of alcoholic ketoacidosis that failed to fulfill all three criteria were adjudicated by three toxicologists. Exclusion criteria included (1) detectable toxic alcohol concentration, (2) hemodialysis and/or multiple doses of fomepizole, (3) no osmol gap documented, (4) other diagnoses that lead to a metabolic acidosis. Demographics, pH, anion gap, lactate concentration, and osmol gap were extracted.</p><p><strong>Results: </strong>Of 1,493 patients screened, 55 met criteria for alcoholic ketoacidosis. Sixty-four percent were male, and their median age was 52 years. The median osmol gap was 27 [IQR 18-36]. The largest anion gap was 57 mmol/L, and the lowest pH was 6.8. Forty-five (82%) of the patients with alcoholic ketoacidosis had osmol gaps >10; 38 (69%) had osmol gaps >20; 24 (44%) had osmol gaps >30; 11 (20%) had osmol gaps > 40.</p><p><strong>Discussion: </strong>The large range of osmol gaps in patients with alcoholic ketoacidosis often reaches values associated with toxic alcohol poisoning. The study is limited by the potential for transcribing errors and the inability to identify the cause of the osmol gap.</p><p><strong>Conclusions: </strong>In this retrospective study, patients with alcoholic ketoacidosis had a median osmol gap of 27. Given that alcoholic ketoacidosis is easily and inexpensively treated, proper identification may prevent costly and invasive treatment directed at toxic alcohol poisoning.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"609-614"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal insufficiency associated with long-term use of electronic cigarettes reportedly containing etomidate in two patients.","authors":"Yongzhang Qin, Huimin Lin, Weimin Lv, Shihua Hong, Ziqian Huang","doi":"10.1080/15563650.2024.2396462","DOIUrl":"10.1080/15563650.2024.2396462","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"672-673"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poisoning and envenomation linkage to evaluate outcomes and clinical variation in Australia (PAVLOVA): a longitudinal data-linkage cohort of acute poisonings, envenomations, and adverse drug reactions in New South Wales, Australia, 2011-2020.","authors":"Rose Cairns, Firouzeh Noghrehchi, Jacques E Raubenheimer, Kate M Chitty, Geoffrey K Isbister, Angela L Chiew, Jonathan Brett, Andrew H Dawson, Jared A Brown, Nicholas A Buckley","doi":"10.1080/15563650.2024.2398119","DOIUrl":"10.1080/15563650.2024.2398119","url":null,"abstract":"<p><strong>Introduction: </strong>Poisoning is a leading cause of morbidity and mortality that is increasing in many countries. Better data are needed to understand epidemiology and outcomes of poisoning. This work describes a new poisoning data linkage cohort in New South Wales, Australia (population approximately 8 million).</p><p><strong>Methods: </strong>This is a longitudinal health record linkage, 2011-2020, including data from: ambulance call-outs, emergency department presentations, hospital admissions, death registrations, the poisons centre, and four tertiary toxicology units. Individuals with poisoning, venomous animal/plant exposures, or adverse drug reaction events were included.</p><p><strong>Results: </strong>There were 845,217 linkable events relating to 400,642 ambulance, 688,484 emergency department, 682,013 admission, 40,456 toxicology, and 11,879 death records. There were 572,841 people with events; the median age at the time of first event was 57 years, and 51.9% were female. Events leading to patient admission were most commonly adverse drug reactions (<i>n</i> = 511,263), intentional poisonings (<i>n</i> = 68,646), unintentional poisonings (<i>n</i> = 54,840) and animal/plant exposures (<i>n</i> = 11,092). Demographics varied by cause: intentional poisoning (median age 33 years, 61.7% female); unintentional poisoning/animals/plants (median age 43 years, 45% female); and adverse drug reactions (median age 70 years, 54% female). Adolescent females had highest rates of intentional poisoning, while unintentional poisoning had a bimodal distribution, highest in children <5 years old and males aged 20 to 50 years. Substance use disorders were documented comorbidities for 44% of intentional poisoning, 29% of unintentional poisoning, and 13% of adverse drug reaction-related admissions; mood disorders were documented for 54%, 17% and 10% of these admissions, respectively.</p><p><strong>Discussion: </strong>Poisonings and hospitalised adverse drug reactions are common in New South Wales, affecting approximately 8% of the population in 10 years. This linkage improves understanding of poisoning risks and outcomes in Australia.</p><p><strong>Conclusions: </strong>This novel data linkage provides a unique opportunity to study poisoning across multiple settings for an individual over an extended period.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"615-624"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Images in acute diquat poisoning, including hepatic portal venous gas and gastrointestinal pneumatosis on computed tomography.","authors":"Guangcai Yu, Jieru Wang, Baotian Kan, Wei Li, Xiangdong Jian","doi":"10.1080/15563650.2024.2398773","DOIUrl":"10.1080/15563650.2024.2398773","url":null,"abstract":"<p><strong>Introduction: </strong>Severe diquat poisoning often leads to acute kidney injury, gastrointestinal injury, paralytic ileus, rhabdomyolysis, respiratory failure, refractory circulatory failure, and brainstem damage.</p><p><strong>Case summary: </strong>A previously healthy 38-year-old man was admitted to our hospital with anuria, mild abdominal distension, and calf pain after ingesting diquat (200 g/L) 100 mL approximately 13 h before presentation. His blood diquat concentration was 8.14 µg/L on admission. Gastrointestinal catharsis, haemoperfusion, and haemodiafiltration were performed. Subsequently, he developed marked abdominal distention, impaired consciousness, hypotension, and respiratory failure, leading to death.</p><p><strong>Images: </strong>Computed tomography revealed gas accumulation in the portal venous system and mesenteric vessels. Moreover, gastrointestinal pneumatosis was present. Computed tomography also revealed changes in the lung, brainstem, and calf muscles.</p><p><strong>Conclusion: </strong>Diquat poisoning can result in acute kidney injury, hepatic injury, gastrointestinal injury, paralytic ileus, rhabdomyolysis, refractory circulatory failure, brainstem damage, and hepatic portal venous gas, all observed in this patient.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"669-671"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unintentional poisoning in older Australians: a retrospective audit of New South Wales Poisons Information Centre data.","authors":"Qi Xuan Koh,Sarah Wise,Jacques E Raubenheimer,Deborah Debono,Darren M Roberts,Jane E Carland","doi":"10.1080/15563650.2024.2398766","DOIUrl":"https://doi.org/10.1080/15563650.2024.2398766","url":null,"abstract":"INTRODUCTIONPoisons information centres provide phone-based risk assessment and management advice on poisonings. Unintentional poisonings are a common reason for consulting a poisons information centre, and older adults are at increased risk of unintentional poisoning and adverse outcomes. We describe patterns of unintentional poisoning in older adults reported to a regional poisons information centre.METHODSWe conducted a retrospective audit of poisons information centre call records and identified unintentional poisonings involving older adults (≥75 years) over a 12-month period to determine patient demographics and poisoning circumstances (substances, contributing factors, and disposition recommendation). Univariate analyses identified variables associated with hospital referral and multivariate models to identify independent risk factors in home-dwelling older adults.RESULTSWe identified 2,757 calls. More exposures occurred in women (62%) and involved therapeutic errors (70.8%). Paracetamol was the most common drug involved (11%), and cardiovascular drugs were the most common drug class (36%). Only 14.3% of the study population was referred to hospital. Independent risk factors for hospital referral in home-dwelling older adults were exposure to cardiovascular, centrally acting and antihyperglycaemics, non-oral route of administration and symptoms at the time of the call.DISCUSSIONUnintentional poisoning is not uncommon, and our findings are similar to those in other countries over recent decades. These findings suggest that unintentional poisoning in older adults is inadequately addressed by current medication safety strategies. Our findings indicate the value of timely advice by poisons information centres for preventing potentially unnecessary hospitalizations.CONCLUSIONFurther research is needed to identify more effective approaches to medication safety strategies for older adults. Poisons information centre data contribute to pharmacovigilance activities and could inform patient care.","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"15 1","pages":"1-11"},"PeriodicalIF":3.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in chlorine and chloramine gas exposures reported to United States poison centers.","authors":"Anthony Atalla,Joshua Shulman,Jason Rose,Michael Lynch","doi":"10.1080/15563650.2024.2390139","DOIUrl":"https://doi.org/10.1080/15563650.2024.2390139","url":null,"abstract":"INTRODUCTIONChlorine and chloramine gas inhalation can occur when household cleaners are mixed. The increased emphasis on disinfecting practices during the COVID-19 pandemic may have contributed to an increase in chlorine and chloramine gas exposures in the United States, which has not been studied.METHODSIn a retrospective review, reported data on chlorine and chloramine gas exposures in the National Poison Data System were collected from January 1, 2015, to December 31, 2022. Data included demographics and exposure details, including location, dose, formulation, co-exposures, treatments, and outcomes. Demographic analyses and descriptive statistics were conducted.RESULTSDuring the study period, 85,104 total exposures to chlorine and chloramine gas were reported, consisting of 79,281 isolated exposures and 5,823 co-exposures. Total exposures increased by 61% from 8,385 in 2015 to 13,503 in 2022, with the largest increase of 38.3% occurring from 2019 to 2020. Total exposures remained increased through 2022 with no return to pre-pandemic levels. Most exposures occurred in \"own residence\" (n = 72,213, 84.9%), with a larger proportion of exposures occurring at home peri-pandemic versus pre-pandemic (88.4% versus 81.7%). One percent (n = 1,030) of exposures were admitted to a non-critical care unit, 0.73% (n = 619) were admitted to a critical care unit, and 0.03% (n = 26) resulted in death.DISCUSSIONThe onset of the COVID-19 pandemic and increased emphasis on cleaning practices were likely contributing factors to the marked increase in exposures in 2020, which persisted through 2022. Cleaning practices that developed during the beginning of the pandemic likely persisted despite returning to more normal daily routines, which may explain the ongoing increase in reported exposures. Most reported exposures were unintentional, mild in symptomatology, and required the use of non-invasive therapies, if any.CONCLUSIONSFuture efforts should focus on public education on the safe use of cleaning products to prevent exposure to toxic chlorine and chloramine gases.","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"477 1","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microhemorrhages in diquat-induced encephalopathy identified using susceptibility-weighted imaging.","authors":"Chuanying Shi,Weifei Wang","doi":"10.1080/15563650.2024.2401073","DOIUrl":"https://doi.org/10.1080/15563650.2024.2401073","url":null,"abstract":"INTRODUCTIONIntracerebral bleeding that predominantly affects the pons, midbrain, cerebral peduncle, basal ganglia, and thalamus may occur in severe diquat poisoning. We employed magnetic resonance-susceptibility-weighted imaging to highlight the presence of microhemorrhages in a patient with diquat poisoning.Case summary: A 15-year-old female patient presented with kidney and liver damage after ingesting diquat. Three days later, she developed coma. She received seven sessions of hemoperfusion and was discharged with residual cognitive impairment and right limb muscle weakness after 66 days of hospitalization.Images: Cranial computed tomography on day 5 and magnetic resonance imaging on day 8 revealed swelling in the pons, midbrain, and thalamus without evidence of hemorrhage. However, susceptibility-weighted imaging on day 8 demonstrated multiple punctate low signals, suggesting the presence of microhemorrhages.CONCLUSIONSusceptibility-weighted imaging is a useful technique for detecting microhemorrhages in patients with diquat-induced encephalopathy, as microhemorrhages are often not detectable on computed tomography or conventional magnetic resonance imaging.","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"36 1","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High concordance between urine toxicology results and self-reported fentanyl use in Nevada and New Mexico.","authors":"Mia Rae Kirk, May McCarthy, Andres Reyes, Benjamin Chase, Jessica Anderson, Robert W Harding, Phillip Fiuty, Kimberly Page, Karla D Wagner","doi":"10.1080/15563650.2024.2391011","DOIUrl":"10.1080/15563650.2024.2391011","url":null,"abstract":"<p><strong>Background: </strong>Co-use of stimulants and opioids is often deliberate. However, the possibility remains that some people are unintentionally consuming fentanyl. To advance understanding of overdose risk, we examined the rate of concordance between self-reported fentanyl use and corresponding urine toxicology screen results.</p><p><strong>Methods: </strong>Between August 2022-August 2023, 411 participants (adults who reported any non-medical drug use in the past three months) in Nevada and New Mexico completed a cross-sectional survey, of whom 64% (<i>n</i> = 270; the analytical sample) also completed a urine toxicology screen, which detects fentanyl use in the past three days. Positive predictive value, negative predictive value, sensitivity, and specificity were calculated using self-reported past three-day fentanyl use (yes/no) and urine toxicology screen results for the presence of fentanyl (positive/negative).</p><p><strong>Results: </strong>Of the 270 participants who provided a urine sample, 268 are included in the descriptive statistics (two with inconclusive urine toxicology screen results were excluded). Of the 268 participants, 146 (54.5%) had a fentanyl-positive urine toxicology screen result, 122 (45.5%) had a fentanyl-negative urine toxicology screen result, 137 (51.1%) reported past three-day fentanyl use, and 130 (48.5%) reported no past three-day fentanyl use. Only 6.9% of those with a fentanyl-positive urine toxicology screen did not report recent fentanyl use. The sensitivity of self-reported fentanyl use was 93%, specificity was 97%, positive predictive value was 97%, and negative predictive value was 92%.</p><p><strong>Discussion: </strong>The rate of unanticipated exposure to fentanyl (that is, positive urine screen and negative self-report) in this sample was low, at 6.9%. This runs counter to the national narrative that there is widespread unknown contamination of fentanyl in the drug supply.</p><p><strong>Conclusion: </strong>Future research is needed to further explore how people who use multiple substances interpret their overdose risk and what harm reduction methods they employ.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unexpected computed tomography finding in a suspected body packer.","authors":"Ping Wu, Safiyyah Nok Sze Lui, Heather Hoi Ching Lee, Oi Fung Wong","doi":"10.1080/15563650.2024.2395547","DOIUrl":"https://doi.org/10.1080/15563650.2024.2395547","url":null,"abstract":"<p><strong>Introduction: </strong>Computed tomography can be used to screen and diagnose the presence of drug-filled packets in the body. We present an unusual computed tomography finding in a suspected body packer.</p><p><strong>Case summary: </strong>A traveller suspected of being a body packer was brought to the emergency department complaining of low back pain. On examination, there was an abdominal cast circumferentially encasing his abdomen, which he alleged was part of the management of his lower back pain in his own country.</p><p><strong>Images: </strong>A plain computed tomogram of the abdomen and pelvis revealed that the cast was made of materials with a nodular appearance and heterogeneous density, which was different from that of a plaster of Paris cast. An investigation later confirmed the cast contained cocaine.</p><p><strong>Conclusion: </strong>Our case demonstrates how a body packer can traffic drugs outside their body for an alleged medical reason.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethion food poisoning outbreak in Pereira, Colombia, 2022.","authors":"Edna Margarita Sanchez, Diana Marcela Walteros, Jorge Mario Estrada, Diana Yolima Bustos Álvarez, Jose Leonardo Gomez","doi":"10.1080/15563650.2024.2388756","DOIUrl":"https://doi.org/10.1080/15563650.2024.2388756","url":null,"abstract":"<p><strong>Introduction: </strong>Ethion is an organophosphate used as an acaricide and insecticide, that is restricted worldwide. In Colombia, pesticide poisoning is the third most common cause of chemical intoxication. On 9 October 2022, an outbreak of ethion poisoning occurred in Pereira. The aim of this study was to describe the clinical and epidemiological characteristics of the outbreak.</p><p><strong>Methods: </strong>This is a descriptive study of an outbreak of organophosphate poisoning. The onset of symptoms occurred on 9 October 2022, following the consumption of empanadas. Information was collected on sociodemographic characteristics and clinical manifestations, as well as from paraclinical examinations. Data were obtained from clinical histories, field epidemiological investigations, and inspection visits. Food samples were collected for analysis by gas chromatography-mass spectrometry. Attack rates, proportions, and measures of central tendency, dispersion, and position were calculated.</p><p><strong>Results: </strong>The case definition was met by 37 individuals with a median age of 30 years; all presented with muscarinic symptoms, 29 patients presented with nicotinic symptoms, and 20 patients presented with neurological symptoms. Males were the most affected (57%), and the most common time of symptom onset was 10:00 am. Twenty-three patients (62%) required intensive care unit admission, of whom 14 (38%) required mechanical ventilation. No deaths were reported. Erythrocyte acetylcholinesterase activity was reduced in all patients. Ethion was detected in mass-prepared maize and empanadas at concentrations greater than 0.1 mg/kg. The consumption of empanadas was identified as the common source.</p><p><strong>Discussion: </strong>In Colombia, pesticide poisonings are the third most common type of poisoning caused by chemical substances reported to the National Health Institute through the National Public Health Surveillance System. In the present outbreak, ethion was in empanadas, likely due to contamination of cooking oil.</p><p><strong>Conclusions: </strong>We describe a large ethion-contaminated food poisoning outbreak reported in Colombia. The main symptoms were muscarinic, and the main treatment measures employed were atropine and respiratory support. Increased awareness of pesticide poisoning and training for food handlers are needed.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}