Clinical Otolaryngology最新文献

{"title":"The Value of Systemic Immune-Inflammation Index in the Occurrence and Prognosis of Sudden Sensorineural Hearing Loss: A Meta-Analysis.","authors":"Feifei Sun, Jun Bai, Xinyuan Liu, Mingjun Zhao","doi":"10.1111/coa.70169","DOIUrl":"https://doi.org/10.1111/coa.70169","url":null,"abstract":"<p><strong>Objectives: </strong>Sudden sensorineural hearing loss (SSNHL) is a common otolaryngology emergency. This study aimed to evaluate the association of the systemic immune-inflammation index (SII) with the occurrence and prognosis of SSNHL.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>Databases including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed.</p><p><strong>Participants: </strong>A total of 1263 participants from 11 studies, comprising 716 SSNHL patients and 547 healthy controls.</p><p><strong>Main outcome measures: </strong>Weighted mean difference (WMD) and 95% confidence interval (CI) for SII levels.</p><p><strong>Results: </strong>This meta-analysis included 11 studies involving 1263 participants, of whom 716 were SSNHL patients and 547 were healthy controls. The pooled results showed that SII was significantly higher in SSNHL patients than in healthy controls (WMD = 393.46, 95% CI: 222.02-564.91, p < 0.001). In addition, SII was significantly lower in the hearing recovery group than in the non-recovery group (WMD = -208.36, 95% CI: -412.27 to -4.34, p = 0.045).</p><p><strong>Conclusion: </strong>Elevated SII is associated with SSNHL occurrence and poorer hearing recovery. However, further prospective studies with adequate adjustment for confounders are required to clarify its independent prognostic value and clinical utility.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Postural-Perceptual Dizziness in Older Adults: Associations With Intrinsic Capacity Decline, Probable Sarcopenia and Geriatric Syndromes.","authors":"Nagihan Sözen Gencer, Sibel Cavdar, Mehmet Fatih Özhan, Omer Hizli","doi":"10.1111/coa.70170","DOIUrl":"https://doi.org/10.1111/coa.70170","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent postural-perceptual dizziness (PPPD) is a chronic dizziness disorder in older adults, characterized by persistent non-vertiginous dizziness and postural instability. This study aimed to investigate the associations of intrinsic capacity, sarcopenia and geriatric syndromes with PPPD in older adults.</p><p><strong>Methods: </strong>This cross-sectional study included 263 individuals aged over 65 years (128 with PPPD and 135 without PPPD) attending geriatric and otorhinolaryngology outpatient clinics. PPPD was diagnosed according to Bárány Society criteria. Comprehensive geriatric assessment included intrinsic capacity domains, frailty (FRAIL scale), handgrip strength (HGS), sarcopenia parameters and history of falls. Multiple logistic regression models were constructed to evaluate independent associations while avoiding collinearity between overlapping variables. Separate models were used to assess physical performance, intrinsic capacity, sarcopenia and geriatric syndromes.</p><p><strong>Results: </strong>Participants with PPPD had significantly lower intrinsic capacity, slower gait speed, lower handgrip strength, higher depressive symptoms, higher frailty and more frequent falls (all p ≤ 0.005). In locomotion-based models, slower gait speed (OR = 0.121, 95% CI: 0.031-0.474; p = 0.002), higher GDS-15 scores (OR = 1.131, 95% CI: 1.021-1.252; p = 0.018) and fall history (OR = 2.660, 95% CI: 1.502-4.711; p = 0.001) were independently associated with PPPD. In muscle strength models, lower handgrip strength was also associated with PPPD (OR = 0.927, 95% CI: 0.879-0.978; p = 0.006). Domain-based analysis showed that locomotor and psychological impairments were independently associated with PPPD. Lower intrinsic capacity was strongly associated with PPPD (OR = 0.497, 95% CI: 0.377-0.656; p < 0.001). In clinically oriented models, probable sarcopenia (OR = 2.185, 95% CI: 1.188-4.018; p = 0.012), frailty (OR = 2.381, 95% CI: 1.323-4.285; p = 0.004) and depression (OR = 2.558, 95% CI: 1.387-4.717; p = 0.003) were independently associated with PPPD, while malnutrition did not show a significant association.</p><p><strong>Conclusion: </strong>PPPD in older adults extends beyond a purely vestibular disorder, encompassing geriatric dimensions such as frailty, muscle weakness and depressive symptoms. An integrated otolaryngology-geriatrics care model is warranted, and longitudinal studies evaluating the impact of geriatric interventions on PPPD's natural history are needed.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse-Led Telephone Triage Clinic Service for Head and Neck Suspected cancer Referrals: A Prospective Study of 986 Referrals.","authors":"Raiza Elmira S Imperial, Charlotte Freeman, Catherine Lyons, Arunjit Takhar, Georgios Oikonomou, Babatunde Odutoye, Enyinnaya Ofo, Theofano Tikka","doi":"10.1111/coa.70164","DOIUrl":"https://doi.org/10.1111/coa.70164","url":null,"abstract":"<p><strong>Background: </strong>Head and neck cancer (HNC) referral conversion in the UK is less than 3%. A nurse-led telephone assessment clinic (TAC) using the HaNC-RC v.2 triage tool was introduced to identify high-risk (HR) referrals.</p><p><strong>Methods: </strong>Prospective data were collected from all HNC referrals (n = 986) over 6 months, with descriptive analysis of TAC triage outcomes.</p><p><strong>Results: </strong>Over 6 months, 986 referrals were reviewed, with a 4.4% (n = 43) cancer conversion rate. Of 483 (49.0%) TAC patients, 115 (23.8%) were high-risk (HR) triaged using the HaNC-RC v.2 tool. Cancer was diagnosed in 8 (7.0%) HR and 3 (0.9%) LR patients (early thyroid malignancies), who were subsequently upgraded to HR (p-value = < 0.001) with FDS compliance of 88% (95% CI: 83.5-92.1). Allowing for clinical capacity constraints, the first F2F clinical appointment with an HNC consultant was given to 63.1% of HR patients, and 7.7% of these patients were later confirmed to have cancer. HR and LR patients were seen within a mean of 9.2 and 10.2 days (p-value = 0.043), respectively. The mean waiting time was improved from 10.7 days (1st month) to 5.9 days (6th month) for an HR clinic slot (p-value = 0.04).</p><p><strong>Conclusion: </strong>This service evaluation study supports the use of the HaNC-RC v.2 at the 7.1% threshold in a TAC nurse-led clinic model alongside an STT pathway. The TAC service facilitated optimised use of consultant clinic slots, prioritising HR patients without compromising LR patients' outcomes and facilitated a reduction in USoC clinic slot requirements whilst helping FDS target compliance.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haemostatic Agent Use and Associated Complications After Thyroid Surgery: A Retrospective Cohort Study in a Tertiary Head and Neck Centre.","authors":"Mariam Zehrah Shahid, Emma Turner, Robert Taylor, Ian Smith","doi":"10.1111/coa.70166","DOIUrl":"https://doi.org/10.1111/coa.70166","url":null,"abstract":"<p><strong>Background: </strong>Haemostatic agents are increasingly used in thyroid surgery to improve operative outcomes. Although randomised controlled trials (RCTs) have demonstrated benefits, their real-world efficacy is under-researched. To assess whether these agents may facilitate day-case thyroidectomies in the UK, this study evaluated postoperative outcomes associated with intraoperative application of topical haemostatic agents.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study analysed patients aged ≥ 18 years who underwent elective thyroidectomies between May 2023 and May 2025. The primary outcome was the incidence of postoperative complications associated with intraoperative topical haemostatic agents, analysed using Fisher's exact test to compare patients who received haemostatic agents with those who did not. Secondary outcomes, including total drain output and length of inpatient stay, were analysed using the Mann-Whitney U test.</p><p><strong>Results: </strong>In 167 thyroidectomies, haemostatic agents were used in 69 (41.3%) patients: oxidised regenerated cellulose in 41 operations (59.4%), fibrin sealants in 29 (42.0%), and both in one (1.6%). Overall, postoperative complications occurred in 37 (22%) patients. A significantly increased incidence of postoperative complications was observed with the use of haemostatic agents (p < 0.001; OR = 11.1; 95% CI, 2.69-50.5). No difference was observed in total drain output or length of stay between the two groups.</p><p><strong>Conclusion: </strong>In this cohort, postoperative complications were associated with the use of haemostatic agents, highlighting the challenge of observing RCT-demonstrated data in routine clinical practice. Further research with adjusted modelling is needed before determining the role of haemostatic agents in thyroid surgery. Until then, they cannot be relied upon to facilitate day-case thyroidectomies.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric Voice Disorders in a Multidisciplinary Voice Clinic: A Retrospective Observational Study.","authors":"Hao Meng Yip, Lesley-Ann Cochrane, Lesley Cavalli, Emily Gallagher, Nicola Gorb, Christopher G Jephson","doi":"10.1111/coa.70167","DOIUrl":"https://doi.org/10.1111/coa.70167","url":null,"abstract":"<p><strong>Background: </strong>Paediatric voice disorders encompass a broad diagnostic spectrum, but contemporary descriptions of multidisciplinary voice clinic case-mix, assessment and management remain limited.</p><p><strong>Methods: </strong>We performed a retrospective observational study of routinely collected clinical data from a quaternary multidisciplinary paediatric voice clinic in the United Kingdom. Children and adolescents aged 4-17 years who were seen between January 2024 and December 2025 were included. Patient-level variables included demographics, symptom duration, referral-to-first clinic waiting time, and primary diagnosis. Appointment-level variables included documentation of patient-reported outcome measures, endoscopic findings reported in clinic letters, management outcomes, and procedure follow-through.</p><p><strong>Results: </strong>Of 111 listed appointments, 96 were attended (74 new and 22 follow-up) and 15 were non-attendances. These attended appointments represented 87 patients; median age at first appointment was 12 years (range 4-17 years), and 51/87 (58.6%) were male. Dysphonia was the main presenting symptom in 83/87 (95.4%). Median symptom duration at referral was 6.3 years (range 0.12-17.0 years), and median referral-to-first clinic waiting time was 154 days (range 16-1032 days). The most common diagnoses were vocal cord palsy (19/87, 21.8%), vocal cord nodules (11/87, 12.6%), and muscle tension dysphonia (9/87, 10.3%). In the vocal cord palsy/paresis subgroup (n = 20), 15/20 were left-sided and 13/20 were secondary to post-cardiac surgery/patent ductus arteriosus ligation.</p><p><strong>Conclusions: </strong>Children commonly experienced prolonged symptoms before specialist review, with a heterogeneous diagnostic spectrum and frequent vocal fold immobility. Standardised outcome capture and longer follow-up are needed to evaluate interventions and inform referral guidance.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olfactory Threshold Can Be Reliably Tested With Sniffin' Sticks in Non-Clinical Settings: Associations Shown in a Diverse, General Population.","authors":"Marta Rokosz, Xenia Reinert, Antje Haehner, Thomas Hummel","doi":"10.1111/coa.70163","DOIUrl":"https://doi.org/10.1111/coa.70163","url":null,"abstract":"<p><strong>Objective: </strong>The olfactory threshold part of the Sniffin' Sticks test is widely used to assess chemosensory function, yet most studies are conducted in controlled laboratory or clinical environments with selective samples. This study examined odour threshold performance with the Sniffin' Sticks threshold test in a large, heterogenous sample, testing whether established associations generalise outside the lab.</p><p><strong>Method: </strong>A total of 798 museum visitors aged 18-88 years completed the threshold test and rated their olfactory and gustatory ability, nasal patency, and sensitivity. Participants were classified as normosmic, hyposmic, or anosmic based on threshold scores. Associations with age, sex, health status, smoking, and alcohol use were analysed.</p><p><strong>Results: </strong>Threshold performance was positively associated with self-rated chemosensory ability and negatively with age. Women showed higher performance, greater self-rated ability, and better nasal patency and sensitivity than men. Normosmic participants were younger and reported higher function than other groups, especially hyposmic individuals. Chronic illness and nasal problems were linked to poorer performance and lower self-ratings. Smoking related to lower self-rated olfactory ability but not threshold scores; self-rated alcohol use showed no effect. The prevalence of anosmia and hyposmia was comparable to epidemiological data.</p><p><strong>Conclusion: </strong>The Sniffin' Sticks threshold test provides a valid and practical tool for assessing olfactory sensitivity in naturalistic, non-clinical settings.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azelastine-Fluticasone Intranasal Combination Therapy in Otorhinolaryngology: Clinical Evidence, Current Practice Patterns and Future Perspectives.","authors":"Giorgio Ciprandi, Ignazio La Mantia, Attilio Varricchio","doi":"10.1111/coa.70168","DOIUrl":"https://doi.org/10.1111/coa.70168","url":null,"abstract":"<p><strong>Background: </strong>Allergic rhinitis (AR) represents a significant burden in Ear Nose Throat (ENT) practice and markedly affects quality-of-life and work productivity of AR patients. The fixed combination of intranasal azelastine and fluticasone propionate (AzeFlu) has emerged as a valuable therapeutic option for moderate-to-severe AR. Recent updates to international guidelines and real-world evidence warrant a comprehensive review of its role in ENT practice, with particular attention to both seasonal and perennial AR.</p><p><strong>Methods: </strong>This narrative review synthesises evidence from the ARIA-EAACI 2024-2025 guidelines, systematic reviews and network meta-analyses of randomised controlled trials, pharmacovigilance data, and results from an Italian multidisciplinary inter-societal Delphi Consensus. We evaluated efficacy, safety, patient acceptability and implementation considerations specific to otorhinolaryngology practice.</p><p><strong>Results: </strong>Network meta-analyses demonstrate that AzeFlu provides superior symptom control compared to monotherapy for both nasal and ocular symptoms in seasonal and perennial AR, with a rapid onset of action (15-30 min). The combination shows particular efficacy in patients with moderate-to-severe symptoms inadequately controlled by monotherapy. Safety profiles are comparable to those of monotherapy, with no significant effects on growth or the HPA axis in children. Real-world data indicate high treatment satisfaction and adherence. The Italian Delphi Consensus achieved > 80% agreement on key management principles, particularly emphasising control of Type 2 inflammation and the role of combination therapy in treatment algorithms. Evidence for perennial AR remains more limited, and future primary research specifically targeting perennial rhinitis populations is warranted.</p><p><strong>Conclusions: </strong>Azelastine-fluticasone combination therapy represents an evidence-based, guideline-recommended option for moderate-to-severe AR in ENT practice. Its dual mechanism, rapid onset, favourable safety profile and high patient acceptability support its integration into contemporary treatment algorithms, particularly for patients requiring enhanced symptom control beyond monotherapy. The combination represents a meaningful therapeutic advancement, and further research is needed to fully characterise its role in perennial AR management.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Norfolk Smell and Taste Clinic Experience-A Decade of Olfactory and Gustatory Dysfunction.","authors":"Jeremy J Wong, Adam Lloyd, Ishan Singh, Louis Luke, Carl Philpott","doi":"10.1111/coa.70110","DOIUrl":"10.1111/coa.70110","url":null,"abstract":"","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"788-794"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Device to Improve the Tolerability of Intranasal Corticosteroid Sprays for Allergic Rhinitis and Postoperative Chronic Rhinosinusitis: A Crossover Trial.","authors":"Sethmi Ranasinghe, Xenia Berger, Wandia Kimita, Kristi Biswas, Raymond Kim, Richard Douglas","doi":"10.1111/coa.70137","DOIUrl":"10.1111/coa.70137","url":null,"abstract":"<p><strong>Background: </strong>Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are commonly treated with intranasal corticosteroid sprays. Despite their efficacy, unpleasant sensations associated with their application, including post-nasal drip and nasal irritation, are often cited as reasons for poor compliance. Optimising the intranasal application experience is key to improving long-term adherence. We developed a nasal adaptor for metered-dose inhalers (MDIs) to reduce the unpleasantness of nasal administration, potentially improving patient compliance.</p><p><strong>Methods: </strong>Two crossover trials were conducted in AR and postoperative CRS participants (n = 16 per group). Participants used a standard fluticasone nasal spray (50 μg) and a fluticasone MDI (125 μg) with the adaptor for 3 weeks each, separated by a 1-week washout period. Device order was alternated, and doses were adjusted to ensure an approximately equal fluticasone dose. Device preference was determined using an adjusted Clinical Trial Patient Preference Questionnaire, and symptom improvement was assessed using Total Nasal Symptom Score and Sino-nasal Outcome Test-22 questionnaires.</p><p><strong>Results: </strong>Symptom improvement was comparable between the devices. However, in both groups, 11/16 (69%) participants preferred the MDI with the adaptor over the standard nasal spray, citing fewer unpleasant sensations. Satisfaction score improvement was significantly greater with the novel device in the CRS cohort. Participants reported a higher likelihood of compliance with the novel device, suggesting improved adherence.</p><p><strong>Conclusions: </strong>An MDI with the adaptor was preferred over a standard nasal spray among AR and postoperative CRS participants. The enhanced tolerability may promote improved compliance, and consequently, more effective long-term symptom control.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"776-783"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Paediatric Sialorrhea: Outcomes of Botulinum Toxin and Surgical Procedures in a UK Tertiary Centre.","authors":"J Yapp, P Bruno, Y Embury-Young, F Protts, M Saunders","doi":"10.1111/coa.70132","DOIUrl":"10.1111/coa.70132","url":null,"abstract":"","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":"801-804"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13432519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}