Critical Care Medicine最新文献

{"title":"Lidocaine Versus Amiodarone in Patients With Shockable Out-of-Hospital Cardiac Arrest: A Target Trial Emulation.","authors":"Georg Gelbenegger, Sheldon Cheskes, Ian R Drennan, Steve Lin, Bernd Jilma, Markus Zeitlinger, Damon C Scales, Anselm Jorda","doi":"10.1097/CCM.0000000000007265","DOIUrl":"10.1097/CCM.0000000000007265","url":null,"abstract":"<p><strong>Objectives: </strong>Amiodarone or lidocaine are recommended for the treatment of shockable out-of-hospital cardiac arrest (OHCA). Previous comparisons between the two antiarrhythmic drugs were inconclusive.</p><p><strong>Design: </strong>This analysis included data from the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry 3 (2011-2015). A target trial framework was used to overcome confounding inherent in observational comparisons.</p><p><strong>Setting: </strong>Data from patients with OHCA were prospectively collected by emergency medical services (EMS) at multiple North American sites.</p><p><strong>Patients: </strong>Adults with nontraumatic OHCA and an initial shockable rhythm who received at least three defibrillation attempts were included. Time zero was defined as first antiarrhythmic drug administration, at which eligibility criteria had to be met.</p><p><strong>Interventions: </strong>Two antiarrhythmic treatment strategies were compared: lidocaine vs. amiodarone.</p><p><strong>Measurements and main results: </strong>The primary outcome was survival to hospital discharge. The key secondary outcome was favorable neurologic outcome at discharge (modified Rankin scale score of 3 or less). Group differences were adjusted using inverse probability weighting (key covariates: age, sex, location of OHCA, witness status, bystander resuscitation, automated external defibrillator shock, elapsed time from call to advanced life support arrival/first EMS shock/advanced airway, intraosseous access) and a multiple logistic regression model. Of 2451 patients included, 987 received lidocaine and 1464 received amiodarone. The adjusted percentage point difference in survival to hospital discharge was 2.8% favoring lidocaine (95% CI, -0.6 to 6.2); the estimated survival probabilities were 26.2% (275/987) with lidocaine and 23.5% (329/1464) with amiodarone. No difference was observed in the estimated probability of favorable neurologic outcome at discharge between the lidocaine group (17.7%) and the amiodarone group (16.2%) (adjusted difference, 1.5%; 95% CI, -1.5 to 4.5).</p><p><strong>Conclusions: </strong>No statistically significant difference in survival or favorable neurologic outcome was observed between lidocaine and amiodarone; however, the wide CIs cannot exclude a clinically meaningful benefit for lidocaine. These findings are consistent with randomized controlled trials, but residual confounding cannot be excluded.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2579-2589"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU Open-Access Databases for Artificial Intelligence in Sepsis: Balancing Innovation With Data Quality Challenges.","authors":"Joanne Jegou, Ioana Manolescu, Stéphane Ruckly, Jean-François Timsit, Michael Thy","doi":"10.1097/CCM.0000000000007319","DOIUrl":"10.1097/CCM.0000000000007319","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the suitability of three major open-access ICU databases (Medical Information Mart for Intensive Care IV [MIMIC-IV], eICU Collaborative Research Database [eICU-CRD], and Amsterdam University Medical Center Database [AmsterdamUMCdb]) for artificial intelligence (AI)-based sepsis research, with a focus on data completeness, internal consistency, terminological standardization, and structural redundancy affecting clinical interpretability and reproducibility.</p><p><strong>Design: </strong>A descriptive comparative design was employed to evaluate data completeness, terminological consistency, structural integrity, and clinical usability, with emphasis on sepsis-related variables such as antimicrobial administration, hemodynamic support, and mortality indicators.</p><p><strong>Setting: </strong>Open-access ICU electronic health record databases including MIMIC-IV (2008-2019), eICU-CRD (2014-2015), and AmsterdamUMCdb (2003-2016), accessed under credentialed use agreements. Documentation, schema, and metadata were reviewed in parallel to primary datasets.</p><p><strong>Interventions: </strong>Structured queries and descriptive analyses were performed to quantify missing values, distinct diagnosis strings, medication administration completeness, and redundancy of mortality markers. Manual semantic inspection of terminology, units, and coding ( International Classification of Diseases , 9th revision/10th revision) was applied to evaluate inconsistency and typographical variability. Comparisons were made across key clinical dimensions including diagnosis, mortality, microbiology, and antibiotic administration.</p><p><strong>Measurements and main results: </strong>Marked heterogeneity and data quality limitations were identified. MIMIC-IV demonstrated extensive missingness in medication route (49%) and dose (58%), 99.9% missing fields in microbiology quantity, and diagnosis redundancy with 17,557 unique strings and 174 near-duplicate variants. eICU-CRD exhibited 1.9% admissions lacking diagnosis and discordance between ICU and hospital mortality in 7,319 stays. AmsterdamUMCdb showed fewer structural inconsistencies but limited demographics and the highest proportion of admissions without diagnosis (61.4%), complicated by mixed English-Dutch terminology. All three databases lacked reliable sepsis diagnosis timestamps, constraining analysis of early intervention.</p><p><strong>Conclusions: </strong>Although widely used and valuable for sepsis research, open-access ICU databases exhibit substantial missingness, redundancy, semantic variability, and demographic imbalance. These limitations require rigorous preprocessing and highlight the need for standardized data collection to improve the validity and generalizability of AI-driven sepsis studies.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2686-2696"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychoactive Medication Prescribing After Critical Illness in American Adults Not Justified by a Documented Supporting Diagnosis.","authors":"Ting Ting Wu, O Joseph Bienvenu, Louisa H Smith, Jane S Saczynski, Robert Cavanaugh, John W Devlin","doi":"10.1097/CCM.0000000000007310","DOIUrl":"10.1097/CCM.0000000000007310","url":null,"abstract":"<p><strong>Objectives: </strong>To describe psychoactive medication (PM) prescribing in the 30 days after an ICU admission requiring mechanical ventilation not supported by a documented diagnosis in American adults not prescribed a PM before ICU admission. This nondiagnostically supported PM prescribing was explored in patient subgroups and for up to 2 years.</p><p><strong>Design, setting, and patients: </strong>This retrospective cohort study analyzed data from the U.S. claims database PharMetrics Plus for Academics for adults admitted to an ICU requiring invasive mechanical ventilation between January 1, 2018, and December 31, 2019. Patients prescribed a PM or admitted to an ICU or long-term care facility in the year prior, or who ended insurance coverage during the index hospitalization, were excluded.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Common and uncommon diagnostic codes potentially justifying each PM class prescription were identified using a literature review and expert consensus. A total of 416 of 7898 patients (5.3%) were newly prescribed 484 PMs across four PM classes in the 30-day postdischarge period [193 anxiolytics (39.9%), 176 antidepressants (36.2%), 103 antipsychotics (21.3%), and 12 sleep aids (2.5%)]. A total of 207 prescriptions (42.8%) of these 484 PM prescriptions were not accompanied by a documented supporting diagnosis: 54 of 103 antipsychotics (52.4%), 88 of 193 anxiolytics (45.6%), 5 of 12 sleep aids (41.7%), and 60 of 176 antidepressants (44.1%). Patient subgroups significantly associated with greater 30-day PM prescribing not supported by a documented diagnosis were: younger than 65 (antipsychotics); no history of dementia (anxiolytics); a discharge to home (antidepressants, antipsychotics); and ICU readmission (sleep aids). New PM prescribing in the absence of a supporting documented diagnosis persisted over the next 2 years (31-90 d, 24.7%; 91-180 d, 37.8%; 181-365 d, 42.7%; 366-730 d, 36.6%).</p><p><strong>Conclusions: </strong>Although the prevalence of new PM prescribing to American ICU survivors in the 30 days after discharge is relatively low, nearly half is not supported by a documented diagnosis. Future prospective research should determine the prevalence of nondiagnostically documented PM prescribing that is unwarranted.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2555-2566"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Temperature Management at 35°C vs. 37°C for Heatstroke in ICU: A Pilot Randomized Controlled Trial.","authors":"Yu-Cong Wang, Jian-Wen Wang, Xu Li, Jie Jiang, Ling Lin, Zhong-Lin Yu, Yu-Kun Mu, Chun-Miao Pan, Da-Hai Geng, Xiao-Jiao Liu, Xin Fu, Tong-Ling Li, Zhi-Wei Yao, Lu-Ping Wang, Ai-Jia Ma, Yi-Song Cheng, Min He, Jing Yang, Xiao-Dong Jin, Yan Kang, Bo Wang, Zhong-Wei Zhang, Qin Wu","doi":"10.1097/CCM.0000000000007266","DOIUrl":"10.1097/CCM.0000000000007266","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility of conducting a trial comparing targeted temperature management (TTM) at 35°C-37°C in intubated heatstroke patients, while collecting preliminary data on safety and clinical outcomes.</p><p><strong>Design: </strong>Pilot multicenter randomized clinical trial (June to December 2024).</p><p><strong>Setting: </strong>Ten tertiary ICUs in China.</p><p><strong>Patients: </strong>Thirty-five intubated adults (18 yr or older) with heatstroke meeting predefined diagnostic criteria. Key exclusions: nonenvironmental hyperthermia, expected death within 24 hours, or contraindications to temperature management.</p><p><strong>Interventions: </strong>Patients were randomly assigned 1:1 to two TTM strategies. The therapeutic hypothermia group received protocolized rapid cooling using a combination of ice packs, precooled blankets, and ice-cold IV saline to achieve the target of 35.0°C within 2 hours, which was then maintained for 48 hours. The controlled normothermia group received conventional cooling measures (ice packs, 32°C blankets) only if body temperature exceeded 38.0°C, with the goal of maintaining core temperature between 36.5°C and 37.5°C. Shivering was managed according to a stepwise protocol, with a \"lytic cocktail\" (chlorpromazine, promethazine, and meperidine) available as rescue therapy for refractory shivering in both groups.</p><p><strong>Measurements and main results: </strong>Recruitment rate was 83.7%, retention rate was 97.2%, and protocol adherence exceeded 88%. For clinical outcomes, no significant differences were observed in 28-day poor functional outcome (17.6% vs. 16.7%) or survival (82.4% vs. 83.3%). However, therapeutic hypothermia was associated with significantly higher rates of severe gastrointestinal injury (Acute Gastrointestinal Injury grade 3-4: 52.9% vs. 0%; p < 0.001) and arrhythmias (41.2% vs. 11.1%; p = 0.045). The lytic cocktail was required in 100% of hypothermia-group patients vs. 27.8% in the normothermia group ( p < 0.001).</p><p><strong>Conclusions: </strong>This pilot study confirms the operational feasibility of a large-scale randomized clinical trial. However, therapeutic hypothermia was associated with significantly worse gastrointestinal injury and higher arrhythmia incidence, without evidence of neurologic or survival benefit. The universal requirement for pharmacological shivering control in the hypothermia group raises additional safety considerations. Based on current evidence, this strategy should not be routinely adopted in ICU heatstroke management.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2741-2753"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The authors reply.","authors":"Marc Leone, Ashish K Khanna","doi":"10.1097/CCM.0000000000007303","DOIUrl":"https://doi.org/10.1097/CCM.0000000000007303","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"54 10","pages":"2783-2784"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering Resilience: The Role of Team Dynamics in Mitigating Burnout and Enhancing Well-Being in the Neurocritical Care Unit.","authors":"Vishank A Shah, Junaid Ansari, Miriam Quinlan, Karissa L Dushel, Elizabeth Zink, Jessica Jenkins, Shirley Anderson, Salia Farrokh, David Hering, Shawn Trautman, Rachel Bartock, Austen Lefebvre, Sung-Min Cho, Susanne Muehlschlegel, Jessica Bienstock, Jose I Suarez","doi":"10.1097/CCM.0000000000007281","DOIUrl":"10.1097/CCM.0000000000007281","url":null,"abstract":"<p><strong>Objectives: </strong>Staff in neurocritical care units (NCCUs) are particularly vulnerable to burnout, negatively affecting team dynamics and education. We evaluated the impact of several stakeholder-led, resilience-building interventions on staff burnout and team dynamics in the NCCU.</p><p><strong>Design: </strong>Participatory, stakeholder-led, quality improvement intervention-based project with serial cross-sectional surveys.</p><p><strong>Setting: </strong>NCCUs at the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, within the Johns Hopkins Medicine NCCU Division.</p><p><strong>Subjects: </strong>Multidisciplinary NCCU members, including fellows, attending physicians, advanced practice providers (APPs), pharmacists, nurses, and ancillary staff, were eligible. Participation was voluntary and anonymous.</p><p><strong>Interventions: </strong>Between October 2023 and September 2024, a multidisciplinary working group identified key drivers of burnout and impaired team dynamics and implemented interventions targeting individual and organizational resilience. Strategies included a shared vision statement, a zero-tolerance pledge for unprofessional behavior, enhanced leadership communication, recognition mechanisms, team-building professional development sessions, social events, workflow revisions, and restructuring of educational programs.</p><p><strong>Measurements and main results: </strong>Surveys were conducted at baseline, 6 months, 1 year, and 2 years, using the Maslach Burnout Inventory and Team Dynamics Surveys. The average response rate was 68% (53% nurses, 20% faculty, 9% fellows, and 18% APPs/pharmacists/ancillary staff). Over 2 years, the median (interquartile range) total emotional exhaustion score improved from 25 (19-30) to 9 (9-18), depersonalization score from 9 (7-13) to 5 (5-10), and the personal accomplishment score from 29 (26-32) to 40 (32-40; all p < 0.001). Sustained improvement was also noted in all domains of the Team Dynamics Survey (all p < 0.001). During this timeframe, the mean fellow in-service examination score also increased between April 2024 (pre-intervention) and April 2025 (+14%; p < 0.001), 1-year post-intervention.</p><p><strong>Conclusions: </strong>A participatory, stakeholder-driven quality improvement initiative with multipronged interventions targeting resilience and team dynamics reduced burnout, improved team well-being, and was temporally associated with improved trainee educational performance in high-acuity NCCUs. This framework is feasible, sustainable, and adaptable to other ICU environments.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2697-2708"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Support Interventions in the ICU: Reckoning With the Past and Planning for the Future.","authors":"Rebecca A Aslakson, Christopher E Cox, Douglas B White","doi":"10.1097/CCM.0000000000007322","DOIUrl":"10.1097/CCM.0000000000007322","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2773-2775"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postintensive Care Frailty of Older Patients With Septic Shock: A Post Hoc Analysis of a Multicenter Randomized Controlled Trial.","authors":"Ryo Yamamoto, Takahiro Yamanaka, Daiki Kaito, Akia Endo, Kazuma Yamakawa, Takashi Tagami, Yutaka Umemura, Junichi Sasaki","doi":"10.1097/CCM.0000000000007304","DOIUrl":"10.1097/CCM.0000000000007304","url":null,"abstract":"<p><strong>Objectives: </strong>Postintensive care frailty impairs quality of life in survivors of severe illness. While anabolic hormone deficiency and prolonged inflammation are considered key physiologic mechanisms, specific features associated with frailty progression remain unclear. This study aimed to elucidate clinical characteristics associated with frailty deterioration following recovery from septic shock in older adults.</p><p><strong>Design: </strong>Post hoc analysis of a randomized controlled trial.</p><p><strong>Setting: </strong>ICUs in Japan.</p><p><strong>Patients: </strong>Adults of 65 years or older with septic shock.</p><p><strong>Measurements and main results: </strong>Data were analyzed from a randomized controlled trial investigating optimal blood pressure targets in patients of 65 years or older with septic shock. Frailty at 90 days after intensive care was classified as no-to-mild, moderate, and severe based on the Clinical Frailty Scale (CFS) scores of less than or equal to 4, 5-6, and greater than or equal to 7, respectively. Baseline characteristics, treatments, and outcomes were compared across these frailty categories. Factors associated with postintensive care frailty were identified using ordinal logistic regression fitted with a generalized estimating equation model. Among 513 eligible patients, 339 patients survived to 90 days; 103 patients (30.4%) had no-to-mild frailty, 114 patients (33.6%) had moderate frailty, and 122 patients (36.0%) had severe frailty, respectively. Higher presepsis CFS scores (adjusted odds ratio [aOR], 2.03 [1.72-2.40] per 1-point increase; p < 0.001), higher sequential organ failure assessment (SOFA) scores (aOR, 1.16 [1.06-1.26] per 1-point increase; p < 0.001), and corticosteroid use (aOR, 1.72 [1.14-2.61]; p < 0.001) were independently associated with frailty. Subgroup analyses revealed that corticosteroid use was associated with frailty deterioration in patients with baseline frailty (CFS ≥ 5), whereas SOFA scores were associated with frailty in patients with tissue hypoperfusion (lactate, ≥ 2 mmol/L).</p><p><strong>Conclusions: </strong>Baseline frailty before sepsis, organ dysfunction severity, and corticosteroid therapy independently predict severe postintensive care frailty in older adults with septic shock.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":"2660-2669"},"PeriodicalIF":7.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between Beliefs and Reality: How to Help Family Members Deal With Prognostic Expectations for Critically Ill Patients","authors":"Pascal Beuret,Gabrielle Veislinger","doi":"10.1097/ccm.0000000000007166","DOIUrl":"https://doi.org/10.1097/ccm.0000000000007166","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"4 1","pages":"2785-2786"},"PeriodicalIF":8.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting Positive End-Expiratory Pressure in the Acute Respiratory Distress Syndrome","authors":"Sarina K. Sahetya,Arthur S. Slutsky,Roy G. Brower","doi":"10.1097/ccm.0000000000007320","DOIUrl":"https://doi.org/10.1097/ccm.0000000000007320","url":null,"abstract":"","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":"16 1","pages":"2709-2716"},"PeriodicalIF":8.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}