European Journal of Trauma and Emergency Surgery最新文献

{"title":"Rehabilitation of severely injured patients.","authors":"Thomas Mendel, Ingo Marzi, Christiane Anke","doi":"10.1007/s00068-025-02830-w","DOIUrl":"10.1007/s00068-025-02830-w","url":null,"abstract":"<p><p>Rehabilitation is a vital component of the holistic care of severely injured patients, addressing physical limitations, preventing complications, and promoting social and professional reintegration. Tailored measures are required across all phases of care, depending on individual injury patterns. Adequate early rehabilitation within inpatient settings necessitates appropriate personnel and infrastructure. Rehabilitation teams must include specialists from diverse therapeutic disciplines. Although financial frameworks vary by country, comprehensive funding for high-quality therapy programmes is essential for effective treatment.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"149"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment and clinical outcomes in lower extremity necrotizing soft tissue infection.","authors":"Mesut Kariksiz, Okan Ates","doi":"10.1007/s00068-025-02835-5","DOIUrl":"https://doi.org/10.1007/s00068-025-02835-5","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing soft tissue infection (NSTI) is a rapidly progressing infection of the soft tissues under the skin, which poses a life-threatening risk if not treated promptly. Due to the non-specific nature of symptoms at presentation, the diagnosis is often delayed, leading to a high mortality rate and increased risk of amputation. Early treatment requires both surgical intervention and antibiotic therapy. This study aims to investigate the effects of clinical parameters, applied treatments, and initial interventions on mortality and amputation rates in patients with NSTI.</p><p><strong>Materials and methods: </strong>In a retrospective study, 50 patients diagnosed with NSTI between 2021 and 2024 were included. Patient demographic characteristics (age, gender, comorbidities), isolated microorganisms, antibiotics administered, interventions performed, and the final outcomes were analyzed. Additionally, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, duration of intensive care unit (ICU) stay, length of hospital stay, rates of mortality and amputation were examined.</p><p><strong>Results: </strong>Among the 50 patients in this study, the mortality rate due to NSTI was 20% (10 patients), and the amputation rate was 60% (30 patients). Both the length of hospital stay and duration of ICU stay were significantly associated with mortality. Diabetes mellitus (DM) was found to be significantly related to amputation. The LRINEC score, presence of chronic renal failure, sepsis, hyperbaric oxygen therapy (HBOT), smoking, and timing of surgical intervention were not significantly associated with amputation rates. The most common isolated microorganism was Streptococcus pyogenes.</p><p><strong>Conclusion: </strong>Although the LRINEC score is widely used, it does not play a critical role in the management of NSTI. Factors like underlying comorbidities and hospital stay more significantly affect mortality and amputation rates. Early diagnosis and treatment are recommended to improve patient outcomes.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"148"},"PeriodicalIF":1.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700094","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":"Impact of fracture morphology on the biomechanical stability of osteosynthetic fixation.","authors":"Marianne Hollensteiner, Mischa Mühling, Philipp Blum, Sabrina Sandriesser, Dirk Baumeister, Markus Greinwald, Julian Fürmetz, Peter Augat","doi":"10.1007/s00068-025-02802-0","DOIUrl":"10.1007/s00068-025-02802-0","url":null,"abstract":"<p><p>Biomechanical testing is essential for evaluating osteosyntheses, particularly in assessing stability, stiffness, and fragment motion. However, traditional flat-fracture models created via osteotomy fail to replicate the complex morphology of real-world fractures, potentially reducing the applicability of results. This study introduces patient-specific distal femur fracture models to investigate the impact of fracture morphology on the biomechanical performance of osteosyntheses. Realistic fracture models were generated using 3D printing and molding, based on CT-derived geometry, alongside traditional osteotomy models. Four groups were tested: osteotomized and realistic fracture models, with and without gaps. All constructs were treated with distal femur locking plates and subjected to axial and torsional loading. Dynamic testing simulated physiological conditions and tracked interfragmentary motions with a 3D optical motion system. Realistic fracture models exhibited higher torsional stiffness and reduced interfragmentary motion compared to osteotomized models, particularly in closed fracture gaps. Axial stiffness increased significantly upon fracture gap closure in all gap groups, transitioning from exclusively plate-bearing to construct-bearing configurations. The irregular geometry of realistic fractures provided enhanced interlocking, improving stability under both axial and torsional loads. Patient-specific fracture models better replicate the mechanical behaviour of clinical distal femur fractures, demonstrating advantages over osteotomized fracture models. The inclusion of realistic fracture geometries in biomechanical testing improves the transfer of biomechanical results into a clinical setting and offers valuable insights for optimizing designs and improving clinical outcomes.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"144"},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of 1-year mortality in a clinical cohort of hip fracture patients.","authors":"Mads Sundet, Mette Martinsen, Maren Paus, Haldor Valland, Henriette Haugeli Halvorsen, Joseph Sexton, Ulf Sundin, Siri Lillegraven","doi":"10.1007/s00068-025-02812-y","DOIUrl":"10.1007/s00068-025-02812-y","url":null,"abstract":"<p><strong>Purpose: </strong>Knowledge about factors associated with mortality after hip fracture is important both for analytical and clinical purposes. This study aimed to assess patient risk factors and commonly used composite scores for prediction of 1-year mortality in a large clinical cohort.</p><p><strong>Methods: </strong>Hip fracture patient data were prospectively recorded in a local hospital database. Consecutive fractures from 2006 to 2020 were included, 6040 fractures in 5496 patients. Associations between 1-year mortality and different exposures were estimated using univariate and two multivariate logistic regression models. ROC analysis was used to compare the ability of the Nottingham Hip Fracture Score (NHFS), Age-adjusted Charlson Comorbidity Index (ACCI) the American Society of Anesthesiologists score (ASA) and the Orthopedic Frailty Score (OFS) to predict 1-year mortality.</p><p><strong>Results: </strong>Females sustained 73.9% of the fractures. Total 1-year mortality was 24.8%. Patients with overweight and class 1 obesity had lower 1-year mortality rates than normal weight patients [overweight: adjusted OR 0.58 (0.45-0.77), class 1 obesity: adjusted OR 0.40 (0.21-0.75)]. Mortality was elevated in males (adjusted OR 2.04, 95% CI 1.76-2.36), and nursing home residents (adjusted OR 2.99, 95% CI 2.60-3.44). We found no significant association between waiting time before surgery and mortality. Models including ACCI (AUC 0.74), NHFS (AUC 0.75) and OFS (AUC 0.73) had a similar ability to predict 1-year mortality, while a model including ASA (AUC 0.71) had a significantly lower prediction ability than ACCI and NHFS.</p><p><strong>Conclusions: </strong>Sex, age, cognitive impairment, and residential status predicted 1-year mortality. The study found an apparent \"obesity paradox\", where overweight patients had a lower mortality rate than normal weight patients, but unmeasured confounding may have biased this analysis. ACCI and NHFS predicted mortality better than the combination of age, sex, and ASA.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"147"},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intended and suicidal trauma to the anterior neck in Finnish young adults.","authors":"Riikka E Mäkitie, Silja Kosola, Taru Ilmarinen","doi":"10.1007/s00068-025-02813-x","DOIUrl":"10.1007/s00068-025-02813-x","url":null,"abstract":"<p><strong>Purpose: </strong>Self-inflicted injuries are a leading cause of death in young adults. Trauma to the anterior neck, such as from cutting and hanging, can have serious consequences given the complex anatomy and closeness of critical structures. Considering the recent increase in intended and inter-personal violence, we evaluated the occurrence and clinical characteristics of self-harm neck injuries in young adults.</p><p><strong>Methods: </strong>We retrospectively reviewed all neck traumas treated at the Helsinki University Hospital in patients aged 18 to 30 years in 2005-2023. Patient records were systematically evaluated for cohort demographics, injury type, clinical characteristics, given treatment, follow-up, and possible psychiatric comorbidities.</p><p><strong>Results: </strong>In total 169 events were recorded, with an evident increase in the recent years (45% of all in 2020-2023) and particularly in females. Females were younger than males (p = 0.010) and their trauma generally milder, often managed in outpatient care (82%). Severe penetrating injuries occurred primarily in males (p = 0.005) who were older (p = 0.004) and without prior suicidal events (p = 0.005). They required surgical interventions and prolonged in-house treatment. Overall, the cohort was characterized by a heavy burden of psychiatric comorbidities (98%) and substance abuse (53%); 78% had other suicidal events. Four patients (2.9%) deceased from a recorded suicide during the study period.</p><p><strong>Conclusions: </strong>We report an alarming increase in suicidal self-harm especially among young females and severe intended neck traumas in older males without preceding suicidal behavior. Our findings warrant timely preventative actions on an individual and societal level and call for refined guidelines for clinical management.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"146"},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing the disaster: severe abdominal injury in child passengers of motor vehicle accidents often indicate even more serious trauma.","authors":"Christopher Spering, R Lefering, D Bieler, L Hackenberg, C C Dobroniak, G Müller, W Lehmann, Rüther H","doi":"10.1007/s00068-025-02811-z","DOIUrl":"10.1007/s00068-025-02811-z","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess severe abdominal injury in child passengers of different ages of motor vehicle accidents and analyze the concomitant pattern of injury regarding injury severity, trauma management and outcome.</p><p><strong>Method: </strong>Data acquisition from Trauma Register DGU^® (TR-DGU) in a 10-years period (2010-2020) of seriously injured children (max. AIS 2+ / intensive care) 0-15 years of age, as motor vehicle passengers (cMVP) (n = 1,035). Primarily treated in or transferred to a German Trauma Center. Matched pairs analysis with adult severely injured motor vehicle passengers (aMVP) (age 20-50 years, n = 26,218), matching 1:4 (child: adult), was performed to identify causes of mortality.</p><p><strong>Results: </strong>The study group (cMVP) included 1,035 children. The mean age was 9.5 years, 50.5% were male and the mean Injury Severity Score (ISS) was 18.7 points. 93.0% were transported from scene directly to the final trauma center. Transferred patients showed a higher ISS (26 vs. 18 points), higher rate of severe traumatic brain injury (TBI), a higher rate of serious abdominal injury and a higher mortality rate (12.5% vs. 7.4%). Most of the severe abdominal injuries occurred after the third year of age (first peak between 8 and 9 years; second peak 14-15 years). Serious injuries to the pelvis show a similar distribution but less often, the same applies to thoracical injuries. Severe brain and head injuries show an antiproportional distribution to the age groups with the highest rate in the 0-1 year old (78%) and the lowest in the 14-15 year old (40%). The highest mortality rate was shown in the youngest age groups, related to TBI (AIS_TBI ≥ 3; 62% in 0-1 years). The matched pairs analysis shows a higher mortality rate of cMVP compared to aMVP within the first 24 h after hospital admission and a significantly higher rate of shock and unconsciousness, while the intubation rate is significantly lower.</p><p><strong>Conclusion: </strong>Child passengers of motor vehicle accidents are in need of a specific and age-related attention towards security systems. Severe injuries in children are rare, yet life threatening. The highest mortality rate is related to severe TBI, especially in the youngest children. But also severe abdominal as well as thoracic injuries their concomitant trauma need to be prevented and are indicators for even more severe injuries. It seems to be favorable for cMVP to be directly transported to designated special centers with sufficient capacity and competency to treat and manage severely injured children.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"145"},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma systems in Europe / hospital categories.","authors":"Inger B Schipper, Hans-Peter Simmen, Roman Pfeifer","doi":"10.1007/s00068-025-02828-4","DOIUrl":"10.1007/s00068-025-02828-4","url":null,"abstract":"<p><p>Trauma systems are vital components of healthcare infrastructure, addressing the significant burden of severe injuries across Europe. Effective trauma systems improve patient outcomes and reduce mortality by providing timely, specialised care. However, significant disparities remain between countries, with only a few well-structured and maintained systems currently operating in Europe.Developing trauma systems requires collaboration among healthcare providers, emergency services, and government agencies. Standardised protocols for triage, transport, and treatment are essential, supported by robust infrastructure, public education, and injury prevention initiatives.Trauma systems comprise four core components:• Injury Prevention.• Pre-Hospital Care.• Facility Care.• Post-Hospital Care/Rehabilitation.These components rely on key elements such as leadership, professional resources, education, quality improvement, and funding. Political commitment, geographical considerations, and the efforts of dedicated clinicians are crucial for ensuring system success.Trauma systems across Europe are evolving under diverse healthcare structures. Over recent decades, dedicated clinicians, often with support from national medical societies, have initiated and sustained these systems. Typically, trauma hospitals, or trauma centres (TCs), are categorised into two or three levels, with the highest being 'Level I TC' or 'Major TC,' capable of managing the most complex cases. This chapter outlines general requirements for these categories, leaving individual nations to tailor standards to their healthcare systems.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"143"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engineering the bone reconstruction surgery: the case of the masquelet-induced membrane technique.","authors":"Marjorie Durand, Laurent Mathieu, Julien Venant, Alain-Charles Masquelet, Jean-Marc Collombet","doi":"10.1007/s00068-025-02815-9","DOIUrl":"10.1007/s00068-025-02815-9","url":null,"abstract":"<p><p>The reconstruction of large bone defects remains challenging for orthopedic surgeons. Autologous bone grafts (ABGs) are the gold standard treatment for limited size defects, but larger bone defects (> 5 cm) require the use of more sophisticated techniques, such as the Masquelet technique. Over the last three decades, the Masquelet or induced membrane technique (IMT) has become increasingly popular as it does not require high-precision microsurgery skills and the time taken to achieve bone consolidation is independent of the length of the defect. IMT is a two-stage procedure. In the first stage, a polymethylmethacrylate (PMMA) cement spacer is implanted into the bone lesion and a physiological immune reaction initiates the formation of a fibrotic induced membrane (IM) with both angiogenic and osteogenic properties. The second stage, performed several weeks later, involves removal of the spacer followed by the implantation of a standard ABG in the preserved IM cavity for subsequent bone repair. In this extensive review, we explain how the success of this surgical procedure can be attributed to the synergy of four key components: the inducer (the PMMA cement), the recipient (the IM), the effector (the bone graft) and the modulator (the mechanical environment). Conversely, we then explain how each key component can contribute to the failure of such treatment. Finally, we discuss existing or emerging innovative and biotechnology-oriented strategies for optimizing surgical outcome with respect to the four components of IMT described above.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"138"},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of hemorrhagic shock on brain perfusion in a swine model of raised intracranial pressure.","authors":"Hossam Abdou, Rebecca Treffalls, Grzegorz Jodlowski, Noha Elansary, Thomas Ptak, Patrick F Walker, Jonathan J Morrison","doi":"10.1007/s00068-025-02819-5","DOIUrl":"https://doi.org/10.1007/s00068-025-02819-5","url":null,"abstract":"<p><strong>Purpose: </strong>In patients with hemorrhagic shock and an intracranial space occupying lesion (SOL), brain perfusion is severely compromised due to raised intracranial pressure (rICP), significantly worsening outcomes. This study aims to develop a swine model of a SOL with rICP and shock and characterize the effect on brain perfusion.</p><p><strong>Methods: </strong>Ten male swine were divided into two groups- normal ICP (nICP) and rICP. rICP animals had an intracranial Fogarty balloon catheter inserted, which was infused with saline to simulate a SOL. Animals underwent hemorrhage to systolic blood pressures (SBP) of 60, 40, and 20mmHg. Cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured using CT perfusion.</p><p><strong>Results: </strong>The CBF/Mean arterial pressure (MAP) and CBV/MAP curves were modeled using non-linear regression, with both groups demonstrating a sigmoid relation. In both the CBF/MAP and CBV/MAP curves, animals with rICP had loss of autoregulation at a higher MAP compared to nICP. The curves were an excellent fit for CBF (nICP R² = 0.95; rICP R² = 0.77) and CBV (nICP R² = 0.96; rICP R² = 0.78).</p><p><strong>Conclusions: </strong>This study aids in quantifying the compounding insult of raised ICP and hemorrhage with regard to brain perfusion. Raised ICP results in autoregulatory failure at a higher MAP compared to animals with nICP. These results can help inform future studies that should be aimed at evaluating novel interventions for this complex clinical scenario.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"137"},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656573","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":"Operating room (OR) requirements.","authors":"Roman Pfeifer, Frank Hildebrand, Sascha Halvachizadeh","doi":"10.1007/s00068-025-02823-9","DOIUrl":"10.1007/s00068-025-02823-9","url":null,"abstract":"<p><p>The International Health Facility Guidelines 2023 provide critical recommendations for operating room (OR) design and management, addressing layout, equipment specifications, and safety protocols. By adhering to these guidelines, healthcare facilities can ensure optimal conditions for surgical procedures, minimise risks to patients and staff, and enhance overall efficiency. These recommendations serve as a vital resource for healthcare administrators, architects, and medical personnel, facilitating high-quality surgical care and improved outcomes for trauma patients.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"135"},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}