Fertility and sterility最新文献

{"title":"Childhood adversity and doctor visits in gynecology: to screen or not to screen","authors":"Janneke van ’t Hooft M.D., Ph.D. , Dinushi De Alwis M.D. , Ben Willem Mol M.D., Ph.D.","doi":"10.1016/j.fertnstert.2024.12.018","DOIUrl":"10.1016/j.fertnstert.2024.12.018","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 598-599"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871901","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":"Epigenetic implications of socioeconomic status and education on sperm DNA methylation patterns","authors":"Kelaney Stalker B.S. , Chad Pollard B.S. , Neil J. Perkins Ph.D. , Elizabeth A. DeVilbiss Ph.D. , Tim Jenkins Ph.D.","doi":"10.1016/j.fertnstert.2024.10.010","DOIUrl":"10.1016/j.fertnstert.2024.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>To identify differentially methylated regions and assess epigenetic age and instability scores within each cohort of differing income levels and educational attainment.</div></div><div><h3>Design</h3><div>Retrospective analysis of epigenetic data.</div></div><div><h3>Subjects</h3><div>A total of 1,429 semen samples from participants in the Folic Acid and Zinc Supplementation Trial study.</div></div><div><h3>Exposure</h3><div>Socioeconomic status, approximated by self-reported income, and education level.</div></div><div><h3>Main Outcome Measures</h3><div>Differential sperm DNA methylation, epigenetic age, epigenetic stability.</div></div><div><h3>Results</h3><div>There were four significant differentially methylated regions associated with the income cohorts and seven associated with the education cohorts, suggesting epigenetic patterns vary with socioeconomic status. Adjusted epigenetic age (germ-line age differential values) did not differ significantly in either cohort; however, a higher number of unstable promoters were observed in the lowest education cohort, indicating dysregulation in the epigenome.</div></div><div><h3>Conclusion</h3><div>These findings suggest a biologic link between income and education level in sperm epigenetic patterns, which may influence reproductive health. The increase in unstable promoters in the lower education cohorts may contribute to health disparities associated with educational attainment; however, it is important to consider lifestyle factors and environmental exposures as potential underlying causes. Further research is needed to fully elucidate the implications of these epigenetic changes and their relationship to health outcomes.</div></div><div><h3>Clinical Trial Registration Number</h3><div><span><span>Clinicaltrials.gov</span><svg><path></path></svg></span>, NCT#01857310.</div></div><div><div>Implicaciones epigenéticas del estatus socioeconómico y la educación en los patrones de metilación del ADN espermático</div></div><div><h3>Objetivo</h3><div>Identificar regiones diferencialmente metiladas y evaluar la edad epigenética y los índices de inestabilidad dentro de cada cohorte según los diferentes niveles de ingresos y el grado de escolaridad.</div></div><div><h3>Diseño</h3><div>Análisis retrospectivo de datos epigenéticos.</div></div><div><h3>Sujetos</h3><div>Un total de 1429 muestras de semen de participantes del estudio \"Folic Acid and Zinc Supplementation Trial\"</div></div><div><h3>Exposición</h3><div>Estatus socioeconómico, aproximado mediante el nivel de ingresos autodeclarado y el grado de educación alcanzado.</div></div><div><h3>Principales variables de resultado</h3><div>Metilación diferencial del ADN espermático, edad epigenética y estabilidad epigenética.</div></div><div><h3>Resultados</h3><div>Se identificaron cuatro regiones diferencialmente metiladas asociadas con los distintos niveles de ingresos y siete regiones relacionadas con el grado de escolaridad, lo qu","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 616-623"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461558","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":"External validation of a fully automated evaluation tool: a retrospective analysis of 68,471 scored embryos","authors":"Lorena Bori Ph.D. , Marco Toschi Ph.D. , Rebeca Esteve M.Sc. , Arantza Delgado Ph.D. , Antonio Pellicer M.D. , Marcos Meseguer Ph.D.","doi":"10.1016/j.fertnstert.2024.10.006","DOIUrl":"10.1016/j.fertnstert.2024.10.006","url":null,"abstract":"<div><h3>Objective</h3><div>To externally validate a fully automated embryo classification system for in vitro fertilization (IVF) treatments.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>A total of 6,434 patients undergoing 7,352 IVF treatments contributed 70,456 embryos.</div></div><div><h3>Exposure</h3><div>Embryos were evaluated by conventional morphology and retrospectively scored using a fully automated deep learning-based algorithm across conventional IVF, oocyte donation, and preimplantation genetic testing for aneuploidy (PGT-A) cycles.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcomes were implantation and live birth, including odds ratios (ORs) from generalized estimating equation models. Secondary outcomes were embryo morphology, euploidy, and miscarriage. Exploratory outcomes included a comparison between conventional methodology and artificial intelligence algorithm with areas under the receiver operating characteristics curves (AUCs), agreement degree between artificial intelligence and embryologists, Cohen’s Kappa coefficient, and relative risk.</div></div><div><h3>Results</h3><div>Implantation and live birth rates increased as the automatic embryo scores increased. The generalized estimating equation model, controlling for confounders, showed that the automatic score was associated with an OR of 1.31 (95% confidence interval [CI], 1.25–1.36) for implantation in treatments using oocytes from patients and an OR of 1.17 (95% CI, 1.14–1.20) in the oocyte donation program, with no significant association with PGT-A treatments. For live birth, the ORs were 1.27 (95% CI, 1.21–1.33) for patients, 1.16 (95% CI, 1.13–1.19) for donors, and 1.05 (95% CI, 1–1.10) for PGT-A cycles. The average score was higher in embryos with better morphology, in euploid embryos compared with aneuploid embryos, and in embryos that resulted in a full-term pregnancy compared with those that miscarried. Concordance between the highest-scoring embryo and the embryo with the best conventional morphology was 71.4% (95% CI, 67.7%–75.0%) in treatments with patient oocytes and 61.0% (95% CI, 58.6%–63.4%) in the oocyte donation program. Overall, the Cohen's Kappa coefficient was 0.63. The automatic embryo score showed similar AUCs to conventional morphology, although implantation was higher when the transferred embryo matched the highest-scoring embryo from each cohort (57.36% vs. 49.98%). Relative risk indicated a 1.14-fold increase in implantation likelihood when the top-ranked embryo was transferred.</div></div><div><h3>Conclusions</h3><div>A fully automated embryo scoring system effectively ranked embryos based on their potential for implantation and live birth. The performance of the conventional methodology was comparable to that of the artificial intelligence-based technology; however, better clinical outcomes were observed when the highest-scoring embryo in the cohort was transferred","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 634-643"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461560","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":"Reply of the Authors: “Enhancing health management in patients with primary ovarian insufficiency: an in-depth exploration of multimorbidity associations”","authors":"Abirami Kirubarajan M.D., M.Sc. , Alison K. Shea M.D., Ph.D.","doi":"10.1016/j.fertnstert.2024.11.009","DOIUrl":"10.1016/j.fertnstert.2024.11.009","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Page 738"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617793","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":"Filling in the gaps on outcomes of ovarian tissue cryopreservation in girls with Turner syndrome","authors":"Victoria A. Elliott M.D. , Leena Nahata M.D. , Gwendolyn P. Quinn Ph.D.","doi":"10.1016/j.fertnstert.2025.01.017","DOIUrl":"10.1016/j.fertnstert.2025.01.017","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 593-594"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062036","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":"Neurodevelopmental or behavioral disorders in children conceived after assisted reproductive technologies: a nationwide cohort study","authors":"Patricia Angel Cand.scient.san , Maja Hermansen Ph.D. , Cecilia Høst Ramlau-Hansen Ph.D. , Anne Gaml-Sørensen Ph.D. , David Møbjerg Kristensen Ph.D. , Rune Lindahl-Jacobsen Ph.D.","doi":"10.1016/j.fertnstert.2024.10.017","DOIUrl":"10.1016/j.fertnstert.2024.10.017","url":null,"abstract":"<div><h3>Objective</h3><div>To study differences in risk for drug-treated neurodevelopmental or behavioral disorders in children conceived through assisted reproductive technologies in comparison with children conceived without assisted reproductive technologies and to examine if different treatments alter these risks.</div></div><div><h3>Design</h3><div>Nationwide registry-based cohort study.</div></div><div><h3>Subjects</h3><div>Liveborn children born in Denmark between 1994 and 2012 after assisted reproductive technologies in comparison with children conceived without assisted reproductive technologies aged 0–7.</div></div><div><h3>Exposure</h3><div>Conception after assisted reproductive technologies treatment, including in vitro fertilization, intracytoplasmic sperm injection, intrauterine insemination, and “others” comprising frozen embryo transfer, and frozen embryo transfer in both in vitro fertilization and intracytoplasmic sperm injection and testicular sperm aspiration.</div></div><div><h3>Main Outcome Measures</h3><div>Prescription of neurodevelopmental or behavioral disorders medication in offspring: antipsychotics, anxiolytics, antidepressants, antiepileptics, attention-deficit hyperactivity disorder medication, and hypnotics/sedatives obtained from nationwide registers. Unadjusted and adjusted odds ratios with 95% confidence intervals were calculated. The association was examined in different sensitivity analyses, including sibling and mediator analyses.</div></div><div><h3>Results</h3><div>In total, 57,964 (4.7%) children conceived after assisted reproductive technologies and 1,183,070 (95.3%) children not conceived using assisted reproductive technologies were included. The adjusted analysis showed higher odds of prescribing neurodevelopmental or behavioral medication to assisted reproductive technology-conceived children (odds ratio: 1.15; 95% confidence interval: 1.09–1.20) compared with other children. Prescription of antipsychotics in assisted reproductive technology-conceived children was the most common association in intrauterine insemination treatments, hypnotics/sedatives with both including in vitro fertilization and intracytoplasmic sperm injection and antiepileptics with \"other\" treatments. Birth weight partially mediated the association between assisted reproductive technologies and diminished the odds of neurodevelopmental or behavioral medication use in children conceived using assisted reproductive technologies. Sibling analysis showed no increased risk for the first-born child conceived without assisted reproductive technology vs. the second-born child conceived with assisted reproductive technology and vice versa.</div></div><div><h3>Conclusion</h3><div>On the basis of the minor observed effects, a potentially higher increased attentiveness of assisted reproductive technology parents, the demonstrated mediation effect of birth weight and preterm birth on the observed association, and the no effect of the within-m","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 665-676"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461565","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":"Human embryos with segmental aneuploidies display delayed early development: a multicenter morphokinetic analysis","authors":"Matteo Figliuzzi Ph.D. , Lorena Bori M.Sc. , Christian Simon Ottolini Ph.D. , Ludovica Picchetta M.Sc. , Silvia Caroselli M.Sc. , Marco Reverenna Ph.D. , Maurizio Poli Ph.D. , Alison Campbell Ph.D. , Rachel Smith M.Sc. , Giovanni Coticchio Ph.D. , Danilo Cimadomo Ph.D. , Laura Francesca Rienzi Ph.D. , Marcos Meseguer Ph.D. , Antonio Capalbo Ph.D.","doi":"10.1016/j.fertnstert.2024.10.042","DOIUrl":"10.1016/j.fertnstert.2024.10.042","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether segmental aneuploid embryos display unique morphokinetic patterns.</div></div><div><h3>Design</h3><div>Retrospective multicenter study including a total of 7,027 embryos cultured between 2016 and 2021 in three European in vitro fertilization centers. Analysis was performed on aggregated multicenter data and separately for data from each center. Embryos with no more than four chromosomal alterations were considered in the analysis, resulting in 3,040 euploids and 2,818 whole-chromosome and 697 segmental aneuploids. Overall, the data set contained 3,742 distinct euploid-segmental sibling pairs.</div></div><div><h3>Subjects</h3><div>Standard morphokinetic features were annotated using various time-lapse systems. Blastocysts were subjected to comprehensive chromosomal screening via preimplantation genetic testing for aneuploidy.</div></div><div><h3>Exposure</h3><div>Morphokinetic patterns were compared among euploid, whole-chromosome aneuploid, and segmental aneuploid embryos.</div></div><div><h3>Main Outcome Measures</h3><div>Morphokinetic timings across groups were compared using statistical analysis, and associations with cleavage features were assessed. Multicenter and center-specific multivariate logistic regression models were calibrated, and their predictive performance was evaluated on independent test set data using area under the receiver operating characteristic curve (AUROC) metrics.</div></div><div><h3>Results</h3><div>Segmental aneuploid embryos cleaved significantly slower than their euploid siblings across the first three cell cycles, with a delay reaching the blastocyst-stage of development. Specifically during these early cell cycles, segmental aneuploid embryos were also shown to be significantly slower than their aneuploid siblings. A logistic model on the basis of morphokinetic data from the multicenter data set and regressed against type of aneuploidy displayed modest predictive performance on an independent test set (train-AUROC = 0.58; test-AUROC = 0.57). Predictive performance improved on the basis of data from a single center displaying adequate predictive performance on an independent test set from the same center (train-AUROC = 0.74; test-AUROC = 0.64). However, the predictive value diminished when tested on data from other centers (AUROC = 0.52–0.55). Finally, the presence of multinucleation and blastomere exclusion at the cleavage stage were associated with segmental aneuploidies. The combination of morphokinetic features and these discrete embryo morphological features into the logistic regression model (train-AUROC = 0.71) provided an improved prediction of segmental aneuploidy, supporting future investigations using more comprehensive annotation systems.</div></div><div><h3>Conclusion</h3><div>The developed predictive framework may help improve decision-making in preimplantation genetic testing for aneuploidy cycles, helping in the evaluation of embryos showing segmental a","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 624-633"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603865","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":"Efficacy and safety of estetrol (15 mg)/drospirenone (3 mg) combination in a cyclic regimen for the treatment of primary and secondary dysmenorrhea: a multicenter, placebo-controlled, double-blind, randomized study","authors":"Yutaka Osuga M.D., Ph.D. , Takao Kobayashi M.D., Ph.D. , Akihiro Hirakawa Ph.D. , Toshiaki Takayanagi B.M.L.S. , Masayoshi Nogami M.Sc. , Kyaw Tayzar M.D., Ph.D. , Takayuki Mochiyama M.Pharm. , Masashi Hirayama M.Phrama. , Jean-Michel Foidart M.D., Ph.D. , Tasuku Harada M.D., Ph.D.","doi":"10.1016/j.fertnstert.2024.11.003","DOIUrl":"10.1016/j.fertnstert.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy and safety of the estetrol (E4) (15 mg)/drospirenone (DRSP) (3 mg) combination in a cyclic regimen in Japanese women with primary and secondary dysmenorrhea.</div></div><div><h3>Design</h3><div>A 16-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study, followed by a 36-week, open-label, extension study.</div></div><div><h3>Subjects</h3><div>A total of 162 Japanese women with primary and secondary dysmenorrhea.</div></div><div><h3>Intervention</h3><div>Participants were randomly allocated to either the E4/DRSP group or the placebo group. In the E4/DRSP group, participants orally received one tablet containing E4 (15 mg) and DRSP (3 mg daily) for 24 days, followed by a placebo tablet for 4 days, constituting one cycle. The placebo group was given one placebo tablet daily for 28 days. After 16 weeks, participants in the placebo group were switched to receive E4/DRSP for 36 weeks.</div></div><div><h3>Main Outcome Measures</h3><div>Absolute change in the most severe total dysmenorrhea score from baseline to the end of the 16-week double-blinded period.</div></div><div><h3>Results</h3><div>Estetrol/drospirenone reduced the most severe total dysmenorrhea score by 2.3 points from baseline at week 16. The between-group difference was significant (−1.4, two-sided 95% confidence interval, −1.8 to −1.0), showing superiority to placebo. The responder rate, the proportion of participants who achieved a ≥2.0-point reduction in the most severe total dysmenorrhea score from baseline, was 64.3% in the E4/DRSP group, significantly higher than in the placebo group, 28.4%. In the E4/DRSP group, visual analogue scale scores for pelvic pain and dysmenorrhea symptoms during the menstrual bleeding periods were decreased by 44.2 and 42.3 mm, respectively, from baseline at week 16, significantly more than in the placebo group. Objective gynecological examinations suggested amelioration of pelvic tenderness, uterine mobility, and cul-de sac induration in the E4/DRSP group. Estetrol/drospirenone improved the quality of life-related questionnaires (interference with daily activities and sleeping) and global impression scores. Intermenstrual bleeding was the primary treatment-emergent adverse event in the E4/DRSP group, similar to combined oral contraceptives. There were no cases of venous thromboembolism and less impact on hemostasis parameters in the E4/DRSP group.</div></div><div><h3>Conclusion</h3><div>Estetrol/drospirenone is an effective treatment for dysmenorrhea, offering a safe, new treatment option with potentially reduced thromboembolic risk.</div></div><div><h3>Clinical Trial Registration Number</h3><div>jRCT2011210023.</div></div><div><div>Eficacia y seguridad de la combinación de estetrol (15 mg)/drospirenona (3 mg) en un régimen cíclico para el tratamiento de dismenorrea primaria y secundaria: un estudio multicéntrico, controlado con placebo, doble ciego, aleatorizado.</div></d","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 700-708"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617645","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":"Socioeconomic shadows in sperm epigenetics: insights and opportunities","authors":"Sandro C. Esteves M.D., Ph.D.","doi":"10.1016/j.fertnstert.2025.01.002","DOIUrl":"10.1016/j.fertnstert.2025.01.002","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Page 595"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988747","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":"Universal karyotyping for oocyte donors: necessary safeguard or unnecessary expense?","authors":"Daniela Diego M.D., Heather S. Hipp M.D.","doi":"10.1016/j.fertnstert.2025.01.021","DOIUrl":"10.1016/j.fertnstert.2025.01.021","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 4","pages":"Pages 600-601"},"PeriodicalIF":6.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064863","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}