Heart rhythm最新文献

{"title":"The maternal exposure of digoxin and flecainide in relation to the safety and effectiveness in the treatment of non hydropic fetal tachycardia.","authors":"Rosa M A Smeets, Ingrid M van Beynum, Charlotte van Kesteren, Jérôme M J Cornette, Johanna A van der Zande, Jolien W Roos-Hesselink, Marieke M Beex-Oosterhuis, Robert B Flint","doi":"10.1016/j.hrthm.2025.05.039","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.039","url":null,"abstract":"<p><strong>Background: </strong>Sustained fetal tachycardia requires transplacental antiarrhythmic therapy. Little is known about the dose-concentration-effect correlation and safety in the mother, fetus and newborn.</p><p><strong>Objective: </strong>This study evaluates the relationship between maternal dose of digoxin and flecainide therapy for fetal tachycardia, maternal and umbilical cord concentrations and side effects.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Methods: </strong>We included 28 pregnant women initially treated with digoxin monotherapy for fetal tachycardia between June 2007 and January 2023. The main endpoint was the correlation between maternal drug exposure, effect, and side effects.</p><p><strong>Results: </strong>Oral digoxin monotherapy converted 9 (32%) fetuses to sinus rhythm after a median of 4.5 days (IQR 3-6.5) 18 fetuses required additional oral flecainide (300 mg daily), resulting in a total conversion rate of 93% (26/28). Equal starting doses of digoxin caused similar maternal digoxin concentrations regardless of gestational age, with no significant difference between responders and non-responders (p=0.504). Side effects, primarily nausea, led to dose reductions, but treatment remained effective. Maternal digoxin concentrations remained stable throughout pregnancy and little inter-patient variability was observed. Flecainide exposure varied both within and between patients. The median fetus/mother digoxin ratio was similar in both monotherapy (n=3) and combination (n=9) therapy groups (0.51 (IQR 0.28-0.76) vs 0.45 (IQR 0.39-0.64), p=0.864). The median fetus/mother flecainide ratio was 0.82 (IQR 0.69-1.29).</p><p><strong>Conclusion: </strong>Digoxin monotherapy successfully treated fetal tachycardia in only 32% of cases. Adding flecainide improved response to 93%, although it increased side effects, which could be managed with dose reductions. Maternal digoxin levels were stable throughout pregnancy.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ultra-rapid genomic testing for management of malignant pediatric arrhythmia.","authors":"Yuji Doi, Andreas Pflaumer, Ivan Macciocca, Vanessa Connell, Sebastain Lunke, Zornitza Stark, Andrew Davis","doi":"10.1016/j.hrthm.2025.05.037","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.037","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right atrial cardioneuroablation of asystolic reflex syncope.","authors":"Leonardo Calò, Marco Rebecchi, Ermenegildo De Ruvo, Domenico Giamundo, Antonella Sette, Marco Tomaino, Matthias Hunteruber, Nicola Bottoni, Matteo Iori, Paolo Donateo, Roberto Maggi, Attilio Del Rosso, Martina Rafanelli, Vincenzo Russo, Stefano Strano, Michele Brignole","doi":"10.1016/j.hrthm.2025.05.038","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.038","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) should focus on the vagal ganglia located in right atrium close to the sinoatrial and the atrioventricular nodes OBJECTIVE: To evaluate efficacy and safety of right atrial CNA METHODS: Patients with severe, asystolic reflex syncopes identified by implantable loop recorder (ILR) or tilt testing underwent right atrial CNA and were subsequently monitored using ILR.</p><p><strong>Results: </strong>The population included 28 patients with a mean age of 40.5±13.4 years, of whom 71% were male. Over a median follow-up period of 12.5 months, 8 patients experienced 44 episodes of asystole lasting longer than 3 seconds, as recorded by an ILR. The burden of asystolic episodes significantly reduced from 0.89 episodes per month before CNA (145 over 163 patient-months) to 0.11 episodes per month after CNA (44 over 397 patient-months), with a relative risk reduction (RRR) of 0.12, p=0.0001. Similarly, the burden of syncopal episodes decreased from 0.23 episodes per month before CNA to 0.06 episodes per month after CNA, resulting in an RRR of 0.24, p=0.0001. Median heart rate increased from 75 bpm (IQR: 72-79) before ablation to 83 bpm (IQR: 78-85) after ablation, lasting up to 9 months post-procedure. No patients experienced complications during the procedure. During follow-up, two patients received pacemakers, one underwent a redo procedure, and four experienced mild transient symptoms: three had palpitations and one had dyspnoea, none requiring therapy.</p><p><strong>Conclusion: </strong>Right atrial CNA reduced asystolic episodes by 88% and syncopal episodes by 76% during the mid-term follow-up. Adverse events were infrequent and mild.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Left Bundle Branch Area Pacing Upgrade in Patients with Right Ventricular Pacing-Induced Cardiomyopathy.","authors":"Samir Shah, Dipen Zalavadia, Nischay Shah, Shunmuga S Ponnusamy, Pugazhendi Vijayaraman, Robert D Schaller","doi":"10.1016/j.hrthm.2025.05.029","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.029","url":null,"abstract":"<p><strong>Background: </strong>Pacemaker-induced cardiomyopathy (PICM) is an increasingly recognized consequence of right ventricular pacing (RVP), which can lead to significant decline in left ventricular ejection fraction (LVEF) and development of heart failure symptoms. Left bundle branch area pacing (LBBAP) is an effective strategy for cardiac resynchronization therapy (CRT), but its role in PICM is not well defined.</p><p><strong>Objective: </strong>This study sought to determine what the clinical and echocardiographic responses were in patients with PICM who underwent LBBAP.</p><p><strong>Methods: </strong>This was an observational, retrospective, multicenter study. Patient and lead-related characteristics along with clinical and echocardiographic data were tracked.</p><p><strong>Results: </strong>Sixty-four patients were included, with a mean LVEF of 36.5 ± 8.8 and New York Heart Association (NYHA) status of 2.72 ± 0.68 before LBBAP. Successful LBBAP was achieved with a significant reduction in QRS duration (172.5 ± 21.9 to 133.4 ± 19.2 ms, p<0.001) which was associated with an increase in LVEF by an average of 1.0 ± 17.7% (p<0.001), and an improvement in NYHA status (2.72 ± 0.68 to 1.75 ± 0.6, p<0.001). Lead extraction was performed in 18/64 patients (28%). Outcomes did not significantly differ between patients with ≥90% and <90% RV pacing burdens.</p><p><strong>Conclusions: </strong>This study - the largest series investigating LBBAP for PICM to date - supports LBBAP as a viable, effective alternative to conventional CRT in PICM, offering improvements in cardiac function and patient symptoms. However, larger randomized trials are needed to validate these findings in a broader, more heterogeneous population.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Cardiac Resynchronization Therapy on Cardiac Sarcoidosis: Insight into Mechanism of Mechanical Response and the Role of Myocardial Work.","authors":"Shun Kondo, Yasuya Inden, Satoshi Yanagisawa, Kiichi Miyamae, Hiroyuki Miyazawa, Takayuki Goto, Masaya Tachi, Tomoya Iwawaki, Masafumi Shimojo, Yukiomi Tsuji, Toyoaki Murohara","doi":"10.1016/j.hrthm.2025.05.030","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.030","url":null,"abstract":"<p><strong>Background: </strong>Cardiac resynchronization therapy (CRT) improves the prognosis of patients with heart failure and complete left bundle branch block (CLBBB); however, its efficacy in cardiac sarcoidosis (CS) remains unclear.</p><p><strong>Objective: </strong>This study evaluated the mechanisms of CRT response in patients with and without CS, focusing on myocardial work (MW) assessment.</p><p><strong>Methods: </strong>Twenty and 73 patients with CS and dilated cardiomyopathy (DCM) who underwent CRT implantation and had CLBBB and QRS width of ≥150 ms were assessed. Two-dimensional speckle-tracking echocardiography was performed before implantation, and 1 week and 6 months after implantation. MW was estimated by pressure-strain analysis using echocardiography. Responders were defined as ≥15% decrease in left ventricular end-systolic volume (LVESV) after 6 months. The outcomes and changes in MW were compared between the groups.</p><p><strong>Results: </strong>The CS group exhibited a lower response rate (40% vs. 84%, p<0.001) and a higher incidence of death and left ventricular assist device implantation than the DCM group. The CS group had a higher MW of the septal wall and smaller MW differences in the lateral-septal wall before implantation than the DCM group. After implantation, the increase in the septal wall MW was significantly lower in the CS group, resulting in smaller reduction in the lateral-septal wall MW difference. MW difference in lateral-septal wall and basal septum thinning were determinants for the LVESV reduction.</p><p><strong>Conclusion: </strong>Patients with CS had poor outcomes after CRT. Baseline MW differences in the lateral-septal wall and improvements in septal MW may play an essential role in improving cardiac function.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter ablation for atrial fibrillation: results from a European Survey.","authors":"Pedro A Sousa, Christian-Hendrik Heeger, Sérgio Barra, Vishal Luther, Johannes Steinfurt, Juan Fernandez-Armenta, John Silberbauer","doi":"10.1016/j.hrthm.2025.05.028","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.028","url":null,"abstract":"<p><strong>Background: </strong>Current data are limited regarding how electrophysiologists are integrating emerging technologies and updated atrial fibrillation (AF) guidelines into clinical practice.</p><p><strong>Objective: </strong>This survey aimed to analyze the peri-procedural management of patients undergoing AF ablation across Europe.</p><p><strong>Methods: </strong>An online-based questionnaire was conducted between September and November 2024. An additional set of questions was sent to all participants six months later.</p><p><strong>Results: </strong>A total of 203 physicians from 23 European countries participated. Fifty-three per cent had >10 years of experience as electrophysiologists, 58% worked in university hospitals, and 63% worked in centers performing over 400 procedures annually. Pre-procedural imaging is routinely used by 53%, with computed tomography being the most common modality (47.7%). General anesthesia is utilized by 42.4%, and 29.6% of physicians do not interrupt anticoagulants prior to the procedure. In paroxysmal AF ablation, pulmonary vein isolation (PVI) is the main strategy (93%). Point-by-point radiofrequency (RF) was the predominant energy source (68%), with 65% of physicians performing RF adopting a high-power strategy (>50W). For persistent AF ablation, high-density mapping catheters are used by 82.8%, and 66.4% perform additional lesions beyond PVI, most commonly targeting low-voltage areas and aiming at posterior wall isolation. Between the two phases of the survey, half of the physicians switched from RF or cryoballoon to pulsed field ablation. Intermittent use of 24-hour Holter is the primary strategy in 44.3% of cases for monitoring AF recurrence.</p><p><strong>Conclusion: </strong>This survey highlights some discrepancies between the routine clinical practice of European physicians performing AF ablation and European guidelines, emphasizing the need for better integration of emerging technologies and greater adherence to updated protocols across Europe.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing and Managing a Mortality and Morbidity Program in the Electrophysiology Lab: An Essential Component of Quality.","authors":"Bruce A Koplan, Anne Marie Smith, John N Catanzaro","doi":"10.1016/j.hrthm.2025.05.026","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.026","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior offset of inferior caval vein and its impact on cavotricuspid conduction block difficulty during cryoablation for common-type atrial flutter.","authors":"Minoru Nodera, Takashi Kaneshiro, Sadahiro Murota, Shinya Yamada, Masayoshi Oikawa, Yasuchika Takeishi","doi":"10.1016/j.hrthm.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.027","url":null,"abstract":"<p><strong>Background: </strong>Anatomical factors influencing the difficulty of achieving cavotricuspid isthmus (CTI) conduction block during cryoablation for common-type atrial flutter (AFL) remain unclear.</p><p><strong>Objective: </strong>This study aimed to investigate these factors and their impact on procedural parameters.</p><p><strong>Methods: </strong>We enrolled 100 consecutive patients who underwent CTI cryoablation. We evaluated associations between anatomical factors measured via preoperative computed tomography scans. The CTI was defined as the line connecting the midpoints of the tricuspid annulus and the inferior vena cava in the horizontal view. The CTI rotation (CR) angle was defined as the angle between the vertical line passing through the midpoint of the tricuspid annulus and the CTI line, with a larger CR angle indicating a greater posterior offset of the inferior caval vein. Procedural parameters, including freezing characteristics and procedure time from the start of CTI ablation to final confirmation of conduction block, were assessed.</p><p><strong>Results: </strong>The CR angle was positively associated with procedure time (B = 0.369, P < 0.001), while other anatomical factors showed no significant associations. Patients were stratified into two groups based on the median CR angle. Those in the larger CR angle group had significantly longer procedure times (P = 0.005) and longer times to reach nadir freezing temperature at both the tricuspid annulus-side (P = 0.031) and middle-side (P = 0.038) segments of the CTI than those in the smaller CR angle group.</p><p><strong>Conclusion: </strong>A larger CR angle may be associated with increased difficulty achieving CTI conduction block during cryoablation, potentially complicating catheter positioning.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endo-epicardial Transmural Lesion Formation Utilizing Multipolar Radiofrequency Ablation.","authors":"Istok Menkovic, Humberto Butzke da Motta, Maxime Cerantola, Marcio Sturmer, Leila Laroussi, Giuliano Becker, Jonathan Boudreau Beland, Alexios Hadjis","doi":"10.1016/j.hrthm.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.020","url":null,"abstract":"<p><strong>Background: </strong>Conventional unipolar radiofrequency catheter ablation (RFCA) is limited by maximal lesion depths that fail to eliminate VTs with deep mid-myocardial critical components. The use of multipolar mapping catheters as an active part of the ablation circuit may provide a solution to these limitations.</p><p><strong>Objective: </strong>To evaluate a novel endo-epicardial multipolar-RFCA technique for creating transmural lesions in an in-vivo porcine model.</p><p><strong>Methods: </strong>Two catheter configurations were evaluated: (1) standard bipolar configuration with a 3.5-mm irrigated-tip catheter paired with an 8-mm non-irrigated-tip catheter. (2) Multipolar configuration with a 3.5-mm irrigated-tip catheter paired with a multipolar mapping catheter. In both configurations, the 3.5-mm irrigated-tip catheter was positioned on the endocardial surface of the LV with the corresponding catheter positioned perpendicularly on the epicardial surface.</p><p><strong>Results: </strong>The study included 10 subjects with a total of 30 lesions created using 6 different sets of catheter configurations and ablation parameters. Histopathological analysis revealed an average lesion depth was 10.6 ± 3.1 mm (range: 5-17 mm), corresponding to a lesion depth/tissue thickness ratio of 93.5 ± 12%. 20 out of 30 lesions (67%) achieved transmurality. No safety complications such as steam pops, fistulas, perforations, or tamponades were observed.</p><p><strong>Conclusion: </strong>Endo-epicardial multipolar radiofrequency ablation can be performed effectively and safely using a multipolar mapping catheter as the return electrode in the epicardial space. Lesions created were voluminous with a high degree of transmurality, with no complications related to the application of radiofrequency recorded. This catheter configuration may present a novel solution to rapidly identify and target ventricular arrhythmias arising from the mid-myocardium.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ablation of atrial fibrillation and risk of stroke: a Meta-analysis.","authors":"Rui Providencia, Hussam Ali, Sérgio Barra, Antonio Creta, Kishore Kukendra-Rajah, Prapa Kanagaratnam, Michal M Farkowski, Riccardo Cappato","doi":"10.1016/j.hrthm.2025.05.021","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.05.021","url":null,"abstract":"<p><strong>Background: </strong>Despite treatment with anticoagulants, patients with atrial fibrillation (AF) remain exposed to a relevant residual risk of stroke. It remains to be proven if catheter ablation of AF can lead to an additional stroke protection benefit in these patients.</p><p><strong>Objective: </strong>Investigating a possible stroke protective benefit by catheter ablation in AF.</p><p><strong>Methods: </strong>Systematic review of contemporary randomized controlled trials comparing catheter ablation vs. medical treatment. We searched MEDLINE, EMBASE and CENTRAL in February 2025, pooled data through risk ratios (RRs) with 95% confidence intervals (CIs), and calculated the Number Needed to Treat (NNT). Quality of evidence was assessed using the GRADE framework. Sub-group and sensitivity analyses were performed for presence/absence of heart failure, CHA₂DS₂VASc≥2 or <2, paroxysmal/persistent AF, early ablation, studies allowing discontinuation of oral anticoagulation post-ablation, higher/lower quality, published ≤5 vs >5 years ago, and ≥12 vs < 12 months follow-up.</p><p><strong>Results: </strong>We identified 18 eligible randomized controlled trials, including 5877 patients. Catheter ablation was associated with a significant reduction in stroke (RR: 0.63, 95%CI 0.45 to 0.87, P=0.006; Quality of evidence: Moderate), with low heterogeneity observed (I²=0), and a NNT of 78.7 patients to prevent one stroke. Sub-group and sensitivity analyses yielded similar estimates with 30 to 40% relative risk reduction for all sub-analyses, except for trials with less than one year of follow-up.</p><p><strong>Conclusion: </strong>Pooling of high-quality randomized controlled trial data suggests that catheter ablation may lead to significant stroke reduction. A confirmatory trial will be required to provide a conclusive answer to this matter.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}