International Urogynecology Journal最新文献

{"title":"Body Mass Index and Depressive Symptoms as Risk Factors for Urinary Incontinence in Women: A Nationally Representative Study.","authors":"Kun Li, Xiao Yan, Meng Zhang, Yang He, Chengjun Luo","doi":"10.1007/s00192-025-06140-y","DOIUrl":"10.1007/s00192-025-06140-y","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Urinary incontinence (UI) is associated with body mass index (BMI) and may be influenced by depressive symptoms. This study was aimed at assessing the relationship between BMI and UI risk and frequency in adult women, with a focus on depressive symptoms, measured by Patient Health Questionnaire-9 (PHQ-9) score, as a potential mediator.</p><p><strong>Methods: </strong>Data from 6107 adult women in the National Health and Nutrition Examination Survey from 2005 to 2018 were analyzed. Weighted multivariable-adjusted regression analysis determined odds ratios (ORs) and 95% confidence intervals (CIs) for BMI-UI associations. Restricted cubic spline (RCS) analysis evaluated nonlinear relationships, and causal mediation analysis examined the mediating role of depressive symptoms. Subgroup analyses were stratified by PHQ-9 score.</p><p><strong>Results: </strong>Higher BMI was associated with increased UI risk and frequency. When BMI was categorized into quartiles, UI risk progressively increased from Q2 to Q4. In the fully adjusted model, OR for UI risk in Q4 vs Q1 was 2.53 (95% CI 1.83, 3.52; p < 0.001), with a significant trend across quartiles. RCS analysis indicated a nonlinear relationship, with increased UI risk, particularly at BMI levels above 30. Depressive symptoms were independently associated with higher UI risk and frequency, with significant mediation effects. Mediation analysis revealed that PHQ-9 score accounted for approximately 6.8% of the effect of the BMI on UI risk and 6.5% on UI frequency (both p < 0.001).</p><p><strong>Conclusions: </strong>Elevated BMI and depressive symptoms are independently associated with increased UI risk and frequency among adult women. The mediation effect of depressive symptoms underscores the importance of addressing mental health and weight management to reduce UI risk. These findings advocate a holistic approach to UI prevention and treatment, integrating physical and mental health strategies.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1309-1318"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004441","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":"Female Orgasmic Disorder: How Far We Have [Not] Come?","authors":"Rima Anggrena Dasrilsyah, Reut Rotem, Bobby O'Leary, Claudine Domoney, Barry O'Reilly","doi":"10.1007/s00192-025-06206-x","DOIUrl":"10.1007/s00192-025-06206-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The female orgasm is a complex physiological and psychological response essential for sexual well-being and overall health. Historically misinterpreted, its significance is now better understood through modern research integrating neurobiological, hormonal, and psychological factors. Female orgasmic disorder (FOD), characterized by persistent difficulty in achieving orgasm, significantly affects emotional and relational well-being. This review summarizes current knowledge on the female orgasm, its dysfunction, and treatment modalities.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using MEDLINE/PubMed and Google Scholar, focusing on studies published between 2000 and 2024. Keywords included \"female orgasmic disorder,\" \"female orgasm,\" \"anorgasmia,\" and \"female sexual dysfunction.\" After screening abstracts and full texts, 20 articles were included, supplemented by additional sources through reference review.</p><p><strong>Results: </strong>The female orgasm involves interplay between anatomical structures such as the clitoris, vagina, and pelvic floor muscles, as well as neural pathways and hormonal interactions. FOD is classified as primary (lifelong) or secondary (acquired) and is influenced by psychosocial, relational, and medical factors. Treatment options include cognitive-behavioral therapy, directed masturbation, pelvic floor muscle training, pharmacological interventions such as sildenafil, bupropion, or hormonal therapy, mechanical devices, and emerging regenerative therapies such as platelet-rich plasma and stem cell treatments.</p><p><strong>Conclusions: </strong>Understanding the female orgasm and its dysfunction is essential for improving sexual health care. A biopsychosocial approach that integrates personalized, patient-centered treatments can enhance outcomes. Future research should focus on refining therapeutic strategies and expanding knowledge on novel interventions.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1163-1171"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527857","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":"Words Matter, Acronyms Too.","authors":"Tony Bazi","doi":"10.1007/s00192-025-06245-4","DOIUrl":"10.1007/s00192-025-06245-4","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1121-1122"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626226","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":"Patients' Perceptions of Stress Urinary Incontinence Treatment: A Scoping Review of Qualitative Studies.","authors":"Nienke J E Osse, Marian K Engberts, Hugo W F van Eijndhoven, Paul L P Brand, Marco H Blanker","doi":"10.1007/s00192-025-06061-w","DOIUrl":"10.1007/s00192-025-06061-w","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Treatment options for female stress urinary incontinence (SUI) are often offered in a stepped-care approach. However, the shift towards patient-centred care and shared decision making (SDM) has prompted an increased interest in patients' perceptions of treatment decision making. This scoping review maps the available qualitative research on women's perceptions of the treatment decision-making process for SUI and identifies knowledge gaps.</p><p><strong>Methods: </strong>This scoping review was performed according to the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Three databases were searched using a systematic search strategy, without restriction in publication date or language. After thorough screening, 19 of the initial 3,473 publications were included.</p><p><strong>Results: </strong>Four themes were identified; pre-existing experiences and notions that women bring to the consultations (things women consider before their consultation); treatment and patient characteristics (treatment aspects and personal values patients deem important); aspects of the consulting health care professional and facilities (availability of treatment options and counselling styles of physicians); ways of reaching a decision (three different ways that women used to make their decision. There were gaps in the literature on aspects affecting women's treatment preferences, their preferred decision-making style and how they want to be involved in this decision-making process.</p><p><strong>Conclusions: </strong>This scoping review provides a global overview of women's perceptions on and preferences for treatment for SUI, and highlights a lack of knowledge on women's ideas of the treatment decision process. To provide clinicians with better guidance for their counselling and decision-making approaches, studies on women's perceptions of the decision-making process and the different decision-making styles are needed.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1149-1162"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399106","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":"Incorporating Perineorrhaphy into the LeFort Colpocleisis: A Modified Surgical Approach.","authors":"Savci Bekir Telek, Brad St Martin, Oz Harmanli","doi":"10.1007/s00192-025-06041-0","DOIUrl":"10.1007/s00192-025-06041-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Perineorrhaphy with levator myorrhaphy is considered a standard part of colpocleisis. Typically, this is done through a separate incision after colpocleisis is completed. We present a video to demonstrate a modified approach to LeFort colpocleisis incorporating perineorrhaphy into the procedure.</p><p><strong>Methods: </strong>A rectangular piece of anterior vaginal mucosa is dissected off the underlying fibromuscular tissue starting from 2-3 cm distal to the cervix and ending proximal to the urethrovesical junction. Similarly, a symmetrical posterior vaginal mucosa is dissected starting from the introitus and ending 2-3 cm distal to the cervix. The lateral edges of the rectangles between the anterior and posterior vaginal walls are sutured to create channels. The raw surfaces, including the fibromuscular tissue on the anterior and posterior vagina, are sutured to each other in three rows. Vaginal epithelium is closed continuously starting from the anterior wall and ending with posterior epithelium at the introitus.</p><p><strong>Results: </strong>Dissection of the anterior and posterior vaginal epithelium mimics standard colporrhaphy. The number of incisions and suturing is decreased by incorporating perineorrhaphy into colpocleisis. Sagittal closure with this technique restores the Aa point to a more anatomical position.</p><p><strong>Conclusion: </strong>These modifications may decrease operative time and de novo stress incontinence and allow less experienced surgeons to consider colpocleisis. Our surgical approach, which incorporates perineorrhaphy into colpocleisis, enables easier adaptation to the procedure and may decrease de novo stress incontinence.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1327-1331"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052512","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":"Development and Validation of Machine Learning Models for Risk Prediction of Postpartum Stress Urinary Incontinence: A Prospective Observational Study.","authors":"Liyun Wang, Nana Wang, Minghui Zhang, Yujia Liu, Kaihui Sha","doi":"10.1007/s00192-025-06057-6","DOIUrl":"10.1007/s00192-025-06057-6","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This study aims to develop a postpartum stress urinary incontinence (PPSUI) risk prediction model based on an updated definition of PPSUI, using machine learning algorithms. The goal is to identify the best model for early clinical screening to improve screening accuracy and optimize clinical management strategies.</p><p><strong>Methods: </strong>This prospective study collected data from 1208 postpartum women, with the dataset randomly divided into training and testing sets (8:2). Five machine learning algorithms-logistic regression, decision trees, random forests, support vector machines (SVM), and eXtreme gradient boosting (XGBoost)-were used to construct the PPSUI risk prediction model. Model performance was evaluated using multiple metrics, and the best-performing model was selected and validated for generalizability with the testing set.</p><p><strong>Results: </strong>The final model retained ten features: birth weight, weight gain during pregnancy, BMI before delivery, pre-pregnancy BMI, age of delivery, gestation, parity, pre-delivery uterine height, age of first delivery, and labor analgesia. Among the five algorithms, the random forest model performed best, with a test AUC of 0.995 (95% CI 0.990-0.999, P < 0.05), accuracy of 0.956, precision of 0.957, recall of 0.944, specificity of 0.966, and F1 score of 0.951. The model's high generalizability was confirmed with the testing set and further validated through bootstrapping and tenfold cross-validation.</p><p><strong>Conclusion: </strong>The random forest model shows strong clinical potential for PPSUI risk prediction and early screening. Future studies should expand the sample size and include multi-center data to further enhance the model's clinical applicability.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1217-1228"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065598","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":"Analysis of Various Surgical Approaches to Supratrigonal Vesicovaginal Fistula Repair: A Tertiary Care Centre Experience.","authors":"Shivani Madhuchandra Iyer, Sanjeet Singh, Alok Srivastav","doi":"10.1007/s00192-025-06104-2","DOIUrl":"10.1007/s00192-025-06104-2","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vesicovaginal fistula (VVF) is a devastating obstetric complication. Transvaginal, transabdominal, laparoscopic and robotic repairs have been proposed. This study was carried out to compare peri-operative and post-operative parameters of supratrigonal VVF repair to find out the best surgical approach among vaginal, abdominal and laparoscopic approaches.</p><p><strong>Methods: </strong>A quasi-experimental study was carried out from January 2015 to January 2021. A total of 175 women suffering from VVF were screened and 150 women with supratrigonal VVF were recruited. VVF repair was performed using transvaginal, transabdominal and laparoscopic approaches (50 repairs using each approach). Parameters such as success rate, operative time, blood loss, post-operative complications and hospital stay were recorded. Statistical analysis was carried out using SPSS Version 21. Written informed consent was taken before the recruitment of subjects.</p><p><strong>Results: </strong>Lower (uterine) segment Caesarean section, open or laparoscopic hysterectomy and obstructed labour were the common causes. Statistical analysis showed that mean operative time was significantly lower in vaginal repair, whereas analgesic requirement, hospital stay and blood loss were significantly lower in vaginal and laparoscopic repair. Urinary tract infection was seen in all three approaches, and was resolved by administration of antibiotics post-operatively. Minor wound infection was seen only in the transabdominal repair group, which resolved with the regular application of dressings. None of the patients developed recurrence during follow-up.</p><p><strong>Conclusions: </strong>Transvaginal and laparoscopic repairs are safe and effective approaches for VVF repair. However, laparoscopic repair requires a steep learning curve. Transvaginal repair has a significantly shorter operative time. Hence, in simple supratrigonal VVF, a transvaginal repair can be a preferred option.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1273-1279"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648270","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":"A Prospective Study of the Impact of Persistent Nocturnal Enuresis on Female Sexual Function.","authors":"Kubilay Sarıkaya, Adem Sancı, Serkan Akpınar, Emre Hepşen, Metin Yığman","doi":"10.1007/s00192-025-06172-4","DOIUrl":"https://doi.org/10.1007/s00192-025-06172-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The aim of this study is to examine the effects of persistent nocturnal enuresis on female sexual function.</p><p><strong>Methods: </strong>This prospective study included adult females with monosymptomatic nocturnal enuresis (group 1) and healthy controls (group 2), all of whom were sexually active and in a relationship, between March 2023 and April 2024. The comparative analysis of group 1 and group 2 was performed using individual items from the Female Sexual Function Index (FSFI), the total FSFI score, and the overall Rosenberg Self-Esteem Scale (SES) score. Additionally, the Incontinence Quality of Life Questionnaire (I-QOL) was employed to assess the patients' quality of life. The comparative statistical analyses were conducted using the Mann-Whitney U test and the independent samples t test. Statistical significance was considered to be p < 0.05.</p><p><strong>Results: </strong>A total of 60 patients were included, with 30 patients (age range 19-36) in group 1 and 30 healthy controls (age range 19-41) in group 2. Group 1 had a significantly higher I-QOL score (median 55, range 20-108) than group 2 (median 5, range 1-25; p < 0.001). FSFI score was significantly lower in group 1 across all domains: desire, arousal, lubrication, orgasm, satisfaction, and pain (p < 0.05 for all). The total FSFI score was also significantly lower in group 1 (16.21 ± 2.38) than in group 2 (24.50 ± 3.97; p < 0.001). Additionally, group 1 had a significantly lower median SES score (11, range 5-20) than group 2 (17, range 8-29; p < 0.001).</p><p><strong>Conclusions: </strong>Nocturnal enuresis negatively affects sexual function and self-esteem in adult females. These findings emphasize the importance of addressing these aspects in the management of enuresis.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191811","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":"Same Day Discharge with Vaginal Packing Following Pelvic Floor Reconstruction: An Analysis of Safety and Healthcare Utilization.","authors":"Tyler Trump, Omer Anis, Howard B Goldman","doi":"10.1007/s00192-025-06186-y","DOIUrl":"https://doi.org/10.1007/s00192-025-06186-y","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vaginal packing is sometimes placed during pelvic floor reconstructive surgery to aid with hemostasis. Historically, these patients were admitted overnight. In the interest of moving patients safely and efficiently through the discharge process select patients are discharged home with vaginal packing. The objective of this study is to assess healthcare utilization and safety among patients discharged with packing.</p><p><strong>Methods: </strong>Retrospective review of patients undergoing pelvic organ prolapse (POP) surgery by a single surgeon between 2016 and 2023. Patients were identified before and after the 2020 COVID pandemic as this marked a transition point where same day discharge became heavily emphasized. The historic cohort (group 1) represents patients admitted overnight with vaginal packing compared to those discharged home same day to remove their own packing (group 2). Healthcare utilization and complications were recorded in the first 30 days postoperatively.</p><p><strong>Results: </strong>Thirty-eight patients were identified in group 1 and 39 in group 2. Age, BMI, and estimated blood loss was similar. There were 20 total unplanned encounters with 10 in each group (p = 0.95). Unplanned encounters in group 1 were seven phone calls/messages, one office visit, and two ED visits compared to three phone calls/messages, five office visits, and two ED visits in group 2. Overall complication rate was similar with six in group 1 and seven in group 2 (p = 0.80). There were zero cases of retained packing.</p><p><strong>Conclusion: </strong>Patients may safely be discharged home with vaginal packing in place with similar rate of complications and healthcare utilization when compared to hospital admission.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191813","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":"Physical Activity, Quality of Life, and Pelvic Floor Disorders Before and After Hysterectomy for Gynecological Cancer: A Prospective Cohort Study.","authors":"Robyn Brennen, Kuan Yin Lin, Linda Denehy, Sze-Ee Soh, Thomas Jobling, Orla M McNally, Simon Hyde, Helena Frawley","doi":"10.1007/s00192-025-06157-3","DOIUrl":"https://doi.org/10.1007/s00192-025-06157-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This study investigated physical activity (PA) levels and health-related quality-of-life (HRQoL) before and after, and associations between pelvic floor disorders (PFD) and PA/HRQoL after, hysterectomy for gynecological cancer.</p><p><strong>Methods: </strong>Secondary analysis of a longitudinal cohort study, with assessments before, 6 weeks, and 3 months after hysterectomy for gynecological cancer. The International Physical Activity Questionnaire-short form was used to assess PA and European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30 (QLQ-C30) to assess HRQoL. Changes over time were analyzed using generalized estimating equations or linear mixed models. Associations between PFD with PA and HRQoL were analyzed using logistic regressions and analyses of variance.</p><p><strong>Results: </strong>Of 126 participants, median age 63 years, most had endometrial (69%) and/or stage 1 cancer (72%) and underwent total hysterectomy (65%). Pre-surgery, 39% met PA guidelines, increasing to 53% 3 months post-surgery (+14%, 95% CI 2-25). Mean global health status/QoL domain scores from the QLQ-C30 did not change significantly (+4.4/100 points, 95% CI -0.8 to 9.6). Three months post-surgery, whether participants met PA guidelines was not associated with PFD. Participants with anal incontinence or double incontinence had lower global health status/QoL scores than participants without these symptoms (mean (SD) AI 61.4 (17.8) vs no AI 72.5 (18.7), p = 0.006; DI 61.5 (17.9) vs no DI 71.7 (18.8), p = 0.019).</p><p><strong>Conclusion: </strong>PA levels were low pre- and post-surgery but worse preoperatively. This presents an opportunity for prehabilitation interventions to optimize physical function. There was no association between meeting PA guidelines and PFD. Global health status/QoL was slightly below population norms pre- and post-surgery. Lower HRQoL was associated with some symptoms of PFD.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191812","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}