International Urogynecology Journal最新文献

{"title":"MRI-Based Structural Failure Comparison between Chinese and American White Women With Prolapse: A Case-Control Study.","authors":"Bing Xie, Lahari Nandikanti, Carolyn W Swenson, Jing Wu, Tianhang Liu, Xin Yang, Yi Li, Xiuli Sun, John O DeLancey, Luyun Chen, Jianliu Wang","doi":"10.1007/s00192-024-05945-7","DOIUrl":"10.1007/s00192-024-05945-7","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Although some evidence suggests that Chinese and white women might have different pelvic floor anatomy such as levator complex and connective tissue support for pelvic organs, it is unknown if these differences affect the mechanisms of pelvic organ prolapse. We sought to determine whether differences exist in MRI-based structural failure patterns between Chinese and American white women with prolapse.</p><p><strong>Methods: </strong>This is a case-control study in different racial cohorts recruited in China and the USA. The Chinese cohort included 19 women with anterior-predominant prolapse and 24 controls with normal pelvic support. The American white cohort included 30 women with anterior-predominant prolapse and 30 controls. Both cohorts underwent the same clinical evaluation and MRI protocol. Three structural support systems were quantified on stress 3D MRI at maximal Valsalva: vaginal factors (length, width); connective tissue attachment (cervix, lateral paravaginal height); and hiatus factors (urogenital hiatus size, major levator ani injury). Abnormal structural support was defined as any measurement outside the normal range defined as the 5th to 95th percentile in controls from the respective cohort. The percentages of the women with abnormal support in the two cohorts were compared.</p><p><strong>Results: </strong>Among those with prolapse, Chinese women were more likely than white women to have abnormally long vaginal length and width (90% vs 40%, p < 0.001; 53% vs 23%, p = 0.031 respectively). The occurrence of abnormal apical location, paravaginal location, and genital hiatus size ranged from 89 to 100% in Chinese women and from 63 to 80% in white women.</p><p><strong>Conclusions: </strong>Prolapse in American white women most commonly involves structural failure of connective tissue attachments and hiatus factors and less frequently involves vaginal wall factors, whereas prolapse in Chinese women frequently involves all support structures.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"363-371"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667906","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 New Combined Urogynecology and Colorectal Surgery Pelvic Floor Clinic-1 Year On.","authors":"Su-Wen Anne Mak, Sharmini Su Sivarajah, Simone Meiqi Ong, Cheryl Xi Zi Chong, Hong Liang Chua, Jill Cheng Sim Lee","doi":"10.1007/s00192-024-05968-0","DOIUrl":"10.1007/s00192-024-05968-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This study is aimed at characterizing patients seen at a new combined pelvic floor clinic (CPFC) established at a tertiary women's hospital in Singapore. Study goals include identifying patterns of symptom clusters and reviewing management strategies compared with international care standards, improving understanding of complex female pelvic floor dysfunction, and guiding future development of clinical and ancillary support.</p><p><strong>Methods: </strong>This is a single-center, retrospective cohort study of medical case record review for all patients seen at the CPFC between 1 September 2020 and 31 August 2021. All patients seen at CPFC during this study period were included for analysis. Data were deidentified and aggregated, with analysis performed for descriptive and summary statistics. Institutional Review Board approval was obtained with waiver of informed consent.</p><p><strong>Results: </strong>Sixty-six referrals were made to the CPFC, with 57 patients seen in 11 clinic sessions across the 12-month period. The most common reasons for referral were fecal or flatus incontinence (30, 52.6%), severe constipation or defecatory dysfunction (21.1%), and rectal prolapse (17.5%). Most patients (78.9%) had multiple symptoms.</p><p><strong>Conclusions: </strong>Our patient demographic profile aligns with known risk factors for pelvic floor dysfunction, presenting with gastrointestinal symptoms-similar to PFCs worldwide. The new workflow and services were well positioned to address patients' needs, including those left previously untreated, or received uncoordinated care. Conservative approaches were first employed, like with other global PFCs. The combined multidisciplinary model of care resulted in good outcomes for patients managed both conservatively and surgically. Future studies to analyze patient satisfaction are planned.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"331-338"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620465","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":"Turkish Validation and Reliability Analysis of the International Female Coital Incontinence Questionnaire.","authors":"Mehmet Murat Seval, Şerife Esra Çetinkaya, Derya Gökmen, Kazibe Koyuncu Demir, Bulut Varlı, Fulya Dökmeci","doi":"10.1007/s00192-024-06039-0","DOIUrl":"10.1007/s00192-024-06039-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Coital incontinence (CI) is an important problem that negatively affects women's quality of life and is often underreported owing to embarrassment, indicating the importance of its assessment with validated questionnaires. The aim of this study was to validate the Turkish-translated version of the International Female Coital Incontinence Questionnaire (IFCI-Q) for the objective evaluation of women with CI in Turkish-speaking populations.</p><p><strong>Methods: </strong>Ninety women with CI filled out the Turkish-translated version of IFCI-Q. Confirmatory factor analysis (CFA), Cronbach's alpha, and intraclass correlation coefficients (ICCs) were evaluated for the construct validity, internal consistency, and test-retest reliability, respectively. Known group validity, which is the ability of the scale to reveal the expected difference according to patients' demographics and PISQ-12 scores, was evaluated.</p><p><strong>Results: </strong>The construct validity was confirmed after excluding the first and third items of the questionnaire (CFI 0.966, TLI 0.944). The first item was excluded from the CFA as all women who completed the IFCI-Q had CI and therefore answered this item questioning the existence of CI as \"yes.\" The third item was eliminated because its factor loading was below 0.20. Cronbach's alpha value for the scale was 0.67. ICC was calculated as 0.97 (0.95-0.98; p < 0.001), indicating a strong positive agreement between the test scores at two time points 2 weeks apart.</p><p><strong>Conclusions: </strong>The Turkish version of IFCI-Q seems to be a reliable, consistent, and valid instrument in the screening and assessment of CI in a gynecology outpatient clinic-based cohort of Turkish-speaking women.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"439-445"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970891","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":"Effects of Urinary Incontinence Subtypes on Quality of Life and Sexual Function among Women Seeking Weight Loss.","authors":"Zhao Tian, Linru Fu, Xiuqi Wang, Tangdi Lin, Wei Chen, Zhijing Sun","doi":"10.1007/s00192-024-05977-z","DOIUrl":"10.1007/s00192-024-05977-z","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The objective was to detect subtypes of urinary incontinence (UI) and their effects on quality of life (QoL) and sexual function among women seeking weight loss.</p><p><strong>Methods: </strong>A cross-sectional study focusing on women seeking weight loss with UI symptoms was carried out. Participants were stratified into three groups: stress UI, urgency UI, and mixed UI groups. The effects of the three groups on QoL and sexual function were compared.</p><p><strong>Results: </strong>A total of 564 individuals (46.8%) were reported to present with UI symptoms. Among these, 216 (38.3%), 71 (12.6%), and 277 (49.1%) had stress UI, urgency UI, and mixed UI respectively. The severity of UI was greater in the urgency UI and mixed UI groups than in the stress UI group, with varying ratios observed among patients with different severities of UI: stress UI was highest in mild cases, and the mixed UI was highest in moderate or severe cases. Mixed UI had the most detrimental effect on QoL and sexual function. However, after controlling for the severity of UI, mixed UI still had a greater detrimental effect on UI-specific QoL, and no differences were identified among the three groups regarding general QoL or sexual function.</p><p><strong>Conclusion: </strong>This study revealed variations in the constituent ratios of UI subtypes related to the severity of UI and the effects of various UI subtypes on QoL and sexual function among women seeking weight loss. Notably, the mixed UI demonstrated the most severe symptoms and the most detrimental impact, particularly as assessed by UI-specific QoL questionnaires.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"381-389"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681770","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":"Silicone Irregular Hexagon Pessary Versus Polyvinyl Chloride Ring Pessary for Pelvic Organ Prolapse: Randomised Controlled Trial.","authors":"Chin Yong, Tanaka Dune, Rebecca Shaya, Ann Cornish, Dean McKenzie, Marcus Carey","doi":"10.1007/s00192-024-05933-x","DOIUrl":"10.1007/s00192-024-05933-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vaginal pessaries are the mainstay of the non-surgical management of pelvic organ prolapse (POP). A flexible silicone irregular hexagonal (SIH) pessary was developed based on the results of a prior vaginal case study. We hypothesised that the SIH pessary would have a higher rate of retention and self-management than the polyvinyl chloride (PVC) pessary.</p><p><strong>Methods: </strong>This was a prospective non-blinded, randomised controlled trial with institutional review board approval. Eligible participants were randomised and fitted with the assigned pessary. They were reviewed 1 week, 6 months and 1 year after the initial pessary fitting. Participants who returned for follow-up completed the study questionnaires. The primary outcome was success, defined as continued use of the allocated pessary at 6 months. Secondary outcomes included the ability to perform pessary self-care, treatment satisfaction and pessary-related complications. Statistical tests were performed with alpha or statistical significance defined as a p value of ≤ 0.05, two-tailed.</p><p><strong>Results: </strong>A total of 104 participants were randomised, with 52 subjects in each arm. Primary outcome data were analysed using per protocol analysis. Continuing pessary usage at 6 months was 68.1% for the PVC pessary group and 65.1% for the SIH group, with no statistically significant differences between the two groups (p = 0.765). Subjects with SIH were more likely to perform pessary self-care. There were no significant differences in subjects' satisfaction, quality-of-life scores or treatment complications between groups.</p><p><strong>Conclusions: </strong>The pessary continuation rate between the SIH and the PVC pessary groups was similar at 6 months. Participants with an SIH pessary were more likely to self-manage.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"289-298"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371828","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":"Management of Sacrocolpopexy Mesh Complications-A Narrative Review and Clinical Experience from a Large-Volume Center.","authors":"Chen Shenhar, Howard B Goldman","doi":"10.1007/s00192-024-05955-5","DOIUrl":"10.1007/s00192-024-05955-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Despite the reputation of sacrocolpopexy as a highly durable reconstructive surgery for pelvic organ prolapse, mesh-related complications remain a significant deterrent for patients. This review discusses the incidence, presentation, diagnosis, management and prevention of sacrocolpopexy mesh complications.</p><p><strong>Methods: </strong>We reviewed the literature on sacrocolpopexy focusing on long-term mesh complications and their management. As the literature is not specifically robust, we also give our recommendations based on experience from a large-volume center. Intraoperative videos and images are provided to illustrate findings and management techniques.</p><p><strong>Results: </strong>Sacrocolpopexy mesh complications include vaginal mesh exposure; bladder or bowel erosions; inflammatory and infectious conditions including spondylodiscitis; and mesh-related pain. Presentation ranges from overt symptoms such as mesh palpated in the vagina to insidious-like spondylodiscitis manifesting as back pain and malaise. Diagnosis relies on methodical history taking, review of operative reports, and a physical examination, with office-based endoscopy studies and imaging as indicated. Various management options have been described in the literature. We recommend an expectant approach for asymptomatic patients; For symptomatic vaginal exposure, we encourage removal of entire mesh arm(s) via an abdominal approach; however, many prefer to utilize a transvaginal or partial excisional approach first. Spondylodiscitis is managed with long-term antibiotics and often requires mesh removal. Prevention strategies include using a lightweight polypropylene mesh attached to well- vascularized vaginal walls, avoiding direct placement on any sutured vaginotomy or cystotomy. Delayed absorbable monofilament suture is non-inferior to permanent suture.</p><p><strong>Conclusions: </strong>Sacrocolpopexy mesh complications can be challenging to diagnose and manage. Symptomatic cases often require a proactive approach; listening to patients when they describe persistent symptoms with postoperative onset; a low threshold for further evaluation; and upfront discussion of management options.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"231-241"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619641","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":"Special Edition on Sacrocolpopexy: A Worldwide Effort.","authors":"Catherine A Matthews","doi":"10.1007/s00192-025-06056-7","DOIUrl":"10.1007/s00192-025-06056-7","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"229-230"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005328","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 Cross Sectional Study of Cytokines in Women with Refractory Detrusor Overactivity versus Controls.","authors":"Kylie J Mansfield, Zhuoran Chen, Samantha Ognenovska, Nancy Briggs, Ronald Sluyter, Kate H Moore","doi":"10.1007/s00192-024-05999-7","DOIUrl":"10.1007/s00192-024-05999-7","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Previous work has suggested that refractory detrusor overactivity (DO) was commonly associated with urinary tract infection (UTI), which can lead to inflammatory changes in the bladder. This study aimed to investigate the concentrations of urinary cytokines in a large sample of women with refractory detrusor overactivity (DO) and age matched controls.</p><p><strong>Methods: </strong>The urinary concentration of 27 cytokines in 140 women (95 with refractory DO and 45 age matched controls (women without urge incontinence)) was determined using the Human Cytokine 27-plex Assay. Cytokine concentrations were correlated with a \"UTI score\", the presence or absence of bacteriuria or pyuria on the day of sample collection and a previous history of UTI.</p><p><strong>Results: </strong>Pro-inflammatory cytokines were increased in refractory DO women compared to the controls. In women with refractory DO, the UTI score significantly correlated with urinary cytokine concentrations in 15 of the 22 cytokines detected. A previous history of UTI did not affect urinary cytokine concentrations in refractory DO women with no current UTI. Increasing pyuria was associated with increasing concentrations of urinary cytokines.</p><p><strong>Conclusion: </strong>Careful comparison of cytokine concentrations in women with refractory DO versus age matched controls has shown that changes in pro-inflammatory cytokines are related to the UTI disease burden, suggesting that an underlying inflammatory response, together with UTI, may be an aetiological contributor to the development of refractory DO.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"351-361"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667896","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":"Assessing the Work Productivity Impact of Overactive Bladder Syndrome Among Employees at a Brazilian Hospital.","authors":"Marta Q S Fontenele, Janaina M O Nunes, Fuad A Hazime, Silvio H M de Almeida","doi":"10.1007/s00192-024-05985-z","DOIUrl":"10.1007/s00192-024-05985-z","url":null,"abstract":"<p><strong>Introduction and hypotheses: </strong>Few studies have investigated the relationship between work productivity (WP) and overactive bladder syndrome (OABS). The majority of those that do use generic productivity questionnaires or only include WP as a secondary outcome. We evaluated the impact of OABS on specific domains of WP, with the hypothesis that OABS has an impact on the domains of efficiency, concentration, vigor, and irritability, lost working hours, interruptions, and impairment to the work schedule.</p><p><strong>Methods: </strong>An observational, cross-sectional study with 576 female employees (without SBH 447, dry OABS 63, wet OABS 66) was carried out. The 8-item Overactive Bladder Questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB), and a WP questionnaire developed by the authors were used. Non-parametric tests were adopted to associate OABS with productivity. The correlation between the instruments was performed using the Spearman test, adopting a value of p = 0.05.</p><p><strong>Results: </strong>There was a significant impact of urinary symptoms on WP (p = 0.03) in the domains of productivity/efficiency (p = 0.03), restlessness (p < 0.05), and interruptions to go to the bathroom (p = 0.03), which was higher among employees with wet OABS. Urgency and urge urinary incontinence (UUI) were the symptoms with the greatest productive impact (p = 0.01, p < 0.001). A significant correlation was found between WP scores and OAB-V8 and ICIQ-AOB scores in both groups (p < 0.05).</p><p><strong>Conclusion: </strong>OABS impacted WP, in the domains of efficiency, restlessness, and interruptions to go to the bathroom, with urgency and UUI being the symptoms with the greatest impact on productivity.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"317-330"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620471","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":"Evaluating the Benefit of a Urogynecologic Telehealth Consultation after Obstetric Anal Sphincter Injury.","authors":"Kyra Bonasia, Susan Luong, Jocelyn Stairs, Aisling Clancy","doi":"10.1007/s00192-025-06077-2","DOIUrl":"https://doi.org/10.1007/s00192-025-06077-2","url":null,"abstract":"<p><strong>Introduction: </strong>Obstetric anal sphincter injuries (OASI) are associated with significant risk of complications, including pain, infection, and long-term pelvic floor dysfunction. The primary aim of this study was to evaluate the utility and acceptability of a postpartum telehealth consultation focused on pelvic floor health for patients after OASI.</p><p><strong>Methods: </strong>This prospective study used a pre-post design comparing standard postpartum care versus standard postpartum care plus a telehealth urogynecology consultation focused on pelvic floor recovery. The primary outcome was symptom burden as measured by the Pelvic Floor Distress Inventory (PFDI-20) score 16-weeks postpartum. Patient experience was evaluated using the QQ10 and the Patient Enablement Instrument. T-tests and chi-squared tests were used to compare groups.</p><p><strong>Results: </strong>A total of 119 participants completed study activities (control group n = 62, intervention group n = 57). There was no significant difference between the two groups in PFDI-20 scores (55.6 versus 46.6, p = 0.23). The individual items most likely to be endorsed among all participants were related to flatal incontinence (52.1%) and fecal urgency (49.6%). For the subset analysis of 35 patients with severe OASI (3C or fourth-degree tears), those who had a telehealth consultation had lower PFDI-20 scores (56.6 versus 34.7; p = 0.04). QQ10 estimated a value score of 79/100 and a burden score of 18/100 for the telehealth consultation.</p><p><strong>Conclusions: </strong>A postpartum telehealth consultation focused on pelvic floor health may benefit patients with severe OASI who reported reduced symptom burden. Participants rated a telehealth consultation as high value and low burden for this condition.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065617","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}