Jornal de pediatria最新文献

{"title":"Alternative antibiotics for the treatment of bacterial meningitis in children: a systematic review of efficacy and safety.","authors":"Ana Clara Valente de Alencar, Athus Graziani Apollaro Rego, Carolina Soares Chady, Alisson Gabriel Maués Miranda, Lara Fernanda Alves de Souza, João Vitor Martins Pinto, Bárbara de Souza Maia do Nascimento, Camili Giseli Oliveira de Menezes, Isa Mendes Moreira, José Carlos Favacho Furlan, Ester Carolina Vieira Maia, Maria Fernanda Nakayama Martins, Nayara Cristina Cardoso da Silva, Paula do Socorro de Oliveira da Costa Laurindo, Luis Edilson de Azevedo Ferreira, Antônio Rafael Quadros Gomes, Heliton Patrick Cordovil Brígido","doi":"10.1016/j.jped.2025.05.002","DOIUrl":"10.1016/j.jped.2025.05.002","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aimed to evaluate the efficacy and safety of alternative antibiotics and different standard treatment regimens for bacterial meningitis in children, considering the increasing antimicrobial resistance and the need for adapted therapeutic options. To justify the use of alternative antibiotics, the authors analyzed the specific efficacy of ampicillin, chloramphenicol, cefuroxime and meropenem, which showed potential to overcome cases of antimicrobial resistance.</p><p><strong>Data sources: </strong>A search was performed in databases such as PubMed, Scopus, Web of Science and Cochrane Library, without data restrictions, including planned clinical trials that compared alternative antibiotics and different standard treatment regimens, such as ceftriaxone, in children with bacterial meningitis. Inclusion criteria include studies reporting cure rates, complications and safety of treatments.</p><p><strong>Summary of results: </strong>An analysis of 14 studies, totaling 2,014 children, indicated that antibiotics such as ampicillin, chloramphenicol, cefuroxime and meropenem had comparable efficacy and safety to standard treatment regimens. The review showed that, in many cases, alternative regimens and shorter treatment durations could be effective, without significantly increasing complications or mortality.</p><p><strong>Conclusion: </strong>The results suggest that alternatives to standard treatment, such as ampicillin, chloramphenicol, cefuroxime and meropenem, are viable and safe options for the treatment of bacterial meningitis in children. These results help to adapt clinical practices, especially in settings with high antimicrobial resistance and resource limitations, by providing evidence for shorter and equally effective treatment regimens.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A breath of life, and heartbeats for life: the science and soul of neonatal resuscitation.","authors":"Waldemar A Carlo, Amy Mackay, Vivek V Shukla","doi":"10.1016/j.jped.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.jped.2025.05.005","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empower your child's health: tailored strategies to prevent rhinosinusitis.","authors":"Francesca De Bernardi, Chiara Zeroli, Sandra Coecke, Massimo Landi, Stefania Gallo, Paolo Castelnuovo, Luana Nosetti","doi":"10.1016/j.jped.2024.02.005","DOIUrl":"https://doi.org/10.1016/j.jped.2024.02.005","url":null,"abstract":"<p><strong>Objective: </strong>This review explores preventive strategies for pediatric rhinosinusitis and examines their potential impact on children's mental well-being, advocating for a comprehensive holistic approach that includes medical disciplines and government policies to support EU and global prevention strategies.</p><p><strong>Sources: </strong>A comprehensive search encompassed Medline, Embase, PubMed, and the Cochrane Library for English-language articles from January 2010 to December 2023. Inclusion criteria involved papers on pediatric rhinosinusitis prevention in the pediatric population, published in peer-reviewed journals. Following the removal of duplicates and exclusion of irrelevant studies, 20 unique titles were included in the review.</p><p><strong>Summary of the findings: </strong>The review underscores the challenges posed by the similarity of symptoms between pediatric rhinosinusitis and other common childhood illnesses. It emphasizes the interconnected nature of upper and lower airways, illustrating the potential impact on both physical and mental well-being in children. The findings highlight the necessity for a multifaceted prevention approach, supported by individualized prevention plans, medical professional involvement, and government policies.</p><p><strong>Conclusions: </strong>The holistic research and clinical approach proposed in this review contribute valuable insights into the global efforts aimed at reducing the incidence of pediatric rhinosinusitis while promoting the mental well-being of children. The article serves as an informative resource for readers seeking a deeper understanding of pediatric rhinosinusitis prevention strategies. The review emphasizes the necessity of a multidisciplinary approach, involving pediatricians, otolaryngologists, pneumologists, and allergologists, in PRS prevention. Government prioritization of preventive measures is essential. Precision medicine and integrative approaches are recommended for tailored treatment plans.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotype-phenotype correlation of neurodevelopmental disorders in patients with dystrophinopathies.","authors":"Fabrício M Soares, Bruna F Rosa, Gabriela M Giordani, Daniele L Rocha, Ana Carolina Brusius-Facchin, Michele M Becker, Jonas Alex M Saute","doi":"10.1016/j.jped.2025.01.014","DOIUrl":"10.1016/j.jped.2025.01.014","url":null,"abstract":"<p><strong>Objective: </strong>Neurodevelopmental disorders are frequently and heterogeneously diagnosed among patients with dystrophinopathies. The authors aimed to evaluate how the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), or Autism Spectrum Disorder (ASD), and genotype are related to DMD genotype.</p><p><strong>Methods: </strong>In an observational cross-sectional study, standardized instruments were applied to 50 participants and their caregivers, mainly from a reference center for rare diseases in Southern Brazil (n = 38) or other Brazilian centers (n = 12). Participants were divided according to genotype and affected dystrophin isoforms.</p><p><strong>Results: </strong>The overall diagnostic rate of symptoms of ASD was 34 %, similar to OCD (35.5 %), with half of the participants (51.4 %) having symptoms compatible with ADHD. Cerebral isoforms were affected in more than half of the participants (52 %). Symptoms compatible with ASD and OCD, and Childhood Autism Rating Scale (CARS) scores were associated with genotype and impairment of cerebral isoforms of dystrophin.</p><p><strong>Conclusions: </strong>The prevalence of symptoms compatible with ASD (and higher CARS scores) and OCD among patients with dystrophinopathies are related to the position of the causal variant in DMD and the consequent involvement of cerebral isoforms, indicating an important genotype-phenotype correlation. The diagnosis of a patient with a genotype that affects these isoforms indicates the need for neuropsychological assessment and multidisciplinary follow-up.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between the safety of the HPV vaccine versus placebo: a systematic review and meta-analysis of randomized clinical trials.","authors":"Swelen Aparecida Dos Santos, Mariane Yoshie Sato, Pedro Henrique Gunha Basilio, Meire Ellen Pereira, Rafaela Climaco Julião, Nielson da Cunha Arruda, Davi Paula da Silva, Cláudia Sirlene Oliveira, Victor Horacio de Souza Costa-Junior, Izonete Cristina Guiloski","doi":"10.1016/j.jped.2025.04.009","DOIUrl":"10.1016/j.jped.2025.04.009","url":null,"abstract":"<p><strong>Objective: </strong>Human Papillomavirus (HPV) is a virus that targets epithelial tissues. Virtually all cases of cervical cancer are related to HPV, emphasizing the importance of vaccines in prevention. Although >200 million doses have been administered worldwide, concerns persist about adverse reactions. This study evaluated the safety of the HPV vaccine and the main adverse effects.</p><p><strong>Data sources: </strong>The study was registered in the PROSPERO database (CRD42023365692). The systematic searches were conducted in the PubMed, Scopus, Embase, Cochrane, Science Direct, and Web of Science databases using the search strategy \"HPV\" AND \"vaccine\" AND \"safety\" NOT \"COVID\" from 01/01/2007 to 31/12/2022. Inclusion criteria were based on the PICOT strategy, focusing on studies with humans, vaccinated populations comprising children, adolescents, and adults, and Phase II/III randomized clinical trials. The PEDro scale was used to assess the quality of the studies.</p><p><strong>Summary of findings: </strong>Eleven articles were qualified for qualitative synthesis and meta-analysis. The results indicated that HPV vaccination was associated with increased local reactions, fatigue, and myalgia compared to the placebo. However, there were no significant differences in serious adverse events, gastrointestinal reactions, cutaneous effects, headache, or fever between the vaccine and placebo groups.</p><p><strong>Conclusion: </strong>Local reactions, fatigue, and myalgia were more prevalent in the HPV vaccine group; the overall safety profile of the vaccine was favorable. The HPV vaccine was deemed safe, mirroring the profile of adverse reactions seen with other vaccines. With its potential to prevent cancer, the benefits of HPV vaccination far outweigh the minimal risks.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative randomized clinical trial on postoperative pain in circumcision with ultrasound-guided versus conventional anesthetic block.","authors":"Isabela P Moraes, Flavia P Payan, Camila G Fachin, Rogério de Fraga","doi":"10.1016/j.jped.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.jped.2025.05.004","url":null,"abstract":"<p><strong>Objective: </strong>Circumcision is a common surgical procedure worldwide, with indications ranging from medical to cultural-religious contexts. Effective pain control is crucial to reduce analgesic use and improve patient safety. Recent advances include the use of the Plastibell® device and ultrasound-guided dorsal penile nerve block, aimed at minimizing surgical time and complications. This study compares postoperative pain in patients undergoing circumcision with either the landmark dorsal penile nerve block (blind block) or ultrasound-guided block.</p><p><strong>Methods: </strong>In this prospective, randomized study, patients aged 3-14 years undergoing elective circumcision were assigned to receive either anesthetic technique. Pain was assessed using physiological parameters (heart rate variation, movement during surgery) and subjective measures (Wong-Baker scale) at multiple time points, along with analgesic consumption. The sample was subdivided into patients aged ≤5 years and >5 years.</p><p><strong>Results: </strong>Pain scores before hospital discharge were higher in patients under 5 years. The blind block was faster to perform but had a higher incidence of hematomas and a trend toward greater block failure, indicated by increased heart rate, patient movement, and opioid use, although differences were not statistically significant. Ultrasound-guided blocks showed fewer complications and a tendency for better pain control.</p><p><strong>Conclusion: </strong>Both anesthetic techniques provide comparable pain control in circumcision; however, ultrasound guidance may reduce complications and improve block success, supporting its use as a safe and effective alternative to the conventional method.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on the incidence of acute mastoiditis in a tertiary reference children's hospital in Brazil.","authors":"Hemily I A Neves, Joel Lavinsky, Luana V Margheti, Mauricio S Miura, Patrícia B Ogando, Marcelo A M da R Filho, José F L Neto","doi":"10.1016/j.jped.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.jped.2025.05.003","url":null,"abstract":"<p><p>Many countries implemented mitigation strategies during the COVID-19 pandemic. Consequently, studies conducted between 2020 and 2022 reported changes in respiratory tract infection incidence and seasonality patterns, alongside a reduction in associated illnesses such as acute otitis media (AOM). Following the pandemic, a resurgence in AOM and acute mastoiditis (AM) cases has been observed.</p><p><strong>Objectives: </strong>To compare the incidence of AM hospitalizations and complications across three periods: pre-pandemic, pandemic, and post-pandemic. Additionally, the study aims to evaluate associations with patient age, need for surgical intervention, antibiotic therapy, and isolated etiological agents.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed pediatric charts from three 22-month periods: pre-pandemic (P1), pandemic (P2), and post-pandemic (P3). These periods were compared in terms of case numbers, presence and severity of AM complications, patient demographics (age and sex), and treatment approaches.</p><p><strong>Results: </strong>A total of 9 AM cases were recorded in (P1), 5 in the (P2), and 25 in (P3). This represents a 25.5 % reduction in AM incidence during the pandemic compared to the pre-pandemic period, though this was not statistically significant (p = 0.8027). However, a significant 103.3 % increase in AM incidence was noted between the pre- and post-pandemic periods (p = 0.0322). No significant differences were found among periods regarding age, sex, complications, case severity, surgical intervention, antibiotic duration, or length of hospitalization.</p><p><strong>Conclusion: </strong>Although AM incidence slightly declined during the pandemic, the post-pandemic period showed a significant rise in the incidence of cases compared to pre-pandemic values.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and nutritional profile of children and adolescents with autism spectrum disorder in Brazil: a nationwide online survey.","authors":"Gabriele Gonçalves de Souza Corrêa, Fernanda Valente Mendes Soares, Zilton Farias Meira de Vasconcelos, Ana Carolina Carioca Costa, Adriana Duarte Rocha","doi":"10.1016/j.jped.2024.12.008","DOIUrl":"10.1016/j.jped.2024.12.008","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the clinical and nutritional profile of children and adolescents with ASD in Brazil and their eating problems.</p><p><strong>Method: </strong>This is a cross-sectional study using a national online survey, with a sample of 613 children and adolescents with ASD aged between 2 and 17 years. Data analysis consisted of descriptive analysis, followed by Pearson's chi-square test with a statistical significance of 0.05 and a 95% confidence interval.</p><p><strong>Results: </strong>Food allergy was reported by 33.8% of the participants, the most frequent being cow's milk (70.2%), among those who reported gastrointestinal problems, constipation was the most frequent (54.1%). The presence of pica was reported by 25% and food selectivity was present in 77.2%, with greater refusal of fruit, vegetables and pasty textures. Most of the participants do not have follow-ups with a nutritionist and 44.5% are on some special diet, excluding gluten/wheat (75.4%) and without casein/animal milk (76.1%). More than half of the participants did not eat fruit (50.6%), vegetables (68.1%), or leafy greens (83.6%) frequently. A positive correlation was found between food selectivity and gastrointestinal symptoms (p-value < 0.050); food allergy and gastrointestinal symptoms (p-value < 0.001) and pica and gastrointestinal symptoms (p-value < 0.001).</p><p><strong>Conclusions: </strong>The results of this study show changes in food consumption and increased risk of nutritional deficiencies for children and adolescents with ASD in Brazil.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The full blood count as a tool of differentiation between benign and malignant lymphadenopathy in pediatric and adolescent populations.","authors":"Mariana Moreira Magnabosco da Silva, Leniza Costa Lima Lichtvan, Thaís Cugler Meneghetti","doi":"10.1016/j.jped.2025.05.001","DOIUrl":"10.1016/j.jped.2025.05.001","url":null,"abstract":"<p><strong>Objective: </strong>Studies have shown the benefit of ratios between cell types in full blood count for the diagnosis and prognosis of various pathologies, but its use in the investigation of lymphadenopathy is still controversial. The aim of this study is to assess whether there is a difference between the full blood count ratios of children and adolescents with lymphadenopathy who had benign or malignant causes identified in excisional biopsies during the investigation of lymphadenopathy.</p><p><strong>Method: </strong>This is a cross-sectional observational study. A total of 72 participants between 0 and 17 years old who underwent an excisional lymph node biopsy and had their full blood count collected up to 15 days before the procedure were included. The participants were divided into two groups, malignant and benign, according to the biopsy result. Neutrophils/lymphocytes (N/L), monocytes/lymphocytes (M/L), and platelets/lymphocytes (P/L) ratios were then calculated and compared between the groups.</p><p><strong>Results: </strong>The mean full blood count ratios for the benign and malignant groups, respectively, were: N/L 2.36 × 3.28 (p=0.09), M/L 0.30 × 0.32 (p= 0.722), P/L 180.53 × 191.30 (p=0.249).</p><p><strong>Conclusion: </strong>The use of full blood count ratios as predictors of malignant or benign results has no proven statistical significance. Higher ratio values tend towards malignant results but should be interpreted with caution, as this is only one of the factors to be considered during the investigation.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increase in new-onset type 1 diabetes diagnoses among Brazilian children and adolescents during the COVID-19 pandemic.","authors":"Renata Szundy Berardo, Melanie Rodacki, Bruna S Pugliese, Fernanda Roisman, Juliane Rocha, Daniel Gilban, Bianca Balassiano, Cristine Barboza Beltrão, Isla Aguiar Paiva, Juliana Veiga Moreira, Jorge Luescher, Ludmila Campos, Isabella Coutinho, Isabel Rey Madeira, Alessandra S M F da Costa, Lucianne R M Tannus, Nádia C P Rodrigues, Lenita Zajdenverg","doi":"10.1016/j.jped.2025.04.001","DOIUrl":"10.1016/j.jped.2025.04.001","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine if there was a rise in new T1DM cases in children during the pandemic in a large metropolitan area in Brazil.</p><p><strong>Methods: </strong>The authors conducted a cross-sectional study at five public tertiary care centers that specialize in diabetes in children, comparing all new T1DM cases (ages 0.5-18y) diagnosed from March 2020 to December 2021 (pandemic period, PP) with those from March 2018 to December 2019 (historical period, HP).</p><p><strong>Results: </strong>There were 167 new cases in the PP compared to 99 in the HP, reflecting a 68.7 % rise, with a notable peak observed in the third quarter of 2020 (p = 0.006). The average age of diagnosis was 8.4 ± 4.2 years in the PP and 7.5 ± 3.6 years in the HP, with no significant difference (p = 0.06). The gender distribution, BMI Z scores, and duration of diabetes symptoms before diagnosis were similar. The incidence of diabetic ketoacidosis (DKA) at onset was elevated but did not increase during the pandemic (62.6 % historical vs. 59.3 % pandemic period). During the PP, 24 % of patients reported symptoms of SARS-CoV-2 infection before the diagnosis of T1DM or at admission, and 13 % (7/53) of tested patients were positive for SARS-CoV-2.</p><p><strong>Conclusions: </strong>The present findings indicate a significant rise in new T1DM cases among children during the COVID-19 pandemic compared to prior years, without differences in DKA at onset.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}