Journal of Cardiothoracic Surgery最新文献

{"title":"Assessment of the quality of life comparison between open and endovascular aortic arch surgery: a pilot study.","authors":"Eric Thiam Aik Lim, Hannah S Kim, Andrew McCombie, Andrew D P Laing, Adib Khanafer","doi":"10.1186/s13019-024-03263-z","DOIUrl":"10.1186/s13019-024-03263-z","url":null,"abstract":"<p><strong>Background: </strong>Advancement in endovascular endografts have paved the way to the possibility of performing endovascular aortic arch repair in recent years. This has started to supersede the need for open aortic arch surgery. There remains a paucity of data looking into the quality of life comparison between open aortic arch surgery and endovascular aortic arch repair.</p><p><strong>Method: </strong>A retrospective, observational pilot study was performed on patients who underwent endovascular inner branched aortic arch repair and open aortic arch surgery. Patients completed the RAND SF-36 questionnaire at the 6 week follow-up post-surgery. Mean score across all eight subscales were compared to the New Zealand population norm based on the New Zealand Health Survey as cited in the SoFIE-Health study.</p><p><strong>Results: </strong>A total of 12 patients were included in this study over a 3 year period. We demonstrated that endovascular aortic arch repair is associated with a better quality of life compared to open aortic arch surgery across all eight subscales. Pain scores were found to be higher than the population normal in the endovascular aortic arch repair group while the open aortic arch surgery group had a score lower than the population norm (P < 0.01).</p><p><strong>Conclusion: </strong>There appears to be a trend towards better quality of life following endovascular aortic arch repair compared to open aortic arch repair.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"701"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909701","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 case series of VATS intrapericardial pneumonectomy: a bi-centric experience.","authors":"Güntuğ Batıhan, Kenan Can Ceylan","doi":"10.1186/s13019-024-03270-0","DOIUrl":"https://doi.org/10.1186/s13019-024-03270-0","url":null,"abstract":"<p><strong>Background: </strong>Intrapericardial pneumonectomy is a complex procedure indicated for large lung tumors where safe dissection of major vascular structures outside the pericardium is unfeasible or when the pericardium itself is invaded. Traditionally managed via open thoracotomy, recent advancements in VATS techniques now allow for intrapericardial pneumonectomy even in cases with extensive tumors or locally advanced disease. In this article, we detail the clinical outcomes and surgical considerations of six patients with non-small cell lung cancer who underwent VATS intrapericardial pneumonectomy. In this article, we detail the clinical outcomes and surgical considerations of six patients with non-small cell lung cancer who underwent VATS intrapericardial pneumonectomy.</p><p><strong>Case presentation: </strong>This study analyzed data from 24 patients who underwent VATS pneumonectomy for non-small cell lung cancer at two thoracic surgery centers in Turkey between January 2015 and March 2024. Among them, 6 patients underwent intrapericardial pneumonectomy; 5 had left pneumonectomy, and 1 had right pneumonectomy. All patients were male, with a mean age of 72.8 years, and a mean tumor size of 6.2 cm. Pericardial invasion was observed in 5 patients. Postoperative complications included respiratory failure and septic shock in one patient, leading to death. Long-term follow-up showed one additional death due to cancer progression; four patients are alive and under routine follow-up.</p><p><strong>Conclusions: </strong>VATS intrapericardial pneumonectomy offers a viable alternative to traditional open surgery for patients with large or locally advanced non-small cell lung cancer, providing enhanced visualization, reduced postoperative pain, and faster recovery. Our multi-center experience with six patients demonstrates the procedure's feasibility and safety, even in challenging cases with pericardial invasion. Despite the complexity of the surgery, the use of advanced VATS techniques and careful intraoperative assessments can lead to successful outcomes. However, given the associated risks, especially with postoperative complications, further studies with larger cohorts are needed to validate these findings and refine surgical techniques.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"696"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907131","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":"Preoperative D-dimer level predicts adverse events after coronary endarterectomy combined with coronary artery bypass grafting: a retrospective cohort study.","authors":"Lianxin Chen, Xieraili Tiemuerniyazi, Ziang Yang, Liaoming He, Yifeng Nan, Yangwu Song, Wei Zhao, Wei Feng","doi":"10.1186/s13019-024-03272-y","DOIUrl":"https://doi.org/10.1186/s13019-024-03272-y","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the role of D-dimer (DD) on the prognosis of patients undergoing coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>A total of 371 patients undergoing CE with CABG between January 2018 and July 2022 were retrospectively enrolled. The primary endpoint was the perioperative major adverse cardiovascular and cerebrovascular events (MACCE). Univariate logistic regression was performed to detect the relationship between preoperative DD level and the occurrence of perioperative MACCE. Receiver operating characteristics method was applied to determine the optimal cut-off threshold, while the multivariable logistic regression analysis was used to adjust the potential confounders.</p><p><strong>Results: </strong>Univariate logistic regression revealed that preoperative DD level was associated with increased risk of perioperative MACCE. The optimal cut-off for DD was 0.235 µg/ml. More patients in the high DD group suffered from perioperative MACCE than the low DD group (13.2% vs. 3.9%, P = 0.004), even after multiple adjustment (odds ratio [OR]: 2.93, 95% confidence interval [CI]: 1.07-8.04, P = 0.036) in the multivariable logistic analysis. The occurrence of perioperative myocardial infarction was also much higher in high DD group (3.1% vs. 11.2%, P = 0.013).</p><p><strong>Conclusions: </strong>In conclusion, high preoperative DD levels might predict an increased risk of perioperative adverse events after CE with CABG.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"697"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907196","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":"Bronchial artery pseudoaneurysm presenting with hemoptysis and hemothorax after pulmonary lobectomy: a case report and literature review.","authors":"Wei-Hao Zhang, Cheng-Yan Jin, Xiao Qi, Guang-Xin Zhang","doi":"10.1186/s13019-024-03328-z","DOIUrl":"https://doi.org/10.1186/s13019-024-03328-z","url":null,"abstract":"<p><strong>Background: </strong>Bronchial artery pseudoaneurysm is a rare vascular disorder, and cases of bronchial pseudoaneurysms reported after lung surgery are even rarer. The number of reported cases is very limited due to the unclear pathogenesis, lack of diagnostic criteria and treatment guidelines, and nonspecific clinical manifestations.</p><p><strong>Case presentation: </strong>The paper reports a case of a patient with primary lung adenocarcinoma who developed hemoptysis, chest and back pain, and right hemothorax after lobectomy. Due to the lack of experience in treatment, we suspected that the above symptoms were caused by postoperative broncho-vascular fistula. The second thoracotomy and bronchoscopy examination did not reveal any obvious hemorrhage or fistula, and a subsequent bronchial arteriography confirmed the presence of a pseudoaneurysm in the right main bronchial artery. Later, the patient underwent transcatheter bronchial artery embolization and was followed up for half of a year after the operation without experiencing any of the previously mentioned symptoms.</p><p><strong>Conclusions: </strong>The case reports the successful cure of bronchial artery pseudoaneurysm after pulmonary lobectomy through bronchial artery embolization.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"693"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907134","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":"Epithelioid hemangioendothelioma prognosis and outcome: report of two challenging cases.","authors":"Parviz Mardani, Zahra Hashempour, Reza Shahriarirad, Armin Amirian","doi":"10.1186/s13019-024-03338-x","DOIUrl":"https://doi.org/10.1186/s13019-024-03338-x","url":null,"abstract":"<p><strong>Background: </strong>Epithelioid hemangioendothelioma (EHE) is an uncommon vascular malignancy characterized by an unpredictable clinical course and a high potential for recurrence and metastasis. The lack of standard treatment guidelines, coupled with the tumor's inconsistent response to available treatments, complicates the management of EHE and leads to widely varying patient prognoses.</p><p><strong>Case presentation: </strong>We report two cases of EHE with distinct presentations reflecting the site of involvement. The first case involved a patient with pulmonary EHE who initially benefited from complete surgical resection of the tumor after chemotherapy. However, the patient experienced two episodes of metastatic recurrence, resistant to further surgical and chemotherapeutic interventions, ultimately leading to the patient's death forty-two months after the diagnosis. The second case presented with a mediastinal EHE involving the para-esophageal area. Partial tumor resection was achieved but postoperative imaging revealed extensive metastasis and pleural effusion. Despite additional treatments, the disease progressed rapidly, and the patient passed away fourteen months following the initial diagnosis.</p><p><strong>Conclusions: </strong>The optimal therapeutic approach for EHE remains controversial due to its unpredictable treatment response, particularly in recurrent or metastatic cases. Therapeutic investigations are needed to establish evidence-based guidelines that can address treatment challenges and ensure the best possible outcome for each patient.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"694"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907148","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":"Determining influences of intraoperative s-ketamine on postoperative delirium and cognitive function: methodology is important.","authors":"Dan-Feng Wang, Fei Gao, Fu-Shan Xue","doi":"10.1186/s13019-024-03242-4","DOIUrl":"https://doi.org/10.1186/s13019-024-03242-4","url":null,"abstract":"<p><p>The letter to the editor was written in response to the recent article by Wang et al. \"The influence of low-dose s-ketamine on postoperative delirium and cognitive function in older adults undergoing thoracic surgery\", which is published in Journal of Cardiothoracic Surgery. 2024; 19(1):324. This article concludes that intravenous low-dose S-ketamine during thoracic surgery in older patients significantly reduces the incidences of postoperative delirium and cognitive dysfunction, indicating a potential neuroprotective effect of intraoperative low-dose S-ketamine. In view to the retrospective nature of this study and their inconsistent findings with the results of a recent randomized controlled trial performed in patients undergoing non-cardiac thoracic surgery, we believe that several methodological issues and potential confounders in this study deserve further clarification and discussion before accepting their conclusions. Our main concerns include lacking the times and number of delirium monitoring per postoperative day, alone use of the Confusion Assessment Method form for delirium screening, not providing the factors related to the occurrence of postoperative delirium in the ICU stay, and application of a non-standard definition for postoperative cognitive impairment. We believe that clarification of these issues is useful for improving the transparency of their methodology and facilitating the interpretation of their results.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"698"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907135","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":"Windsock mitral valve after prior aortic valve endocarditis.","authors":"Augustine W Kang, Hanjay Wang, Diane M Libert, Gerald J Berry, Jack H Boyd","doi":"10.1186/s13019-024-03302-9","DOIUrl":"https://doi.org/10.1186/s13019-024-03302-9","url":null,"abstract":"<p><strong>Background: </strong>Windsock deformities, though rare, represent a severe form of valvular aneurysm distinguished by localized balloon-like protrusions of the leaflet body. Here, we present a compelling case of windsock mitral valve (MV) formation subsequent to incompletely managed aortic valve (AV) endocarditis. The case is illustrated through radiographic, intraoperative, and histopathologic images.</p><p><strong>Case presentation: </strong>We present the case of a 44 year old male patient who presented with symptoms suggestive of infective endocarditis. Despite initiation of appropriate antimicrobial therapy and surgical intervention for AV involvement, the patient developed progressive valvular dysfunction. Subsequent imaging studies revealed the emergence of windsock deformity in the mitral valve apparatus. Intraoperative assessment confirmed the presence of this rare valvular anomaly, which was further corroborated by histopathologic examination.</p><p><strong>Conclusions: </strong>We provide, for the first time in the literature, a clear intraoperative view and example of windsock mitral valve (MV) developing after incompletely treated aortic valve (AV) endocarditis.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"700"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907204","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":"Short term outcomes of the first pediatric cardiac surgery program in Rwanda.","authors":"Yayehyirad Ejigu, Vongai C Mlambo, Kara L Neil, Habtamu Sime, Rex Wong, Michel R Gatera, Gaston Nyirigira, Yilkal C Sewnet, Yihan Lin, Bertrand Byishimo, Gloria Rukomeza, Yves Mutabandama, Emmanuel Rusingiza","doi":"10.1186/s13019-024-03295-5","DOIUrl":"https://doi.org/10.1186/s13019-024-03295-5","url":null,"abstract":"<p><strong>Background: </strong>While the number of cardiac surgery programs in sub-Saharan Africa are increasing, it is still insufficient. With only 0.08 pediatric cardiac surgeons per million people, few cardiac centers routinely perform pediatric cardiac surgery. This has led to reliance on humanitarian medical missions or referral abroad for most African nations. This study outlines the outcomes of Rwanda's first sustainable pediatric cardiac surgery program.</p><p><strong>Methods: </strong>A retrospective chart review was performed for all pediatric patients who received cardiac surgery between October 2022 and April 2024. Patient demographics, procedures, operative times, length of stay, complications, and 30-day mortality were synthesized. Perioperative factors associated with complications and prolonged intensive care unit length of stay were evaluated using logistic and linear regression analysis, respectively.</p><p><strong>Results: </strong>207 patients received 240 cardiac procedures. At time of surgery, 45% of patients were 1-5 years old (n = 95). The top five procedures were repair of Ventricular Septal Defect, Patent Ductus Arteriosus, Atrial Septal Defect, Tetralogy of Fallot and Coarctation of the Aorta. 30-day mortality was 1.9% (n = 4) and 6.3% (n = 13) experienced a major complication. Additionally, 24% (n = 50) experienced minor complications, most commonly, pneumonia. The linear combination of surgery duration, cross clamp and bypass time was significantly associated with having complications (aOR = 0.67, p = 0.01). Younger age, longer operative times, number of inotropes and the presence of complications were associated with an increased intensive care unit stay.</p><p><strong>Conclusions: </strong>The 30-day surgical outcomes are favorable compared to programs with a similar case mix, showing that pediatric cardiac surgery can be safely performed in developing countries with local cardiac teams. Prolonged bypass and cross clamp times were associated with higher complication rates and increased inotrope use was associated with longer intensive care unit stay.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"699"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907199","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":"Successful treatment of cardiac dysfunction due to left main trunk obstruction and severe acute aortic regurgitation secondary to acute type A aortic dissection using Impella: a case report.","authors":"Ai Sakai, Kenji Iino, Hideyasu Ueda, Yoshitaka Yamamoto, Hirofumi Takemura","doi":"10.1186/s13019-024-03228-2","DOIUrl":"https://doi.org/10.1186/s13019-024-03228-2","url":null,"abstract":"<p><strong>Background: </strong>Acute type A aortic dissection (A-AAD) with severe acute aortic regurgitation (AR) and coronary involvement is a potentially fatal condition that causes left ventricular volume overload and catastrophic acute myocardial infarction. We present the successful management of a patient using Impella 5.5 following cardiopulmonary arrest caused by A-AAD with severe acute AR and left main trunk (LMT) obstruction.</p><p><strong>Case presentation: </strong>A 50-year-old man presented with acute anterior chest pain. The patient subsequently experienced a cardiac arrest, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was administered accordingly. Contrast-enhanced computed tomography indicated type A aortic dissection extending from the sinotubular junction to the left common iliac artery. Transthoracic echocardiography revealed inversion of the aortic flap into the left ventricular outflow tract, resulting in acute severe AR and LMT obstruction. Based on these findings, the patient was diagnosed with A-AAD accompanied by severe acute AR and LMT obstruction. Emergent total arch replacement with a frozen elephant trunk (FET) was performed. However, the patient could not be weaned from cardiopulmonary bypass owing to cardiogenic shock, necessitating the introduction of VA-ECMO. Pulmonary capillary wedge pressure remained high at 22 mmHg. Subsequently, Impella 5.5 was introduced via a branch of the vascular graft to address the extensive myocardial damage due to preoperative LMT obstruction, acute AR-induced left ventricular volume overload, and increased afterload from VA-ECMO. The patient's cardiac function gradually improved. VA-ECMO and Impella 5.5 were weaned on postoperative day 8 and 20, respectively. However, three months postoperatively, a MitraClip was used to progress secondary mitral regurgitation associated with left ventricular remodeling after myocardial infarction. The patient gradually recovered from the neurological deficit and was transferred for physical rehabilitation five months postoperatively.</p><p><strong>Conclusions: </strong>The patient exhibited severe cardiac dysfunction due to extensive myocardial infarction and acute AR from A-AAD. Retrograde perfusion via VA-ECMO was required for systemic organ perfusion but was expected to hinder cardiac recovery. This report demonstrates that Impella effectively aids the restoration of cardiac function in such desperate conditions.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"695"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907201","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":"Prognostic value of albumin-bilirubin grade in lung cancer: a meta-analysis.","authors":"Jiao Jiang, Hongjuan Li, Lin Chen, Xiaoming Qiu","doi":"10.1186/s13019-024-03311-8","DOIUrl":"https://doi.org/10.1186/s13019-024-03311-8","url":null,"abstract":"<p><strong>Purpose: </strong>To clarify the prognostic role of pretreatment albumin-bilirubin (ALBI) grade in lung cancer patients.</p><p><strong>Methods: </strong>The PubMed, EMBASE, Web of Science and CNKI databases were searched up to April 20, 2024. Primary outcomes included the overall survival (OS), progression-free survival (PFS) and cancer-specific survival (CSS). Hazard ratios (HRs) with 95% confidence intervals (CIs) were combined and subgroup analysis based on the type of lung cancer [non-small cell lung cancer (NSCLC) vs. small cell lung cancer (SCLC)] and treatment [surgery vs. immune checkpoint inhibitors (ICIs) vs. chemotherapy] was conducted.</p><p><strong>Results: </strong>Eight studies with 2,057 patients were included. Pooled results indicated that elevated pretreatment ALBI grade was significantly related to poor OS (HR = 2.50, 95% CI: 2.03-3.09, P<0.001), PFS (HR = 1.91, 95% CI: 1.56-2.33, P<0.001) and CSS (HR = 1.90, 95% CI: 1.11-3.11, P = 0.018). Subgroup analysis for OS based on the pathological type and primary treatment manifested similar results.</p><p><strong>Conclusion: </strong>Pretreatment ALBI grade is associated with prognosis in lung cancer and patients with elevated ALBI grade are more likely to experience worse survival.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"19 1","pages":"685"},"PeriodicalIF":1.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903226","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}