Journal of critical care最新文献

{"title":"Elevated glycocalyx shedding components as the early predictors of unfavorable outcomes in patients after cardiac arrest: A single-center observational study","authors":"Dan He ,&nbsp;Shuqun Hu ,&nbsp;Ningjun Zhao ,&nbsp;Xianliang Yan ,&nbsp;Chenglei Su","doi":"10.1016/j.jcrc.2025.155026","DOIUrl":"10.1016/j.jcrc.2025.155026","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association of serum glycocalyx shedding components (Heparan sulfate, HS; Hyaluronic acid, HA; Syndecan-1, Sdc-1) with outcomes after CA.</div></div><div><h3>Methods</h3><div>Patients who were comatose for &gt;24 h after CA in the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from 9/2021 to 04/2023 were enrolled. Serum samples were collected 24 h after CA to measure the concentrations of glycocalyx shedding components. The outcomes were the 30-day Cerebral Performance Categories (CPC) scale and 30-day mortality. The association of glycocalyx shedding with outcomes was examined by regression analysis. The area under the curve was used to evaluate the value of glycocalyx shedding for predicting outcomes. Sensitivity analysis and subgroup analysis were conducted.</div></div><div><h3>Results</h3><div>111 patients were enrolled. The unfavorable group (CPC 3–5, <em>n</em> = 69) had significantly higher serum concentrations of HA and Sdc-1 than the favorable group (CPC 1–2, <em>n</em> = 42) (HA:149.7 ng/ml vs. 824.8 ng/ml, <em>P</em> &lt; 0.001; Sdc-1: 303.8 ng/L vs. 447.0 ng/L, <em>P</em> = 0.026)but not HS. Elevated serum HA concentrations was an independent risk factor for unfavorable 30-day neurological function (OR = 2.485, 95 % CI = 1.656–3.729). For the 30-day mortality, the nonsurvivor group (<em>n</em> = 53) had significantly higher serum concentrations of HA, HS and Sdc-1 (HA: 177.3 ng/ml vs. 1106.7 ng/ml, <em>P</em> <em>&lt;</em> 0.001; HS: 2403.7 ng/ml vs. 3383.3 ng/ml <em>P</em> = 0.030; Sdc-1: 352.1 ng/L vs. 487.8 ng/L, <em>P</em> = 0.005) than the survivor group (<em>n</em> = 58). However, only elevated serum HA and Sdc-1 concentrations are independent risk factors for 30-day mortality (HA: HR = 2.321, 95 % CI = 1.776–3.035; Sdc-1: HR = 1.702, 95 % CI = 1.038–2.792).</div></div><div><h3>Conclusions</h3><div>Elevated serum HA at 24 h after CA is an independent risk factor for 30-day unfavorable neurological function or mortality and elevated serum Sdc-1 concentrations is an independent risk factor for 30-day mortality. Our results suggested the potential value of serum glycocalyx shedding components as predictors for the outcomes in post-CA patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155026"},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038955","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":"Predicting a strongly positive fluid balance in critically ill patients with acute kidney injury: A multicentre, international study","authors":"Kyle C. White ,&nbsp;Rinaldo Bellomo ,&nbsp;Kevin B. Laupland ,&nbsp;Michelle L. Gatton ,&nbsp;Marlies Ostermann ,&nbsp;Philipa McIlroy ,&nbsp;Stephen Luke ,&nbsp;Peter Garrett ,&nbsp;Alexis Tabah ,&nbsp;Stephen Whebell ,&nbsp;Prashanti Marella ,&nbsp;James McCullough ,&nbsp;Kiran Shekar ,&nbsp;Antony G. Attokaran ,&nbsp;Aashish Kumar ,&nbsp;Jason Meyer ,&nbsp;Barnaby Sanderson ,&nbsp;Ary Serpa-Neto","doi":"10.1016/j.jcrc.2025.155016","DOIUrl":"10.1016/j.jcrc.2025.155016","url":null,"abstract":"<div><h3>Background</h3><div>In critically ill patients with acute kidney injury (AKI), a fluid balance (FB) &gt; 2 L at 72 h after AKI diagnosis is associated with adverse outcomes. Identification of patients at high-risk for such fluid accumulation may help prevent it.</div></div><div><h3>Methods</h3><div>We used Australian electronic medical record (EMR)-based clinical data to develop the “AKI-FB risk score”, validated it in a British cohort and used it to predict a positive FB &gt;2 L at 72 h after AKI diagnosis.</div></div><div><h3>Results</h3><div>We developed the AKI-FB score in 32,030 patients with a median age of 63 years and a median APACHE 2 score of 16. We validated it in 4465 patients, with significant differences in admission diagnoses and interventions. The key score variables were admission after trauma, sepsis or septic shock, and, on the day of AKI diagnosis, highest creatinine, daily cumulative FB, mechanical ventilation, noradrenaline use, noradrenaline equivalent dose &gt;0.07 μg/kg/min, lactate ≥2 mmol/L, transfusion, and nutritional support. A score threshold of 32 had a sensitivity of 75 % and a specificity of 72 % for predicting a &gt; 2 L positive FB with an AUC-ROC of 0.805; 95 % CI 0.799 to 0.810. External validation demonstrated an AUC of 0.761 (95 % CI 0.746 to 0.775).</div></div><div><h3>Conclusion</h3><div>We developed and validated the “AKI-FB risk score” to predict patients who developed a positive FB &gt;2 L within 72 h of AKI diagnosis. This prediction score was robust and facilitated the identification of high-risk AKI patients who could be the tarted for preventive measures and be included in future clinical trials of FB management.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155016"},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038956","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":"Application of radiomics in acute and severe non-neoplastic diseases: A literature review","authors":"Yu Fang ,&nbsp;Qiannan Zhang ,&nbsp;Jingjun Yan ,&nbsp;Shanshan Yu","doi":"10.1016/j.jcrc.2025.155027","DOIUrl":"10.1016/j.jcrc.2025.155027","url":null,"abstract":"<div><div>Radiomics involves the integration of computer technology, big data analysis, and clinical medicine. Currently, there have been initial advancements in the fields of acute cerebrovascular disease and cardiovascular disease. The objective of radiomics is to extract quantitative features from medical images for analysis to predict the risk or treatment outcome, help in differential diagnosis, and guide clinical decisions and management. Radiomics applied research has reached a more advanced stage yet encounters several obstacles, including the need for standardization of radiomics features and alignment with treatment requirements for acute and severe illnesses. Future research should aim to seamlessly incorporate radiomics with various disciplines, leverage big data and artificial intelligence advancements, cater to the requirements of acute and critical medicine, and enhance the effectiveness of technological innovation and application in diagnosing and treating acute and critical illnesses.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155027"},"PeriodicalIF":3.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028808","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":"Cardiogenic shock in patients with active onco-hematological malignancies: A multicenter retrospective study","authors":"Mickael Lescroart ,&nbsp;Hélène Kemp ,&nbsp;Olivier Imauven ,&nbsp;Jean Herlé Raphalen ,&nbsp;François Bagate ,&nbsp;Julien Schmidt ,&nbsp;Nahema Issa ,&nbsp;Maxens Decavele ,&nbsp;Anne-Sophie Moreau ,&nbsp;Fabienne Tamion ,&nbsp;Bruno Mourvillier ,&nbsp;Laure Calvet ,&nbsp;Emmanuel Canet ,&nbsp;Christine Lebert ,&nbsp;Stephanie Pons ,&nbsp;Guillaume Lacave ,&nbsp;Florent Wallet ,&nbsp;Hadrien Winiszewski ,&nbsp;Hamid Merdji ,&nbsp;Marc Pineton De Chambrun ,&nbsp;Lara Zafrani","doi":"10.1016/j.jcrc.2025.155028","DOIUrl":"10.1016/j.jcrc.2025.155028","url":null,"abstract":"<div><h3>Purpose</h3><div>Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs).</div></div><div><h3>Methods</h3><div>This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010−2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients.</div></div><div><h3>Results</h3><div>The 30-day survival rate was 44.8 %. Multivariate analysis identified previous cardiomyopathy (OR = 1.61), acute kidney injury (OR = 1.62), lactate levels (OR = 1.08 per 1 mmol/L), pulmonary embolism (OR = 3.04), invasive mechanical ventilation (OR = 3.48), and epinephrine use (OR = 2.09) as factors associated with 30-day mortality. Among ICU survivors, 54 % were alive at 1 year with a median left ventricular ejection fraction of 52 %. OH malignancy was significantly associated with 30-day mortality (HR 2.54).</div></div><div><h3>Conclusion</h3><div>The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155028"},"PeriodicalIF":3.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028810","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":"Water treatment-free prolonged intermittent kidney replacement therapy: A new approach for kidney replacement therapy in the ICU setting. A retrospective study.","authors":"Noémie Zucman ,&nbsp;Fabrice Uhel ,&nbsp;Charles Verney ,&nbsp;Jean-Damien Ricard ,&nbsp;Didier Dreyfuss ,&nbsp;Damien Roux","doi":"10.1016/j.jcrc.2025.155014","DOIUrl":"10.1016/j.jcrc.2025.155014","url":null,"abstract":"<div><div>The optimal modalities of kidney replacement therapy (KRT) in the ICU remain debated. Intermittent haemodialysis (IHD) and continuous veno-venous haemofiltration (CVVH) are the two main methods. Intermittent haemodialysis requires a water treatment system, which may not be available in all jurisdictions. We report the experience of an innovative strategy of intermittent KRT without water treatment system.</div><div>Based on the manufacturer's recommendations, the dialysate flow during “CVVHDF post” (post-dilution continuous veno-venous haemodiafiltration) mode was increased by connecting the substitution pump in parallel with the dialysate pump using a Y-connector. This doubled the flow rate of dialysate, allowing for 9000 mL/h during intermittent KRT sessions at a blood flow rate of 250 mL/min. We called this technique “water treatment-free prolonged intermittent kidney replacement therapy” (WTF-PIKRT).</div><div>We report our experience in 18 patients who underwent 88 WTF-PIKRT sessions (median duration 5 h (IQR [4, 6])) between August 2019 and May 2020. The median urea reduction ratio was 38 % (IQR [29,49]). Hypotension occurred during 21.6 % of sessions. Hypokalemia or hypophosphatemia occurred in less than 5 % of sessions.</div><div>WTF-PIKRT represents an attractive alternative to conventional IHD when a water treatment system is not available. Despite its lower efficacy compared with IHD, it may have significant organizational and economic impact.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155014"},"PeriodicalIF":3.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970921","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":"Bio-inspired gloden jackal optimization of XGBoost model enhances 30-day sepsis mortality predictions","authors":"Hemant Kumar ,&nbsp;Rashi Agarwal ,&nbsp;Amit Yadav","doi":"10.1016/j.jcrc.2024.155013","DOIUrl":"10.1016/j.jcrc.2024.155013","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155013"},"PeriodicalIF":3.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949651","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":"Systematic review and meta-analysis of the treatment of hypernatremia in adult hospitalized patients: impact on mortality, morbidity, and treatment-related side effects","authors":"Nuanprae Kitisin ,&nbsp;Nattaya Raykateeraroj ,&nbsp;Yukiko Hikasa ,&nbsp;Larissa Bianchini ,&nbsp;Nuttapol Pattamin ,&nbsp;Anis Chaba ,&nbsp;Akinori Maeda ,&nbsp;Sofia Spano ,&nbsp;Glenn Eastwood ,&nbsp;Kyle White ,&nbsp;Rinaldo Bellomo","doi":"10.1016/j.jcrc.2024.155012","DOIUrl":"10.1016/j.jcrc.2024.155012","url":null,"abstract":"<div><h3>Background</h3><div>Hypernatremia is relatively common in acutely ill patients and associated with mortality. Guidelines recommend a slow rate of correction (≤ 0.5 mmol/L per hour). However, a faster correction rate may be safe and improve outcomes.</div></div><div><h3>Objectives</h3><div>To evaluate the impact of sodium correction rates on mortality and hospital length of stay and to assess types of hypernatremia treatment and treatment side effects.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis according to PRISMA guidelines, searching Ovid MEDLINE, Embase, and CENTRAL databases from inception to August 2024. Studies reporting sodium correction rates and clinical outcomes in hospitalized adults were included. A random-effects meta-analysis assessed mortality and hospital length of stay, with subgroup analyses exploring correction timing and severity. Treatment method and side effects were analyzed qualitatively.</div></div><div><h3>Results</h3><div>We reviewed 4445 articles and included 12 studies. Faster correction rates (&gt; 0.5 mmol/L/h) overall showed no significant change in mortality and a high level of heterogeneity (OR 0.68, 95 % CI: 0.38–1.24, I² = 95 %). However, subgroup analyses found significantly lower mortality with faster correction of hypernatremia at the time of hospital admission (OR 0.48, 95 % CI: 0.35–0.68, I² = 2 %), with fast correction within the first 24 h of diagnosis (OR 0.48, 95 % CI: 0.31–0.73, I² = 65 %), and for severe hypernatremia (OR 0.55, 95 % CI: 0.33–0.92, I² = 79 %). There was no significant different in hospital length of stay by correction rate. No major neurological complications were reported when the correction rate was &lt; 1 mmol/L/h.</div></div><div><h3>Conclusion</h3><div>Faster sodium correction appears safe and may benefit patients with severe admission-related hypernatremia, particularly within the first 24 h. Further studies are needed to refine correction protocols.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155012"},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092707","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":"Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications","authors":"Kamel A. Gharaibeh ,&nbsp;Mohammad O. Abdelhafez ,&nbsp;Kolman E.B. Guedze ,&nbsp;Hussain Siddiqi ,&nbsp;Abdurrahman M. Hamadah ,&nbsp;Avelino C. Verceles","doi":"10.1016/j.jcrc.2024.155011","DOIUrl":"10.1016/j.jcrc.2024.155011","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluated the impact of choosing the right versus left internal jugular vein (IJV) for initial central venous catheter (CVC) placement on hemodialysis catheter-related outcomes in critically ill patients.</div></div><div><h3>Materials and methods</h3><div>Medical records from the University of Maryland Medical Center were reviewed for adult critical care patients who received an IJV CVC between January 1, 2019, and December 31, 2022, and later required an additional temporary hemodialysis catheter.</div></div><div><h3>Results</h3><div>The study included 214 patients, with 100 (46.7 %) receiving the primary CVC in the right IJV and 114 (53.3 %) in the left IJV. The right IJV group had higher hemodialysis catheter re-insertion rates (40 % vs. 2.6 % in the left IJV group, <em>P</em> &lt; 0.001) related to using a different site other than the right IJV for the initial hemodialysis catheter (85 % for the right IJV group vs. 1.75 % for the left IJV group). Hemodialysis catheters were exchanged over a guidewire in 23 % of the right IJV group vs. 0.9 % in the left IJV group (<em>P</em> &lt; 0.001). Additionally, 38 % of patients in the right IJV group required three venous access interventions, with 14 % needing four or more, versus only 2.6 % requiring three interventions in the left IJV group.</div></div><div><h3>Conclusions</h3><div>Initiating CVC placement in the right IJV in critically ill patients is associated with a higher risk of hemodialysis catheter re-catheterization related to the use of veins other than the right IJV for hemodialysis catheter placement and an increased need for venous access interventions compared to placement in the left IJV.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"87 ","pages":"Article 155011"},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927251","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":"Can ChatGPT-4 perform as a competent physician based on the Chinese critical care examination?","authors":"Xueqi Wang,&nbsp;Jin Tang,&nbsp;Yajing Feng,&nbsp;Cijun Tang,&nbsp;Xuebin Wang","doi":"10.1016/j.jcrc.2024.155010","DOIUrl":"10.1016/j.jcrc.2024.155010","url":null,"abstract":"<div><h3>Background</h3><div>The use of ChatGPT in medical applications is of increasing interest. However, its efficacy in critical care medicine remains uncertain. This study aims to assess ChatGPT-4's performance in critical care examination, providing insights into its potential as a tool for clinical decision-making.</div></div><div><h3>Methods</h3><div>A dataset from the Chinese Health Professional Technical Qualification Examination for Critical Care Medicine, covering four components—fundamental knowledge, specialized knowledge, professional practical skills, and related medical knowledge—was utilized. ChatGPT-4 answered 600 questions, which were evaluated by critical care experts using a standardized rubric.</div></div><div><h3>Results</h3><div>ChatGPT-4 achieved a 73.5 % success rate, surpassing the 60 % passing threshold in four components, with the highest accuracy in fundamental knowledge (81.94 %). ChatGPT-4 performed significantly better on single-choice questions than on multiple-choice questions (76.72 % vs. 51.32 %, <em>p</em> &lt; 0.001), while no significant difference was observed between case-based and non-case-based questions.</div></div><div><h3>Conclusion</h3><div>ChatGPT demonstrated notable strengths in critical care examination, highlighting its potential for supporting clinical decision-making, information retrieval, and medical education. However, caution is required regarding its potential to generate inaccurate responses. Its application in critical care must therefore be carefully supervised by medical professionals to ensure both the accuracy of the information and patient safety.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155010"},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098889","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":"Letter to the editor: “Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study”","authors":"Yudai Iwasaki,&nbsp;Takayuki Ogura","doi":"10.1016/j.jcrc.2024.155008","DOIUrl":"10.1016/j.jcrc.2024.155008","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"86 ","pages":"Article 155008"},"PeriodicalIF":3.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894949","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}