Journal of critical care最新文献

{"title":"Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19","authors":"Laurence W. Busse MD, MBA, FCCM ,&nbsp;J. Pedro Teixeira MD ,&nbsp;Christopher L. Schaich PhD ,&nbsp;Caitlin C. ten Lohuis ACNP-BC ,&nbsp;Nathan D. Nielsen MD, MSc ,&nbsp;Jeffrey M. Sturek MD, PhD ,&nbsp;Lisa H. Merck MD, MPH ,&nbsp;Wesley H. Self MD, MPH ,&nbsp;Michael A. Puskarich MD, MSCR ,&nbsp;Akram Khan MBBS ,&nbsp;Matthew W. Semler MD, MSc ,&nbsp;Ari Moskowitz MD, MPH ,&nbsp;David N. Hager MD, PhD ,&nbsp;Abhijit Duggal MD, MPH, MSc ,&nbsp;Todd W. Rice MD, MSc ,&nbsp;Adit A. Ginde MD, MPH ,&nbsp;Brian R. Tiffany MD, PhD ,&nbsp;Nicole M. Iovine MD ,&nbsp;Peter Chen MD ,&nbsp;Basmah Safdar MD, MSc ,&nbsp;Sean P. Collins MD, MSc","doi":"10.1016/j.jcrc.2024.154950","DOIUrl":"10.1016/j.jcrc.2024.154950","url":null,"abstract":"<div><h3>Background</h3><div>Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown.</div></div><div><h3>Methods</h3><div>Using plasma samples collected from participants enrolled in the fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines Host Tissue platform trial, we measured DPP3 and renin in 184 subjects hospitalized with acute hypoxemia from COVID-19 without baseline vasopressor requirement. We calculated the odds ratio of development of shock (defined as the initiation of vasopressor therapy) by Day 28 based on Day 0 DPP3 and renin levels.</div></div><div><h3>Results</h3><div>Subjects with DPP3 above the median had a significantly higher incidence of vasopressor initiation within 28 days (28.4 % vs. 16.7 %, <em>p</em> = 0.031) and higher 28-day mortality (25.0 % vs. 6.7 %, <em>p</em> &lt; 0.001). After adjusting for covariables, DPP3 above the median was associated with shorter time to vasopressor initiation, greater 28-day mortality, fewer vasopressor-free days, and greater odds of a hypotensive event over 7 days. Significant associations were not observed for renin.</div></div><div><h3>Conclusions</h3><div>In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154950"},"PeriodicalIF":3.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638899","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":"Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?","authors":"Benjamin Assouline ,&nbsp;Gianlucca Belli ,&nbsp;Karim Dorgham ,&nbsp;Quentin Moyon ,&nbsp;Alexandre Coppens ,&nbsp;Marc Pineton de Chambrun ,&nbsp;Juliette Chommeloux ,&nbsp;David Levy ,&nbsp;Ouriel Saura ,&nbsp;Guillaume Hekimian ,&nbsp;Matthieu Schmidt ,&nbsp;Alain Combes ,&nbsp;Charles-Edouard Luyt","doi":"10.1016/j.jcrc.2024.154945","DOIUrl":"10.1016/j.jcrc.2024.154945","url":null,"abstract":"<div><h3>Purpose</h3><div>Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.</div></div><div><h3>Methods</h3><div>Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.</div></div><div><h3>Results</h3><div>Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.</div></div><div><h3>Conclusion</h3><div>Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154945"},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621502","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":"Clinical impact of hypermagnesemia in acute kidney injury patients undergoing continuous kidney replacement therapy: A propensity score analysis utilizing real-world data","authors":"Ming-Jen Chan ,&nbsp;Jia-Jin Chen ,&nbsp;Cheng-Chia Lee ,&nbsp;Pei-Chun Fan ,&nbsp;Yi-Jiun Su ,&nbsp;Ya-Lien Cheng ,&nbsp;Chao-Yu Chen ,&nbsp;VinCent Wu ,&nbsp;Yung-Chang Chen ,&nbsp;Chih-Hsiang Chang","doi":"10.1016/j.jcrc.2024.154947","DOIUrl":"10.1016/j.jcrc.2024.154947","url":null,"abstract":"<div><h3>Purpose</h3><div>While hypomagnesemia is known to be a risk factor for acute kidney injury (AKI), the impact of hypermagnesemia on prognosis in AKI patients undergoing continuous kidney replacement therapy (CKRT) remains unclear. This study investigates the relationship between hypermagnesemia and clinical outcomes in this patient population.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using data from a multicenter medical repository spanning from 2001 to 2019, involving patients who underwent CKRT. Patients were categorized into normomagnesemia (&lt;2 mEq/L) and hypermagnesemia groups based (≥2 mEq/L) on their levels at CKRT initiation.</div></div><div><h3>Results</h3><div>Among the 2625 patients, 1194 (45.5 %) had elevated serum magnesium levels. The hypermagnesemia group exhibited a similar rate of non-recovery of renal function at 90-days compared to the normomagnesemia group (63.1 % vs. 62.8 %, odds ratio [OR] = 1.01, 95 % confidence interval [CI] 0.90–1.14). Furthermore, the high magnesium group demonstrated higher one-year all-cause mortality (hazard ratio [HR] 1.14, 95 % CI 1.07–1.21) and an elevated risk of one-year arrhythmia (HR 4.77, 95 % CI 1.59–14.29). There was no difference of incidence of seizure between hypermagnesemia and normomagnesemia group.</div></div><div><h3>Conclusions</h3><div>Our study suggests that hypermagnesemia in AKI patients undergoing CKRT is not associated with improved renal recovery but is linked to worse clinical outcomes, including all-cause mortality and arrhythmia. Close monitoring of serum magnesium levels is recommended in this population for optimizing clinical outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154947"},"PeriodicalIF":3.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621497","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: “What every intensivist should know about: Trust in the icu”","authors":"Hannah M. Vincent BSN, RN ,&nbsp;Jan Bakker","doi":"10.1016/j.jcrc.2024.154949","DOIUrl":"10.1016/j.jcrc.2024.154949","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154949"},"PeriodicalIF":3.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621566","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":"Decreased renal cortical perfusion post-EGDT is associated with MAKE-30 in sepsis","authors":"Qiqi Li ,&nbsp;Rong Li ,&nbsp;Can Wang ,&nbsp;Qian Zhang ,&nbsp;Qian Zhang ,&nbsp;Yan Huo ,&nbsp;Yangong Chao ,&nbsp;Xiaoting Wang ,&nbsp;Zhenjie Hu ,&nbsp;Lixia Liu ,&nbsp;for the Chinese Critical UltraSound Study Group(CCUSG)","doi":"10.1016/j.jcrc.2024.154943","DOIUrl":"10.1016/j.jcrc.2024.154943","url":null,"abstract":"<div><h3>Objective</h3><div>This study explores alterations in renal cortical perfusion post-Early Goal-Directed Therapy (EGDT) in sepsis patients, to investigate its association with major adverse kidney events within 30 days (MAKE-30) and identify hemodynamic factors associated with renal cortical perfusion.</div></div><div><h3>Methods</h3><div>Sepsis patients admitted to the ICU from Jan 2022 to Jul 2023 were prospectively enrolled. Contrast-enhanced ultrasound (CEUS) assessed renal cortical perfusion post-EGDT. Hemodynamic parameters and renal resistive index (RRI) were collected. Patients were categorized into MAKE-30 and non-MAKE-30 groups. The study examined the association between renal cortical perfusion and MAKE-30, explored the hemodynamic factors related to renal cortical perfusion.</div></div><div><h3>Results</h3><div>Of 94 sepsis patients, 46 (48.9 %) experienced MAKE-30. Distinctions in pulmonary (<em>P</em> = 0.012) and abdominal infection sites (<em>P</em> = 0.001) and significant SOFA (<em>P</em> &lt; 0.001) and APACHE II scores (<em>P</em> = 0.003) differences were observed. No significant differences in baseline characteristics, vasopressor, or diuretic doses were noted (<em>P</em> &gt; 0.05). Hemodynamic parameters in MAKE-30 and non-MAKE-30 patients showed no significant differences. RRI was higher in MAKE-30 patients (0.71 vs 0.66 <em>P</em> = 0.005). Renal microcirculation parameters, including AUC (<em>p</em> = 0.035), rBV (<em>p</em> = 0.021), and PI (<em>p</em> = 0.003), were lower in MAKE-30. Reduced cortical renal perfusion was associated with an increased risk of MAKE-30. Renal cortical perfusion RT was identified as an independent factor associated with this risk (HR 2.278, 95 % CI (1.152–4.507), <em>P</em> = 0.018). RRI correlated with renal cortical perfusion AUC (<em>r</em> = −0.220 p 0.033).</div></div><div><h3>Conclusion</h3><div>Despite normal systemic hemodynamics post-sepsis EGDT, MAKE-30 patients show reduced renal cortical perfusion. CEUS-derived RT is an independent factor associated with this change. RRI correlates with renal cortical perfusion.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154943"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593767","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":"Optimizing fosfomycin dosing regimens in critically ill patients with and without continuous renal replacement therapy","authors":"Taniya Charoensareerat ,&nbsp;Phongphak Bunrit ,&nbsp;Sasina Phanpoka ,&nbsp;Thananya Netthanomsak ,&nbsp;Dhakrit Rungkitwattanakul ,&nbsp;Sutthiporn Pattharachayakul ,&nbsp;Nattachai Srisawat ,&nbsp;Weerachai Chaijamorn","doi":"10.1016/j.jcrc.2024.154946","DOIUrl":"10.1016/j.jcrc.2024.154946","url":null,"abstract":"<div><h3>Purpose</h3><div>To define the optimal fosfomycin dosing regimens for drug-resistant gram-negative bacteria in critically ill patients and those receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulations.</div></div><div><h3>Materials and methods</h3><div>A pharmacokinetic model for patients with and without CRRT was created to predict fosfomycin deposition in these patients. The pharmacodynamics (PD) targets were AUC/MIC ratio &gt; 21.5, 28.2, and 98.8 for drug-resistant <em>Klebsiella pneumoniae</em> (KP), <em>Pseudomonas aeruginosa</em> (PA) and <em>Escherichia coli</em> (EC) infections, respectively. The optimal regimen was defined when the probability of target attainment (PTA) was &gt;90 % of the virtual patients.</div></div><div><h3>Results</h3><div>The fosfomycin dosing regimens for KP infections with MIC 64 mg/L in critically ill patients and who received CRRT were 6 g every 8 h and 8 g every 12 h, respectively. For PA infections, the regimens of 6 g every 6 h and 7 g every 8 h achieved the target in critically ill patients and those undergoing CRRT. No regimen achieved the 90 % PTA against the EC infection with MIC &gt;32 mg/L.</div></div><div><h3>Conclusions</h3><div>Dosing regimens for bacteria with high MICs as 64 mg/L in these patients were 18–24 g/day. Dose adjustments were required in those undergoing CRRT. Clinical validation is strongly needed.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154946"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593768","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":"Long-term characteristics and outcomes of septic critically ill patients with and without COVID-19","authors":"Felix Niebhagen ,&nbsp;Lars Heubner ,&nbsp;Anna Kirsch ,&nbsp;Andreas Güldner ,&nbsp;Hanns-Christoph Held ,&nbsp;Ralph Schneider ,&nbsp;Ulf Bodechtel ,&nbsp;Jan Mehrholz ,&nbsp;Thea Koch ,&nbsp;Mario Menk ,&nbsp;Peter Spieth","doi":"10.1016/j.jcrc.2024.154942","DOIUrl":"10.1016/j.jcrc.2024.154942","url":null,"abstract":"<div><h3>Background</h3><div>In-hospital mortality of septic critically ill patients with COVID-19 is significantly higher than in those without COVID-19. The knowledge on long-term outcomes remains scarce. In this retrospective analysis, we compare clinical characteristics, long-term functional outcomes, and survival in septic critically ill patients with and without COVID-19.</div></div><div><h3>Methods</h3><div>Data of septic critically ill patients without COVID-19 were collected as part of the Comprehensive Sepsis Center Dresden-Kreischa registry from 2020 to 2023. The data of septic critically ill patients with COVID-19 were collected as part of the local ARDS/COVID-19 registry over the same period. Diagnosis of sepsis was based on the Sepsis-3 definition. Variables collected for analyses were obtained from electronic health records. Long-term follow-up was performed 6–12 months after sepsis diagnosis. Survival was depicted using Kaplan-Meier curves. Associations between long-term mortality and risk factors were modeled by Cox Regression.</div></div><div><h3>Results</h3><div>372 septic patients without COVID-19 and 301 with COVID-19 were enrolled. Septic patients with COVID-19 were significantly younger, had a significantly lower Charlson Comorbidity Index, and had a significantly higher SOFA score at ICU admission. Long-term follow-up showed a significantly higher mortality in septic patients with COVID-19 (73.4 % vs. 30.1 %; HR 3.4 (95 % CI 2.73–4.27; <em>p</em> &lt; 0.05)). COVID-19 infection was associated with significant increased mortality (adjusted HR 3.27; 95 % CI 2.48–4.33; <em>p</em> &lt; 0.05) and reduced health-related quality of life, measured by the EQ-5D-3 L Index, (0.56 (0.16–0.79) vs. 0.79 (0.69–0.99); p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>In our cohort of septic critically ill patients, health-related quality of life and long-term survival were considerably reduced in patients with concomitant COVID-19. Furthermore, COVID-19 could be identified as an independent risk factor for higher long-term mortality in these patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154942"},"PeriodicalIF":3.2,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561229","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: \"Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit\"","authors":"Rashid Nadeem ,&nbsp;Reham Helmy Amin Saad","doi":"10.1016/j.jcrc.2024.154940","DOIUrl":"10.1016/j.jcrc.2024.154940","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154940"},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552400","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":"Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D","authors":"Jae Ho Kim ,&nbsp;Joonhee Yoon ,&nbsp;Ji-Eun Kim ,&nbsp;Seongho Jo ,&nbsp;Yuri Lee ,&nbsp;Ji Won Kim ,&nbsp;Seun Deuk Hwang ,&nbsp;Seoung Woo Lee ,&nbsp;Joon Ho Song ,&nbsp;Kipyo Kim","doi":"10.1016/j.jcrc.2024.154944","DOIUrl":"10.1016/j.jcrc.2024.154944","url":null,"abstract":"<div><h3>Background</h3><div>Intermittent hemodialysis (IHD) is commonly implemented in patients with AKI-D, irrespective of the initial kidney replacement therapy (KRT) modality. However, concerns remain regarding the hemodynamic instability during IHD. This study aimed to assess the association between hypotensive episodes during IHD and kidney recovery in AKI-D patients.</div></div><div><h3>Methods</h3><div>We retrospectively enrolled AKI-D survivors who received IHD in the intensive care units of a tertiary care hospital in Korea from January 2018 to February 2024.</div></div><div><h3>Results</h3><div>A total of 1791 IHD sessions from 209 AKI-D survivors were analyzed. The patients underwent a median of 7 IHD sessions (interquartile range [IQR] 3–11), with an incidence of intradialytic hypotension (IDH) of 16.8 % per patient. Of these, 43.1 % were dialysis-dependent at hospital discharge. The number of IDH was a significant predictor of dialysis dependence (odds ratio [OR] 1.56; 95 % confidence interval [CI] 1.16–2.22). Patients experiencing ≥3 IDH episodes had a substantially higher risk of dialysis dependence compared to those without IDH (OR 9.41; 95 % CI 2.41–41.69). In per-session analysis, the target ultrafiltration rate was identified as an independent risk factor for IDH occurrence.</div></div><div><h3>Conclusions</h3><div>Our study revealed that IHD-related hypotension during hospitalization has a cumulative negative impact on kidney recovery in AKI-D survivors.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154944"},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545740","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":"Is it a case of higher, the worse, or are beta-lactam antibiotics the innocent bystanders?","authors":"Aaron J. Heffernan ,&nbsp;Jason A. Roberts","doi":"10.1016/j.jcrc.2024.154934","DOIUrl":"10.1016/j.jcrc.2024.154934","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154934"},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535346","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}