Journal of Clinical Anesthesia最新文献

{"title":"Overdiagnosis of catheter-related thrombosis: When intensive screening detects clinically irrelevant findings","authors":"Hui-Ting Yuan , Nan Qin , Ying Zhou","doi":"10.1016/j.jclinane.2025.111920","DOIUrl":"10.1016/j.jclinane.2025.111920","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111920"},"PeriodicalIF":5.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of dexamethasone and lidocaine combination on incidence of post-operative sore throat: A meta-analysis and trial sequential analysis","authors":"Jibran Ikram ,&nbsp;Aizaz Ali ,&nbsp;Abdul Moeez ,&nbsp;Muhammad Momin Khan ,&nbsp;Ubaidullah ,&nbsp;Aafeen Mujeeb ,&nbsp;Muhammad Abdullah Ali ,&nbsp;Sana Tanveer ,&nbsp;Malik W.Z. Khan ,&nbsp;Bushra Zaman ,&nbsp;Aamer Syed ,&nbsp;Muhammad Ahmad Nadeem ,&nbsp;Ayesha Zahid ,&nbsp;Mohammad Khudirat ,&nbsp;Sawaira ,&nbsp;Steven Minear ,&nbsp;Sabry Ayad","doi":"10.1016/j.jclinane.2025.111924","DOIUrl":"10.1016/j.jclinane.2025.111924","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative sore throat (POST) is a common complication after endotracheal intubation, occurring in 30–50 % of patients. While lidocaine (local anesthetic) and dexamethasone (anti-inflammatory) are used individually to prevent POST, their combined efficacy remains unclear. This meta-analysis synthesizes evidence from randomized controlled trials to determine whether Intravenous dexamethasone-lidocaine combination is more effective than dexamethasone alone in reducing POST incidence.</div></div><div><h3>Methods</h3><div>A systematic search was conducted across PubMed, Embase, and Web of Science to identify studies comparing the effect of dexamethasone with and without lidocaine on the incidence of POST, cough, and hoarseness. Statistical analysis was performed on RevMan. Data were pooled using a random-effects model (Mantel-Haenszel method), with results reported as risk ratios (RR) and 95 % confidence intervals (CIs); heterogeneity was assessed using the I² statistic. A <em>p</em>-value less than 0.05 was considered statistically significant. We use Gradpro GDT and Trial sequential analysis to assess the certainty and reliability of evidence, respectively.</div></div><div><h3>Results</h3><div>Our search retrieved 116 articles, of which 31 were duplicates. At the end of the selection process based on prespecified eligibility criteria, three randomized controlled trials were included in the final meta-analysis. Dexamethasone-lidocaine significantly reduces the incidence of POST compared to dexamethasone alone, with a (RR: 0.53; 95 % CI: 0.37–0.75; <em>P</em> = 0.0003, I² = 0 %). The meta-analysis showed no statistically significant difference in postoperative cough (RR: 0.81; 95 % CI: 0.41–1.61; <em>P</em> = 0.55, I² = 24 %) and hoarseness (RR: 0.60; 95 % CI: 0.29–1.22; <em>P</em> = 0.16, I² = 24 %) between the dexamethasone-lidocaine combination and dexamethasone alone. Non-significance doesn't prove groups are comparable; wide confidence intervals suggest a potentially meaningful difference in cough incidence. GRADE assessment analysis showed high evidence for POST and cough but showed moderate evidence for hoarseness and cough. Trial sequential analysis showed insufficient evidence to conclude that Dexamethasone-lidocaine reduces the incidence of POST.</div></div><div><h3>Conclusion</h3><div>The dexamethasone-lidocaine combination suggests a clinically meaningful reduction in POST compared to dexamethasone alone, with consistent effects across studies. While not impacting hoarseness and cough, these robust findings support adopting this readily available, cost-effective strategy to enhance recovery after intubation. The combination's benefit on the most common postoperative complications justifies its inclusion in airway management protocols. Further trials are needed to support and enhance the reliability of this current evidence.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111924"},"PeriodicalIF":5.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response of letter to the editor regarding “effects of neuromuscular block reversal with neostigmine/glycopyrrolate versus sugammadex on bowel motility recovery after laparoscopic colorectal surgery: A randomized controlled trial”","authors":"Jin-Woo Park MD, PhD","doi":"10.1016/j.jclinane.2025.111923","DOIUrl":"10.1016/j.jclinane.2025.111923","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111923"},"PeriodicalIF":5.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between race, ethnicity, and surgical case cancellations: A retrospective study in a cohort of patients undergoing oncological surgeries","authors":"Juan P. Cata MD ,&nbsp;Pascal Owusu-Agyemang MD ,&nbsp;Taiwo Adesoye MD ,&nbsp;Lei Feng MS","doi":"10.1016/j.jclinane.2025.111925","DOIUrl":"10.1016/j.jclinane.2025.111925","url":null,"abstract":"<div><h3>Background</h3><div>Surgical delays and cancellations have been shown to occur more frequently in racial and ethnic minority patients. We hypothesized that race and ethnicity are independent risk factors for surgical cancellations in patients with cancer.</div></div><div><h3>Methods</h3><div>This retrospective study reviewed surgical procedures in a large tertiary cancer center. The primary outcome was surgical cancellation before or on the intended surgery date. The primary exposure variable was a patient's self-reported race and ethnicity. A multivariable logistic regression model was fitted to estimate the effects of covariates on the status of case cancellation. A <em>p</em>-value &lt;0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Of 109,400 surgical cases, the overall rate of cancellation was 4.45 %. The highest rate was among patients in the head and neck service (15.04 %). Overall, changes in treatment were a frequent cause of cancellations (54.9 %). Black patients had the highest rate of cancellations among all ethnicities (5.4 %), with the breast surgical oncology service having the highest rate of cancellations among Black patients (16.6 %). After only including unique first clinical encounters of each patient (<em>N</em> = 78,227) and with adjustment of gender, age-adjusted CCI and primary surgery type in a mixed effects model which treated surgery date as a cluster variable, patients identified as NH-Asian (OR, 99.8 % CI: 0.56, 0.40–0.79), and NH-White (OR, 99.8 % CI: 0.64, 0.53–0.78) had statistically significant lower odds of surgical cancellation compared to NH-Black patients. Those identified as NHPIA (OR, 99.8 % CI: 0.57, 0.22–1.51), Hispanic or Latino (OR, 99.8 %: 0.82, 0.65–1.03), and Other (OR, 95 % CI: 0.76, 0.46–1.26) did not have significant lower odds of surgical cancellation compared to NH-Black patients.</div></div><div><h3>Conclusions</h3><div>Our work suggests that in the context of cancer care, Black or African-American patients have an increased risk of surgical cancellations.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111925"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery","authors":"Heleen Driessens ,&nbsp;Lis S.M. Hoeijmakers ,&nbsp;Olav D.J. Zwerver ,&nbsp;Allard G. Wijma ,&nbsp;Nicole D. Hildebrand ,&nbsp;Remy R.Y.C. Queisen ,&nbsp;Mayella Kuikhoven ,&nbsp;Marcel den Dulk ,&nbsp;Steven W.M. Olde Damink ,&nbsp;Joost M. Klaase ,&nbsp;Bart C. Bongers","doi":"10.1016/j.jclinane.2025.111916","DOIUrl":"10.1016/j.jclinane.2025.111916","url":null,"abstract":"<div><h3>Background</h3><div>The widespread implementation of a preoperative assessment of aerobic capacity requires a practical field test. This study investigated the validity of the modified steep ramp test (SRT) for evaluating preoperative aerobic capacity and to evaluate its usefulness for preoperative risk assessment in patients planned for pancreatic surgery.</div></div><div><h3>Methods</h3><div>Patients scheduled for pancreatic surgery who preoperatively performed cardiopulmonary exercise testing (CPET) and the modified SRT within 14 days were included. To assess its criterion validity, the correlation between the achieved work rate at peak exercise (WR_peak) at the modified SRT and oxygen uptake (VO₂) at peak exercise (VO_2peak) during CPET was determined. To evaluate the ability of the modified SRT to correctly classify patients as fit or unfit, receiver operating characteristic (ROC) analyses were performed based on the CPET VO_2peak cutoff 18.0 ml.kg⁻¹.min⁻¹ and VO₂ at the ventilatory anaerobic threshold (VAT) cutoff 11.0 ml.kg⁻¹.min⁻¹.</div></div><div><h3>Results</h3><div>Forty-eight patients (21 females) aged 68.7 ± 7.6 years were included. Modified SRT WR_peak (W/kg) demonstrated a very strong correlation with CPET VO_2peak (<em>ρ</em> = 0.865, <em>r</em> = 0.926). The modified SRT WR_peak cutoff to most accurately classify patients as fit or unfit was 2.095 W/kg for the CPET VO_2peak cutoff (area under the curve (AUC) of 0.948) and the CPET VO₂ at the VAT cutoff (AUC of 0.814).</div></div><div><h3>Conclusions</h3><div>The modified SRT is a valid short-term practical exercise test to preoperatively assess aerobic capacity in patients undergoing pancreatic surgery. A modified SRT performance below 2.1 W/kg seems clinically most suitable to select candidates for further preoperative CPET evaluation and/or prehabilitation, given its positive and negative predictive value.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111916"},"PeriodicalIF":5.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144548828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and utility of anesthesiology entrustable professional activities assessed with a mobile web application","authors":"Pedro Tanaka M.D., Ph.D. (Medicine), M.A.C.M., Ph.D. (Education) ,&nbsp;Yoon Soo Park Ph.D ,&nbsp;Jonathan Chen MD PhD ,&nbsp;Alex Macario M.D., M.B.A","doi":"10.1016/j.jclinane.2025.111922","DOIUrl":"10.1016/j.jclinane.2025.111922","url":null,"abstract":"<div><h3>Background</h3><div>A prior study developed and validated 14 Entrustable Professional Activities (EPA) for anesthesia residents for anesthesiology residency programs to use as the basis for workplace assessment.</div></div><div><h3>Objective</h3><div>The goals of this study were to: 1) measure the reliability of seven of those 14 EPAs using entrustment data collected via a mobile web application (Web App) and 2) examine implementation and utility of the EPA Web App.</div></div><div><h3>Methods</h3><div>Web App design prioritized a simple and efficient user interface, and incorporated revisions based on feedback. Assessments were completed during the 2020–2021 academic year. Generalizability theory was used to examine the distribution of EPA global scores. Qualitative interview data of Web App usage by participants focused on domains of the Consolidated Framework for Implementation Research.</div></div><div><h3>Results</h3><div>The Web App was used in a total of 1116 observations in 31 residents. Two EPAs were effective in discriminating differences in resident performance, whereas two were not. With 24 observations, one of the EPAs had a G coefficient of 0.68 and phi coefficient of 0.66 approaching a level suitable for formative feedback, whereas the other EPAs did not reach the 0.7 threshold (for moderate reliability in formative assessment, not summative use) even with 24 observations. Several constructs were elicited from the interview data in the domains of intervention characteristics, individual characteristics, outer setting, and inner setting.</div></div><div><h3>Conclusion</h3><div>The utility of the Web App for EPA assessment was deemed positive for formative, low-stakes assessment. EPAs may not all necessarily be able to discriminate differences in resident performance. However, even a single EPA assessment may still be useful as one component of competency-based medical education via programmatic assessment.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111922"},"PeriodicalIF":5.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericapsular nerve group (PENG) block compared to intrathecal morphine for analgesic efficacy in total hip arthroplasty: A placebo-controlled randomized double-blind non-inferiority trial","authors":"Krešimir Oremuš ,&nbsp;Vladimir Trkulja ,&nbsp;Giorgina Gasparini ,&nbsp;Siniša Šoštarić ,&nbsp;Nikola Čičak ,&nbsp;Miroslav Hašpl ,&nbsp;Slobodan Mihaljević","doi":"10.1016/j.jclinane.2025.111921","DOIUrl":"10.1016/j.jclinane.2025.111921","url":null,"abstract":"<div><h3>Background</h3><div>We hypothesized that pericapsular nerve group (PENG) block was non-inferior to intrathecal (IT) morphine regarding analgesia after total hip arthroplasty (THA) with no untoward effects on the motor function.</div></div><div><h3>Methods</h3><div>In a double-blind placebo-controlled non-inferiority trial, patients undergoing unilateral THA under spinal anesthesia were randomized to receive a PENG block (20 mL 0.5 % levobupivacaine +2 mg dexamethasone) or IT morphine (100 μg). They received multimodal oral postoperative analgesia with rescue intravenous morphine for breakthrough pain, and were repeatedly evaluated for pain over the first 48 postoperative hours using a 0–10 numerical rating scale (NRS), and for the straight leg raise test at 4, 6 and 12 h. Co-primary outcomes were (i) maximum pain at rest and (ii) at active hip flexion – estimated for the overall period based on three consecutive scores – and (iii) milligram morphine equivalents (MME) delivered over 48 h. Non-inferiority margins for the PENG block – IT morphine differences were 0.75 NRS points for the pain scores, and 10 for the cumulative MME (corresponds to one 4 mg intravenous morphine rescue dose).</div></div><div><h3>Results</h3><div>All randomized patients (<em>N</em> = 60, 1:1 ratio) completed all trial procedures. PENG block – IT morphine differences in the maximum pain at rest (difference = 0.182, 95 %CI -0.218 to 0.582) and at hip flexion (difference = −0.270, 95 %CI -0.990 to 0.453) were well below 0.75 NRS points, and the difference in MME (difference = −2.1, 95 %CI -6.5 to 1.9) was well below 10 MME. Age-adjusted straight leg raise test failure rates were similar in the two groups (11.7 % vs. 12.8 %, difference = −1.1, 95 %CI -9.7 to 7.5).</div></div><div><h3>Conclusion</h3><div>Compared to IT morphine, PENG block provides non-inferior analgesia after THA under spinal anesthesia without additional compromise of the motor function.</div><div>Trial registration number: <span><span>NCT05308420</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111921"},"PeriodicalIF":5.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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: “Cerebrospinal fluid proteome of patients with persistent pain and/or postpartum depression after elective cesarean delivery: An exploratory prospective cohort study”","authors":"Weijia Du,&nbsp;Zhihao Sheng,&nbsp;Zhiqiang Liu","doi":"10.1016/j.jclinane.2025.111915","DOIUrl":"10.1016/j.jclinane.2025.111915","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111915"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns regarding methodology in the publication “flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation – A randomized controlled trial”","authors":"Matthias Thoma ,&nbsp;Erich Moresco","doi":"10.1016/j.jclinane.2025.111919","DOIUrl":"10.1016/j.jclinane.2025.111919","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111919"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Anesthesia Risk Assessment Score (ARAS) for postoperative mortality and adverse discharge to a nursing facility","authors":"Rafi Khandaker BA ,&nbsp;Karuna Wongtangman MD ,&nbsp;Marcus Frank ,&nbsp;Felix Borngaesser MD ,&nbsp;Richard V. Smith MD ,&nbsp;Linda Nie BA ,&nbsp;Shweta Garg MS ,&nbsp;Bilal Tufail MD ,&nbsp;Jeffrey Freda MD, MBA ,&nbsp;Preeti Anand MD ,&nbsp;Adela Aguirre-Alarcon MD ,&nbsp;Matthias Eikermann MD, PhD ,&nbsp;Carina P. Himes MD","doi":"10.1016/j.jclinane.2025.111918","DOIUrl":"10.1016/j.jclinane.2025.111918","url":null,"abstract":"<div><h3>Background</h3><div>We developed a simple questionnaire that the surgeon's office uses when meeting with their patients to book a case. In this study, we used these questions to evaluate their predictive value for mortality and adverse discharge to a nursing facility in comparison with the American Society of Anesthesiologists Physical Status [ASA-PS] and other risk assessment scores.</div></div><div><h3>Methods</h3><div>We analyzed data from adult patients undergoing non-ambulatory surgery between January 2016 and February 2023 at Montefiore Medical Center, a tertiary academic center in the Bronx, NY. The predetermined questionnaire items were defined as candidate predictors. Stepwise backwards elimination was used to identify independent predictors of mortality within 30 days of surgery. Model discrimination was assessed using area under the receiver operating characteristic curve [ROC-AUC] and was compared with ASA-PS, machine learning ASA [ML-ASA], Revised Cardiac Risk Index [RCRI], and Modified 5 Item Frailty Index [mFI-5] scores. Similarly, the model was evaluated in predicting non-home (adverse) discharge. Internal validation was performed using an independent cohort.</div></div><div><h3>Results</h3><div>In a developmental cohort of 59,099 patients, 891 (1.53 %) patients died within 30 days after surgery and 5013 (9.1 %) were adversely discharged. The final Anesthesia Risk Assessment Score [ARAS] model consisted of 6 independent predictors including history of stroke, seizure, heart failure/pacemaker or defibrillator implantation, liver failure, blood or bleeding disorder, and metabolic equivalents ≤4. The model showed superior predictive ability for 30-day postoperative mortality [AUC 0.82] compared to ASA-PS, ML-ASA, RCRI and mFI-5 [0.78, 0.79, 0.76, 0.72; p &lt; 0.001, respectively]. Similar performance was observed when predicting adverse discharge [AUC 0.76 vs 0.70, 0.74, 0.65, 0.73; p &lt; 0.001, respectively]. The results remained robust in the validation cohort (n = 13,137).</div></div><div><h3>Conclusion</h3><div>Six clinical questions that can be obtained directly from patients predict postoperative mortality and adverse discharge. The predictive accuracy is comparable to the ASA-PS, RCRI, and mFI-5 scores, with the advantage of being able to be used early in the preoperative evaluation triage process prior to clinician input.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"106 ","pages":"Article 111918"},"PeriodicalIF":5.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}