Journal of Clinical Anesthesia最新文献

{"title":"Richard (Rick) Dutton MD","authors":"","doi":"10.1016/j.jclinane.2025.111837","DOIUrl":"10.1016/j.jclinane.2025.111837","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111837"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936677","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":"Factors associated with chronic postsurgical pain in robot-assisted laparoscopic radical prostatectomy: The planned secondary analysis of a randomized controlled trial","authors":"Nobuhiro Tanaka , Yuma Kadoya , Takanori Suzuka , Takayuki Yamanaka , Mitsuru Ida , Naoki Ozu , Shunta Hori , Masahiko Kawaguchi","doi":"10.1016/j.jclinane.2025.111827","DOIUrl":"10.1016/j.jclinane.2025.111827","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111827"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746829","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":"Preliminary insights into monitoring bivalirudin anticoagulation: A retrospective cohort study of aPTT versus a chromogenic anti-IIa assay","authors":"Sean G. Yates ,&nbsp;Ravi Sarode ,&nbsp;Markus Velten ,&nbsp;Jennifer Thibodeau ,&nbsp;Abe DeAnda Jr ,&nbsp;Ibrahim F. Ibrahim ,&nbsp;Lisa Skariah","doi":"10.1016/j.jclinane.2025.111836","DOIUrl":"10.1016/j.jclinane.2025.111836","url":null,"abstract":"<div><h3>Background</h3><div>Bivalirudin infusions are traditionally monitored with activated partial thromboplastin time (aPTT) despite the poor correlation with bivalirudin dose-response curves. This discordance may lead to over or under-anticoagulation, predisposing patients to bleeding or thrombosis and repeated dose adjustments. While a chromogenic bivalirudin-specific anti-IIa assay, which measures bivalirudin plasma concentrations, is available, the extent to which this test may improve clinical monitoring and patient outcomes remains unclear. Accordingly, we aimed to retrospectively assess the correlation between the bivalirudin dose and the anti-IIa assay and to establish a therapeutic range. We then performed a retrospective comparative cohort study assessing the impact of anti-IIa monitoring compared to aPTT on patient outcomes.</div></div><div><h3>Methods</h3><div>Plasma samples from adults receiving bivalirudin anticoagulation were analyzed to assess the correlation between bivalirudin dose, aPTT, and the anti-IIa assay. A retrospective comparative analysis was then conducted to evaluate operational and clinical outcomes in patients monitored with aPTT versus the anti-IIa assay.</div></div><div><h3>Results</h3><div>Analysis of 127 samples from 11 bivalirudin-anticoagulated adults showed a very weak correlation between bivalirudin dose and aPTT (r² = 0.08), while a strong correlation was seen with the anti-IIa assay (r² = 0.65). The dose-response slope's coefficient of variation (CV) for the aPTT and anti-IIa assay were 31 % and 6.6 %, respectively. Patients monitored with the anti-IIa assay had significantly higher time in therapeutic range than those monitored with aPTT (92.1 % vs. 26 %, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>These findings suggest that the anti-IIa assay provides more reliable bivalirudin monitoring than aPTT, with a significant reduction in minor bleeding.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111836"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835193","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":"Prevalence of postoperative neurocognitive disorders in older non-cardiac surgical patients: A systematic review and meta-analysis","authors":"Wendy W.Y. Huang HBSc ,&nbsp;Shirley Fan ,&nbsp;Wei-Ya Li ,&nbsp;Vetri Thangavelu HBSc ,&nbsp;Aparna Saripella ,&nbsp;Marina Englesakis MLIS ,&nbsp;Ellene Yan HBSc ,&nbsp;Frances Chung MBBS MD","doi":"10.1016/j.jclinane.2025.111830","DOIUrl":"10.1016/j.jclinane.2025.111830","url":null,"abstract":"<div><h3>Study objective</h3><div>The growing number of older persons undergoing surgery are at a higher risk of neurocognitive disorder due to multimorbidity and age-related changes. Previous reviews estimated postoperative neurocognitive disorder or cognitive dysfunction (POCD) prevalence without accounting for the sample size or study quality. The prevalence of POCD in this population requires further investigation. This systematic review and meta-analysis applies systematic weighting to estimate the pooled prevalence of POCD in older non-cardiac surgical patients.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>MEDLINE, MEDLINE ePub, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews for relevant articles.</div></div><div><h3>Patients</h3><div>Non-cardiac surgical patients aged ≥60 years old.</div></div><div><h3>Interventions</h3><div>Perioperative cognitive assessments.</div></div><div><h3>Measurement</h3><div>The primary outcome was the prevalence of POCD.</div></div><div><h3>Main results</h3><div>Thirty-nine studies (<em>n</em> = 12,921) were included with mean age of 70.0 ± 8.9 years and 44.3 % women. The overall prevalence of POCD was 23 % (95 % CI: 20 %, 27 %) at day 7, 16 % (95 % CI: 7 %, 25 %) at 1 month, 10 % (95 % CI: 8 %, 13 %) at 3 months and 3 % (95 % CI: 2 %, 4 %) at 1 year. Our meta-regression showed a higher prevalence of POCD in abdominal surgeries at day 7 (β = 0.13, 95 % CI: 0.03–0.22, <em>P</em> = 0.01) and 3 months (β = 0.49, 95 % CI: 0.40–0.58, <em>P</em> &lt; 0.001), versus orthopedic surgeries.</div></div><div><h3>Conclusions</h3><div>The overall prevalence of POCD in older non-cardiac surgical populations was 23 %, 16 %, 10 %, and 3 % at day 7, 1 month, 3 months, and 1 year, respectively. Abdominal surgery had a higher prevalence of POCD than orthopedic surgery. The substantial risk of POCD calls for cognitive screening, risk mitigation and interventions to improve surgical outcomes. Through routine preoperative cognitive screening and addressing modifiable risk factors, the incidence and impact of POCD can be markedly reduced, enhancing patient outcomes and recovery.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111830"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis","authors":"Lukas M. Müller-Wirtz MD ,&nbsp;William M. Patterson MPH ,&nbsp;Sascha Ott MD MPHA ,&nbsp;Kurt Ruetzler MD ,&nbsp;Alparslan Turan MD ,&nbsp;Daniel I. Sessler MD ,&nbsp;Thomas Volk MD ,&nbsp;Christine Kubulus MD","doi":"10.1016/j.jclinane.2025.111826","DOIUrl":"10.1016/j.jclinane.2025.111826","url":null,"abstract":"<div><h3>Background</h3><div>The risk of regional analgesia catheter-related infections in immunocompromised patients remains uncertain. We therefore tested the hypotheses that catheter-related infections appear earlier and are more severe, and that antibiotic prophylaxis is more effective in immunocompromised than immunocompetent patients.</div></div><div><h3>Methods</h3><div>Data were extracted from the Network for Safety in Regional Anesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We used multivariable cox and ordinal regression to assess the effect of immune function and antibiotic prophylaxis indicated by surgery on infection onset and severity.</div></div><div><h3>Results</h3><div>We analyzed data from 196,711 catheters, including 1347 in immunocompromised patients. Infection severities in immunocompetent patients were none (190,220 (97.4 %)), mild (4517 (2.3 %)), and moderate/severe (627 (0.3 %)). In immunocompromised patients, infection severities were none (1285 (95.4 %)), mild (58 (4.3 %)), and moderate/severe (4 (0.3 %)). Immunocompromised patients who were not given antibiotics had a 29 % greater infection hazard (HR 1.29 [95 %CI: 0.95, 1.76], <em>p</em> = 0.1) and 91 % greater odds of higher infection severities (OR 1.91 [95 %CI: 1.39, 2.63], <em>p</em> &lt; 0.001). Antibiotics were more effective in delaying infection onset (HR 0.65 [95 %CI: 0.38, 1.12], <em>p</em> = 0.12) and preventing infection (OR 0.54 [95 %CI: 0.31, 0.94], <em>p</em> = 0.029) in immunocompromised than immunocompetent patients. The number of patients needed-to-treat to prevent an infection with antibiotics was 55 in immunocompromised patients versus 83 in immunocompetent patients.</div></div><div><h3>Conclusions</h3><div>Regional analgesia catheter-related infections occur slightly earlier and are more frequent in immunocompromised patients. Antibiotics are marginally effective for catheter infection prophylaxis and should be restricted to patients who are severely immunocompromised with and at special risks.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111826"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board w/barcode","authors":"","doi":"10.1016/j.jclinane.2025.111843","DOIUrl":"10.1016/j.jclinane.2025.111843","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111843"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936675","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":"Comment on: Postoperative delirium under general anesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomized controlled trials","authors":"Chia-Hao Ho ,&nbsp;Ya-Ying Chang ,&nbsp;Cheng-Wei Lu","doi":"10.1016/j.jclinane.2025.111834","DOIUrl":"10.1016/j.jclinane.2025.111834","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111834"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828308","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":"Implementation of a goal directed perfusion strategy to reduce cardiac surgery associated kidney injury: A before and after study","authors":"Jules Loeb ,&nbsp;Geoffroy Hariri ,&nbsp;Vincenzo Montana ,&nbsp;Aude Carillion ,&nbsp;Axel Hirwe ,&nbsp;Pauline Dureau ,&nbsp;Nima Djavidi ,&nbsp;Aymeric Lancelot ,&nbsp;Pascal Leprince ,&nbsp;Guillaume Lebreton ,&nbsp;Adrien Bouglé","doi":"10.1016/j.jclinane.2025.111828","DOIUrl":"10.1016/j.jclinane.2025.111828","url":null,"abstract":"<div><h3>Purpose</h3><div>Cardiac surgery associated acute kidney injury (CSA-AKI) is a frequent and severe complication. Goal Directed Perfusion (GDP) during cardiopulmonary bypass (CPB) has been developed to reduce post-operative complications, in particular CSA-AKI. Hence, we aimed to assess the implementation of a GDP strategy during CPB on the incidence of CSA-AKI in a large, unselected cardiac surgery population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, before and after study, including all patients admitted to our surgical intensive care unit (ICU) following a cardiac surgery with CPB in the year prior to GDP implementation (No-GDP group), and in the year following its implementation (GDP group). Primary endpoint was the incidence of acute kidney injury (AKI) according to KDIGO classification in each group. Secondary endpoints were ICU mortality and length of stay, and the main post-operative complications after cardiac surgery. Risk factors of AKI were evaluated using a multivariable logistic regression model.</div></div><div><h3>Results</h3><div>Among 903 patients in our analysis, 314 (34 %) developed AKI. The incidence of AKI was lower after the implementation of GDP strategy (<em>n</em> = 111; 27.6 % vs <em>n</em> = 203; 40.5 %, <em>p</em> &lt; 0.001). In the multivariable analysis, GDP was an independent factor of AKI reduction (OR 0.37, 95 %CI [0.27–0.52], p &lt; 0.001). This benefit was significant regarding stage 1 AKI, but not stage 2 or 3 AKI. GDP was not associated with a change in post-operative ICU mortality, length of stay or any other post-operative complication.</div></div><div><h3>Conclusion</h3><div>GDP strategy implantation during CPB is associated with a reduction of postoperative AKI.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111828"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835198","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":"Alterations in the gut microbiome and metabolome in elderly patients with postoperative delirium: A prospective nested case-control study","authors":"Jiang Huo MD ,&nbsp;Shiyi Han MD ,&nbsp;Xinyu Hao MD ,&nbsp;Zhikang Zhou BD ,&nbsp;Jingsheng Lou MD, PhD ,&nbsp;Hao Li MD, PhD ,&nbsp;Jiangbei Cao MD, PhD ,&nbsp;Yingqun Yu MD, PhD ,&nbsp;Weidong Mi MD, PhD ,&nbsp;Yanhong Liu MD, PhD","doi":"10.1016/j.jclinane.2025.111833","DOIUrl":"10.1016/j.jclinane.2025.111833","url":null,"abstract":"<div><h3>Objective</h3><div>To elucidate the role of gut microbiota and their metabolites, including short-chain fatty acids (SCFAs) and targeted metabolomics, in the development of postoperative delirium (POD) in elderly patients.</div></div><div><h3>Design</h3><div>Prospective nested case-control study.</div></div><div><h3>Setting</h3><div>A Chinese tertiary hospital.</div></div><div><h3>Participants</h3><div>Elderly patients underwent elective orthopedic surgery.</div></div><div><h3>Methods</h3><div>Participants were assessed for POD using the 3-min Diagnostic Confusion Assessment Method (3D-CAM). Biological samples, including feces and plasma, were collected. A 1:1 propensity score matching (PSM) was conducted to match POD cases with non-POD cases. 16S ribosomal RNA (rRNA) sequencing and metabolomics analyses were performed on the matched case series. Predictive models were developed using logistic regression analysis, incorporating bacterial genera and metabolites that exhibited significant differences between the two groups as predictors.</div></div><div><h3>Results</h3><div>Among 234 patients who were followed up, 41 were diagnosed with POD. A total of 39 cases were matched for both the POD and control groups using PSM. No significant differences were found in the <em>α</em>-diversity and <em>β</em>-diversity of preoperative gut microbiota between the two groups. However, specific bacterial genera, including <em>Romboutsia, Bacteroides faecalis, Blautia mucilaginosa,</em> and <em>Eggerthella lenta</em>, exhibited significant differences. The risk of POD was associated with higher postoperative plasma levels of propionic acid, histidine, aspartate, and ornithine. Logistic regression and receiver operating characteristic curve analyses revealed that indicators derived from the gut microbiota and metabolites could predict POD, with an area under the curve of 0.8413 (95 % confidence interval (CI): 0.7393–0.9434).</div></div><div><h3>Conclusion</h3><div>This study identified four preoperative bacterial genera and four postoperative plasma metabolites associated with an increased risk of POD in elderly orthopedic patients, suggesting the potential of gut microbiota and metabolite profiles as biomarkers for improving risk prediction and guiding interventions.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111833"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823563","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":"Efficacy of erector spinae plane block for postoperative pain management: A meta-analysis and trial sequential analysis of randomized controlled trials","authors":"João Pedro Fernandes Gonçalves,&nbsp;Manuela Lopes Duran,&nbsp;Eduardo Silva Reis Barreto,&nbsp;César Romero Antunes Júnior,&nbsp;Luiz Gustavo Albuquerque,&nbsp;Liliane Elze Falcão Lins-Kusterer PhD,&nbsp;Liana Maria Torres de Araujo Azi MD, PhD,&nbsp;Durval Campos Kraychete MD, PhD","doi":"10.1016/j.jclinane.2025.111831","DOIUrl":"10.1016/j.jclinane.2025.111831","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain remains a major problem across a wide range of surgical procedures. The efficacy and clinical utility of the Erector Spinae Plane Block (ESPB) in reducing postoperative pain remains uncertain.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy and safety of the ESPB compared with placebo or sham block in perioperative pain management.</div></div><div><h3>Evidence review</h3><div>We searched PubMed, Embase, Web of Science, Scopus, and Cochrane CENTRAL for randomized controlled trials (RCTs) comparing ESPB to placebo or sham block in surgical patients. Primary outcomes included postoperative pain at 2 h, 6 h, 24 h, and 48 h, intraoperative and cumulative postoperative opioid consumption (24 h), and postoperative nausea and vomiting, pruritus, and block-related adverse events. Subgroup and sensitivity analyses, as well as meta-regressions, were performed to explore sources of heterogeneity. Trial sequential analysis (TSA) was used to assess the quantitative robustness of the available data. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024583633.</div></div><div><h3>Findings</h3><div>Forty-three RCTs were included, with 1361 patients randomized to the Erector Spinae Plane Block group. ESPB reduced postoperative pain at 2 h (MD −1.46;95 % CI −1.98 to −0.94;<em>p</em> &lt; 0.001;I² = 91 %), 6 h (MD −1.23;95 % CI −1.64 to −0.83;p &lt; 0.001;I² = 89 %), 24 h (MD −0.47;95 % CI −0.67 to −0.28;p &lt; 0.001;I² = 78 %), and 48 h (MD −0.24;95 % CI −0.39 to −0.09;<em>p</em> = 0.002;I² = 10 %). Also, intraoperative opioid consumption (MD -137.43 μg;95 % CI −208.73 to −66.13;<em>p</em> &lt; 0.001;I² = 100 %), 24 h cumulative opioid consumption (MD −25.62 mg;95 % CI −31.31 to −19.93;<em>p</em> &lt; 0.001;I² = 99 %), and incidence of postoperative nausea and vomiting (RR 0.56;95 % CI 0.44 to 0.72;p &lt; 0.001;I² = 16 %) were significantly lower in patients submitted to ESPB. No significant differences were found in postoperative pruritus (RR 0.62;95 % CI 0.35 to 1.10;<em>p</em> = 0.105;I² = 27 %). Notably, no block-related adverse events were reported in any study. Certainty of evidence was rated as low to moderate for most outcomes. TSA suggested that no further trials are needed to assess ESPB efficacy in the analyzed outcomes, except for postoperative pruritus.</div></div><div><h3>Conclusion</h3><div>ESPB is a safe and effective regional anesthesia technique that significantly reduces postoperative pain and opioid consumption across various surgical procedures.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111831"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790827","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}