Journal of Clinical Monitoring and Computing最新文献

{"title":"Entropy of difference works similarly to permutation entropy for the assessment of anesthesia and sleep EEG despite the lower computational effort.","authors":"Alexander Edthofer, Dina Ettel, Gerhard Schneider, Andreas Körner, Matthias Kreuzer","doi":"10.1007/s10877-024-01258-8","DOIUrl":"10.1007/s10877-024-01258-8","url":null,"abstract":"<p><p>EEG monitoring during anesthesia or for diagnosing sleep disorders is a common standard. Different approaches for measuring the important information of this biosignal are used. The most often and efficient one for entropic parameters is permutation entropy as it can distinguish the vigilance states in the different settings. Due to high calculation times, it has mostly been used for low orders, although it shows good results even for higher orders. Entropy of difference has a similar way of extracting information from the EEG as permutation entropy. Both parameters and different algorithms for encoding the associated patterns in the signal are described. The runtimes of both entropic measures are compared, not only for the needed encoding but also for calculating the value itself. The mutual information that both parameters extract is measured with the AUC for a linear discriminant analysis classifier. Entropy of difference shows a smaller calculation time than permutation entropy. The reduction is much larger for higher orders, some of them can even only be computed with the entropy of difference. The distinguishing of the vigilance states between both measures is similar as the AUC values for the classification do not differ significantly. As the runtimes for the entropy of difference are smaller than for the permutation entropy, even though the performance stays the same, we state the entropy of difference could be a useful method for analyzing EEG data. Higher orders of entropic features may also be investigated better and more easily.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"655-668"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894841","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":"Empirical pharmacodynamic model of phenylephrine and intrathecal bupivacaine for mean arterial pressure prediction in obstetric patients presenting for elective cesarean delivery under spinal anesthesia.","authors":"Sherwin C Davoud, Basak Ozaslan, Eleonora M Aiello, Ricardo Kleinlein, Braden Eberhard, Hassan Hassan, Francis J Doyle, Vesela P Kovacheva","doi":"10.1007/s10877-025-01288-w","DOIUrl":"10.1007/s10877-025-01288-w","url":null,"abstract":"<p><p>Cesarean delivery under spinal anesthesia may be complicated by hypotension in up to 80% of the patients. The response to standard-of-care prophylactic phenylephrine infusion varies, and there is little guidance on achieving optimal blood pressure control. In this work, we developed a data-driven pharmacodynamic relationship between intravenous phenylephrine, intrathecal bupivacaine, and maternal mean arterial pressure (MAP) in patients presenting for cesarean delivery. In this single-center cohort study, secondary use data were available for normotensive patients presenting for cesarean delivery. Intraoperative MAP, intrathecal bupivacaine, and intravenous phenylephrine doses were recorded prospectively every minute. The recorded data were used to identify and confirm a time series (Autoregressive with Exogenous Input (ARX)) model for predicting the MAP using MATLAB 2021a System Identification Toolbox and the Prediction Error Method. An independent model validation was conducted using a second dataset collected after the model fitting stage. Model identification was performed on 172 patients, using 70% for model fitting and 30% for testing. The final ARX model, which takes the past three data points to make predictions, performed 48.9% better than a mean constant model for one-minute ahead MAP predictions with a root mean square error (RMSE) of 3.6 ± 1.3 mmHg. Similar performance was observed on independent validation using a second dataset (N = 84), yielding an RMSE of 4.2 ± 1.6 mmHg for one-minute ahead MAP predictions. Our ARX model showed good performance at up to a three-minute prediction horizon and could be used for future decision support applications to guide phenylephrine dose titration.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"775-785"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692336","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":"Renal Doppler ultrasound to predict acute kidney injury in critically ill patients with acute circulatory failure.","authors":"Balaji Rajaraman, Vanlal Darlong, Kapil Dev Soni, Richa Aggarwal, Maya Dehran, K Devasenathipathy, Anjan Trikha, Dalim Kumar Baidya","doi":"10.1007/s10877-025-01309-8","DOIUrl":"10.1007/s10877-025-01309-8","url":null,"abstract":"<p><p>Renal Doppler ultrasonography may have an important role in the detection of acute kidney injury (AKI) in early stages. This study was aimed to determine whether renal Doppler parameters at day 1 can predict the development of AKI at day 5 in acute circulatory failure (ACF). After ethics committee approval and informed written consent from patients or legally acceptable representatives, we recruited n = 80 critically ill adult patients with ACF in this single-center, prospective observational study. Baseline demographic, clinical, and laboratory parameters were noted. Renal resistive index (RRI), power Doppler ultrasound (PDU) score, and their ratio (RRI/PDU) were measured at baseline and three consecutive days. The primary outcome was the development of AKI at day five, and the secondary outcomes were 28-day mortality, length of ICU stay, duration of ventilation, and vasopressor-free days. Out of 80 patients, n = 32 (40%) developed AKI. At baseline, fluid balance (ml/kg) and APACHE II score were higher and pH was lower in AKI group. RRI and RRI/PDU values were significantly higher, and PDU was significantly lower in the AKI group compared to the non-AKI group from day 1 to day 3. Moreover, changes in these parameters (ΔPDU and ΔRRI/PDU at day 2 and day 3) were significantly more in the AKI group. On regression analysis, all three Doppler parameters from day 1 to day 3 demonstrated very good to excellent accuracy in predicting the development of AKI. To conclude, renal Doppler parameters (RRI, PDU, and RRI/PDU) on day 1 through day 3 can predict the development of AKI by day 5 in critically ill adults with acute circulatory failure.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"757-765"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275027","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":"Variations of SPI during outpatient laparoscopic cholecystectomy without muscle relaxants using ANI-guided remifentanil.","authors":"E Boselli, B Allaouchiche","doi":"10.1007/s10877-025-01297-9","DOIUrl":"10.1007/s10877-025-01297-9","url":null,"abstract":"<p><p>This study compared ANI and SPI during outpatient laparoscopic cholecystectomy without muscle relaxants. Forty adult patients were included in this prospective observational study. Induction was performed using propofol, ketamine and remifentanil. All patients received bilateral TAP block. Maintenance of anesthesia was performed using remifentanil targeted to ANI 50-80 and desflurane targeted to MAC 0.8-1.2 without muscle relaxants. The ANI and SPI values were collected at different time-points and analyzed using repeated-measures ANOVA. The relationship between ANI and SPI were analyzed by linear regression. All procedures were performed without muscle relaxants. The mean ± SD ANI values significantly decreased from 70 ± 12 at induction to 57 ± 15 at intubation and 56 ± 17 at extubation and were maintained in the 50-80 target range throughout incision to exsufflation. The mean ± SD SPI values significantly decreased from 60 ± 15 at induction to 38 ± 16 at intubation, increased at 73 ± 14 at extubation and were in the 20-50 target range throughout incision to exsufflation. There was a poor but significant negative linear relationship (r² = 0.053, p < 0.001) between SPI and ANI values. During laparoscopic cholecystectomy without muscle relaxants, remifentanil titrated to achieve a target ANI range of 50-80 provides SPI values with poor correlation ranging from 20 to 50, corresponding to adequate nociception-antinociception balance. Other studies comparing ANI and SPI guided remifentanil administration are required to determine the effect of each strategy on patient outcomes during laparoscopic cholecystectomy or other types of surgery.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"707-715"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010172","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":"EEG features associated with Alzheimer's disease and Frontotemporal dementia are not reflected by processed indices used in anesthesia monitoring.","authors":"Stefan Schwerin, Srdjan Z Dragovic, Julian Ostertag, Duy-Minh Nguyen, Gerhard Schneider, Matthias Kreuzer","doi":"10.1007/s10877-025-01294-y","DOIUrl":"10.1007/s10877-025-01294-y","url":null,"abstract":"<p><p>Patients with dementia face increased risks after general anesthesia. Improved perioperative electroencephalogram (EEG) monitoring techniques could aid in identifying vulnerable patients. However, current technology relies on processed indices to measure \"depth-of-anesthesia\". Analyzing OpenNeuro Dataset ds004504, we compared resting-state, eyes-closed EEG recordings of healthy controls (n = 27) with patients diagnosed with Alzheimer's disease (AD, n = 35) and Frontotemporal dementia (FTD, n = 23). We focused on prefrontal recordings. Analysis included spectral analysis, the \"fitting-oscillations&-one-over-f\"-algorithm for aperiodic and periodic signal features, as well as calculations of openibis, permutation entropy (PeEn), spectral entropy (SpEn), and spectral edge frequency (SEF). Spectral differences were pronounced, including a higher alpha/theta-ratio of controls (2.62 [95%CI: 1.54-3.62]) compared to both AD (0.55 [95%CI: 0.26-1.92], P < 0.001, AUC: 0.765 [0.642-0.888]) and FTD (0.83 [95%CI: 0.33-1.65], P = 0.007, AUC: 0.779 [0.652-0.907]). Oscillatory peak detection within the alpha frequency band was more robust in control (versus AD: P = 0.003, Cramér's V = 0.374; versus FTD: P = 0.003, Cramér's V = 0.414). Processed index parameters did not show a clear trend. FTD was associated with a higher prefrontal openibis (95.53 [95%CI: 93.43-97.39]) than control (91.98 [95%CI: 89.46-96.27], P = 0.033, AUC: 0.717 [0.572-0.862]) and an elevated SEF (23.68 [95%CI: 14.10-25.57] Hz) compared to AD (16.60 [95%CI: 14.22-22.22] Hz, P = 0.041, AUC: 0.676 [0.532-0.821]). AD and FTD are associated with EEG baseline abnormalities, and a standard prefrontal montage, as used intraoperatively, could present a promising technical screening approach for cognitive vulnerability. However, these EEG features are obscured by processed index parameters currently used in neuroanesthesia monitoring. OpenNeuro Dataset ds004504 \"A dataset of EEG recordings from: Alzheimer's disease, Frontotemporal dementia and Healthy subjects\" (doi: https://doi.org/10.18112/openneuro.ds004504.v1.0.7 ).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"681-696"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968386","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":"Balancing sensitivity and specificity: investigating the effect of age delay and critical illness events on the number of threshold alarms.","authors":"Christina Chiziwa, Mphatso Kamndaya, Patrick Phepa, Alick O Vweza, Job Calis, Bart Bierling","doi":"10.1007/s10877-025-01311-0","DOIUrl":"https://doi.org/10.1007/s10877-025-01311-0","url":null,"abstract":"&lt;p&gt;&lt;p&gt;In critical care settings, continuous vital sign monitoring is crucial to ensure patient safety and timely intervention. While traditional patient monitor threshold alarm systems have been life-saving, they often generate numerous non-actionable alarms, which can overwhelm caregivers and lead to ineffective patient monitoring. We still have these numerous false alarms because we have a gap in understanding the importance of age-specific threshold settings, delay, and critical illness events inclusion in understanding the specificity and sensitivity of the threshold alarms. This study investigated the effect of age-specific thresholds, delay, and critical illness events on the number of threshold alarms to balance their specificity and sensitivity. Secondary data from 772 pediatric patients was extracted from the IMPALA Project conducted in the High Dependency Unit (HDU) at Queen Elizabeth and Zomba Central Hospitals in Malawi. Threshold crossing detector algorithms and age-defining functions were used to generate alarms and impute age-specific thresholds. Z-test was used to determine differences between normal threshold alarms and age-specific threshold alarms. Threshold alarms were categorized into different delays based on their durations to identify an adaptive delay that would minimize the threshold alarms to manageable alarms. Time series analysis was leveraged to extract and compare threshold alarms around patients with and without critical illness events per hour. Additionally, we investigated the variability of threshold alarms during the hour time windows before and after each critical illness event, considering factors such as delay and age. A multi-regression model was used to determine the effects of critical illness events on the number of threshold alarms, with a significance level set at p &lt; 0.05, indicating statistical significance. The age-specific threshold had a positive influence on the threshold alarms by reducing the total number of threshold alarms [31.14% for ECGHR, 17.54% ECGRR and 54.79% for SPO2]. There was a greater significant difference between normal and age-specific threshold alarms (p &lt; 0.00001). A 15-s delay reduced the total number of threshold alarms by 45%. We had more threshold alarms being generated 1 h before critical illness events occurrence, and applying delay and age-specific threshold had more impact on threshold alarms 3 h after the occurrence of critical illness events [Respiratory support (Total threshold alarms (232), 15 s delay (77), 15 s and age-specific threshold (17)] and most threshold alarms 1 h before critical illness events had longer durations. Critical illness [Convulsion (p &lt; 0.0001), Malaria treatment (p &lt; 0.0001), Death (p = 0.053), Respiratory support (p = 0.046), and Sepsis (p = 0.051)] had positive effects on the threshold alarm. There was a drop and increase in the vital sign values during the occurrence of these critical illness events [Bronchodilator support (β =  - 0.0030)","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731205","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":"Identification of an error in the implementation of the Eleveld model in a commercial TCI pump.","authors":"Nicolas Milliet","doi":"10.1007/s10877-025-01333-8","DOIUrl":"https://doi.org/10.1007/s10877-025-01333-8","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731206","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":"Presentation of a novel method to estimate analog mean systemic filling pressure based on cardiac power.","authors":"Enrique Monares-Zepeda, Christopher Barrera-Hoffmann, Ulises Wilfrido Cerón-Díaz, Yesica Ivone Martínez-Baltazar","doi":"10.1007/s10877-025-01336-5","DOIUrl":"https://doi.org/10.1007/s10877-025-01336-5","url":null,"abstract":"<p><p>Mean systemic filling pressure (MSFP) is a critical hemodynamic parameter for managing critically ill patients. Existing estimation methods either require invasive procedures or assume constant vascular resistances, limiting their applicability in clinical settings. We propose a novel method to estimate MSFP using cardiac power (CP), this method was developed in a cohort of 50 patients, validated in a different cohort of 50 patients, and tested in a historical cohort of 21 patients, showing a high correlation (r = 0.95 - 0.90) and agreement with Parkin analog Mean Systemic Filling Pressure (MSFPa) method. In brief MSFPe = (3.3*CP) + 2.2. Our method provides an accurate, non-invasive bedside approach for estimating MSFP, facilitating hemodynamic assessment in critically ill patients and opening new research avenues on vascular resistance dynamics.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731207","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":"Assessment of intraoperative high frequency variability index as a predictor of postoperative pain after open liver or pancreatic surgery under combined general and epidural anesthesia: a prospective observational study.","authors":"Keisuke Yoshida, Takahiro Hakozaki, Takayuki Hasegawa, Tatsumi Yakushiji, Yukihiro Fukuhara, Shinju Obara, Satoki Inoue","doi":"10.1007/s10877-025-01332-9","DOIUrl":"https://doi.org/10.1007/s10877-025-01332-9","url":null,"abstract":"<p><p>The aim of the present study was to investigate the utility of the intraoperative high frequency variability index (HFVI) / Analgesia Nociception Index (ANI) for predicting postoperative pain in patients undergoing open liver or pancreatic surgery under combined general and epidural anesthesia, with a particular focus on HFVI/ANI measured immediately before extubation. We investigated whether maximum postoperative pain at rest and postoperative morphine consumption were associated with intraoperative HFVI/ANI values, including those measured immediately before extubation, the mean intraoperative values, the difference between values immediately before and 5 min after the first administration of local anesthetics via epidural catheter, and the difference between values immediately before and 5 min after the start of surgery. We analyzed the data obtained from 52 patients and found that HFVI/ANI measured immediately before extubation showed a limited but statistically significant association with postoperative pain at rest. However, receiver operating characteristic curve analysis failed to demonstrate clinically useful predictive performance of HFVI/ANI for postoperative pain defined as Numerical Rating Scale > 3 or > 7. In addition, no association was observed between intraoperative HFVI/ANI measured at any time point and postoperative morphine consumption. The present study demonstrated that intraoperative HFVI/ANI may reflect postoperative pain levels to a limited extent, particularly when measured immediately before extubation, but lacks sufficient accuracy to be used as a standalone predictor of postoperative pain.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698698","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":"Evaluating the efficacy of intraoperative NIRS cutoff values in detecting spinal cord ischemia during surgery.","authors":"Sebastian Zinn, Nia Joseph, Travis Stanley CreveCoeur, Roman M Sniecinski, Paul S García","doi":"10.1007/s10877-025-01331-w","DOIUrl":"https://doi.org/10.1007/s10877-025-01331-w","url":null,"abstract":"<p><strong>Purpose: </strong>Paralysis is a serious complication of surgeries that interferes with the blood supply of the anterior spinal cord, with rates of spinal cord injury (SCI) from approximately 1% in general spine surgeries to 4-40% following thoracoabdominal aortic aneurysm (TAAA) repair. Near-infrared spectroscopy (NIRS) provides a non-invasive, real-time method for monitoring tissue oxygenation, largely unaffected by anesthetics. Given the heightened risk of neurologic injury during TAAA repair, this procedure is used to evaluate the effectiveness of standard regional spinal oxygen saturation (rSpO₂) cutoff values in predicting neurological outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed 25 patients undergoing open TAAA repair. NIRS data were recorded at the ischemic site and a reference location throughout surgery. Neurological outcomes were assessed postoperatively based on paralysis, hemiparesis, or extremity weakness. After excluding eight patients due to poor signal quality, 17 patients were included. NIRS values at six key time points were compared between outcome groups. Bayesian statistics assessed the relationship between significant NIRS \"drops\" (< 80% of baseline) and neurological outcomes.</p><p><strong>Results: </strong>Seven patients exhibited new neurological deficits (4 temporary). No credible association was found between intraoperative NIRS drops and postoperative neurological outcomes at any analyzed time point. A moderate effect was observed at the end of surgery (Hedges' g = - 1.21), suggesting a potential difference between groups, although the Bayesian credible interval included zero (posterior mean = - 0.82, 94% HDI [- 1.8, 0.18]).</p><p><strong>Conclusions: </strong>In this limited cohort, intraoperative NIRS cutoff values did not significantly correlate with postoperative neurological deficits following TAAA repair. Postoperative NIRS monitoring may be more informative for detecting spinal cord ischemia and preventing paralysis.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690469","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}