Journal of Clinical Neurophysiology最新文献

{"title":"Pediatric Continuous EEG Monitoring Utilization: An 8-Year Cohort Study Using the Pediatric Health Information System Database.","authors":"Whitney Fitts, Craig Press, Isabella Zaniletti, Giulia M Benedetti, Kendell Nash, Elizabeth M Wells, Ricka Messer, Jamie Palaganas, Mahendranath Moharir, Juan Piantino, Matthew Kirschen, Brian Appavu, Nicholas S Abend","doi":"10.1097/WNP.0000000000001287","DOIUrl":"https://doi.org/10.1097/WNP.0000000000001287","url":null,"abstract":"<p><strong>Purpose: </strong>Continuous electroencephalography (CEEG) is recommended in critically ill neonates and children at risk for experiencing seizures. Its utilization across time and conditions remains unclear. We evaluated trends in CEEG use and variation based on patient and hospital level factors for six common indications.</p><p><strong>Methods: </strong>This retrospective cohort study queried data from 40 children's hospitals in the Pediatric Health Information Systems database from January 2016 to December 2023. Using ICD-10 diagnosis codes, we defined six CEEG indications: neonatal hypoxic-ischemic encephalopathy (HIE), extracorporeal membrane oxygenation, cardiac arrest, stroke, traumatic brain injury, and neonates postcardiac surgery (post-CS). CEEG utilization was assessed annually. Associations between CEEG utilization and year, age, sex, race, history of seizures or epilepsy, medical complexity, payer, hospital region, and the Child Opportunity Index (COI) were evaluated in unadjusted ORs and an adjusted OR (aOR) in a multivariable generalized linear model.</p><p><strong>Results: </strong>CEEG use varied by condition: neonatal HIE 67%, extracorporeal membrane oxygenation 47%, cardiac arrest 39%, stroke 36%, traumatic brain injury 21%, and post-CS 21%. CEEG use increased over the study period for extracorporeal membrane oxygenation (aOR 4.65; 2.47-8.77; P < 0.001), post-CS (aOR 3.5; 1.36-8.99; P = 0.009), and cardiac arrest (aOR 1.95; 95% CI 1.22-3.12; P = 0.005). CEEG use varied by hospital and condition. Younger age and increased medical complexity were associated with higher odds of CEEG. There was no consistent pattern of CEEG variation by race, ethnicity, insurance type, or COI, although condition specific differences were present.</p><p><strong>Conclusions: </strong>CEEG utilization has increased over time but remains variable across hospitals and indications. Comparative effectiveness approaches that leverage variation could determine optimal CEEG practices.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Nerve Cross-Sectional Area in Healthy Thai Children: Reference Values for Clinical Neuromuscular Ultrasound.","authors":"Tanitnun Paprad, Jakkrit Amornvit, Chernkhuan Stonsaovapak, Kamin Naothaworn, Nath Pasutharnchat, Tunchanok Paprad","doi":"10.1097/WNP.0000000000001284","DOIUrl":"10.1097/WNP.0000000000001284","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasonography of the nerve cross-sectional area (CSA) is increasingly used to support the diagnosis of peripheral neuropathies. However, normative CSA reference values in children, particularly in Southeast Asian populations, are limited.</p><p><strong>Methods: </strong>Ultrasonographic nerve CSA measurements were conducted in 164 healthy Thai children aged 1 to 18 years at King Chulalongkorn Memorial Hospital, Thailand. Participants were classified into six age groups. CSA was measured in 10 peripheral nerves at 34 anatomical sites and bilateral cervical roots (C5-C7), and the median CSAs were calculated. Correlations between CSA and body weight, height, and age were calculated using Spearman and Pearson correlation coefficients. Intraobserver and interobserver reliability were evaluated in a subset of participants using intraclass correlation coefficients.</p><p><strong>Results: </strong>Normative CSA values were established for all examined nerves and sites. Most nerves demonstrated proximal-to-distal tapering in CSA, with the median nerve exhibiting a unique pattern of larger CSA at the wrist and mid-upper arm. C7 root was the largest cervical root measured (median CSA up to 7.0 mm 2 in older adolescents). CSA demonstrated moderate-to-strong correlations with anthropometric variables, including weight, height, and age ( r = 0.36-0.78). The tibial, sciatic, and median nerves showed the strongest correlations (all P < 0.001). Intraobserver and interobserver reliability were good-to-excellent across the selected nerves.</p><p><strong>Conclusions: </strong>Nerve CSA is influenced by age, weight, height, and location in this Southeast Asian population. These normative reference values may serve as a reference for distinguishing normal from pathological findings and aid clinical decision making in pediatric neurophysiological practice.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Do the Intracerebral Electrodes See and Do Not See?","authors":"Maria Fratello, Francesca Pizzo, Jean-Michel Badier, Christian-G Bénar, Víctor J López-Madrona","doi":"10.1097/WNP.0000000000001231","DOIUrl":"10.1097/WNP.0000000000001231","url":null,"abstract":"<p><strong>Summary: </strong>Stereoelectroencephalography (SEEG) is a powerful technique for delineating the epileptogenic zone network in patients with drug-resistant epilepsy, providing direct access to both superficial and deep brain structures. However, its clinical value depends critically on the accurate interpretation of the recorded signals-which requires clear understanding of what we are actually recording, and what we are not. In this review, we examine the fundamental biophysical principles underlying SEEG signal generation, mainly the anatomical organization of brain structures and their distance from SEEG contacts. We address the types of epileptic patterns that SEEG can detect and how their interpretation depends on the referencing montage. Building on these concepts, we discuss the types of activity that may be missed or misrepresented. Finally, we explore emerging strategies to extend the field of view of SEEG electrodes. This review is intended both as an introduction for newcomers to the origin of SEEG signals and as an update for experienced users, reaffirming key concepts and presenting new methodological perspectives.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surface EEG to Identify Cognitive Motor Dissociation After Acute Brain Injury.","authors":"Satoshi Egawa, Nicole Casson, Joel Neves Briard, Qi Shen, Vedant Kansara, Itamar Niesvizky-Kogan, Elizabeth Carroll, Jerina C Carmona, You Lim Song, Alex J Klein, Angela Velazquez, Wells Andres, Shivani Ghoshal, David Roh, Sachin Agarwal, Soojin Park, E Sander Connolly, Jan Claassen","doi":"10.1097/WNP.0000000000001280","DOIUrl":"10.1097/WNP.0000000000001280","url":null,"abstract":"<p><strong>Purpose: </strong>Cognitive motor dissociation (CMD) is associated with long-term recovery in acute brain injury, but CMD testing is only available in few centers. Our objective was to identify surface EEG patterns with high sensitivity or positive predictive value (PPV) for CMD in patients with acute disorders of consciousness to refine allocation of this resource-intensive test.</p><p><strong>Methods: </strong>In this observational cohort study, we enrolled clinically unresponsive, acutely brain injured patients who underwent continuous surface EEG and CMD assessments. CMD was detected by applying a machine learning algorithm to EEG acquired during a motor command paradigm presentation. Electroencephalographers blinded to CMD test results applied standardized ACNS criteria to the EEGs acquired during CMD assessments. We calculated accuracy measures of surface EEG findings for CMD test results using generalized estimating equations, with an exchangeable matrix and accounting for repeated measures per patient.</p><p><strong>Results: </strong>We included 185 patients (mean age: 62 ± 17; 85 [46%] female) and 282 CMD assessments. CMD testing was positive in 39 (14%) assessments. Sensitivity and PPV of normal background voltage, symmetry, and continuity were, respectively, 77% (95% CI: 60%-88%) and 19% (95% CI: 13%-26%), 74% (95% CI: 58%-86%) and 14% (95% CI: 10%-20%), and 74% (95% CI: 58%-86%) and 14% (95% CI: 9%-19%). All EEGs with burst suppression, suppression, sporadic epileptiform discharges, lateralized periodic discharges, bilateral independent periodic discharges, electrographic seizures, and brief potentially ictal rhythmic discharges had negative CMD tests.</p><p><strong>Conclusions: </strong>Surface EEG findings are not reliable to screen for CMD or to identify patterns conferring higher CMD pretest probability.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of EEG Monitoring in Hypoxic-Ischemic Brain Injury After Cardiac Arrest.","authors":"Ninad Bhat, Edilberto Amorim","doi":"10.1097/WNP.0000000000001261","DOIUrl":"10.1097/WNP.0000000000001261","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and synthesize current evidence on the cost-effectiveness of EEG monitoring in postcardiac arrest care, with a focus on its utility in neuroprognostication and clinical decision making.</p><p><strong>Methods: </strong>A narrative review was conducted to summarize the recent literature on EEG utilization, guidelines, and cost-effectiveness analyses. Studies examining continuous EEG, routine EEG, and point-of-care EEG using cost-utility frameworks, quality-adjusted life year modeling, and health system variability were analyzed.</p><p><strong>Results: </strong>Despite class I recommendations from the AHA and ACNS, EEG remains underused in postcardiac arrest management. Although continuous EEG provides superior temporal resolution and facilitates prognostic assessment, it comes with significant costs associated with equipment, personnel, and EEG interpretation. Cost-effectiveness analysis shows that small improvements in prognostic specificity of 1% to 4% may render EEG monitoring cost-effective in a closed health care system. Routine EEG and point-of-care-EEG systems offer new strategies for expanding access and reducing costs. However, studies are predominantly retrospective, single-center, and heterogeneous in their analytic methodology, which limits generalizability.</p><p><strong>Conclusions: </strong>EEG monitoring after cardiac arrest may be cost-effective if modest gains in prognostic accuracy are achieved. Further data from prospective, multicenter studies and long-term financial and outcome data using standardized statistical metrics will be needed for broader use. By doing so, more robust use guidelines and cost-effectiveness thresholds can be created for postcardiac arrest EEG monitoring.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"423-431"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology and Prognostic Significance of Myoclonus in Hypoxic-Ischemic Encephalopathy.","authors":"Markus Leitinger, Simone Beretta","doi":"10.1097/WNP.0000000000001272","DOIUrl":"10.1097/WNP.0000000000001272","url":null,"abstract":"<p><strong>Summary: </strong>Cerebral hypoxia due to cardiac arrest is frequently complicated by myoclonus manifesting hours to days after the return of spontaneous circulation. However, myoclonus per se-without further characterization-lacks sufficient biological specificity and does not allow for reliable prognostic interpretation. Accumulating evidence underscores the critical role of EEG monitoring in the assessment of postanoxic patients, particularly with regard to background continuity and the presence of status epilepticus, as defined by the American Clinical Neurophysiology Society. These parameters have emerged as key determinants in prognostication. A structured research framework for the classification of postanoxic myoclonus has been proposed to mitigate the risk of false-positive predictions of poor neurological outcome and to prevent unwarranted withdrawal of life-sustaining therapy in selected patient subgroups. These subgroups are defined by continuous, nearly continuous, or discontinuous EEG background activity, particularly in the absence of concomitant status epilepticus. This framework constitutes a robust foundation for the systematic acquisition of relevant clinical and paraclinical data. In addition, a standardized communication tool may facilitate precise information exchange among physicians and efficient interprofessional patient management.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"403-409"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Neurophysiologic Testing in Prognostication of Hypoxic-Ischemic Encephalopathy.","authors":"Erik Westhall, Marjolein Admiraal","doi":"10.1097/WNP.0000000000001264","DOIUrl":"10.1097/WNP.0000000000001264","url":null,"abstract":"<p><strong>Summary: </strong>Electroencephalography (EEG) and somatosensory evoked potentials (SSEP) are important components of multimodal prognostication in comatose patients after cardiac arrest (CA). The EEG changes considerably during the first days after CA. The prognostic value of some EEG patterns is time-dependent, whereas that of others is not. Persistence of burst-suppression with heterogeneous (variable) bursts and generalized suppression (<10 µV) ≥24 hours after CA strongly predicts poor outcome. Burst-suppression with identical or highly epileptiform bursts and periodic discharges on a suppressed background strongly predict poor outcome, also within the first 24 hours during ongoing sedation and temperature management. These synchronous patterns are best assessed with early continuous EEG-monitoring (cEEG), because their prevalence gradually decreases. Early (<12 hours) return of a continuous normal-voltage background activity on cEEG is a strong predictor of good outcome. A reactive and continuous background on a late routine-EEG also indicates a good prognosis. Full-montage or simplified cEEG provides early prognostic information and improves sensitivity for both poor and good outcome prediction compared with a single late routine-EEG. Bilateral absence of cortical potentials (N20) on median nerve SSEP is one of the most reliable tools for predicting poor outcome, including during ongoing sedation. Sensitivity is limited, but specificity is near 100% if recordings are of sufficient quality, with clearly discernible peripheral potentials and low noise levels. Currently not included in guidelines, very low cortical SSEP amplitudes (approximately 0.5 µV or less) are strongly predictive of poor outcome. However, further research is needed to establish consensus criteria.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"393-402"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative EEG Analyses for Outcome Prediction in Comatose Patients After Cardiac Arrest.","authors":"Michel J A M van Putten, Marleen C Tjepkema-Cloostermans","doi":"10.1097/WNP.0000000000001269","DOIUrl":"10.1097/WNP.0000000000001269","url":null,"abstract":"<p><p>Conventional visual interpretation of EEG has several limitations, including inter- and intraobserver variability, a substantial review burden, and the need to reduce a continuously evolving spatiotemporal signal to categorical descriptions. Quantitative analysis of the EEG may help overcome some of these limitations by capturing signal characteristics and temporal dynamics that are difficult to summarize consistently in words alone. In this review, we briefly summarize the main approaches that have been used to support EEG-based outcome prediction in comatose patients after cardiac arrest. These range from explicit feature-based indices, such as the Cerebral Recovery Index, to machine-learning classifiers using larger EEG feature sets, and, more recently, to deep learning models trained directly on raw EEG. Importantly, these methods are relevant not only for the early identification of patients with a poor prognosis but also for identifying patients with a realistic chance of good neurologic recovery. Furthermore, qEEG increases objectivity, reducing dependence on categorical wording and supporting continuous bedside assessment of neurologic recovery. These approaches can reach sensitivities of 50% to 60% at specificities of > 99% for poor and > 95% for good neurologic outcome, respectively, particularly for early EEG (recorded < 24 hour after cardiac arrest). Within a multimodal prognostic framework, qEEG can serve as a valuable decision-support tool to assist final assessment by a trained electroencephalographer.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"418-422"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148330022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Principles of Management of Postcardiac Arrest Patients in the ICU.","authors":"Claudio Sandroni, Tobias Cronberg, Jerry P Nolan","doi":"10.1097/WNP.0000000000001254","DOIUrl":"10.1097/WNP.0000000000001254","url":null,"abstract":"<p><strong>Summary: </strong>Postcardiac arrest (CA) care in the intensive care unit is pivotal to mitigating hypoxic-ischemic brain injury (HIBI), the leading cause of death and disability in resuscitated patients. This narrative review synthesizes current evidence and guideline recommendations on key domains of post-CA management, including diagnostic evaluation, hemodynamic optimization, oxygenation and ventilation strategies, temperature control, and sedation. Immediate coronary angiography is indicated in patients with ST-segment elevation, while a selective approach is warranted in others, guided by clinical findings. Whole-body computed tomography facilitates early identification of extracardiac causes and resuscitation-related injuries. Current consensus supports maintaining mean arterial pressure above 60 to 65 mm Hg, normoxemia (PaO 2 75-100 mm Hg), and normocapnia (PaCO 2 35-45 mm Hg). Lung-protective ventilation and head-up positioning are standard practices. Recent high-quality trials have challenged the neuroprotective role of therapeutic hypothermia; current guidelines recommend active fever prevention targeting a temperature of ≤37.5° C for at least 72 hours after CA. Sedation should be tailored to facilitate neurologic assessment, with short-acting intravenous agents preferred.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"384-392"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148330012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Functional Significance of 14 and 6 Hz Positive Spikes in Self-Limited Epilepsy With Centrotemporal Spikes: A Case-Control Study.","authors":"Margil Ranpariya, Natasha Qutab, Jonathan Hanson, Ping Li, Hannah Foster, Osman Farooq","doi":"10.1097/WNP.0000000000001220","DOIUrl":"10.1097/WNP.0000000000001220","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the prevalence and functional significance of 14 and 6 Hz positive spikes (PS) in children with Self-limited Epilepsy with Centrotemporal spikes and explore their potential correlation with clinical features and neurophysiological mechanisms.</p><p><strong>Methods: </strong>Our study included 52 pediatric Self-limited Epilepsy with Centrotemporal spikes patients and 52 age-matched controls who underwent ≥48-hour video-EEG monitoring in the epilepsy monitoring unit at Oishei Children's Hospital from 2016 to 2024. EEGs were reviewed by blinded epileptologists to identify the presence, localization, and lateralization of 14 and 6 Hz PS.</p><p><strong>Results: </strong>Fourteen and 6 Hz PS were detected in 80.8% ( n = 42) of SeLECTs patients versus 0% of controls ( P < 0.001). No significant lateralization correlation was found between PS and centrotemporal spikes ( P = 0.651); only 28.6% of PS cases matched centrotemporal spikes lateralization.</p><p><strong>Conclusions: </strong>This study demonstrates a significantly higher prevalence of 14 and 6 Hz PS in children with Self-limited Epilepsy with Centro-temporal spikes. Their high prevalence and similar age-dependent expression and sleep-related activation suggest that PS may reflect developmental immaturity in thalamocortical networks, immature corticolimbic circuits, and heightened cortical excitability. These findings challenge the traditional view of PS as benign and support their potential role in thalamocortical dysregulation in self-limited childhood epilepsies.</p>","PeriodicalId":15516,"journal":{"name":"Journal of Clinical Neurophysiology","volume":" ","pages":"441-445"},"PeriodicalIF":1.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}