Journal of Clinical Medicine最新文献

{"title":"The Role of Cardiovascular Magnetic Resonance Imaging in Athletic Individuals-A Narrative Review.","authors":"Neil Grech, Mark Abela","doi":"10.3390/jcm14103576","DOIUrl":"https://doi.org/10.3390/jcm14103576","url":null,"abstract":"<p><p>Cardiovascular magnetic resonance imaging (MRI) is an advanced cardiac imaging modality that is often required when evaluating athletic individuals. Unrestricted imaging planes, excellent spatial resolution, and a lack of ionising radiation are some of the benefits of this modality. Cardiac MRI has been established as the gold standard imaging modality for morphological assessment, volumetric analysis, and tissue characterisation. Cardiac MRI without any doubt is an excellent diagnostic tool when evaluating athletes with symptoms or those individuals exhibiting equivocal findings at screening. It is also useful for athletes who fall within the grey zone and is especially important among athletes with a suspected or confirmed diagnosis. Cardiac MRI plays a strategic role when adopting a shared decision-making model in athletes with heart disease, tailoring and personalising medical care to the condition and the athlete's wishes. The aim of this review is to provide a comprehensive yet practical overview of the role of cardiac MRI when evaluating athletes in clinic.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159473","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":"Unusual Presentation of Metastatic Testicular Mixed-Germ Cell Tumor with Intracardiac Extension: A Case Report.","authors":"Marlon Rojas-Cadena, Felipe Rodríguez-Arcentales, Williams Lata, Karla Mera Sacoto, Luis Guerrero, Katherin Narváez Inca, Marlon Arias-Intriago, Esteban Ortiz-Prado, Juan S Izquierdo-Condoy","doi":"10.3390/jcm14103564","DOIUrl":"https://doi.org/10.3390/jcm14103564","url":null,"abstract":"<p><p><b>Background:</b> Testicular germ cell tumors (GCTs) are highly curable malignancies, particularly when diagnosed early. However, cardiac metastases are exceedingly rare-occurring in less than 1% of cases-and pose significant diagnostic and therapeutic challenges. Intracardiac involvement is exceptionally uncommon and typically necessitates a multidisciplinary approach for optimal management. <b>Objective:</b> To present a rare case of metastatic testicular GCT with intracardiac extension in a young male, underscoring the diagnostic complexity and therapeutic considerations of this unusual clinical scenario. <b>Case Report:</b> A 23-year-old male presented with diffuse abdominal pain, dyspnea, and a palpable right testicular mass. Imaging revealed a testicular tumor with metastases to the lungs, liver, retroperitoneal lymph nodes, and a large intracardiac mass extending from the inferior vena cava into the right atrium. Histopathology confirmed a mixed-germ cell tumor consisting of 75% seminoma, 20% embryonal carcinoma, and 5% teratoma. The patient underwent radical right orchiectomy followed by chemotherapy with the BEP regimen (bleomycin, etoposide, cisplatin). Cardiac magnetic resonance imaging confirmed the intracardiac mass, which significantly decreased in size after treatment. Serum tumor markers (AFP and β-hCG) also showed substantial post-treatment declines, corresponding with clinical improvement. <b>Conclusions:</b> This case highlights a rare presentation of metastatic testicular GCT with intracardiac involvement, emphasizing the importance of recognizing atypical metastases. Despite its complexity, the patient responded well to chemotherapy, reinforcing the effectiveness of current treatments. Long-term follow-up and a multidisciplinary approach are essential for monitoring recurrence and complications, contributing to the understanding of rare metastatic patterns and the need for further research.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Targeting LDL-C Levels Below 70 mg/dL Beneficial for Cardiovascular and Overall Health? A Critical Examination of the Evidence.","authors":"Folkert H van Bruggen, David M Diamond","doi":"10.3390/jcm14103569","DOIUrl":"https://doi.org/10.3390/jcm14103569","url":null,"abstract":"<p><p>Over the past two decades, cardiovascular disease (CVD) prevention guidelines have progressively lowered LDL-C targets to <70 mg/dL for high-risk individuals based on the assumption of a linear relationship between LDL-C levels and CVD risk. However, the available evidence challenges this premise. Multiple studies demonstrate a weak or inconsistent association between LDL-C levels and atherosclerosis progression at the individual patient-level. Systematic reviews supporting the linearity assumption have notable limitations, including extrapolation beyond observed LDL-C ranges and potential ecological fallacy, as meta-regression analyses rely on study-level data, while patient-level data within the same trials often show no association between LDL-C reduction and CVD outcomes. Moreover, randomized controlled trials explicitly designed to assess LDL-C targets have yielded inconclusive and biased results. LDL-C itself is a heterogeneous marker, with particle size and composition influencing its atherogenicity. The cardiovascular benefits of lipid-lowering therapies may arise in part from pleiotropic effects unrelated to LDL-C lowering. Additionally, several studies indicate that higher LDL-C levels are paradoxically associated with longevity in elderly populations that is equal to or even greater than that of the general population. Collectively, this body of evidence raises questions about the validity of current LDL-C targets < 70 mg/dL in high-risk patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158725","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":"Socioeconomic Disadvantage, Residential Remoteness and Access to Specialised Interventions in Cerebral Palsy: A Cross-Sectional Study.","authors":"Simon P Paget, Kirsty Stewart, Lisa Copeland, Emma Waight, Nadine Smith, Felicity Baker, Jennifer Lewis, On Behalf Of The Australian Selective Dorsal Rhizotomy Research Group And Australian Paediatric Intrathecal Baclo-Fen Research Group","doi":"10.3390/jcm14103579","DOIUrl":"https://doi.org/10.3390/jcm14103579","url":null,"abstract":"<p><p><b>Aim</b>: Socioeconomic factors are known to influence access to health services, including for children with cerebral palsy (CP). This study aims to determine whether socioeconomic disadvantage and/or geographical remoteness influence access to specialised CP interventions: selective dorsal rhizotomy (SDR) and intrathecal baclofen (ITB). <b>Methods</b>: This was a cross-sectional study of children with CP from (i) the Australian SDR Research Registry and (ii) an Australian ITB audit study. Socioeconomic disadvantage was grouped (quintiles) using the Index of Relative Socioeconomic Disadvantage (IRSD). Geographical remoteness was determined using the Australian Statistical Geographical Standard. IRSD quintiles and remoteness were compared with the Australian CP Register (ACPR) (birth years 1995-2016). <b>Results</b>: A total of 64 children (31.3% female) had received SDR surgery and 52 children (48.1% female) had received ITB therapy. Of these, 7 (11.1%) (SDR) and 7 (13.5%) (ITB) lived in the most disadvantaged neighbourhoods (IRSD quintile 1); 41 children (65.1%) (SDR) and 42 (82.4%) (ITB) lived in major cities. In comparison, 1630 (18.8%) of children on the ACPR resided in IRSD quintile 1; 6122 (70.4%) resided in major cities. There were no statistical differences in IRSD distribution between ACPR, SDR, and ITB groups. More children in major cities received ITB therapy (<i>p</i> = 0.03) and more children in outer regional/remote areas had received SDR (<i>p</i> = 0.03). <b>Conclusions</b>: Access to SDR and ITB in Australia varies by geographical remoteness. Equity of access is important to monitor, and interventions should be considered to reduce inequity.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159026","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":"Comparative Outcomes of Amblyopia Treatment in High Astigmatism: Stability and Sustained Improvements.","authors":"Chia-Chen Hsu, Lung-Chi Lee, Hsu-Chieh Chang, Chun-Hao Huang, Ke-Hung Chien","doi":"10.3390/jcm14103577","DOIUrl":"https://doi.org/10.3390/jcm14103577","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Astigmatism is a major risk factor for amblyopia. While optical correction improves visual acuity (VA), the long-term treatment outcomes, particularly in children with high astigmatism, remain understudied. This study aimed to determine the treatment effects, time course, and visual outcomes in children aged 3-7 years with high astigmatism and compared their VA improvement with those with low astigmatism. <b>Methods</b>: This retrospective cohort study included 63 children with untreated high with-the-rule astigmatism (≥+2.50 diopters [D]) and 46 with low astigmatism (≤1.50 D). The children with high astigmatism were classified based on their baseline best-corrected VA (BCVA) into good-VA (20/25 or better, <i>n</i> = 24), mild-VA-impairment (20/25-20/40, <i>n</i> = 19), and amblyopia (20/40 or worse, <i>n</i> = 20) groups. The primary outcomes include maximal improvement in mean BCVA post treatment, the cumulative probability of achieving a VA of 20/25 or better, and being within one line of the fellow eye. <b>Results</b>: The amblyopia, mild-VA-impairment, good-VA, and low astigmatism control groups showed mean improvements of logarithm of the minimum angle of resolution of 0.36 ± 0.08, 0.15 ± 0.05, 0.03 ± 0.04, and 0.01 ± 0.04, respectively. Post treatment with optical correction and/or patching over a mean duration of 46.61 ± 35.22 weeks, amblyopia resolved in all affected children. In the mild-VA-impairment group, only one child did not respond successfully to the treatment. The mean final VA showed no significant intergroup differences (<i>p</i> = 0.115). No amblyopia recurrence was observed at a mean follow-up of 118.33 weeks post resolution. <b>Conclusions</b>: Timely optical correction and patching effectively improve VA in children with high astigmatism, achieving outcomes comparable to those with low astigmatism.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159056","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":"Perceived and Dispositional Hope as Health-Related Constructs: Adaptation and Validation of the Polish Version of the Perceived Hope Scale.","authors":"Elżbieta Katarzyna Kasprzak, Karolina Mudło-Głagolska, Andreas Krafft","doi":"10.3390/jcm14103578","DOIUrl":"https://doi.org/10.3390/jcm14103578","url":null,"abstract":"<p><p><b>Background</b>: The effectiveness of treatment depends on recognizing the needs and limitations of patients. Hope is a personal resource that facilitates the treatment and recovery process. Dispositional hope encompasses goal-directed action, whereas perceived hope lacks reference to specific content or behavior. This study examined which construct is more strongly related to psychological, physical, and emotional health. Perceived hope requires a new tool for measurement. Adaptation to the Polish cultural context is the second goal of this research. <b>Methods</b>: Data were collected in the international online study Barometer of Hope (n = 1608). Adult participants completed the PSH, ADHS, and a battery of self-report questionnaires assessing several key well-being outcomes. <b>Results</b>: Perceived hope appears to be a more salient construct related to psychological health than dispositional hope, although both aspects of hope demonstrate similar associations with physical health. Confirmatory factor analysis (CFA) supported the hypothesized one-factor structure of the Polish version of the Perceived Hope Scale (PHS-PL), indicating high internal consistency as well as strong convergent and discriminant validity. The PHS-PL showed positive correlations with optimism, life satisfaction, happiness, positive affect, and dispositional hope, and negative correlations with depression/anxiety, loneliness, and negative affect. Additionally, perceived hope was negatively associated with the likelihood of a crisis scenario and positively associated with the likelihood of a flourishing scenario. <b>Conclusions</b>: Our findings confirm that hope is a health-enhancing resource. The PHS is a simple, short, culturally universal method that directly measures hope and can also be successfully used by non-psychologists, such as nurses, physicians, and caregivers.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159074","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":"High Prevalence of Metabolic-Associated Fatty Liver Disease (MAFLD) in Children and Adolescents with Severe Obesity.","authors":"Magdalena Mierzwa, Żaneta Malczyk, Mirosław Bik-Multanowski, Stephanie Brandt-Heunemann, Bertram Flehmig, Ewa Małecka-Tendera, Artur Mazur, Elżbieta Petriczko, Michael B Ranke, Martin Wabitsch, Małgorzata Wójcik, Agata Domżol, Agnieszka Zachurzok","doi":"10.3390/jcm14103565","DOIUrl":"https://doi.org/10.3390/jcm14103565","url":null,"abstract":"<p><p><b>Background</b>: Severe obesity in children and adolescents presents a particular health burden due to high prevalence of complications and comorbidities, including metabolic-associated fatty liver disease (MAFLD). The aim of this study was to assess the prevalence of MAFLD in Polish children and adolescents with severe obesity, and assess its relation to anthropometric profiles and metabolic risk factors. <b>Patients and Methods</b>: In 212 children and adolescents with severe obesity (aged 3-18 years), physical examination, body composition, liver ultrasound (US), and biochemical assessment were performed. MAFLD was diagnosed based on the presence of steatosis in US and/or persistently elevated alanine aminotransferase concentration. <b>Results</b>: MAFLD was present in 125 (59.0%) patients. Metabolic Syndrome (MetS) was diagnosed among 57.5% of patients without MAFLD, and in 66.5% of patients with MAFLD (<i>p</i> > 0.05). Impaired fasting glucose, impaired glucose tolerance, and high HOMA-IR occurred more frequently in MAFLD than in non-MAFLD patients (<i>p</i> < 0.05). In the MAFLD group, a higher number of patients with ≥4 components of MetS were observed than in the non-MAFLD group (33.6% vs. 12.6%, <i>p</i> = 0.0004). <b>Conclusions</b>: The prevalence of MAFLD among children and adolescents with severe obesity was 59%. These patients are characterised by more pronounced insulin resistance and higher number of MetS components.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159293","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":"Enhancing Intraoral Scanning Accuracy: From the Influencing Factors to a Procedural Guideline.","authors":"Anca Maria Fratila, Adriana Saceleanu, Vasile Calin Arcas, Nicu Fratila, Kamel Earar","doi":"10.3390/jcm14103562","DOIUrl":"https://doi.org/10.3390/jcm14103562","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Intraoral scanning, a fast-evolving technology, is increasingly integrated into actual dental workflows due to its numerous advantages. Despite its growing adoption, challenges related to the accuracy of digital impressions remain. The existing literature identifies most of the factors influencing intraoral scanning accuracy (defined by precision and trueness), but it is fragmented and lacks a unified synthesis. In response to this gap, the present study aims to consolidate and structure the current evidence on the determinant factors and, based on these findings, to develop a clinically applicable procedural guideline for dental practitioners. <b>Methods</b>: A comprehensive literature review identified 43 distinct factors influencing intraoral scanning. <b>Results</b>: These factors encompass variables such as software versions and updates, implant characteristics (e.g., position, angulation, scan body design), materials, environmental conditions (e.g., lighting), and procedural elements including scanning strategy, pattern, aids, and operator experience. Subsequently, these identified factors were systematically classified into five distinct groups based on inherent similarities and relevance within the scanning workflow: IOS-characteristics and maintenance, intraoral morphology, materials, ambient conditions, and scanning strategy. To translate these findings into a practical framework, a four-step protocol was developed, designed for straightforward application by researchers and clinicians. <b>Conclusions</b>: This protocol-comprising: (1) Maintenance, (2) Evaluation, (3) Establishment and Execution of Scanning Strategy, and (4) Verification-aims to guide users effectively through the intraoral scanning process, mitigate common clinical challenges, and ensure broad applicability across diverse scanner systems, irrespective of the manufacturer or model.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159326","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":"PSMA PET as a Tool for Active Surveillance of Prostate Cancer-Where Are We at?","authors":"Jonathon Carll, Jacinta Bonaddio, Nathan Lawrentschuk","doi":"10.3390/jcm14103580","DOIUrl":"https://doi.org/10.3390/jcm14103580","url":null,"abstract":"<p><p>Active surveillance remains the preferred treatment for men with low-risk prostate cancer and select men with favourable intermediate-risk prostate cancer. It involves the close observation of clinicopathological parameters to assess for disease progression, aiming to delay or avoid definitive treatment and related toxicities for as long as possible, without compromising oncological outcomes. A recent advancement in prostate cancer staging is the PSMA PET scan, which uses a tracer that strongly binds a highly expressed cellular biomarker for prostate cancer. Recent articles have also demonstrated that PSMA PET may be a useful tool for risk-stratifying prostate cancer, with the SUVMax of the scan correlated with higher-grade prostate cancer. This has ignited interest in the potential use of PSMA PET to identify men with higher-risk prostate cancer who may be unsuitable for active surveillance, particularly those who were incorrectly classified as lower risk upon initial diagnosis. This review article aims to assess the current state of the literature and clinical guidelines regarding the use of PSMA PET as a tool to risk-stratify prostate cancer, and whether it can be incorporated into active surveillance protocols to identify men who were incorrectly risk-stratified at time of initial diagnosis.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159519","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":"Perspective on Perinatal Birth Canal Injuries: An Analysis of Risk Factors, Injury Mechanisms, Treatment Methods, and Patients' Quality of Life: A Literature Review.","authors":"Patrycja Głoćko, Sylwia Janczak, Agnieszka Nowosielska-Ogórek, Wiktoria Patora, Olga Wielgoszewska, Mateusz Kozłowski, Aneta Cymbaluk-Płoska","doi":"10.3390/jcm14103583","DOIUrl":"https://doi.org/10.3390/jcm14103583","url":null,"abstract":"<p><p>Perineal injuries are a common complication of vaginal delivery, affecting 75-85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing-preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159299","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}