Kate McGoldrick , SallyAnne Collis , Linda Mulligan
{"title":"A retrospective study of the injury patterns seen in fatal falls downstairs","authors":"Kate McGoldrick , SallyAnne Collis , Linda Mulligan","doi":"10.1016/j.jflm.2024.102767","DOIUrl":"10.1016/j.jflm.2024.102767","url":null,"abstract":"<div><h3>Introduction</h3><div>Fatal falls involving stairs are often associated with advanced age, intoxication, acute natural pathology and less commonly – the involvement of a third-party. The injury patterns seen in these cases are often complex and from a medico-legal standpoint, determining third-party involvement based on pathology alone can prove a significant challenge. Classifying the manner of death in such cases, can become particularly complex when the injury pattern appears inconsistent with a simple fall downstairs, or there is an absence of eye-witness testimony.</div></div><div><h3>Aim</h3><div>To explore the circumstances and injury patterns seen in cases of fatal falls downstairs which were classified as accidental vs. undetermined by the coroners.</div></div><div><h3>Study design</h3><div>This retrospective study explored the injury patterns present in all cases of fatal falls downstairs referred to the Office of the State Pathologist (OSP) over a 10-year-period (2012–2022) (n = 51).</div></div><div><h3>Results</h3><div>Fatal falls downstairs which were classified as undetermined were found to have a greater number of craniofacial fractures, spinal fractures and intracranial injuries when compared to accidental falls. Undetermined staircase deaths also displayed more significant fracturing involving the facial skeleton.</div></div><div><h3>Conclusion</h3><div>Ultimately, where there is a question of third-party involvement, the Post-Mortem Examination (PME) findings alone cannot determine the manner of death. The pathologist's examination may identify injuries that are inconsistent with a simple fall downstairs, but it is the coroner who must conduct a thorough investigation into the circumstances of the fatal fall and ultimately determine the classification of the death.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102767"},"PeriodicalIF":1.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445543","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":"Age estimation at death in individuals over 50 using CT images: An innovative anthropological approach","authors":"Mohamed Kenani , Marwa Boussaid , Oumeima Brahim , Mohamed Amine Mesrati , Abir Aissaoui","doi":"10.1016/j.jflm.2024.102766","DOIUrl":"10.1016/j.jflm.2024.102766","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of the present work is to develop a novel method for predicting age in individuals over 50 years old, utilizing regression models.</div></div><div><h3>Methods</h3><div>The conducted study is of an analytical cross-sectional nature, involving a sample of 44 young subjects and 107 elderly subjects. The necessary data for this research were extracted from \"The New Mexico Decedent Image Database.\" Based on the phenomenon of height shrinkage with age, we created models for young subjects and applied them to elderly subjects, allowing us to extract the variables.</div></div><div><h3>Results</h3><div>We obtained highly encouraging results with an R<sup>2</sup> of 0.73, a mean absolute error of 3.94, and stable cross-validation. We used a Student's t-test, which demonstrated no significant difference between predicted and actual values (p-value >0.05). We also conducted a learning curve analysis and examined residuals against predicted values. This suggests that the forecasts are accurate, with no significant bias in predictions.</div></div><div><h3>Conclusion</h3><div>This work has allowed us to conclude that it is possible to reliably estimate the age of subjects over 50, taking into account age-related physiological and pathological changes.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102766"},"PeriodicalIF":1.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407407","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}
Alexandria Yap , Radhika Sundararajan , Andrew Milewski , Mert Keceli , Mohammed Alkhafaji , Rachel Kowalsky
{"title":"“It changed my whole entire thinking”: Identifying narrative elements in medical affidavit writing for asylum seekers","authors":"Alexandria Yap , Radhika Sundararajan , Andrew Milewski , Mert Keceli , Mohammed Alkhafaji , Rachel Kowalsky","doi":"10.1016/j.jflm.2024.102759","DOIUrl":"10.1016/j.jflm.2024.102759","url":null,"abstract":"<div><div>The medical affidavit is critically significant for asylum seekers. Studies have shown that asylum seekers applying with a medical affidavit (versus without a medical affidavit) have double the success rate. There are many training resources for clinician-evaluators on the interviewing process, but little instruction exists on the affidavit writing process. Our objective was to identify the most common narrative elements in medical affidavits of successful (versus unsuccessful) asylum seekers to provide further writing guidance for clinician-evaluators. We hypothesized that these elements, when thoughtfully employed, help clinician-evaluators best represent their clients in the US immigration system. We focused on the most vulnerable applicants: those applying after the one-year deadline. Using grounded theory, we coded 23 affidavits filed after the one-year deadline for narrative elements. We identified seven narrative elements more common in medical affidavits of asylum seekers who filed after the one-year deadline and were successful: (1) Recommending specific clinical interventions; (2) Quoting elevated diction by the client; (3) Using headlines; including anecdotes that describe (4) The client forming human connections, (5) Archetypal female characters, (6) Love stories, or (7) Moments of realization.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102759"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396344","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":"Fatality from Firework-Induced Trauma: A Case Report","authors":"Antun Ferenčić, Tomaž Zupanc, Martin Mervic","doi":"10.1016/j.jflm.2024.102761","DOIUrl":"10.1016/j.jflm.2024.102761","url":null,"abstract":"<div><div>This case report presents the tragic death of a 56-year-old Slovenian woman who sustained fatal injuries from a stray firework during a New Year's Eve celebration in January 2024. The firework, launched by a relative, struck the woman in the right eye, causing extensive cranial and cerebral trauma. Despite immediate medical intervention, including attempted resuscitation, the woman was pronounced dead at the scene. The autopsy revealed severe damage, including fractures extending from the right orbital cavity to the occipital region and a penetrating brain injury affecting multiple regions of the brain. The case is complicated by the removal of the firework from the injury site before the arrival of emergency services, making the reconstruction of the exact sequence of events challenging. The findings emphasize the devastating consequences of fireworks-related injuries and the unique forensic challenges they present in determining the precise cause of death.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102761"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335245","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}
Laura Donato , Douglas H. Ubelaker , Valentina Bugelli , Jessika Camatti , Michele Treglia , Luigi Tonino Marsella , Rossana Cecchi
{"title":"Facial growth parameters in Down syndrome: Review of the literature and forensic application for missing persons age progression","authors":"Laura Donato , Douglas H. Ubelaker , Valentina Bugelli , Jessika Camatti , Michele Treglia , Luigi Tonino Marsella , Rossana Cecchi","doi":"10.1016/j.jflm.2024.102756","DOIUrl":"10.1016/j.jflm.2024.102756","url":null,"abstract":"<div><h3>Purpose</h3><div>Individuals with Down syndrome (DS) show growth trajectories which deviate from standard ones due to variations in the growth of facial structures. Studying the effect of aging on the faces of DS individuals is necessary to obtain an accurate result through age progression, a technique based on the study of physiognomic features and used in cases of missing persons. Here we present scientific publications that delve into the rhythms of aging and morphological characteristics of facial features in DS individuals to enable appropriate age progression in cases of missing DS individuals.</div></div><div><h3>Results</h3><div>The scientific literature considered in this review studies the growth of soft tissue and bone substrate by comparing standard growth values with those measured through anthropometric measurements of individuals with DS. Growth trajectories are described by considering morphological trends both by comparing standard values with those found in individuals with DS and by observing individual physiognomic traits.</div></div><div><h3>Conclusions</h3><div>When a young individual with DS goes missing, the realization of an age progression requires knowledge of the aging dynamics peculiar to the DS face. Therefore, physical, cognitive, and clinical factors must be considered. Delayed physical development and early aging, such as the onset of puberty and weight gain, have an important impact on the realization of age progression. In fact, depending on the life period to be considered, the effects of aging must be calibrated based on the knowledge gathered from scientific research.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102756"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356792","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}
Tess M. Wemeijer , Inez Moorman , Tristan Krap , (H) Erik Stigter , Wilma L.J.M. Duijst
{"title":"A study to determine a practical method for weight estimation of deceased persons","authors":"Tess M. Wemeijer , Inez Moorman , Tristan Krap , (H) Erik Stigter , Wilma L.J.M. Duijst","doi":"10.1016/j.jflm.2024.102765","DOIUrl":"10.1016/j.jflm.2024.102765","url":null,"abstract":"<div><h3>Background</h3><div>Body weight is an important parameter for estimating the postmortem interval (PMI) at a crime scene. However, a challenge arises at crime scenes when a weight scale for measuring the total body weight is unavailable. Anthropometry-based models to estimate body weight have been developed in previous studies. This study aims to determine the accuracy of body weight estimations by practitioners, test the anthropometry-based models for applicability to deceased individuals, and examine a potential new method based on applying heel weight.</div></div><div><h3>Methods</h3><div>A prospective study was conducted at the Isala Hospital in the Netherlands. During the study period, deceased people that were admitted to the hospital mortuary were included consecutively. The body weight of deceased persons estimated by practitioners was compared to the actual body weight. Anthropometric measurements were taken and used to perform eight sex dependant anthropometry-based models, with accuracy for the actual body weight calculated using RMSE values. A Pearson's correlation test was used to determine the correlation between heel weight and total body weight.</div></div><div><h3>Results</h3><div>During the study period, a total of 100 cases, 56 males and 44 females, were included. Overall, only 33.3 % of practitioners' estimations were within 5 % of the actual measured weight. The model based on abdominal and thigh circumference performed best for weight estimation in males and the models based on mid-arm circumference, abdominal circumference, calf circumference and, in one model, subscapular skinfold performed best in females. A Pearson's correlation test revealed a weak positive correlation between weight of the heel and total body weight (Pearson's correlation coefficient: 0.214).</div></div><div><h3>Discussion</h3><div>Estimations of underweight or obese patients posed a challenge for weight estimation. Especially in these cases, study results showed that anthropometry-based models have potential for daily practice. However, additional research is required to assess the reliability of the best performing models before implementation in forensic casework. The correlation between the weight of the heel and body weight was low, therefore implementation of the current method is not recommended, and further research is required.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102765"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396345","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":"In vitro β-hydroxybutyrate stability evaluation in femoral blood and vitreous humor for integration into forensic toxicology practices","authors":"Aurélien Bauduin , Chadi Abbara , Antoine Baudriller , Laurent Leuger , Séverine Ferec , Stéphane Malbranque , Nathalie Jousset , Marie Briet , Guillaume Drevin","doi":"10.1016/j.jflm.2024.102764","DOIUrl":"10.1016/j.jflm.2024.102764","url":null,"abstract":"<div><div>Thanatological biochemistry has gained prominence in determining causes of death, especially when suspected fatal pathologies do not exhibit clear postmortem macroscopic and/or microscopic features, such as in cases of ketoacidosis. Indeed, in these cases, the measurement of β-hydroxybutyrate (BHB) in femoral blood and/or vitreous humor is of particular importance. However, data on its in vitro stability remain scarce, especially in vitreous humor. In this context, the study reported here aims to assess the in vitro stability of BHB. BHB quantification was performed using a liquid chromatography coupled with tandem mass spectrometry method. To investigate BHB stability, two different postmortem matrices were considered: femoral blood and vitreous humor. These matrices were pooled, aliquoted and spiked with BHB at three different concentrations (50 mg/L, 100 mg/L, and 200 mg/L; n = 3). Initial BHB concentrations were established on day 1. Each sample was then divided into two aliquots for storage under two conditions: 20 °C and 4 °C. Analyses were performed on Day 3, 7, 14, and 28. The study revealed no significant degradation of BHB in femoral blood or vitreous humor over time (days 1–28), confirming the robustness and reliability of BHB measurement in these matrices as a postmortem biomarker of ketoacidosis under the tested temperature conditions (+4 °C or −20 °C). These results support a systematic integration of BHB measurement into the routine workflow of forensic toxicology laboratories<strong>.</strong></div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102764"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356793","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}
Alberto Amadasi , Lorenzo Franceschetti , Julia Babigian , Antonia Locatelli , Larissa Amadasi
{"title":"Between blunt, sharp and hacking trauma: Observing the characteristics of pickaxe injuries","authors":"Alberto Amadasi , Lorenzo Franceschetti , Julia Babigian , Antonia Locatelli , Larissa Amadasi","doi":"10.1016/j.jflm.2024.102763","DOIUrl":"10.1016/j.jflm.2024.102763","url":null,"abstract":"<div><div>Pickaxe injuries have never been thoroughly investigated in forensic science. This case, involving the fatal wounding of a 28-year-old individual by pickaxe blows to the head, abdomen, and hand, highlights the unique injury patterns associated with such an instrument. The injuries observed in the frontal skull exhibited characteristics akin to typical chop wounds, while those on the parietal skull bore similarities to blunt force trauma. The pickaxe penetrated the hands and the abdomen, with the depth of penetration directly correlating to the force applied. Consequently, pickaxe injuries can be considered a hybrid of different injury mechanisms, a fact that should be carefully considered in forensic analysis.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102763"},"PeriodicalIF":1.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327220","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}
Sara Sablone , Andrea Nicola Cardinale , Ettore Gorini , Lucia Diella , Alessandra Belati , Linda Bussini , Valeria Cento , Michele Bartoletti , Francesco Introna , Davide Fiore Bavaro
{"title":"Beyond the distance between juridic and scientific decision-making process: An evidence-based prediction algorithm for professional liability assessment in healthcare-associated infections","authors":"Sara Sablone , Andrea Nicola Cardinale , Ettore Gorini , Lucia Diella , Alessandra Belati , Linda Bussini , Valeria Cento , Michele Bartoletti , Francesco Introna , Davide Fiore Bavaro","doi":"10.1016/j.jflm.2024.102762","DOIUrl":"10.1016/j.jflm.2024.102762","url":null,"abstract":"<div><h3>Background</h3><div>HAIs (Healthcare-Acquired-Infections) have been recently the subject of judgment n. 6386 pronounced on 3rd March 2023 by the Italian Supreme Court. This sentence provided three criteria to determine whether a health facility is responsible for the patient contracting a nosocomial infection, i.e. time criterion, topographical criterion and clinical criterion. Accordingly, the healthcare facility is obliged to prove the fulfillment of a series of preventive hygiene measures specifically detailed by the legislator. Herein, the positive predictive value of these criteria (“juridic criteria”) in the identification of professional liability for nosocomial infections was evaluated in comparison with clinical criteria reviewed by Infectious Disease specialists (“Infectious-Disease criteria”, i.e. presence of a Multidrug Resistant Organism (MDRO); development of surgical site infection; inadequate antibiotic therapy; inadequate disinfection).</div></div><div><h3>Methods</h3><div>Two retrospective cohorts were compared from the Portal of Telematic Services of the Ministry of Justice; 51 patients were extrapolated from Italian judgments concerning claims for Gram-negative nosocomial infections in the three-year period 2020–2022. On the other side, from the electronic database of University Hospital of Bari we extracted 349 patients affected by Gram-negative infections in the same timespan. Both “juridic” criteria and “Infectious-Disease” criteria were then applied to the full cohort after stratification for cohort of origin and after stratification for nosocomial or non-nosocomial infections. Predictive value of criteria was evaluated through receiver operating characteristic (ROC) curves and area under the curve (AUC).</div></div><div><h3>Results</h3><div>Overall, the incidence of definite nosocomial infections (according to final judgement or clinical records discharge letter) was 84 % in juridic cohort and 46 % in “real-world” series.</div><div>Data suggested that the presence of all three juridic criteria [ROC AUC = 0.944 (95%CI = 0.924–0.963)] or the four clinical criteria [ROC AUC = 0.948 (95%CI = 0.928–0.969)] predicted well a case of nosocomial infection with professional liability.</div><div>Moreover, by summarizing both criteria in a single classification system, the generated ROC curve (was the one with the highest AUC [0.9488 (95%CI = 0.928–0.969)].</div><div>Accordingly, further tests were performed, evaluating the predictive value of one juridic criterium plus at one of more Infectious-Disease criteria. Interestingly, the ROCs curves demonstrated that the presence of at least 1 juridic criteria plus at least 2 Infectious Disease criteria reached a predictive value comparable to 2 or 3 juridic criteria.</div></div><div><h3>Conclusions</h3><div>The results highlight the efficiency of new criteria laid down in the judgment of the Italian Supreme Court to attribute liability for nosocomial infection despite the dispute","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102762"},"PeriodicalIF":1.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319664","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":"Transfer and persistence of microbiota markers from the human hand to the knife: A preliminary study","authors":"Sukriye Karadayı , İlknur Yılmaz , Tülin Özbek , Beytullah Karadayı","doi":"10.1016/j.jflm.2024.102757","DOIUrl":"10.1016/j.jflm.2024.102757","url":null,"abstract":"<div><p>New scientific techniques and methods are always needed to link the perpetrators to the incident or the crime scene. Recent microbiota studies based on NGS (Next-generation sequencing) show that various biological samples from crime scenes have the potential to be used in forensic investigations. Especially when DNA traces belonging to more than one person are insufficient to fully determine the genetic profile, a secret sample, such as a microbiota sample created by the suspect's touch, can be used. In this preliminary study, a fictionalized experimental model was designed to investigate the transfer and persistence of the hand microbiome on the knife handle, which has a high potential to be used in criminal incidents, by metagenomic analysis methods. In addition, it was aimed to determine the transfer of specific bacterial species identified only to the person among the five participants onto the knife handle and their persistence over time. In the first stage of the research, samples were collected from the hands of 5 volunteer participants using the swap method, including their palms. Then, after each participant held a different knife, samples were collected from the knife handles via swabs from different angles of the knives at 4 and 24 h and analyzed by metagenomic methods. The findings of this preliminary study showed that the heatmap graphs generated after UniFrac distance analysis were not successful in establishing any similarity between the hand samples and the post-transfer knife handle samples. Nonetheless, it was observed that the transfer of bacterial species detected in the hand samples to knives differed according to the individuals and some bacterial species were transferred to the knife samples held by the participants. The number of bacterial species detected that are specific to each participant's hand sample was 302 in total, and it was determined that a total of 8.28 % of these bacterial species were transferred to the knife handle samples of the 4th hour and 6.95 % to the knife samples of the 24th hour. In the presented study, considering the transfer of some bacterial species in the hand microbiome, which are effective in the variation between individuals, onto the knife; It has been evaluated that some rare bacterial species can be important potential markers to associate the object with the perpetrator.</p></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102757"},"PeriodicalIF":1.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239479","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}