Journal of Intensive Care Medicine最新文献

{"title":"Anticoagulation Monitoring Strategies During Extracorporeal Membrane Oxygenation (ECMO) Therapy - Differences Between Simultaneously Obtained Coagulation Tests: A Retrospective Single-Center Cohort Study.","authors":"Alexander C Reisinger, Nikolaus Schneider, Marco Koellinger, Stefan Hatzl, Gerald Hackl, Reinhard Raggam, Dirk von Lewinski, Florian Posch, Philipp Eller","doi":"10.1177/08850666241313357","DOIUrl":"https://doi.org/10.1177/08850666241313357","url":null,"abstract":"<p><strong>Introduction: </strong>During extracorporeal membrane oxygenation (ECMO) systemic anticoagulation with unfractionated heparin (UFH) is standard-of-care. However, there is uncertainty regarding optimal anticoagulation monitoring strategies.</p><p><strong>Methods: </strong>We retrospectively investigated venovenous and venoarterial ECMO patients at the medical ICUs at the Medical University of Graz, Austria. We analyzed the correlation and concordance of R-time in thromboelastography (TEG), activated partial thromboplastin time (aPTT), and anti-Xa activity. The proportion within target range, the association of coagulation parameters above or below target range (aPTT 54-72 s; equals 1.5-2× upper limit of normal (ULN), anti-Xa activity 0.2-0.5 U/mL, and R-time in assays without heparinase 675-900 s; equals 1.5-2× ULN) with mortality, bleeding events and thrombotic complications were investigated.</p><p><strong>Results: </strong>We analyzed 671 clusters of simultaneously performed coagulation tests in 85 ECMO cases that fulfilled inclusion criteria. Median age of patients was 57 years and 32% were female. There were poor correlations between the three coagulation tests and the proportion of discordance was 46%. Within the target range were 21% of R-time, 15% of aPTT, and 44% of anti-Xa activity measurements. Singular and multiple bleeding events occurred in 25 and 32 patients, respectively. The most common bleeding locations were catheter and cannula insertion sites followed by pulmonary hemorrhage. In VA-ECMO, anti-Xa activity was associated (OR 1.03 [1.01-1.06], p = 0.005) and correlated with bleeding events (spearman rho 0.49, p = 0.002; point biserial 0.49, p = 0.001). aPTT level below target range was associated with reduced mortality (OR 0.98 [0.97-0.99], p = 0.024). Thrombotic events occurred in six patients with no association of coagulation tests.</p><p><strong>Conclusion: </strong>There was a high rate of discordance and poor correlation between aPTT, anti-Xa activity and R-time in TEG in ECMO patients. We found high rates of bleeding events and in VA-ECMO an association with elevated anti-Xa activity levels.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241313357"},"PeriodicalIF":3.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255816","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":"Relationship Between the Prognostic Nutritional index and Short-Term Prognosis among Patients with Community-Acquired Bacterial Pneumonia: A Retrospective Analysis of the MIMIC-IV.","authors":"Qingsong Wu, Lianyi Liao, Qingjun Deng","doi":"10.1177/08850666251315718","DOIUrl":"https://doi.org/10.1177/08850666251315718","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to investigate the association between the prognostic nutritional index (PNI) and the short-term outcomes in patients with community-acquired bacterial pneumonia (CABP).</p><p><strong>Design: </strong>This study employed a retrospective design, utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-IV database.</p><p><strong>Participants: </strong>371 individuals from the MIMIC-IV database who were diagnosed with CABP.</p><p><strong>Primary and secondary outcomes: </strong>The primary endpoint was 28-day all-cause mortality. The secondary endpoint was the length of stay (LOS) in the intensive care unit (ICU) and in hospital.</p><p><strong>Results: </strong>The area under the curve of PNI for predicting 28-day all-cause mortality is 0.702 (95% CI 0.630 to 0.775; <i>p</i> < 0.001). Patients were divided into two groups based on their PNI at admission: the low PNI (<35.75) group and the high PNI group (≥35.75). CABP patients with higher PNI presented a lower 28-day all-cause mortality rate (adjusted HR: 0.53, 95% CI 0.28-0.98, <i>p</i> = 0.044). Moreover, a negative linear correlation was found between the PNI and short-term mortality rates via restricted cubic splines. Eventually, there was no difference in the LOS in the ICU or hospital between the two groups.</p><p><strong>Conclusion: </strong>These findings suggest a negative correlation between the PNI at admission and the short-term mortality rate of CABP. PNI is helpful for early identification of high-risk patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251315718"},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189268","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":"Muscle Dysfunction and Physical Recovery After Critical Illness.","authors":"Matthew F Mart, Joshua I Gordon, Felipe González-Seguel, Kirby P Mayer, Nathan Brummel","doi":"10.1177/08850666251317467","DOIUrl":"10.1177/08850666251317467","url":null,"abstract":"<p><p>During critical illness, patients experience significant and rapid onsets of muscle wasting and dysfunction with loss of strength, mass, and power. These deficits often persist long after the ICU, leading to impairments in physical function including reduced exercise capacity and increased frailty and disability. While there are numerous studies describing the epidemiology of impaired muscle and physical function in the ICU, there are significantly fewer data investigating mechanisms of prolonged and persistent impairments in ICU survivors. Additionally, while several potential clinical risk factors associated with poor physical recovery have been identified, there remains a dearth of interventions that have effectively improved outcomes long-term among survivors. In this article, we aim to provide a thorough, evidence-based review of the current state of knowledge regarding muscle dysfunction and physical function after critical illness with a focus on post-ICU and post-hospitalization phase of recovery.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666251317467"},"PeriodicalIF":3.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189283","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":"Right Heart Failure in the Intensive Care Unit: Etiology, Pathogenesis, Diagnosis, and Treatment.","authors":"Elizabeth Tarras, Akhil Khosla, Paul M Heerdt, Inderjit Singh","doi":"10.1177/08850666231216889","DOIUrl":"10.1177/08850666231216889","url":null,"abstract":"<p><p>Right heart (RH) failure carries a high rate of morbidity and mortality. Patients who present with RH failure often exhibit complex aberrant cardio-pulmonary physiology with varying presentations. The treatment of RH failure almost always requires care and management from an intensivist. Treatment options for RH failure patients continue to evolve rapidly with multiple options available, including different pharmacotherapies and mechanical circulatory support devices that target various components of the RH circulatory system. An understanding of the normal RH circulatory physiology, treatment, and support options for the RH failure patients is necessary for all intensivists to improve outcomes. The purpose of this review is to provide clinical guidance on the diagnosis and management of RH failure within the intensive care unit setting, and to highlight the different pathophysiological manifestations of RH failure, its hemodynamics, and treatment options available at the disposal of the intensivist.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"119-136"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460337","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":"Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model.","authors":"Ralph T Perry, John W Weimer, Carrie Pratt, Marci D Newcome, Gabor Bagameri, J Kyle Bohman","doi":"10.1177/08850666241268458","DOIUrl":"10.1177/08850666241268458","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS).</p><p><strong>Design: </strong>Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway.</p><p><strong>Setting: </strong>A large tertiary referral academic cardiac surgery ICU.</p><p><strong>Participants: </strong>There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase.</p><p><strong>Interventions: </strong>Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model.</p><p><strong>Measurements and main results: </strong>Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (<i>P</i> = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (<i>P</i> = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (<i>P</i> = .30).</p><p><strong>Conclusions: </strong>Overall, implementation of an NP/PA-led postcardiac surgical ICU team (<i>rapid recovery pathway</i>) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"178-183"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878887","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":"Dexmedetomidine Improves Microcirculatory Alterations in Patients With Initial Resuscitated Septic Shock.","authors":"Jingyuan Xu, Yeming Wang, Chang Shu, Wei Chang, Fengmei Guo","doi":"10.1177/08850666241267860","DOIUrl":"10.1177/08850666241267860","url":null,"abstract":"<p><p><b>Trial registration:</b> Clinicaltrials.gov NCT02270281. Registered October 16, 2014.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"137-144"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080589","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":"Respiratory-rate Oxygenation index for Predicting Noninvasive Ventilation Associated With High-flow Nasal Cannula Failure in Acute Respiratory Failure Due to SARS-CoV-2.","authors":"Camille Blakeley, Stéphanie Pons, Emmanuel Pardo, Elodie Baron, Noémie Claviéras, Valentine Battisti, Mona Assefi, Jean-Michel Constantin","doi":"10.1177/08850666241268452","DOIUrl":"10.1177/08850666241268452","url":null,"abstract":"<p><strong>Purpose: </strong>The respiratory rate-oxygenation (ROX) index is used to predict high-flow nasal cannula (HFNC) success in acute respiratory failure, including in Coronavirus disease 2019 (COVID-19) patients. However, no study has described its performance to predict failure of alternating sessions of noninvasive ventilation (NIV) and HFNC in severe COVID-19 patients.</p><p><strong>Material and methods: </strong>We conducted a monocentric retrospective cohort study. COVID-19 patients admitted in the intensive care unit (ICU) for acute respiratory failure were treated by alternating sessions of HFNC and NIV. The primary endpoint was the ability for ROX index at 2 hours (h) of NIV initiation to predict HFNC/NIV failure defined by orotracheal intubation (OTI) within 7 days after noninvasive support initiation.</p><p><strong>Results: </strong>One hundred and five patients were included in analysis, of which 47% (<i>n</i> = 49) required OTI by day seven. ROX index values were significantly lower in intubated group at all time points but 24 h. In multivariate analysis, a ROX index at 2 h < 4.88 was associated with a higher risk of HFNC/NIV failure (Hazard Ratio 1.90 [95% Confidence Interval 1.03-3.51], <i>p</i> = 0.039). The area under the receiver operating characteristic curve for ROX index at 2 h was 0.702 [0.608-0.790]. Optimal cut-off value was 5.22. Sensitivity and specificity for predicting intubation with this threshold were 71.4% and 63.3%, respectively.</p><p><strong>Conclusions: </strong>In our study, the ROX index had a good predictive power for alternating sessions of HFNC and NIV failure in patients with acute respiratory failure due to SARS-CoV-2.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"151-163"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801142","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":"Telemedicine Rounding Support for Public Health System Pediatric Intensive Care Units in Brazil can Improve Outcomes.","authors":"Vanessa Cristina Jacovas, Hilda Maria Rodrigues Moleda Constant, Maria Cristina Cotta Matte, Carina Galves Crivella, Maria Eulália Vinadé Chagas, Guilherme Carey Fröhlich, João Ronaldo Mafalda Krauzer, Luciano Remião Guerra, Aristóteles de Almeida Pires, Luciane Gomes da Cunha, Taís de Campos Moreira, Felipe Cezar Cabral","doi":"10.1177/08850666241268842","DOIUrl":"10.1177/08850666241268842","url":null,"abstract":"<p><p>There are discrepancies in resources and expertise available between pediatric intensive care units (PICUs) in Brazil that likely significantly impact the clinical outcomes of patients. The goal of this study was to evaluate the impact of telemedicine rounding support in two public PICUs located in the North and Northeast regions of Brazil. Our intervention involves telehealth rounds connecting two \"level II\" PICUs with specialist doctors from a hospital of recognized excellence. A before-and-after study was carried out to evaluate telemedicine's impact on PICUs between December 2018 and July 2019. Nine hundred and forty patients were evaluated during this period (426 pre-telemedicine, 514 post-telemedicine). The intervention occurred through telerounds between the command center and the ICUs assisted by telemedicine. In unit A, the implementation of telemedicine reduced the mortality rate from 18.86% to 9.29%, while in unit B, it decreased from 10.76% to 9.72%. There was no change in the median length of stay in unit A, but in unit B, it increased from 6 to 8 days. Logistic regression analysis confirmed a significant reduction in mortality in unit A (odds ratio (OR) 0.50; 95% confidence interval (CI) 0.29-0.86). The study found a positive correlation between adherence to telemedicine recommendations and mortality reduction across both units. This suggests that telemedicine can effectively improve outcomes in PICUs, particularly in regions with limited health-care resources.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"145-150"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154354","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":"Extracorporeal-CPR Versus Conventional-CPR for Adult Patients in Out of Hospital Cardiac Arrest- Systematic Review and Meta-Analysis.","authors":"Swetha Reddy, Samuel Garcia, Logan J Hostetter, Alexander S Finch, Fernanda Bellolio, Pramod Guru, Danielle J Gerberi, Nathan J Smischney","doi":"10.1177/08850666241303851","DOIUrl":"10.1177/08850666241303851","url":null,"abstract":"<p><strong>Objective: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) utilizes veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in cardiac arrest patients to reduce the risk of mortality and multiorgan dysfunction from systemic hypoperfusion. We aimed to compare clinical outcomes of patients receiving ECPR versus conventional cardiopulmonary resuscitation (CCPR) for refractory cardiac arrest.</p><p><strong>Data sources: </strong>This was a systematic review and meta-analysis. A librarian searched the main databases, Ovid MEDLINE (including epub ahead of print, in-process & other non-indexed citations), Ovid EMBASE and Ovid Cochrane Central Register of Controlled Trials from inception through July 2024.</p><p><strong>Study selection: </strong>We included randomized controlled trials and observational studies that compared the outcomes of ECPR to CCPR in cardiac arrest patients. Primary outcomes were neurological sequelae and survival.</p><p><strong>Data extraction: </strong>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently screened articles, extracted data on selected articles and performed risk of bias assessments using ROBINS-I for non-randomized controlled trials and the revised Cochrane risk of bias tool for randomized controlled trials with disagreements settled by a third independent reviewer.</p><p><strong>Data synthesis: </strong>Out of 3458 studies identified and screened, 28 studies including 304,360 cardiac arrest patients met eligibility criteria and were included. Survival at hospital discharge was 20% for ECPR versus 3.3% for CCPR (OR 0.48 [CI 0.27, 0.84]). Favorable neurological outcome at hospital discharge was 11.8% for ECPR versus 1.9% for CCPR (OR 0.41 [CI 0.17, 1.01]). Complications from bleeding were ten times higher in the ECPR group (35.3% vs 3.7%; OR 0.08 [0.03, 0.24]).</p><p><strong>Conclusions: </strong>ECPR appeared to be superior to CCPR for improved neurological outcome and survival in cardiac arrest patients, although bleeding was increased. There was large heterogeneity in the included studies and outcomes reported. Future prospective studies may improve the identification of subgroups of patients that will benefit most from ECPR.Systematic review and meta-analysis registration: PROSPERO - CRD42023394128.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"207-217"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785950","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":"Stroke Volume and Stroke Volume Variation, but not Cardiac Index Is Associated With Survival of Majorly Burned Patients in Early Burn Shock.","authors":"Marianne Kruse, Philip Plettig, David Josuttis, Denis Guembel, Claas Guethoff, Bernd Hartmann, Simon Kuepper, Volker Gebhardt, Marc Dominik Schmittner","doi":"10.1177/08850666241268470","DOIUrl":"10.1177/08850666241268470","url":null,"abstract":"<p><p>Adequate fluid therapy is crucial to maintain organ function after burn trauma. Major burns lead to a systemic response with fluid loss and cardiac dysfunction. To guide fluid therapy, measurement of cardiac pre- and afterload is helpful. Whereas cardiac function is usually measured after admission to intensive care unit (ICU), in this study, hemodynamic monitoring was performed directly after arrival at hospital. We conducted a prospective cohort study with inclusion of 19 patients (male/female 13/6, 55 ± 18 years, mean total body surface area 36 ± 19%). Arterial waveform analysis (PulsioFlexProAqt^®, Getinge) was implemented immediately after admission to hospital to measure cardiac pre- and afterload and to guide resuscitation therapy. Cardiac parameters 3.75 (2.67-6.0) h after trauma were normal regarding cardiac index (3.45 ± 0.82) L/min/m², systemic vascular resistance index (1749 ± 533) dyn sec/cm⁵ m², and stroke volume (SV; 80 ± 20) mL. Stroke volume variation (SVV) was increased (21 ± 7) % and associated with mortality (mean SVV survivors vs nonsurvivors 18.92 (±6.37) % vs 27.6 (±5.68) %, <i>P</i> = .017). Stroke volume was associated with mortality at the time of ICU-admission (mean SV survivors vs nonsurvivors 90 (±20) mL vs 50 (±0) mL, <i>P</i> = .004). Changes after volume challenge were significant for SVV (24 ± 9 vs19 ± 8%, <i>P</i> = .01) and SV (68 ± 24 vs 76 ± 26 mL, <i>P</i> = .03). We described association of SVV and SV with survival of severely burned patients in an observational study. This indicates high valence of those parameters in the early postburn period. The use of an autocalibrated device enables a very early monitoring of parameters relevant to burn shock survival.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"164-171"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875107","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}