Journal of minimally invasive gynecology最新文献

{"title":"Pelvic Splenosis Mimicking Pelvic Tumor","authors":"Liuqing Yang BA , Yuanyuan Cao MMed , Rulin Yang MD , Zanhui Jia MD","doi":"10.1016/j.jmig.2024.11.011","DOIUrl":"10.1016/j.jmig.2024.11.011","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 567-568"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food and Drug Administration Database Secondary Analysis: Difference in Operative Hysteroscopy Device Adverse Event Reporting","authors":"Arielle N. Valdez-Sinon MD, PhD ,&nbsp;Anja S. Frost MD ,&nbsp;Anita M. Madison MD, MPH ,&nbsp;Rand El Sharaiha MD ,&nbsp;Kristin E. Patzkowsky MD ,&nbsp;Megan E. Gornet MD","doi":"10.1016/j.jmig.2025.04.009","DOIUrl":"10.1016/j.jmig.2025.04.009","url":null,"abstract":"<div><h3>Study Objective</h3><div>To investigate, describe, and compare adverse event reports (AERs) and their patterns amongst commonly used operative hysteroscopy devices.</div></div><div><h3>Design</h3><div>A secondary analysis of the Manufacturer and User Facility Device Experience (MAUDE) published by the Food and Drug Administration.</div></div><div><h3>Setting</h3><div>N/A.</div></div><div><h3>Patients or Participants</h3><div>Women who underwent hysteroscopic surgery, with adverse events reported to MAUDE.</div></div><div><h3>Interventions</h3><div>Search terms within the MAUDE database included “resectoscope,” “hysteroscopic reciprocating morcellator,” “MyoSure,” and “TruClear.” Reports were categorized by device type, patient complications, and required interventions. Statistical analysis utilized Fisher’s exact tests.</div></div><div><h3>Measurements and Main Results</h3><div>Between January 2014 and April 2024, 1872 AERs were identified for hysteroscopes: 664 for resectoscopes and 1208 for morcellation devices (MyoSure, <em>N</em> = 645 and TruClear, <em>N</em> = 563). While absolute complication rates are not able to calculated from MAUDE, there were significant differences in the reporting of patient complications: resectoscope devices had higher frequency of infection (p &lt; .01) while morcellation devices had higher frequency reporting of hemorrhage (p &lt; .001), uterine perforation (p &lt; .001), and bowel perforation (p &lt; .001). Morcellation device AERs more often reported operative intervention (1.1% vs 12.4%, p &lt; .001). Subgroup analysis comparing AERs of morcellation devices showed the majority (73.2%) of TruClear AERs registered no patient impact or harm, while only 21.2% of MyoSure AERs reported no patient impact. MyoSure device AERs had higher frequency of hemorrhage (p &lt; .001), infections (p &lt; .001), uterine perforations (p &lt; .001), and bowel perforations (p &lt; .001). Additionally, MyoSure AERs reported more surgical intervention compared to TruClear AEs (19.5% vs 4.3%, p &lt; .001).</div></div><div><h3>Conclusion</h3><div>While conclusions within the MAUDE database are limited, especially given the lack of data concerning the volume of surgeries done with each device and the voluntary reporting mechanism, there are significant differences in the types of adverse events reported among operative hysteroscopy instruments. Morcellation AERs had a significantly higher frequency of patient complications and described more surgical interventions compared to AERs for resectoscopes. When comparing MyoSure and TruClear, MyoSure AERs described a significantly greater proportion of serious patient complications compared to TruClear device AERs. Devices with similar functions may differ in how stakeholders report complications.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 646-653.e1"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Surgery for Excision of Clinically Suspected Endometriosis Improves Perception of Lower Urinary Symptoms","authors":"Kelly L. Budge MD, MRes,&nbsp;Tamar Yacoel MD,&nbsp;Kateryna Kolesnikova MD,&nbsp;Khashayar Shakiba MD","doi":"10.1016/j.jmig.2025.01.015","DOIUrl":"10.1016/j.jmig.2025.01.015","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if surgical excision of suspected pelvic endometriosis patient's complaints of voiding dysfunction.</div></div><div><h3>Design</h3><div>This is a retrospective cohort study.</div></div><div><h3>Setting</h3><div>A large academic institution with a single urogynecologist provider between 2020 and 2021.</div></div><div><h3>Participants</h3><div>Patients with clinically-suspected endometriosis who also underwent minimally invasive surgical excision of endometriotic lesions were included. Clinical suspicion was based on symptoms including dysmenorrhea, pelvic pain, dyspareunia, urinary dysfunction, and dyschezia.</div></div><div><h3>Interventions</h3><div>A questionnaire was administered postoperatively to assess the perceived change in the severity of lower urinary tract symptoms (LUTS), specifically urinary urgency, frequency, and nocturia. The questionnaire was administered between 1 and 25 months after surgery. Documented pre-operative LUTS assessment was compared to postoperative symptoms.</div></div><div><h3>Results</h3><div>Of 71 patients (76.3% response rate), 90.1% (n=64) of patients with suspected endometriosis had preoperative LUTS. Of those with LUTS, symptoms were significantly decreased after surgical excision, a mean of 9.4±6.9 months after surgery. Endometriosis or adenomyosis was histologically confirmed in 81.7% (n=58) of participants: endometriosis, 69.0% (n=49); adenomyosis, 51.9% (n=14) of those who underwent hysterectomy. 87.7% (n=43) of patients with confirmed endometriosis had preoperative LUTS. Pathology-positive patients with preoperative LUTS experienced a significant reduction in symptoms: urinary urgency (p &lt;.0001), frequency (p &lt;.0001), and nocturia (p &lt;.0001) postoperative. Most endometriotic lesions were in the peritoneum (77.6%, n=38) and only 2.1% (n=1) were located on the bladder.</div></div><div><h3>Conclusion</h3><div>LUTS are often overlooked or not discussed enough by healthcare providers in connection with endometriosis. Excision of suspected endometriosis by minimally invasive surgical intervention provided significant relief of LUTS, even in the absence of visible bladder lesions. Surgical management has an increasing clinical role in the improvement of LUTS.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 621-628.e2"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involvement of Morrison's Pouch in Right Upper Quadrant Endometriosis","authors":"Donya Derakshani BS ,&nbsp;Staci E. Beamer MD ,&nbsp;Chee-Chee Stucky MD ,&nbsp;Megan Wasson DO","doi":"10.1016/j.jmig.2024.10.006","DOIUrl":"10.1016/j.jmig.2024.10.006","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 576-578"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Medication for Ovarian Endometrioma Reduces Cyst Size and Pain but Not rASRM Score","authors":"Hye-Ji Jung MD,&nbsp;Sung Eun Kim MD,&nbsp;Hyeonmyeong Hong MD,&nbsp;Dong-Yun Lee MD, PhD,&nbsp;DooSeok Choi MD, PhD","doi":"10.1016/j.jmig.2025.01.010","DOIUrl":"10.1016/j.jmig.2025.01.010","url":null,"abstract":"<div><h3>Study Subject</h3><div>To investigate the impact of preoperative hormonal medication, including combined oral contraceptives or dienogest, on operative findings in ovarian endometrioma surgery.</div></div><div><h3>Design</h3><div>A single-center, retrospective study.</div></div><div><h3>Setting</h3><div>Department of Gynecology, Samsung Medical Center, Republic of Korea.</div></div><div><h3>Participants</h3><div>Among patients who underwent ovarian endometrioma surgery for the first time at Samsung Medical Center between January 2020 and July 2023, those who started hormonal medication at another institution before their initial visit to our center, those with a waiting period of less than 3 months until the surgery date, and those with an endometrioma size of less than 4 cm at the initial visit were excluded. A total 140 remaining patients were included in the study. The patients were divided into two groups: the group that received preoperative hormonal medication (combined oral contraceptives or dienogest) and the group that did not receive medication.</div></div><div><h3>Interventions</h3><div>To evaluate the impacts of preoperative hormonal medication on ovarian endometrioma patients, the operative findings were compared between the groups.</div></div><div><h3>Results</h3><div>Of the 140 patients, 65 were in the no-medication group and 75 were in the medication group. Except for the median duration of follow-up and age, there were no differences in the baseline characteristics between the two groups. Operative findings were quantified using the revised American Society for Reproductive Medicine score. Although medication significantly reduced the size of the ovarian endometrioma, there were no significant differences in revised American Society for Reproductive Medicine score between the two groups. However, the medication group experienced significant preoperative pain relief.</div></div><div><h3>Conclusion</h3><div>Preoperative hormonal medication can reduce the size of ovarian endometriomas but does not significantly affect the overall operative findings. Nevertheless, preoperative medication is helpful in reducing pain in patients before surgery.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 601-605"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Uterine Scar Pregnancy After Curettage Surgery: A Case Report","authors":"Siman Liu MMed,&nbsp;Zhong Lin MD,&nbsp;Xiu Lin MBBS","doi":"10.1016/j.jmig.2024.11.005","DOIUrl":"10.1016/j.jmig.2024.11.005","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 569-570"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvaginal Ultrasound Guided Versus Laparoscopic Ethanol Sclerotherapy; Techniques, Tips & Tricks","authors":"Yavuz Emre Şükür MD ,&nbsp;Batuhan Aslan MD ,&nbsp;Necati Berk Kaplan MD","doi":"10.1016/j.jmig.2025.03.015","DOIUrl":"10.1016/j.jmig.2025.03.015","url":null,"abstract":"<div><h3>Study Objective</h3><div>To present and compare transvaginal ultrasound guided versus laparoscopic ethanol sclerotherapy (EST) techniques.</div></div><div><h3>Design</h3><div>Step-by-step video demonstration of both sclerotherapy techniques.</div></div><div><h3>Setting</h3><div>A university hospital's reproductive health and research center.</div></div><div><h3>Patient</h3><div>1. Patient with bilateral large endometriomas and infertility. 2. Patient with symptomatic endometriosis and a large endometrioma wishing to conceive naturally.</div></div><div><h3>Intervention</h3><div>Transvaginal ultrasound guided EST can be performed with local anesthesia/sedation or general anesthesia [<span><span>1</span></span>]. Following vaginal iodine cleansing and antibiotic prophylaxis, endometrioma is punctured once with a single lumen 15-16-gauge needle and aspirated. The needle is held steadily until the end of the procedure to prevent leakage of contents or alcohol. Then the cyst cavity is flushed until the irrigation fluid becomes completely clear. Ethanol, equal to 60% of the aspirated cyst volume, is injected, and totally aspirated 10 minutes later [<span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>]. In case of laparoscopic EST, the endometrioma is punctured directly with ipsilateral 5 mm trocar and the cyst contents are aspirated. The cyst cavity is flushed and a 14F Foley catheter is placed to suspend the cyst and prevent alcohol leakage. Then, the cyst cavity is filled with ethanol which is totally aspirated after 10 minutes [<span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span>]. Following catheter removal, excise the cyst portion not exposed to ethanol and assess inner surface of the cyst. After the steps, the operation is continued with other surgeries.</div></div><div><h3>Main Result</h3><div>A video presenting transvaginal EST in preparation for IVF and laparoscopic EST during endometriosis surgery.</div></div><div><h3>Conclusion</h3><div>Both transvaginal and laparoscopic ethanol sclerotherapy are effective, minimally invasive, and cost-efficient techniques. In any fertility situation where preventing damage to the tubal mucosa is important (due to the possibility of leaked alcohol damaging the tubes and causing peritoneal adhesions), where a biopsy of the cyst is needed, there is difficult access to the pouch/ovaries, or other pathology needs to be treated, we prefer a laparoscopic approach.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 581-582"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Bilateral Salpingectomy and Gonadectomy in a Patient With 45,X/46,XY Mosaicism","authors":"Sahra Nathoo MD ,&nbsp;Lacey C. Brennan MD, MBE ,&nbsp;Miguel Russo MD ,&nbsp;Nigel Pereira MD","doi":"10.1016/j.jmig.2024.10.005","DOIUrl":"10.1016/j.jmig.2024.10.005","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 573-575"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome and Surgical Technique of Robot-Assisted Living Donor Hysterectomy for Uterus Transplantation","authors":"Masato Tamate MD, PhD ,&nbsp;Giuliano Testa MD ,&nbsp;Laura Divine MD ,&nbsp;Liza Johannesson MD, PhD","doi":"10.1016/j.jmig.2025.02.013","DOIUrl":"10.1016/j.jmig.2025.02.013","url":null,"abstract":"<div><h3>Objective</h3><div>To show our standardized minimally invasive living uterus donor surgery for uterus transplantation and present the outcome.</div></div><div><h3>Setting</h3><div>Uterus transplantation (UTx) is a novel clinical treatment for women with absolute uterine factor infertility who hope to have children [<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>]. While the outcomes for recipients and live births are crucial concerns, it is equally important to ensure that the living donor surgery is minimally invasive and safe. However, Uterus vessels are suboptimal due to small caliber, thin walls, and variable anatomic presentation [<span><span>5</span></span>]. Since living donors are healthy individuals, improving surgical procedures to reduce invasiveness and complications is essential.</div></div><div><h3>Participants</h3><div>Eighteen living donors performed by robot-assisted hysterectomy for UTx.</div></div><div><h3>Interventions</h3><div>The steps of the robotic-assisted living donor hysterectomy presented are:</div><div>1. Ligation of the round ligaments and exposure of the retroperitoneal space.</div><div>2. Dissection of the superior uterine veins.</div><div>3. Dissection of the uterine arteries and the inferior uterine veins.</div><div>4. Dissection of the ureters, bladder, and rectum.</div><div>5. Vaginotomy and transection of the vessels.</div><div>6. Transvaginal uterine graft extraction and closure of the vaginal cuff.</div><div>The results were analyzed in two phases: cases performed between 2019 and 2022, (<em>n</em> = 8), and cases performed between 2023 and 2024 (<em>n</em> = 10). There was no significant difference in the background characteristics of the patients between both groups. However, surgical time and complication rates improved in the later phase (<span><span>Supplementary Tables 1</span></span> and <span><span>2</span></span>). At a 1-year follow-up, donors reported no concerns with sexual activity and no complications. Additionally, ovarian hormone levels remained stable with no significant decreases observed.</div></div><div><h3>Conclusions</h3><div>While the primary goal of UTx is to achieve live birth, it is crucial that donor surgery remains safe and efficient. All uteri were successfully implanted in recipients, so far resulting in 10 successful live births. Our standardized technique represents a safe approach that minimizes donor harm and allows for the preservation of donor ovaries. Although our standardized technique represents a safe approach that minimizes living donor harm and allows for the preservation of donor ovaries, it is important that this procedure is only carried out in centers with vast experience with transplantation and gynecological surgery. Our data shows a steep learning curve and better results with growing experience.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 579-580"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Beginning of a Paradigm Shift: Increase in Perioperative Complications Following Vaginal Hysterectomy Compared to Laparoscopic Hysterectomy Using the ACS-NSQIP 2016 to 2019 Database","authors":"Abigail Cain MD,&nbsp;Brooke Andrews MD, MPH,&nbsp;Miriam Alvarez PhD,&nbsp;Jennifer Travieso MD,&nbsp;Winifred Mak MD, PhD,&nbsp;Alison Brooks-Heinzman MD,&nbsp;Zachary Chipman MD,&nbsp;Michael Breen MD,&nbsp;Marian Yvette Williams-Brown MD,&nbsp;Christina Salazar MD, MSCE","doi":"10.1016/j.jmig.2025.01.016","DOIUrl":"10.1016/j.jmig.2025.01.016","url":null,"abstract":"<div><h3>Study Objective</h3><div>This study aimed to compare the perioperative outcomes of laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) between 2016 and 2019.</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting</h3><div>National database study.</div></div><div><h3>Patients</h3><div>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent elective LH or VH between 2016 and 2019.</div></div><div><h3>Interventions</h3><div>Our primary outcome of interest was a composite incidence of perioperative complications. We generated a propensity score using a multiple logistic regression model to adjust for confounding factors and to reduce the selection bias between the 2 groups. We matched patients who underwent elective LH to patients who underwent elective VH on the logit of the propensity score.</div></div><div><h3>Measurements and Main Results</h3><div>Of the 76 706 women in the cohort (2016–2019), 62 124 (80.9%) underwent LH and 14 582 (19.0%) underwent VH. After propensity matching (n = 8991 per group), the results of the matched cohort revealed significant differences in the primary composite outcome. The composite risk of death, complications, reoperation, and readmission was lower among patients who underwent LH than among those who underwent VH, such that the primary composite outcome occurred in 5.62% of LH patients compared to 6.65% of VH patients (relative risk [RR] 0.845, 95% confidence interval (CI) 0.753–0.947, p = .004). In addition, the risk of both transfusion and readmission was higher among patients who underwent VH than among those who underwent LH (transfusion: RR 1.372, 95% CI 1.078–1.745, p = .010; readmission: RR 1.546, 95% CI 1.216–1.966, p = .001).</div></div><div><h3>Conclusion</h3><div>We have found that there is a lower 30-day composite morbidity for patients when undergoing LH compared to VH. These data demonstrate a higher risk of perioperative complications in women undergoing VH and should further inform a surgeon's surgical considerations when deciding the optimal route of hysterectomy, depending on the expertise of the surgeon.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 7","pages":"Pages 629-638"},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}