Journal of NeuroInterventional Surgery最新文献

{"title":"Association between dehydration trajectory, delayed cerebral ischemia, and functional outcome in patients with aneurysmal subarachnoid hemorrhage: assessment of interaction and mediation.","authors":"Peng Zhang, Qi Tu, Minfeng Tong, Kefeng Shi, Tingyu Yang, Jiale Wang, Weizhong Zhang, Qi Pang, Zequn Li, Zhijian Xu","doi":"10.1136/jnis-2024-022953","DOIUrl":"https://doi.org/10.1136/jnis-2024-022953","url":null,"abstract":"<p><strong>Background: </strong>Blood urea/creatinine (U/Cr) ratio is considered to be an ideal biomarker of dehydration. We investigated the association between the U/Cr ratio trajectory and delayed cerebral ischemia (DCI) as well as functional outcome in aneurysmal subarachnoid hemorrhage (aSAH). Additionally, we explored the role of DCI as a mediator and its interaction with dehydration.</p><p><strong>Methods: </strong>Consecutive aSAH patients were reviewed. A latent class growth mixture model (LCGMM) was applied to classify the dehydration trajectory over 7 days. Multivariate logistic regression was conducted to examine associations between dehydration trajectories, DCI, and poor outcome. Furthermore, causal mediation analysis combined with a four-way decomposition approach was employed to quantify the extent to which DCI mediates or interacts with dehydration in influencing poor outcomes.</p><p><strong>Results: </strong>A total of 519 aSAH patients were included. By applying the LCGMM method, we categorized participants into three dehydration trajectory groups: low group (n=353), decreasing group (n=97), and high group (n=69). Multivariate analysis demonstrated that dehydration trajectory was independently associated with both DCI and poor outcome. The effect of dehydration trajectory on poor outcome was partially mediated by DCI, involving both pure mediation and mediated interaction. Specifically, the excess relative risk of DCI was decomposed into four components: controlled direct effect (66.42%), mediation only (16.35%), interaction only (6.09%), and mediated interaction (11.16%).</p><p><strong>Conclusion: </strong>Among aSAH patients, dehydration trajectory was significantly associated with poor functional outcome, with DCI serving as a partial mediator through both direct and interaction effects.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of carotid artery stenting with open- versus closed-cell stents.","authors":"Guilin Zhang, Dongqiao Xiang, Haohao Lu, Fu Xiong, Yanyan Cao, Ling Xiang, Chuansheng Zheng, Xuefeng Kan","doi":"10.1136/jnis-2025-023058","DOIUrl":"https://doi.org/10.1136/jnis-2025-023058","url":null,"abstract":"<p><strong>Background: </strong>The stent type may be associated with adverse events in carotid artery stenting (CAS). This study aimed to compare the clinical outcomes (stroke/myocardial infarction (MI)/death) of CAS with open- and closed-cell stents for patients with carotid artery stenosis.</p><p><strong>Methods: </strong>Between April 2012 and May 2024, the clinical data of 223 patients who underwent CAS in our center were retrospectively analyzed. In terms of the stent type used, patients were divided into a closed-cell stent group and an open-cell stent group. Clinical outcomes between the two groups were compared. Univariate and multivariate analyses were performed to identify the independent risk factors. Subgroup analyses in terms of carotid plaque types and smoking history were conducted in carotid artery stenosis patients receiving CAS with open- and closed-cell stents.</p><p><strong>Results: </strong>The combined in-hospital stroke/MI/death rate was significantly lower in the closed-cell stent group than in the open-cell stent group (p=0.026). Open-cell stents, smoking, and unstable plaques were the independent risk factors associated with a higher in-hospital stroke/MI/death rate. Subgroup analyses showed that for patients with unstable plaques, the combined in-hospital stroke/MI/death rate was significantly higher in the open-cell stent group than in the closed-cell stent group (p=0.016). For patients who smoked, the combined in-hospital stroke/MI/death rate was significantly higher in the open-cell stent group than in the closed-cell stent group (p=0.038).</p><p><strong>Conclusion: </strong>For carotid artery stenosis patients with unstable carotid plaques or smoking history, using closed-cell stents in CAS may help reduce the combined in-hospital stroke/MI/death rate.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of first pass effect in mechanical thrombectomy for vertebrobasilar artery occlusion: a comprehensive meta-analysis of prevalence, outcomes, and predictive factors.","authors":"Lei Guo, Jun Zhang, Jianhong Wang, Shu Yang, Yang Xiang, Fuqiang Guo","doi":"10.1136/jnis-2024-022960","DOIUrl":"10.1136/jnis-2024-022960","url":null,"abstract":"<p><strong>Background: </strong>First-pass effect (FPE) is crucial for better outcomes in mechanical thrombectomy (MT) for acute large vessel occlusions. However, its frequency and predictors in vertebrobasilar artery occlusion (VBAO) remain unclear.</p><p><strong>Objective: </strong>To conduct a comprehensive systematic review and meta-analysis to assess the incidence of FPE in MT for VBAO and its impact on key clinical outcomes. Additionally, to explore potential predictors of achieving FPE, addressing critical knowledge gaps and providing evidence to optimize treatment strategies for patients with VBAO.</p><p><strong>Methods: </strong>A systematic literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library up to November 1, 2024. Studies evaluating FPE in patients with acute VBAO undergoing MT were included. The prevalence of FPE was estimated using a meta-analysis of proportions, and associations with clinical outcomes and predictive factors were assessed using pooled ORs with random-effects models.</p><p><strong>Results: </strong>Twenty studies involving 4315 patients met inclusion criteria. The overall prevalence of FPE in patients with VBAO was 41% (95% CI 33% to 50%). FPE was significantly associated with improved 90-day outcomes (modified Rankin Scale (mRS) score 0-2: OR=2.00, 95% CI 1.45 to 2.75; mRS score 0-3: OR=2.33, 95% CI 1.78 to 3.04), reduced risk of symptomatic intracranial hemorrhage (OR=0.49, 95% CI 0.27 to 0.87), and lower mortality (OR=0.43, 95% CI 0.32 to 0.57). The results showed that significant positive predictors of FPE included female sex, atrial fibrillation, cardioembolic or unknown stroke etiology, mid- or distal basilar artery occlusion, contact aspiration techniques, and the use of larger catheters. Conversely, negative predictors were identified as a history of hypertension, hyperlipidemia, prior stroke or transient ischemic attack, higher baseline NIHSS scores, prolonged procedure time, and the use of general anesthesia.</p><p><strong>Conclusion: </strong>Achieving FPE in acute VBAO is strongly associated with improved clinical outcomes. Important clinical, procedural, and anatomical factors related to FPE were identified, aiding clinical decisions and thrombectomy techniques.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First reported series of intracranial and carotid aneurysm embolization performed at an ambulatory neurosurgery center: preliminary experience.","authors":"Pui Man Rosalind Lai, Kenneth V Snyder, Elad I Levy","doi":"10.1136/jnis-2025-023228","DOIUrl":"https://doi.org/10.1136/jnis-2025-023228","url":null,"abstract":"<p><strong>Background: </strong>Intracranial aneurysm embolization is traditionally performed in a hospital setting, but there is growing interest in transforming these procedures to outpatient facilities, while ensuring patient safety and effectiveness. We present the first series of patients undergoing flow diverting embolization at an ambulatory neurosurgery center (ANSC) and assessed feasibility, safety, and patient satisfaction.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of patients undergoing flow diverting embolization at the ANSC between August 1, 2024, and January 3, 2025. Patient demographics, procedural details, and periprocedural events were recorded. Patients were observed at the ANSC before transfer to a rehabilitation facility for overnight monitoring in a simulated home environment. A postprocedural satisfaction survey (scale 0-5; 5=best experience) was completed at the 2 week follow-up.</p><p><strong>Results: </strong>Nine patients (mean age 55±13 years) underwent embolization under conscious sedation. Eight aneurysms in the internal carotid artery (mean aneurysm size 6.3±2.8 mm) and one cervical pseudoaneurysm were treated using the Pipeline Vantage (Medtronic, Dublin, Ireland) via a transfemoral approach. Mean procedural time was 35±1 min; mean turnover time was 17±0.2 min. No periprocedural or delayed complications occurred. Patients were observed for a mean 5.3±1.5 hours in the ANSC and discharged home from rehabilitation on postprocedure day 1. Patient satisfaction was unanimously rated 5.</p><p><strong>Conclusions: </strong>The results showed that flow diverting embolization for aneurysms can be safely and feasibly performed in the outpatient setting with careful patient selection and use of the latest generation flow diverters. An ANSC may offer meaningful benefits, including reducing hospital burden, lower costs, and improvement of overall efficiency, while maintaining patient safety and quality.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contour neurovascular system: have we sufficient clinical data to use it in current clinical practice?","authors":"Laurent Pierot, Laurent Spelle","doi":"10.1136/jnis-2024-022517","DOIUrl":"10.1136/jnis-2024-022517","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"447-448"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of calcium channel blockers on perioperative ischemic events in hypertensive patients with intracranial aneurysms undergoing neurointervention.","authors":"Qichen Peng, Yangyang Zhou, Chao Wang, Xuanping Xie, Linggen Dong, Yisen Zhang, Hongqi Zhang, Jun Wang, Liang Li, Pinyuan Zhang, Yuanli Zhao, Yang Wang, Fushun Xiao, Bin Luo, Wenqiang Li, Shiqing Mu","doi":"10.1136/jnis-2024-021543","DOIUrl":"10.1136/jnis-2024-021543","url":null,"abstract":"<p><strong>Background: </strong>Although calcium channel blockers (CCBs) are useful in stroke prevention, their specific role in preventing stroke in hypertensive patients with intracranial aneurysms undergoing endovascular stent placement remains unclear.</p><p><strong>Methods: </strong>We retrospectively examined 458 hypertensive patients with intracranial aneurysms who underwent stent treatment, drawn from a larger multicenter cohort comprising 1326 patients across eight centers. Patients were dichotomized into two groups according to use of a CCB. Propensity score matching (PSM) was performed to balance group differences in patient and aneurysm characteristics. We conducted a comparison of patient and aneurysm characteristics, ischemic complications, and clinical outcomes between the two groups.</p><p><strong>Results: </strong>The CCB and non-CCB groups comprised 279 and 179 patients, respectively. PSM resulted in 165 matched pairs. After PSM, the incidence of ischemic events within 1 month of the procedure (4.2% vs 10.9%; P=0.022) and proportion of patients with modified Rankin Scale score >2 at last follow-up (1.5% vs 7.8%; P=0.013) were significantly lower in the CCB group. Among patients treated with combination therapy, inclusion of a CCB was associated with a lower incidence of ischemic events (1.5% vs 13.3%; P=0.345), but the difference was not statistically significant after correction.</p><p><strong>Conclusions: </strong>CCB use in hypertensive patients undergoing endovascular stenting for treatment of intracranial aneurysms is associated with a lower incidence of ischemic events and a lower incidence of unfavorable neurological outcomes, especially when used in combination therapy.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"375-381"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portable cerebral blood flow monitor to detect large vessel occlusion in patients with suspected stroke.","authors":"Christopher G Favilla, Grayson L Baird, Kedar Grama, Soren Konecky, Sarah Carter, Wendy Smith, Rebecca Gitlevich, Alexa Lebron-Cruz, Arjun G Yodh, Ryan A McTaggart","doi":"10.1136/jnis-2024-021536","DOIUrl":"10.1136/jnis-2024-021536","url":null,"abstract":"<p><strong>Background: </strong>Early detection of large vessel occlusion (LVO) facilitates triage to an appropriate stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales are not sufficiently sensitive, so we investigated the ability of the portable Openwater optical blood flow monitor to detect LVO.</p><p><strong>Methods: </strong>Patients were prospectively enrolled at two comprehensive stroke centers during stroke alert evaluation within 24 hours of onset with National Institutes of Health Stroke Scale (NIHSS) score ≥2. A 70 s bedside optical blood flow scan generated cerebral blood flow waveforms based on relative changes in speckle contrast. Anterior circulation LVO was determined by CT angiography. A deep learning model trained on all patient data using fivefold cross-validation and learned discriminative representations from the raw speckle contrast waveform data. Receiver operating characteristic (ROC) analysis compared the Openwater diagnostic performance (ie, LVO detection) with prehospital stroke scales.</p><p><strong>Results: </strong>Among 135 patients, 52 (39%) had an anterior circulation LVO. The median NIHSS score was 8 (IQR 4-14). The Openwater instrument had 79% sensitivity and 84% specificity for the detection of LVO. The rapid arterial occlusion evaluation (RACE) scale had 60% sensitivity and 81% specificity and the Los Angeles motor scale (LAMS) had 50% sensitivity and 81% specificity. The binary Openwater classification (high-likelihood vs low-likelihood) had an area under the ROC (AUROC) of 0.82 (95% CI 0.75 to 0.88), which outperformed RACE (AUC 0.70; 95% CI 0.62 to 0.78; P=0.04) and LAMS (AUC 0.65; 95% CI 0.57 to 0.73; P=0.002).</p><p><strong>Conclusions: </strong>The Openwater optical blood flow monitor outperformed prehospital stroke scales for the detection of LVO in patients undergoing acute stroke evaluation in the emergency department. These encouraging findings need to be validated in an independent test set and the prehospital environment.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"388-393"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined effect of ASPECTS and age on outcome of patients with large core infarction treated with mechanical thrombectomy.","authors":"Zibao Li, Linyu Li, Zhouzhou Peng, Shoucai Zhao, Xianjun Huang, Shitao Fan, Xu Xu, Jinfu Ma, Chengsong Yue, Nizhen Yu, Changwei Guo, Jie Yang","doi":"10.1136/jnis-2024-021469","DOIUrl":"10.1136/jnis-2024-021469","url":null,"abstract":"<p><strong>Background: </strong>Despite the remarkable effectiveness of endovascular treatment (EVT), recent randomized controlled trials indicate that up to half of patients with large core infarction have a very poor outcome (modified Rankin Scale score 5-6 at 90 days). This study investigates the combined effect of Alberta Stroke Program Early CT Score (ASPECTS) and age on very poor outcome in patients with large core infarction treated with EVT.</p><p><strong>Methods: </strong>This subanalysis of the MAGIC registry, which is a prospective, multicenter cohort study of early treatment in acute stroke, focused on patients with ASPECTS ≤5 presenting within 24 hours of stroke onset and receiving CT followed by EVT from November 1, 2021 to February 8, 2023. Multivariable logistic regression was used to investigate the independent and joint association of ASPECTS and age with very poor outcome.</p><p><strong>Results: </strong>Among the 490 patients (57.3% men; median (IQR) age 69 (59-78) years), very poor outcome occurred more frequently in those with lower ASPECTS (65.2% in ASPECTS 0-2 vs 43.4% in ASPECTS 3-5; P<0.001). The predictive value of successful recanalization for very poor outcome was significant in patients with ASPECTS 3-5 (P=0.010), but it diminished in those with ASPECTS 0-2 (P=0.547). Compared with patients with ASPECTS 3-5 and age ≤69 years, the risk of a very poor outcome increased incrementally in those with lower ASPECTS, advanced age, or both (P<0.05). Graphical plot analysis showed a significantly lower probability of very poor outcome in younger patients (≤69 years) compared with older patients (>69 years) across all ASPECTS points.</p><p><strong>Conclusion: </strong>These findings suggest prioritizing young patients as candidates for EVT in those with ASPECTS 0-2.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"341-345"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The need for thoracic magnetic resonance imaging before vertebral augmentation surgery in patients with lumbar vertebral fractures.","authors":"Yuye Zhang, Wenxiang Tang, Yanping Niu, Xushen Zhao, Jun Hua, Xiaozhong Zhou, Fanguo Lin","doi":"10.1136/jnis-2024-022043","DOIUrl":"10.1136/jnis-2024-022043","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral compression fractures (OVCFs) of the lumbar region may be accompanied by thoracic fractures. Treating only the lumbar fractures can lead to worsening of the thoracic fractures or unresolved postoperative symptoms. This study aims to investigate the need to perform thoracic MRI before vertebral augmentation (including percutaneous vertebroplasty and percutaneous kyphoplasty) in patients with lumbar OVCF.</p><p><strong>Methods: </strong>This study retrospectively analyzed patients with lumbar OVCF who were scheduled for surgical treatment. All patients underwent thoracic and lumbar MRI before surgery. We evaluated the proportion of thoracic fractures accompanying lumbar fractures at each segment and identified the common locations of these accompanying fractures. Univariate and multivariate analyses were conducted to determine the risk factors and optimal thresholds for predicting accompanying thoracic fractures.</p><p><strong>Results: </strong>The study recruited 700 patients, of whom 96 (13.71%) had new thoracic fractures along with lumbar fractures. The most common thoracic segments affected were T10 (22.50%), T9 (19.17%), T8 (26.67%), and T7 (20.83%). Univariate analysis showed significant differences in age and cause of injury between the thoracic fracture group and the control group. The bone density of the thoracic fracture group was significantly lower than that of the control group. Multivariate logistic regression analysis indicated that lifting heavy objects, sprains, and low bone density are risk factors for thoracic fractures in patients with lumbar OVCF.</p><p><strong>Conclusion: </strong>It is crucial to perform thoracic MRI before surgery in patients with lumbar OVCF. This helps to avoid missing thoracic fractures, prevent the worsening of injuries, and ensure better postoperative outcomes.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"434-437"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic disease might well impact a patient 'systemically'.","authors":"James M Milburn, Kelsey Rose Casano, Joshua A Hirsch","doi":"10.1136/jnis-2024-022473","DOIUrl":"10.1136/jnis-2024-022473","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"445-446"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}