Journal of NeuroInterventional Surgery最新文献

{"title":"Management of carotid artery web: a nationwide survey of vascular neurologists versus neurointerventionalists.","authors":"Farhan Khan, Dania Mallick, Dylan Wolman, Radmehr Torabi, Krisztina Moldovan, Mahesh Jayaraman, Karen Furie, Shadi Yaghi","doi":"10.1136/jnis-2025-023232","DOIUrl":"https://doi.org/10.1136/jnis-2025-023232","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery web (CW) is an under-recognized cause of cryptogenic stroke, with variability in practice and controversy regarding its optimal management. Due to the lack of society guidelines, it is unclear how neurointerventional radiologists (NIRs) and vascular neurologists approach this condition. Therefore, we conducted a survey to understand practice patterns for the management of CW.</p><p><strong>Methods: </strong>A 10-question survey, including demographic data and clinical vignettes, was developed using REDCap (Research Electronic Data Capture) and sent to board-certified vascular neurologists and NIRs. Responses were categorized into binary outcomes (medical therapy vs carotid revascularization). Statistical analyses, including Chi-square, Fisher's exact, and Kruskal-Wallis, were used for group comparisons.</p><p><strong>Results: </strong>Of 1640 participants, 247 completed the survey, with 77% being vascular neurologists and 23% neurointerventionalists. Participants identified cryptogenic stroke (80.1%) and recurrent stroke (74.4%) as key factors considering CW as the underlying stroke etiology. For a cryptogenic ischemic stroke, neurointerventionalists were more likely than neurologists to favor carotid revascularization (52% vs 37%, p=0.035). In patients with ischemic stroke and competing mechanisms such as atrial fibrillation, nearly half of neurointerventionalists, but only one-third of neurologists, recommended revascularization for secondary prevention (48% vs 31%, p=0.021). NIRs, when compared with neurologists, had a strong preference for carotid artery stenting over carotid endarterectomy (86% vs 35%, p=0.002).</p><p><strong>Conclusions: </strong>There is clinical equipoise regarding the management of CW and ischemic stroke. Randomized clinical trials are needed to minimize variability in treatment approaches.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086256","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/jnis-2025-023673","DOIUrl":"https://doi.org/10.1136/jnis-2025-023673","url":null,"abstract":"","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078518","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":"Five-year results of the SCENT trial with Surpass flow diverters to treat large or giant wide-neck aneurysms.","authors":"Philip M Meyers, Alexander L Coon, Peter Kan, Aclan Dogan, Mark Bain, Babu G Welch, Koji Ebersole, Joost De Vries, Ajay K Wakhloo, Philipp Taussky, Paul Jenkins, Ricardo A Hanel","doi":"10.1136/jnis-2024-022977","DOIUrl":"10.1136/jnis-2024-022977","url":null,"abstract":"<p><strong>Background: </strong>One-year and 3-year outcomes for the SCENT trial have previously been reported. However, 5-year (long-term) clinical outcomes have not previously been described.</p><p><strong>Methods: </strong>In this multicenter prospective trial, 180 aneurysms in 180 subjects were treated with the Surpass flow diverter system across 26 sites. Patients were followed according to a standardized protocol at 1 month, 6 months, 1 year, 3 years, and 5 years. Aneurysm occlusion, in-stent stenosis, modified Rankin Scale (mRS) scores, and complications were recorded.</p><p><strong>Results: </strong>The 5-year clinical follow-up reported 119 subjects and nine deaths with a completion rate of 71.1%, with 5-year angiographic follow-up available in 82 of the surviving 171 patients (48%). Aneurysm occlusion (Raymond Class I) for those patients who underwent angiographic follow-up was 77.8% (91/117) and 90.2% (74/82) at 3 and 5 years. The primary effectiveness composite endpoint was achieved in 80.3% (57/71) of patients. The cumulative proportion of subjects experiencing new or worsening major ipsilateral stroke was 12.8% (23/180) at 36 months, with no new occurrences at 60 months. No late aneurysm ruptures occurred during the 5-year follow-up, and no additional retreatments occurred between 36 and 60 months. Between 3 and 5 years, 52 potential site-reported serious adverse events were sent to CEC for adjudication. Of these, nine were CEC-adjudicated to be serious and four were determined to be related to the procedure/device.</p><p><strong>Conclusions: </strong>Five-year findings demonstrate the long-term safety and effectiveness of the Surpass flow diverter for intracranial aneurysm treatment, supported by high occlusion rates and low rates of delayed adverse events in this study.</p><p><strong>Trial registration number: </strong>NCT01716117.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996774","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":"Flow diversion for distal cerebral aneurysms: a systematic review and meta-analysis.","authors":"Ahmet Günkan, Marina Vilardo, João Paulo Liute Scarramal, Alperen Elek, Jhon E Bocanegra-Becerra, Leonardo Januario Campos Cardoso, Adam A Dmytriw, Andrea Maria Alexandre, Arturo Consoli, Vitor M Pereira, Yilmaz Onal, Frédéric Clarençon, Luca Scarcia","doi":"10.1136/jnis-2025-023362","DOIUrl":"https://doi.org/10.1136/jnis-2025-023362","url":null,"abstract":"<p><strong>Background: </strong>Flow diverters (FDs) are increasingly used off-label for distal cerebral aneurysms (DCAs), those located at or beyond the anterior cerebral artery (ACA) A2, middle cerebral artery M2, and posterior cerebral artery P2 segments. However, data on their safety and efficacy remain limited. This systematic review and meta-analysis synthesizes current evidence on FD treatment for DCAs.</p><p><strong>Methods: </strong>A comprehensive search was performed across PubMed, Scopus, and Web of Science, including studies with ≥5 patients reporting FD treatment of DCAs. Efficacy outcomes included adequate and complete aneurysm occlusion and retreatment rates. Safety outcomes included good functional outcome (modified Rankin Scale (mRS) score 0-2), procedure-related morbidity, mortality, complications, in-stent stenosis, and covered branch occlusion at follow-up. Pooled analyses with 95% confidence intervals (CI) were conducted using a random-effects model.</p><p><strong>Results: </strong>Eighteen studies (441 patients, 70% women; mean age: 57.2±13.6 years) with 445 DCAs were included. Most aneurysms were unruptured (93.7%) and located in the ACA territory (78.4%). Adequate and complete occlusion at last follow-up were 90% (95% CI, 86 to 95) and 79% (95% CI, 74 to 85), respectively. The retreatment rate was 1.6% (95% CI, 0.2 to 3). Good functional outcome was achieved in 97% (95% CI, 95 to 99). Procedure-related complications occurred in 9% (95% CI, 5 to 13), with morbidity and mortality of 1.5% and 0.6%, respectively. In-stent stenosis and covered branch occlusion rates were 3% (95% CI, 0 to 8) and 5.5% (95% CI, 2 to 9), respectively.</p><p><strong>Conclusion: </strong>FDs appear to be safe and effective for DCAs, with high occlusion rates and low retreatment and complication rates.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029256","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":"Endovascular rodent model using tail access and ultrasound guidance.","authors":"Julien Ognard, Gerard El Hajj, Yong-Hong Ding, Sarah Lortscher, Esref Alperen Bayraktar, Alexander A Oliver, Waleed Brinjikji, Ramanathan Kadirvel, David F Kallmes","doi":"10.1136/jnis-2025-023444","DOIUrl":"https://doi.org/10.1136/jnis-2025-023444","url":null,"abstract":"<p><p>We have developed a cost-effective method to study the fate of stents, particularly flow diverter stents placed in the abdominal aorta, in a rat model. This technique utilizes (caudal) tail artery access,1-5 thereby avoiding the need for surgical exposure of the femoral or carotid arteries and reducing procedural invasiveness,6 7 aligning with the principles of refinement and reduction in animal research.7 This approach may be particularly beneficial for studies requiring multiple or iterative vascular access. The use of ultrasound guidance further reduces costs and infrastructure requirements by eliminating the need for specialized angiography suites.8 This makes this technique accessible to a broader range of research settings, promoting wider adoption and collaboration in the field of endovascular research. A detailed demonstration of this method is provided in the accompanying educational video (video 1).neurintsurg;jnis-2025-023444v1/V1F1V1Video 1-Technical video describing the tail artery access and flow diverter deployment using ultrasound guidance.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024491","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 fluid mechanics of aspiration thrombectomy.","authors":"Michael T Froehler, Bryan C Good","doi":"10.1136/jnis-2024-022780","DOIUrl":"https://doi.org/10.1136/jnis-2024-022780","url":null,"abstract":"<p><p>Large vessel occlusion causing acute ischemic stroke is ideally treated with endovascular clot retrieval, which is increasingly being performed via direct aspiration thrombectomy. Successful aspiration thrombectomy depends on multiple tenets of fluid and solid mechanics, including the application of hydrostatic and hydrodynamic forces to lodged clots. These fundamental concepts predict factors that may increase efficacy in clot removal, and help to explain the differences in performance seen among varying aspiration techniques (remote vs direct), catheters (suction force increases with diameter), and vacuum sources (pump type, whether electrical or manual, should not have an impact on negative pressure). Cyclic aspiration is also predicted to show more substantial clot removal and ingestion than static aspiration due to the dynamic forces it imposes on elastic clots.In this paper we will review the basic scientific principles underlying the fluid mechanics of aspiration thrombectomy and explain the application of these principles in practice, to provide a more thorough understanding for the neurointerventional clinician.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030458","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":"Feasibility of emergent single-step intracranial self-expanding stent deployment using over-the-wire coronary balloons in intracranial atherosclerosis-related large vessel occlusion thrombectomy.","authors":"Alhamza R Al-Bayati, Mohamed F Doheim, Mahmoud H Mohammaden, Michael Lang, Bradley Gross, Diogo C Haussen, Raul G Nogueira","doi":"10.1136/jnis-2025-023074","DOIUrl":"https://doi.org/10.1136/jnis-2025-023074","url":null,"abstract":"<p><strong>Background: </strong>The currently US Food and Drug Administration approved intracranial stent delivery system involves a multistep deployment process that requires the use of an exchange length microwire (ELW). In this study, we describe a single-step approach to deploy the Neuroform Atlas stent without the need for ELW or lesion re-access, using the MINI TREK II over-the-wire (OTW) semi-compliant coronary balloon.</p><p><strong>Methods: </strong>We performed a retrospective review of prospectively maintained mechanical thrombectomy databases from two comprehensive stroke centers. The study included consecutive large vessel occlusion (LVO) stroke patients who underwent single-step angioplasty with the MINI TREK II OTW balloon followed by deployment of the Neuroform Atlas intracranial stent, without the use of an ELW.</p><p><strong>Results: </strong>A total of 12 patients met the inclusion criteria. Among them, the median age was 67 years (IQR: 58-73) and 50% were female. Most patients had middle cerebral artery (MCA) M1 occlusion (75%). One-third of the patients received intravenous thrombolysis. All patients achieved successful reperfusion (modified Treatment in Cerebral Ischemia (mTICI) 2b/3) with a median of two passes. The median National Institutes of Health Stroke Scale (NIHSS) score decreased from 14 (IQR: 10-19) at baseline to 4 (IQR: 1-9) at discharge, and the median modified Rankin Scale (mRS) score was 1 (IQR: 1-4) at discharge and 3 (IQR: 2-4) at 90 days. None of the patients in this series experienced symptomatic intracranial hemorrhage, though two patients (16.7%) were dead at 90 days but there was no procedural-related mortality.</p><p><strong>Conclusions: </strong>This preliminary experience demonstrates the technical feasibility and success of single-step deployment of the Neuroform Atlas stent following angioplasty with the MINI TREK II OTW balloon, without the need for an ELW or lesion re-access. Larger prospective studies with extended clinical follow-up are needed to validate these findings.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986434","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":"Outcomes of patients with acute ischemic stroke associated with large vessel occlusion admitted during regular and off-hours: a sub-analysis of the RESCUE-Japan Registry 2.","authors":"Takayuki Funatsu, Hirotoshi Imamura, Nobuyuki Ohara, Satoru Fujiwara, Kazutaka Uchida, Takeshi Morimoto, Hiroshi Yamagami, Nobuyuki Sakai, Shinichi Yoshimura","doi":"10.1136/jnis-2025-023127","DOIUrl":"https://doi.org/10.1136/jnis-2025-023127","url":null,"abstract":"<p><strong>Background: </strong>Off-hour admissions can adversely affect clinical outcomes, though evidence in patients with acute ischemic stroke (AIS) associated with large vessel occlusion (LVO) remains limited. This study aimed to examine the impact of off-hour versus regular-hour admissions on outcomes in patients with AIS associated with LVO.</p><p><strong>Methods: </strong>Data from the Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism (RESCUE)-Japan Registry 2, a prospective multicenter registry of patients with AIS associated with LVO were used. Eligible patients were aged ≥20 years and admitted within 24 hours of stroke onset. Off-hour admissions were defined as those occurring between 17:00 and 09:00 on weekdays and at all times on holidays, reflecting typical periods of reduced healthcare staffing. The primary outcome was a modified Rankin Scale score of 0-2, assessed 90 days post-admission.</p><p><strong>Results: </strong>Of the 2390 patients, 1794 (71.7%) and 676 (28.3%) were admitted during off-hours and regular hours, respectively. Intravenous recombinant tissue-type plasminogen activator was administered to 617 (36.0%) off-hour patients and 336 (49.7%) regular-hour patients (P<0.0001). Endovascular therapy was provided to 915 (53.4%) off-hour patients and 361 (53.4%) regular-hour patients (P=0.99). Favorable outcomes (mRS score 0-2) were observed in 604 (35.2%) off-hour patients and 272 (40.2%) regular-hour patients (P=0.02). Multivariate logistic regression analysis showed no significant difference in the primary outcome between groups (adjusted OR 1.07; 95% CI 0.84 to 1.35; P=0.56).</p><p><strong>Conclusion: </strong>These findings suggest that off-hour and regular-hour admissions have similar clinical outcomes in patients with AIS associated with LVO in this Japanese cohort.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970564","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":"Cangrelor versus GPIIb/IIIa inhibitors as adjunctive therapy in endovascular treatment of large vessel occlusion stroke.","authors":"Małgorzata Milnerowicz, Jean-Philippe Desilles, Raoul Pop, Cyril Dargazanli, Julien Labreuche, Igor Sibon, Benjamin Gory, Sébastien Soize, Romain Bourcier, Mikael Mazighi, Christophe Cognard, Jildaz Caroff, Jean Christophe Gentric, Frédéric Clarençon, Sebastian Richter, Kevin Janot, Bertrand Lapergue, Gaultier Marnat","doi":"10.1136/jnis-2025-023260","DOIUrl":"https://doi.org/10.1136/jnis-2025-023260","url":null,"abstract":"<p><strong>Background: </strong>Endovascular treatment (EVT) failures and early reocclusions in stroke often result from arterial wall disease, incomplete thrombus withdrawal, or acute endothelial injury. Intracranial and extracranial atherosclerosis, in particular, poses a risk of reocclusion, sometimes requiring tailored interventions (eg, angioplasty, stenting). While glycoprotein (GP) IIb/IIIa inhibitors have been widely studied in ischemic stroke, cangrelor remains less explored.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of cangrelor compared with GPIIb/IIIa inhibitors in large vessel occlusion stroke (LVOS).</p><p><strong>Methods: </strong>This retrospective analysis from the Endovascular Treatment in Ischemic Stroke Registry included patients from 34 French centers who received cangrelor or GPIIb/IIIa inhibitors during EVT between July 2018 and September 2023. Eligible cases had refractory occlusions or arterial disease at risk of reocclusion. The primary outcome was a 90-day favorable outcome. Secondary outcomes included excellent functional outcome, early neurological improvement, intracranial hemorrhage (ICH), procedural complications, and day 1 arterial patency. Propensity score overlap weighting was used for comparisons.</p><p><strong>Results: </strong>Of 559 patients, 160 received GPIIb/IIIa inhibitors and 399 received cangrelor. Favorable outcomes were comparable (41.7% vs 43.7%; OR=1.1; 95% CI 0.61 to 1.93), as were rates of excellent functional outcome and early neurological improvement. Angiographic efficacy was similar, with modified Thrombolysis in Cerebral Infarction ≥2b rates of 89.5% for GPIIb/IIIa and 90.1% for cangrelor. No significant differences were observed in day 1 patency, 90-day mortality, or symptomatic ICH.</p><p><strong>Conclusions: </strong>Cangrelor showed comparable safety and efficacy to GPIIb/IIIa inhibitors. These results, along with the specific pharmacodynamics, make this drug a promising agent in the acute management of complex intracranial and extracranial LVOS.</p><p><strong>Trial registration number: </strong>NCT03776877.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012162","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":"Unruptured brain arteriovenous malformation risk stratification.","authors":"Denise Brunozzi, Ali Alaraj","doi":"10.1136/jnis-2024-022779","DOIUrl":"https://doi.org/10.1136/jnis-2024-022779","url":null,"abstract":"<p><p>Cerebral arteriovenous malformations (AVMs) are an uncommon type of central nervous system vascular anomaly that have the potential to rupture and cause intracranial hemorrhage. AVM hemorrhagic risk assessment has been mainly based on anatomical features derived from imaging; the most recent focus on AVM hemodynamics, vessel wall imaging, and molecular analysis of the inflammatory response, provide new insights into the hemorrhagic risk stratification. The greater data availability provided by innovative imaging techniques and biological analysis of biomarkers and genetic polymorphism further demonstrates the existence of a complex interaction between anatomically altered vasculature, non-physiological hemodynamics, and inflammatory molecular activity. The accurate prediction of cerebral AVM rupture, essential to guide the management decision by comparing the risk of observation to the risk of intervention, has yet to be solved. This review of several studies aims to summarize the current evidence on brain AVM rupture risk stratification.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976436","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}