Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"Clinical Outcomes of Salvage Microsurgical Resection after Radiation Therapy for Sporadic Vestibular Schwannomas","authors":"Omid Moshtaghi, Patrick Barba, Peter Dixon, Yin Ren, Marc Schwartz, Rick Friedman","doi":"10.1055/a-2297-3849","DOIUrl":"https://doi.org/10.1055/a-2297-3849","url":null,"abstract":"<p>\u0000<b>Background</b> The purpose of this study was to evaluate clinical outcomes after salvage microsurgery for vestibular schwannoma (VS) treated initially with modern radiotherapy techniques as compared to those treated with primary microsurgical resection.</p> <p>\u0000<b>Methods</b> Patients who underwent microsurgical resection of sporadic VS undergoing a translabyrinthine approach at a single academic skull base tertiary referral center were included. Baseline and postoperative dynamic gait index, functional gait assessment, House–Brackmann facial nerve grading, and completeness of resection were prospectively recorded.</p> <p>\u0000<b>Results</b> Of the 265 patients reviewed, 21 (7.9%) patients underwent prior radiation. Median age of the cohort was 55 years (interquartile range: 51–63). The likelihood of achieving a gross total resection was significantly lower for radiated as compared to nonradiated patients (odds ratio: 0.18, 95% confidence interval: 0.05–0.53, <i>p</i> = 0.004) when controlling for tumor size. Radiated patients had better postoperative facial nerve function on the first postoperative day, but this difference was not significant at long-term follow-up. Radiated patients had lower preoperative postural stability scores than nonradiated patients on FGA (26 vs. 23, <i>p</i> = 0.035). Postoperatively, radiated patients had comparable outcomes compared to nonradiated patients when controlling for age and tumor size.</p> <p>\u0000<b>Conclusions</b> Compared to patients with VS treated with surgery alone, previously radiated patients are less likely to achieve gross total resection in the salvage setting. Radiated patients scored better on facial nerve outcomes compared to nonradiated patients in the initial postoperative period but demonstrated similar long-term outcomes.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"50 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140800884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Handheld Robot for Endoscopic Endonasal Skull Base Surgery: Updated Preclinical Validation Study (IDEAL Stage 0)","authors":"Joachim Starup-Hansen, Nicola Newall, Emmanouil Dimitrakakis, Danyal Z. Khan, George Dwyer, Keshav Iyengar, Dimitrios Psychogyios, John G. Hanrahan, Siddharth Sinha, James Booker, Danail Stoyanov, Hani J. Marcus","doi":"10.1055/a-2297-3647","DOIUrl":"https://doi.org/10.1055/a-2297-3647","url":null,"abstract":"<p>\u0000<b>Background and Objectives</b> Endoscopic endonasal surgery (EES) has become increasingly popular, yet anatomical constraints posed by the nose and limitations of nonarticulated instruments render EES technically challenging, with a steep associated learning curve. Therefore, we developed a handheld robot to enhance dexterity in endoscopic neurosurgical procedures. A previous trial of the robot demonstrated its potential advantages in endoscopic neurosurgery but also the need for improvements. In this study, we assess the feasibility, acceptability, and comparative performance of the updated robotic prototype (version 0.2) against standard instruments in a preclinical phantom and cadaveric trial.</p> <p>\u0000<b>Methods</b> Ethical approval was received. Participants were stratified according to their neurosurgical experience. In the phantom study, a randomized crossover design compared the robot against standard instruments at a phantom tumor resection task. Statistical analysis was performed using Mann–Whitney U tests and paired <i>t</i>-tests. In the cadaver-based user study, participants evaluated the device's functional domains through a qualitative interview design.</p> <p>\u0000<b>Results</b> In the phantom study, the device demonstrated a learning curve: initial resection attempts favored the traditional instrument (84% vs. 59%, <i>p</i> = 0.055), but parity was achieved by the fifth attempt (80% vs. 83%, <i>p</i> = 0.76). Acceptability was evident, as most clinicians (7/8) preferred the robot for its superior range, ergonomics, and precision. Also, the robot exhibited a diminished cognitive workload. The cadaveric study underscored the robot's clinical feasibility, through sufficient workspace reach and force delivery.</p> <p>\u0000<b>Conclusion</b>: Overall, our robot demonstrates promising acceptability and feasibility for endoscopic neurosurgery, yet further iterative developments are required before proceeding to in-human clinical trials.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140565926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution of Pituitary Surgery in an Australian Health Care Framework","authors":"Nicholas G. Candy, Alistair K. Jukes, Eng H. Ooi, Rowan Valentine, Nick Vrodos, Stephen Santoreneos, Steve Floreani, Peter-John Wormald, Alkis J. Psaltis","doi":"10.1055/s-0044-1786044","DOIUrl":"https://doi.org/10.1055/s-0044-1786044","url":null,"abstract":"<p>\u0000<b>Background</b> The outcomes in pituitary surgery have dramatically changed over the past 130 years. Endoscopic endonasal transsphenoidal approaches are now an accepted method for operating on pituitary tumors, a skillset which takes time to develop. The Australian health care framework provides a unique mixture of public and private care for a geographically dispersed population. In this article, we aim to examine how outcomes for patients in South Australia changed as endoscopic pituitary surgery was adopted and how the Australian health care framework influenced the development of a skull base team.</p> <p>\u0000<b>Methods</b> The case notes of all patients undergoing pituitary surgery between 2006 and 2020 in South Australia. All patients treated by this author group were included.</p> <p>\u0000<b>Results</b> A total of 428 pituitary adenomas were surgically treated. Overall, 182 out of 249 patients (70%) had a complete resection with no recurrence at follow-up, and 49 patients (19%) had a residual that was observed and did not require treatment. Therefore, 89% of patients between the years 2006 and 2020 did not require any further treatment following their pituitary surgery. Upon examination of the 142 patients with functional adenomas, 112 (79%) patients had no recurrence in hormonal dysfunction following surgery, and the remaining 30 (21%) patients required further treatment.</p> <p>\u0000<b>Conclusion</b> We have demonstrated that acceptable outcomes can be achieved in a low-to-moderate volume setting across multiple hospitals when a coordinated effort is made to consolidate these cases within a small group of subspeciality-trained surgeons, as opposed to a more generalist approach.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"3 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140565931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usefulness of YouTube Videos Related to Endoscopic Sinus Surgery for Surgical Residents","authors":"Justin Shapiro, Marc Levin, Saud Sunba, Emily Steinberg, Vince Wu, John M. Lee","doi":"10.1055/s-0044-1786045","DOIUrl":"https://doi.org/10.1055/s-0044-1786045","url":null,"abstract":"<p>\u0000<b>Objective</b> The use of online teaching modalities to supplement surgical learning has increased recently, demonstrating promising results. Previous studies have analyzed the value and usefulness of YouTube as an educational source to learners, including teaching surgical skills to Otolaryngology–Head and Neck Surgery (OHNS) trainees. YouTube videos on endoscopic sinus surgery (ESS) still need to be explored as ESS remains a common, yet challenging surgery that OHNS residents encounter regularly. This study aimed to objectively evaluate the usefulness of YouTube videos on ESS for surgical education.</p> <p>\u0000<b>Design</b> YouTube was searched using the following keywords: “uncinectomy,” “maxillary antrostomy,” “anterior ethmoidectomy,” and “ethmoid bulla resection.” These represent the initial ESS steps residents learn. Each video was assessed for eligibility by two independent reviewers.</p> <p>\u0000<b>Outcome Measures</b> The LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS) and ESS-specific criteria were used to assess educational quality. Video popularity index (VPI) was used to calculate video popularity.</p> <p>\u0000<b>Results</b> Of the 38 videos that met inclusion criteria, the average LAP-VEGaS score was 6.59 (± ) 3.23 standard deviation. Most videos were designated low quality. There was a weak positive correlation between whether a video included ESS-specific criteria and LAP-VEGaS score (<i>r</i> = 0.269, <i>p</i> = 0.102). There was a significant positive correlation between VPI and LAP-VEGaS scores (<i>r</i> = 0.497, <i>p</i> = 0.003).</p> <p>\u0000<b>Conclusions</b> Overall, the quality of included videos was poor. OHNS residents should not rely solely or primarily on YouTube videos to learn surgical skills relevant to ESS. To maximize potential of online teaching, high-quality videos should be used to compliment other methods of teaching.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"10 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140565832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum: Reliability of Neuronavigation in Localizing the Internal Acoustic Canal during Middle Fossa Approach.","authors":"Tufan Agah Kartum, Baris Kucukyuruk, Alperen Kaya, Levent Aydin, Necmettin Tanrıöver, Galip Zihni Sanus","doi":"10.1055/s-0044-1786156","DOIUrl":"https://doi.org/10.1055/s-0044-1786156","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1055/a-2235-9956.].</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"86 1","pages":"e1"},"PeriodicalIF":0.9,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review: Success Rate of Endoscopic Endonasal versus Combined Endonasal and Transorbital Neuroendoscopic Approach for Nontraumatic Cerebrospinal Fluid Leak Repairs in the Lateral Recess of Sphenoid Sinus","authors":"Umnia Nasir Ahmed, Mohammed Saqlain Siddiqui, Haissan Iftikhar, Karan Jolly, Hannah Nieto, Jameel Muzaffar","doi":"10.1055/s-0044-1785486","DOIUrl":"https://doi.org/10.1055/s-0044-1785486","url":null,"abstract":"<p>\u0000<b>Background</b> Cerebrospinal fluid (CSF) leaks from the lateral recess of the sphenoid sinus (LRS) occur due to a skull base defect and are important to treat due to the associated morbidity, e.g., life-threatening meningitis. Nontraumatic CSF leaks have a predilection toward obesity which is a rising phenomenon. LRS is notoriously difficult to access because of its lateral location and its associated neurovascular complications. An alternative surgical corridor has been explored which is the transorbital neuroendoscopic (TONES) approach.</p> <p>\u0000<b>Objective</b> To compare the success rate of the endoscopic endonasal with the TONES approaches.</p> <p>\u0000<b>Rationale</b> This is the first systematic review on the endoscopic endonasal and combined transorbital approaches to treat CSF leaks from the LRS.</p> <p>\u0000<b>Method</b> A PRISMA-concordant systematic review. PubMed, MEDLINE, EMBASE, Web of Science, and SCOPUS were searched. The studies underwent abstract and full-text screening by two reviewers. The data collected included patient demographic, surgical approach, reconstruction method, layers and materials, follow-up period, ROBINS-I bias, complications, and success rate.</p> <p>\u0000<b>Results</b> In total, 26 of 4,385 studies were included for further synthesis. Of these studies, a total of 336 patients were identified from a cohort of 910 patients. The endoscopic endonasal approach showed a repair success rate of 95.24% and the combined TONES and endonasal approach showed a success rate of 100%.</p> <p>\u0000<b>Conclusion</b> Both the endoscopic endonasal and transorbital approach provide a good success rate. However, due to the small TONES sample, large, randomized control trials are needed.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140595517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Meningiomas Invading the Cavernous Sinus: The “Inevitable Ones”","authors":"Carlos Eduardo da Silva, Tamara Vidaletti","doi":"10.1055/a-2273-5509","DOIUrl":"https://doi.org/10.1055/a-2273-5509","url":null,"abstract":"<p>\u0000<b>Introduction</b> Giant meningiomas invading the cavernous sinus (GMICSs) are a subgroup of challenging tumors due to their volume and the extent of neurological impairment. Preserving quality of life is one of the most relevant aspects of treating patients with GMICS.</p> <p>\u0000<b>Methods</b> A retrospective study was conducted for surgeries performed between 2012 and 2022, including 33 patients presenting meningiomas with the largest diameter of at least 5 cm invading the cavernous sinus. The data from surgical intervention, Simpson grade of resection, tumor location, and morbimortality related to the surgeries were reviewed.</p> <p>\u0000<b>Results</b> The group comprised 25 women and 8 men with a median age of 56 years. The mean follow-up period was 52 months. The tumors were in the sphenoid wing, anterior clinoid, spheno-orbital, spheno-petroclival, petroclival, and Meckel's cave. Simpson grade I, II, and III were obtained in 70% of cases. The meningiomas were classified as WHO grade 1 in 94%, grade 2 in 3%, and grade 3 in 3%. The overall mortality was 3%. Permanent cranial nerve deficits occurred in 21%, transient cranial nerve deficits in 42%, cerebrospinal fistula in 15%, and hemiparesis in 18%. The recurrence/regrowth rate was 6%. The Karnofsky Performance Status score of 100 and 90 was 82%.</p> <p>\u0000<b>Conclusions</b> The surgical treatment of GMICS is an effective treatment modality with acceptable morbimortality and good long-term control. Involvement of the internal carotid artery is essential to determine the extent of resection inside the cavernous sinus, and training in the microsurgical laboratory is mandatory for safe surgical treatment.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"24 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140323420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum: Grade 3 Meningioma Survival and Recurrence Outcomes in an International Multicenter Cohort.","authors":"Kira Tosefsky, Alexander D Rebchuk, Justin Z Wang, Yosef Ellenbogen, Richard Drexler, Franz L Ricklefs, Thomas Sauvigny, Ulrich Schüller, Christopher B Cutler, Brandon Lucke-Wold, Yusuf Mehkri, Sanju Lama, Garnette R Sutherland, Michael Karsy, Brian L Hoh, Manfred Westphal, Gelareh Zadeh, Stephen Yip, Serge Makarenko","doi":"10.1055/s-0044-1782669","DOIUrl":"https://doi.org/10.1055/s-0044-1782669","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1055/s-0044-1779888.].</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"85 Suppl 1","pages":"e1"},"PeriodicalIF":0.9,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Screening for Hereditary Head and Neck Paraganglioma in Asymptomatic SDHx Variant Carriers in the Netherlands","authors":"Anouk Frederique Heesters, Carli Tops, Thomas Potjer, Eleonora P.M. Corssmit, Jean-Pierre Bayley, Erik Hensen, Jeroen Jansen","doi":"10.1055/s-0044-1781438","DOIUrl":"https://doi.org/10.1055/s-0044-1781438","url":null,"abstract":"<p>\u0000<b>Background</b> SDHx variant carriers have an increased risk of developing head and neck paraganglioma. The Dutch guidelines state that these patients require lifelong follow-up, but no clear recommendation is made about the frequency of screening.</p> <p>\u0000<b>Objective</b> To determine the annual risk of developing head and neck paraganglioma in SDHx variant carriers after a negative initial screening.</p> <p>\u0000<b>Methods</b> We conducted a retrospective single-center cohort study in the Netherlands that included 49 SDHA, SDHB, and SDHD variant carriers with a negative first screening and at least one follow-up. The main outcome measure was the annual risk of developing a paraganglioma for the SDHx variants separately.</p> <p>\u0000<b>Results</b> Between 2000 and 2022, nine patients developed a paraganglioma all of whom were carriers of a SDHD variant (<i>n</i> = 23). Neither the 24 SDHB-related cases nor the 2 SDHA variant carriers developed a paraganglioma after a median of 4.83 and 5.92 years of follow-up, respectively.</p> <p>\u0000<b>Conclusion</b> The 5-year risk for head and neck paragangliomas in pathological SDHx variant carriers is less than 20%. A 5-year interval for screening SDHx carriers seems sufficient to prevent the unnoticed development of head and neck paragangliomas that warrant treatment.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"10 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of Endonasal Odontoidectomy in Pediatric versus Adult Populations: A Systematic Review and Meta-Analysis","authors":"Nikitha Kosaraju, Christine K. Lee, Z. Jason Qian, Juan C. Fernandez-Miranda, Jayakar V. Nayak, Michael T. Chang","doi":"10.1055/a-2257-5439","DOIUrl":"https://doi.org/10.1055/a-2257-5439","url":null,"abstract":"<p>\u0000<b>Introduction</b> Endonasal odontoidectomy (EO) is a procedure for addressing compressive pathology of the craniovertebral junction. While EO has been well established in adults, its complications and cervical fusion practices are less understood in pediatric patients, despite differences in sinonasal and craniocervical anatomy. This study summarizes and compares EO complications and need for cervical fusion in pediatric and adult patients.</p> <p>\u0000<b>Methods</b> This was a systematic review and meta-analysis. Literature review was conducted using PubMed, Web of Science, and Embase to identify studies reporting complications post-EO in adult and pediatric patients. Complications were categorized as neurologic, swallowing, or respiratory. Complication and posterior fusion rates were compared using a random-effects model.</p> <p>\u0000<b>Results</b> A total of 738 articles were identified, of which 28 studies including 307 adult cases and 22 pediatric cases met inclusion criteria for systematic qualitative and quantitative review. The rates for adult and pediatric cases, respectively, were: respiratory complications 13.4 versus 9.1%, swallowing complications 12.1 versus 4.5%, neurologic complications 8.5 versus 9.1%, and cervical fusion rates 73.3 versus 86.4%. Across eight studies qualifying for meta-analysis, there were no differences in cervical fusion (odds ratio [OR]: 0.5, 95% confidence interval [CI]: [0.1, 2.1]), respiratory complications (OR: 3.5, 95% CI: [0.8, 14.5]), or swallowing complications (OR: 3.5, 95% CI: [0.5, 26.0]); however, pediatric patients had a higher rate of neurologic complications (OR: 5.2, 95% CI: [1.1, 25.0]).</p> <p>\u0000<b>Conclusion</b> In EO, rates of aerodigestive complications and cervical fusion are similar in both populations. There may be an increased risk of neurologic complications in pediatric patients, although more high-quality studies are needed.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"22 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}