Journal of Perinatal Medicine最新文献

{"title":"The fetus as a patient: professional responsibility in contemporary Perinatal Medicine.","authors":"Frank A Chervenak, Asim Kurjak, Milan Stajonevic, Joachim Dudenhausen, Amos Grünebaum","doi":"10.1515/jpm-2025-0338","DOIUrl":"https://doi.org/10.1515/jpm-2025-0338","url":null,"abstract":"<p><p>The concept of the fetus as a patient has evolved over the past several decades, driven by advances in fetal medicine, neonatology, and bioethics. Pioneering international work by Erich Saling, Ian Donald, William Liley, L. Stanley James, and Roberto Caldeyro-Barcia transformed the fetus from a passive presence into an active subject of medical diagnosis and intervention, laying the groundwork for a dual-patient ethical model in obstetric care. The Society \"The Fetus as a Patient,\" established in the early 1990s, galvanized international collaboration among clinicians and ethicists, promoting the recognition of the fetus as a patient. Since its inception, the <i>Journal of Perinatal Medicine</i> has served as the official and essential publication of the Society for the Fetus as a Patient, disseminating many of its most influential papers. Central to this evolution is the professional responsibility model, which delineates clinicians' ethical obligations to both pregnant and fetal patients, emphasizing evidence-based advocacy and beneficence while respecting maternal autonomy. The model defines the fetus as a patient when the pregnant woman seeks care and when interventions can reasonably benefit the fetus, with viability as an inflection point serving as a key ethical threshold. Technological advances in the 21st century, such as fetal surgery and gene therapy, have further advanced the ethical landscape, necessitating nuanced, preventive ethics and transparent communication. The 2009 and 2024 International Academy of Perinatal Medicine New York declarations have reinforced the global commitment to equitable, ethically sound perinatal care, balancing maternal rights and fetal interests. As maternal-fetal medicine continues to advance, ongoing ethical reflection, institutional support, and interdisciplinary international collaboration remain essential for aligning clinical innovation with professional integrity and justice in perinatal care.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567562","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":"Feasibility and reproducibility of speckle tracking echocardiography in routine assessment of the fetal heart in a low-risk population: a letter reply.","authors":"Adalina Sacco, Ayisha Kazi, Diane Lambo, Victoria Jowett, Pranav Pandya","doi":"10.1515/jpm-2025-0326","DOIUrl":"https://doi.org/10.1515/jpm-2025-0326","url":null,"abstract":"","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575717","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":"Serum biomarkers in the early detection of necrotizing enterocolitis: a systematic review.","authors":"Sara Pimenta, Susana Pissarra, Paulo Soares, Inês Azevedo, Joana Pereira-Nunes","doi":"10.1515/jpm-2025-0180","DOIUrl":"https://doi.org/10.1515/jpm-2025-0180","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease with high morbidity and mortality that predominantly affects preterm infants. Early diagnosis remains challenging due to nonspecific symptoms and delayed detection of radiological signs.</p><p><strong>Content: </strong>This systematic review provides an updated overview of the available evidence on serum biomarkers for early NEC detection, focusing on their diagnostic accuracy and clinical utility. A structured search was conducted in MEDLINE, Scopus, and web of science, identifying 40 studies evaluating biomarkers across various categories, including hematological indices, acute phase reactants, immunological markers, tissue damage and tissue repair markers, and metabolic markers.</p><p><strong>Summary: </strong>Our findings highlight intestinal fatty acid-binding protein (I-FABP) as a promising biomarker for NEC prediction within the first 24 h of life. Ischemia-modified albumin (IMA) and certain multi-marker panels also showed high diagnostic accuracy. Despite these promising results, small sample sizes and heterogeneity in study design, biomarker thresholds, and patient populations limit immediate clinical implementation.</p><p><strong>Outlook: </strong>Future multicenter studies are essential to validate promising biomarkers, particularly I-FABP and IMA, and establish standardized cut-off values. Integrating biomarkers into multi-marker panels, alongside clinical and non-invasive approaches, may improve early NEC detection, enhance diagnostic accuracy, and guide timely interventions to optimize neonatal outcomes.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528446","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 seven-year retrospective cohort study on non-immune foetal hydrops from a single centre in an LMIC setting.","authors":"Varunashree Nagasamudra Devendrappa, Lois Sara James, Swati Rathore, Preethi Navaneetham, Mary Purna Chacko, Sumita Danda, Manisha Madhai Beck","doi":"10.1515/jpm-2024-0518","DOIUrl":"https://doi.org/10.1515/jpm-2024-0518","url":null,"abstract":"<p><strong>Objectives: </strong>To study the clinical profile, aetiology and outcomes of foetuses diagnosed with non-immune hydrops (NIHF) at a single centre between 2016 and 2023.</p><p><strong>Methods: </strong>Pregnancies diagnosed with NIHF were studied retrospectively, using the antenatal records and neonatal electronic database.</p><p><strong>Results: </strong>Ninety-two foetuses were diagnosed with NIHF including 8 sets of twins. Majority (64 %) were diagnosed in second trimester followed by 25 % in first trimester. One fourth (24 %, n=22) had IUFD (Intrauterine foetal demise) at diagnosis. Congenital anomalies were present in (57 %, 52) most common being cystic hygroma, (10/52) followed by foetal chylothorax and cardiac anomalies. Multiple anomalies were present in 15 % cases. Genetic evaluation, either chromosomal and/or DNA based test was done only in 62 % (57/92). More than one third (39 %, 22) had an abnormal karyotype, most common being 45, XO in 54 %, (12/22) followed by trisomy 21(9/22, 41 %). Twin-to-twin transfusion syndrome (TTTS) was seen in 75 % twins. Overall, most common etiologies were genetic, congenital anomalies, and unknown seen in 30 %, 26 %, and 23 % respectively. Majority of those with unknown aetiology were not/partially evaluated (13/21, 62 %). Recurrent NIHF was seen in 8 women. Two of them were diagnosed to have monogenic disorder while another one was carrier of a balanced chromosomal translocation.</p><p><strong>Conclusions: </strong>Genetic aetiology was found in one third. The most common cause in twins was TTTS. One fifth had unknown aetiology, mostly due to lack of complete diagnostic work up.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690578","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":"Prediction of gestational diabetes mellitus using clinical and ultrasonographic parameters: development of independent maternal and fetal models.","authors":"Sinem Tekin, Aydın Ocal, Filiz Yarsilikal Guleroglu, Cagseli Göksu Ozgün Selcuk, Omer Gökhan Eyisoy, Emine Ufuk Büyükkaya Ocal, Ali Cetin","doi":"10.1515/jpm-2025-0135","DOIUrl":"https://doi.org/10.1515/jpm-2025-0135","url":null,"abstract":"<p><strong>Objectives: </strong>To develop predictive models for gestational diabetes mellitus (GDM) using maternal clinical and ultrasonographic parameters, as well as fetal ultrasonographic measurements obtained during routine second-trimester obstetric examination.</p><p><strong>Methods: </strong>Our prospective case-control study included 80 pregnant participants (32 with GDM and 48 healthy controls) between 24 and 28 weeks of gestation. We evaluated maternal parameters including anthropometric measurements such as neck circumference and waist-hip ratio, ultrasonographic measurements like maternal adipose thickness, as well as fetal ultrasonographic parameters including pancreatic hyperechogenicity, soft tissue measurements, and cardiac parameters. Following ultrasonographic examination, all participants underwent a 75-g oral glucose tolerance test (OGTT). Two separate logistic regression models were developed for maternal and fetal parameters to evaluate their association with the presence or absence of GDM.</p><p><strong>Results: </strong>The maternal model achieved 90.0 % accuracy through a stepwise integration of suprapubic subcutaneous adipose tissue thickness (OR=1.35, 95 % CI: 1.11-1.64), visceral adipose tissue (OR=1.68, 95 % CI: 1.18-2.40), gravidity (OR=2.09, 95 % CI: 1.32-3.33), and family history of diabetes. The fetal model reached 82.5 % accuracy using two parameters: pancreatic hyperechogenicity (OR=0.02, 95 % CI: 0.00-0.14) and fetal abdominal subcutaneous tissue thickness (OR=5.09, 95 % CI: 1.75-14.78). The maternal model demonstrated excellent discriminative ability with an AUC of 0.95.</p><p><strong>Conclusions: </strong>Both maternal and fetal ultrasonographic parameters can serve as effective predictors of GDM when combined with clinical risk factors. These models, which can be easily incorporated into routine second-trimester ultrasound examinations, offer potential for early identification of high-risk patients without additional patient visits or invasive testing.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293909","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":"Exploration of copy number variations and candidate genes in fetal congenital heart disease using chromosomal microarray analysis.","authors":"Di Yao, Ruyu Xia, Xu Jiang, Caiqin Guo, Nan Shi, Hehua Tao, Lan Yang","doi":"10.1515/jpm-2024-0599","DOIUrl":"https://doi.org/10.1515/jpm-2024-0599","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate copy number variations (CNVs) and potential candidate genes associated with fetal congenital heart disease (CHD) and to compare the prevalence of CNVs among different CHD subtypes.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 391 fetuses diagnosed with CHD between 2019 and 2023. 391 fetuses with case were divided into three groups: isolated CHD (Group 1), complex CHD (Group 2), and CHD with extracardiac anomalies (Group 3). Amniocentesis was performed for all pregnant women, with both karyotyping and CMA conducted. Gene Ontology (GO) annotation and KEGG pathway analyses were conducted for isolated and complex CHD cases.</p><p><strong>Results: </strong>CMA and karyotype detected total abnormalities in 22 % of all CHD fetuses, including a chromosomal aneuploidy rate of 7.2 %, a pathogenic CNV (pCNV) rate of 6.1 %. The overall detection rates for Groups 1, 2, and 3 were 11.6 %, 12.5 %, and 50 %, respectively. Group 3 exhibited significantly higher rates of chromosomal aneuploidy (23.7 %) and pCNV (17.8 %) compared to Groups 1 and 2 (p < <i>0.001</i>). No significant differences in maternal age were observed among the three CHD groups. KEGG pathway analysis identified the top three enriched pathways for complex CHD were nucleocytoplasmic transport, cell adhesion molecules, and the mRNA surveillance pathway.</p><p><strong>Conclusions: </strong>The rates of chromosomal aneuploidy and CNV abnormalities in CHD cases with extracardiac anomalies were significantly higher than in the other two groups. Maternal age was not associated with the chromosomal abnormalities observed in CHD cases. KEGG pathway analysis indicated more intricate molecular pathways in complex CHD.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187207","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":"Effect of oral hydration therapy on amniotic fluid index and maternal-neonatal outcomes in pregnant women with oligohydramnios: a systematic review and meta-analysis.","authors":"Anita Yadav, Priyanka Yadav, Kalyani P Deshmukh, Anusha Kamath, Chanchal Goyal, Avinash Prakash, Aravind P Gandhi","doi":"10.1515/jpm-2025-0176","DOIUrl":"https://doi.org/10.1515/jpm-2025-0176","url":null,"abstract":"<p><strong>Objectives: </strong>Maternal oral hydration therapy is a non-invasive approach to improving AFI, but its effectiveness remains uncertain. This systematic review and meta-analysis were therefore undertaken to assess the effectiveness of maternal oral hydration therapy in increasing AFI in pregnancies complicated by oligohydramnios and to evaluate its impact on maternal and neonatal outcomes.</p><p><strong>Methods: </strong>A systematic search of Cochrane Library, Embase, PubMed, Scopus, and Web of Science was conducted. Eligible studies included randomized controlled trials (RCTs), quasi-experimental studies, and analytical observational studies. All studies published till 22 November 2024 in the above databases were included. No restrictions were placed on geographic location or study setting. Two reviewers independently undertook the screening. Relevant studies were identified, screened, and duplicates removed using NESTED Knowledge. Risk of bias was assessed using NOS, JBI, and ROBINS-I tools. Statistical analyses, including meta-analysis using a random-effects model, were conducted in R Studio and Comprehensive Meta-Analysis (CMA) software. Heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>Out of the 12 included studies four qualified for meta-analysis. Pooled results showed a significant increase in AFI at 2 hours (mean difference: 0.996; 95 % CI: 0.781-1.210), 1 day (0.853; 95 % CI: 0.532-1.174), 2 days (1.649; 95 % CI: 0.943-2.356), and 1 week (2.232; 95 % CI: 0.943-3.520). However, high heterogeneity was observed due to variations in fluid type, volume, and frequency.</p><p><strong>Conclusions: </strong>It can be concluded that oral hydration therapy significantly increases AFI and is a simple intervention for managing oligohydramnios, especially in resource-limited settings.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181468","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":"Risk factors and adverse outcomes associated with hepatitis C virus in pregnancy.","authors":"Moti Gulersen, Erez Lenchner, Amos Grunebaum, Frank A Chervenak, Eran Bornstein","doi":"10.1515/jpm-2025-0146","DOIUrl":"https://doi.org/10.1515/jpm-2025-0146","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate maternal sociodemographic factors and adverse pregnancy outcomes associated with hepatitis C virus (HCV) infection during pregnancy in a large population of live births.</p><p><strong>Methods: </strong>Retrospective analysis of the United States (US) Centers for Disease Control and Prevention Natality Live Birth database (2016-2021). All births were eligible for inclusion. Deliveries with missing data on HCV infection were excluded. Multiple sociodemographic factors and adverse pregnancy and neonatal outcomes were compared between pregnancies complicated by maternal HCV infection and those without HCV. Multivariable logistic regression was utilized to evaluate the association of sociodemographic factors with HCV and adjust outcomes for potential confounders.</p><p><strong>Results: </strong>Of the 22,604,938 live births included, 107,761 (0.48 %) were complicated by maternal HCV. Patients with HCV in pregnancy were more likely to be advanced maternal age, have Medicaid insurance, or smokers. In addition, HCV in pregnancy was associated with higher risks of concurrent infections with hepatitis B virus, syphilis, gonorrhea, or chlamydia. HCV was associated with an increased risk of preterm birth <37 weeks, low birthweight, congenital anomalies at birth, low 5-min Apgar scores, NICU admission, antibiotic treatment for suspected neonatal sepsis, as well as immediate and prolonged ventilation.</p><p><strong>Conclusions: </strong>Based on this recent, large US population cohort, HCV in pregnancy is more commonly associated with certain sociodemographic factors and several adverse pregnancy and neonatal outcomes. These data are an important step in the attempt to identify at-risk patients and employ strategies to better manage and optimize care for these pregnancies.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180027","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":"Gestational diabetes insipidus. A systematic review of case reports.","authors":"Mónica Bermúdez González, Esther Alvarez Silvares, Gonzalo Rubio Pérez","doi":"10.1515/jpm-2024-0499","DOIUrl":"https://doi.org/10.1515/jpm-2024-0499","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the clinical characteristics and etiopathogenic factors associated with gestational diabetes insipidus (GDI), analyzing maternal and perinatal outcomes.</p><p><strong>Methods: </strong>A systematic review was performed in PubMed, Embase and Scopus of articles on GDI published from January 1, 1980 to April 3, 2024. The review included 55 case reports on GDI, with a total of 64 women. Data on age, parity, diagnosis, management, and maternal and perinatal morbidity and mortality were collected. Descriptive statistical analysis was performed with SPSS version 17.0, considering a p value <0.05 as significant. Study quality was assessed with the Joanna Briggs Institute critical appraisal checklist.</p><p><strong>Results: </strong>Of the 64 women studied, 65.6 % were primiparous and the mean gestational age at diagnosis was 32.7 weeks. There was a high prevalence of twin gestations (21.9 %) and a significant percentage of cesarean deliveries (54 %). Preeclampsia, Acute fatty liver of pregnancy and HELLP syndrome were significantly more prevalent. The incidence of prematurity was 54.7 % and the perinatal mortality rate was 78.1 ‰. These complications showed statistical significance (p<0.05), indicating the severity of GDI and its impact on obstetric outcomes.</p><p><strong>Conclusions: </strong>GDI represents a complex clinical challenge with important implications for maternal-fetal health. The understanding of its aetiology, linked to vasopressinase activity and its relationship with various obstetric pathologies, is crucial for the diagnosis and proper management of this condition.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181469","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":"Integrating NIPT and ultrasound for detecting fetal aneuploidies and abnormalities.","authors":"Wiku Andonotopo, Muhammad Adrianes Bachnas, Adhi Pribadi, Muhammad Alamsyah Azis, Muhammad Ilham Aldika Akbar, Ernawati, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, Dudy Aldiansyah, Julian Dewantiningrum, Mochammad Besari Adi Pramono, John Wantania, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak","doi":"10.1515/jpm-2025-0005","DOIUrl":"https://doi.org/10.1515/jpm-2025-0005","url":null,"abstract":"<p><p>The advent of non-invasive prenatal testing (NIPT) utilizing cell-free fetal DNA (cfDNA) has transformed the landscape of early chromosomal anomaly detection. When paired with high-resolution ultrasound imaging, it establishes a robust framework for prenatal diagnostics. This study explores the efficacy of merging NIPT findings with detailed ultrasound markers to enhance the identification of both chromosomal and structural fetal abnormalities. Data from 190 cases demonstrated a cfDNA efficacy rate of 91.58 % (cfDNA ≥4 %) and a detection rate of 4.74 % for aneuploidies. The investigation delves into key findings for trisomies, monosomies, and physical malformations, backed by state-of-the-art diagnostic benchmarks. Markers such as nuchal translucency (NT), craniofacial characteristics, and cardiac irregularities were analyzed alongside genetic results. This integrative strategy significantly refines diagnostic precision, paving the way for personalized prenatal care and management.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182144","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}