Journal of pediatric surgery最新文献

{"title":"The Only Constant is Change: A Longitudinal Analysis of Women's Representation Across American Pediatric Surgical Association (APSA) Committee Leadership.","authors":"Nikhil R Shah, Brielle Ochoa, R Scott Eldredge, Ronald B Hirschl, Marion C Henry, Kathleen van Leeuwen","doi":"10.1016/j.jpedsurg.2024.161901","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161901","url":null,"abstract":"<p><strong>Background: </strong>Women have historically been underrepresented in surgical leadership and in specialty organizations. This study longitudinally examines representation of women across committee leadership within the American Pediatric Surgical Association (APSA).</p><p><strong>Methods: </strong>Annual APSA committee chair and vice-chair rosters (2003-2023) were obtained. If not self-reported in the membership roster, gender was classified based upon review of publicly available data. Proportions of women who served as chairs and vice-chairs were quantified by committee and by year.</p><p><strong>Results: </strong>Overall, the proportion of women serving as APSA committee chairs and vice-chairs increased from 11% to 48% during the study period (p = 0.001). In examining each position, the proportion of women chairs increased from 12% to 40% (p = 0.042), while women vice-chairs increased from 10% to 58% (p = 0.009). The committees with the highest cumulative proportion of women chairs were Benjy Brooks (100%), Diversity Equity & Inclusion (100%), Finance (100%), Global Pediatric Surgery (67%), and Wellness (67%). Four committees- Trauma, Access to Surgery for Kids, Practice, and Professional Development - were not led by a woman chair in the entire study period. Additionally, five committees that traditionally have had significant impact on organizational workflow and agendas all had cumulative proportions of women chairs of less than 50% - Education (33%), Publications (28.6%), Outcomes (19%), Surgical Quality & Safety (18.8%) and Program (9.5%).</p><p><strong>Conclusion: </strong>These results demonstrate encouraging trends in the gender diversity of APSA leadership. However, this progress does not appear to be evenly distributed; leadership of key committees continues to lack substantial women's representation.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Era in Medical Information: ChatGPT Outperforms Medical Information Provided by Online Information Sheets About Congenital Malformations.","authors":"Maya Paran, Anastasia Almog, Yael Dreznik, Nadav Nesher, Dragan Kravarusic","doi":"10.1016/j.jpedsurg.2024.161894","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161894","url":null,"abstract":"<p><strong>Background: </strong>ChatGPT has demonstrated notable capabilities and has gained popularity in various medical tasks, including patient education. This study evaluates the content and readability of ChatGPT's responses to parents' questions about congenital anomalies.</p><p><strong>Methods: </strong>Information on four congenital anomalies (congenital diaphragmatic hernia, esophageal atresia and tracheoesophageal fistula, anorectal malformation, and gastroschisis) was assessed. Seven questions frequently asked by parents were posed for each anomaly, and responses generated by GPT-4 were compared to online information sheets from three top pediatric medical centers. Two senior pediatric surgeons, blinded to the source, evaluated the answers based on accuracy, comprehensiveness, and conciseness. Reading time and readability of the answers were also assessed.</p><p><strong>Results: </strong>ChatGPT answered all 28 questions, while online information sheets varied in completeness. ChatGPT's responses were rated significantly higher regarding full accuracy, comprehensiveness, and conciseness compared to the online information sheets (p < 0.00001, <0.00001, 0.0002, respectively). Despite having longer reading times and more challenging to read, ChatGPT's responses were more precise and detailed.</p><p><strong>Conclusions: </strong>ChatGPT outperforms online information sheets in providing accurate, comprehensive, and concise answers about congenital anomalies. This positions ChatGPT as a beneficial supplementary resource in pediatric healthcare. Future research should explore real-world applications and usability among parents.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Low Titer Group O Whole Blood (LTOWB) Transfusion in Initial Resuscitation of Pediatric Trauma Patients: Assessing Potential Benefits.","authors":"Si-Min Park, Joe Rodriguez, Zidong Zhang, Shin Miyata","doi":"10.1016/j.jpedsurg.2024.161892","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161892","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhagic shock secondary to trauma is a leading cause of pediatric mortality in the United States. Timely intervention is crucial to prevent many of these deaths. Children and adults exhibit distinct responses to trauma due to varying blood volume ratios and injury patterns. Pediatric patients with hypotension face a heightened risk of shock, demanding a more assertive resuscitation.</p><p><strong>Methods: </strong>This study is a review of the literature on LTOWB transfusion in pediatric trauma. We conducted electronic database searches until December 2022, using keywords related to LTOWB and pediatric trauma resuscitation. Randomized/non-randomized, retrospective/prospective studies were considered, assessing serological safety, adverse reactions, clinical outcomes, and cost-effectiveness.</p><p><strong>Results: </strong>Six articles were ultimately reviewed. No adverse reactions related to hemolysis biomarkers were observed. Clinical outcomes exhibited no significant differences in mortality, hospital, or ventilator days between LTOWB and component therapy (CT). However, LTOWB transfusion resulted in faster resolution of base deficit, lower INR, and reduced requirement for additive plasma and platelet transfusions. In military and massive transfusion cases, LTOWB was associated with decreased mortality and lower transfusion volumes. One article suggested potential economic advantages.</p><p><strong>Conclusions: </strong>LTOWB transfusion appears to be a promising option for pediatric trauma resuscitation, offering benefits in rapid administration and component balance. While some studies indicate potential advantages in clinical outcomes and cost-effectiveness, the current evidence is limited and requires further investigation. Future research should focus on large-scale studies to validate these findings, especially concerning economic benefits, and develop standardized protocols for LTOWB use in pediatric settings.</p><p><strong>Levels of evidence: </strong>Treatment Study, LEVEL III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Commonly Utilized Diagnostic Biopsy Techniques for Pediatric Patients With Cancer: A Systematic Review by the APSA Cancer Committee.","authors":"Martha Teke, Barrie S Rich, Ashley Walther, Dana Schwartz, Lucas A McDuffie, Gisela Butera, Jonathan P Roach, David H Rothstein, Dave R Lal, Kimberly Riehle, Andres Espinoza, Nicholas Cost, Elisabeth Tracy, David Rodeberg, Timothy Lautz, Jennifer H Aldrink, Erin G Brown","doi":"10.1016/j.jpedsurg.2024.161893","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161893","url":null,"abstract":"<p><strong>Background: </strong>Historically, surgical biopsy (SB) for diagnosis of pediatric solid tumors was considered necessary to provide adequate tissue for histologic and molecular analysis. Less invasive biopsy techniques such as image-guided core needle biopsy (CNB), have shown comparable accuracy with decreased morbidity in some adult studies. However, data regarding the safety and efficacy of CNB in pediatric tumors is limited. This study's aim was to assess the overall rate of successful diagnosis and safety of CNB compared to SB in children with malignancies.</p><p><strong>Methods: </strong>A PRISMA compliant systematic review was performed in MEDLINE via PubMed, Embase and CINAHL Plus database searches from 2010 to 2023. Studies were included with relevance to the following clinical question: For children with concern for malignancy requiring biopsy for diagnosis, how does CNB compare to open or laparoscopic/thoracoscopic SB in terms of safety and diagnostic efficacy? Data for patients ≤21 years requiring biopsy for diagnosis of liver tumors, neuroblastoma (NB), soft tissue sarcoma (STS), and lymphoma were included.</p><p><strong>Results: </strong>Twenty-seven studies including 2477 patients met inclusion criteria, with 2065 undergoing CNB and 412 SB. Of the 2477 patients, 820 patients had NB, 307 liver tumors, 96 STS, 151 lymphoma, and 1103 patients were from studies that included multiple diagnoses. The average complication rate for CNB was 2.9% compared to 21.4% for SB (p < 0.001). Bleeding was the most common complication in both groups, but significantly higher after SB (22.1% vs 2.3%) (p < 0.001). CNB was diagnostic in 90.8% of patients compared to 98.8% who underwent SB (p < 0.001).</p><p><strong>Conclusions: </strong>Rates of successful diagnosis were greater than 90% for both CNB and SB, though significantly higher for SB. Conversely, complication rates were close to ten times higher after SB compared to CNB. Given its relatively lower risk profile, CNB can be a safe and useful diagnostic tool for children with solid malignancies. Research focused on enhancing CNB's diagnostic accuracy while maintaining low morbidity should be further explored.</p><p><strong>Level of evidence: </strong>Treatment study, Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"15 Years of Vacuum Bell Therapy for Pectus Excavatum: Long-term Outcomes and Influencing Factors.","authors":"Hendrik van Braak, Sjoerd A de Beer, Youssef Al Ghouch, Sander Zwaveling, Matthijs W N Oomen, L W Ernest van Heurn, Justin R de Jong","doi":"10.1016/j.jpedsurg.2024.161891","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161891","url":null,"abstract":"<p><strong>Background: </strong>Long-term results and factors affecting outcomes of vacuum bell therapy for pectus excavatum are relatively unknown.</p><p><strong>Methods: </strong>We conducted a retrospective study on patients (<18y) treated with vacuum bell therapy between May 2008 and October 2021. Primary outcome was treatment success; secondary outcomes were analysis of daily time spent on treatment, treatment duration, complications, long-term follow-up, treatment for patients awaiting a Nuss procedure, treatment for female patients, and factors affecting outcomes.</p><p><strong>Results: </strong>Of 259 patients treated with vacuum bell therapy, 18.9% (n = 49/259) were still being treated, 17.4% (n = 45/259) were lost to follow-up and 63.7% (n = 165/259) completed treatment, with a 52.1% (n = 86/165) success rate. Median follow-up was 64.0 months (interquartile range 48.0-87.0). More time spent daily on vacuum bell therapy, total treatment duration, and overnight use led to a higher success rate (P = 0.002, P < 0.001, P < 0.001 resp.). Complications (22.8%, n = 59/259) were minor, recurrence occurred in 2.3% (n = 2/86) of patients. Of the patients treated while awaiting a Nuss procedure, 26.7% (n = 4/15) no longer required the Nuss procedure. Breast growth made 39.3% (n = 11/28) of female patients quit treatment. Deeper deformities (P = 0.02, P = 0.009), flexible chest wall (P = 0.007) and symptomatic pectus excavatum (P = 0.02) resulted in lower success rates.</p><p><strong>Conclusions: </strong>Vacuum bell therapy is successful in up to 52.1% of patients. Overnight vacuum bell use and treatment while awaiting a Nuss procedure should be encouraged. Older patients with a stiff chest wall can be successfully treated with prolonged treatment. For female patients watchful waiting or early treatment, to prevent challenges during breast growth, is preferred.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Bayesian Network Predicting Intubation Following Hospital Arrival Among Injured Children.","authors":"Travis M Sullivan, Mary S Kim, Genevieve J Sippel, Waverly V Gestrich-Thompson, Caroline G Melhado, Kristine L Griffin, Suzanne M Moody, Rajan K Thakkar, Meera Kotagal, Aaron R Jensen, Randall S Burd","doi":"10.1016/j.jpedsurg.2024.161888","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161888","url":null,"abstract":"<p><strong>Background: </strong>Inadequate airway management can contribute to preventable trauma deaths. Current machine learning tools for predicting intubation in trauma are limited to adult populations and include predictors not readily available at the time of patient arrival. We developed a Bayesian network to predict intubation in injured children and adolescents using observable data available upon or immediately after patient arrival.</p><p><strong>Methods: </strong>We obtained patient demographic, injury, resuscitation, and transportation characteristics from trauma registries from four American College of Surgeons-verified level 1 pediatric trauma centers from January 2010 through December 2021. We trained and validated a Bayesian network to predict emergent intubation after pediatric injury. We evaluated model performance using the area under the receiver operating and calibration curves.</p><p><strong>Results: </strong>The final model, TITAN (Timing of Intubation in Trauma Analysis Network), incorporated five factors: Glasgow Coma Scale, mechanism of injury, injury type (e.g., penetrating, blunt), systolic blood pressure, and age. The model achieved an area under the receiver operating characteristic curve of 0.83 (95% CI 0.80, 0.85) and had a calibration curve slope of 0.98 (95% CI 0.67, 1.29). TITAN had high specificity (98%), negative predictive value (97%), and accuracy (96%) at a binary probability threshold of 22.6%.</p><p><strong>Conclusion: </strong>The TITAN Bayesian network predicts the risk of intubation in pediatric trauma patients using five factors that are observable early in trauma resuscitation. Prospective validation of the model performance with patient outcomes is needed to assess real-life application benefits and risks.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological, Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Esophageal Atresia in Germany: Analysis of National Hospital Discharge Data From 2016 to 2022.","authors":"Max Ungruh, Jochen Hubertus, Anke Widenmann, Jost Kaufmann, Heiko Reutter, Reinhard Busse, Miriam Wilms, Ulrike Nimptsch","doi":"10.1016/j.jpedsurg.2024.161890","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161890","url":null,"abstract":"<p><strong>Background: </strong>Esophageal atresia (EA) is a complex malformation. Multidisciplinary management is necessary, with the operative repair being the most challenging step in the treatment algorithm. The complete care structure for children with EA in Germany has not been analyzed yet.</p><p><strong>Methods: </strong>In the observed period 2016-2022, inpatient EA cases were analyzed 1) during the hospital stay of birth, and 2) during the hospital stay of corrective surgery in patients aged up to 365 days, both based on national hospital discharge data. Patients' comorbidities, hospital caseload, treatment characteristics (e.g. surgical approach) and outcome parameters were analyzed.</p><p><strong>Results: </strong>1) 1190 newborn EA cases were treated in 260 hospitals during the perinatal period. 54% had at least one additional malformation, and 16% had a birthweight below 1500 g. In-hospital mortality was 8.4%. 2) 1475 corrective operations for EA were performed in 111 hospitals with a consistent median annual caseload of 2 (P25-P95 1-8) per hospital. At least one indicator for a complicated perioperative course was documented in 63.7% of cases. The use of bronchoscopy was coded in 50% of cases. Median ventilation time during the entire hospital stay was 176 h (P25-P95: 95-1759 h).</p><p><strong>Conclusions: </strong>Newborns with EA are complex and early postoperative complications are common. The care structure is decentralized, and there was no trend towards centralization in the observed period. The low documented use of bronchoscopy is noteworthy. Centralization of the highly complex and schedulable corrective surgery for EA is necessary to evaluate outcomes and might improve the quality of care and resource utilization. CATEGORY OF THE MANUSCRIPT AND TYPE OF STUDY: original article, observational cross-sectional study, secondary data analysis.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Liquid Biopsy in Neuroblastoma: A Scoping Review.","authors":"Jitender Singh,Nitin J Peters,Pramod Avti,Amita Trehan,J K Mahajan,Prema Menon,Deepak Bansal,Ravi Prakash Kanojia","doi":"10.1016/j.jpedsurg.2024.161887","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161887","url":null,"abstract":"BACKGROUNDNeuroblastoma (NBL), is the most common, non-CNS solid tumor of childhood. This disease presents with unique biological and clinical challenges necessitating accurate diagnosis, prognosis assessment, treatment, and vigilant monitoring. Liquid biopsy is an upcoming, innovative, and non-invasive diagnostic modality. It has the potential to detect tumors and perform therapeutic monitoring through the analysis of circulating biomarkers in blood, urine, saliva, and other bodily fluids.METHODOLOGYThis scoping review offers an in-depth exploration, of the current landscape of liquid biopsy-based biomarkers in NBL. The review looks at the clinical implications, prevalent challenges, and future outlook of their clinical applications in NBL. The scoping review adhered to the guidelines of the PRISMA extension for scoping reviews, known as PRISMA-ScR, as the skeletal framework. The review involved comprehensive searches for liquid biopsy-based biomarkers in NBL across multiple databases, including PUBMED, EMBASE, SCOPUS, and WEB of Science, without restrictions.RESULTSThe scoping review process uncovered a significant body of literature (n = 201) that underwent meticulous scrutiny, ultimately leading to the final selection of studies (n = 15). The liquid biopsy biomarkers included circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), exosomes, and other entities in bodily fluids. Their evaluation focused on associations with clinical outcomes such as overall survival, event-free survival, and risk stratification in NBL.CONCLUSIONOur findings highlight the potential of liquid biopsy biomarkers to revolutionize NBL diagnosis and therapeutic monitoring. This rapidly evolving frontier in pediatric oncology suggests significant advancements in precision medicine for the management of NBL.","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on: Environmental Impact of Traveling to the Annual American Pediatric Surgical Association Meeting.","authors":"Christopher S Muratore","doi":"10.1016/j.jpedsurg.2024.161889","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161889","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Ultrasound Reliably Detect Complicated Appendicitis in Pediatric Patients?","authors":"Mohamed Zouari, Manel Belhajmansour, Oumaima Jarboui, Najoua Ben Kraiem, Mahdi Ben Dhaou","doi":"10.1016/j.jpedsurg.2024.161885","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161885","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}