Journal of Pediatric Urology最新文献

{"title":"Systematic review and meta-analysis on the role of transcutaneous electrical nerve stimulation in children with overactive bladder - Pooled analysis of nine randomized controlled trials.","authors":"Sathyamurthy Arunaa, Ramesh Babu, Ramasundaram Madhu, Sambandan Kumaravel","doi":"10.1016/j.jpurol.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.012","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of overactive bladder (OAB) in children by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase and the Cochrane Library was conducted to identify RCTs comparing TENS with standard therapies (urotherapy, sham TENS, or oxybutynin) in children with OAB. Inclusion criteria encompassed RCTs published between 2004 and 2024, reporting TENS as a primary intervention. Data were pooled using a meta-analysis framework, and heterogeneity was assessed using I² statistics. Risk of bias was evaluated using the ROBVIS tool.</p><p><strong>Results: </strong>Nine RCTs involving 382 children were included. Five studies compared active TENS with sham TENS, of which three reported superior efficacy for TENS, while two found no difference. Two studies compared TENS with oxybutynin; one demonstrated TENS superiority, while the other found comparable efficacy. One study showed TENS to be as effective as urotherapy, and another found that TENS combined with oxybutynin was superior to either treatment alone. The meta-analysis revealed that TENS significantly increased the likelihood of a full response compared to other treatments (OR 3.96, 95 % CI 2.46-6.38, p < 0.001). TENS was effective both as a standalone therapy (OR 4.34) and as an adjunct (OR 3.27). Parasacral TENS demonstrated a higher response rate than posterior tibial TENS.</p><p><strong>Conclusion: </strong>TENS is an effective, non-invasive therapy for pediatric OAB, either as monotherapy or in combination with urotherapy or medication. However, variability in study protocols and limited long-term follow-up data highlight the need for standardized treatment protocols and larger RCTs to assess long-term outcomes, including relapse rates.</p><p><strong>Prospero registration number: </strong>CRD420251114932.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-pubertal outcomes of hypospadias surgery performed during infancy: High satisfaction with urinary function and minimal lower urinary tract symptoms.","authors":"Annaleena Anttila, Niklas Pakkasjärvi, Seppo Taskinen","doi":"10.1016/j.jpurol.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.013","url":null,"abstract":"<p><strong>Objectives: </strong>To assess long-term lower urinary tract symptoms (LUTS) in post-pubertal patients operated on for hypospadias during infancy.</p><p><strong>Patients and methods: </strong>We analysed patient-reported LUTS in 176 post-pubertal patients born between 1991 and 2003, who underwent early hypospadias repair at a median age of 1.4 years (IQR 1.1-1.9). At their last follow-up visit, patients returned pre-mailed questionnaires evaluating LUTS before transitioning from the pediatric unit. The results were compared to a healthy control group. We also assessed the impact of hypospadias severity on voiding and storage symptoms.</p><p><strong>Results: </strong>At a median age of 16.3 years, 19 % of patients had undergone stricture treatment following hypospadias repair. Frequent (often/always) or severely disturbing (moderate/major) voiding or storage symptoms were rare and comparable to controls according to DAN-PSS questionnaire (p > 0.05 for all comparisons). Most symptoms were mild, and the occurrence of mild symptoms varied between patients and controls. The severity of hypospadias did not affect the occurrence of voiding or storage symptoms. The occurrence of bothersome LUTS was also similar between patients with and without prior stricture treatment (p > 0.5 for all).</p><p><strong>Conclusion: </strong>Most patients reported satisfaction with their urinary function after urethroplasty, indicating that long-term LUTS do not significantly increase following hypospadias when complications including strictures are identified and managed. To enable long-term outcomes after childhood hypospadias surgery, structured follow-up is essential to detect and treat such complications.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of hormonal and surgical interventions versus surgery alone on fertility potential in undescended testes: A systematic review and meta-analysis.","authors":"Fransiskus Rajagukguk, Gerhard Reinaldi Situmorang, Irfan Wahyudi, Arry Rodjani, Putu Angga Risky Raharja","doi":"10.1016/j.jpurol.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.009","url":null,"abstract":"<p><strong>Background: </strong>The role of hormonal therapy as an adjunct to surgery in managing undescended testes (UDT) remains controversial. Its implications for future fertility are still unclear, and clinical practices vary globally.</p><p><strong>Objective: </strong>To evaluate the effects of combined hormonal and surgical treatment versus surgery alone on fertility potential in males with UDT.</p><p><strong>Study design: </strong>A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Embase, ClinicalTrials.gov, and Cochrane up to April 14, 2025. Eligible studies were randomized controlled trials and cohort studies comparing combined hormonal and surgical therapy with surgery alone, reporting on fertility-related potentials. Risk of bias was assessed using RoB 2.0 or the Newcastle-Ottawa Scale, and data synthesis was performed using RevMan 5.4.</p><p><strong>Results: </strong>Nine studies comprising 652 patients were included. Hormonal therapy combined with surgery significantly increased the number of spermatogonia per tubule (mean difference [MD] 0.23; 95 % CI: 0.07 to 0.38; p = 0.003), with more pronounced effects in bilateral UDT (MD 0.35; 95 % CI: 0.17-0.53; p = 0.001). However, no significant improvements were observed in long-term fertility markers, including sperm count, inhibin B, or testosterone. FSH levels were slightly lower in the combined group (MD -0.77 IU/L; 95 % CI: -1.29 to -0.26; p = 0.003).</p><p><strong>Conclusion: </strong>Adjunctive hormonal therapy may enhance early germ cell maturation, particularly in bilateral UDT. However, current evidence does not demonstrate clear long-term benefits in fertility-related potentials. Future high-quality, biomarker-stratified, and longitudinal studies are essential, and should include direct endpoints such as sperm counts and paternity, to fully determine the clinical utility of pre-orchidopexy hormonal treatment.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic evaluation and treatment of UTIs in children with neurogenic bladder.","authors":"Jacqueline G Holden, Sowdhamini Wallace, Pearl W Chang, Stephanie Davis-Rodriguez, Rana F Hamdy, John M Morrison, Michael J Tchou, Victor Trevisanut, Vijaya Vemulakonda, Catherine S Forster","doi":"10.1016/j.jpurol.2025.09.008","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.008","url":null,"abstract":"<p><strong>Objective: </strong>Children with neurogenic bladder (NGB) are at increased risk for urinary tract infections (UTIs), but there is a lack of guidelines to assist clinicians in diagnosing and treating these children. Our objective was to describe the presentation and treatment of provider diagnosed UTIs in children with NGB compared to children with vesicoureteral reflux (VUR) and to assess the proportion of children with NGB who met a consortium definition of UTI.</p><p><strong>Study design: </strong>We included children <18 years old with either VUR or NGB who were diagnosed in the emergency department with a febrile UTI in our multicenter retrospective cohort study. We extracted and compared UTI symptoms and urinalysis results specific to children with NGB to children with VUR. We measured the proportion of UTI diagnoses concordant with the Urologic Management to Preserve Initial Renal Function (UMPIRE) consensus definition of UTI, defined as ≥ 100,000 CFU/mL of 1 or 2 organisms, pyuria, and ≥ two symptoms of UTI.</p><p><strong>Results: </strong>The most common symptom among all children in the cohort was vomiting (38.8 %). Of the 215 children with NGB, 41.3 % met the UMPIRE definition for UTI. More children with NGB had multidrug resistant organisms (MDROs) cultured from their urine than those with VUR. Children with NGB, both who did and did not require CIC, had increased odds of MDRO in urine culture compared to those with VUR. Children with NGB were more likely to be prescribed broad-spectrum antibiotics than children with VUR.</p><p><strong>Conclusions: </strong>Most children with NGB diagnosed with febrile UTI in the ED did not meet a commonly recommended definition for UTI. The higher prevalence of MDRO UTIs and broad-spectrum antibiotic use in children with NGB highlights the need for accurate diagnostic approaches for UTI in this population, as well as the difficulty in diagnosing UTI in patients with NGB.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do I do it: Modified Devine procedure with sleeve dartos fasciectomy for post-circumcision concealed penis.","authors":"Meng Gui, Lei Zhang, Hao Wang, Qingbao He","doi":"10.1016/j.jpurol.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.007","url":null,"abstract":"<p><p>Concealed penis after circumcision can result in a buried penis appearance due to fibrotic dartos tissue tethering the shaft. We present a modified Devine's procedure that includes complete circumferential excision of the abnormal dartos fascia (\"sleeve\" dartos fasciectomy) and dermal anchoring of the shaft skin to fully release the penis and improve exposure. In 22 boys treated with this technique, stretched penile length approximately doubled (from ∼1.8 cm to 4.3 cm) with no recurrences. Only minor complications occurred, and patient/family satisfaction with the postoperative appearance was high. This approach provides a simple, effective solution for post-circumcision concealed penis.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of paediatric varicocele in Australia and New Zealand: A survey of the Australian and New Zealand association of paediatric surgeons (ANZAPS).","authors":"Tanay Bapna, Sarthak Tandon, Craig A McBride, Udaya Samarakkody, Kiarash Taghavi, Ramesh M Nataraja, Maurizio Pacilli","doi":"10.1016/j.jpurol.2025.09.006","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.006","url":null,"abstract":"<p><strong>Purpose: </strong>The diagnosis and management of paediatric varicocele remain controversial. We aimed to evaluate current practices in Australia and New Zealand (ANZ).</p><p><strong>Methods: </strong>An anonymous survey using the online Qualtrics platform (© 2024 Qualtrics), distributed to 114 ANZ active paediatric surgeons and paediatric urologists. Data collected included demographics, diagnostic processes, operative indications and techniques, and post-operative follow-up. Descriptive statistical analysis was conducted.</p><p><strong>Results: </strong>A total of 61 (53 %) responses were collected. The most commonly used diagnostic method was clinical examination with ultrasound (63% of respondents), with 82 % of this group requesting ultrasounds of the testes and abdomen. The principal indications for surgery were testicular volume discrepancies (95 % of respondents) and patient discomfort (97 %). A laparoscopic method was the first-line surgical approach for 51 % of respondents, interventional radiology (IR) for 45 %, and an open approach for 4 %. Mass ligation was the most common laparoscopic technique (74 %), with metallic clips used by 52 %. The majority of respondents favouring IR deferred to interventional radiologists regarding specific approaches. Most respondents (76 %) reported following-up patients for 1-2 years post-operatively.</p><p><strong>Conclusion: </strong>We have identified consistent practices among ANZ surgeons regarding the clinical assessment and indications for intervention. Differences are noted with the operative management, with a clear divide between a laparoscopic approach and radiological approach; this may reflect institutional expertise and pathways. This survey forms the basis for collaborative research to standardise the diagnosis and management of paediatric varicocele.</p><p><strong>Level of evidence: </strong>Level 5.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on 'Vaginoplasty in female bladder exstrophy-epispadias complex: Analysis of operative technique, outcomes, and complications'.","authors":"Lingling Chen, Lianyi Bao","doi":"10.1016/j.jpurol.2025.08.044","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.08.044","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor re Lower urinary tract symptoms in children with mild to moderate spastic cerebral palsy: Associations with functional level, trunk and respiratory parameters.","authors":"Funda Uysal Tan, Mustafa Ozgur Tan","doi":"10.1016/j.jpurol.2025.08.045","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.08.045","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up patterns and post-injury physical activity recommendations in pediatric high-grade renal trauma: A multicenter, retrospective analysis from the traumatic renal injury collaborative in kids (TRICK) consortium.","authors":"Jacob W Lucas, Jeffrey L Ellis, Nora H Broadwell, Ching Man Carmen Tong, Albert S Lee, Christopher J Long, Vinaya P Bhatia, Douglass B Clayton, Gabriella L Crane, Harold N Lovvorn, Michael L Nance, Robert T Russell, Ming-Hsien Wang, Christina P Ho, David Kitchens, Dana A Weiss","doi":"10.1016/j.jpurol.2025.08.024","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.08.024","url":null,"abstract":"<p><strong>Introduction: </strong>There is little consensus regarding optimal timing of follow-up or recommendations for duration of abstinence from sports following traumatic renal injuries.</p><p><strong>Objective: </strong>We aimed to characterize patterns of follow-up and post-trauma activity recommendations following high-grade pediatric renal trauma (HGRT) and provide tentative guidelines based on these findings.</p><p><strong>Study design: </strong>We reviewed all pediatric patients ≤18 years-old presenting to five level-1 pediatric trauma centers with AAST (American Association for the Surgery of Trauma) HGRT (grades III-V) from 2007 to 2020. Patient follow-up patterns and recommendations regarding time to return to sports were assessed from hospital records.</p><p><strong>Results: </strong>310 patients were included in final analysis: 135 grade III, 143 grade IV, and 32 grade V renal injuries. Higher injury severity score (ISS) was associated with higher renal trauma grade (p = 0.003). After hospital discharge, 41.94 % of the cohort had documented follow-up with urology and 37.42 % followed up with trauma surgery. A majority, 66.45 % (206/310), received recommendations regarding time to return to physical activity, with a median recommendation of 6.0 weeks [0,24]. Significant differences were seen between trauma centers independent of ISS or concomitant visceral injuries (recommendation given, p = 0.003; specialty providing recommendation, p < 0.001; and median time to resumption of physical activity, p < 0.001). Grade V HGRT had rates of post-trauma hypertension approaching 10 %.</p><p><strong>Discussion: </strong>In this large, multicenter high-grade pediatric renal trauma cohort, less than half of patients followed up with urology after the hospital stay. Additionally, only 66.45 % of patients received recommendations regarding abstinence from sports activities, and with highly variable timeframes between pediatric trauma institutions but not between the severity of renal trauma. There were no readmissions after 5 weeks of healing. Based on these findings, the authors tentatively recommend 6-8 weeks for return to activity with at least one of the following: 1) patient is asymptomatic and 2) confirmed healing on follow-up imaging.</p><p><strong>Conclusion: </strong>Even at level-1 pediatric trauma centers, follow-up after discharge and return to sports instructions for HGRT in the pediatric population was limited and highly variable between institutions. These findings suggest the need for better standardization of follow-up and post-trauma activity recommendations and suggest patient populations, specifically Grade V HGRT, who may benefit from resources for improved follow-up.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of sociodemographic factors and patient transfer on hospital throughput and surgical outcome in acute testicular torsion.","authors":"Hannah Lachmayr, Vivian Williams, Vivienne Feng, David Johnson, Erin Casey, Caleb P Nelson, Julia B Finkelstein","doi":"10.1016/j.jpurol.2025.09.005","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.005","url":null,"abstract":"<p><strong>Introduction: </strong>Timely diagnosis and management of acute testicular torsion (ATT) is a benchmark for quality of care. We sought to evaluate whether patient sociodemographic factors and transfer status had an impact on hospital throughput and orchiectomy in ATT patients.</p><p><strong>Methods: </strong>From 1/1/2022 to 9/9/2023, patients were identified by CPT code for operations to treat ATT and confirmed by chart review. Patient demographics were noted, and socioeconomic status (SES) was estimated using a distress score produced via the Distressed Communities Index (DCI), a multidimensional measure of social context. We denoted patients who were transferred to our urban tertiary care children's hospital and tracked emergency department (ED) registration time, time of arrival in the operating room (OR), and whether a repeat scrotal ultrasound (SUS) was performed for transfer patients. Based on a quality improvement measurement framework, the time between ED and OR (i.e., hospital throughput) served as our process measure, and orchiectomy rate was our outcome measure.</p><p><strong>Results: </strong>100 patients were diagnosed with ATT at a median age of 14 years (IQR 12-15). Median time from ED to OR was 110 min (IQR 79-144). Sixty-one patients were transferred to our institution, and this cohort reflected a higher proportion of White, non-Hispanic patients (p = 0.04) with a lower median distress score (14.4 vs 36.8, p = 0.03). Obtaining a repeat SUS in 25 transfer patients (41 %) prolonged the time to OR by a median of 20 min (p < 0.01). Regardless of repeat SUS, transfer patients had faster hospital throughput than those patients who presented primarily to our institution (p < 0.01). Overall, the orchiectomy rate was 18 %, and this outcome was associated with younger patient age (p < 0.01) and longer reported duration of symptoms (p < 0.01).</p><p><strong>Discussion: </strong>Transfer patients had a higher SES and experienced faster hospital throughput than patients presenting primarily to our institution. Repeating SUS in transfer patients added modestly to the time to OR but did not impact the likelihood of orchiectomy. In fact, neither transfer status nor sociodemographic factors, other than patient age, were associated with orchiectomy. Further research is needed to identify factors that affect testicular viability and what efforts might improve surgical outcomes.</p><p><strong>Conclusions: </strong>Patients with ATT transferred to our institution after presenting to a local hospital experienced prompt management with quicker time from ED to OR, though this did not impact their surgical outcome. Only younger patient age and longer reported duration of symptoms increased the likelihood of orchiectomy.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}