Journal of Thrombosis and Haemostasis最新文献

{"title":"Intravenous Immunoglobulin (IVIG) use in HIT and efficacy of early IVIG compared to standard of care treatment.","authors":"Jivtesh Singh, Grace Gorecki, Prabhsimrat Gill, Samantha Maples, Irina Chibisov, Angela Verdoni, Robert A Kaplan, Rama Ganesh, Deep Shah, Arjun Lakshman","doi":"10.1016/j.jtha.2026.09.029","DOIUrl":"https://doi.org/10.1016/j.jtha.2026.09.029","url":null,"abstract":"<p><strong>Background: </strong>Heparin-induced thrombocytopenia (HIT) is an immune-mediated prothrombotic complication of heparin exposure. Intravenous immunoglobulin (IVIG) has been proposed as an adjunctive therapy for refractory or autoimmune HIT. Real-world utilization patterns and impact of early administration on clinical outcomes remain unclear.</p><p><strong>Methods: </strong>We performed a retrospective chart review across the Allegheny Health Network (2015-2025). We described clinical characteristics and outcomes among all HIT patients who received IVIG (n=29). We also compared early IVIG recipients (n=24) to controls (n=129) using 1:2 propensity score matching. The primary outcome was time to platelet recovery, analyzed using Kaplan-Meier estimation and Cox proportional hazards regression.</p><p><strong>Results: </strong>IVIG was used in a cohort of patients with a median platelet count nadir of 26 × 10⁹/L (IQR of 16 - 35 ×10⁹/L) and thrombosis was present at diagnosis in 75.8% of patients. Platelet recovery was achieved in 93.1% at a median of 6 days (IQR 3 - 9 Days) days from first dose of IVIG administration, with a favorable safety profile. Early IVIG (within 3 days of HIT diagnosis) was associated with significantly faster platelet recovery in the matched cohort (median 3 vs. 5 days; HR 2.15, 95%CI 1.09-4.26, p=0.028). Higher platelet nadir predicted faster recovery (HR 2.247 per 10 × 10⁹/L, p < 0.001). No significant differences in thrombosis, bleeding, or mortality were observed.</p><p><strong>Conclusions: </strong>At our institution, IVIG use in HIT was confined to severely ill patients with high thrombotic burden. Early IVIG administration accelerated platelet recovery compared to standard-of-care alone. Prospective multicenter studies are needed to confirm these findings.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039737","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":"Teclistamab for the treatment of autoantibody-mediated coagulation disorders.","authors":"Johannes Thaler, Karoline Gleixner, Lisbeth Eischer, Gabriel Kammerer, Joachim Rettl, Lisa Sailer, Christian Sillaber, Peter Quehenberger, Maria Theresa Krauth, Paul Knöbl, Cihan Ay, Hermine Agis","doi":"10.1016/j.jtha.2026.09.028","DOIUrl":"10.1016/j.jtha.2026.09.028","url":null,"abstract":"<p><strong>Background: </strong>Teclistamab is a bispecific monoclonal antibody that targets B-cell maturation antigen on plasma cells and other B lineage cells and CD3 on T cells, thereby redirecting cytotoxic T cells to eliminate B-cell maturation antigen-expressing antibody-producing cells. Autoantibody-mediated coagulation disorders are often driven by long-lived antibody-producing cells that may persist despite conventional immunosuppression or B-cell depletion.</p><p><strong>Objective: </strong>To investigate whether teclistamab represents a treatment option for patients with refractory or rapidly progressive autoantibody-mediated coagulation disorders.</p><p><strong>Methods: </strong>We retrospectively analyzed 7 patients with autoantibody-mediated coagulation disorders treated with teclistamab. Diagnoses included acquired von Willebrand disease (n = 2), acquired factor XI deficiency (n = 2), and catastrophic antiphospholipid syndrome (CAPS; n = 3). Five patients had an underlying paraprotein, whereas 2 patients with CAPS had no detectable paraprotein.</p><p><strong>Results: </strong>All 7 patients achieved complete remission (median time to remission: 24 weeks [range: 2-35]) following teclistamab. In the 4 patients with acquired von Willebrand disease or factor XI deficiency, improvement in the disease-defining coagulation parameter and cessation of bleeding were observed following initiation of teclistamab. In the 3 patients with CAPS, disappearance of antiphospholipid antibodies or normalization of the lupus anticoagulant sensitive activated partial thromboplastin time was observed and accompanied by clinical stabilization without further thromboembolic events. Treatment was generally well tolerated. Three patients developed grade 1 cytokine release syndrome. One patient developed transient colitis, while another patient experienced reversible seronegative inflammatory joint symptoms. All patients received immunoglobulin replacement.</p><p><strong>Conclusion: </strong>Teclistamab treatment was associated with complete remissions in patients with autoantibody-mediated coagulation disorders. These observations warrant further evaluation of teclistamab in selected patients.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039686","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":"Teclistamab in relapsed, multirefractory acquired hemophilia A after failure of anti-CD19 chimeric antigen receptor T-cell therapy.","authors":"Christiane E Dobbelstein, Kalin Stoyanov, Krasimira Aleksandrova, Lubomir Arseniev, Jana Leise, Stephan Klöß, Felicitas R Thol, Florian H Heidel, Andreas Tiede, Christian R Schultze-Florey","doi":"10.1016/j.jtha.2026.09.027","DOIUrl":"10.1016/j.jtha.2026.09.027","url":null,"abstract":"<p><p>A patient with relapsed acquired hemophilia A (AHA), who previously failed multiple lines of immunosuppressive therapy, including autologous anti-CD19 chimeric antigen receptor cell therapy, received teclistamab, a bispecific monoclonal antibody engaging autologous CD3-positive T cells with the B cell maturation antigen on plasma cells and mature B cells. Teclistamab was well tolerated without clinically significant adverse events, except for hypogammaglobulinemia. Prompt and durable remission was observed that lasted for more than 1 year posttreatment. This is the first case of refractory acquired hemophilia A successfully treated with teclistamab, providing a proof-of-concept for plasma cell-directed bispecific antibodies and supporting their further evaluation.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039653","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":"Conceptualizing the future of thromboprophylaxis for hospitalized children.","authors":"Robert Marcel T Huibonhoa, Anthony A Sochet, E Vincent S Faustino","doi":"10.1016/j.jtha.2026.09.019","DOIUrl":"10.1016/j.jtha.2026.09.019","url":null,"abstract":"<p><p>The practice of thromboprophylaxis in hospitalized children is evolving. Emerging research on pediatric hospital-acquired venous thromboembolism (HA-VTE) prevention is expanding, yet clinical gaps and barriers persist. In this review, we conceptualize the future of thromboprophylaxis in children to address current challenges related to the prediction of HA-VTE and assessment of bleeding risk, the safe application of effective pharmacological agents, and implementation of pediatric HA-VTE preventive practices. With rapid advances in artificial intelligence, biotechnology, and multiomics technologies, we consider the major role these technologies can play in thromboprophylaxis. Using a precision medicine framework, we emphasize an individualized risk prediction approach by applying pediatric risk assessment models as clinical decision support tools and developing personalized antithrombotic regimens. In addition, we review some current state-of-the-art experimental pharmacological agents that may be developed in the future. Lastly, we discuss the importance of both individual and collaborative stewardship in guiding and successfully implementing sound thromboprophylaxis practice in children. Overall, we envision the future of pediatric thromboprophylaxis supporting pediatric research on HA-VTE prevention, fostering safe, evidence-based practice, and ultimately improving outcomes.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025326","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":"Mediation of the sex disparity in COVID-19 mortality by arterial and venous thromboembolism: a multicenter cohort study the Dutch COVID & Thrombosis Coalition.","authors":"Daniek A M Meijs, Chantal Visser, Mark J R Smeets, Eva K Kempers, Lloyd Brandts, Bernard J van Varik, Chahinda Ghossein-Doha, Iwan C C van der Horst, Marieke J H A Kruip, Hugo Ten Cate, Suzanne C Cannegieter, Bas C T van Bussel","doi":"10.1016/j.jtha.2026.09.025","DOIUrl":"https://doi.org/10.1016/j.jtha.2026.09.025","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have demonstrated a notable sex difference in Coronavirus Disease 2019 (COVID-19) mortality without a clear explanation. Concurrent thrombosis could underlie this sex disparity.</p><p><strong>Objective: </strong>To investigate whether differentially occurring venous and arterial thromboembolic events (VTE and ATE, respectively) explain the association between sex and mortality in COVID-19 patients.</p><p><strong>Methods: </strong>A multicenter cohort study in the Netherlands was conducted between February 2020 and May 2022. Suspected or confirmed COVID-19 patients admitted to the ward or Intensive Care Unit (ICU) were included. All-cause mortality, VTE, and ATE were the primary outcomes. Counterfactual mediation analyses with a random intercept for center were performed to decompose the total effect of sex on mortality into the natural direct effect (NDE; i.e. the effect of sex on mortality not operating through VTE/ATE) and natural indirect effect (NIE; i.e. the effect of sex on mortality mediated by VTE/ATE), and to estimate the proportion mediated (PM; fraction of the total effect explained by VTE/ATE) through VTE and ATE.</p><p><strong>Results: </strong>3255 COVID-19 patients were included. Females showed lower cumulative incidences of mortality (15 vs. 22%), VTE (10 vs. 16%), and ATE (1.4 vs. 3%) than males. Females demonstrated lower OR for mortality (OR 0.59 (95%CI 0.49-0.72)), VTE (OR 0.57 (95%CI 0.46-0.72)) and ATE (OR 0.64 (95%CI 0.39-1.03)) than males. Counterfactual mediation analyses showed that the proportions mediated were 7.95% (95%CI 3.01-17.63%) for VTE and 3.28% (95%CI 0.42-8.68%) for ATE, respectively.</p><p><strong>Conclusion: </strong>The lower incidence of VTE and ATE in females explains the sex difference in mortality in hospitalized COVID-19 patients, only to a minor extent. Further investigation is warranted to unravel sex-related factors in COVID-19.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017297","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":"Perioperative management of patients on factor XI or factor XIa inhibitors.","authors":"Alex C Spyropoulos, James D Douketis","doi":"10.1016/j.jtha.2026.09.020","DOIUrl":"10.1016/j.jtha.2026.09.020","url":null,"abstract":"<p><p>Factor (F)XI and XIa inhibitors-which include antisense oligonucleotides, monoclonal antibodies, and small peptidomimetic molecules-represent a new class of anticoagulants that inhibit the intrinsic pathway and attenuate thrombosis without disruption of hemostasis, thus making them potentially ideal anticoagulants to use in perioperative settings. Surgical data in patients with FXI deficiency (including severe FXI deficiency) reveal a phenotype that suggests uncomplicated hemostasis, especially in surgical areas of low fibrinolytic activity. Periprocedural data from completed Phase 2 clinical trials demonstrate 2 observations: (1) for primary venous thromboprophylaxis of patients undergoing major orthopedic surgery who are at risk of major bleeding, strategies to inhibit FXI result in a lower risk of venous thromboembolism and lower clinically relevant bleeding compared with current recommended therapy such as enoxaparin; (2) for patients on long-term FXI inhibitors undergoing elective procedures, there is potential for simpler and potentially safer periprocedural paradigms without interruption of FXI inhibitors compared with the simplified and standardized approach with direct oral anticoagulants, at least for low and (some) moderate bleed risk procedures. Further work, including tailored perioperative prospective management studies, targeted FXI inhibitor reversal strategies, and assays to assess the anticoagulant effects of FXI inhibitors in perioperative settings, is needed.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017286","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":"Structural analysis of the primary specificity of thrombin.","authors":"Tristan Friet, George Mikhail, Bassem M Mohammed, Leslie A Pelc, Alessia Dei Rossi, Sergey Korolev, Enrico Di Cera","doi":"10.1016/j.jtha.2026.09.021","DOIUrl":"10.1016/j.jtha.2026.09.021","url":null,"abstract":"<p><strong>Background: </strong>Thrombin has dual trypsin-like and chymotrypsin-like specificity: it prefers substrates carrying Arg at the site of cleavage (P1) in the activation peptide because of the presence of D189 in the primary specificity (S1) site but can also cleave substrates carrying Phe at P1.</p><p><strong>Objectives: </strong>Explore the structural basis of the P1-S1 interaction with mutants of D189 and substrates carrying different residues at P1.</p><p><strong>Methods: </strong>X-ray crystallography is used to solve the structures of thrombin wild-type and mutants D189A, D189F, and D189K bound to the irreversible inhibitors H-D-Phe-Pro-Arg-CH₂Cl (FPRck), H-D-Phe-Pro-Phe-CH₂Cl (FPFck), and H-D-Phe-Pro-Gln-CH₂Cl (FPQck).</p><p><strong>Results: </strong>X-ray structures of thrombin wild-type and mutants D189A, D189F, and D189K bound to FPRck, FPFck, and FPQck are solved at high resolutions, from 1.2 Å to 2.5 Å. Mutations of D189 do not affect the stability of free thrombin but shift the substrate preference from Arg to Phe at P1 and the stability of the inhibited complex from FPRck to FPFck. The structures reveal the flexibility of the S1 site in accommodating side chains of different chemical properties to optimize the P1-S1 interaction. In the D189K-FPRck complex, the inhibitor is trapped in an intermediate state, covalently bound only to the catalytic H57 and with the Arg side chain positioned outside of the active site.</p><p><strong>Conclusions: </strong>The S1 site of thrombin features significant structural flexibility and can support the replacement of D189 with Ala, Phe, or even Lys. The results set the stage for future studies aimed at re-engineering primary specificity in thrombin and other trypsin-like proteases.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017272","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":"Platelet Membrane Protrusions: Roles in Hemostasis and Beyond.","authors":"Martina Wolff, Celina Owczarek, Andreas Greinacher","doi":"10.1016/j.jtha.2026.09.018","DOIUrl":"https://doi.org/10.1016/j.jtha.2026.09.018","url":null,"abstract":"<p><p>Platelet membrane protrusions (PMPTs) are a remarkably diverse set of dynamic structures formed by platelets in response to shear stress. They are actively generated and play an integral role in hemostasis, potentially bridging the crosstalk between platelets and leukocytes. Unlike filopodia and lamellipodia, known for driving active cellular motility, PMPTs exhibit distinct characteristics. Some PMPTs, such as glycoprotein Ib-rich tethers and FLIPRs (FLow-Induced PRotrusions), possess pro-coagulant functions, either directly via phosphatidylserine exposure or by fragmenting into microparticles that provide a surface for coagulation activation. With the exception of tractopods, all PMPTs - including PITTs (Platelet-derived Integrin- and Tetraspanin-enriched Tethers) and FLIPRs- support leukocyte adhesion, thereby influencing immune cell recruitment and activation. This strongly indicates a role of PMPTs in the crosstalk between hemostasis and inflammation. Further evidence supporting this connection comes from observations of increased PMPT frequency in infection and certain autoimmune disorders. This review summarizes current knowledge on how PMPTs are formed, summarizes their structural characteristics, and the sparse information available regarding their biological roles and clinical significance.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012469","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":"Diagnosis and management of subsegmental pulmonary embolism.","authors":"Tzu-Fei Wang, Grégoire Le Gal, Marc Carrier","doi":"10.1016/j.jtha.2026.09.024","DOIUrl":"10.1016/j.jtha.2026.09.024","url":null,"abstract":"<p><p>Subsegmental pulmonary embolism (PE) accounts for 5% to 10% of PE diagnoses, but the optimal diagnostic and management strategies, as well as the long-term outcomes, remain debatable. Recent studies have provided more insights into outcomes in this population, and a randomized controlled trial is ongoing to evaluate the role of anticoagulation therapy in patients with isolated subsegmental PE. In this article, we used cases to illustrate the challenges in diagnosis and to discuss management approaches. We aimed to provide evidence-based recommendations whenever possible and point out potential areas for future research.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008490","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":"Coagulation dynamics during coronary angiography in patients receiving chronic direct oral anticoagulants: insights from the randomized POPular MEASURE study.","authors":"Ashley Verburg, Wilbert Bor, Magdolna Nagy, Henri Mh Spronk, Hugo Ten Cate, Christian Hackeng, Jur Ten Berg","doi":"10.1016/j.jtha.2026.09.026","DOIUrl":"10.1016/j.jtha.2026.09.026","url":null,"abstract":"<p><strong>Background: </strong>The role of peri-procedural unfractionated heparin (UFH) in patients receiving chronic direct oral anticoagulants (DOACs) undergoing coronary angiography (CAG) remains uncertain.</p><p><strong>Objective: </strong>To investigate whether omission of UFH affects thrombin generation and coagulation dynamics.</p><p><strong>Methods: </strong>In this prospective, randomized, mechanistic study, 120 patients undergoing elective CAG were included: 80 on chronic DOAC therapy randomized to UFH (DOAC + UFH, N = 39) or placebo (DOAC + placebo, N = 41), and a parallel reference cohort without oral anticoagulation receiving UFH (N = 40). Blood samples were collected at baseline, 30, 120, and 240 minutes after UFH administration. The primary endpoint was peak thrombin generation assessed using prothrombin fragment 1+2 (F1+2), with noninferiority of DOAC + placebo vs reference tested against a prespecified margin of 100 pmol/L.</p><p><strong>Results: </strong>Peak F1+2 levels were lower in DOAC + placebo vs reference (165.5 vs 248.7 pmol/L; mean difference, -133.0 pmol/L), with the upper bound of the 1-sided 97.5% confidence interval (-36.4 pmol/L) below the noninferiority margin (P < .001). No difference was observed between DOAC + placebo and DOAC + UFH (165.5 vs 166.2 pmol/L; P = .93). Secondary markers were consistent: thrombin generation was lower in DOAC-treated patients vs reference, with no difference in fibrin formation or platelet activation. UFH prolonged clot initiation without affecting clot strength or fibrinolysis.</p><p><strong>Conclusions: </strong>In patients on chronic DOAC therapy undergoing CAG, omission of peri-procedural UFH was not associated with increased thrombin generation. DOAC therapy alone provided sustained suppression of coagulation activation, questioning the routine use of UFH in this setting.</p>","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008510","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}