Journal of the Neurological Sciences最新文献

{"title":"Task-based fMRI assessment of rTMS over the primary motor cortex in poststroke hemiparetic upper extremity rehabilitation: A systematic review","authors":"Youxin Sui ,&nbsp;Jack Jiaqi Zhang ,&nbsp;Kenneth N.K. Fong","doi":"10.1016/j.jns.2025.123623","DOIUrl":"10.1016/j.jns.2025.123623","url":null,"abstract":"<div><h3>Background</h3><div>Repetitive transcranial magnetic stimulation (rTMS) delivered to the primary motor cortex (M1) is a well-established interventional modality promoting poststroke hemiparetic upper extremity recovery. Functional magnetic resonance imaging (fMRI) is a reliable technique that can be used to investigate the neural mechanism of stroke recovery. The objective of this review is to evaluate the impact of M1-rTMS on poststroke brains, measured by task-based fMRI, and to investigate the relationship between brain activation and poststroke hemiparetic upper extremity recovery facilitated by M1-rTMS.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, Web of Science, and the Cochrane Library were searched from Jan 2000 to Jan 2024. Two independent researchers screened the literature, extracted data, and qualitatively summarized the fMRI findings from the included studies.</div></div><div><h3>Results</h3><div>Thirteen studies involving 374 poststroke patients are included in this review. During hemiparetic hand movement, 5 out of 10 studies reported increased activation in the ipsilesional M1 following Low frequency-rTMS over the contralesional M1. These activations were represented in both the stimulated M1 and in the sensorimotor networks. Three studies found increased lateralization of brain activation towards the ipsilesional M1 to be positively correlated with motor improvements after stroke and one study found decreased bilateral M1–M1 inhibition to be positively correlated with improved motor performance.</div></div><div><h3>Conclusions</h3><div>Task-based fMRI extends the modulatory effect of rTMS over the M1 in poststroke hemiparetic upper extremity recovery. The treatment mechanism of M1-rTMS is in line with the re-establishment of bi-hemispheric balance, which is correlated with upper extremity recovery after stroke.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123623"},"PeriodicalIF":3.6,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714408","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: Impact of mode of onset on outcomes in acute ischemic stroke patients undergoing endovascular treatment","authors":"Yajuan Li,&nbsp;Lei Duan","doi":"10.1016/j.jns.2025.123631","DOIUrl":"10.1016/j.jns.2025.123631","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123631"},"PeriodicalIF":3.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750746","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":"Detailed immune cell profiling of paediatric patient with limb girdle muscular dystrophy R3","authors":"Chantal A. Coles ,&nbsp;Sedi Jalali ,&nbsp;Katy de Valle ,&nbsp;Nick Manton ,&nbsp;Vasiliki Karlaftis ,&nbsp;Chantal Attard ,&nbsp;Emily Galea ,&nbsp;Robin Forbes ,&nbsp;Adam T. Piers ,&nbsp;Damian R. Clark ,&nbsp;Ian R. Woodcock ,&nbsp;Daniel G. Pellicci ,&nbsp;Peter J. Houweling","doi":"10.1016/j.jns.2025.123629","DOIUrl":"10.1016/j.jns.2025.123629","url":null,"abstract":"<div><div>Muscular dystrophies are associated with inflammation and necrotic myofibres where muscle is replaced with adipocytes/fibrosis. Glucocorticoids provide clinical improvement in reducing immune markers for some muscular dystrophies however, knowledge of the immune cells involved is limited. Here we present a childhood onset case of Limb Girdle Muscular Dystrophy (LGMD) with two pathogenic variants for <em>SGCA</em> gene. Muscle biopsy (eight-years) was consistent with sarcoglycanopathy, revealing necrotic myofibres, inflammatory infiltrate (CD45⁺) positive for monocyte/macrophages (CD45⁺CD68⁺) and evidence of adipocytes/fibrosis. Blood was collected (eleven-years) to perform detailed immune cell profiling identifying &gt;60 subtypes of Innate, T and B cells (compared to age-sex matched controls). We found alterations in natural killer (NK) cells (CD3⁻CD19⁻CD20⁻CD14-CD56^dim/^bright), monocytes (CD3⁻CD19⁻CD20⁻CD14^+/-HLADR⁺CD16^+/−), dendritic cells (DCs) (CD3⁻CD19⁻CD20⁻CD14⁻CD16⁻HLADR⁺), T lymphocytes (CD3⁺CD4^+/-CD8^+/−), unconventional T lymphocytes (CD3⁺γδTCR⁺ and CD3⁺Vα7.2^hiCD161^hi and CD3⁺TCRVα24Jα18) and B lymphocytes (CD3⁻CD19⁺CD20⁺). This is the first study to perform detailed immune cell profiling of a LGMD patient. The data presented is a singular result but highlights the need to build cohort studies for a more in-depth investigation of the LGMDR3 immune profile and discovery of immune targeted therapies.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123629"},"PeriodicalIF":3.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723473","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":"Folate, vitamin B12, one carbon metabolism and the nervous system","authors":"Edward H. Reynolds","doi":"10.1016/j.jns.2025.123627","DOIUrl":"10.1016/j.jns.2025.123627","url":null,"abstract":"<div><div>Folate, vitamin B12 and one carbon metabolism are fundamental to genetics and epigenetics, and to nervous system development and brain health at all ages. The neuropsychiatric complications of deficiency or inborn errors of folate and vitamin B12 are well documented but there has been controversy about whether excess folic acid is also harmful to the nervous system, especially in the presence of vitamin B12 deficiency.</div><div>There is now substantial and consistent clinical, epidemiological and experimental evidence that excess folic acid is potentially harmful to the nervous system. Recent experimental evidence confirms that both folate deficiency and excess impair cortical neurogenesis and is greatest when vitamin B12 deficiency is combined with excess folic acid. Excess folic acid increases the demand for vitamin B12 and aggravates the block in the folate cycle resulting from vitamin B12 deficiency. The balance between folate and vitamin B12 is crucial to methylation and to genetics and epigenetics. Both folate deficiency and excess may impair cellular differentiation and nervous system development by hypomethylation or hypermethylation of genes. In countries with folic acid fortification policies many subjects are exposed to excess folate. The long term genetic, epigenetic and transgenerational implications are yet to be clarified. The safe UL of folic acid should be reconsidered in relation to the vitamin B12 status of individuals and populations. The combination of a natural folate together with vitamin B12 would greatly improve the benefits and reduce the harms of current fortification policies.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123627"},"PeriodicalIF":3.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694544","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":"Reversible rituximab demyelination in anti-MAG polyneuropathy: A role for IVIG?","authors":"Gloria Mak ,&nbsp;David Bennett ,&nbsp;Cecile Phan ,&nbsp;Michael Chu ,&nbsp;Douglas W. Zochodne","doi":"10.1016/j.jns.2025.123626","DOIUrl":"10.1016/j.jns.2025.123626","url":null,"abstract":"<div><h3>Background and aims</h3><div>Anti-myelin-associated glycoprotein (MAG) demyelinating neuropathy is a clinically heterogeneous slowly progressive large fiber sensorimotor polyneuropathy. Management of anti-MAG neuropathy is challenging, and a small subset of anti-MAG neuropathy patients have been previously reported to deteriorate after rituximab therapy, perhaps triggered by an upsurge in autoantibody release secondary to B lymphocyte lysis. We report a patient with this complication that responded to IVIg therapy.</div></div><div><h3>Method</h3><div>Case description and serial electrophysiological studies.</div></div><div><h3>Results</h3><div>Serial electrophysiological studies confirmed subacute demyelination in our patient with anti-MAG neuropathy treated with rituximab followed by improvement following IVIg.</div></div><div><h3>Interpretation</h3><div>The use of IVIG therapy can be considered in cases where rituximab leads to clinical and electrophysiological worsening of anti-MAG neuropathy.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123626"},"PeriodicalIF":3.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687139","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":"First analysis of the Myasthenia Gravis SPOTLIGHT Registry: outcomes with eculizumab and ravulizumab","authors":"James F. Howard Jr ,&nbsp;Dubravka Dodig ,&nbsp;Lida Zeinali ,&nbsp;Samir P. Macwan ,&nbsp;Ashley Yegin ,&nbsp;Michael T. Pulley ,&nbsp;Ema Rodrigues ,&nbsp;Pushpa Narayanaswami","doi":"10.1016/j.jns.2025.123628","DOIUrl":"10.1016/j.jns.2025.123628","url":null,"abstract":"<div><h3>Background</h3><div>Complement component 5 inhibitors are indicated for the treatment of anti-acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG). Clinical trials have demonstrated improved functional ability, muscle strength, and quality of life (QOL) in patients treated with eculizumab or ravulizumab. Evidence for their effectiveness and safety in clinical practice is reported here.</div></div><div><h3>Methods</h3><div>Data from the global MG SPOTLIGHT Registry were collected from patients with gMG currently or previously treated with eculizumab or ravulizumab in routine clinical practice. Effectiveness was evaluated among patients with ≥3 outcome measurements using MG Activities of Daily Living (MG-ADL) and MG-QOL 15-revised (MG-QOL15r) patient-reported outcomes and/or Myasthenia Gravis Foundation of America Clinical Classification (MGFA class) physician assessments. Safety data were also assessed.</div></div><div><h3>Results</h3><div>189 patients were treated with eculizumab. Mean (95% CI) MG-ADL scores (n=110) decreased by 4.2 (-5.0, -3.4) points and MG-QOL15r scores (n=40) decreased by 7.5 (-9.9, -‍5.0) points from before eculizumab initiation to first assessment during/after treatment (median eculizumab treatment duration: 18.0 months). 45/103 (43.7%) patients were MGFA class 0-II before eculizumab versus 89/103 (86.4%) at first assessment. After transitioning to ravulizumab, improvements in MG-ADL scores (n=37), MG-QOL15r scores (n=14), and MGFA class (n=34) were maintained (median ravulizumab treatment duration: 8.7-11.4 months). Few treatment-related serious adverse events (eculizumab: <em>Aspergillus</em> infection, nervous system disorder [n=1 each]; ravulizumab: anaphylactic reaction [n=1]) and no meningococcal infections were reported with eculizumab or ravulizumab treatment.</div></div><div><h3>Conclusions</h3><div>In routine clinical practice, eculizumab was well tolerated and effective for patients with gMG. Treatment benefits were maintained after transition to ravulizumab.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123628"},"PeriodicalIF":3.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827957","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":"Traumatic brain injury, environmental exposures, and subjective cognition in post-9/11 veterans enrolled in the VA Million Veteran Program","authors":"Kelsey M. Schilling ,&nbsp;Lay Kodama ,&nbsp;Kelsey R. Thomas ,&nbsp;Catherine Chanfreau-Coffinier ,&nbsp;VA Million Veteran Program,&nbsp;Victoria C. Merritt","doi":"10.1016/j.jns.2025.123625","DOIUrl":"10.1016/j.jns.2025.123625","url":null,"abstract":"<div><div>Using data from the VA Million Veteran Program (MVP), this study aimed to (1) examine rates of environmental exposures as a function of traumatic brain injury (TBI) history in post-9/11 veterans and (2) examine the independent and interactive effects of TBI and exposures on subjective cognition. Participants included 6707 MVP-enrolled veterans (78 % male; age: <em>M</em> = 44.66, <em>SD</em> = 10.91) who were deployed in support of the Iraq/Afghanistan-era conflicts, completed MVP surveys, and participated in the VA TBI Screening and Evaluation Program (TBI-SEP). Veterans were classified into three groups based on the results of the TBI-SEP: (1) negative TBI screen; (2) positive TBI screen but no TBI diagnosis; or (3) positive TBI screen and confirmed TBI diagnosis. Environmental exposures were extracted from MVP surveys and included solvents/fuels; pesticides; lead; other metals; combustion products; open-air burn pits; and chemical/biological warfare (CBW) agents. The Medical Outcomes Study Cognitive Functioning-Revised (MOS-Cog-R) scale was used to assess subjective cognition. Chi-square tests showed that exposure rates were highest among veterans screening positive for TBI. The most commonly reported exposure types were combustion products, burn pits, and solvents/fuels. Adjusted linear regressions showed that both TBI and environmental exposures independently contributed to worse subjective cognition, but there were no synergistic effects between TBI and exposures on cognition, except for CBW agents. Our findings emphasize the importance of considering environmental exposures as independent risk factors for subjective cognitive difficulties in post-9/11 veterans and support the use of toxic exposure screenings to connect veterans with appropriate resources and clinical care.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123625"},"PeriodicalIF":3.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679867","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":"Oxidative stress and inflammatory response in cerebral infarction due to hyperlipidemia and lipid-lowering, anti-inflammatory, and antioxidant therapy","authors":"Xuan Zhou ,&nbsp;You-Quan Gu ,&nbsp;Lei Li","doi":"10.1016/j.jns.2025.123620","DOIUrl":"10.1016/j.jns.2025.123620","url":null,"abstract":"<div><div>Hyperlipidemia is widely recognized as an independent risk factor for cerebral infarction. Research has demonstrated that hyperlipidemia contributes to cerebral infarction through multiple mechanisms, such as oxidative stress, inflammatory responses, blood-brain barrier (BBB) disruption, impaired cerebral blood flow (CBF) regulation, and insufficient collateral perfusion. Numerous studies have indicated that hyperlipidemia promotes atherosclerosis, predominantly via oxidative stress and inflammatory responses, thereby elevating the risk of cerebral infarction. This article offers a comprehensive review of recent literature on the mechanisms by which hyperlipidemia induces cerebral infarction, with a particular emphasis on the roles of oxidative stress and inflammatory responses. Additionally, therapeutic strategies targeting these etiologies, including lipid-lowering, anti-inflammatory, and antioxidant interventions, have been summarized for the treatment of cerebral infarction and the improvement of patient outcomes.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123620"},"PeriodicalIF":3.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827956","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 dysphagia on early psychosocial consequences after acute ischemic stroke","authors":"Anel Karisik ,&nbsp;Kurt Moelgg ,&nbsp;Lucie Buergi ,&nbsp;Lukas Scherer ,&nbsp;Benjamin Dejakum ,&nbsp;Silvia Felicetti ,&nbsp;Christian Boehme ,&nbsp;Thomas Toell ,&nbsp;Raimund Pechlaner ,&nbsp;Simon Sollereder ,&nbsp;Sonja Rossi ,&nbsp;Michael Thomas Eller ,&nbsp;Gudrun Schoenherr ,&nbsp;Wilfried Lang ,&nbsp;Stefan Kiechl ,&nbsp;Michael Knoflach ,&nbsp;Lukas Mayer-Suess ,&nbsp;for the STROKE-CARD registry study group","doi":"10.1016/j.jns.2025.123624","DOIUrl":"10.1016/j.jns.2025.123624","url":null,"abstract":"<div><h3>Background</h3><div>Post-stroke dysphagia is common and known to impair both recovery and overall quality of life of stroke survivors. This study explores whether its impact extends to psychosocial consequences following acute ischemic stroke.</div></div><div><h3>Methods</h3><div>We prospectively evaluated 1117 consecutive patients with acute ischemic stroke (STROKE-CARD Registry 2020–2023, study center Innsbruck, Austria) for post-stroke dysphagia using standardized clinical and instrumental swallowing examinations during initial hospital stay. Outcomes were dependency in daily activities, changes in living arrangements, and employment status, assessed at hospital admission and three months post-stroke.</div></div><div><h3>Results</h3><div>Dysphagia was diagnosed in 233 patients (20.9 %) at hospital admission (mean age 70.6 ± 13.4 years, 36.3 % females). At three months post-stroke, patients with dysphagia showed significantly higher rates of adverse psychosocial outcomes compared to those without: dependency in daily activities (23.0 % vs 5.1 %, aOR 2.63 [1.5–4.5]), need for care allowance (34.2 % vs 9.0 %, aOR 2.41 [1.6–3.8]). In working-age patients (≤65 years), those with dysphagia were more likely to have not returned to work (69.4 % vs 29.7 %, aOR 2.61 [1.2–5.8]). These associations remained significant after adjusting for age, sex, stroke severity, and functional disability at discharge.</div></div><div><h3>Conclusions</h3><div>Post-stroke dysphagia is associated with serious psychosocial consequences including increased dependency in daily living and a higher risk of being unable to return to work. These findings underscore the need for awareness as well as comprehensive rehabilitation strategies addressing both physical and psychosocial consequences of dysphagia.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123624"},"PeriodicalIF":3.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657144","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":"Persistence of pulsatile tinnitus in patients with idiopathic intracranial hypertension following resolution of papilledema","authors":"Adam Snowden ,&nbsp;Gregory P. Van Stavern ,&nbsp;Leanne Stunkel","doi":"10.1016/j.jns.2025.123608","DOIUrl":"10.1016/j.jns.2025.123608","url":null,"abstract":"<div><h3>Background</h3><div><strong>Papilledema</strong> is commonly used as part of the diagnostic criteria for and to monitor progression and treatment of Idiopathic Intracranial Hypertension (IIH). Treatment is aimed at reducing intracranial pressure, and papilledema is typically seen to resolve with sufficient reduction of intracranial pressure. However, associated symptoms of intracranial hypertension may persist, adversely impacting quality of life. Our aim was to quantify the persistence of pulsatile tinnitus in IIH patients after resolution of their papilledema.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of patients seen in our tertiary academic neuro-ophthalmology clinic for management of IIH between September 2019 and October 2023.</div></div><div><h3>Results</h3><div>246 consecutive patients with IIH were identified, 132 cases in whom papilledema had been documented to be present and were later documented to have resolved. 73 % (97/132) presented with pulsatile tinnitus. Of the patients with pulsatile tinnitus, 61 (59/97) were documented to have ongoing symptoms of pulsatile tinnitus even after resolution of papilledema. There were no significant differences in age, BMI, papilledema grade, or presence of transverse sinus stenosis at presentation between those with persistent tinnitus and those with resolved symptoms.</div></div><div><h3>Conclusions</h3><div>Pulsatile tinnitus persists in a large portion of IIH patients even after resolution of papilledema. Further research is needed to characterize the underlying mechanisms and its impact on quality of life.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123608"},"PeriodicalIF":3.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679973","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}