Journal of Trauma and Acute Care Surgery最新文献

{"title":"Diagnosis and management of acute mesenteric ischemia: What you need to know.","authors":"Matti Tolonen, Pirkka Vikatmaa","doi":"10.1097/TA.0000000000004585","DOIUrl":"10.1097/TA.0000000000004585","url":null,"abstract":"<p><strong>Abstract: </strong>Acute mesenteric ischemia (AMI) is associated with high mortality rates. There are multiple challenges to establishing an accurate early diagnosis and providing state-of-the-art care for AMI patients. A high index of suspicion is key for early diagnosis. Once suspicion is raised, a triphasic computed tomography angiography is the essential diagnostic tool. Avoiding delays, using hybrid operating rooms and contemporary revascularization techniques for arterial occlusive AMI, can significantly improve the prognosis. Regional health care systems should be developed to direct AMI patients into centers with sufficient capabilities for providing all aspects of care at all hours. The acute care surgeon has a central role in performing laparotomies and bowel resections when needed and coordinating the management flow in close collaboration with vascular surgeons and interventional radiologists for prompt and effective revascularization. A significant share of patients with an arterial occlusive AMI can be managed by endovascular revascularization without the need for a laparotomy. There are no reliable tools for predicting transmural bowel necrosis, and individual assessment and clinical experience are very important in decision-making when choosing between laparotomy and close observation. During laparotomy, an atherosclerotic occlusion at the root of the superior mesenteric artery can be stented by using a retrograde open mesenteric or percutaneous approach, and surgical bypass is seldom needed. Using hospital-specific management pathways is very useful for the standardization of care in arterial occlusive AMI. In venous AMI, systemic anticoagulation is sufficient in most cases. In patients whose symptoms do not resolve, there are various options for endovascular and surgical revascularization. In nonocclusive mesenteric ischemia, prevention by maintaining sufficient abdominal perfusion pressure is key. High-level evidence is scarce, but with current knowledge, the prognosis of AMI patients has plenty of room for improvement.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"151-161"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663717","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":"Investigating the protective effect of direct peritoneal resuscitation on intestinal barrier function in rat models of sepsis.","authors":"Jiamin Ji, Zhirong Zhao, Lan Ming, Zhaofeng Luo, Mingyi Li, Weiliang Tian, Fan Yang, Qian Huang","doi":"10.1097/TA.0000000000004616","DOIUrl":"10.1097/TA.0000000000004616","url":null,"abstract":"<p><strong>Background: </strong>In sepsis, hypercytokinemia increases intestinal permeability, leading to bacterial translocation, which further exacerbates systemic inflammation and multiple organ dysfunction. This study investigates the impact of direct peritoneal resuscitation as an adjunctive treatment on intestinal barrier integrity in rat models of sepsis induced by severe intra-abdominal infection.</p><p><strong>Methods: </strong>A cecal ligation and puncture procedure was performed on Sprague-Dawley rats to establish a sepsis model, with random allocation to the following resuscitation groups (n = 8): Sham, SP (sepsis), CR (conventional intravenous resuscitation), PLS (peritoneal lavage with normal saline), Lac-PDS (peritoneal lavage with 2.5% Glu-Lac-PDS), and Pyr-PDS (peritoneal lavage with 2.5% Glu-Pyr-PDS). The laboratory results, serum inflammatory cytokines, hematoxylin and eosin staining, transmission electron microscopy, intestinal tight junction protein and mucins expression levels, and serum D-lactate levels of rats in each group were observed. p <0.05 was regarded as statistically significant.</p><p><strong>Results: </strong>After direct peritoneal resuscitation treatment, white blood cell and interleukin-10 were significantly increased; lactate, tumor necrosis factor α, and interleukin-6 were significantly decreased; liver and kidney functions were significantly improved; and intestinal pathological damage and subcellular changes were significantly reduced. The expressions of tight junction proteins and mucins were increased, and serum D-lactate was significantly reduced. The efficacy of the Pyr-PDS group was better than other treatment groups.</p><p><strong>Conclusion: </strong>Direct peritoneal resuscitation adjunctive therapy improved overall condition and barrier function of intestine in rat models of sepsis induced by severe intra-abdominal infection. Pyr-PDS demonstrated greater efficacy than Lac-PDS in reducing inflammation and protecting intestinal barrier function.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"264-271"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094132","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":"Nonpharmacological interventions to reduce posttraumatic stress disorder, depression, or anxiety symptoms after trauma: A systematic review and meta-analysis.","authors":"Justin Solarczyk, Matt Ciminero, Sheila Sprague, Heather A Vallier, Saam Morshed","doi":"10.1097/TA.0000000000004673","DOIUrl":"10.1097/TA.0000000000004673","url":null,"abstract":"<p><strong>Background: </strong>Recent novel digital interventions may be transformative in overcoming persistent barriers to access in-person psychological therapies.</p><p><strong>Objective: </strong>This study aimed to synthesize evidence from randomized controlled trials (RCTs) of nonpharmacological interventions that prevents or treats anxiety, depression, or posttraumatic stress disorder (PTSD) among civilians recovering from physical traumatic injury.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, PsychINFO, Cochrane Central Register of Controlled Trials, and Google Scholar for articles since inception to December 28, 2023. We performed English-language RCTs of patients 18 years or older who sustained a physical injury and were assessed for symptoms of PTSD, depression, or anxiety within 1 year of injury. Dual reviewers performed screening for advancement to full-text review, data extraction, and final eligibility for systematic review and meta-analysis, and conflicts were resolved by the senior author. Meta-analysis used random effects. The primary outcome was standardized mean difference (SMD) between intervention and comparator groups.</p><p><strong>Results: </strong>We identified 3,001 articles for title and abstract review. Overall, nonpharmacological interventions significantly prevented or treated PTSD (pooled SMD, -0.71; 95% confidence interval [CI], -1.06 to -0.36), depression (pooled SMD, -0.42; 95% CI, -0.68 to -0.17), and anxiety (pooled SMD, -0.69; 95% CI, -1.01 to -0.37). Cognitive behavioral therapy (CBT) was associated with decreased symptoms of PTSD (pooled SMD, -1.10; 95% CI, -1.54 to -0.66), depression (pooled SMD, -0.87; 95% CI, -1.22 to -0.52), and anxiety. Non-CBT significantly reduced anxiety (pooled SMD, -0.40; 95% CI, -0.74 to -0.07). Collaborative care, non-CBT, and digital treatments failed to reach significance for PTSD and depression.</p><p><strong>Conclusion: </strong>Our systematic review and meta-analysis of RCTs suggest efficacy of CBT for PTSD, depression, and anxiety and non-CBT for anxiety, after physical trauma.</p><p><strong>Level of evidence: </strong>Systematic Review and Meta-analysis; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"289-297"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172904","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":"Preface.","authors":"Raul Coimbra","doi":"10.1097/TA.0000000000004769","DOIUrl":"https://doi.org/10.1097/TA.0000000000004769","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765044","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":"Enteral protein supplementation in critically ill trauma and surgical patients: A single-center randomized clinical trial.","authors":"Grant E O'Keefe, Siobhan P Brown, Marilyn M Shelton, Qian Qiu, Erika K Bisgaard, Ida M Wilson, Jamie L Robinson, Daniel J Roubik, Alex Malloy, Susanne May","doi":"10.1097/TA.0000000000004745","DOIUrl":"10.1097/TA.0000000000004745","url":null,"abstract":"<p><strong>Background: </strong>Critically ill trauma and surgical patients are highly catabolic, with expected high protein needs. However, there is uncertainty regarding the amount of protein required to optimize their outcomes. We conducted a single-center, randomized clinical trial to test the hypothesis that supplementing enteral protein intake would improve outcomes.</p><p><strong>Methods: </strong>Between November 15, 2016, and November 26, 2021, critically ill trauma and surgical patients were randomized either to a treatment arm aimed to deliver 2 g/kg/d of enteral protein or to standard nutritional care. Data were collected and subjects were followed until hospital discharge. Serum transthyretin concentration 14 to 21 days following intensive care unit admission and ventilator-free days were prespecified endpoints.</p><p><strong>Results: </strong>We randomized 500 subjects who were predominantly male (77%), suffered traumatic injuries (86%), and had a median age of 47 years. Those in the treatment arm received twice the amount of protein than those in the control arm (1.2 ± 0.65 g/kg/d vs. 0.6 ± 0.39 g/kg/d averaged over the first 7 days of hospitalization; p < 0.001). We observed no significant difference in mean transthyretin concentrations (difference of means, 0.8 mg/dL; 95% confidence interval, -1.3 to 2.8; p value = 0.46) or ventilator-free days (difference of means, -1.1; 95% confidence interval, -2.8 to 0.6; p value = 0.21). Participants receiving supplemental protein had higher blood urea nitrogen concentrations and were more likely to require reintubation.</p><p><strong>Conclusion: </strong>In this clinical trial of critically ill trauma and surgical patients, protein supplementation did not improve outcomes but was associated with increased complications.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649783","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":"Evidence-based, cost-effective management of acute mesenteric ischemia: An algorithm of the Journal of Trauma and Acute Care Surgery Emergency General Surgery Algorithms working group.","authors":"Snow Adler, Walter L Biffl, Jeffrey S Weiss, Todd W Costantini, Jose J Diaz, Kenji Inaba, David H Livingston, Lena Napolitano, Ali Salim, Robert J Winchell, Raul Coimbra","doi":"10.1097/TA.0000000000004734","DOIUrl":"https://doi.org/10.1097/TA.0000000000004734","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715098","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":"Evaluation of emergency pulmonary hilar control for lethal vascular injury in swine.","authors":"Jonathan B Livezey, Andrew Anklowitz, David R Chow, Thomas M R McKinley, Taylor Williams, Laura Riddle, David Mendoza, Chance Spalding, Marcos Aranda, John P Kuckelman","doi":"10.1097/TA.0000000000004739","DOIUrl":"https://doi.org/10.1097/TA.0000000000004739","url":null,"abstract":"<p><strong>Background: </strong>Traumatic pulmonary hilar injuries are rapidly fatal requiring decisive control for survival. There is currently insufficient data comparing hilar control techniques to make recommendations. We sought to determine the optimal maneuver to control massive pulmonary hilar hemorrhage in a live swine model.</p><p><strong>Methods: </strong>Sus scrofa swine underwent a left anterolateral thoracotomy followed by penetrating injury to the superior pulmonary vein. Animals were randomized to one of three groups: control group (CG)-no intervention, hilar clamp (clamp), or a hilar twist (twist) maneuver. Animals were monitored for 1 hour after intervention. Biopsies of the bilateral pulmonary parenchyma were obtained to compare the effect of the intervention.</p><p><strong>Results: </strong>Twenty animals were included as CG (n = 5), clamp (n = 7), or twist (n = 8). Clamp animals had a significantly increased survival time (p = 0.038). Blood loss was significantly increased in the CG compared with the clamp and twist groups (p < 0.001). There was not any difference in blood loss between the clamp and twist groups (p = 0.29). The time to complete the intervention was significantly shorter in the clamp compared with the twist cohort (p = 0.006). Fifty-seven percent of clamp animals required additional interventions to control the hemorrhage compared with 12.5% of twist animals (p = 0.067). One hundred percent of the CG animals required vasopressor support compared with 0% of the clamp animals (p < 0.001) and 25% of the twist animals (p = 0.001). Histologic inflammatory scores of the twist parenchyma were significantly higher compared with the clamp and CG (p = 0.02 and p = 0.01 respectively).</p><p><strong>Conclusion: </strong>Pulmonary hilar control is a critical skill in trauma to control life-threatening exsanguination. Hilar clamping may be a superior maneuver for temporizing hilar trauma.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Not applicable-basic science article.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715097","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 road less recovered: Examining the effect of trauma on frailty trajectories in older patients.","authors":"Jessica Falon, Priyadharshani Samarasinghe, James Elhindi, Urna Rahman, Aswin Shanmugalingam, Isabella Zappala, Jeremy Hsu","doi":"10.1097/TA.0000000000004751","DOIUrl":"https://doi.org/10.1097/TA.0000000000004751","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is associated with increased mortality and complications in older trauma patients. However, the impact of trauma on functional outcomes in older patients has not been well studied. We hypothesized that trauma would worsen an older person's function postinjury as measured using the Rockwood Clinical Frailty Scale (CFS), and that frail patients would experience poorer health outcomes compared with prefrail and nonfrail patients.</p><p><strong>Methods: </strong>This was a prospective cohort study including all trauma patients 65 years or older admitted to a Level 1 trauma center. CFS scores were recorded at baseline (pretrauma), 3, 6, and 12 months postinjury. This was compared between nonfrail (CFS scores 1-3), prefrail (CFS score 4), and frail (CFS score ≥5) patients using a linear mixed-effects model adjusted for age, sex, mechanism, comorbidities, injury severity, surgery during admission, and intensive care unit admission. In-hospital and 12-month health outcomes were recorded and compared.</p><p><strong>Results: </strong>A total of 224 patients were included. Twelve-month mortality in frail patients (28%) was significantly higher than prefrail (20%) and nonfrail (5%) patients (p < 0.01). Increasing frailty was associated with higher rates of discharge into supported care (p < 0.01) and reinjury (p < 0.01), with over one in three frail patients experiencing reinjury within 12 months. Pretrauma frail patients demonstrated a prolonged deterioration in frailty and failed to recover by 12 months. Nonfrail and prefrail patients both became more frail, and although they made some recovery, neither group returned to their functional baseline by 12 months.</p><p><strong>Conclusion: </strong>Trauma produces significant frailty decline, resulting in a period of heightened vulnerability to mortality, morbidity, and reinjury. Pretrauma frailty influences the trajectory of functional decline and recovery, which is helpful for providing prognostic information, establishing goals of care, and selecting patients who may benefit from interventions aimed at reversing frailty.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level I.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715124","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":"Popliteal artery injuries: What you need to know.","authors":"Juan A Asensio, Santiago A Ceron, Ime D Inyang, Sarah E Johnson, Mallory Williams, Jose M Velasco","doi":"10.1097/TA.0000000000004752","DOIUrl":"https://doi.org/10.1097/TA.0000000000004752","url":null,"abstract":"<p><strong>Abstract: </strong>Popliteal artery injuries are rare even in busy urban trauma centers. The vast majority result from penetrating mechanisms of injury. These injuries are uncommon; therefore, few trauma surgeons and trauma centers have developed significant experience with their management. Experiences from both military and urban arenas of warfare consistently report the highest complications and amputation rates of all vascular injuries secondary to popliteal artery injuries. The popliteal artery is an end artery. Injuries cause significant ischemia, which threaten limb viability. From a surgical standpoint, they are difficult to expose and require excellent surgical technique to repair and restore blood flow in a timely fashion, prioritizing operative efficiency to decrease ischemia. This is of the utmost importance to obtain excellent results. Past and recent military conflicts have provided trauma surgeons with excellent experiences to develop a framework to manage these injuries, specifically the Vietnam War. If there are any lessons to be learned from the recent conflicts in Iraq, Afghanistan, and, currently, Ukraine, it is that trauma surgeons must be prepared to effectively and rapidly operate on these injuries.</p><p><strong>Level of evidence: </strong>Therapeutic Study; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715100","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":"Surgical management of retroperitoneal vascular injuries in combat abdominal trauma: Experience at Role 2 facilities during the war in Ukraine.","authors":"Igor Sobko, Iurii Sivash, Volodymyr Rogovskyi, Boris Koval, Alina Slobodianiuk","doi":"10.1097/TA.0000000000004716","DOIUrl":"https://doi.org/10.1097/TA.0000000000004716","url":null,"abstract":"<p><strong>Background: </strong>Combat-related retroperitoneal vascular injuries are among the most severe and rarely occur in isolation, often resulting in high mortality. This study analyzes their management in combat abdominal trauma at Role 2 during the ongoing war in Ukraine using a damage control surgery approach to minimize organizational and technical errors.</p><p><strong>Methods: </strong>A retrospective review included 65 cases of retroperitoneal vascular injury among 1,407 patients with combat-related abdominal trauma managed by a Role 2 surgical team in eastern Ukraine in 2023. The severity of anatomical injuries was assessed using the Hannover Polytrauma Score, while the patient's condition was evaluated using the Admission Trauma Score (AdTS). Surgical care followed damage-control surgery principles, including vascular ligation, temporary shunting, pelvic tamponade, and prehospital interventions such as resuscitative endovascular balloon aortic occlusion and the abdominal aortic junctional tourniquet.</p><p><strong>Results: </strong>Retroperitoneal vascular injuries comprised 4.6% of all combat abdominal trauma cases, with 95.4% accompanied by other injuries. The most frequently affected vessels were the inferior vena cava (33.9%) and iliac vessels (50.3%). Ligation was the primary hemostatic method; vessel repair was performed in 58.5% of cases. Mortality peaked at 54.6% within 3 days postinjury because of massive blood loss and hemorrhagic shock. Hemorrhagic shock (classes III and IV) occurred in 77% of patients. Overall mortality was 50.8%. Nonsurvivors had significantly higher Hannover Polytrauma Score (27.0 ± 7.8), AdTS (10.4 ± 2.6), and blood lactate levels nearly three times greater than survivors.</p><p><strong>Conclusion: </strong>Retroperitoneal vascular injuries remain highly lethal, emphasizing the need for early hemorrhage control and timely surgical intervention. Resuscitative endovascular balloon aortic occlusion and abdominal aortic junctional tourniquet at the prehospital stage showed potential in stabilizing patients for evacuation. Blood lactate levels and AdTS are valuable tools for triage and treatment decisions at Role 2 facilities.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715122","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}