Journal of Tropical Pediatrics最新文献

{"title":"Efficacy of Bacillus clausii as an adjuvant therapy in pathological neonatal unconjugated hyperbilirubinemia in the Nile Delta region of Egypt: a randomized controlled trial.","authors":"Samah S M Hussein, Sahar M El-Haggar, Sahar K Hegazy, Mohamed A Rowisha","doi":"10.1093/tropej/fmag047","DOIUrl":"10.1093/tropej/fmag047","url":null,"abstract":"<p><p>Neonatal jaundice (NJ) is a common condition that may progress to serious complications such as kernicterus. Probiotics can also be used for treatment of jaundice by their effect on intestinal motility and microbial flora of the intestine. We aimed to evaluate the effect of probiotic supplementation as an adjuvant therapy in pathological neonatal unconjugated hyperbilirubinemia. A randomized, parallel-group comparative study was conducted on 44 neonates with confirmed pathological unconjugated hyperbilirubinemia admitted to the Neonatal Intensive Care Unit at Tanta University Hospital (Egypt) between May 2024 and April 2025. Participants were randomized (1:1) into two groups: phototherapy alone (control group n = 22) and phototherapy plus oral Bacillus clausii probiotic (probiotic group n = 22). Demographic data and bilirubin fractions were recorded. The primary outcome was the change in bilirubin levels; secondary outcomes included inflammatory biomarkers. Baseline characteristics were comparable between groups. Both groups exhibited significant declines in total serum bilirubin and indirect bilirubin, but only the probiotic group showed a significant reduction in direct bilirubin. By the end of treatment, the probiotic group showed a significantly greater reduction in lipopolysaccharide and tumor necrosis factor-α levels compared with the control group. Hospital stay was significantly shorter with probiotic therapy (3.8 ± 1.18 vs 6.3 ± 2.14 days; P < .001). Bacillus clausii supplementation alongside phototherapy significantly enhanced bilirubin reduction, decreased inflammatory markers, and shortened hospitalization, supporting its role as a beneficial adjunct therapy in neonatal hyperbilirubinemia.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with severity and fatality of COVID-19 in Brazilian children and adolescents (2020-2023): a population-based study.","authors":"Ana Luiza Magalhães de Andrade Lima, Guilherme Jorge Costa, Maria Júlia Gonçalves de Mello","doi":"10.1093/tropej/fmag035","DOIUrl":"https://doi.org/10.1093/tropej/fmag035","url":null,"abstract":"<p><p>COVID-19 pandemic posed significant health challenges worldwide, with substantial impact on pediatric populations. In Brazil, hospitalizations and deaths among children and adolescents have continued throughout the pandemic despite beginning of vaccination. The objective of this study was to analyze sociodemographic background, presentation, and clinical outcomes among hospitalized Brazilian individuals under 20 years with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, analyzing risk factors for severity and death according to age group. Consisted of a population-based cross-sectional study using secondary data from children and adolescents (<20 years) hospitalized with COVID-19 in Brazil (March 2020-December 2023). Data from Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) included sociodemographic, clinical, and vaccination information. Cox proportional hazards models assessed intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and fatality by age group; 30-day survival was estimated using Kaplan-Meier analysis. A total of 123 382 hospitalizations were recorded; children under five accounted for 56.2% of cases and 43.3% of deaths. Hospitalized adolescents (11-19 years) showed the most severe outcomes, with relatively higher ICU admission (30.9%), IMV use (11.8%), and fatality (6.5%), in addition to lower overall survival (48.3%). Across all age groups, being hospitalized in the North or Northeast and IMV were associated with the highest risk of death. Overall, only 10.4% of the study population had received at least one vaccine dose. Adolescents experienced a higher relative frequency of severe clinical outcomes and lowest survival, although, in absolute numbers, more children under 5 years of age were hospitalized and died. These findings underscore the urgency of expanding pediatric vaccine coverage as a public health priority in Brazil.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chlorhexidine use in newborn care: a scoping review of evidence across settings and interventions.","authors":"Aditya Hemendra Bhatt, Anil Chauhan, Jigisha Patadia, Upendra Chaudhari","doi":"10.1093/tropej/fmag061","DOIUrl":"10.1093/tropej/fmag061","url":null,"abstract":"<p><p>Neonatal infections remain a critical global health challenge, claiming approximately 2.4 million lives annually and accounting for 25%-45% of all neonatal deaths worldwide. Chlorhexidine, a broad-spectrum antiseptic agent, has emerged as a promising intervention for preventing neonatal infections across various care settings. We conducted a scoping review to systematically map the available evidence on the use of chlorhexidine in newborn care, examining its effects on omphalitis, sepsis, and neonatal mortality, stratified by birth setting. Following PRISMA-ScR and Joanna Briggs Institute methodology, we developed a Population-Concept-Context framework. We systematically searched PubMed and Google Scholar for peer-reviewed literature. Three chlorhexidine intervention types were examined: cord care, skin antisepsis, and bathing policies. Quality assessment employed Cochrane RoB 2, AMSTAR 2, NOS, and AGREE II tools. Sixteen studies were included: 8 RCTs/cluster RCTs, 5 systematic reviews, 2 narrative reviews, and 1 clinical guideline. Chlorhexidine cord care demonstrated substantial benefits in home birth settings, with omphalitis reductions of 68%-75% and mortality reductions of 23%-38%. In facility settings, results were more variable, with benefits primarily in high-risk populations. Chlorhexidine skin antisepsis showed promise for preterm and low birth weight infants, achieving 28% mortality reduction. Evidence for bathing policies remained limited. Chlorhexidine cord care demonstrates robust effectiveness in home birth settings and high-mortality contexts. Implementation strategies should be tailored to local epidemiology, baseline mortality rates, and healthcare infrastructure. Risk-stratified approaches may be optimal for facility-based care.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 5","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Turkish pregnant women's opinions, beliefs, and attitudes about maternal tetanus, diphtheria, and pertussis, influenza, coronavirus disease 2019, and respiratory syncytial virus vaccines.","authors":"Nesli Ağralı-Eröz, Eda Karadağ-Öncel, Alkım Gülşah-Şahingöz, Derya Burkankulu, Ceren Sağlam, Ayşegül Elvan-Tüz, Selin Taşar, Aslıhan Arslan-Maden, Halil Gürsoy Pala, Dilek Yılmaz, Mehmet Yekta Öncel","doi":"10.1093/tropej/fmag032","DOIUrl":"10.1093/tropej/fmag032","url":null,"abstract":"<p><p>Maternal vaccines, including coronavirus disease 2019 (COVID-19), influenza, tetanus, diphtheria, acellular pertussis (Tdap), and respiratory syncytial virus, have demonstrated strong effectiveness in protecting both mothers and their infants. This study aimed to evaluate pregnant women's attitudes toward maternal vaccination in Türkiye. We conducted a cross-sectional survey among women in their third trimester of pregnancy. Maternal immunization behavior was the primary outcome measure. Attitudes, beliefs, and sociodemographic factors associated with vaccine acceptance were analyzed. In total, 457 respondents completed the questionnaire. Pregnancy-related vaccination rates for tetanus, COVID-19, influenza, and Tdap were 88.6%, 16.2%, 1.3%, and 0.9%, respectively. Vaccination rates were significantly higher among pregnant women who received vaccine information (P < .001). Women with a high school education were less likely to refuse vaccination (aOR = 0.33, 95% CI: 0.12-0.93; P = .037). Being followed at a hospital in a more socioeconomically advantaged area was associated with greater vaccine acceptance (aOR = 5.21, 95% CI: 1.77-15.34; P = .003). In addition, women who believed that vaccines were protective during pregnancy were more likely to accept vaccination (aOR = 0.46, 95% CI: 0.21-0.99; P = .048). Women in Türkiye with a high school education were less likely to refuse vaccination, socioeconomically advantaged areas were associated with greater vaccine acceptance, and belief in vaccine protection increased uptake.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating first episode of viral wheezing by assessing response to salbutamol nebulization in children 6 months to 2 years of age admitted as bronchiolitis-a prospective cohort study.","authors":"Kranthi Kumar Karrolla, Venkatesh Chandrasekaran, Rahul Dhodapkar","doi":"10.1093/tropej/fmag039","DOIUrl":"10.1093/tropej/fmag039","url":null,"abstract":"<p><p>Some infants diagnosed as bronchiolitis might actually be having their first episode of viral wheeze. Although wheezing is common to both conditions, their treatment approaches differ. The objectives of this study were to estimate the proportion of infants aged 6 months to 2 years with episodic viral wheeze (EVW) among those admitted as bronchiolitis, to determine the factors predicting salbutamol response, and to compare the short-term outcomes between them. This prospective observational study included infants admitted with bronchiolitis. Assuming that one fourth of them might be having EVW, with 5% alpha error and 80% power, the sample size was estimated to be 136, including an attrition of 10%. After obtaining parental consent, 2 doses of nebulized salbutamol were administered to assess treatment response. Baseline demographics, atopy status, and respiratory swab results were collected and analysed. The proportion of infants responding to salbutamol, the factors influencing response and the outcomes, were studied. Among the 137 participants studied, salbutamol response was observed in 50 (36.5%) and were designated as EVW. Family h/o atopy was seen in 25 (50%) participants in the EVW group compared to 13 (14.9%) in the bronchiolitis group (P = .0001). Shorter hospital stay (P = .018), oxygen (P = .016) and heated, humidified, high flow nasal cannula requirement (P = .03) was seen in EVW compared to the bronchiolitis group. To conclude, about one in three infants admitted as bronchiolitis presenting predominantly with wheeze, show a bronchodilator response. In them, a better treatment outcome is seen when managed as EVW.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Outcome of Children with Scrub typhus: A Tertiary Care Centre Observation.","authors":"Ashok Singh, Priyanka Dua, Om Prakash Mishra, Anu, Sweta Sharma, Sweta Singh, Anu Anu, Ashok Kumar","doi":"10.1093/tropej/fmag017","DOIUrl":"10.1093/tropej/fmag017","url":null,"abstract":"<p><strong>Objective: </strong>Scrub typhus is an acute febrile illness and often can present with multi-organ dysfunction. The primary objective of the study was to find out its clinical presentation and associated complications and secondary objectives for the response to therapy in relation to severity of disease and observe the mortality.</p><p><strong>Methods: </strong>This was a prospective observational study conducted in children, aged 1 - 18 years, with diagnosis of scrub typhus at a tertiary -care center. The diagnosis of Scrub typhus was based on compatible clinical presentation and positive specific IgM antibody titer.</p><p><strong>Results: </strong>Seventy children with scrub typhus (males 67.1%), median age of 9 years (interquartile range 5 - 13) presented with fever (100%), abdominal pain (54.2%), vomiting (38.6%), cough (32.8%), and rash (22.8%). On examination, hepatomegaly (67.1%), pallor (61.4%), conjunctival congestion (60%) and splenomegaly (52.8%) were the predominant features. Nearly half of cases had fluid retention (45.7%), with respiratory distress (38.5%), myocarditis (31.4%), secondary hemophagocytic lymphohistiocytosis (28.6%), shock (25.7%), acute kidney injury (18.6%), and encephalitis (18.6%). Parenteral doxycycline was given along with supportive measures such as oxygen therapy, respiratory support, diuretic, and vasopressors. Patients having three or four of severe manifestations (fluid retention, myocarditis, shock and hemophagocytic lymphohistiocytos) had almost 17 - 18 times probability of late response to doxycycline in contrast to those who had two severe features (nearly 14 times, P = 0.001). Mortality was in 4.3% of cases.</p><p><strong>Conclusion: </strong>Scrub typhus is a serious infection presenting with multi-system involvement. Prompt therapy with Doxycycline along with supportive therapy help in better outcome.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Peer Training Increases the Level of Knowledge on Sexual and Reproductive Health in Adolescents.","authors":"","doi":"10.1093/tropej/fmag024","DOIUrl":"https://doi.org/10.1093/tropej/fmag024","url":null,"abstract":"","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Status of non-thiamine B-vitamins in children with septic shock from a lower middle-income country: a case-control study.","authors":"Ajay Kumar, Arun Kumar Baranwal, Savita Verma Attri, Praveen Kumar-M, Arushi Gahlot Saini, Muralidharan Jayashree","doi":"10.1093/tropej/fmag030","DOIUrl":"10.1093/tropej/fmag030","url":null,"abstract":"<p><p>The role of B-vitamins in septic shock is gaining attention, especially among patients with deficiencies. However, evidence beyond thiamine remains limited. This study aimed to evaluate the status of riboflavin, niacin, pyridoxine, folate, and cobalamin in children with septic shock in a low- and middle-income country (LMIC) setting, and to explore their potential association with patient outcomes. We enrolled 79 consecutive patients (aged 6 months-12 years) with fluid-refractory septic shock from July 2018 to December 2019. We also included 22 sibling controls and 64 external controls from an immunization clinic for comparison. Children with chronic illnesses or those receiving vitamin supplementation were excluded. Plasma levels of riboflavin, niacin, pyridoxine, folate, and cobalamin were measured at enrolment, and patient survival was assessed as the primary outcome. Patients and their siblings were more stunted than external controls, both in prevalence (P = .014) and severity (P = .012). Plasma levels of all five B-vitamins were significantly lower in patients compared to sibling controls (all P values less than .001). Sibling controls had lower levels of riboflavin (P < .001), niacin (P < .001), pyridoxine (P = .072), folate (P = .070), and cobalamin (P < .001) than external controls. Among the patients, non-survivors had lower levels of riboflavin (P = .20) and pyridoxine (P = .04), while folate levels were surprisingly higher (P = .037). With shared nutrition in families, findings suggest exacerbation of the likely pre-existing B-vitamin deficiencies during septic shock in children from LMICs. This highlights the need to evaluate the potential adjunctive therapeutic role of B-vitamins in paediatric septic shock in LMICs.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of congenital toxoplasmosis among live births in a tertiary center in Southern Brazil.","authors":"Sizuane Rieger Holler, Caroline Dos Passos, Ashiley Lacerda Ribeiro, Stéfani Zanetti Küster, Estefany Alves Silvestre, Davi Rodrigues Martins, Ana Clara Machado Teixeira, Maria Thawanna Zortea Antunes, Adrianne R Bischoff, Clarissa Gutierrez Carvalho","doi":"10.1093/tropej/fmag037","DOIUrl":"10.1093/tropej/fmag037","url":null,"abstract":"<p><p>Toxoplasmosis affects approximately one-third of the global population. Despite the high seroprevalence in Brazil, contemporary data on the incidence and clinical spectrum of congenital toxoplasmosis (CT) in tertiary-care settings remain limited. Few studies have specifically addressed the incidence of symptomatic CT, limiting the identification of risk factors, preventive strategies, and optimal patient management, particularly in the context of recent healthcare disruptions and environmental changes. This study aims to determine the incidence of exposure to gestational toxoplasmosis and CT among live births in a tertiary center in Southern Brazil, and to identify factors associated with vertical transmission and disease manifestations. We conducted a retrospective cohort study of newborns exposed to gestational toxoplasmosis between 2015 and 2024 at a tertiary referral center. Clinical, laboratory, and imaging data were extracted from medical records. Statistical analyses included Chi-square and Student's t-test, with significance set at P < .05. Among 222 exposed infants, 18 developed CT, corresponding to an incidence of 6.2 per 10 000 live births. A marked increase in incidence was observed in recent years, peaking in 2024, coinciding with major regional flooding events. Positive neonatal IgM serology was present in 10 cases (55.6%). Neurological abnormalities on brain imaging were identified in 59% of infected infants, ocular lesions in 39%, and auditory impairment in 5.6%. Late gestational seroconversion and suboptimal prenatal care were associated with infection. This study provides contemporary, real-world epidemiological data from a tertiary referral center in Southern Brazil, highlighting temporal trends potentially linked to environmental and healthcare disruptions, as well as persistent gaps in prenatal screening and treatment. These findings underscore the need for improved prenatal care strategies and surveillance systems to reduce the burden of CT.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surfactant use and outcomes in middle-income versus high-income countries.","authors":"Johan van Dyk, Michael C Harrison, Erika M Edwards, Danielle E Y Ehret, Lloyd Tooke","doi":"10.1093/tropej/fmag031","DOIUrl":"10.1093/tropej/fmag031","url":null,"abstract":"<p><p>Preterm birth remains a leading cause of neonatal mortality, disproportionately affecting low-and middle-income countries (LMICs). Surfactant replacement therapy (SRT) is a key intervention for neonatal respiratory distress syndrome (RDS). However, due to cost and differing guidelines there are likely differences in SRT in different parts of the world. This study compared surfactant use, timing of administration, and associated neonatal outcomes in very low birth weight (VLBW) infants born in high-income countries (HICs) versus middle-income countries (MICs), with further analysis of public and private centers within MICs. This secondary analysis of prospectively collected data using the Vermont Oxford Network database included 271 826 inborn VLBW infants from 2018 to 23. Data were stratified by country income classification and ownership (public center vs. private center) in MICs. Surfactant use was highest in private MIC centers (64.1%), followed by HICs (55.3%), and public MIC centers (43.5%). Median time to first surfactant dose was shortest in private MIC centers (60 min) and longest in public MIC centers (120 min). Infants in HICs were more likely to receive delivery room continuous positive airway pressure and earlier surfactant. Survival post-SRT was highest in HICs (88.1%) and lowest in public MIC centers (69.5%) with sepsis being a particular problem in MICs. Disparities in the proportion of infants receiving SRT, the timing of doses, and neonatal outcomes such as mortality and sepsis rates persist between HICs and MICs, and between public and private sectors in MICs.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13188974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}