Lymphatic research and biology最新文献

{"title":"Characteristic Computed Tomography Findings in Female Patients with Secondary Genital Lymphedema.","authors":"Ryusuke Sumiya, Takashi Kageyama, Hayahito Sakai, Reiko Tsukuura, Takumi Yamamoto","doi":"10.1089/lrb.2024.0006","DOIUrl":"10.1089/lrb.2024.0006","url":null,"abstract":"<p><p><b><i>Background:</i></b> Female genital lymphedema (FGL) is a challenging disease, and appropriate preoperative evaluation is crucial before surgical treatments. Computed tomography (CT) is expected useful for FGL evaluation, but little is known. This study aimed to clarify characteristic CT findings of FGL with a case report of CT findings-guided lymphaticovenous anastomosis (LVA). <b><i>Methods:</i></b> Medical charts of secondary lower extremity lymphedema patients who underwent CT and indocyanine green (ICG) lymphography were reviewed. Genital regions with dermal backflow patterns on ICG lymphography were diagnosed as FGL. Prevalence of characteristic CT findings of lymphedema was compared between genitalia regions with and without FGL. A case of genital lymphedema treated with LVA under the guidance of CT findings was presented. <b><i>Results:</i></b> A total of 51 patients (32 with FGL, and 19 without FGL) were included in this study. Genital ICG included stages 0/I/II/III/IV/V in 19 (37.3%)/5 (9.8%)/11 (21.6%)/9 (17.6%)/7 (13.7%)/0 (0%) cases, respectively. Characteristic CT findings included thick skin in 14 (27.5%), thick fascia in 17 (33.3%), high density of the superficial fat in 11 (21.6%), high density of the deep fat in 13 (25.5%), fluid collection in 8 (15.7%), detectable inguinal lymph node in 42 (82.4%), and honeycomb appearance in 7 regions (13.7%). Between genital regions with and without FGL, there were statistically significant differences in all the characteristic CT findings (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> Characteristic CT findings of secondary FGL were identified. Preoperative CT evaluation may be useful for selecting appropriate LVA sites for optimal results.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"188-193"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399499","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":"The Use of Ultrasonography to Detect Lymphatic Dysfunction.","authors":"Stanley G Rockson","doi":"10.1089/lrb.2025.0039","DOIUrl":"10.1089/lrb.2025.0039","url":null,"abstract":"","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"63"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730497","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":"Screening Lymphatic Ultrasound to Detect Lymphatic Dysfunction.","authors":"Hisako Hara, Makoto Mihara","doi":"10.1089/lrb.2024.0064","DOIUrl":"10.1089/lrb.2024.0064","url":null,"abstract":"<p><p><b><i>Background:</i></b> We currently perform noncontrast lymphatic ultrasound, which has a higher resolution and is less invasive than contrast lymphatic ultrasound. This study aimed to clarify the usefulness of screening lymphatic ultrasound (SLUS) to evaluate lymphatic function. <b><i>Methods:</i></b> A retrospective study was conducted on 22 patients with leg lymphedema. We performed SLUS by dividing the leg into four areas (thigh and calf, lateral and medial) and the dorsum of the foot. Lymphatic findings were recorded according to NECST (Normal, Ectasis, Contraction, and Sclerosis type) classification. If no lymphatics were found, we recorded them as \"not found.\" To differentiate between lymphatic vessels and veins, we referred to D-CUPS (Doppler, Crossing, Uncollapsible, Parallel, and Superficial fascia). The time required for SLUS was recorded. Indocyanine green (ICG) lymphography was also performed in 10 patients. <b><i>Results:</i></b> The mean age of the 22 patients was 63.9 years (range 50-86 years). The average time required for SLUS was 6 minutes 45 seconds for both legs. The identification rate of the lymphatic vessels was 95.5% for the medial thigh and medial calf, but decreased in the lateral calf and dorsum of the foot. When examining the distribution of the NECST classification, the ectasis type tended to be more common on the medial side than on the lateral side. Combined with the ICG lymphographic findings, dermal backflow (DB)-positive areas had significantly more ectasis type, and DB-negative areas had significantly more normal type and were not found (<i>p</i> < 0.01). <b><i>Conclusion:</i></b> SLUS should be useful for screening lymphatic vessel function.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"64-70"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950909","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":"The Concept of Palliative Lymphaticovenular Anastomosis.","authors":"Kahori Tsukura, Satoshi Onoda, Toshihiko Satake, Erika Hamada","doi":"10.1089/lrb.2024.0079","DOIUrl":"10.1089/lrb.2024.0079","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Lymphaticovenular anastomosis (LVA) is the first-line surgical treatment for lymphedema. The therapeutic effects of LVA, including edema reduction and cellulitis prevention, vary among patients. We examined cases of palliative LVA in patients with lymphedema who were in the terminal stage due to recurrence or distant metastasis of the primary disease, with a focus on the course and usefulness of palliative LVA. <b><i>Methods and Results:</i></b> A total of 13 palliative LVAs were performed in 12 patients undergoing palliative treatment. LVA was performed without interfering with chemotherapy or radiation. Data on site and stage of edema, compression treatment status, number of anastomoses, percentage change in circumferential diameter (the total circumference at six locations was compared), treatment efficacy, and patient prognosis were collected. Edema was present in the upper and lower extremities of 10 and 2 patients, respectively. The average postoperative decrease in circumferential diameter was 8.6%. Psychological evaluation was based on the self-reports of patients, and 11 out of 12 patients showed improvement in their mental state. Two patients died during the observation period due to deterioration in the underlying disease. <b><i>Conclusion:</i></b> We reported our experience with palliative LVA in patients with advanced malignancies. Many patients had favorable physical and psychological outcomes. Surgery can be performed safely with appropriate planning based on the condition of the patients. Palliative LVA may be a treatment option for patients with recurrent or distant metastases of the primary disease who are refractory to edema treatment.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"71-77"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950978","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":"Lymphedema, Fatigue, and Quality of Life in Breast Cancer Survivors with Axillary Lymph Node Dissection.","authors":"Seyma Acikgoz Orhan, Esma Ozsaker","doi":"10.1089/lrb.2024.0047","DOIUrl":"10.1089/lrb.2024.0047","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Health-related quality of life (QOL) has gained importance due to the increasing incidence of breast cancer and the survival rate of breast cancer patients. We aimed to investigate the relationship between lymphedema, fatigue, and QOL in breast cancer survivors with axillary lymph node dissection. <b><i>Methods:</i></b> A total of 122 female breast cancer survivors with axillary lymph node dissection who applied to the oncology center of a teaching and research hospital between April 1, 2022, and July 1, 2022, were included in the cross-sectional study. An individual identification form, the EQ-5D General Quality of Life Scale, and the Cancer Fatigue Scale were used to collect data. Mann-Whitney <i>U</i> test, Kruskal-Wallis <i>H</i> test, Bonferroni post hoc test, and Spearman's correlation were used to assess differences between the survivor groups. <b><i>Results:</i></b> The study found that 40.2% of breast cancer survivors experienced lymphedema. The mean scores on the EQ-5D index, Visual Analogue Scale (VAS), and Cancer Fatigue Scale were 0.27 ± 0.25, 71.12 ± 14.21, and 35.86 ± 6.98, respectively. The Cancer Fatigue Scale total score and the EQ-5D VAS showed a strong positive correlation (<i>r</i> = 0.630; <i>p</i> < 0.05). Conversely, the total Cancer Fatigue Scale and the EQ-5D VAS scores showed a significant negative correlation (<i>r</i> = -0.626; <i>p</i> < 0.05). <b><i>Conclusions:</i></b> The study found that almost half of the breast cancer survivors experienced lymphedema. They also had excellent general health, moderate fatigue, and a good overall QOL.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"107-114"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950868","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":"The Comparative Frequency of Breast Cancer-Related Lymphedema Determined by Perometer and Circumferential Measurements: Relationship with Functional Status and Quality of Life.","authors":"Gul Mete Civelek, Pınar Borman, Cansu Sahbaz Pirincci, Aysegul Yaman, Gokhan Ucar, Dogan Uncu, Seda Kahraman, Meltem Dalyan","doi":"10.1089/lrb.2024.0008","DOIUrl":"10.1089/lrb.2024.0008","url":null,"abstract":"<p><p><b><i>Background:</i></b> The aim of this study was to comparatively determine the frequency of breast cancer-related lymphedema (BCRL) by using prospective monitoring with perometer and circumferential measurements in a group of patients who underwent breast cancer surgery. We also aimed to evaluate the relationship between volume changes and functional status and quality of life (QoL) in patients with breast cancer-related subclinical lymphedema. <b><i>Materials and Methods:</i></b> Patients who had unilateral breast cancer surgery for breast were assessed with circumferential and perometer, respectively, for volumes at baseline, 3rd-month, 6th-month, 9th-month, and 12th-month by the same physiotherapist. Every patient was informed about lymphedema symptoms and prevention. The demographic and clinical properties were recorded. Functional status and QoL were evaluated by Q-DASH and the Lymphedema Quality of Life Questionnaire-Arm questionnaires. <b><i>Results:</i></b> A total of 101 female patients with a mean age of 49.02 + 10.59 years completed the 12-month follow-up. Most of the patients were overweight, had an axillary dissection in addition to breast surgery, and received radiotherapy. The frequency of subclinical and clinical BCRL at the end of 12 months was determined by 34.7% and 23.8% with circumferential measures and perometer, respectively. QoL and functional scores did not differ between patients with and without subclinical lymphedema. <b><i>Conclusion:</i></b> After the first 12 months after surgery, the frequency of BCRL assessed by circumferential measurements was higher than the frequency assessed by perometer. Periodic monitoring of women with breast cancer for the presence of BCRL, preferably by the same person together with patient education is suggested in order to allow early detection and timely intervention for BCRL.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"88-94"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932016","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":"Can Lymphatic Transport Impaired by Total Knee Arthroplasty be Managed with Manual Lymphatic Drainage?","authors":"Emine Cihan, Necmiye Un Yıldırım, Yeşim Bakar, Onur Bilge","doi":"10.1089/lrb.2023.0049","DOIUrl":"10.1089/lrb.2023.0049","url":null,"abstract":"<p><p><b><i>Objective:</i></b> It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). <b><i>Method:</i></b> Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. <b><i>Results:</i></b> A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: <i>χ</i>² = 47.175; <i>p</i> = 0.000; control; <i>χ</i>² = 30.995; <i>p</i> < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; <i>p</i> = 0.015; <i>p</i> = 0.001; <i>p</i> < 0.000). Leg volume significantly decreased over time in both groups after surgery (<i>p</i> < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; <i>p</i> = 0.192; <i>p</i> = 0.343; <i>p</i> = 0.453; <i>p</i> = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; <i>p</i> = 0.002; <i>p</i> = 0.005; <i>p</i> = 0.006, respectively), it increased with exercise in the control group, first day (<i>p</i> = 0.004) and second day (<i>p</i> = 0.019). <b><i>Conclusions:</i></b> MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"123-129"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895755","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":"Effect of Chamomile and Olive Oils on Volume, Range of Motion, and Quality of Life in Breast Cancer-Related Lymphedema: A Randomized Controlled Trial.","authors":"Zahra Sheikhi, Hossein Yarmohammadi, Masood Soltanipur, Parisa Mokhtari-Hesari, Shirin Fahimi, Ali Montazeri, Ghazaleh Heydarirad","doi":"10.1089/lrb.2024.0070","DOIUrl":"10.1089/lrb.2024.0070","url":null,"abstract":"<p><p><b><i>Background:</i></b> Lymphedema is one of the disturbing complications after breast cancer treatment that may affect the quality of life (QoL) of breast cancer survivors (BCSs). <b><i>Methods:</i></b> In this double-blind randomized clinical trial, 63 patients with breast cancer-related lymphedema (BCRL) were included in the study. Group A received standard complete decongestive therapy (CDT), group B received CDT with olive oil, and group C received CDT with chamomile and olive oil. Lymphedema volume and range of motion (RoM) were measured at the beginning of the study and at sessions 7, 14, and 21. Patients' QoL was measured using the Short Form 36 questionnaire at baseline, at the end of the trial, and 1 month after the trial. For statistical analysis, SPSS software with a significance level of <i>p</i> < 0.05 was used. <b><i>Results:</i></b> The mean age of patients was 55.4 ± 10.1 years. Although the volume of lymphedema was reduced and RoM was increased in all groups, there was no significant difference between the three groups. However, the change in volume and RoM was more evident in group C. Moreover, the effect of interventions on health-related QoL dimensions in all groups was not statistically significant. However, in some dimensions, the score did not decrease in group B during follow-up. <b><i>Conclusions:</i></b> Chamomile and olive oils are tolerable for BCSs with BCRL; however, adding this intervention to CDT seems to have no superiority to CDT alone.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"130-136"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895759","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":"Depression and Psychological Distress in Patients with Lower Extremity Lymphedema: A Mixed-Method Study.","authors":"Xuchuan Zhou, Xuefeng Su, Gejia Ma, Yueling Tang, Junzheng Wu, Bin Liu","doi":"10.1089/lrb.2024.0071","DOIUrl":"10.1089/lrb.2024.0071","url":null,"abstract":"<p><p><b><i>Background:</i></b> Lower extremity lymphedema is a chronic and incurable condition. Treatment options for lymphedema have continued to advance and prognosis has improved; however, the condition still poses a substantial negative impact on patients' mental health. Therefore, the key questions raised in this study are \"How many patients with lower limb lymph have depression symptoms?\" and \"Are there any differences in the symptoms and distress factors of patients with lower extremity lymphedema, and how do they experience distress?\" <b><i>Methods and Results:</i></b> A total of 112 lower extremity lymphedema patients from June 2021 to December 2023 were enrolled in the study. Quantitative and qualitative data of patients were collected and analyzed. Participants completed the Patient Health Questionnaire (PHQ-9), and we interviewed participants with moderate/severe depressive symptoms with score ≥10. A total of 83 participants completed this study. Overall, 39.76% of the participants had a PHQ-9 score ≥5, indicating that they had mild depressive symptoms; 13.25% of the participants had a PHQ-9 score ≥10, indicating that they had moderate or severe depressive symptoms. Compared with participants who had received treatment before the study, participants who did not receive any treatment before the study had a higher risk of depression (χ² = 6.705, <i>p</i> = 0.031). There was no significant difference in the degree of depression in patients with different stages of lymphedema (χ² = 8.430, <i>p</i> = 0.077). From the qualitative interview data, we extracted five common themes: \"loss of self,\" \"isolation from surroundings,\" \"discomfort caused by symptoms and complications,\" \"concern about the progression or deterioration of the original malignant tumor,\" and \"fear that surgical treatment may be ineffective.\" <b><i>Conclusions:</i></b> This study found that patients with lower extremity lymphedema are prone to psychological symptoms of depression. To clarify the reason that affect psychological distress is important information to improve the psychological health support for patients with lower extremity lymphedema.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"115-122"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007623","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":"Characterization of Pain in Lipedema: Reliability and Validity of Pain Pressure Thresholds and Hand-Held Sphygmomanometer Assessments in People with Lipedema.","authors":"Francesco Bettariga, Luca Fumagalli, Daniele Aloisi, Luca Maestroni, Sara Mantovani","doi":"10.1089/lrb.2024.0058","DOIUrl":"10.1089/lrb.2024.0058","url":null,"abstract":"<p><p><b><i>Background:</i></b> Lipedema is a chronic condition characterized by abnormal deposition of subcutaneous adipose tissue, leading to pain. The lack of internationally recognized diagnostic criteria complicates the characterization of pain. Physiological parameters such as pain pressure threshold (PPT) represent promising prognostic markers for diagnosing lipedema, yet they remain understudied. This study aimed to evaluate the reliability and validity of two pain pressure measurements, PPT and the hand-held sphygmomanometer (HHS) in lipedema. <b><i>Methods:</i></b> A total of 28 adult females diagnosed with lipedema were recruited. Both PPT, using a digital algometer, and HHS, using a manual aneroid HHS, were performed to assess pain in the lower limbs. The testing was performed in a standing position with PPT and HHS placed on the calf. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were employed to assess the within session reliability, while the validity between PPT and HHS was analyzed using <i>R</i>² in a linear regression model. <b><i>Results:</i></b> The results showed excellent reliability for both PPT and HHS, with ICC indicating high consistency (ICC = 0.93 to 0.97) and CV showing acceptable scores (CV = 3.62% to 9.06%). In addition, good validity between PPT and HHS was also observed (<i>R</i>² = 0.69 to 0.74), suggesting that HHS can be a reliable alternative to PPT for pain assessment in lipedema. <b><i>Conclusion:</i></b> These findings have important clinical implications, as they expand the knowledge of pain characterization in people with lipedema, potentially aiding in diagnostic refinement. In addition, a cost-effective and accessible method for assessing pain was examined (i.e., HHS), showing promising findings and providing an objective method to help diagnose lipedema.</p>","PeriodicalId":18168,"journal":{"name":"Lymphatic research and biology","volume":" ","pages":"95-100"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885384","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}