Military Medicine最新文献

{"title":"Medical Support to Irregular Warfare: A Systematic Literature Review, 2000-2024.","authors":"Derek Licina, Chelsea Cherenfant, Jennifer Gurney, Chris Gonzalez, Ronald Hardin, Mason Remondelli, Ryan Leone, Teresa Duquette-Frame, Dallas Burelison, Peter Cloutier, Michael MacLaren, Alisha Harris","doi":"10.1093/milmed/usaf212","DOIUrl":"https://doi.org/10.1093/milmed/usaf212","url":null,"abstract":"<p><strong>Introduction: </strong>Irregular Warfare (IW) is used by the United States and other nations to shape the environment, deter, or prevent conflict, and prevail in war through asymmetric activities. Irregular Warfare occurs in resource-constrained environments with inadequate medical infrastructure or in those that are contested, denied, or sensitive. These environments pose challenges to providing medical care to U.S., ally, and partner nation forces and civilians. The purpose of this research was to identify what global lessons learned since 9/11 can be applied to current challenges and future direction that enhance medical support to IW.</p><p><strong>Materials and methods: </strong>A systematic literature review of peer-reviewed and grey literature using 88 databases within PubMed, Scopus, EBSCOhost, and ProQuest was conducted. Data on the characteristics of irregular warfare medicine from 2000 to the present were extracted and documented. This included the US Department of Defense (DoD) doctrine, organization, training, materiel, leadership and education, personnel, facilities, and policy (DOTMLPF-P) framework and DoD medical functional areas.</p><p><strong>Results: </strong>Of the 12,656 sources identified, 7,988 remained after excluding duplicate matches. A total of 1,063 met the inclusion criteria and were primarily written by civilians (51.7%), covering 81 different countries, representing all Geographical Combatant Commands. US Central Command featured most prominently (61.9%) and was therefore heavily biased toward counterinsurgency (30.3%) as a form of IW. Most publications focused on hemorrhage (14.5%), with disease non-battle injury closely behind (14.2%). Noncombatants were the focus of a majority of the articles (29.6%) while service members were most cited as the recipients of care (41.6%). From a DOTMLPF-P perspective, organization was discussed the most (17.2%) followed by personnel (15.2%). When considering medical functional areas, medical treatment featured prominently (28.9%) trailed by medical logistics (17.6%). The key findings were categorized into 10 themes: (1) interagency and multinational synchronization are essential, (2) medical resiliency requires strategic planning, (3) Global Health Engagement is an important enabler, (4) gaps remain in medical doctrine, (5) low-signature operations drive new needs, (6) host nation capabilities are vital, (7) extended care drives new training requirements, (8) ethics and human rights remain a concern, (9) mental health remains a priority, (10) and technological innovations are required.</p><p><strong>Conclusions: </strong>The advancement in medical care during the past 24 years of IW have enhanced survivability of combatants and noncombatants alike. Unfortunately, challenges remain. The lack of clear IW medicine policy and doctrine has obscured roles, responsibilities, requirements, and capabilities among the various stakeholders within the DoD and beyond. Efforts to ad","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187347","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":"Assessment of the Validity of the Post-Traumatic Stress Disorder Checklist for DSM-5 Scale for Post-Traumatic Stress Disorder Screening in a Cohort of Non-Native French Speaking Soldiers From the Foreign Legion: A Prospective Analysis.","authors":"Jérémy Guichard, Kévin Bostanci, Julien Dezile, Emeric Saguin","doi":"10.1093/milmed/usaf222","DOIUrl":"https://doi.org/10.1093/milmed/usaf222","url":null,"abstract":"<p><strong>Introduction: </strong>Post-traumatic stress disorder (PTSD) is a multifaceted psychiatric disorder arising from exposure to traumatic events, characterized by intrusion symptoms, avoidance behaviors, heightened arousal, and negative cognitive and mood alterations. Military personnel are particularly vulnerable to PTSD because of frequent exposure to life-threatening situations during deployments. In France, studies have reported PTSD prevalence rates of 1.7% and 4.8% among military personnel. Early detection and intervention through regular psychological assessments are essential, as chronic PTSD offers limited therapeutic options. The PTSD Checklist for DSM-5 (PCL-5) is widely used for screening, with demonstrated validity in various settings, including the military. However, its application among non-native French speakers in the French Foreign Legion requires validation as a result of potential comprehension issues.</p><p><strong>Materials and methods: </strong>This study assessed the psychometric properties of the French version of the PCL-5 in a cohort of French Foreign Legion soldiers deployed in Mali during Operation Barkhane in early 2022. The PCL-5 was administered approximately 1 month postdeployment. Two commonly accepted PCL-5 cutoff scores, 31 and 33, and 4 subscores were used based on recommendations. French proficiency levels were categorized into 5 levels based on validated oral and written examinations. Descriptive statistics, Spearman's correlation coefficients, analysis of variance, and the Kruskal-Wallis test were utilized to analyze the data.</p><p><strong>Results: </strong>The final sample comprised 250 legionnaires. The mean PCL-5 score was 21.24 (SD=5.23). Six individuals scored above the cutoff; however, after clinical examination, only one was diagnosed with PTSD (prevalence rate of 0.40%), while the others had anxiety or interpersonal issues. The PCL-5 demonstrated excellent internal consistency (Cronbach's alpha=0.96). Subscale internal consistency ranged from 0.60 to 0.93. No significant correlation was found between PCL-5 scores and French proficiency levels.</p><p><strong>Discussion: </strong>This study confirms the reliability of the PCL-5 as a PTSD screening tool within the French Foreign Legion, demonstrating strong internal consistency and applicability across diverse linguistic backgrounds. The high sensitivity of the PCL-5 resulted in false positives, underscoring the necessity of follow-up clinical evaluations to confirm PTSD diagnoses and provide appropriate care. The lack of significant correlations between PCL-5 scores and French proficiency suggests the tool effectively screens individuals regardless of language proficiency. Future research should aim to enhance item comprehension among non-native speakers and explore additional screening instruments to complement the PCL-5 in this unique linguistic population.</p><p><strong>Clinical trial registration: </strong>20230928_C2EDFRI_4.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187345","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 Situations and Medical Procedures Performed by French Combat Medics in Military Operations: Implications for Training and Doctrine.","authors":"Emmanuelle Roux, Jean Cotte, Tanneguy Lostie de Kerhor, Catherine Piepers, Matthias Huck, Pierre-Julien Cungi, Eric Meaudre, Quentin Mathais","doi":"10.1093/milmed/usaf219","DOIUrl":"https://doi.org/10.1093/milmed/usaf219","url":null,"abstract":"<p><strong>Introduction: </strong>French combat medics (SC2) play a crucial role in managing battlefield casualties during overseas deployments. They are trained to manage a wide range of life-threatening conditions, sometimes without immediate medical support. This study aims to describe the clinical situations encountered by SC2 and the procedures they perform in operational environments.</p><p><strong>Materials and methods: </strong>A retrospective study of professional practices based on an online questionnaire was conducted to identify the types of injuries managed by SC2 and the frequency of procedures performed. The exposure levels of SC2 and their proficiency in performing life-saving interventions were assessed. This research project was approved by the Ethics Committee of the French Research Bureau of the Directorate for Training, Research, and Innovation.</p><p><strong>Results: </strong>Data from 374 questionnaires were analyzed in this study. Hemorrhage was the most frequent condition encountered, representing 56.3% of cases (n=209). Tourniquet application was performed by 48.5% of SC2 at least once, with a 92% success rate. Airway obstruction was managed in 15.8% of cases (n=58), with advanced airway procedures such as cricothyroidotomy being performed in 4.1% of cases (n=15). SC2 managed shock in 43.2% of cases (n=153) and severe traumatic brain injury in 46.4% (n=163).Vascular access was the most performed technical procedure, with 87.5% of personnel exposed (n=309). SC2 had to frequently manage these situations without nurse or physician support, in up to 42.6% of hemorrhagic cases.</p><p><strong>Conclusions: </strong>Although hemorrhage control remains the primary challenge, SC2 must be prepared to handle a broad spectrum of battlefield injuries, including complex airway and circulatory management. In high-intensity conflicts, they may need to provide prolonged field care (PFC) without immediate SC3 support. These findings highlight the need to adapt training programs and doctrinal guidelines to better equip SC2 for independent casualty management in austere environments.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187346","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":"Dynamic Interactions in Chronic Pain-Related Outcomes: \u2028A Secondary Data Analysis of a Pragmatic Clinical Trial With Sequential, Multiple Assignment, Randomized Trial Design.","authors":"Dahee Wi, Diane M Flynn, Chang Park, Jeffrey C Ransom, Honor M McQuinn, Tyler J Snow, Larisa A Burke, Alana D Steffen, Sotaro Shimada, Ardith Z Doorenbos","doi":"10.1093/milmed/usaf225","DOIUrl":"https://doi.org/10.1093/milmed/usaf225","url":null,"abstract":"<p><strong>Objective: </strong>Effective chronic pain management is essential for maintaining psychological health and quality of life. Chronic pain often co-occurs with psychological and physiological concerns such as sleep-related impairment, fatigue, and pain catastrophizing, all of which interact and influence treatment outcomes. This study explored the dynamic interactions among chronic pain-related outcomes in adults undergoing complementary and integrative health and/or standard rehabilitative care interventions.</p><p><strong>Materials and methods: </strong>Using a secondary analysis of a pragmatic clinical trial, we analyzed data from 182 adults with chronic pain who completed data at both pre- and post-intervention time points at a pain treatment facility. We investigated associations between 10 patient-reported outcomes: pain intensity, anger, anxiety, depression, fatigue, pain interference, physical function, satisfaction with social roles and activities, pain catastrophizing, and sleep-related impairment. Cross-sectional network analyses evaluated static relationships at pre- and post-intervention, and cross-lagged panel network analysis captured temporal dynamics.</p><p><strong>Results: </strong>Pain interference, depression, anxiety, and fatigue showed the highest strength centrality in the cross-sectional networks, and sleep-related impairment, pain interference, physical function, and pain intensity exhibited the highest out-expected influence centrality in the cross-lagged panel network model. Bootstrap analyses confirmed network stability and moderate accuracy.</p><p><strong>Conclusion: </strong>These findings highlight that relying solely on cross-sectional relationships between outcomes can overlook the evolving relationships between them during an intervention. Understanding these dynamic patterns is critical for refining intervention strategies and tailoring them to effectively target key outcomes. Incorporating such insights into clinical practice can lead to more adaptive and impactful chronic pain management approaches.</p><p><strong>Clinical trial registration: </strong>Identifier: NCT03297905.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180406","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":"Evaluation of Vitamin D Levels in a Military Associated Population With Recurrent Aphthous Stomatitis.","authors":"Nathan D Krivitzky, Casey M Slack, Amar Kosaraju, Kraig S Vandewalle","doi":"10.1093/milmed/usaf213","DOIUrl":"https://doi.org/10.1093/milmed/usaf213","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent aphthous stomatitis (RAS) is a common condition that can significantly impact a patient's quality of life. Despite extensive research, its etiology remains unclear, though it is believed to be multifactorial. Vitamin D plays a crucial role in modulating innate and adaptive immune responses, making it a potential factor in RAS pathogenesis, which may be linked to immune dysfunction. This study aims to investigate the association between vitamin D deficiency and RAS in a North American military-centric population.</p><p><strong>Materials and methods: </strong>A total of 92 subjects were included: 46 with RAS and 46 without a history of aphthous lesions. Demographic data, including age, gender, and ethnicity, were recorded. Serum vitamin D levels were measured using electrochemiluminescence.</p><p><strong>Results: </strong>The mean serum vitamin D level in the RAS group was 23.7±9.4 ng/mL, while the control group had a mean level of 21.6±9.5 ng/mL. Both groups were vitamin D deficient, and no statistically significant difference was found between them. Although no differences were observed regarding age and ethnicity, a significant difference was noted based on gender.</p><p><strong>Conclusions: </strong>Serum vitamin D levels did not differ significantly between individuals with and without RAS. These findings suggest that vitamin D deficiency alone may not be a determining factor in RAS pathogenesis.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182874","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":"Acute Myocardial Ischemia Secondary to Coronary Vasospasm From Long-Term High-Dose Caffeine Consumption.","authors":"Capt Juliet Corcillo, Lt Col Brian P Murray, Col Paul DeFlorio","doi":"10.1093/milmed/usaf233","DOIUrl":"https://doi.org/10.1093/milmed/usaf233","url":null,"abstract":"<p><p>Chest pain is a prevalent emergency department (ED) complaint, with approximately 20 million annual visits in North America and Europe. Acute ST-elevation myocardial infarction (STEMI) is a critical diagnosis among these complaints, but numerous STEMI mimics, such as variant (Prinzmetal) angina, complicate diagnosis and resource allocation. Variant angina, a reversible coronary vasospasm, is a rare diagnosis often labeled as nonobstructive coronary artery disease. The prevalence of coronary vasospasm is low, making it challenging to quantify. Various mechanisms, including arterial wall dysfunction and vasoactive substances, are hypothesized to precipitate vasospastic events. This case details a confirmed instance of variant angina in a 30-year-old, physically fit male firefighter who consumed approximately 900 mg of caffeine daily. Unlike previously documented cases of cardiac vasospasm following a single massive overdose, this report highlights the association between chronic high caffeine consumption and confirmed vasospasm for the first time.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183023","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":"Periscaphoid and Lunate Dislocation With an Intact Rotated, Scapholunate Interosseous Ligament: A Case Report.","authors":"James D Baker, Erin Swan, Gabriel Mason, Casey Sabbag","doi":"10.1093/milmed/usaf228","DOIUrl":"https://doi.org/10.1093/milmed/usaf228","url":null,"abstract":"<p><p>Perilunate disassociation injuries are rare and may be missed in the acute setting. Prompt identification and management are critical to prevent late complications such as arthritis and instability. These injuries can present several patterns with soft tissue disruption, fracture, or a combination of both. In this report, we present a unique pattern of a periscaphoid, perilunte injury with an intact scapholunate interosseous ligament and describe our treatment strategy and outcome.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160257","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":"Barriers to Screening, Diagnosis, and Prevention of Cardiovascular Disease in Women Veterans.","authors":"Katherine Taylor, Michele Kane, Jennifer Bail","doi":"10.1093/milmed/usaf229","DOIUrl":"https://doi.org/10.1093/milmed/usaf229","url":null,"abstract":"<p><strong>Introduction: </strong>Veterans are known to be at high risk for cardiovascular disease. Women veterans are not only a part of this specialty group, but as they are women-they face some unique experiences and barriers to cardiovascular care that their male counterparts do not. The purpose of this article is to identify barriers as well as facilitators to screening, prevention, and diagnosis of cardiovascular care to women veterans.</p><p><strong>Materials and methods: </strong>A literature review was conducted, utilizing the keywords \"veterans\" AND \"female\" AND \"cardiovascular disease or heart disease\" AND \"screening or prevention or diagnosis\" in CINAHL and PubMed; as well as a search in SCOPUS using \"barriers\" AND \"veteran\" AND \"female\" AND \"Cardiovascular.\"</p><p><strong>Results: </strong>Patient-level barriers included social determinant of health determinant issues, lack of social support, being unaware of their risk of cardiovascular disease or how to implement heart-healthy diet and exercise, and gender bias via the Veterans Affairs staff or provider. Provider level barriers included not having enough time with the patient, not having information on resources for women veterans that are available, the electronic medical record not having screening tools for the provider and patient to use together for discussion or not having the ability to communicate the risk education and recommendations.</p><p><strong>Conclusions: </strong>The gaps in care brought to light in this article make the case for patient and provider tools that include considerations such as mental health, gender-specific care, and education surrounding their risk status and how to access resources to implement healthy lifestyle changes.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160255","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":"From Battlefield to Bedside: Prioritizing Procedural Skills and Competency Expectations for Military Physician Assistants Through a Modified Delphi Method.","authors":"M A J Robyn L Chalupa, M A J Lenard W Tol, M A J Ryan A McMahon, L T C Julie A Rizzo","doi":"10.1093/milmed/usaf246","DOIUrl":"https://doi.org/10.1093/milmed/usaf246","url":null,"abstract":"<p><strong>Introduction: </strong>The U.S. Army-Baylor University Doctor of Science in Physician Assistant Studies General Surgery program is an 18-month curriculum consisting of approximately 4,800 hours of training in clinical, procedural, and operative skills. Maximizing efficient use of medical providers will be paramount in future military conflicts with a high number of casualties expected in a resource-limited environment. This study was designed to ensure that fellowship-trained military physician assistants are meeting surgeon expectations in both garrison and deployed environments.</p><p><strong>Materials and methods: </strong>This study used the Delphi method to prioritize skills and establish performance levels for fellowship-trained physician assistants. The initial survey used a 5-point Likert agreement scale to rate whether trained physician assistants should be able to perform that skill in garrison and deployed environments. The second survey also included questions on the competency level that surgeons expect a trained physician assistant to possess upon graduation, using Accreditation Council for Graduate Medical Education Surgery milestone descriptions for \"patient evaluation and decision making,\" \"intraoperative patient care technical skills,\" and \"postoperative patient care.\"</p><p><strong>Results: </strong>Consensus was reached on 18 skills in both environments. Using the surgery milestones, the average expected competency level of a trained physician assistant t is 2.7 in \"patient evaluation and decision making,\" 2.5 for \"intraoperative patient care technical skills,\" and 2.8 for \"postoperative patient care.\"</p><p><strong>Conclusions: </strong>The expert opinion garnered through this study can focus training and guide competency assessments. By acknowledging military surgeon expectations, our graduates will be better prepared to participate in interprofessional teams during future conflicts.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160256","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":"From Gonorrhea to Gangrene: The Real Story Behind Penicillin Allocation During World War II.","authors":"Sheena M Eagan, Sanders Marble","doi":"10.1093/milmed/usaf234","DOIUrl":"https://doi.org/10.1093/milmed/usaf234","url":null,"abstract":"<p><p>This article challenges the widely cited narrative of reverse triage in World War II penicillin allocation. Drawing on archival sources, it reveals that treatment decisions reflected logistical realities and evolving evidence-not utilitarian ethics. The true story underscores patient-centered priorities and the complexities of wartime medical innovation during the therapeutic revolution.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151183","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}