Military Medicine最新文献

{"title":"Scholarships-for-Service: Financial Outcomes of Military and Government Scholarships for Medical Students.","authors":"Collin P Todd, Rocco J Bruno, Heidi Halvorsen, Ryan M Leone, Mason H Remondelli, Joel M Schofer","doi":"10.1093/milmed/usaf371","DOIUrl":"https://doi.org/10.1093/milmed/usaf371","url":null,"abstract":"<p><strong>Introduction: </strong>The cost of medical education has risen significantly, leading many prospective physicians to seek financial assistance through military and government scholarship programs. These programs, including the Health Professions Scholarship Program (HPSP), Uniformed Services University of the Health Sciences, Medical and Dental Student Stipend Program (MDSSP), and Department of Veterans Affairs (VA) HPSP, offer tuition coverage, stipends, and financial incentives in exchange for service commitments. Although these pathways provide the potential for debt-free education and early-career compensation, concerns remain about their long-term financial trade-offs compared to civilian medical practice. Previous studies suggest that while military and government service physicians may experience lower initial salaries, pension benefits and retention incentives can offset financial disparities over time. However, current literature lacks a comprehensive analysis that accounts for key financial factors, including specialty-specific earnings, military bonuses, and federal pension structures. This study seeks to fill this gap by systematically comparing the lifetime financial outcomes of 6 physician career pathways across 3 medical specialties: orthopedic surgery, internal medicine, and anesthesiology.</p><p><strong>Materials and methods: </strong>A financial model was constructed to track lifetime earnings from medical school entry at age 22 to retirement at age 65. Each pathway was analyzed based on 2 career trajectories: early leave, representing physicians who separate after completing their minimum service obligation, and late leave, representing those who complete a pension-eligible military or government career. Compensation calculations incorporate base salaries, stipends, residency pay, bonuses, retention incentives, and pensions. Location-dependent factors such as Basic Allowance for Housing and cost-of-living adjustments were integrated for accuracy. Civilian salaries were sourced from Eastern Virginia Medical School resident pay tables and Doximity's 2023 Physician Compensation Report, while military and VA compensation data were derived from government reports.</p><p><strong>Results: </strong>Findings indicate that while military physicians generally earn lower salaries during service compared to their civilian counterparts, benefits such as debt-free education, stipends, and pension plans contribute to long-term financial competitiveness. The largest determinant of lifetime earnings was specialty selection rather than pathway choice. Orthopedic surgeons consistently earned the highest lifetime compensation across all pathways, while internal medicine physicians exhibited more comparable earnings between military and civilian careers. Notably, pathways incorporating VA service and reserve military duty, such as MDSSP and VA HPSP, demonstrated competitive lifetime earnings relative to civilian practice, particularly in ","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619059","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 Committee on Surgical Combat Casualty Care Publishes Role 2 Orthopedic Surgery Needs Assessment for Large-Scale Combat Operations.","authors":"Nathan Marsh, Christopher Renninger, Jennifer Gurney, Matthew D Tadlock, Jerome Benavides","doi":"10.1093/milmed/usaf338","DOIUrl":"https://doi.org/10.1093/milmed/usaf338","url":null,"abstract":"<p><p>Although combat extremity injuries were highly prevalent during the Global War on Terror, orthopedic surgeons were not always present in the forward surgical environment. We describe the Joint Trauma System's line of effort to evaluate the need for orthopedic surgeons providing forward surgical care during potential Large-Scale Combat Operations.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608758","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":"Increases in Musculoskeletal Diagnosis Rates Corresponding With the Transition to the Army Combat Fitness Test.","authors":"Janse T Schermerhorn, Elizabeth L Rich, Josh B Kazman, Daniel R Clifton, D Alan Nelson","doi":"10.1093/milmed/usaf287","DOIUrl":"https://doi.org/10.1093/milmed/usaf287","url":null,"abstract":"<p><strong>Introduction: </strong>Non-combat musculoskeletal (MSK) disorders are a major cause of morbidity in the U.S. Army. Physical fitness tests are required for training and readiness, but they may be accompanied by injury risks. The Army recently transitioned from the Army Physical Fitness Test (APFT) to the Army Combat Fitness Test (ACFT). We hypothesize that this transition in, and associated changes in individual and group training regimens are associated with increased MSK diagnoses.</p><p><strong>Materials and methods: </strong>We conducted a retrospective review of recently enlisted active duty service members from 2016 to 2022 and analyzed the incidence of MSK diagnoses within the first 6 months of military service. The 3 cohorts were control APFT (2016-2019), COVID (2020-2021), and ACFT (April 2022-October 2022). Survival analyses were used to compare ACFT and COVID cohorts with the control APFT.</p><p><strong>Results: </strong>We studied 13,228 males (control: 75%; COVID: 17%; ACFT: 9%) and 2,404 females (control: 74%; COVID: 17%; ACFT: 9%). Among men, the ACFT cohort elevated hazard ratios (HRs) for general acute MSK (HRadj: 1.60; 95% CI: 1.32, 1.95) and cumulative MSK conditions (HRadj: 1.79; 95% CI: 1.63, 1.97) compared to controls. Among women, the ACFT group also had elevated risk compared to controls, but not by as much as in men (acute MSK: HRadj: 1.34; 95% CI: 0.97, 1.85; cumulative: 1.36; 95% CI: 1.14, 1.62). Compared to the control group, the COVID group had reduced rates of cumulative MSK conditions (males, HRadj: 0.86, 95% CI: 0.79, 0.94; females: HRadj: 0.83, 95% CI: 0.73, 0.95) and non-statistically significant differences in acute MSK conditions (males, HRadj: 1.99, 95% CI: 0.83, 1.18; females, HRadj: 0.87, 95% CI: 0.66, 1.16). Within cohorts, the incidence rate for women was almost twice that of men for many MSK diagnoses, particularly for acute knee conditions (women, control group: 1.4%; men, control group: 0.5%) and acute back conditions (women, control group: 0.9%; men control group: 0.4%).</p><p><strong>Discussion: </strong>Among new enlistees, risk for MSK conditions has fluctuated, likely in response to the introduction of the ACFT in April 2022 and to COVID lockdowns. Consistent with much prior research, women had much higher rates of MSK conditions than men, which might mask trends over time. Continued monitoring of MSK trends over time and practices around the ACFT is necessary to maximize force readiness and minimize overall MSK disorder burden.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608757","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":"A Systematic Review of Evidence-Based Prevention Approaches for Alcohol Problems with Viability for Military Implementation.","authors":"Jennifer Piscitello, Richard E Heyman, Amy M Smith Slep, Jasara N Hogan","doi":"10.1093/milmed/usaf182","DOIUrl":"https://doi.org/10.1093/milmed/usaf182","url":null,"abstract":"<p><strong>Introduction: </strong>Hazardous alcohol use in the military exceeds that of the general population and is associated with a host of negative personal, health, social, emotional, and occupational consequences. Prevention is a cost-effective way to reduce problematic drinking. Despite numerous reviews and meta-analyses synthesizing the literature on prevention programs targeting civilians, there is a dearth of such resources specifically targeting active duty service members and other military personnel. The purpose of this systematic review was to summarize existing evidence-based prevention programs that have documented success in reducing the onset of alcohol problems in young adults, emphasizing programs that may be implementable in the U.S. military.</p><p><strong>Materials and methods: </strong>We identified alcohol prevention programs through two methods: we conducted (1) a meta-review of evidence-based prevention programs in clearinghouses and (2) a systematic review of alcohol-prevention evaluations in military settings.</p><p><strong>Results: </strong>Integrated results review 6 prevention programs that were identified as a good fit based on inclusion criteria (i.e., universal or selective prevention, administrable to individuals or small groups) with sufficient support for effectiveness. All included programs demonstrate research supporting their application in either active duty or veteran populations.</p><p><strong>Conclusions: </strong>This review adds to the literature by synthesizing the current evidence-based prevention programs targeting the onset of alcohol problems, with an emphasis on those programs that have strong potential for successful implementation among military populations. Specific recommendations and considerations for implementation are provided.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608756","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":"Ruptured Orbital Dermoid Cyst Masked as a Migraine in a 25-Year-Old Male.","authors":"Ashley M Maitland, Ryan E Wolf, Jason H Wong, Jose T Fernandez, Todd J Mondzelewski","doi":"10.1093/milmed/usaf341","DOIUrl":"https://doi.org/10.1093/milmed/usaf341","url":null,"abstract":"<p><p>Dermoid cysts are a variation of teratoma made up of ectoderm and mesoderm and represent a large proportion of scalp and skull masses found in children. Orbital dermoid cysts are an exceedingly rare form of primary orbital tumors. We present a case of a 25-year-old active duty male presenting with new onset migraines, eye pain on waking, and intermittent blurred vision. According to current clinical practice guidelines, intracranial imaging was obtained, which revealed an orbital mass. The mass was successfully excised, and surgical pathology confirmed the diagnosis of an orbital dermoid cyst. We examine this clinical presentation as a way to reinforce primary care clinical practice guidelines. Orbital dermoid cysts are a rare diagnosis, especially in the primary care setting and typically present with symptoms that are often quite subtle. This case serves as an example to primary care providers and other physicians to have a low threshold for intracranial imaging in new-onset headaches or a change in the pattern of chronic headaches.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567538","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":"Personal Spirituality is Correlated With Psychological Resilience in a Training Marine Population.","authors":"Nikki Barczak-Scarboro, Paul E Rapp, Christopher J Cellucci, Rachel Chamberlin, Rory McCarthy, Gloria H Park","doi":"10.1093/milmed/usaf200","DOIUrl":"https://doi.org/10.1093/milmed/usaf200","url":null,"abstract":"<p><strong>Introduction: </strong>Spirituality is a recognized component of the DoD Chairman of the Joint Chief of Staff's Total Force Fitness Framework. Although it is often considered akin to religiosity, the Total Force Fitness framework took care to consider components not centered on a theist perspective. Spirituality is considered an adaptive interpersonal characteristic for human flourishing and functioning. It is therefore commonly supposed that spirituality supports resilience, and that spirituality and resilience should be correlated. This study presents data investigating this hypothesis.</p><p><strong>Materials and methods: </strong>A cohort of 452 junior officers (81.46% [n = 334] male; 25.69 ± 4.67 years old) in the U.S. Marine Corps completed an online survey including spirituality (Special Operations Command Spiritual Fitness Scale, SFS), and resilience (Ego-Resiliency Scale, ER89) metrics. The SFS was constructed to capture the elements of spiritual fitness as outlined in the Chairman of the Joint Chiefs of Staff Instruction 3405.01.</p><p><strong>Results: </strong>Four procedures for quantifying correlation were implemented. All four found a moderate positive correlation between elements of spirituality and resilience.</p><p><strong>Conclusion: </strong>The results supported the hypothesis that personal spirituality is related to resilience in military personnel. Replication and longitudinal design of these constructs and their complexities will bolster ongoing military resilience and spirituality programs.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575858","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 Affecting Urogenital Health Behaviors in Women Serving in the Korean Military: A Mixed Methods Study.","authors":"Soo Yeon Kim, Gwang Suk Kim, Joungyoun Kim, Hyewon Kim, Ju-Hee Nho, Sue Kim","doi":"10.1093/milmed/usaf339","DOIUrl":"https://doi.org/10.1093/milmed/usaf339","url":null,"abstract":"<p><strong>Background: </strong>Although women serving in the Korean military are steadily increasing, little is known on the status and related factors of their urogenital health behaviors (UHB), especially during field training. This study aims to identify UHB status and its affecting factors among female military personnel in South Korea.</p><p><strong>Materials and methods: </strong>An exploratory sequential mixed methods design was used. First, the experiences of UHB were explored through interviews (n = 17), followed by a cross-sectional survey to identify its affecting factors (n = 719). The integration phase was done via joint display of findings.</p><p><strong>Results: </strong>The experiences of UHB centered on 4 categories: 'holding it to avoid restroom use'; 'Walking on eggshells (noonchi) in unavoidable situations'; 'seeking solutions independently'; and 'hoping for an improved work environment.' The majority of participants reported problems in changing feminine hygiene products in the field (344 out of 377, 91.2%) Among those who had experienced duty or training in the field in the past 6 months (n = 520) 90% (n = 469) reported having reduced water intake in the field and 91.0% (n = 473) delayed urination during field training. Branch, position, length of service, confidence in performing UHB, job stress, supervisor support, military health provider support, unit type, presence of female supervisor had significant influences on UHB. Thus, quantitative findings corroborated with and further built up the qualitative findings.</p><p><strong>Conclusions: </strong>Interventions for improving female military personnel's UHB are needed, especially for those whose branches are combat or combat support, who work in battalion level units, and who are in staff positions.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560453","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":"Integrating Leadership and Technical Skills: Insights From Prolonged Casualty Care During Operation Gunpowder.","authors":"Kiyrie Simons, Yen Lee, Cynthia Shen, Ting Dong, Hannah G Kleber, Angela M Yarnell, Erin S Barry","doi":"10.1093/milmed/usaf355","DOIUrl":"https://doi.org/10.1093/milmed/usaf355","url":null,"abstract":"<p><strong>Introduction: </strong>Military medical providers must rapidly assess and treat casualties while managing prolonged care in resource-limited environments. Tactical Combat Casualty Care and Prolonged Casualty Care (PCC) provide structured frameworks for battlefield medicine, but training often separates technical and leadership development. To address this gap, Operation Gunpowder at the Uniformed Services University was adapted to integrate leadership and clinical skills. This study examines the relationships between student leadership performance, self-reported training experiences, and faculty and peer evaluations.</p><p><strong>Materials and methods: </strong>This study analyzed data from 203 third-year medical and graduate nursing students participating in the 36-hour Operation Gunpowder field practicum. Leadership performance was assessed using the Leader-Follower Framework, which evaluates Character, Context, Competence, Communication, and Leadership Transcendent Skills. Students completed post-practicum surveys and reflections, and Pearson correlations were conducted between survey responses and leadership performance ratings. Qualitative responses were reviewed for themes related to quantitative findings.</p><p><strong>Results: </strong>In each squad, students who rated Primary Survey, Wound Care, or Evacuation Skills as useful had lower leadership performance scores, particularly in Character (r = -0.46 to -0.52, P < .05) and Communication (r = -0.46, P < .05). Confidence in PCC knowledge was positively correlated with adaptability (Context, r = 0.44, P < .05), suggesting that early PCC training may improve situational responsiveness. Squads that found hands-on practice most beneficial had lower Communication scores (r = -0.48, P < .05), indicating potential gaps in team coordination. Students who prepared for less than 1 hour before the practicum performed better in leadership dimensions, including Communication (r = 0.56, P < .01).</p><p><strong>Conclusions: </strong>These findings highlight challenges in integrating leadership into technical skills training. Enhancing PCC exposure, embedding communication exercises in hands-on training, and optimizing pre-practicum preparation may improve leadership development. Insights from this study can inform refinements to military medical training, including Operation Bushmaster, to better prepare future military medical officers for battlefield decision-making and leadership.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560454","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":"Case Report of a Combat Casualty in Ukraine With Foreign Body (Bullet) Migration to the Heart.","authors":"Yaroslav Tielushko, Iurii Mikheiev, Stacy Shackelford, Roman Kuziv","doi":"10.1093/milmed/usaf188","DOIUrl":"https://doi.org/10.1093/milmed/usaf188","url":null,"abstract":"<p><p>The article provides a detailed description of a case of combat injury in Ukraine due to a bullet wound to the neck involving intravascular migration of the bullet through major veins into the right atrium. Surgical care was provided at a role 3 hospital in eastern Ukraine. The authors emphasize the differences in the clinical picture and surgical treatment of a patient with migration of a foreign body to the heart compared to traumatic cardiac injury. The key to success in performing surgical interventions in such cases is the integration of examinations, conditions, and experience of specialists providing treatment.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553981","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":"Impact of International Department of Defense Surgical Missions on Readiness: Perspectives from Military Surgeons.","authors":"Sharon Kim, Pranish Katawal, Debashree Mitra, Robert Lee, Sorana Raiciulescu, Carolyn Gosztyla, Jacob Stephenson, John Maddox, Joseph Aryankalayil, Tamara Worlton","doi":"10.1093/milmed/usaf348","DOIUrl":"https://doi.org/10.1093/milmed/usaf348","url":null,"abstract":"<p><strong>Introduction: </strong>Declining surgical case volumes in the Military Healthcare System have raised concerns about the readiness of Department of Defense (DoD) surgeons for deployment. Reduced opportunities for major surgeries at Military Treatment Facilities correlate with declines in surgical Knowledge, Skills, and Abilities metrics, which measures deployment preparedness. This challenge, termed the \"Walker Dip,\" is exacerbated during peacetime. International surgical missions and military Global Health Engagement (GHE) have been proposed to bridge this gap by offering military surgeons the chance to manage complex cases in low-resource settings. Although GHE missions aim to strengthen global partnerships and improve interoperability, their direct impact on readiness remains unclear. This study evaluates military surgeons' perceptions of readiness following participation in DoD surgical missions to better inform future mission planning.</p><p><strong>Materials and methods: </strong>An anonymous, voluntary survey was developed by medical students and military surgeons with GHE experience. Eligible participants were military surgeons with experience in DoD international surgical missions, excluding combat deployments and disaster response missions. The survey collected demographic data, mission characteristics, and participants' perceived readiness using Likert scales. Data analysis included descriptive statistics, chi-square tests, and Spearman's rank correlations.</p><p><strong>Results: </strong>A total of 47 respondents met the inclusion criteria. The majority were general surgeons (72%), with 57% serving in the Navy. Fifty-five percent of participants rated the missions helpful to their readiness, while 44.7% were neutral or found them unhelpful. Key factors associated with mission helpfulness included managing complex cases, treating critically ill patients, and performing blood transfusions (P < .05). Although case complexity significantly correlated with perceived readiness (P = .002), case volume did not (P = .109). Navy surgeons were less likely to rate missions as helpful compared to Army and Air Force surgeons (P = .002).</p><p><strong>Conclusion: </strong>This study highlights the critical role of case complexity and exposure to high-acuity patients in enhancing surgical readiness. International surgical mission planning for readiness should prioritize complexity and operational relevance over procedural volume. Further, optimizing mission design will ensure readiness and preparedness for future deployments while balancing global health and military objectives. Future research should explore standardized metrics to evaluate readiness and the long-term impact and ethical implications of these missions.</p>","PeriodicalId":18638,"journal":{"name":"Military Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553984","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}