Neurology最新文献

{"title":"Better Communication With the Public: Understanding Science Phobia and Mistrust as Neurobiological Phenomena.","authors":"Nina F Schor","doi":"10.1212/WNL.0000000000213862","DOIUrl":"10.1212/WNL.0000000000213862","url":null,"abstract":"<p><p>Much has been written recently about science mistrust and illiteracy and consequent phobia of recommendations and interventions that have grown out of that science. Both reinforcing and reversing these phenomena depend on strategies aimed at brain networks that generate them. The neurogenesis of specific phobias involves a network that includes the amygdala and the hypothalamus and their connection through the stria terminalis. Decreased GABAergic inhibition of this circuit results in limbic activation and induction of fear pathways. The neurogenesis of mistrust involves suppression of a network that includes the central amygdala and the shell of the nucleus accumbens, both of which are rich in oxytocin receptors and yield dopaminergic output. Oxytocin signaling mediates trust, whereas, at least in men, dihydrotestosterone signaling mediates mistrust. The possibility of involvement of these limbic circuits in both science phobia and mistrust may underlie the high efficacy of emotionally focused communication in reinforcing them. Yet, recent efforts to reverse science phobia and mistrust have more often involved intellectually focused communication. Assuming limbic network origins of science phobia and mistrust, this commentary presents and discusses the use of emotionally focused communication and explicit, public identification of manipulative techniques and innuendo to influence the prevalence of these phenomena.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213862"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An FDG-PET-Based Machine Learning Framework to Support Neurologic Decision-Making in Alzheimer Disease and Related Disorders.","authors":"Leland Barnard, Hugo Botha, Nick Corriveau-Lecavalier, Jonathan Graff-Radford, Ellen Dicks, Venkatsampath Gogineni, Gemeng Zhang, Brian J Burkett, Derek R Johnson, Sean J Huls, Aditya Khurana, John L Stricker, Hoon-Ki Paul Min, Matthew L Senjem, Winnie Z Fan, Heather Wiste, Mary M Machulda, Melissa E Murray, Dennis W Dickson, Aivi T Nguyen, R Ross Reichard, Jeffrey L Gunter, Christopher G Schwarz, Kejal Kantarci, Jennifer L Whitwell, Keith Anthony Josephs, David S Knopman, Bradley F Boeve, Ronald C Petersen, Clifford R Jack, Val J Lowe, David T Jones","doi":"10.1212/WNL.0000000000213831","DOIUrl":"10.1212/WNL.0000000000213831","url":null,"abstract":"<p><strong>Background and objectives: </strong>Distinguishing neurodegenerative diseases is a challenging task requiring neurologic expertise. Clinical decision support systems (CDSSs) powered by machine learning (ML) and artificial intelligence can assist with complex diagnostic tasks by augmenting user capabilities, but workflow integration poses many challenges. We propose that a modeling framework based on fluorodeoxyglucose PET (FDG-PET) imaging can address these challenges and form the basis of an effective CDSS for neurodegenerative disease.</p><p><strong>Methods: </strong>This retrospective study focused on FDG-PET images in a discovery cohort drawn from 3 research studies plus routine clinical patients. When selecting research study participants, the inclusion criterion was the availability of an FDG-PET image from within 2.5 years of diagnosis with 1 of 9 specific neurodegenerative syndromes or designation as unimpaired. Participants from disease groups were recruited from the clinical patient population while unimpaired participants came primarily from a population study. The discovery cohort was used to develop a clinical decision support framework we call StateViewer, which applies a neighbor matching algorithm to detect the presence of 9 different neurodegenerative phenotypes. The ML performance of this framework was evaluated in the discovery cohort by nested cross-validation and externally validated in the Alzheimer's Disease Neuroimaging Initiative. Potential for clinical integration was demonstrated in a radiologic reader study focused on differentiating posterior cortical atrophy from Lewy body dementia.</p><p><strong>Results: </strong>The discovery cohort contained 3,671 individuals with a mean age of 68 years and consisted of 49% reported female. Our model framework was able to detect the presence of 9 different neurodegenerative phenotypes with a sensitivity of 0.89 ± 0.03 and an area under the receiver operating characteristic curve of 0.93 ± 0.02. In the radiologic reader study, readers using our model were found to have 3.3 ± 1.1 times greater odds of making a correct diagnosis than readers using a current standard-of-care workflow.</p><p><strong>Discussion: </strong>Our proposed framework provides strong classification performance with high interpretability, and it addresses many of the challenges that face clinical integration of ML-based decision support tools. One limitation of this study is a uniform discovery cohort that is not representative of other patient populations in some regards.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213831"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time Course and Severity of Cognitive Changes as a Function of Aβ Positivity and <i>APOE</i> Genotype in Alzheimer Disease.","authors":"Casey R Vanderlip, Craig E L Stark","doi":"10.1212/WNL.0000000000213853","DOIUrl":"10.1212/WNL.0000000000213853","url":null,"abstract":"<p><strong>Background and objectives: </strong>APOE4 is the strongest genetic risk factor of sporadic Alzheimer disease (AD), associated with greater β-amyloid (Aβ) deposition and accelerated cognitive decline, especially in episodic memory. However, it remains unclear whether this decline is driven by increased Aβ burden in APOE4 carriers or by greater susceptibility to Aβ-related effects. In this study, we examined whether the accelerated decline in episodic memory among APOE4 carriers is due to increased Aβ deposition or heightened susceptibility to Aβ-related effects.</p><p><strong>Methods: </strong>We analyzed data from individuals in the Alzheimer's Disease Neuroimaging Initiative who underwent neuropsychological assessments, Aβ PET imaging, and APOE genotyping. Using sampled iterative local approximation, we estimated Aβ duration, defined as the number of years each individual was amyloid positive (Aβ+). Using these estimates, we examined its impact on cognitive trajectories across multiple domains, including episodic memory, executive function, processing speed, visuospatial abilities, semantic memory, and crystallized intelligence.</p><p><strong>Results: </strong>We analyzed data from 1,542 participants (mean age = 72.2 years, SD = 7.2; 50.8% female; mean education = 16.3 years, SD = 2.6) and found that APOE4 was associated with steeper declines in episodic memory as a function of Aβ duration. Homozygous APOE4 carriers (4/4) exhibited the most pronounced decline, followed by heterozygotes (3/4), with noncarriers (3/3) showing the slowest decline. This genotype-dependent pattern was specific to episodic memory; no consistent or meaningful differences were observed across other cognitive domains. In all genotype groups, episodic memory was the first domain to show impairment. However, the lag between memory decline and subsequent nonmemory decline was substantially longer in APOE homozygote individuals compared with the other groups, suggesting a more domain-specific vulnerability early in the disease process.</p><p><strong>Discussion: </strong>These findings suggest that APOE4 carriers, particularly homozygotes, exhibit reduced cognitive resilience to Aβ accumulation, but that this effect is largely specific to episodic memory. These findings indicate that cognitive trajectories in AD differ by APOE genotype, highlighting the importance of examining clinical symptoms in the context of APOE status. Future research should investigate whether these differences are driven by distinct pathologic mechanisms in APOE4 carriers.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213853"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1RA-Associated Diabetic Lumbosacral Radiculoplexus and Common Fibular Neuropathies: A Case-Control Evaluation.","authors":"James D Triplett,Marcus V Pinto,Nathan P Young,Nathan P Staff,Marathe S Chinmay,Michael Horowitz,Catarina Aragon Pinto,Ruple S Laughlin,Kamal Shouman,Sarah E Berini,Michelle L Mauermann,Divyanshu Dubey,Jay Mandrekar,P James B Dyck,Christopher J Klein","doi":"10.1212/wnl.0000000000213916","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213916","url":null,"abstract":"BACKGROUND AND OBJECTIVESGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used to treat obesity and diabetes. Semaglutide, a GLP-1RA, is linked to nonarteritic ischemic optic neuropathy (NAION), macular edema, and retinopathy. Because diabetic lumbosacral radiculoplexus neuropathy (DLRPN) and common fibular neuropathy (CFN) are associated with weight loss, we examined whether GLP-1RA usage is linked to these neuropathies.METHODSWe conducted a retrospective case-controlled study from April 28, 2005 (the first GLP-1RA Food and Drug Administration approval), to December 25, 2024. Patients diagnosed with DLRPN or CFN were analyzed for GLP-1RA exposure and clinical characteristics. A control group, matched for age, sex, body mass index (BMI), and diabetes status, was used to assess for an association with GLP-1RA use.RESULTSWe identified 26 individuals who developed 27 DLRPN episodes, with median symptom onset 6 months (range 3-35 months) after GLP-1RA initiation. At onset, they had a median glycated hemoglobin A1c (HbA1c) reduction of 2.4% (range 1%-8.5%) and a BMI decrease of 4 units (range 1-15), reflecting a 13.9% (range 3.6%-28.5%) weight loss. Microvasculitis was present in 4 of 5 nerve biopsies. Among 77 individuals with CFN, 82 episodes developed, with a mean GLP-1RA duration of 15 months (range 1-112 months). In individuals with CFN, the median HbA1c reduction was 1.2% (range -0.4% to 5%) and the BMI decrease was 4 units (range 0-15), corresponding to a 15.7% (range 3.0%-37.0%) weight loss. Patients with DLRPN experienced greater HbA1c reductions than patients with CFN (2.4% vs 1.2%, p < 0.001). New NAION, macular edema, or retinopathy were not seen with episodes. Compared with controls, GLP-1RA users were 51% more likely to develop DLRPN (odds ratio [OR] 1.5, 95% CI 1.2-1.9, p = 0.0008) and 30% more likely to develop CFN (OR 1.3, 95% CI 1.0-1.5, p = 0.018). All episodes occurred after 2015, with 3 DLRPN events and 7 CFN events occurring between 2015 and 2019, rising to 24 and 70 cases in 2020-2024, reflecting increases of 700% and 900%.DISCUSSIONGLP-1RA use is associated with an increased likelihood of DLRPN and CFN. DLRPN and its associated nerve microvasculitis seem more strongly linked to metabolic changes, particularly significant HbA1c reductions, while CFN has compressive neuropathy characteristics and is more influenced by weight loss.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"111 1","pages":"e213916"},"PeriodicalIF":9.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching NeuroImage: Ruptured Intracranial Dermoid Cyst Presenting as Bilateral Tonic-Clonic Seizures in a Young Woman.","authors":"José Ignacio Tudela Martínez,Álvaro García Jiménez,Francisco Martínez García,Pablo Alcaraz Pérez,Lucía Contreras Espejo,Francisca Velázquez Marín","doi":"10.1212/wnl.0000000000213915","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213915","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"267 1","pages":"e213915"},"PeriodicalIF":9.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Offering Genetic Counseling and Testing to All Persons Diagnosed With Frontotemporal Degeneration Spectrum Disorders.","authors":"Laynie Dratch,Kim Jenny,Kristiana Salmon,Ashley Crook,Wendy R Uhlmann,Jamie C Fong,Jill S Goldman,Victoria Klee,Rhona MacLeod,Amina Chaouch,Diane E Lucente,Sarah K Mantia,Jennifer Pagano,Weiyi Mu","doi":"10.1212/wnl.0000000000213814","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213814","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"109 1","pages":"e213814"},"PeriodicalIF":9.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reader Response: Effect of Immunosuppression in Risk of Developing Generalized Symptoms in Ocular Myasthenia Gravis: A Retrospective Cohort Study.","authors":"Lingyu Xu,Bin Zhou,Yan Xu","doi":"10.1212/wnl.0000000000210041","DOIUrl":"https://doi.org/10.1212/wnl.0000000000210041","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"18 1","pages":"e210041"},"PeriodicalIF":9.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Response: Effect of Immunosuppression in Risk of Developing Generalized Symptoms in Ocular Myasthenia Gravis: A Retrospective Cohort Study.","authors":"Deepak Menon,Vera Bril,Carolina Barnett-Tapia","doi":"10.1212/wnl.0000000000210073","DOIUrl":"https://doi.org/10.1212/wnl.0000000000210073","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"5 1","pages":"e210073"},"PeriodicalIF":9.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency, Risk Factors, and Outcomes of Strokes in Patients With Primary Glioma After Cranial Radiation Therapy.","authors":"Dylan Ryan,Megumi Sugita,Gloria Broadwater,Eric Lipp,Katherine B Peters,Nada El Husseini","doi":"10.1212/wnl.0000000000213902","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213902","url":null,"abstract":"BACKGROUND AND OBJECTIVESRadiation therapy is the mainstay of therapy for patients with glioma. While this treatment modality can improve survival, treatment-related complications may include radiation-induced vasculopathy and increased risk of stroke. We aimed to evaluate the stroke frequency, associated risk factors, and outcomes after cranial radiation therapy in patients with glioma.METHODSThis is a retrospective cohort study at a single tertiary academic brain tumor center involving patients diagnosed with gliomas between 2005 and 2021 who received cranial radiation therapy. Data were collected from the time of cranial radiation therapy until last follow-up. Logistic regression analyses were used to evaluate the association of clinical and demographic variables with all-cause, ischemic, and hemorrhagic strokes.RESULTSIn a retrospective cohort of 930 patients, 910 received radiation therapy (mean age 53.8 years; 40% women) and were included in the final analysis. A total of 91 patients (10.0%) were diagnosed with stroke (73.6% ischemic; 15.4% with recurrent strokes). The median time to diagnosis of stroke after onset of radiation therapy was 652 days with median time to recurrent stroke of 102 days. In a univariable model, Black race (odds ratio [OR] 3.83, 95% CI 1.94-7.56), radiation necrosis (OR 4.62, 95% CI 2.02-10.55), hypertension (OR 1.93, 95% CI 1.23-3.01), hyperlipidemia (OR 5.93, 95% CI 3.61-9.57), and diabetes mellitus (OR 2.25, 95% CI 1.28-3.95) were associated with higher odds of all-cause stroke. In multivariable analysis, Black race (OR 3.41, 95% CI 1.59-7.33), radiation necrosis (OR 6.42, 95% CI 2.45-16.79), and hyperlipidemia (OR 6.42, 95% CI 3.91-10.57) were significantly associated with increased odds of all-cause stroke. Radiation necrosis and hyperlipidemia were associated with increased odds of ischemic stroke. Black race, hyperlipidemia, and younger age were associated with increased odds of hemorrhagic stroke. Compared with ischemic strokes, hemorrhagic strokes were associated with higher poststroke disability.DISCUSSIONIn a large, retrospective cohort of adult patients with glioma treated with cranial radiation therapy, 1 in 10 patients were subsequently diagnosed with stroke with 15.4% suffering recurrent strokes. Factors associated with increased odds of stroke included Black race, radiation necrosis, and hyperlipidemia and should be validated in future prospective cohorts. Study limitations include the retrospective design, incomplete stroke workups, and lack of molecular diagnostics.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"10 1","pages":"e213902"},"PeriodicalIF":9.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noncontrast CT vs CT Perfusion Imaging in Patients With Basilar Artery Occlusion: Analysis of the ATTENTION and ATTENTION IA Trials.","authors":"Wei Hu,Thanh N Nguyen,Muhammad Qureshi,Zhongjun Chen,Chunrong Tao,Rui Li,Ting-Yu Yi,Ganghua Feng,Junfeng Su,Tao Cui,Zhihua Cao,Hao Wang,Guoyong Zeng,Guangxiong Yuan,Xiaozhong Jing,Cong Luo,Yuyou Zhu,Adnan I Qureshi,Raul G Nogueira,Xinfeng Liu,Mohamad Abdalkader","doi":"10.1212/wnl.0000000000213911","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213911","url":null,"abstract":"BACKGROUND AND OBJECTIVESAcute CT perfusion (CTP) or MRI is not widely available or routinely performed across many stroke centers. We aimed to evaluate whether patients with acute basilar artery occlusion (BAO) who are selected by noncontrast CT (NCCT) for endovascular therapy (EVT) have similar outcomes compared with patients who are selected by CTP.METHODSThis was a post hoc analysis of individual patient-level data from the ATTENTION and ATTENTION IA trials. Patients with BAO presenting within 24 hours of estimated onset and selected for EVT by NCCT were compared with those selected by CTP. The primary outcome was the 90-day modified Rankin Scale (mRS) score of 0-3. We used inverse probability of treatment weighting (IPTW) to account for confounders.RESULTSOf 550 patients with BAO, 406 met eligibility criteria, of whom 274 (67.5%) were selected for EVT by NCCT and 132 (32.5%) were selected by CTP. The median (interquartile range, [IQR]) age was 67 (57-74) years, 70.7% were male, the median (IQR) baseline NIH Stroke Scale score was 23 (14-35), and the median (IQR) posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) was 9 (8-10). The primary outcome was similar in both NCCT and CTP groups (mRS scores 0-3: 48.5% vs 45.5%, p = 0.56, respectively). Functional independence at 90 days (mRS scores 0-2: 37.2% vs 33.3%, p = 0.44, respectively), symptomatic intracranial hemorrhage (4.5% vs 7.5%, p = 0.29), and 90-day mortality (32.1% vs 34.9%, p = 0.83) were similar in both groups, respectively. In IPTW analysis, there was no difference in mRS scores 0-3 at 90 days (odds ratio 0.88 [95% CI 0.58-1.32], p = 0.53).DISCUSSIONIn patients with BAO treated with EVT up to the 24-hour time window, there was no difference in clinical or safety outcomes in patients selected by NCCT compared with CT perfusion.CLASSIFICATION OF EVIDENCEThis study provides Class IV evidence that in patients with BAO, selection for EVT using NCCT yields similar clinical and safety outcomes compared with selection for EVT using CT perfusion.TRIAL REGISTRATION INFORMATIONATTENTION: ClinicalTrials.gov NCT04751708. ATTENTION IA: ClinicalTrials.gov NCT05684172.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"153 1","pages":"e213911"},"PeriodicalIF":9.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}