Otology & Neurotology最新文献

{"title":"LETTER TO THE EDITOR CONCERNING: \"HEARING DEVICE COIL PLACEMENT LATERAL TO THE TEMPORALIS: AN ALTERNATIVE TO FLAP THINNING FOR COCHLEAR AND TRANSCUTANEOUS BONE-ANCHORED IMPLANTS\".","authors":"Orhan Ozturan, Alper Yenigun, Ramazan Bahadir Kucuk, Erol Senturk, Sabri Baki Eren, Fadlullah Aksoy","doi":"10.1097/MAO.0000000000004477","DOIUrl":"10.1097/MAO.0000000000004477","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"605"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Coherence Tomography as a Tool for Quantitative Imaging of the Tympanic Membrane and Middle Ear.","authors":"Ryan Long, Wihan Kim, Marcela Morán, Frank D Macías-Escrivá, Patricia M Quiñones, John S Oghalai, Brian E Applegate","doi":"10.1097/MAO.0000000000004441","DOIUrl":"10.1097/MAO.0000000000004441","url":null,"abstract":"<p><strong>Objective: </strong>Advances in optical coherence tomography have improved diagnostic imaging for otologic pathologies. We investigated handheld OCT (HHOCT) otoscopic device's ability to quantitatively analyze the middle ear and provide valuable information for the management of middle ear pathologies.</p><p><strong>Study design: </strong>Cross-sectional cohort.</p><p><strong>Methods: </strong>Eleven healthy patients, 5 patients with unilateral pathology, 6 patients with retraction pockets, and 1 patient undergoing ossiculoplasty were imaged using HHOCT in the clinic. Middle ear distances and retraction pocket depth were calculated using OCT volumes and compared to those on CT and in literature. Partial ossicular replacement prosthesis length was calculated before surgery and compared to the length chosen by an expert otologist. Data were characterized using descriptive statistics and paired t -tests. Volumes were analyzed and postprocessed using Amira (Thermofisher Scientific, Waltham, MA) and Fiji (NIH).</p><p><strong>Results: </strong>HHOCT could image and obtain quantitative measurements of the middle ear at the point of care with greater resolution and precision than traditional imaging modalities. Mean incus diameter on OCT was 0.728 ± 0.089 mm, in agreement with cadaver studies. Measured middle ear distances and retraction pocket depths were not statistically significantly different from those measured on CT. The predicted prosthesis size for the ossiculoplasty patient was 2.46 mm, closely matching the 2-mm length chosen by an expert otologist.</p><p><strong>Conclusion: </strong>OCT can provide reliable measurements of the tympanic membrane and middle ear structures not readily available through traditional imaging modalities. Pre- or intrasurgical measurements with OCT may be beneficial for guidance on size and placement of ossicular prosthetics and may improve hearing outcomes.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"525-531"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of Automated Cochlear Length and Cochlear Implant Insertion Angle Predictions with a Surgical Planning Platform.","authors":"Emilio Avallone, Max E Timm, Thomas Lenarz, Daniel Schurzig","doi":"10.1097/MAO.0000000000004480","DOIUrl":"10.1097/MAO.0000000000004480","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative anatomical assessment is essential to optimize the outcome of individualized cochlear implantation. Algorithms based on cochlear diameters simplify this evaluation. The new version of a surgical planning platform is capable of performing this determination automatically. Our study evaluated the robustness of automated measurements and compared individual differences between automated and manual measurements, including predicting cochlear duct length and insertion angles.</p><p><strong>Materials and methods: </strong>The preoperative cone beam CT scans of 55 MED-EL cochlear implant patients were analyzed. Using the surgical planning platform, the anatomical diameters were measured automatically and manually. The values were compared, as well as the predictions of the insertion angles and prediction of cochlear duct length.</p><p><strong>Results: </strong>The analyses showed good agreement between manual and automatic measurements of cochlear diameters, with the exception of cochlear height, where a significant difference was observed. Some discrepancies were noted for the prediction of the cochlear length duct without, however, a significant impact. Predictions of insertion angles based on automated measurements were comparable to the postoperative evaluations, with no significant difference from the manual ones.</p><p><strong>Discussion: </strong>The robustness of automated assessments is essential for integration into clinical practice. Automated measurements of cochlear dimensions are comparable to manual ones. However, image quality and the presence of anatomical abnormalities may influence the results. In this study, the evaluation of the insertion angle prediction was strengthened by comparison with postoperative results taking into account the actual insertion depth.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e161-e169"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RESPONSE TO LETTER TO THE EDITOR REGARDING: HEARING DEVICE COIL PLACEMENT LATERAL TO THE TEMPORALIS: AN ALTERNATIVE TO FLAP THINNING FOR COCHLEAR AND TRANSCUTANEOUS BONE-ANCHORED IMPLANTS.","authors":"Ashley M Nassiri, Cynthia A Hogan, Matthew L Carlson","doi":"10.1097/MAO.0000000000004478","DOIUrl":"10.1097/MAO.0000000000004478","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"606"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the Incidence of Pediatric Otitis Media Pre- and Post-COVID-19 Pandemic in South Korea: A Study Utilizing a HIRA-Customized Cohort for the Population Aged ≤18 Years.","authors":"Taeung Eom, Byungjun Jeong, Seok-Hyun Kim, Sung-Won Choi, Se-Joon Oh, Soo-Keun Kong, Il-Woo Lee, Hyun Min Lee","doi":"10.1097/MAO.0000000000004490","DOIUrl":"10.1097/MAO.0000000000004490","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the changes in the incidence of otitis media and ventilation tube insertion (VTI) rates among South Koreans aged ≤18 years since the COVID-19 pandemic and analyze the impact of social distancing and increased personal hygiene.</p><p><strong>Study design: </strong>A retrospective cohort study utilizing health insurance claim data.</p><p><strong>Setting: </strong>Healthcare facilities across South Korea.</p><p><strong>Patients: </strong>Individuals aged ≤18 years diagnosed with acute suppurative otitis media (AOM), chronic serous otitis media (SOM), or acute mastoiditis (AM).</p><p><strong>Intervention: </strong>Diagnostic and therapeutic interventions, including VTI procedures.</p><p><strong>Main outcome measure: </strong>Changes in the monthly average number of patients and episodes of AOM, SOM, and AM, and the number of VTI procedures, comparing pre-COVID-19 (2018-2019) to post-COVID-19 (January 2020-May 2021) periods.</p><p><strong>Results: </strong>The monthly average number of patients with AOM and number of episodes decreased by 56.6% and 62.9%, respectively (Estimate: 0.37 [95% CI: 0.30-0.46], p = 0.01) post-pandemic. SOM patients and episodes decreased by 58.2% and 61.2%, respectively (estimate, 0.39; 95% CI, 0.33-0.46; p = 0.01). AM patients and episodes decreased by 15.8% and 16.6%, respectively (estimate, 0.83; 95% CI, 0.69-1.00; p = 0.06). The monthly average number of VTI procedures for AOM and SOM also decreased significantly post-pandemic.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic led to a significant decrease in the incidence of otitis media and VTI surgeries in South Koreans aged ≤18 years. This decrease may be attributed to the implementation of social distancing measures and increased personal hygiene practices during the pandemic. These findings provide valuable insights for preventing and managing pediatric otitis media during future respiratory pandemics and similar public health emergencies.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"552-560"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Customized Web Video-Based Vestibular Rehabilitation for Patients With Vestibular Hypofunction: A Randomized Controlled Study.","authors":"Tomohiko Kamo, Hirofumi Ogihara, Ryozo Tanaka, Masato Azami, Takumi Kato, Reiko Tsunoda, Hiroaki Fushiki","doi":"10.1097/MAO.0000000000004494","DOIUrl":"10.1097/MAO.0000000000004494","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of customized web video-based vestibular rehabilitation in patients with chronic vestibular hypofunction.</p><p><strong>Study design: </strong>This study is a randomized controlled trial.</p><p><strong>Setting: </strong>The dizziness specialty clinic.</p><p><strong>Patients: </strong>The participants were diagnosed with chronic vestibular hypofunction.</p><p><strong>Interventions: </strong>The study used a randomized controlled trial design, in which participants were randomly assigned to either the customized web video-based vestibular rehabilitation or booklet-based vestibular rehabilitation in a 1:1 ratio.</p><p><strong>Main outcome measures: </strong>Patients were assessed at three time points: before-intervention (baseline), post-intervention completion (6 wk), and follow-up (12 wk). The primary outcome was the Dynamic Gait Index (DGI), the secondary outcome was the Dizziness Handicap Inventory (DHI), and tertiary outcomes included other functional and psychological assessments.</p><p><strong>Results: </strong>The baseline characteristics of the patients were comparable between the two groups. Statistical analysis revealed a significant time effect for the DGI score ( p < 0.0001). Comparing the post-intervention and follow-up assessments to the baseline assessment, the customized web video-based VR group showed a significant increase in the DGI score. Time × group interaction effects were observed ( F = 5.739, p < 0.01). Both groups showed decreased DHI_total scores when comparing the postintervention and follow-up assessments to the baseline assessment. No serious adverse events were reported during intervention period.</p><p><strong>Conclusions: </strong>The present study demonstrated that customized web video-based VR improved DGI compared with booklet-based VR, and the intervention effect was maintained at 6-week follow-up. Additionally, the findings suggested that both interventions improve to a similar extent DHI. Therefore, vestibular rehabilitation with motion visualized by video may be more effective than that with still image by booklet.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"573-580"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologic Findings after Transpromontorial Approach: Clinical and Pathophysiological Considerations.","authors":"Matteo Alicandri-Ciufelli, Edoardo Serafini, Maria Rosini, Carlotta Liberale, Francesca De Cecco, Elke Loos, Paolo Garofalo, Nicolò Cardobi, Alessia Rubini, Daniele Marchioni","doi":"10.1097/MAO.0000000000004483","DOIUrl":"10.1097/MAO.0000000000004483","url":null,"abstract":"<p><strong>Objectives: </strong>Transpromontorial approaches require obliteration of the surgical cavity and the eustachian tube, along with cul-de-sac external auditory canal closure, without obliteration of the mastoid air cells. This study aims to evaluate the clinical and radiological implications of tympanic cavity obliteration when the mastoid air cell system is preserved.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Thirty-one adult patients with unilateral vestibular schwannoma.</p><p><strong>Intervention: </strong>Patients underwent resection of a vestibular schwannoma through either an exclusive endoscopic transcanal transpromontorial approach (endoTTA) or an expanded transcanal transpromontorial approach (expTTA).</p><p><strong>Main outcome measure: </strong>Postoperative radiologic mastoid and surgical cavity content and clinical outcomes.</p><p><strong>Results: </strong>Thirty-one patients met the inclusion criteria. The mean radiological follow-up was 54 months. Regarding mastoid content, air was present in 13 patients (42%) and trapped fluid in 18 patients (58%). Surgical cavity content revealed air in 14 patients (45%), trapped fluid in 8 patients (26%), total fat obliteration in 5 patients (16%), and partial fat obliteration in 4 patients (13%). No cases of mucocele, cholesterol granuloma, or iatrogenic cholesteatoma were observed. Three main radiological patterns were identified by combining mastoid and surgical cavity findings. EndoTTA was found to be significantly associated with postoperative radiological air content in the mastoid cavity ( p value = 0.013), while no association was found between the type of radiological pattern and the development of complications or symptoms at the last follow-up.</p><p><strong>Conclusions: </strong>EndoTTA and expTTA are safe and effective procedures, with no increased risk of meningitis or CSF leak, even in cases where obliteration tissue is reabsorbed.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e176-e182"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Symptom Changes in Sporadic Vestibular Schwannoma: A Comparison of Observation, Microsurgery, and Radiosurgery.","authors":"Karl R Khandalavala, Christine M Lohse, Nicole M Tombers, Michael J Link, Matthew L Carlson","doi":"10.1097/MAO.0000000000004495","DOIUrl":"10.1097/MAO.0000000000004495","url":null,"abstract":"<p><strong>Objective: </strong>To compare differences in sporadic vestibular schwannoma (VS)-associated patient-reported symptom scores among patients receiving observation, microsurgery, or radiosurgery.</p><p><strong>Study design: </strong>Prospective longitudinal survey.</p><p><strong>Setting: </strong>Tertiary referral center and the national Acoustic Neuroma Association.</p><p><strong>Patients: </strong>Adults with sporadic VS.</p><p><strong>Intervention: </strong>Observation, microsurgery, or radiosurgery.</p><p><strong>Main outcome measure: </strong>Baseline and follow-up surveys on patient-reported severity of tinnitus, dizziness/imbalance, and headaches scored on a 10-point numeric scale, with higher scores indicating more severe symptoms; changes of 2 or more points from baseline were considered clinically important.</p><p><strong>Results: </strong>A total of 455 patients were eligible for study with a mean (SD) follow-up of 4.5 (2.4) years, including 122 (27%) managed with observation, 226 (50%) undergoing microsurgery, and 107 (23%) undergoing radiosurgery. Changes in tinnitus severity scores differed significantly among management groups ( p = 0.006), with severity scores increasing significantly in the radiosurgery (+0.8, p = 0.005) group but not in the observation (+0.2, p = 0.5) or microsurgery (-0.2, p = 0.18) groups. The changes in dizziness/imbalance and headache severity scores did not differ significantly among management groups. When comparing clinically important improvements (decrease of 2 or more points), the microsurgery and observation cohorts had a greater proportion of patients experiencing a clinically important improvement in tinnitus compared with the radiosurgery cohort; no other clinically important changes were significantly different among management groups.</p><p><strong>Conclusions: </strong>In this prospective study of 455 patients comparing patient-reported symptoms after VS management, radiosurgery was associated with worsening tinnitus severity scores overall and resulted in fewer patients reporting clinically important improvements in tinnitus compared with observation and microsurgery. As there was substantial variability in the effect of management modality on changes in symptom severity scores, possible treatment effects on subjective symptoms, including tinnitus, dizziness/imbalance, and headache, should not be used in isolation to inform clinical decision-making for management of sporadic VS.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"581-586"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auditory Characteristics in Children With Enlarged Vestibular Aqueduct.","authors":"Punam Patel, William Parkes, Cedric Pritchett, Matthew Stewart, Arabinda Choudhari, Rahul Nikam, Jobayer Hossain, Robert O'Reilly, Thierry Morlet","doi":"10.1097/MAO.0000000000004485","DOIUrl":"10.1097/MAO.0000000000004485","url":null,"abstract":"<p><strong>Objective: </strong>Enlarged vestibular aqueduct (EVA) is the most common radiographic finding in children diagnosed with congenital sensorineural hearing loss (SNHL). Many institutions use the Cincinnati criteria for diagnosis: width ≥2.0 mm at the operculum and/or ≥1.0 mm at the midpoint. Our goals are to expand our understanding of EVA by examining the audiometric and auditory brainstem response (ABR) characteristics of a large population of children with EVA and hearing loss.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Tertiary-care children's hospital.</p><p><strong>Patients: </strong>All children diagnosed with EVA from 2006 to 2016.</p><p><strong>Interventions: </strong>Diagnostic.</p><p><strong>Main outcome measures: </strong>Vestibular aqueduct measurements were taken at the operculum.</p><p><strong>Results: </strong>One hundred six patients were included (63 females; 60 bilateral EVA). The age of hearing loss diagnosis was significantly younger in patients with bilateral EVA compared with unilateral (0.0 [0-3] yr versus 5.0 [0.9-7.0] yr, p = 0.001). The most common pattern seen on ABR was SNHL-like (57%), followed by large wave I pattern (28.6%), followed by auditory neuropathy spectrum disorder (14.3%). Patients with bilateral EVA were more likely to have progressive hearing loss compared with patients with unilateral EVA ( p = 0.001). There was no correlation between EVA size and hearing stability or between EVA size and pure-tone average at the time of diagnosis.</p><p><strong>Conclusion: </strong>There is a wide range of clinical manifestations of EVA, though we found no significant correlation between size and progressiveness or severity. The clinical significance of a large wave I tracing on ABR is not fully understood and warrants further research.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"544-551"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Image-Guided Percutaneous Endoscopic Ear Surgery: A Novel Augmented Reality-Assisted Minimally Invasive Surgery.","authors":"Masaya Uchida, Yu Matsumoto, Shigefumi Morioka, Ryusuke Hori, Kunio Mizutari","doi":"10.1097/MAO.0000000000004488","DOIUrl":"10.1097/MAO.0000000000004488","url":null,"abstract":"<p><strong>Objective: </strong>Although transcanal endoscopic ear surgery (TEES) offers benefits of minimal invasion, it is difficult to access certain regions of the temporal bone, often necessitating a switch to more invasive methods, such as mastoidectomy. To overcome these challenges, we developed \"image-guided percutaneous endoscopic ear surgery (IGPEES),\" a novel technique designed to enhance the precision and safety of ear operations by integrating augmented reality (AR) and advanced navigation systems, allowing precise, minimally invasive access to the mastoid antrum and other difficult-to-reach areas. This study aimed to evaluate the efficacy and safety of IGPEES through a retrospective analysis of 11 cases.</p><p><strong>Study design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Main outcome measures: </strong>We analyzed the setup time and accuracy for navigation and complication rates of IGPEES.</p><p><strong>Results: </strong>Our results demonstrated that IGPEES reduced setup time and enhanced navigation accuracy compared with conventional surgical navigation systems, with no postoperative complications observed, thereby representing a promising advancement in otologic surgery.</p><p><strong>Conclusion: </strong>The integration of AR into IGPEES facilitates better surgical visualization and precision, potentially transforming standard practices for treating complex ear conditions.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"532-538"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}