Otology & Neurotology最新文献

{"title":"Incidence and Clinical Characteristics of Sniff-related Cholesteatoma: A Prospective, Multicenter, Observational Study.","authors":"Shiori Endo, Toshimitsu Kobayashi, Kunihiro Mizuta, Goro Takahashi, Ryoukichi Ikeda, Kiyoshi Oda, Seiichi Kadowaki, Hiromi Kanazawa, Han Matsuda, Yasuhiro Tanaka, Masatsugu Masuda, Naoki Oishi, Taro Fujikawa, Yuka Morita, Hiroshi Nakanishi, Masumi Kobayashi, Taichi Kan, Hiroshi Hidaka, Kana Lee, Shigeto Ohta, Hiroaki Yazama, Kazuma Sugahara, Takenori Miyashita, Hiroyuki Yamada, Taisuke Kobayashi, Haruo Yoshida, Kuniyuki Takahashi, Takeshi Oshima","doi":"10.1097/MAO.0000000000005089","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005089","url":null,"abstract":"<p><strong>Objective: </strong>Habitual sniffing resulting from insufficient Eustachian tube closure is an important etiologic factor in the development and postoperative recurrence of pars flaccida cholesteatoma. In this study, we aimed to investigate the prevalence and clinical characteristics of cholesteatoma associated with habitual sniffing (sniff-related cholesteatoma) among patients with surgically indicated pars flaccida cholesteatoma.</p><p><strong>Study design: </strong>Prospective, multicenter, observational study.</p><p><strong>Setting: </strong>Twenty-six tertiary otologic referral centers.</p><p><strong>Patients: </strong>A total of 128 consecutive patients aged 15 years or above with newly diagnosed pars flaccida cholesteatoma (stage Ib or higher according to the Japan Otological Society staging system) were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcome measures: </strong>The primary outcome was the prevalence of sniff-related cholesteatoma among patients with surgically indicated pars flaccida cholesteatoma. Patients were classified into 3 groups based on the presence of habitual sniffing episodes and the results of the sniffing test: sniff-related cholesteatoma (both positive), non-sniff-related cholesteatoma (both negative), and others. Demographic and clinical characteristics, including age and sex, were compared among the 3 groups.</p><p><strong>Results: </strong>Among the 128 patients, 53 (41.4%) were classified as having sniff-related cholesteatoma. Furthermore, patients in the sniff-related cholesteatoma group were significantly younger than those in the non-sniff-related group.</p><p><strong>Conclusions: </strong>Approximately 40% of patients with surgically indicated pars flaccida cholesteatoma had sniff-related cholesteatoma, suggesting an association with insufficient Eustachian tube closure. The careful assessment of habitual sniffing may be essential for elucidating disease pathophysiology and optimizing treatment strategies, including postoperative management.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167037","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":"Clinical Characteristics and Hearing Outcomes of Otitis Media With ANCA-Associated Vasculitis: A Four-Group Comparison Including Unclassified Disease.","authors":"Kento Komatsuda, Shinya Morita, Kimiko Hoshino, Yuji Nakamaru, Keishi Fujiwara, Hideaki Takeda, Akihiro Homma","doi":"10.1097/MAO.0000000000005086","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005086","url":null,"abstract":"<p><strong>Objective: </strong>To characterize clinical features, hearing outcomes, and relapse patterns across disease categories of otitis media with antineutrophil cytoplasmic antibody-associated vasculitis (OMAAV), with particular focus on unclassified OMAAV.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral university hospital.</p><p><strong>Patients: </strong>Fifty-six patients (89 ears) diagnosed with OMAAV between 2009 and 2025, classified as eosinophilic granulomatosis with polyangiitis (n=16), granulomatosis with polyangiitis (GPA, n=17), microscopic polyangiitis (n=8), or unclassified OMAAV (n=15).</p><p><strong>Interventions: </strong>Immunosuppressive therapy, including systemic corticosteroids with or without additional immunosuppressants.</p><p><strong>Main outcome measures: </strong>Time from disease onset to treatment initiation, pure-tone audiometric outcomes, and cumulative incidence of otologic and systemic relapse.</p><p><strong>Results: </strong>Patients with unclassified OMAAV demonstrated a significantly longer time to treatment initiation and more severe hearing impairment at presentation compared with those with other subtypes. Across the entire cohort, longer time to treatment initiation was moderately correlated with greater baseline hearing loss. Despite presenting with the most severe hearing impairment, patients with unclassified OMAAV showed hearing improvement comparable to that in the other groups following immunosuppressive therapy.The 3-year cumulative incidence of otologic relapse did not differ significantly among groups. In contrast, systemic relapse occurred most frequently in GPA. Among patients with GPA, temporal analysis revealed heterogeneous patterns of otologic and systemic relapse, and otologic relapse did not consistently precede systemic exacerbation.</p><p><strong>Conclusions: </strong>Unclassified OMAAV is prone to diagnostic delay due to an isolated otologic presentation, resulting in severe hearing loss at onset; however, preserved responsiveness to treatment highlights the importance of early diagnosis and prompt immunosuppressive therapy. Otologic relapse does not consistently precede systemic relapse in granulomatosis with polyangiitis, underscoring the need for careful systemic evaluation regardless of otologic disease activity.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137954","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":"Incidence, Clinical Predictors and Treatment Outcomes of Necrotizing Otitis Externa: Identifying Regional and Remote Risk in Tropical North Queensland.","authors":"James Nightingale, Mark Mackenzie, Shane Anderson","doi":"10.1097/MAO.0000000000005093","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005093","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate incidence, presentation, microbiology, and predictors of necrotizing otitis externa (NOE) outcomes in tropical North Queensland, Australia.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Townsville University Hospital.</p><p><strong>Patients: </strong>Forty-six NOE patients (January 2017-March 2025).</p><p><strong>Interventions: </strong>Review of demographic, clinical, and microbiology data. Outcomes stratified by geography (local <50 km vs. regional/remote >50 to >400 km) and indigenous status, with identification of prognostic factors.</p><p><strong>Main outcome measures: </strong>Incidence, relapse, treatment failure, disease-specific survival, and overall survival per 2024 core outcome set necrotizing otitis externa (COSNOE) guidelines.</p><p><strong>Results: </strong>A total of 46 patients with NOE were diagnosed between January 2017 and March 2025. Over the 8-year study period, NOE incidence trended higher, peaking at 1.21 per 100,000. Patients were elderly (78 years), male (82.6%), and diabetic (71.7%). Pseudomonas aeruginosa (82.2%) dominated alongside high fungal (64.4%) and polymicrobial (71.1%) infections. Advanced age, cranial neuropathy, and advanced disease predicted adverse outcomes (P < 0.05). Culture-negativity correlated with advanced skull base disease (P = 0.045). Indigenous patients (19.5%) were significantly younger (P < 0.001) with equivalent comorbidity burden (P = 0.719). Overall relapse was 21.7%. C-reactive protein <15 mg/L yielded a 91.3% negative predictive value for recurrence (P = 0.026). Regional/remote residence was an independent predictor of relapse (hazard ratio: 10.47, P = 0.027), yielding a lower relapse-free survival compared with local patients (61.1% vs 88.5%; P = 0.044). Twelve-month treatment success was 80.4%, with 1-year disease-specific mortality 11.1% and overall disease-specific survival 84.7%.</p><p><strong>Conclusion: </strong>NOE incidence is rising in North Queensland, driven by distinct tropical and social determinants in a high-risk population. With increasing incidence and high relapse rates, further research is required to improve outcomes for high-risk communities.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113276","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":"Bifurcation of the Facial Nerve and Its Implication in Otologic Surgery.","authors":"Phuong Nguyen, Yew Song Cheng, Christine M Glastonbury, Xin Cynthia Wu","doi":"10.1097/MAO.0000000000005090","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005090","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113303","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":"Relative Roles of Middle Ear Bulla Volume and Eustachian Tube Function in Diving-related Barotrauma: An Experimental Pressure Chamber Study in Guinea Pigs.","authors":"Ceyda Karslı, Cem Uzun","doi":"10.1097/MAO.0000000000005092","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005092","url":null,"abstract":"<p><strong>Hypothesis: </strong>We hypothesized that isolated changes in middle ear air volume do not increase the risk of diving-related middle ear barotrauma, and that Eustachian tube function is the primary determinant of barotrauma development.</p><p><strong>Background: </strong>The relative contributions of middle ear air volume and Eustachian tube function to the development of diving-related middle ear barotrauma remain controversial. This first experimental comparative study aimed to differentiate the effects of middle ear air volume alteration and Eustachian tube function on barotrauma in guinea pigs exposed to high pressure.</p><p><strong>Materials and methods: </strong>A diving protocol using a pressure chamber was applied to 18 guinea pigs with normal hearing and otoscopic findings (first dive simulation). Ears developing barotrauma were recorded. Three weeks later, after complete recovery was confirmed, bulla obliteration was performed in the left ears of 12 randomly selected guinea pigs (obliteration group), while the right ears underwent bulla opening without obliteration (sham surgery group). After a 2-week wound-healing period, the same diving protocol was repeated (second dive simulation). Otoscopic examination, tympanometry, and auditory brainstem response measurements were then performed, followed by decapitation. In a double-blind design, botulinum toxin was injected into the Eustachian tube muscles on one side of the remaining 6 guinea pigs (botox group), and physiological saline was injected on the contralateral side (saline control group).</p><p><strong>Results: </strong>Some degree of barotrauma was commonly seen in all ears. Within-group comparisons of barotrauma occurrence after the first and second dive simulations showed no significant differences in the obliteration, sham, or saline groups. In contrast, barotrauma developed in all ears in which the Eustachian tube muscles were paralyzed with botulinum toxin.</p><p><strong>Conclusions: </strong>Isolated reduction of middle ear volume by bulla obliteration did not influence the development of diving-related middle ear barotrauma. In contrast, functional blockade of the Eustachian tube resulted in consistent barotrauma, indicating that Eustachian tube function is the primary determinant of susceptibility to barotrauma during acute pressure changes. Middle ear volume may, therefore, be better interpreted as a long-term marker of Eustachian tube function rather than a direct causal factor.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113270","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 Tympanic Membrane Regeneration Therapy for Secondary Cholesteatoma With Tympanic Membrane Perforation.","authors":"Shin-Ichi Kanemaru, Tomoya Yamaguchi, Rie Kanai, Eriko Otonari, Maki Yamasoba, Yuki Fujii, Kazunari Nishimura, Hiroyuki Harada, Toshiki Maetani","doi":"10.1097/MAO.0000000000005079","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005079","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of tympanic membrane (TM) regeneration therapy (TMRT) for secondary cholesteatoma (SC) with TM perforation (TMP).</p><p><strong>Study design: </strong>Retrospective case review.</p><p><strong>Setting: </strong>General hospitals.</p><p><strong>Patients: </strong>The study included 38 patients (41 ears) with SC (M/F: 21/17, aged 12 to 86 y) who underwent TMRT and 33 patients (33 ears) with SC (M/F: 15/18, aged 20 to 75 y) who underwent conventional tympanoplasty (CTP).</p><p><strong>Interventions: </strong>During TMRT, an endoscope was used to remove all of the remaining TM, leaving the annulus intact, and then the cholesteatoma was removed completely. For TM repair, the edge of the TMP was disrupted mechanically, and a gelatin sponge immersed in basic fibroblast growth factor was placed inside and outside the tympanic cavity and covered with fibrin glue. The protocol was repeated up to 4 times until closure was complete.</p><p><strong>Main outcome measures: </strong>Operative time, TMP closure rate, and hearing improvement were evaluated. Adverse events, including cholesteatoma recurrence, were monitored for at least 3 years.</p><p><strong>Results: </strong>The surgical time, TM closure rate, and cholesteatoma recurrence rate were 65 minutes, 100% (41/41 ears), and 2.4% (1/41) in the TMRT group and 125 minutes, 93.9% (31/33), and 9.1% (3/33) in the CTP group, respectively. The average hearing improvements were 12.2 and 7.5 dB in the TMRT and CTP groups, respectively.</p><p><strong>Conclusions: </strong>TMRT achieved excellent TM closure, favorable hearing outcomes, and acceptable cholesteatoma control during the short-to-mid-term follow-up period in patients with SC. TMRT may be expanded beyond simple TMPs to selected cases of SC.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113290","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":"Psychological Factors Associated With Discrepancies Between Subjective Balance Confidence and Objective Performance of Patients With Unilateral Vestibular Hypofunction.","authors":"Hirofumi Ogihara, Tomohiko Kamo, Masato Azami, Ryozo Tanaka, Takumi Kato, Reiko Tsunoda, Hiroaki Fushiki","doi":"10.1097/MAO.0000000000005091","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005091","url":null,"abstract":"<p><strong>Objective: </strong>Discrepancies between subjective balance confidence and objective performance may have clinical consequences in patients with vestibular hypofunction. Overestimation may increase fall risks, whereas underestimation may lead to unnecessary activity restriction. The contributing factors remain unclear.</p><p><strong>Study design: </strong>Observational study.</p><p><strong>Setting: </strong>A primary care outpatient clinic.</p><p><strong>Patients: </strong>This study included 160 patients with unilateral vestibular hypofunction.</p><p><strong>Main outcome measures: </strong>The subjective-objective balance discrepancy was quantified using z-score standardization of the Activities-specific Balance Confidence Scale and Functional Gait Assessment (Z_ABC-Z_FGA). Associations between dizziness-related disability, anxiety, and depression (Hospital Anxiety and Depression Scale, HADS) were examined using hierarchical regression with interaction terms.</p><p><strong>Results: </strong>Overestimation was observed in 54.4% of patients; the remaining 45.6% underestimated it. The overestimation group showed lower dizziness-related disability than the underestimation group (33.6±21.0 vs. 45.8±22.0, P=0.001). Dizziness-related disability was independently associated with discrepancy scores (β=-0.327, P<0.001). In exploratory analyses using the dichotomized clinical HADS classification, anxiety (β=-0.315, P<0.001) and depression (β=-0.224, P=0.010) were associated with greater underestimation, attenuated in the overestimation group. These associations were only partly reproduced with continuous HADS scores.</p><p><strong>Conclusions: </strong>Anxiety and depression were associated with the discrepancy, mainly in patients who underestimated their balance ability, whereas dizziness-related disability was independently associated with it. These findings suggest that psychological distress relates to negative self-evaluation of balance and should be considered alongside performance-based measures when interpreting self-reported balance confidence in vestibular rehabilitation.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113273","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":"A Giant Jugular Paraganglioma: A Histopathologic Case from the Temporal Bone Archives.","authors":"Ghazaleh Amiri, Xavier Schumacher, David Nauen, Amanda Lauer, Bryan K Ward","doi":"10.1097/MAO.0000000000005084","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005084","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113214","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":"External Auditory Canal Involvement by Secondary Gliosarcoma: Imaging Features of an Extremely Rare Extracranial Extension.","authors":"Meltem Bozacı Kılıçoğlu, Banu Erkal, Zeynep Alkan","doi":"10.1097/MAO.0000000000005083","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005083","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113293","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 of Vestibular Schwannomas in NF2-Related Schwannomatosis (NF2-SWN) to Losartan: A Case Series.","authors":"Sophie Jabban, Spencer Frome, Kara Anstett, Maya Hatley, Kaleb Yohay, J Thomas Roland, Devorah Segal","doi":"10.1097/MAO.0000000000005087","DOIUrl":"https://doi.org/10.1097/MAO.0000000000005087","url":null,"abstract":"<p><strong>Objective: </strong>Identify response rates of vestibular schwannomas in NF2-related Schwanomatosis to treatment with losartan alone or combined with other treatments.</p><p><strong>Study design: </strong>Single-institution retrospective case series.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Twenty patients with NF2-related Schwannomatosis.</p><p><strong>Interventions: </strong>Losartan alone, Losartan plus other therapy (bevacizumab, brigatinib, axitinib).</p><p><strong>Main outcome measures: </strong>Volumetric progression, defined as a change in VS size >20%, in accordance with the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) criteria. Audiometric progression is defined as a change in hearing measures, either a 10 dB or greater increase in PTA or a 10% or greater decrease in WRS.</p><p><strong>Results: </strong>This study included 20 patients, with 33 VSs, treated at our institution from 2014 to 2023. Losartan treatment duration ranged from 8.09 to 153.04 months (mean: 53.8, SD: 37.32). Twelve VSs were concurrently managed with antineoplastic therapy. Among 21 VSs treated with losartan alone, volumetric regression, progression, and stability were seen in 23.8%, 47.6%, and 28.6% of tumors, respectively. Among 5 VSs treated with combination losartan and bevacizumab, 40% of tumors regressed, 20% progressed, and 40% remained stable during the combination period. One tumor that progressed during bevacizumab monotherapy treatment achieved volumetric stability following combination therapy. Volumetric growth rates during bevacizumab alone did not significantly differ from growth rates following combination therapy.</p><p><strong>Conclusions: </strong>This case series describes response rates among NF2-SWN patients treated with losartan. The potential role of losartan in modulating tumor size, either alone or in combination with bevacizumab, should be further studied through well-controlled studies. The study is limited by a small sample size.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113296","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}