Otology & Neurotology最新文献

{"title":"Dynamic Cone-Beam CT of the Middle Ear for Determining Excursion of the Ossicles: Technical Proof of Concept.","authors":"Steven Arild Wuyts Andersen, Bilal Hussain Akram","doi":"10.1097/MAO.0000000000004422","DOIUrl":"10.1097/MAO.0000000000004422","url":null,"abstract":"<p><strong>Objective: </strong>Conductive hearing loss can be caused by fixation or discontinuity of the ossicles. Current noninvasive methods such as tympanometry and conventional clinical imaging might indicate mobility and/or pathology but cannot quantify the excursion. The objective of this study is to measure the excursion of the malleus and incus using timed pressurization during clinical cone-beam CT (CBCT) of the middle ear.</p><p><strong>Patients: </strong>Five human cadaveric heads.</p><p><strong>Intervention: </strong>CBCT imaging obtained at an isotropic resolution of 0.08 mm of five cadaveric heads (10 ears). A tympanometer was used to pressurize the ear drum and change pressure during the scan.</p><p><strong>Main outcome measures: </strong>The excursion of the manubrium of malleus and the long process of incus was determined based on manual segmentation of the imaging series.</p><p><strong>Results: </strong>It was technically feasible to change pressure midways during scan and use 180° virtual reconstructions of the negative and positive pressure phase to quantify the mobility of the malleus and incus. In ears with normal impedance of the tympanic membrane (type A tympanogram), we found an average excursion of the manubrium of malleus of 0.61 mm and the long process of incus of 0.27 mm.</p><p><strong>Conclusion: </strong>Dynamic CBCT of the middle ear can be used to quantify the excursion of malleus and incus in ears with normal ear drum impedance. This might provide additional information compared with conventional static imaging at atmospheric pressure and other current in vivo methods such as wideband tympanometry. Further studies are needed to explore the clinical value of the method.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e120-e124"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449746","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":"Magnetic Resonance Imaging of Inner Ear and Internal Auditory Canal Structures in the Presence of a Cochlear Implant.","authors":"Rebecca Susan Dewey, Robert A Dineen, Matthew Clemence, Nitin Menon, Richard Bowtell, Patrick Boyle, Douglas E H Hartley","doi":"10.1097/MAO.0000000000004445","DOIUrl":"10.1097/MAO.0000000000004445","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the internal auditory canal (IAC) can be visualized using magnetic resonance imaging (MRI) in users of a cochlear implant (CI) model that can safely undergo MRI at 3 T.</p><p><strong>Patients: </strong>Four normally hearing controls and three individuals unilaterally implanted with a HiRes Ultra 3D (Advanced Bionics LLC, California, USA).</p><p><strong>Interventions: </strong>Participants underwent 3 T MRI using sequences appropriate for the postoperative surveillance of the IAC. Images in normally hearing individuals were acquired after placing a fully functional, unpowered, CI underneath a swimming cap at each of eight candidate scalp positions, four on each side of the head. Images were compared to a control condition without a CI present. and CI users were imaged with similar sequences.</p><p><strong>Main outcome measures: </strong>In normally hearing controls, the likely impact of the artifact on detection of pathology for multiple neuroradiological locations as rated by two independent radiologists. In CI users, a qualitative assessment of the diagnostic usability of images.</p><p><strong>Results: </strong>Visibility of the ipsilateral IAC and cochlea varied among the three CI users, with images from one participant deemed largely usable, while those from the other two participants exhibited less diagnostic certainty, likely due to differences in implant locations and cranial/neuroanatomical variations. Ratings of images in normally hearing participants showed that more middle-to-anterior CI locations were associated with reduced likelihood of overlooking gross abnormalities.</p><p><strong>Conclusion: </strong>Through meticulous surgical placement, bilateral IAC visualization may be achievable for monitoring chronic health conditions such as tumor surveillance in high-risk patients, and as a safety monitoring outcome measure in clinical trials.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e105-e108"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological Study of Challenging Cochlear Implantation in a Patient with Advanced Cochlear Otosclerosis.","authors":"Artur Koerig Schuster, Emre Cureoglu, Rafael da Costa Monsanto","doi":"10.1097/MAO.0000000000004458","DOIUrl":"10.1097/MAO.0000000000004458","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e149-e151"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449263","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":"Endoscopic-Guided Resection of Middle Ear Cholesteatoma: A Systematic Review and Meta-Analysis.","authors":"Rodolfo Baptista Giffoni, Gabriele Dos Santos, Ricardo Santos Aguiar, Lucas Costa Lins, Marcelo Leandro Santana Cruz, Adriano Damasceno Lima","doi":"10.1097/MAO.0000000000004447","DOIUrl":"10.1097/MAO.0000000000004447","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to compare the effectiveness of endoscopic-guided versus microscopic endaural and canal wall up approaches in the resection of middle ear cholesteatoma in both adult and pediatric patients.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to April 2024, covering studies published between 2004 and 2024. Cohort and randomized trials addressing middle ear cholesteatoma resection were included. Excluded were studies with unequal disease extent, canal wall down surgeries, other unrelated otological procedures, and nonlongitudinal studies. Screening of studies and assessment of the risk of bias were performed independently by two pairs of blinded authors. Data abstraction adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.</p><p><strong>Results: </strong>A total of 1,134 cases from 13 studies were included. In the endoscope group, there was a significant reduction in the risk of residual cholesteatoma (RR, 0.65; 95% CI, 0.47-0.89). No significant differences were observed between the groups for postoperative tympanic membrane perforation or cartilage graft displacement. Similarly, postoperative complications, such as disturbances in taste sensation and transient vertigo, did not differ significantly between the two approaches.</p><p><strong>Conclusions: </strong>Endoscopic-guided resection is superior to microscopic surgery in terms of residual cholesteatoma resection, with no significant difference in postoperative complications or tympanic membrane status.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"418-424"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616604","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":"The Natural History of Pediatric Cerebellopontine Angle Lipomas.","authors":"Ruth K Mizu, Benjamin D Lovin, Caitlin M Coviello, Guillermo Aldave Orzaiz, Akash J Patel, Alex D Sweeney","doi":"10.1097/MAO.0000000000004433","DOIUrl":"10.1097/MAO.0000000000004433","url":null,"abstract":"<p><strong>Objective: </strong>To present a series of pediatric patients with cerebellopontine angle (CPA) lipomas in order to understand their natural history and facilitate management recommendations.</p><p><strong>Patients: </strong>Pediatric patients with a diagnosis of CPA lipoma.</p><p><strong>Interventions: </strong>Clinical data collected from a single tertiary care center between January 2000 and August 2022.</p><p><strong>Main outcome measures: </strong>Data related to symptom evolution and tumor growth during follow-up.</p><p><strong>Results: </strong>Six patients were identified from a single institution. Average age at presentation was 8.5 years of age (range, 3.1-14.5 years). The most common presenting symptoms were headaches (63%) followed by sensorineural hearing loss (SNHL) (38%). Average tumor size was 10.8 mm (range, 5.8-18 mm). Average duration of clinic and radiographic follow-up were 61 months (range, 16.9-146.1 months) and 52 months (range, 8.7-133.2 months), respectively. Other than 1 patient who experienced worsening asymmetric SNHL, no patient experienced significant changes in symptoms or tumor growth throughout follow-up. On most recent imaging, the average tumor size was 11.3 mm (range, 7-21 mm), which was not statistically different from initial imaging (p = 0.518).</p><p><strong>Conclusions: </strong>Pediatric CPA lipomas represent a rare entity of lateral skull base tumors. Most patients present with headaches and SNHL in the adolescent age. While progression of SNHL and tumor growth is possible, most patients do not appear to demonstrate worsening symptoms or tumor growth throughout follow-up. As such, initial management with serial MRI appears to be a safe strategy.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"e130-e134"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616661","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":"Impact of Two Visualization Methods for Electrocochleographic Potentials on Hearing and Vestibular Function During Cochlear Implantation.","authors":"Theda Eichler, Antonia Lakomek, Laura Waschkies, Moritz Meyer, Stephan Lang, Ben Williges, Eric Deuss, Diana Arweiler-Harbeck","doi":"10.1097/MAO.0000000000004450","DOIUrl":"10.1097/MAO.0000000000004450","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the impact of two distinct visualization methods for electrocochleographic potentials during cochlear implant electrode insertion on residual hearing preservation and vestibular function. Previous research has demonstrated the benefits of visualizing electrocochleographic (ECochG) potentials in preserving residual hearing during cochlear implantation. In this project, ECochG potentials are represented either through a graph or as arrows that provide a pre-interpreted version of the graph. We aim to determine if these visualization methods influence postoperative residual hearing and vestibular structure integrity.</p><p><strong>Methods: </strong>Residual hearing is audiometrically assessed, and vestibular function is evaluated using the video head impulse test and the dizziness handicap inventory before and after surgery. Furthermore, the subjective workload of surgeons using these methods is assessed via the NASA-Task Load Index questionnaire. The study included 31 patients receiving Flex26 and Flex28 electrodes (MED EL). The patients were randomly assigned to one of the visualization methods.</p><p><strong>Results: </strong>The results of the study demonstrate that there were no significant differences between the two visualization methods, both in terms of residual hearing preservation and postoperative dizziness. Also the ECochG parameters, such as amplitude, do not differ significantly. Additionally, no significant difference was observed in the surgical workload for the operating surgeon.</p><p><strong>Conclusion: </strong>The two visualization methods can therefore be used equivalently in terms of preservation of cochlear structures and mental workload for the surgeons. A simplified ECochG potential interpretation could enable younger surgeons to perform more atraumatic insertions with stable quality of outcome.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"e98-e104"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616606","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":"Increased Costs and Complication Rates in Vestibular Schwannoma Resections for Neurofibromatosis Type 2.","authors":"Rance J T Fujiwara, Julia J Shi, Donald Tan, Hitomi Sakano, Joe Walter Kutz","doi":"10.1097/MAO.0000000000004442","DOIUrl":"10.1097/MAO.0000000000004442","url":null,"abstract":"<p><strong>Objective: </strong>To characterize inpatient costs and complication rates in sporadic and neurofibromatosis type 2 (NF2) patients undergoing resection of vestibular schwannoma (VS).</p><p><strong>Design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>National Inpatient Sample, 1998-2021.</p><p><strong>Participants: </strong>A total of 52,623 inpatient admissions after VS resection.</p><p><strong>Interventions: </strong>Resection of VS.</p><p><strong>Main outcomes and measures: </strong>Patient- and hospital-level demographics of admissions following resection of VS, as well as the frequency of postoperative medical and surgical complications, were tabulated. We evaluated the average cost of admission and compared these outcomes between sporadic and NF2 patients. Multivariate analysis was performed to determine whether NF2 admissions had increased costs and lengths of stay.</p><p><strong>Results: </strong>A total of 51,459 and 1,164 resections were recorded for sporadic and NF2 patients, respectively. Patients with NF2 were younger (mean age 35.3 vs. 51.1 years) and more likely insured by Medicaid (12.8% vs. 5.4%). The average cost for NF2 admissions was $49,141 (95% CI, 42,527-55,754), relative to sporadic tumors at $38,204 (95% CI, 36,408-40,000). NF2 patients had increased rates of surgical complications, including facial nerve dysfunction (31.7% vs. 17.3%), dysphagia (8.8% vs. 2.8%), aspiration pneumonia (3.4% vs. 0.6%), and sepsis (1.8% vs. 0.4%), which were associated with increased hospital costs. NF2 was not independently associated with increased inpatient hospital costs after controlling for patient factors and complications ($3,977 [95% CI, -$111 to 8,066], p = 0.06).</p><p><strong>Conclusions: </strong>Relative to sporadic VS admissions, resections in NF2 patients are associated with significantly increased hospital costs, primarily due to increased rates of postoperative surgical, central nervous system-related, and medical complications.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"446-452"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449264","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":"Transnasal Fluoroscopic-Guided Eustachian Tube Obliteration With a Liquid Embolic Agent for a Recurrent Cerebrospinal Fluid Leak After Translabyrinthine Schwannoma Surgery: A Case Series.","authors":"Angelica Suutari, Juha-Matti Isokangas, Kari Palosaari, Tapani Tikkakoski, Peter Nieminen, Oula Knuutinen, Jaakko Laitakari","doi":"10.1097/MAO.0000000000004428","DOIUrl":"10.1097/MAO.0000000000004428","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative cerebrospinal fluid (CSF) leak after schwannoma surgery occurs in up to 10% of patients. Conventional surgical treatment including fat and muscle packing can prove unsuccessful. We describe a minimally invasive, imaging-guided approach to CSF fistula treatment.</p><p><strong>Patients: </strong>We describe two patients and three procedures with recurrent CSF rhinorrhea after translabyrinthine vestibular or facial nerve schwannoma surgery. First-line procedures including CSF diversion and repeat middle ear packing failed to close the leaks.</p><p><strong>Intervention: </strong>Endonasal endoscopic, fluoroscopic-guided obliteration of the Eustachian tube with n -butyl cyanoacrylate.</p><p><strong>Main outcome measure: </strong>Recurrence of a CSF leak.</p><p><strong>Results: </strong>After treatment, the CSF leak ceased with no recurrence. One patient's facial nerve dysfunction worsened after the procedure.</p><p><strong>Conclusions: </strong>This case series highlights a recently described technique of imaging-guided Eustachian tube obliteration using liquid embolic agent. The procedure was effective in treating recurrent CSF leaks but might cause facial nerve dysfunction.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e125-e129"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449883","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":"Increasing Inpatient Costs and Complication Rates After Vestibular Schwannoma Resections from 1998 to 2021.","authors":"Rance J T Fujiwara, Donald Tan, Hitomi Sakano, Brandon Isaacson, Joe Walter Kutz","doi":"10.1097/MAO.0000000000004498","DOIUrl":"https://doi.org/10.1097/MAO.0000000000004498","url":null,"abstract":"<p><strong>Objective: </strong>To examine temporal trends in postoperative surgical and medical complications after vestibular schwannoma (VS) resections, and to describe changes in inpatient hospitalization costs.</p><p><strong>Study design: </strong>Cross-sectional analysis.</p><p><strong>Setting: </strong>National Inpatient Sample, 1998-2021.</p><p><strong>Participants: </strong>50,991 admissions.</p><p><strong>Interventions: </strong>VS resection.</p><p><strong>Main outcome measures: </strong>Surgical and medical complications after VS resection were recorded annually and trended over time. The annual average cost of inpatient hospitalization (in inflation adjusted 2024 US dollars) and length of stay were also documented for each year. Multivariate analysis was performed to determine whether subsequent calendar years were associated with changes in costs.</p><p><strong>Results: </strong>From 1998 to 2021, the annual average number of VS resections decreased by 32.7% from 3,813 to 2,557. Rates of surgical and medical complications increased from 18.2 to 34.2% (b = 0.73 [95% CI, 0.53-0.93], p < 0.001), and from 4.3 to 7.6% (b = 0.17 [95% CI, 0.11-0.22], p < 0.001), respectively. The number of comorbidities among surgical patients increased over time, and rates of complications increased among patients with higher comorbidity scores, with 54.0% of those with ≥4 comorbidities experience a complication, compared with 28.1% of those with no comorbidities. The mean inpatient cost per admission increased from $30,922 to $45,973, which was statistically significant on multivariate regression (b = $412 [95% CI, 208-615], p < 0.001), despite a decrease in average inpatient stay from 5.4 (SE 0.5) to 4.5 (SE 0.3) days.</p><p><strong>Conclusions: </strong>As the number of VS operations has decreased, the percentage with postoperative complications has increased, likely due to changes in patient selection as well as increasing comorbidities in operative cases. Healthcare expenditures for postoperative admissions have increased significantly over the last two decades, resulting in a roughly $15,000 increase in mean inflation-adjusted inpatient costs per postoperative admission.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972902","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":"Evaluating the Cost-Effectiveness of Unilateral Cochlear Implants Versus Hearing Aids in Older Adults in Japan.","authors":"Norie Imagawa, Shuji Izumi, Takashi Shimazaki, Takashi Yamauchi, Shunya Ikeda, Shinichi Noto, Hiromi Kojima, Machi Suka","doi":"10.1097/MAO.0000000000004504","DOIUrl":"https://doi.org/10.1097/MAO.0000000000004504","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the cost-effectiveness of cochlear implants in older adults with hearing impairment 65 years or older in Japan. In addition, this study aimed to establish a basis for making recommendations for cochlear implants in clinical practice for suitable patients.</p><p><strong>Design: </strong>We conducted a cost-utility analysis using the incremental cost-effectiveness ratio (ICER) to compare unilateral cochlear implants with hearing aids. The study involved participants 65 years or older with severe-to-profound hearing loss attending two cochlear implant surgery facilities in Japan. Costs were calculated from the participants' receipt data and standard clinical paths from medical care providers. Quality-adjusted life years (QALY) were assessed by patients using the Japanese version of the Health Utilities Index Mark 3 and by medical care providers using the visual analog scale (VAS). In addition, sensitivity analyses were performed by varying the utility value, discount rate, age at implantation, and costs to estimate the ICER under different scenarios.</p><p><strong>Results: </strong>Responses were received from 26 cochlear implant users and 8 hearing aid users. After applying the survival and discount rates to the utility values and costs, the ICER was $44,533, which falls within the acceptable willingness-to-pay threshold in Japan. Sensitivity analysis showed that the ICER was the most sensitive to the utility value, followed by the discount rate.</p><p><strong>Conclusions: </strong>The findings indicate that providing cochlear implants to older adults with hearing impairment is not only beneficial in terms of improved hearing performance but also economically efficient.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753425","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}