Pediatric Cardiology最新文献

{"title":"Screening for Structural Heart Defects: A Single-Center Retrospective Cost Analysis for Fetal Echocardiography in Adults with Congenital Heart Disease.","authors":"David M Leone, Benjamin Ittleman, Kathryn Virk, Catherine Albright, Bhawna Arya, Jason Deen","doi":"10.1007/s00246-024-03765-6","DOIUrl":"https://doi.org/10.1007/s00246-024-03765-6","url":null,"abstract":"<p><p>Fetal echocardiography (FE) is recommended for parents with congenital heart disease (pCHD) due to a 3-6% recurrence risk of congenital heart disease (CHD). This study aimed to evaluate the cost of FE for detecting neonatal CHD in pCHD. FE data were collected between 12/2015 and 12/2022. Parents were stratified by CHD complexity: \"simple\" (class I) and \"complex\" (class II/III). Cost analysis compared universal FE with selective FE following a positive level II screening anatomical ultrasound (SAU). Primary outcomes included the cost and number needed to screen (NNT) to detect one case of neonatal CHD. Of 419 pCHD cases, 48 were analyzed separately due to additional FE indications. Among the remaining 371 cases (73% maternal, 27% paternal; mean maternal age: 31 years), 14 postnatal CHD cases were detected (3.8%). Recurrence rates were 1.9% for simple pCHD (n = 156) and 5.1% for complex pCHD (n = 215). Universal FE increased the cost of detecting neonatal CHD. The cost per detected case was $267,157 for simple CHD (NNT = 560) and $135,125 for complex CHD (NNT = 288). The lower sensitivity of SAU reduced the cost of universal FE. In this single-center cohort, the recurrence risk of CHD in pCHD is higher than in the general population, particularly in complex cases. Universal screening in simple pCHD is costlier with high-sensitivity SAU. Targeted screening in complex pCHD may offer a better cost-to-risk ratio, highlighting the need for early detection to improve outcomes. The cost effectiveness is dependent on local SAU sensitivity rates.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Formulation of Quality Improvement Methodology for Risk Mitigation in Congenital Cardiac Catheterization.","authors":"Mary J Yeh, Elsa Bjornlund, Kimberlee Gauvreau, Fatima Ali, Nadeem Aslam, Sarosh P Batlivala, Darren Berman, Martin L Bocks, Kristin Chenault, Thomas Doyle, Todd Gudausky, Michael Hainstock, Ralf Holzer, Juan Ibla, Michael L O'Byrne, Brian P Quinn, Shabana Shahanavaz, Ruchik Sharma, Sara M Trucco, Wendy Whiteside, Lisa Bergersen, Aimee K Armstrong","doi":"10.1007/s00246-024-03738-9","DOIUrl":"https://doi.org/10.1007/s00246-024-03738-9","url":null,"abstract":"<p><p>The C3PO collaborative, with a history of successful quality improvement (QI) initiatives, leveraged registry participants to develop a multi-center QI initiative to reduce adverse events (AEs) in congenital cardiac catheterization. A 32-person, interdisciplinary working group analyzed audited data for all congenital cardiac catheterization cases from 2014-2017. The primary outcome was the occurrence of any high-severity (level 3/4/5) AE. Cases were organized from shortest to longest duration, and level 3/4/5 and 4/5 AE rates were summarized for each procedure duration decile. Observations from the root cause analysis were used to inform the creation of a key driver diagram and determine change strategies and implementation tools. To facilitate pre-procedure communication and risk assessment, an online risk calculator was developed using 2014-2019 data. Between 2014-2017, 14,717 cases were entered from 10 sites. Level 3/4/5 AEs occurred in 732 (5.0%) cases, while 4/5 AEs occurred in 224 (1.5%) cases. The key driver diagram defined three drivers: (1) Pre-Procedure Risk Assessment, (2) Possibly Preventable Events, and (3) Procedure Length Optimization. Actionable change strategies organized around five communication timepoints were developed in interdisciplinary discussions. Pre-case risk calculator outputs were available as a case summary print out and incorporated into a calendar for weekly schedule planning. Pre-intervention (2019) and preliminary intervention period data (2020-2021) are presented here. Through improved resource planning, the protocol equips catheterization teams to respond efficiently to AEs and possibly prevent escalation into dangerous events. This protocol provides reproducible interventions that can be adapted to local practice.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Endotracheal Anesthesia vs Total Intravenous Anesthesia for Children Undergoing Low-Risk Cardiac Catheterization.","authors":"Oluwatomini A Fashina, Elizabeth R Vogel, Elena Ashikhmina Swan, Jason H Anderson, Devon O Aganga, Stephen J Gleich, Paul E Stensrud, Nathaniel W Taggart","doi":"10.1007/s00246-025-03768-x","DOIUrl":"https://doi.org/10.1007/s00246-025-03768-x","url":null,"abstract":"<p><p>Historically, children undergoing cardiac catheterization have been managed with general endotracheal anesthesia (GETA). However, recent practice has favored general anesthesia with total intravenous anesthesia (TIVA). This study compares procedural outcomes in the pediatric cardiac catheterization laboratory (PCCL) for children undergoing low-risk cardiac catheterization with GETA vs. TIVA. We reviewed all patients aged 1-12 years, who underwent outpatient diagnostic or simple interventional catheterization from January 2016 to September 2023. Patients were divided into cohorts by type of anesthesia (GETA vs. TIVA). The primary outcome measure was total patient time in the PCCL (\"door-to-door\" time). Secondary outcomes were procedure duration (\"sheath time\"), length of hospital stay, and the major adverse event (MAE) rate. A total of 401 patients were included. Of these patients, 226 underwent GETA and 175 underwent TIVA. There were 148 interventional procedures and 72 patients had single-ventricle physiology. There was no significant difference between the two cohorts in terms of demographic factors such as age, weight, procedure indication, and physiological complexity as well as outcomes such as sheath time, hospital stay, and MAE. However, the average door-to-door time of the TIVA cohort was 25 min shorter than the GETA cohort (p < 0.001). In this single center, retrospective study of anesthesia management for children undergoing low-risk cardiac catheterization, TIVA is associated with significantly shorter door-to-door time in the PCCL without an increase in procedure duration, hospital stay, or rate of complications. These findings have potential clinical significance supporting increased use of TIVA during pediatric cardiac catheterization.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Membrane Oxygenation in Children with Pulmonary Atresia and Intact Ventricular Septum: Mortality and Associated Outcomes.","authors":"Saul Flores, Rohit S Loomba, Christopher W Mastropietro, Eva Cheung, Venugopal Amula, Monique R Radman, David M Kwiatkowski, Bao N Puente, Jason R Buckley, Kiona Y Allen, Karan B Karki, Saurabh Chiwane, Katherine Cashen, Kurt Piggott, Yamini Kapileshwarkar, Keshava M N Gowda, Aditya Badheka, Rahul Raman, Huaiyu Zang, John M Costello, Ilias Iliopoulos","doi":"10.1007/s00246-024-03764-7","DOIUrl":"https://doi.org/10.1007/s00246-024-03764-7","url":null,"abstract":"<p><p>Data on outcomes of extracorporeal membrane oxygenation (ECMO) are limited in patients with pulmonary atresia intact ventricular septum (PAIVS). The objective of this study was to describe the use of ECMO and the associated outcomes in patients with PAIVS. We retrospectively reviewed neonates with PAIVS who received ECMO between 2009 and 2019 in 19 US hospitals affiliated with the Collaborative Research for the Pediatric Cardiac Intensive Care Society (CoRe-PCICS). Patients who received ECMO were compared to those who did not and patients on ECMO who died were compared to those who survived by bivariate analysis and multivariable logistic regression. The predictive ability of a risk score for inpatient mortality (using beta coefficients) was assessed by receiver operator curve analysis. Of 295 identified patients, 32 (11%) were supported with extracorporeal membrane oxygenation. Of these, 15 (46%) experienced mortality. A higher left pulmonary artery z-score (beta coefficient 0.72) and the presence of ventriculocoronary connections by cardiac catheterization (beta coefficient 1.25) were associated with an increased risk of ECMO (p-value < 0.01). The resulting risk score had an area under the curve of 0.71 (p-value 0.03) for the prediction of need for ECMO. In a multicenter cohort of patients with PAIVS, 11% received ECMO. Of those supported with ECMO, 46% experienced inpatient mortality. A higher left pulmonary artery z-score and the presence of ventriculocoronary connections appear to be risk factors for the use of ECMO.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous Left Coronary Artery from the Pulmonary Artery in Three Patients with MYRF-Associated Cardiac-Urogenital Syndrome.","authors":"Kristian C Becker, Russel Hirsch, Paul J Critser, Kimberley G Miles, Marco Ricci, Ryan Monsberger, K Nicole Weaver, Hieu T Ta, Ashley E Neal","doi":"10.1007/s00246-024-03743-y","DOIUrl":"https://doi.org/10.1007/s00246-024-03743-y","url":null,"abstract":"<p><p>Cardiac-Urogenital Syndrome (CUGS) is a recently identified genetic disease characterized by urogenital, diaphragmatic, ophthalmic, and cardiac abnormalities caused by heterozygous pathogenic variants in the Myelin Regulatory Factor (MYRF) gene. The complete spectrum of disease characteristics and prevalence is not yet defined. This report documents the first known cases of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in MYRF-associated Cardiac-Urogenital Syndrome (MYRF-CUGS).</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associated Cardiac and Extracardiac Anomalies in Patients with Abnormal Coronary Artery from the Pulmonary Artery.","authors":"Pinar Bambul Heck, Franziska Ziermann, Andreas Simmelbauer, Maria von Stumm, Hazer Ercan Bozyer, Peter Ewert, Alfred Hager","doi":"10.1007/s00246-024-03760-x","DOIUrl":"https://doi.org/10.1007/s00246-024-03760-x","url":null,"abstract":"<p><p>Anomalous origin of coronary arteries from the pulmonary artery (ACAPA) are rare but clinically significant condition with high mortality if left untreated. Even more rarely, ACAPA is associated with other congenital heart defects. From 1974 to 2024, 120 patients with anomalous coronary arteries connected to the pulmonary artery were retrospectively analyzed. Medical records including surgical operative notes and angiography protocols were screened for any other cardiac and extracardiac defects. Anomalous left coronary artery connected to the pulmonary artery (ALCAPA) was present in 103 patients, anomalous right coronary artery connected to the pulmonary artery (ARCAPA) in 6, anomalous circumflex coronary artery connected to the pulmonary artery (ACXPA) in 7, anomalous left anterior descending coronary artery connected to the pulmonary artery (ALADPA) in 2, and anomalous single coronary artery connected to the pulmonary artery (ASCAPA) in 2 patients. Anomalous origin of the coronary artery from the pulmonary arteries was associated with other congenital heart defects in 16 patients (13%) and with extracardiac anomalies in 10 patients (8%). Most associated cardiac anomalies were left-sided obstructive defects or shunt-lesions. Patients with ACAPA and associated cardiac defects had poorer perioperative survival. A precise diagnosis of coronary anatomy is crucial for preoperative planning and the success of the surgery of patients with congenital heart defects. In particular, for patients with a challenging postoperative course, an anomalous coronary artery originating from the pulmonary artery should be considered.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifiable Health Behaviours in Children with HCM: Lessons from the Heart Health Survey.","authors":"Mitchell J Wagner, Aamir Jeewa, Tara Pidborochynski, Samuel Lemaire-Paquette, Michael Khoury, Chentel Cunningham, Santokh Dhillon, Nassiba Alami Laroussi, Laurence Vaujois, Frederic Dallaire, Daryl Schantz, Kathryn Armstrong, Wadi Mawad, Timothy J Bradley, Jennifer Conway","doi":"10.1007/s00246-024-03746-9","DOIUrl":"https://doi.org/10.1007/s00246-024-03746-9","url":null,"abstract":"<p><p>Obesity factors into hypertrophic cardiomyopathy (HCM)-related risk as a disease modifying environmental factor. Behaviours such as diet and sleep are seldom reported upon in children with HCM. It was our aim to report on these factors in this population. A multicenter cross-sectional study recruited children and teens with HCM aged 10-19 years old from 10 Canadian pediatric care sites. Patient demographics were obtained from review of medical charts. Participants completed the Healthy Hearts Survey, involving 92 questions related to family health history, personal health, smoking, nutrition, and physical or sedentary activity. A cohort of n = 56 patients with median (IQR) age of 15.5 (13.8-16.8) years were enrolled. Over half (53.6%) were classified as overweight or obese based on BMI, with 75% under activity restriction. Consumption of sugar-rich and starchy foods alongside skipping of meals (43.6%) and snacking (87.5%) were reported. A desire to lose weight was prevalent (48.2%) despite general perceptions of good health. Participants slept a median duration of 8 (7.4-9.0) hours on weekdays, however, sleep disturbances were widely reported. A majority (96.4%) reported less than 20 min of exercise per day over the course of the week. Unhealthy patterns regarding diet, sleep, and physical or sedentary activities that associate with cardiovascular risk are present within children with HCM. These habits may worsen disease burden in children with HCM. It is unclear how activity restriction factors into such patterns. There are modifiable lifestyle factors in children with HCM which, if addressed, could positively impact cardiovascular risk.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Protection in Pediatric Cardiac Surgery.","authors":"Sheida Shams-Molkara, Vitor Mendes, François Verdy, Maria-Helena Perez, Stefano Di Bernardo, Matthias Kirsch, Amir-Reza Hosseinpour","doi":"10.1007/s00246-024-03748-7","DOIUrl":"https://doi.org/10.1007/s00246-024-03748-7","url":null,"abstract":"<p><p>Cardiac surgery, both adult and pediatric, has developed very rapidly and impressively over the past 7 decades. Pediatric cardiac surgery, in particular, has revolutionized the management of babies born with congenital heart disease such that now most patients reach adult life and lead comfortable lives. However, these patients are at risk of cerebral lesions, which may be due to perioperative factors, such as side effects of cardiopulmonary bypass and/or anesthesia, and non-perioperative factors such as chromosomal anomalies (common in children with congenital heart disease), the timing of surgery, number of days on the intensive care unit, length of hospitalization and other hospitalizations in the first year of life. The risk of cerebral lesions is particularly relevant to pediatric cardiac surgery given that cerebral metabolism is about 30% higher in neonates, infants and young children compared to adults, which renders their brain more susceptible to ischemic/hypoxic injury. This issue has been a major concern throughout the history of cardiac surgery such that many preventive measures have been implemented over the years. These measures, however, have had only a modest impact and cerebral lesions continue to be a major concern. This is the subject of this review article, which aims to outline these protective measures, offer possible explanations of why these have not resolved the issue, and suggest possible actions that ought to be taken now.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Oral Feeding in Infants with Congenital Heart Disease Within the First Month of Life is Associated with a Higher Likelihood of Freedom From Tube Feeding at Time of Postoperative Discharge.","authors":"Aseel Dabbagh, Sarah Miller, Michael McCulloch, Geoffrey Rosenthal, Mark Conaway, Shelby White","doi":"10.1007/s00246-024-03750-z","DOIUrl":"https://doi.org/10.1007/s00246-024-03750-z","url":null,"abstract":"<p><p>Though several studies have demonstrated that preoperative oral feeding (PO) can be safe in patients with congenital heart disease, they are commonly prohibited from doing so, potentially precluding the development of such skills. We sought to determine whether preoperative oral feeding is associated with freedom from tube feeding at postoperative discharge. Single-center, observational study including patients in the first month of life (≤ 30 days of age) who underwent a single cardiac surgery between 7/1/2017-6/30/2022 and survived to discharge. Preoperative PO was defined as any oral intake up to the day of cardiac surgery. General demographics and peri-operative characteristics were analyzed. A total of 235 patients were included of which 178 (78%) PO fed preoperatively, and 171 (73%) were discharged taking full PO. Those discharged without tube feeds received more preoperative oral feeds, were less likely to have a chromosomal abnormality/genetic syndrome, had lower STAT categories, and were less likely to have postoperative complications, vocal cord dysfunction or prolonged mechanical ventilation. Multivariate analysis found that any preoperative PO [odds ratio (OR) of 2.78 (CI 1.48, 5.24, p-value = 0.002)] and increasing amounts of PO were predictive of full PO intake at discharge [≤ 20 ml/kg/day (OR 2.06, CI 1.03, 4.14, p-value = 0.042) and > 20 ml/kg/day (OR 4.07, CI 1.88, 8.84, p-value = 0.004)]. Preoperative oral feeding is a strong predictor of discharging with full PO intake after cardiac surgery in the first month of life and that it may also improve with increasing volumes. Multi-institutional analyses are warranted.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposal: Bold New Indications for Transcatheter Pulmonary Flow Restrictors.","authors":"Dietmar Schranz","doi":"10.1007/s00246-024-03759-4","DOIUrl":"https://doi.org/10.1007/s00246-024-03759-4","url":null,"abstract":"<p><p>This proposal presents a proof of concept for the use of pulmonary flow restrictors (PFRs) based on MVP™-devices, drawing from clinical experience, and explores their potential role in the management of newborns with hypoplastic left heart syndrome (HLHS), other complex left heart lesions, and infants with end-stage dilated cardiomyopathy (DCM). At this early stage of age, manually adjusted PFRs can be tailored to patient's size and hemodynamic needs. Although currently used off-label, PFRs have substantial potential to improve outcomes in these vulnerable patient populations. When integrated into a holistic treatment strategy, they represent a promising advancement in care. There is significant potential to reduce mortality and improve the quality of life for neonates with HLHS and variants, as well as to support age-dependent functional regeneration in DCM, all while avoiding the need for advanced surgical procedures, including general anesthesia. The main barrier to broader adoption is the limited availability of appropriately sized MVP devices. However, with ongoing patient-centered knowledge sharing and refinement of transcatheter techniques, there is reason for optimism that PFRs, tailored for individual patients, could provide significant benefits to thousands of infants with congenital heart disease and DCM worldwide.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}