Plastic and reconstructive surgery最新文献

{"title":"It Is Time to Rethink Our Approach to Bias in Medicine.","authors":"Clara M Cullen, Hayley M Sanders, Kevin C Chung","doi":"10.1097/PRS.0000000000011915","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011915","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 5","pages":"745-752"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Implants Elicit Local and Systemic Immune Response: Evidence for Breast Cancer Immunosurveillance.","authors":"Ramsey Timmerman, Sophia Allison, David Dolivo, Puja Jagasia, Kristine Gargiulo, Shreya Battu, Seok Jong Hong, Irene Helenowski, John Y S Kim, Megan Fracol","doi":"10.1097/PRS.0000000000011780","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011780","url":null,"abstract":"<p><strong>Background: </strong>Women with cosmetic implants have lower rates of future breast cancer than the general population. The authors hypothesized that the implant foreign body response could induce a local protective anticancer immunosurveillance. The authors expanded on their previous finding, which showed that women with breast implants have elevated antibody responses to certain breast cancer proteins.</p><p><strong>Methods: </strong>Blood samples and breast tissue were collected from women undergoing first time breast augmentation (implant-naive [IN]) and revision breast augmentation (implant-exposed [IE]). Sera were collected and antibody levels to common breast cancer proteins were quantified by enzyme-linked immunosorbent assay. Reverse transcriptase-polymerase chain reaction was performed on breast tissue samples to quantify immune-related gene expression levels between IN and IE patients. Bulk RNA sequencing was performed to identify differentially expressed genes and altered signaling pathways in the breasts of IN patients versus IE patients.</p><p><strong>Results: </strong>In total, 188 patients were recruited (IN, n = 117; IE, n = 71). Data demonstrated that IE patients had higher levels of antibodies to mucin-1, estrogen receptor-α, and mammaglobin A compared with IN patients. Mucin-1 expression was found to be higher in IE compared with IN breast tissue. RNA- sequencing analysis demonstrated up-regulated pathways in IE breast tissue for B-cell activation and development, T-helper cell type 2-related genes, T-cell activation, chemotactic factors, and responses to estrogen.</p><p><strong>Conclusions: </strong>This is the first study to demonstrate that periimplant inflammation extends beyond the implant capsule to the breast parenchyma. Women with breast implants have more activated B cells in the breast parenchyma and elevated antibody responses to breast cancer antigen.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, V.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 5","pages":"797-809"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modified 270-Degree Closure Technique to Address the Prominent or Locked-Out Premaxilla in Bilateral Cleft Palate Repair.","authors":"James D Vargo, Todd T Thurston, Steven R Buchman","doi":"10.1097/PRS.0000000000011681","DOIUrl":"10.1097/PRS.0000000000011681","url":null,"abstract":"<p><strong>Summary: </strong>The bilateral cleft deformity with a prominent or \"locked-out\" premaxilla presents one of the most challenging repairs in cleft surgery. Despite its relative frequency, traditional hard palate repair techniques fail to fully address this deformity, exposing surgeons and patients to the risk of a large anterior fistula developing when flaps cannot approximate the premaxilla. This greatly increases morbidity for the patient and creates unnecessary challenges during fistula repair or alveolar cleft bone graft later in childhood. The 270-degree closure technique extends the nasal closure 270 degrees around the premaxilla, continuing the hard palate repair through the alveolar clefts. This technique has been performed on 41 patients, with a mean follow-up of 10.8 years. The repair was successful in 93% of patients, with 3 patients developing palatal fistulas, all posterior to the 270-degree closure. The 270-degree cleft palate repair around the prominent premaxilla fills a void in the literature for managing the immense challenge of this deformity. When presurgical orthopedic appliances are not a viable option, this approach can minimize the risk of large or complex fistula formation posterior to the premaxilla.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"902e-907e"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Financial Impact of a Cosurgeon in Breast Microsurgery.","authors":"Robert G DeVito, Benjamin G Ke, Rachel H Park, Scott T Hollenbeck, Chris A Campbell, John T Stranix","doi":"10.1097/PRS.0000000000011791","DOIUrl":"10.1097/PRS.0000000000011791","url":null,"abstract":"<p><strong>Background: </strong>Cosurgeon approaches for autologous breast reconstruction have demonstrated improvements in operative efficiency. The health system financial impact, however, warrants further investigation.</p><p><strong>Methods: </strong>Retrospective review of consecutive autologous reconstructions was performed between 2017 and 2022. Primary outcome measures consisted of length of stay, operative time, and financial metrics. Cases were stratified by cosurgeon presence, timing, and laterality.</p><p><strong>Results: </strong>A total of 264 cases met inclusion criteria; these consisted of 117 cosurgeon and 147 single-surgeon cases. Cosurgeon cases demonstrated decreased length of stay (2.4 days versus 3.1 days; P < 0.01) and decreased operative time in unilateral (269 minutes versus 370 minutes; P < 0.01) and bilateral (399 minutes versus 582 minutes; P < 0.01) cases. Cosurgeon cases were also associated with decreased total cost ($25,160 versus $31,758; P < 0.01), direct cost ($15,558 versus $19,283; P < 0.01), and indirect cost ($9602 versus $12,475; P < 0.01); decreased total charges ($98,728 versus $120,981; P < 0.01); and increased margin ($1099 versus -$6255; P < 0.01). Post hoc analysis revealed significant differences, albeit at varying magnitudes, in these particular metrics across all levels of reconstruction timing with the inclusion of a cosurgeon.</p><p><strong>Conclusions: </strong>Cosurgeon breast microsurgery not only improves operative efficiency, but also translates to improved financial metrics. As the transition is made to value-based care models, this is particularly relevant to health systems offering microsurgical breast reconstruction. Analyses of downstream benefits including optimized patient throughput and surgeon opportunity cost warrant investigation.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"764-775"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining a Multidisciplinary \"Vasculoplastic\" Approach to Limb Salvage: An Institutional Review Examining 300 Lower Extremity Free Flaps.","authors":"Karen R Li, Samuel S Huffman, Nisha J Gupta, Brian N Truong, Christian X Lava, Rachel N Rohrich, Jayson N Atves, John S Steinberg, Cameron M Akbari, Richard C Youn, Christopher E Attinger, Karen K Evans","doi":"10.1097/PRS.0000000000011865","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011865","url":null,"abstract":"<p><strong>Background: </strong>The use of free tissue transfer (FTT) is effective for treatment of chronic nonhealing lower extremity (LE) wounds, requiring collaboration across plastic, vascular, podiatric, orthopedic, and infectious disease disciplines for comprehensive treatment plans to optimize limb salvage. The authors describe their vasculopathic approach with 300 LE FTTs, comparing outcomes between the first 200 LE FTTs and the most recent 100 procedures performed.</p><p><strong>Methods: </strong>A single-institution, retrospective review of 300 LE FTTs from July of 2011 to January of 2023 was performed. Patients were compared between the first 200 (group 1; July of 2011 through February of 2020) and last 100 flaps (group 2; February of 2020 through January of 2023) performed. Patient characteristics, preoperative management, intraoperative details, and outcomes were collected.</p><p><strong>Results: </strong>Group 2 patients had significantly higher rates of diabetes (67.0% versus 48.5%; P = 0.002), peripheral vascular disease (56.0% versus 24.5%; P < 0.001), history of venous thromboembolism (13.0% versus 6.0%; P = 0.039), venous reflux (81.9% versus 67.8%; P = 0.028), and preoperative venous thromboses on venous testing (25.5% versus 10.5%; P = 0.003) compared with group 1. Group 2 patients underwent more pre-FTT endovascular interventions (23.0% versus 16.5%; P = 0.039) and vascular bypasses (4.0% versus 0.0%; P = 0.012). Immediate flap success and amputation rates were similar between the groups, but group 2 had higher rates of partial flap necrosis (7% versus 3%; P = 0.012).</p><p><strong>Conclusion: </strong>The adoption of a vasculoplastic approach allows LE FTT to remain successful and achieve long-term limb salvage despite a highly comorbid population.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 5","pages":"879-891"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion: A Modified 270-Degree Closure Technique to Address the Prominent or Locked-Out Premaxilla in Bilateral Cleft Palate Repair.","authors":"David C Thean, Carolyn R Rogers-Vizena","doi":"10.1097/PRS.0000000000011786","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011786","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"155 5","pages":"908e-909e"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Patterns in Blepharoplasty: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.","authors":"Michael J Stein, Jenna R Stoehr, John Harrast, James E Zins, Alan Matarasso, Arun K Gosain","doi":"10.1097/PRS.0000000000011843","DOIUrl":"10.1097/PRS.0000000000011843","url":null,"abstract":"<p><strong>Background: </strong>The American Board of Plastic Surgery (ABPS) continuous certification tracer data on blepharoplasty offer valuable information on national trends in clinical practice. The current study was performed to analyze evolving trends in blepharoplasty and compare practice patterns with evidence-based medicine (EBM) publications within the same timeframe.</p><p><strong>Methods: </strong>Tracer data for blepharoplasty procedures performed by ABPS-certified surgeons between 2005 and 2020 were analyzed. Data between 2 timeframes-2005 through 2014 (early cohort [EC]) and 2015 through 2020 (recent cohort [RC])-were compared to identify evolving trends in blepharoplasty over time. Results were then compared with EBM-based publications.</p><p><strong>Results: </strong>Of 3050 blepharoplasties (1510 EC; 1540 RC), 82% were performed in female patients, and the average age was 56 years. Blepharoplasty was most frequently performed in an ambulatory setting (56%) compared with in hospital (25%); significantly more cases are being performed in the office ( P < 0.001) in the RC compared with the EC. Mean surgical duration has decreased by 13 minutes ( P < 0.001), and fewer surgical procedures are being performed with concomitant procedures ( P < 0.001). Fewer surgeons use antibiotics ( P < 0.001), and fewer surgeons use deep vein thrombosis prophylaxis in the form of sequential compression devices after anesthesia ( P < 0.001). More skin resections were performed for upper blepharoplasties ( P = 0.016), whereas fewer cases of lower lid blepharoplasty involved either skin-muscle flaps ( P = 0.038) or transcutaneous fat removal ( P = 0.004). Most surgeons did not perform canthal tightening during blepharoplasty (82%).</p><p><strong>Conclusions: </strong>This review of more than 15 years of ABPS blepharoplasty tracer data allows surgeons to compare their practice with national trends and EBM. The tracer data illustrate a shift in technique toward shorter and simpler procedures in the office setting.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"895-901"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphologic Differences between Normocephalic and Scaphocephalic Sagittal Craniosynostosis.","authors":"Alexander Velazquez, Michael S Lebhar, Johnny Yang, Martin McCandless, David Pitre, Mason Shiflett, Kristen Weaver, Todd Nichols, Ian C Hoppe, Laura S Humphries","doi":"10.1097/PRS.0000000000011712","DOIUrl":"10.1097/PRS.0000000000011712","url":null,"abstract":"<p><strong>Background: </strong>Nonsyndromic single-suture sagittal craniosynostosis presentation spans scaphocephalic and normocephalic head shapes. The authors studied craniometric differences between scaphocephalic and normocephalic groups with sagittal synostosis.</p><p><strong>Methods: </strong>Head computed tomography scans of 40 patients with sagittal synostosis (20 with scaphocephaly and 20 with normocephaly) and age- and sex-matched controls were analyzed, including cranial base angles, distances from midline, and intracranial volumes.</p><p><strong>Results: </strong>Cranial index was significantly decreased in index groups compared with controls ( P < 0.001). Right external acoustic meatus angle was significantly larger in patients with scaphocephaly ( P < 0.001) and left external acoustic meatus angle was significantly smaller in patients with normocephaly ( P = 0.002) when compared with controls. Midline angular analysis showed that bifrontal angle was significantly smaller among patients with scaphocephaly versus controls ( P = 0.026). Cranial base distances from midline were longer to the right and left internal acoustic meatus and shorter to the euryon-to-zygomaticofrontal suture for both groups of patients versus their controls ( P < 0.05). Scaphocephalic patients had a larger anterior cranial volume ratio (18% versus 13%; P < 0.001) and normocephalic patients had a larger posterior volume ratio (42% versus 33%; P < 0.001) than controls. Scaphocephalic patients had larger anterior volume ratios than normocephalic patients (1.66 versus 1.16; P = 0.025), but smaller posterior compartment volume ratios (0.90 versus 1.53; P < 0.001).</p><p><strong>Conclusions: </strong>Rightward asymmetries of the linear and angle cranial base measurements existed in both index groups. Intracranial volume distribution lies anteriorly in patients with scaphocephaly but posteriorly in patients with normocephaly. These data show craniometric evidence that although normocephalic and scaphocephalic patients share the diagnosis of sagittal synostosis, they are morphometrically different from each other and from controls.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"852-863"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Bridge Therapy before Microvascular Breast Reconstruction in Morbidly Obese Patients: A Proof-of-Concept Risk Analysis.","authors":"Jacob B Hammond, McKinna Tillotson, YooJin Yoon, Kenneth Meza Monge, Elena M Esch, James A Madura, Akshay Pratap, Julian Winocour, David W Mathes, Christodoulos Kaoutzanis","doi":"10.1097/PRS.0000000000011797","DOIUrl":"10.1097/PRS.0000000000011797","url":null,"abstract":"<p><strong>Background: </strong>Obese patients experience more complications after autologous breast reconstruction. This study evaluates how bariatric surgery modulates risk of complications in the setting of microvascular breast reconstruction.</p><p><strong>Methods: </strong>Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databases were queried for patients with body mass index (BMI) greater than or equal to 35 kg/m 2 undergoing bariatric surgery from 2017 to 2022. Outcomes included BMI and obesity-related comorbidities before and 1 year after bariatric surgery. Paired Breast Reconstruction Risk Assessment scores were analyzed to evaluate risk modulation before and after bariatric surgery in the setting of microvascular breast reconstruction.</p><p><strong>Results: </strong>A total of 1026 patients were included with an average age of 47 and BMI of 44.7 kg/m 2 . Comorbidities included hypertension ( n = 601 [59%]), type 2 diabetes ( n = 291 [28%]), and cardiovascular disease ( n = 10 [1%]). One-year outcomes after bariatric surgery included an average BMI of 32.7 kg/m 2 , with remission of type 2 diabetes in 29% of patients. Paired Breast Reconstruction Risk Assessment analysis for microvascular breast reconstruction before and after bariatric surgery showed reduction in 30-day surgical complications (40.4% versus 24.8%; P < 0.0001), with an absolute risk reduction of 15%, a relative risk reduction of 36%, and a number needed to treat of 7. Each 1-kg/m 2 reduction in preoperative BMI was associated with a 3.4% reduction in surgical complications ( P < 0.0001).</p><p><strong>Conclusion: </strong>There is potential efficacy for metabolic bridge therapy in reducing complications for obese patients undergoing microvascular breast reconstruction.</p><p><strong>Clinical question/level of evidence: </strong>Risk, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"753-760"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic Nerve Sheath Diameter on Computed Tomography Scans Reflects Elevated Intracranial Pressure in Patients with Craniosynostosis.","authors":"Dominic J Romeo, Jonathan H Sussman, Benjamin B Massenburg, Mark Halverson, Jinggang J Ng, Meagan Wu, Grant T Liu, Scott P Bartlett, Jesse A Taylor, Jordan W Swanson","doi":"10.1097/PRS.0000000000011698","DOIUrl":"10.1097/PRS.0000000000011698","url":null,"abstract":"<p><strong>Background: </strong>Assessment for elevated intracranial pressure (ICP) helps guide interventional decision-making to treat craniosynostosis. However, noninvasive techniques for measuring ICP are limited. This study assessed whether optic nerve sheath diameter (ONSD) on low-dose computed tomographic (CT) scans is associated with ICP in patients with craniosynostosis.</p><p><strong>Methods: </strong>Pediatric patients treated between 2014 and 2023 with craniosynostosis, intraoperative ICP measurements by direct subdural catheterization, and spectral domain-optical coherent tomographic (SD-OCT) data were included. ONSD was retrospectively assessed on preoperative CT scans by a masked neuroradiologist and compared with measures and proxies of ICP.</p><p><strong>Results: </strong>Among the 132 patients included (median age, 6.9 years; interquartile range, 4.7 to 9.5 years), 41 (31.1%) had a syndromic diagnosis. Maximal ONSD was increased in patients with an ICP of 15 mmHg or greater (6.1 mm versus 5.5 mm; P < 0.01) and 20 mmHg or greater (6.3 mm versus 5.6 mm; P < 0.01). Maximal ( r = 0.32; P < 0.001), minimum ( r = 0.26; P = 0.003), and average ( r = 0.29; P < 0.001) ONSD correlated with direct ICP measurements. ONSD and SD-OCT measurements were also correlated (maximum retinal nerve fiber layer, r = 0 .21, P = 0.04; maximum retinal thickness, r = 0.24, P = 0.02). An ONSD max threshold of 5.75 mm demonstrated 65% sensitivity and 64% specificity for detecting ICP of 15 mmHg or greater on optimized receiver operating characteristic curve analysis. Multivariable logistic regression generated an algorithm incorporating ONSD max and age to detect an ICP of 20 mmHg or greater with 64% sensitivity and 80% specificity.</p><p><strong>Conclusions: </strong>ONSD measured on low-dose CT scans detected elevated ICP with moderate accuracy. Precision increased when patient age was taken into consideration. Given the ease of accessing CT scan data, this may be a helpful ICP proxy for clinical decision-making.</p><p><strong>Clinical question/level of evidence: </strong>Diagnostic, II.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"837-847"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}