Plastic and reconstructive surgery最新文献

{"title":"Further Refinements in Otoplasty Surgery: A Modified Approach to Prevent Suture Extrusion in Cartilage-Suturing Otoplasty Using a Postauricular Dermofascial Flap.","authors":"Neil W Bulstrode, Elsa M Ronde, Ahmed S Mazeed","doi":"10.1097/PRS.0000000000011342","DOIUrl":"10.1097/PRS.0000000000011342","url":null,"abstract":"<p><strong>Background: </strong>Suture extrusion has been reported to be the most common complication after cartilage-sparing otoplasty. Several studies have described various designs of postauricular flaps to cover the cartilage sutures and reduce the incidence of suture extrusion.</p><p><strong>Methods: </strong>A total of 100 consecutive patients with prominent ears were operated on between January of 2018 and February of 2023 using a deepithelialized postauricular dermofascial flap that is performed as an adjunct to the authors' cartilage-sparing otoplasty technique, which is essentially a combined modified Mustardé and Furnas technique. The flap is used to cover the cartilage-holding sutures with an extra layer of vascularized tissue to avoid the scar being directly over these sutures.</p><p><strong>Results: </strong>The median age of patients was 12 years (interquartile range, 9 to 15). One out of the 100 patients (1%) developed a postauricular skin infection requiring surgical removal of sutures. Primary suture extrusion did not occur; in an earlier study of cartilage-sparing technique without the postauricular flap, 17 out of 200 patients had suture extrusion ( P = 0.001). No hematoma occurred that necessitated return to the theater. Skin necrosis and wound dehiscence did not occur in any case. No patient developed cartilage deformities or relapse requiring surgical correction.</p><p><strong>Conclusions: </strong>Combining cartilage-sparing otoplasty using sutures and the described postauricular dermofascial flap is simple to perform and has significantly reduced the complication rate and improved the outcome compared with cartilage-sparing otoplasty alone. This flap is recommended for both primary and revisional otoplasty.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1191e-1199e"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493030","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":"Overcoming Disappointment.","authors":"Alexander N Khouri, Kevin C Chung","doi":"10.1097/PRS.0000000000011626","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011626","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":"154 6","pages":"1153-1157"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716877","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":"Metformin Eliminates Lymphedema in Mice by Alleviating Inflammation and Fibrosis: Implications for Human Therapy.","authors":"Miaomiao Wei, Liangliang Wang, Xin Liu, Yaping Deng, Sanhong Yang, Wenjie Pan, Xiaoshan Zhang, Guangchao Xu, Shune Xiao, Chengliang Deng","doi":"10.1097/PRS.0000000000011363","DOIUrl":"10.1097/PRS.0000000000011363","url":null,"abstract":"<p><strong>Background: </strong>Secondary lymphedema is a chronic, disabling disease affecting more than 50% of patients with cancer and lacking effective pharmacologic treatment even for early to middle disease stages. Metformin reportedly exerts anti-inflammatory and antifibrotic effects and is safe, with minimal side effects. The authors investigated the role of metformin in lymphedema mouse models and examined underlying molecular mechanisms.</p><p><strong>Methods: </strong>Male C57BL/6 mice (6 to 8 weeks old; n = 15/group) received metformin (300 mg/kg/day) by gavage on day 3 after lymphedema surgery; saline and sham groups were administered the same volume of saline. Hindlimb circumference and tail volume were monitored every 2 days. On day 28, samples were collected for histologic assessment, Western blotting, and reverse transcription quantitative polymerase chain reaction analysis of inflammation, fibrosis, and AMP-activated protein kinase (AMPK) expression. AMPK activity was assayed in patients with secondary lymphedema (International Society of Lymphology stage II) and controls following strict inclusion criteria.</p><p><strong>Results: </strong>Compared with the saline group, the metformin group exhibited hindlimb circumference and tail volume reduced by 469.70% and 305.18%, respectively, on day 28. Dermal thickness was reduced by 38.27% and 72.57% in the hindlimbs and tail, respectively. Metformin decreased CD4+ T-cell infiltration by 19.73%, and decreased expression levels of interleukin-4, interleukin-13, interleukin-17, and transforming growth factor-β1. In addition, it lowered collagen I deposition by 33.18%. Compared with the saline group, the number of lymphatic vessels increased by 229.96% in the metformin group. Both the saline group mice and patients with lymphedema showed reduced AMPK activity; metformin increased p-AMPK expression by 106.12%.</p><p><strong>Conclusion: </strong>Metformin alleviated inflammation and fibrosis and increased lymphangiogenesis in lymphedema mouse models by activating AMPK signaling.</p><p><strong>Clinical relevance statement: </strong>Metformin provides preliminary evidence as a potential therapeutic option for lymphedema.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1128e-1137e"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyethylene Glycol-Mediated Axonal Fusion Promotes Early Sensory Recovery after Digital Nerve Injury: A Randomized Clinical Trial.","authors":"Sriya Nemani, Sara Chaker, Helen Ismail, Julia Yao, Monal Chang, Hakmook Kang, Mihir Desai, Douglas Weikert, Panambur L Bhandari, Brian Drolet, Brinkley Sandvall, John B Hill, Wesley Thayer","doi":"10.1097/PRS.0000000000011334","DOIUrl":"10.1097/PRS.0000000000011334","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve repair is limited by Wallerian degeneration coupled with the slow and inconsistent rates of nerve regrowth. In more proximal injuries, delayed nerve regeneration can cause debilitating muscle atrophy. Topical application of polyethylene glycol (PEG) during neurorrhaphy facilitates the fusion of severed axonal membranes, immediately restoring action potentials across the coaptation site. In preclinical animal models, PEG fusion resulted in remarkable early functional recovery.</p><p><strong>Methods: </strong>This is the first randomized clinical trial comparing functional outcomes between PEG fusion and standard neurorrhaphy. Participants with digital nerve transections were followed up at 2 weeks, 1 month, and 3 months postoperatively. The primary outcome was assessed using the Medical Research Council Classification (MRCC) rating for sensory recovery at each time point. Semmes-Weinstein monofilaments and static 2-point discrimination determined MRCC ratings. Postoperative quality of life was measured using the Michigan Hand Outcomes Questionnaire.</p><p><strong>Results: </strong>Forty-eight transected digital nerves (25 control and 23 PEG) across 22 patients were analyzed. PEG-fused nerves demonstrated significantly higher MRCC scores at 2 weeks (OR, 16.95; 95% CI, 1.79 to 160.38; P = 0.008) and 1 month (OR, 13.40; 95% CI, 1.64 to 109.77; P = 0.009). Participants in the PEG cohort also had significantly higher average Michigan Hand Outcomes Questionnaire scores at 2 weeks (Hodge g , 1.28; 95% CI, 0.23 to 2.30; P = 0.0163) and 1 month (Hodge g , 1.02; 95% CI, 0.04 to 1.99; P = 0.049). No participants had adverse events related to the study drug.</p><p><strong>Conclusion: </strong>PEG fusion promotes early sensory recovery and improved patient well-being following peripheral nerve repair of digital nerves.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, II.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1247-1256"},"PeriodicalIF":3.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139712844","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 Ultrathin Parascapular Flap: Proof of Concept and Use in Plantar Foot Reconstruction\".","authors":"John M Felder, Kenan Tawaklna, Abdullah M Said, Suphalerk Lohasammakul, Nirvana B Saraswat, Joon Pio Hong","doi":"10.1097/PRS.0000000000011902","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011902","url":null,"abstract":"<p><strong>Summary: </strong>Optimal reconstruction of weight-bearing plantar foot defects is challenging due to the need for relatively thin coverage with simultaneous durability. The medial plantar flap provides an excellent tissue match but is not always available or appropriate (Figure 1, 2). Microsurgical free flap reconstruction provides many options for coverage. However, few skin flaps are thin enough to contour appropriately but still provide thick dermis for durable weight-bearing; particularly in patients with an average or obese body habitus.1 Lately, the suprascarpal (\"superthin\") plane of elevation has been increasingly used to provide tailored coverage with appropriate thickness matching to the surrounding tissues.2,3 Even thinner \"ultrathin flaps\" are raised within the subcutaneous fat superficial to the Scarpa's layer.4 The superficial circumflex iliac artery (SCIP) and anterolateral thigh (ALT) perforator flaps are commonly suprascarpally elevated,5,6 and the ultrathin SIEA flap has been recently described.7 The scapular and parascapular flaps have many ideal characteristics, including thick skin,8 minimal donor site morbidity, simple pedicle dissection, and a lengthy robust pedicle. Obese subcutaneous tissue typically precludes use, and para-/scapular flaps may be overlooked for ultrathin elevation. We describe the utility of ultrathin parascapular flaps (UPF) in weight-bearing plantar foot defects.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731835","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 Letter to the Editor in response to \"The impact of body mass index on adverse outcomes associated with panniculectomy: a multimodal analysis\".","authors":"Alexander F Dagi, Christine H Rohde, Jarrod T Bogue","doi":"10.1097/PRS.0000000000011908","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011908","url":null,"abstract":"","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731836","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":"Lipophagy Enhances Fat Graft Retention by Stimulating Dedifferentiation of Mature Adipocytes and Modulating Inflammation.","authors":"Shujie Xu, Xinhui Wang, Yidan Xu, Han Yang, Yunjun Liao, Qiang Chang, Junrong Cai, Feng Lu, Jianhua Gao, Yi Yuan","doi":"10.1097/PRS.0000000000011903","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011903","url":null,"abstract":"<p><strong>Background: </strong>Maintaining lipid metabolic homeostasis is essential for cells to respond to environmental stresses, ensure survival, and preserve functionality. Lipophagy, a form of autophagy in which intracellular lysosomes target and degrade lipid droplets. The authors hypothesize that pharmacologically enhancing or disrupting lipophagy could either improve or impair the retention rates of fat grafts.</p><p><strong>Methods: </strong>Human fat graft nodules, retained for six months, were collected through surgical procedures for analysis. Additionally, a mouse fat graft model was established by mixing fragmented adipose tissue with the autophagy inducer rapamycin (Rapa), the autophagy inhibitor 3-methyladenine (3-MA), or PBS, and subcutaneously implanting into the bilateral lower back of mice for localized activation or inhibition of lipophagy. Samples were collected at various time points for morphological, histological, transcriptomic, and gene expression analysis.</p><p><strong>Results: </strong>A significant increase in lipophagy was demonstrated in both human and mouse fat grafts. Rapa-induced upregulation of lipophagy promoted long-term retention of mouse fat grafts and resulted in fewer cysts and reduced fibrosis. Lipophagy activation facilitated the dedifferentiation of mature adipocytes and adipogenesis. Moreover, lipophagy enhanced the metabolism of oil droplets in macrophages. Activation of lipophagy also reduced long-term macrophage infiltration and collagen deposition in fat grafts while simultaneously increasing the proportion of M2 macrophages.</p><p><strong>Conclusion: </strong>Lipophagy was activated following fat grafting. Lipophagy improves fat graft retention and quality by stimulating the dedifferentiation of mature adipocytes, promoting oil metabolism, and reducing inflammation. Thus, lipophagy serves as a crucial integrative point connecting lipid metabolism, regeneration, and immunity in fat grafts.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731837","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":"Science or Spectacle? A Critical Evaluation of the decade of Aesthetic Medicine Conferences using Punctuated Equilibrium Framework.","authors":"Eqram Rahman, Karim Sayed, Parinitha Rao, Nanze Yu, Keming Wang, Patricia E Garcia, Sotirios Ioannidis, Wolfgang G Philipp-Dormston, Jean D A Carruthers, William Richard Webb","doi":"10.1097/PRS.0000000000011899","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011899","url":null,"abstract":"<p><strong>Introduction: </strong>The global aesthetic medicine industry is rapidly expanding, with conferences serving as crucial platforms for knowledge exchange and collaboration. However, concerns have emerged about the increasing prioritisation of commercial content over scientifically rigorous presentations. This study critically evaluates the balance between commercial and scientific content at aesthetic medicine conferences, utilising artificial intelligence (AI) tools to analyse the impact of industry sponsorship and live procedural demonstrations on educational value.</p><p><strong>Method: </strong>Using the Punctuated Equilibrium Framework (PEF), AI-driven content analysis, social network analysis (SNA), and sentiment analysis were applied to evaluate conference data, including programs, sponsorship details, speaker affiliations, and attendee engagement metrics. The study analysed global and regional aesthetic medicine conferences from 2014 to 2024, identifying patterns and punctuated shifts in the balance between scientific and commercially driven content.</p><p><strong>Results: </strong>AI-based analysis of 487 conferences, comprising over 28,000 sessions and 2 million social media posts, revealed an increasing trend towards commercially focused content, particularly in industry-sponsored events. Approximately 44% of sessions were commercially oriented, with significant spikes during product launches. Academic and clinical speakers were more prevalent in scientific conferences, while industry-affiliated speakers dominated commercial sessions. Social media sentiment, analysed using AI tools, reflected high engagement with procedural demonstrations but also highlighted concerns about educational quality.</p><p><strong>Conclusion: </strong>While industry-driven sessions garnered higher immediate engagement, they reduced long-term cognitive retention and compromised the educational integrity of conferences. The use of AI in this study enabled a deeper understanding of content trends and their effects. Aesthetic medicine conferences must recalibrate the balance between commercial interests and scientific rigour to ensure sustainable professional development and patient safety.</p><p><strong>Evidence level: </strong>IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731840","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":"PHRENIC NERVE RECONSTRUCTION WITH SHORT-TERM DIAPHRAGM PACING CORRECTS DIAPHRAGM PARALYSIS DUE TO INTRATHORACIC NERVE INJURY.","authors":"Matthew R Kaufman, Thomas Bauer, Jeannine Sico, Reza Jarrahy","doi":"10.1097/PRS.0000000000011901","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011901","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic diaphragm paralysis and subsequent pulmonary debilitation has been shown to occur following phrenic nerve injury within the thoracic cavity. In this study, we investigate the effectiveness of intrathoracic reconstruction of the phrenic nerve combined with short-term diaphragm pacing in restoring diaphragm function.</p><p><strong>Methods: </strong>A retrospective review of 34 consecutive patients who underwent intrathoracic phrenic nerve reconstruction and diaphragm pacing for symptomatic diaphragm paralysis was performed. Inclusion criteria included confirmation of diaphragm paralysis on chest fluoroscopy, BMI <40, Age <75, and presence of functional motor units on EMG testing. Surgical treatment consisted of intrathoracic phrenic nerve reconstruction with simultaneous implantation of a diaphragm pacemaker.</p><p><strong>Results: </strong>34 patients met inclusion criteria, including: 23 males and 11 females with an average age of 46 and average BMI of 28.5 kg/m2. Thirty patients (88%) reported improvement in respiratory function. FVC and FEV1 values improved by 15% (p=0.02) and 14% (p=0.049), respectively. A 375% increase in diaphragm motor amplitude was observed, from 0.04mV to 0.19mV (p=0.02). Radiographic improvement in resting diaphragm position and contraction was demonstrated in 71% of patients. Complications included pacemaker site infection (5%), cardiac arrythmia (5%), and asymptomatic abdominal bulge (3%).</p><p><strong>Conclusions: </strong>Intrathoracic phrenic nerve reconstruction with short-term diaphragm pacing is a safe and effective surgical treatment that improves diaphragm function and alleviates symptoms of respiratory insufficiency in patients with diaphragmatic paralysis following intrathoracic phrenic nerve injury. This approach should be considered as part of the treatment algorithm for this patient population.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731839","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 Septum and Nasomaxillary Vault Associated with Unrepaired Unilateral Cleft Lip and Palate: A Data-Driven 3D Model\".","authors":"Andrew D Linkugel, Ezgi Mercan, Philip D Tolley, Mélissa Roy, Russell E Ettinger, Lun-Jou Lo, Alex A Kane, Raymond W Tse","doi":"10.1097/PRS.0000000000011900","DOIUrl":"https://doi.org/10.1097/PRS.0000000000011900","url":null,"abstract":"<p><strong>Background: </strong>Defining the nature of the unilateral cleft lip and palate nasal deformity (uCLND) and its optimal surgical correction continues to be a challenge. The purpose of this study was to develop a data-driven model of the primary unrepaired osseocartilaginous skeleton of the nasomaxillary complex.</p><p><strong>Methods: </strong>CT scans of nineteen 3-month-old infants with unrepaired unilateral cleft lip and palate and nineteen age- and race-matched controls were analyzed. Osseous landmark deviation in subjects with clefts was compared to controls. Segmentation of the osseocartilaginous septum was performed, and deformational differences were calculated between cleft and non-cleft cohorts.</p><p><strong>Results: </strong>Compared to controls, the rhinion, non-cleft nasomaxillary junction, and cleft nasomaxillary junction deviated towards the non-cleft side. The piriform margins each diverge away from midline with the non-cleft side deviating lateral and superior, and the cleft side deviating lateral and posterior. These alterations result in a bony torsion with sigmoidal configuration of the cleft side aperture, vertical shortening of the central midface, and de-projection of the nasal pyramid. Segmentation of the septum revealed anterior deviation toward the non-cleft side with a single convexity toward the cleft.</p><p><strong>Conclusions: </strong>This three-dimensional data-driven model contradicts prior models and confirms a collapsing twist of the cleft side aperture and medialization of the bony margin of the nasal airway with deviation of the nasal bone complex toward the non-cleft side. This analysis defines the critical anatomic characteristics of the cleft nasal deformity and informs the goals of nasal correction at the time of primary repair.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731834","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}