PM&R最新文献

{"title":"Anomalous education: You can't bypass electrodiagnostic training in PM&R residency.","authors":"Ileana M Howard, Faye Chiou Tan, Robert W Irwin, Ruple S Laughlin, Anthony Chiodo, Peter A Grant, Shirlyn Adkins, Monika Krzesniak-Swinarska, Gautam Malhotra, Colin K Franz, Dianna Quan","doi":"10.1002/pmrj.13281","DOIUrl":"https://doi.org/10.1002/pmrj.13281","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506485","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":"Low-value interventions to deimplement: A secondary analysis of a systematic review of low back pain clinical practice guidelines.","authors":"Daniel Tai, Eunyeop Kim, Prateek Grover, Alejandro Rodriguez, Timothy J Olivier, Thiru M Annaswamy","doi":"10.1002/pmrj.13270","DOIUrl":"https://doi.org/10.1002/pmrj.13270","url":null,"abstract":"<p><strong>Objective: </strong>To perform a secondary review of low back pain (LBP) clinical practice guidelines (CPG) identified in a recently conducted systematic review and to synthesize and summarize low-value recommendations as practices that may be candidates for deimplementation.</p><p><strong>Literature survey: </strong>LBP (subacute or chronic) CPGs in English (symptom based, created by a governmental or professional society, published between January 1990 and May 2020) were previously identified using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, Emergency Care Research Institute, Guidelines International Network, National Institute of Health and Care Excellence, and Scottish Intercollegiate Guideline Network.</p><p><strong>Methodology: </strong>Twenty-one CPGs were reviewed from a systematic review (previously published). Full-text review of all 21 CPGs was conducted, and three recommendation categories indicative of low value (recommend strongly against, recommend weakly against, inconclusive/insufficient evidence) were identified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) language and approach.</p><p><strong>Synthesis: </strong>One hundred thirty-five low-value recommendations were identified and classified under eight intervention categories: orthotics/support, traction, physical modalities, pharmacological interventions, injections, surgery, bed rest, and miscellaneous. Traction, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (TUS), and selective serotonin reuptake inhibitors (SSRI) had the most CPGs recommend strongly against their usage. Opioids were recommended strongly against by four CPGs. No significant difference (p > .05) was found between CPG quality and a specific deimplementation recommendation or between CPG quality and the number of strongly against, weakly against, and inconclusive/insufficient evidence recommendations.</p><p><strong>Conclusions: </strong>Clinicians managing patients with chronic LBP should consider deimplementing these low-value interventions (traction, TENS, TUS, and SSRI).</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506488","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":"Autonomic rehabilitation: Vagal and sympathetic impacts of modified occipitomastoid suture V-spread.","authors":"Austin Miller, Daniel Gustin, Jonathan Wilson, Jeffery Johns, James Burch, Thomas Fotopoulos, Rahul Garg, Audrey Vasauskas","doi":"10.1002/pmrj.13268","DOIUrl":"https://doi.org/10.1002/pmrj.13268","url":null,"abstract":"<p><strong>Background: </strong>Autonomic rehabilitation using osteopathic manipulative treatment (OMT) to stimulate the vagus nerve may be a good adjunct therapy by physiatrists who treat dysautonomia. Heart rate variability (HRV) may provide quantitative evidence for the benefits of OMT on autonomic nervous system function. Elevated HRV indicates optimal health and reduced mortality risk, whereas low HRV is associated with stress, pain, and chronic disease pathology.</p><p><strong>Objective: </strong>To analyze the impact of modified occipitomastoid suture v-spread OMT technique on vagal tone by measuring HRV.</p><p><strong>Design: </strong>Within-participant design with 5-minute HRV measurement pre- and post-OMT treatment.</p><p><strong>Setting: </strong>Clinical examination suites.</p><p><strong>Participants: </strong>Thirty healthy osteopathic medical students.</p><p><strong>Interventions: </strong>A modified occipitomastoid suture v-spread treating somatic dysfunction by osteopathic physicians trained in osteopathic neuromusculoskeletal medicine.</p><p><strong>Main outcome measures: </strong>HRV variables related to vagal tone including root mean square of successive differences (RMSSD), percentage of successive normal sinus RR intervals >50 ms (pNN50), high frequency (HF), Parasympathetic Nervous System Index (PNSI), and Sympathetic Nervous System Index (SNSI). Repeated measures t-test analyzed the difference in mean HRV values after OMT.</p><p><strong>Results: </strong>There were statistically significant increases in each of the HRV measures after OMT. Participants had a mean (95% confidence interval) RMSSD of 50.5 ms (38.3-62.8) at baseline and 55.0 ms (41.2-68.7, p = .013) post-OMT. pNN50 was 24.5% (17.6-31.3, n = 30) at baseline and 28.2% (20.8-35.6, p = .003) post-OMT. HF was 1549.6 ms² (389.8-2709.4) at baseline and 1901.8 ms² (618.2-3185.4, p = .103) post-OMT. PNSI was -0.1 (-0.5 to 0.2) at baseline and 0.1 (-0.3 to 1.5, p < .01) post-OMT, and SNSI was 0.2 (-0.1 to 0.6) at baseline and 0.05 (-0.3 to 0.4, p < .01) post-OMT. Normalization, due to high baseline variance, results include RMSSD 1.1 ms (1.0 to 1.1, p = .012), pNN50 1.3 (1.1 to 1.4, p = .011), and HF 1.2 ms² (1.1 to 1.4, p = .018).</p><p><strong>Conclusions: </strong>Modified occipitomastoid suture v-spread may provide clinical benefit through increased vagal tone and decreased sympathetic activity.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506486","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":"Ultrasound visualization of Botulinum toxin injection: Identifying clinical correlates to optimize outcomes in spasticity management.","authors":"Kristen A Harris, Stacey Jou, Lora Kasselman, Steven V Escaldi","doi":"10.1002/pmrj.13269","DOIUrl":"10.1002/pmrj.13269","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin injections are well established and commonly used for spasticity management. Clinicians strive to optimize outcomes from toxin injections. One potential complication is toxin spread beyond the intended muscle, which can lead to unwanted weakness. The utilization of ultrasound allows direct visualization of target muscles and identification of toxin leakage from the target muscle. Ultrasound evaluation of clinical factors that correlate to toxin leakage have not been studied.</p><p><strong>Objective: </strong>To identify cases of botulinum toxin injectate leak beyond the targeted muscle during ultrasound-guided spasticity injections and associate cases of leak with predictive clinical factors, which include muscle size, fibroadipose changes, and number of previous injections.</p><p><strong>Design: </strong>This was a prospective observational study.</p><p><strong>Setting: </strong>An outpatient clinic in an academic medical center.</p><p><strong>Patients: </strong>Patients who demonstrated wrist flexor spasticity warranting intervention were invited to participate.</p><p><strong>Interventions: </strong>Patients received standard-of-care spasticity management with injection of onabotulinumtoxinA into the flexor carpi radialis muscle based upon clinical presentation and prescribing guidelines. Ultrasound video was recorded, and a blinded review was conducted by the study team.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was visualized leak of injectate on recorded ultrasound video. Documented leak was then associated with clinical factors including diameter of the flexor carpi radialis, volume of injectate used, history of prior injections, and fibrotic change of the muscle.</p><p><strong>Outcomes: </strong>The study included 54 patients, 77.8% of whom had an underlying diagnosis of cerebrovascular accident. Injectate leak was observed in 18.5% of injections and could not be confirmed in 9.3% of injections. Multivariable analysis demonstrated increased odds of leak with higher Modified Heckmatt Scale score. No statistically significant increase in leak was noted with higher volume of injectate or smaller muscle diameter.</p><p><strong>Conclusion: </strong>Extramuscular leak of botulinum toxin injection may be associated with fibroadipose muscle change.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472934","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":"Incidence of lymphedema among adults with cerebral palsy.","authors":"Christine R Gettys, Sean Smith, Kimberly K Rauch, Daniel G Whitney","doi":"10.1002/pmrj.13277","DOIUrl":"https://doi.org/10.1002/pmrj.13277","url":null,"abstract":"<p><strong>Background: </strong>Lymphedema is a chronic and progressive condition but is understudied among adults with cerebral palsy (CP).</p><p><strong>Objective: </strong>To compare the 2-year incidence of lymphedema between adults with versus without CP before and after accounting for multimorbidity, cancer diagnosis/treatment, and lymph node/channel surgery.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Nationwide commercial claims data from January 1, 2011 to December 31, 2017.</p><p><strong>Participants: </strong>Adults ≥18 years old with and without CP with at least 12 months of continuous health plan enrollment, defined as the baseline period, were included for analysis. The 12-month baseline period was used to establish information on preexisting lymphedema (for exclusion), presence of cancer, including radiation treatment and lymph node surgery, and the Whitney Comorbidity Index (WCI).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure: </strong>The 2-year incidence rate (IR) and IR ratio (IRR) of lymphedema were evaluated. Cox regression estimated the hazard ratio (HR) of 2-year lymphedema after adjusting for age, gender, WCI, cancer diagnosis/treatment, and lymph node/channel surgery.</p><p><strong>Results: </strong>The 2-year IR of lymphedema was 5.73 (95% confidence interval [CI] = 4.59-6.88) for adults with CP (n = 9922) and 1.81 (95% CI = 1.79-1.83) for adults without CP (n = 12,932,288); the IRR was 3.17 (95% CI = 2.59-3.87) and the adjusted HR was 2.43 (95% CI = 1.98-2.98). There was evidence of effect modification by gender, age, and WCI score. All HRs were elevated, but men with versus without CP had higher HRs than women with versus without CP; HRs for adults with versus without CP were higher for younger participants and those with lower WCI scores.</p><p><strong>Conclusions: </strong>Adults with CP had a higher 2-year rate of lymphedema compared with those without CP. Men with CP had a disproportionately higher rate than women with CP when compared with their gender-based reference cohorts without CP.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392669","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":"Postprocedure protocols after intraarticular orthobiologic injections-A scoping review.","authors":"Ryan C Kruse, Kristina D Rossmiller, Timothy R Fleagle","doi":"10.1002/pmrj.13271","DOIUrl":"https://doi.org/10.1002/pmrj.13271","url":null,"abstract":"<p><p>Osteoarthritis is a chronic degenerative disease affecting 500 million people throughout the world. Although orthobiologics have been proposed as a symptom and disease modifying treatment for osteoarthritis, there is significant heterogeneity in the results of the orthobiologic procedures in the literature. One possible explanation for the heterogeneity is the inconsistent reporting and description of the postorthobiologic protocols. The goal of this scoping review was to identify the current literature on the use of orthobiologics for osteoarthritis and critically evaluate the postorthobiologic protocol within these studies. A total of 200 identified studies met inclusion criteria. In 37.5% of studies, there was no mention of a postorthobiologic protocol. Of the 125 studies that did mention a postorthobiologic protocol, only 38.4% included a rehabilitation protocol, 21.6% included postprocedure weightbearing restrictions, and only 2 (1.6%) mentioned the use of durable medical equipment. Nonsteroidal anti-inflammatory drug restriction was described in 91.2% of study protocols, whereas corticosteroids and immunosuppressants were restricted in 84.8% and 19.2% of protocols, respectively. The results of this scoping review demonstrate the inconsistent reporting of postorthobiologic procedure protocols in the literature, with significant heterogeneity in those that are described. These findings highlight the need for future research and improved reporting of postorthobiologic protocols.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392670","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":"Transcranial Doppler ultrasonography can predict inpatient rehabilitation functional outcome in patients with stroke.","authors":"Nina Navalkar, Kristen Sandefer, Hely Nanavati, Chen Lin","doi":"10.1002/pmrj.13161","DOIUrl":"10.1002/pmrj.13161","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in imaging techniques and treatment modalities, tools to predict recovery after stroke remain limited.</p><p><strong>Objective: </strong>To determine if transcranial Doppler (TCD) mean flow velocities were predictive of functional recovery following ischemic stroke.</p><p><strong>Methods: </strong>Data were collected from patients with stroke admitted to an academic tertiary care facility in the southeastern region of the United States between 2012 and 2019 who had a middle cerebral artery distribution ischemic stroke, TCD, and were discharged to our inpatient rehabilitation facility. Mean flow velocities were categorized as low (<40 cm/s), normal (40-80 cm/s), or high (>80 cm/s). Functional Independence Measure (FIM) scores were collected on admission to and discharge from inpatient rehabilitation. Multiple linear regression models were used to assess the differences in mean FIM score changes by categories of mean flow velocities.</p><p><strong>Results: </strong>We enrolled 57 patients, mean age 60 years, 73.7% male. Compared to the normal velocity group, those with abnormally low velocities had a significantly smaller change in their FIM score (adjusted β = -8.42; p = .01). Compared to the normal velocity group, those with abnormally high velocities experienced a greater change in FIM score, but this association was not statistically significant (beta = 1.12; p = .77).</p><p><strong>Conclusions: </strong>In this limited population, we found that low mean flow velocity as measured by TCD ultrasonography after a middle cerebral artery stroke is associated with poorer functional recovery following inpatient rehabilitation. Our results suggest that the value of TCD ultrasonography as a tool to predict motor recovery after stroke warrants further investigation.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1072-1078"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academy News - October 2024 PM&R.","authors":"","doi":"10.1002/pmrj.13288","DOIUrl":"https://doi.org/10.1002/pmrj.13288","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"16 10","pages":"1168-1169"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392671","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":"A randomized, double-blind, placebo-controlled trial of DaxibotulinumtoxinA for Injection for the treatment of upper limb spasticity in adults after stroke or traumatic brain injury.","authors":"Atul T Patel, Michael C Munin, Ziyad Ayyoub, Gerard E Francisco, Rashid Kazerooni, Todd M Gross","doi":"10.1002/pmrj.13258","DOIUrl":"https://doi.org/10.1002/pmrj.13258","url":null,"abstract":"<p><strong>Background: </strong>Intramuscular injection of botulinum toxin type A is a first-line pharmacotherapy for adults with upper limb spasticity (ULS). However, reemergence of symptoms within 12 weeks of treatment is common and longer-lasting treatments are needed.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of three doses of DaxibotulinumtoxinA for Injection (DAXI) for treatment of ULS in adults with stroke or traumatic brain injury.</p><p><strong>Intervention: </strong>Intramuscular injections of placebo (N = 24), DAXI 250 U (N = 22), DAXI 375 U (N = 19), or DAXI 500 U (N = 18) to the suprahypertonic muscle (SMG) and other muscle groups.</p><p><strong>Design: </strong>Randomized, double-blind, placebo-controlled study.</p><p><strong>Setting: </strong>Twenty-six study centers across the United States.</p><p><strong>Participants: </strong>Eighty-three adult patients with ULS were randomly assigned to each treatment group and followed for up to 36 weeks.</p><p><strong>Outcome measures: </strong>Co-primary endpoints were the Modified Ashworth Scale (MAS) score change from baseline in the designated SMG and Physician Global Impression of Change (PGIC) at Week 6.</p><p><strong>Results: </strong>The mean changes from baseline in MAS score for the designated SMG for placebo and the DAXI 250 U, 375 U, and 500 U groups were -0.6, -0.9, -0.9, and -1.8, respectively, at Week 4 and -0.8, -0.9, -1.0, and -1.5, respectively, at Week 6. Statistically significant improvement in MAS score compared with placebo was reported only for the 500 U dose (Week 4: p < .001; Week 6: p = .049). Significant improvements in PGIC ratings compared with placebo were reported for DAXI 375 U (p = .015) and DAXI 500 U (p = .009) at Week 4 but not for any DAXI doses at Week 6. All DAXI doses were well tolerated with no trend toward more adverse events with increased dose.</p><p><strong>Conclusion: </strong>Results from this Phase 2 study indicate that DAXI 500 U is effective and well tolerated for treatment of adults with ULS.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352491","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":"Virtual reality training versus conventional rehabilitation for chronic neck pain: A systematic review and meta-analysis.","authors":"Jie Hao, Zhengting He, Ziyan Chen, Andréas Remis","doi":"10.1002/pmrj.13158","DOIUrl":"10.1002/pmrj.13158","url":null,"abstract":"<p><strong>Objective: </strong>To identify, critically appraise, and quantitatively synthesize current randomized controlled trials to compare the effects of virtual reality and dose-matched conventional exercises in patients with chronic neck pain.</p><p><strong>Literature search: </strong>PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched for studies published prior to April 15, 2023. The search strategies combined controlled vocabularies and title/abstract keywords on search themes of virtual reality and neck pain.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed using random-effects models.</p><p><strong>Synthesis: </strong>Six randomized controlled trials including 243 participants with chronic neck pain met the inclusion criteria. Four studies were evaluated as good quality and two as fair. Pooled analysis revealed that virtual reality demonstrated significantly better improvements in the Neck Disability Index in both the short term (mean difference [MD] = -2.16; 95% confidence interval [CI]: -3.50 to -0.82) and long term (MD = -2.95; 95% CI: -4.93 to -0.97), and pain intensity in the short term (MD = -0.94, 95% CI: -1.31 to -0.58). No significant between-group differences were found in pain in the long term and kinesiophobia.</p><p><strong>Conclusions: </strong>Virtual reality is a promising intervention to address disability and pain in patients with chronic neck pain. This review supports the clinical significance of augmenting conventional exercise with virtual reality as part of conservative management of chronic neck pain.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1143-1153"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306691","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}