Respiratory medicine最新文献

{"title":"Critical care considerations of chimeric antigen receptor (CAR) T-cell therapy","authors":"Anoosha Ponnapalli,&nbsp;Avneet Kaur Arora,&nbsp;Ayman O. Soubani","doi":"10.1016/j.rmed.2025.107958","DOIUrl":"10.1016/j.rmed.2025.107958","url":null,"abstract":"<div><div>Chimeric Antigen Receptor (CAR) T-cell therapies represents a major advancement in the treatment of refractory hematologic malignancies, with high remission rates for relapsed B-cell lymphomas and leukemias. However, it is associated with a broad spectrum of potentially life-threatening toxicities, many of which require intensive care unit (ICU) management. Key complications include Cytokine Release Syndrome (CRS) and Immune Effector Cell-associated Neurotoxicity Syndrome (ICANS), as well as severe infections, Immune Effector Cell-associated Hematotoxicity (ICAHT), coagulopathies, and organ dysfunctions resulting from the intense inflammatory response induced by CAR T-cells.</div><div>Approximately one third of patients undergoing CAR T-cell therapy require ICU admission. Among those patients, CRS is the leading indication. ICANS and sepsis are other major causes of admission to the ICU.</div><div>This review provides a comprehensive overview of ICU considerations for managing CAR T-cell-related toxicities, covering criteria for ICU admission, approaches to grading and treating complications, and interdisciplinary recommendations to optimize patient outcomes. Enhanced awareness and early intervention are critical in reducing ICU mortality and improving overall survival in patients receiving CAR T-cell therapy.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107958"},"PeriodicalIF":3.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143040936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of cardiac and lung ultrasonography in predicting weaning failure in patients with acute kidney injury requiring mechanical ventilation: A pilot study","authors":"Abhishek Arya ,&nbsp;Sonali Turki ,&nbsp;Sekar Loganathan ,&nbsp;Kamal Kajal ,&nbsp;L.N. Yaddanapudi ,&nbsp;Vikas Saini ,&nbsp;Smita Divyaveer ,&nbsp;Sant ram ,&nbsp;Anjishnujit Bandyopadhyay","doi":"10.1016/j.rmed.2025.107959","DOIUrl":"10.1016/j.rmed.2025.107959","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute Kidney Injury (AKI) has an incidence of 20–50 % in patients admitted in Intensive Care Unit. As weaning failure is associated with increased morbidity, its prediction and understanding of its physiological basis holds extreme importance in guided management and prognostication of these patients. We conducted this prospective, observational, single – center study to evaluate the efficacy of transthoracic echocardiography (TTE) and lung ultrasonography (LUS) in predicting weaning failure in patients with AKI requiring mechanical ventilation.</div></div><div><h3>Methods</h3><div>We performed LUS and TTE before and 2 h after initiating spontaneous breathing trials (SBT) in 32 mechanically ventilated critically ill patients with AKI. Extubation was decided by an independent physician. LUS included global and anterior LUS scores. TTE included measurement of E/A and E/e' ratios to determine LV filling pressures.</div></div><div><h3>Results</h3><div>Out of 32 patients included in this study, weaning failure was observed in 17 (n = 17, 53 %) patients (weaning success n = 15, 47%). Demographic and baseline laboratory parameters were comparable between the study groups. Fluid balance [+370 (250–530)] and SOFA score [8 (7–9)] on admission were significantly higher in weaning failure group (p &lt; 0.001, p = 0.049). LUS scores and difference between LUS scores before and at the end of the SBT were significantly higher among the weaning failure group. The model consisting of baseline variables, SOFA score on the day of weaning and SBT induced changes in global lung score showed highest ability to predict weaning failure with AUC of 0.965, R² = 61 %, p &lt; 0.001.</div></div><div><h3>Conclusion</h3><div>In mechanically ventilated critically ill patients with AKI, LUS scores can predict weaning failure after SBT.</div></div><div><h3>Ctri number</h3><div>CTRI/2020/12/029565.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107959"},"PeriodicalIF":3.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in treating patients with comorbid asthma and bronchiectasis","authors":"Mario Cazzola ,&nbsp;Luigino Calzetta ,&nbsp;Maria Gabriella Matera ,&nbsp;Paola Rogliani ,&nbsp;Vincenzo Patella","doi":"10.1016/j.rmed.2025.107957","DOIUrl":"10.1016/j.rmed.2025.107957","url":null,"abstract":"<div><div>The management of patients with overlapping asthma and bronchiectasis requires a tailored approach, starting with a comprehensive assessment of the patient's clinical profile, including the severity of asthma and the extent of bronchiectasis. Inhaled corticosteroids (ICS) are often recommended, but their use should be carefully monitored because of the risk of increased infection. If asthma is well controlled and bronchiectasis remains stable, a gradual reduction in the dose of ICS may be considered. Adjunctive therapies such as macrolides, which have anti-inflammatory and antimicrobial effects, or leukotriene receptor antagonists (LTRAs) may be beneficial. However, LTRAs should be used with caution in patients with bronchiectasis. Long-acting muscarinic antagonists (LAMA), especially in combination with ICS and long-acting beta-agonists (LABA), can improve bronchodilation and reduce inflammation. Although triple therapy (ICS/LABA/LAMA) is promising, its efficacy in bronchiectasis has not yet been confirmed by randomised controlled trials (RCTs). Ongoing monitoring is essential to adjust treatment as the patient's condition evolves. Preventive measures, including vaccination and regular sputum cultures, are important to minimize the risk of infection. Further research and RCTs are needed to better understand the role of dual bronchodilators and triple therapy in the management of overlapping asthma-bronchiectasis.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107957"},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New updates on hepatopulmonary syndrome: A comprehensive review","authors":"Andrew Z. Zaka ,&nbsp;Safwat A. Mangoura ,&nbsp;Marwa A. Ahmed","doi":"10.1016/j.rmed.2024.107911","DOIUrl":"10.1016/j.rmed.2024.107911","url":null,"abstract":"<div><div>Hepatopulmonary syndrome (HPS) is a serious pulmonary vascular complication that causes arterial hypoxemia in the setting of liver disease. HPS has a progressive course and is associated with a two-fold increased risk of mortality relative to cirrhotic patients without HPS. It primarily affects patients with portal hypertension. The key pathological features of HPS include intrapulmonary angiogenesis and vascular dilations (IPVDs). The prevalence of HPS varies widely due to inconsistent diagnostic criteria and a lack of standardized protocols. Despite advances in understanding its pathophysiology, no effective curative treatments for HPS exist. Liver transplantation remains the only definitive treatment, improving survival and altering the disease natural course. This review explores the pathophysiology, clinical features, and therapeutic strategies for HPS, highlighting recent advances in the literature.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107911"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of ensifentrine in COPD: A systemic review and meta-analysis","authors":"Ambanna Yappalparvi ,&nbsp;Ashok Kumar Balaraman ,&nbsp;G. Padmapriya ,&nbsp;Shilpa Gaidhane ,&nbsp;Irwanjot Kaur ,&nbsp;Madan Lal ,&nbsp;Suhaib Iqbal ,&nbsp;G.V. Siva Prasad ,&nbsp;Atreyi Pramanik ,&nbsp;Teena Vishwakarma ,&nbsp;Praveen Malik ,&nbsp;Promila Sharma ,&nbsp;Ankit Punia ,&nbsp;Megha Jagga ,&nbsp;Doddolla Lingamaiah ,&nbsp;Rachana Mehta ,&nbsp;Sanjit Sah ,&nbsp;Quazi Syed Zahiruddin ,&nbsp;Hashem Abu Serhan ,&nbsp;Muhammed Shabil ,&nbsp;Ganesh Bushi","doi":"10.1016/j.rmed.2024.107863","DOIUrl":"10.1016/j.rmed.2024.107863","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) significantly impacts global health due to persistent airflow limitation and inflammation. Despite standard therapies, symptoms persist. Ensifentrine, targeting both bronchoconstriction and inflammation as a dual phosphodiesterase 3 and 4 inhibitor, offers a promising therapeutic advancement for COPD management. This meta-analysis evaluates the safety and efficacy of ensifentrine in improving lung function, dyspnea, and quality of life in COPD patients.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Web of Science through August 2024 for randomized controlled trials evaluating ensifentrine in COPD patients over a minimum of four weeks. Data extraction and screening utilized Knowledge software, and meta-analyses were performed using R v4.4 with a random-effects model.</div></div><div><h3>Results</h3><div>From 206 studies identified, four met our inclusion criteria. Ensifentrine improved FEV1 significantly at a dose of 3 mg (LS mean difference: 40.90 mL; 95 % CI: 19.65–62.15). It also improved dyspnea as measured by the Transition Dyspnea Index (TDI) (LS mean difference: 0.91; 95 % CI: 0.61–1.21) and quality of life according to the St. George's Respiratory Questionnaire-C (SGRQ-C) scores (LS mean difference: −1.92; 95 % CI: −3.28 to −0.55). Safety profiles were comparable between the ensifentrine and placebo groups, with no significant increase in treatment-emergent adverse events (TEAEs) (RR: 1.02; 95 % CI: 0.94–1.10).</div></div><div><h3>Conclusion</h3><div>Ensifentrine significantly enhances lung function, reduces dyspnea, and improves quality of life in COPD patients, especially at a 3 mg dose. These benefits, coupled with a stable safety profile, support its use as an adjunctive therapy in COPD management.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107863"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pragmatic screening tool for identification of chronic hypercapnia in patients with chronic obstructive pulmonary disease","authors":"Patricia J. Checinski ,&nbsp;Catherine Meldrum ,&nbsp;Wassim W. Labaki ,&nbsp;Philip J. Choi","doi":"10.1016/j.rmed.2024.107888","DOIUrl":"10.1016/j.rmed.2024.107888","url":null,"abstract":"","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107888"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A quantitative method for assessing treatment-related changes within the airway mucosa in patients with chronic bronchitis","authors":"William S. Krimsky ,&nbsp;Paul A. VanderLaan ,&nbsp;Jeffrey S. Iding ,&nbsp;David W. Hunter ,&nbsp;Beryl A. Hatton ,&nbsp;Brett Bannan ,&nbsp;Victor Kim","doi":"10.1016/j.rmed.2024.107889","DOIUrl":"10.1016/j.rmed.2024.107889","url":null,"abstract":"<div><h3>Background</h3><div>No standardized method has yet been established for evaluating airway mucosal aberrancies associated with chronic obstructive pulmonary disease (COPD) or chronic bronchitis (CB). While goblet cell hyperplasia (GCH) is an established pathognomonic hallmark of the CB disease process, no standardized method exists for acquiring mucosal biopsies and assessing morphologic airway mucosa alterations. Additionally, the impacts from interventions targeting the airway mucosa are not well defined. In this context, a reliable and robust measure for assessing airway mucosa at baseline and subsequent to an intervention is critical for characterizing treatment-related changes.</div></div><div><h3>Research question</h3><div>Can standardizing airway biopsy tissue collection and histopathological assessment methods generate a robust and repeatable measure to assess airway mucosa tissue characteristics in the setting of COPD/CB?</div></div><div><h3>Study design &amp; methods</h3><div>Initial tissue collection and histological assessment methods were designed by integrating various aspects from previously published evaluations, applied to an initial tissue sample cohort, and then iteratively refined by independent pathologists.</div></div><div><h3>Results</h3><div>A standardized metric for histologic airway mucosa assessments was developed that specified tissue collection methods, including re-sampling airways at multiple time points to enable evaluation of treatment-related effects by incorporating scores for GCH, eosinophilia, and chronic inflammation, and the degree of GCH heterogeneity present within each sample.</div></div><div><h3>Conclusion</h3><div>This multi-center study generated a robust, reproducible approach for assessing airway mucosa aberrancies in the setting of COPD/CB. The iterative approach established consistent tissue specimen recovery and a granular scoring matrix that enabled quantitative scoring of the various tissue findings with substantial histopathologic interrater reliability.</div></div><div><h3>Clinical trial registration number</h3><div>ClinicalTrials.gov; NCT03107494, NCT04677465; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span>.</div><div>Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12617000330347; URL: anzctr.org.au.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107889"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azithromycin's role in COVID-19 outcomes: Antibacterial or antiviral action?","authors":"Chia Siang Kow,&nbsp;Dinesh Sangarran Ramachandram,&nbsp;Syed Shahzad Hasan,&nbsp;Kaeshaelya Thiruchelvam","doi":"10.1016/j.rmed.2024.107902","DOIUrl":"10.1016/j.rmed.2024.107902","url":null,"abstract":"","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107902"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of physiotherapy modalities on persisting dyspnoea in long COVID: A systematic review and meta-analysis","authors":"Christophe Romanet ,&nbsp;Johan Wormser ,&nbsp;Marine Cachanado ,&nbsp;María Granados Santiago ,&nbsp;Gilles Chatellier ,&nbsp;Marie Carmen Valenza ,&nbsp;François Philippart","doi":"10.1016/j.rmed.2024.107909","DOIUrl":"10.1016/j.rmed.2024.107909","url":null,"abstract":"<div><h3>Background</h3><div>Dyspnoea is often found months and years later in the “long-covid” syndrome, impairing quality of life and further perpetuating anxiety and post-traumatic stress disorders. Physiotherapy was recommended as a treatment in long-covid, but there is still insufficient evidence on its effectiveness.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature search on MEDLINE, PEDro, WOS, Scopus, VHL and the Cochrane Library until July 2023 (PROSPERO registration number: CRD42023427464). We selected comparative trials including adults with persistent breathlessness following COVID-19, regardless of the initial severity, for whom physiotherapy was implemented as a treatment for dyspnoea. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the study quality using the PEDro Scale.</div></div><div><h3>Results</h3><div>19 studies that included 1292 adults fulfilled the inclusion criteria, of which 15 were randomised controlled trials and 4 non-randomised controlled trials. As for the rehabilitation modalities, 6 studies used respiratory muscle training, 6 studies used low to moderate intensity rehabilitation, 6 used high intensity rehabilitation and one used passive rehabilitation. The methods used between and within each group differed greatly, leading to an expected high heterogeneity of results. Nethertheless the random-effects model found a significant difference favouring physiotherapy (SMD -0.63, 95 CI [-1.03; −0.24], p &lt; 0.001, <em>I</em>² = 88 %). Subgroup analysis showed a significant effect in the high intensity rehabilitation group alone, with null heterogeneity.</div></div><div><h3>Conclusion</h3><div>In people suffering from dyspnoea following a SARS-CoV-2 infection, physiotherapy and especially pulmonary rehabilitation may help alleviate respiratory symptoms. Future studies will need to provide more consistent rehabilitation methods and better descriptions of them so as to reveal clear effects and avoid the confusion caused by using too many rehabilitation modalities.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107909"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dupilumab reduces exacerbations and improves lung function in patients with chronic obstructive pulmonary disease and emphysema: Phase 3 randomized trial (BOREAS)","authors":"Surya P. Bhatt ,&nbsp;Klaus F. Rabe ,&nbsp;Nicola A. Hanania ,&nbsp;Claus F. Vogelmeier ,&nbsp;Mona Bafadhel ,&nbsp;Stephanie A. Christenson ,&nbsp;Alberto Papi ,&nbsp;Dave Singh ,&nbsp;Elizabeth Laws ,&nbsp;Paula Dakin ,&nbsp;Jennifer Maloney ,&nbsp;Xin Lu ,&nbsp;Deborah Bauer ,&nbsp;Ashish Bansal ,&nbsp;Lacey B. Robinson ,&nbsp;Raolat M. Abdulai","doi":"10.1016/j.rmed.2024.107846","DOIUrl":"10.1016/j.rmed.2024.107846","url":null,"abstract":"<div><h3>Background</h3><div>Dupilumab, a fully human monoclonal antibody that blocks the shared receptor component for interleukin-4 and interleukin-13, reduced exacerbations and improved lung function in patients with chronic obstructive pulmonary disease (COPD) and type 2 inflammation in the phase 3 BOREAS trial.</div></div><div><h3>Objective</h3><div>To assess clinical outcomes in patients from BOREAS by emphysema status.</div></div><div><h3>Methods</h3><div>Patients with COPD and type 2 inflammation (screening blood eosinophils ≥300 cells/μL) on maximal inhaled therapy were randomized to add-on dupilumab 300 mg or placebo every 2 weeks for 52 weeks. We assessed the annualized moderate/severe COPD exacerbation rates over 52 weeks and change from baseline to Week 12 in prebronchodilator forced expiratory volume in 1 s (FEV₁) in patients with and without investigator-reported emphysema.</div></div><div><h3>Results</h3><div>Investigator-reported emphysema was present in 306/939 patients (32.6 %) at baseline. Dupilumab reduced exacerbation rates vs placebo by 29 % (relative risk [RR] 0.71 [95 % CI 0.53–0.95]) and 31 % (RR 0.69 [95 % CI 0.53–0.89]) in patients with and without emphysema, respectively. Prebronchodilator FEV₁ least squares mean difference from baseline to Week 12 for dupilumab vs placebo was 0.07 L ([95 % CI 0.002–0.14]) and 0.09 L ([95 % CI 0.04–0.14]) in patients with and without emphysema, respectively. No treatment by emphysema interaction effect was observed for the annualized rate of exacerbations (<em>P</em> value for interaction = 0.8296) or change in prebronchodilator FEV₁ (<em>P</em> value for interaction = 0.6438).</div></div><div><h3>Conclusion</h3><div>Dupilumab efficacy was similar in patients with COPD and type 2 inflammation, with or without investigator-reported emphysema.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107846"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}