Respiratory care最新文献

{"title":"Neonatal Noninvasive Ventilation Nasal Mask Interface Pressure and the Inter-Individual Variation of Mask Placement.","authors":"Anne D Zakrajsek, Lissy Kesterson, Marty O Visscher, Vivek Narendran, Orlando S Hoilett, Eric A Nauman","doi":"10.4187/respcare.12217","DOIUrl":"10.4187/respcare.12217","url":null,"abstract":"<p><p><b>Background:</b> The 2014 American Academy of Pediatrics recommendation for CPAP as an alternative to mechanical ventilation for treatment of neonatal respiratory distress prompted a rapid shift to noninvasive respiratory support. Since most patients receive nasal bubble CPAP a concomitant increase in nasal pressure injuries followed. This prospective observational study aimed to develop strategies to reduce nasal mask pressure injury in neonates by (1) quantifying CPAP mask-interface pressure and (2) assessing placement variability. <b>Methods:</b> A micro-electromechanical systems pressure sensor was modified for contact pressure measurements with silicone embedding and calibrated. The CPAP generator and interface components were sized for a 24-week neonatal simulator. Thirteen neonatal ICU staff placed the simulator on CPAP at 6 cm H₂O and 8 L/min of flow with no humidification. Pressure was measured at 3 locations (the forehead, nasal bridge, and philtrum) in triplicate (3 measurements/site). Descriptive statistics; a location-specific, one-way analysis of variance with a Tukey post hoc test; and a 2-sample paired <i>t</i> test of the means of the first and last triplicate were performed. <b>Results:</b> Pressure ranged from 12-377.3 mm Hg. The mean [SD] interface pressure at the philtrum was significantly higher than both the nasal bridge and the forehead (philtrum 173.9 [101.3], nasal bridge 67.8 [28.9], and forehead 79.0 [36.9], <i>P</i> < .001). CPAP fixation varied, including bonnet placement, trunk angle, mask compression, use of hook and loop extenders, and level of vigorous bubble feedback achieved. <b>Conclusions:</b> This study developed a modified pressure sensor for quantifying the pressure exerted by a nasal mask on facial skin. Maximum pressures were higher than those previously reported. Inter-individual differences were present in both quantitative and qualitative measures of pressure. Reduction of NIV-associated pressure injuries may be achieved through NIV fixation technique training and improved nasal mask stability and size increments.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392830","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":"The Effect of Respiratory Therapist Case Managers Integrated into COPD Clinical Care.","authors":"Krystal M Craddock, Jimmy Nguyen, Michael Schivo, Samuel Louie, Nicholas J Kenyon, Brooks T Kuhn","doi":"10.1089/respcare.11728","DOIUrl":"10.1089/respcare.11728","url":null,"abstract":"<p><p><b>Background:</b> Personalized education and treatment selection can improve health behaviors and outcomes in patients with COPD. However, many patients with COPD have incomplete knowledge of their disease, which leads to undertreated symptoms. We hypothesized that an interdisciplinary care approach to COPD with respiratory therapists (RTs) integrated in our dedicated clinic will significantly affect care as measured by COPD Assessment Test (CAT) scores, exacerbation rates, and COPD-related hospitalizations. <b>Methods:</b> This study was a retrospective analysis of patients enrolled in the UC Davis Comprehensive COPD Clinic registry. Between January 2018-January 2020, 241 patients were seen. Patients screened (<i>n =</i> 101) had been followed 12 months post initial COPD clinic visit. Two subjects were excluded from analysis due to discrepancies in CAT assessments, leaving 99 subjects in total. The clinic RT provided assessment, education, and treatment recommendations. We collected CAT scores, exacerbation rates, and those that required hospitalization in the 12 months prior to and after the initial COPD clinic visit. Analysis for CAT is reported as median and interquartile range (IQR), with differences determined by Wilcoxon test. Summary data are reported as percentages, 95% CI, and chi-square test. <b>Results:</b> The initial median CAT score was 22 (IQR 7-34), and 2-month follow-up CAT median was 19 (IQR 11-24, <i>P</i> < .001). There were 115 exacerbations in the 12-month period prior to the initial clinic visit and 63 exacerbations in the 12 months post clinic visit (<i>P</i> = .006). In the 12-month period prior to the clinic visit, there were 44 hospital admissions for COPD exacerbations compared to 20 hospital admissions for COPD exacerbations in the 12 months after initial clinic visit (<i>P</i> = .06). <b>Conclusions:</b> Our retrospective study demonstrated significant improvements in symptoms and exacerbation rates and a non-significant reduction in hospitalizations for COPD. This suggests that an RT-facilitated program may improve meaningful clinical outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450078","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":"Comparison of Spontaneous Breathing Trials in Clinical Practice and Current Clinical Practice Guidelines.","authors":"Morgan E Sorg, Kristen L McHenry","doi":"10.1089/respcare.12478","DOIUrl":"10.1089/respcare.12478","url":null,"abstract":"<p><p><b>Background:</b> The literature suggests there is variability in the clinical practice of spontaneous breathing trials (SBTs). Evidence-based literature and clinical practice guidelines (CPGs) have been published over time to address various aspects of SBT implementation. It can take many years for evidence-based recommendations to be adopted into clinical practice. The American Association for Respiratory Care recently published a CPG addressing 4 aspects of SBT implementation. <b>Methods:</b> This study evaluated how the clinical practice of SBTs compares to the recommendations of the CPG. An online survey was developed to assess how hospitals with SBT protocols perform different components of SBTs. Descriptive statistics were used in the data analysis. <b>Results:</b> A total of 26 representatives from different health care institutions in the United States met the criteria for data analysis; 61.5% of reported protocols use rapid shallow breathing index, which is not in alignment with the current recommendation; 77% reported the use of pressure support (PS); 11.5% specified the use of a T-piece, and 11% specified the option of either PS or T-piece during the SBT. The responses were 100% in alignment with the current recommendation of performing a SBT with or without support; 73.1% aligned with having a standardized approach to performing SBTs by specifying when the SBT will be initiated; 65.4% perform an SBT during the day, though it was not specified if it occurs before noon each day; 53.8% allow for an increase in F_IO₂ during an SBT, which is not in alignment with the current recommendations. <b>Conclusions:</b> The reported hospitals' protocols demonstrated moderate alignment with the 4 CPG recommendations. Identifying current discrepancies between clinical practice and CPGs will allow for the assessment of the adoption of recommendations into clinical practice over time. Further assessment could be performed to determine if there is an impact on patient outcomes.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449987","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":"Classification of Patients Based on Dyspnea and Desaturation During Exercise in Interstitial Lung Disease.","authors":"Kohei Otake, Shogo Misu, Akio Yamamoto, Takumi Yamaguchi, Chisato Nagatani, Hideki Sakai, Masahiro Kaneko, Akira Ishikawa, Hiromi Tomioka","doi":"10.1089/respcare.11712","DOIUrl":"10.1089/respcare.11712","url":null,"abstract":"<p><p><b>Background:</b> Dyspnea and desaturation during exercise are essential assessment items for pulmonary rehabilitation. Characterizing patients using these 2 factors may be important for providing more effective pulmonary rehabilitation. This study aimed to categorize subjects with interstitial lung disease (ILD) using dyspnea and desaturation at the end of the 6-min walk test (6MWT). <b>Methods:</b> This was a retrospective study including 230 stable subjects with ILD who underwent 6MWT in our out-patient department at a general hospital in Japan. The modified Borg scale and oxygen saturation determined by S_pO₂ at the end of the 6MWT were used for cluster analysis using the <i>k</i>-means method with <i>k</i> = 4. <b>Results:</b> Subjects were classified into 4 characteristic clusters. S_pO₂ at the end of the 6MWT was lower in cluster 4 (80.5 ± 3.0%) than in clusters 1 (94.3 ± 2.0%), 2 (94.3 ± 1.9%), and 3 (87.9 ± 1.8%) and was lower in cluster 3 than in clusters 1 and 2. The modified Borg scale score at the end of the 6MWT was higher in clusters 2 (4 [3-8]), 3 (3 [0-9]), and 4 (4 [0-7]) than in cluster 1 (0.5 [0-2.0]) and was higher in cluster 2 than in cluster 3. <b>Conclusions:</b> Subjects with ILD were classified into 4 characteristic clusters using dyspnea and S_pO₂ at the end of the 6MWT. The 4 clusters are characterized as follows: Cluster 1 had mild desaturation and mild dyspnea; cluster 2 had mild desaturation and severe dyspnea; cluster 3 had both moderate desaturation and dyspnea, and cluster 4 had both severe desaturation and dyspnea. These classification data offer insight for individualized pulmonary rehabilitation for patients with ILD.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"56-64"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11824878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449843","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":"Efficacy of Noninvasive Ventilation With Expiratory Washout in Stable COPD Patients.","authors":"Stacey Kung, Alex C Semprini, Louis W Kirton, Jess R Fogarin, Sascha K Zoellner, Richard Beasley, Allie Eathorne, Ruth A C Semprini","doi":"10.1089/respcare.11876","DOIUrl":"10.1089/respcare.11876","url":null,"abstract":"<p><p><b>Background:</b> A noninvasive ventilation (NIV) mask has been designed to deliver NIV with expiratory washout to improve efficacy of ventilation by optimizing clearance of expired gases from the anatomic dead space. This study compared the performance and comfort of a novel investigational mask with expiratory washout with a conventional mask during NIV therapy. <b>Methods:</b> In this pilot crossover study, participants with severe stable COPD attended a single visit to receive bi-level NIV through 2 masks; the investigational mask with expiratory washout and a conventional mask. The order of mask use was randomly allocated, and each mask was used for 60 min with a 30-60-min washout in between. The primary outcome was transcutaneous carbon dioxide at 60 min. Other physiologic and NIV device variables were also assessed. <b>Results:</b> The mean difference (95% CI) in the transcutaneous carbon dioxide between the investigational and conventional masks at 60 min, adjusted for baseline, was -0.74 mm Hg, 95% CI -2.81 to 1.33 mm Hg (<i>P</i> = .45). The investigational mask with expiratory washout elicited a lower tidal volume (-128.7 mL, 95% CI -190.0 to -67.3 mL; <i>P</i> < .001) and minute ventilation (-2.28 L/min,^, 95% CI -3.12 to -1.43 L/min; <i>P</i> < .001), and a higher leak (7.96 L/min, 95% CI 4.39-11.54 L/min; <i>P</i> < .001) than the conventional mask. There were no differences in other physiologic responses or ratings of dyspnea or comfort. <b>Conclusions:</b> NIV therapy delivered by using a novel mask with expiratory washout was similarly effective at reducing transcutaneous carbon dioxide, whereas the delivered tidal volume and minute ventilation were significantly lower when compared with a conventional mask in participants with severe COPD.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"29-37"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11824877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449915","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":"Class III Obesity as a Risk Factor for Persistent Asthma.","authors":"Yonsu Kim, Sheniz Moonie, Ji Won Yoo, Tae-Ha Chung","doi":"10.1089/respcare.11934","DOIUrl":"https://doi.org/10.1089/respcare.11934","url":null,"abstract":"<p><p><b>Background:</b> The burden of asthma remains steady with no decline observed in the past few decades. Obesity prevalence has been steadily increasing with a rate of 41.9% in the United States between 2017-2020. Obesity is an inflammatory chronic condition that may partially contribute to the burden and severity of asthma. This study aimed to examine whether the association between obesity and asthma varies with the categories of obesity (class I, II, and III) and persistent asthma (mild, moderate, and severe asthma). We hypothesized that subjects with elevated body mass index (BMI) are more likely to be diagnosed with persistent asthma than subjects without obesity with asthma. <b>Methods:</b> As a retrospective and cross-sectional study, this study used a total of 1,977 records of subjects with asthma (age ≥ 19 y) hospitalized in Nevada between 2016-2021. BMI and persistent asthma were evaluated as the main exposure and outcome of interest. Logistic regression was used to estimate the magnitude of the association between obesity and persistent asthma. <b>Results:</b> Among the selected subject records, subjects with obesity were more likely to be diagnosed with persistent asthma compared to subjects without obesity (odds ratio 1.50 [CI 1.10-2.05]). Subgroup analyses revealed that subjects with class III obesity (BMI ≥ 40) were more likely than subjects without obesity to be diagnosed with mild persistent asthma (odds ratio 2.21 [CI 1.18-4.16]) and severe persistent asthma (odds ratio 1.74 [CI 1.12-2.70]). <b>Conclusions:</b> Obesity was identified as a risk factor for persistent asthma, particularly class III obesity. This in turn increases the potential for greater health care utilization and economic burden. Public health and clinical interventions are necessary among those with comorbid asthma and obesity.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"100-107"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449657","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":"Ventilation Monitoring Using a Noninvasive Bioelectrical Impedance Device in Critically Ill Children.","authors":"Andrew G Miller, Jordan Pung, Karan R Kumar, Alexandre T Rotta","doi":"10.1089/respcare.12341","DOIUrl":"https://doi.org/10.1089/respcare.12341","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"108-111"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449947","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":"Esophageal Pressure Measurements to Predict Alveolar Recruitment and Overdistension in Patients With ARDS.","authors":"Arnaud W Thille, Sylvain Le Pape","doi":"10.1089/respcare.12624","DOIUrl":"https://doi.org/10.1089/respcare.12624","url":null,"abstract":"","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"112-114"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449917","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":"Impact of High-Flow Nasal Cannula Oxygen Therapy on the Pressure of the Airway System in Humans.","authors":"Darío S Villalba, Amelia Matesa, Sabrina Boni, Facundo J Gutiérrez, Roque Moracci, Gustavo A Plotnikow","doi":"10.1089/respcare.12082","DOIUrl":"https://doi.org/10.1089/respcare.12082","url":null,"abstract":"<p><p><b>Background:</b> The understanding of how pharyngeal pressure is transmitted to the trachea with high-flow nasal cannula (HFNC) implementation and the behavior of tracheal pressure in the presence of mouth leaks remains controversial. This study aimed to assess the impact of HFNC administration on tracheal pressure by comparing measurements taken with open and closed mouth with varying flows. <b>Methods:</b> A crossover study was conducted between March 2019 and June 2023. Subjects age > 18 years, with a tracheostomy and who were in the process of decannulation were included. Tracheal and pharyngeal pressures were measured by using specific devices, with different HFNC flows and mouth conditions. <b>Results:</b> Nine subjects were assessed: 77% women, with an average age of 60.5 years. Tracheal pressure was significantly higher than pharyngeal pressure only in baseline conditions (<i>P</i> = .03). With regard to the rest of the scenarios, there were no significant differences between both pressures. Tracheal pressure was higher than the baseline condition both with an open mouth and a closed mouth (<i>P</i> = .02). The tracheal pressure at 60 L/min with an open mouth was higher than at 40 L/min (<i>P</i> = .042). The median pharyngeal pressure with a closed mouth was higher than with an open mouth, both with 40 and 60 L/min of flow (<i>P</i> = .048 and <i>P</i> < .001, respectively). Pharyngeal pressure at 60 L/min with an open mouth was higher than both baseline condition and at 40 L/min (<i>P</i> = .002 and <i>P</i> = .043, respectively). However, pharyngeal pressure with the closed mouth was significantly higher than with the open mouth both with 40 and 60 L/min of flow (<i>P</i> = .031 and <i>P</i> = .02 respectively). <b>Conclusions:</b> The implementation of HFNC changes airway pressures with values that impact at a tracheal level as flow increases. Our data contribute to the difficult interpretation of the existing interrelation between the flow and its effects on the respiratory system.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"10-16"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449925","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":"Adherence to Lung Protective Ventilation in ARDS: A Mixed Methods Study Using Real-Time Continuously Monitored Ventilation Data.","authors":"Joseph M Plasek, Peter C Hou, Wenyu Zhang, Carlos A Ortega, Daniel Tan, Benjamin J Atkinson, Ya-Wen Chuang, Rebecca M Baron, Li Zhou","doi":"10.1089/respcare.12183","DOIUrl":"https://doi.org/10.1089/respcare.12183","url":null,"abstract":"<p><p><b>Background:</b> Lung-protective ventilation is a standard intervention for mitigating ventilator-induced lung injury in patients with ARDS. Despite its efficacy, adherence to contemporary evidence-based guidelines remains suboptimal. We aimed to identify factors that affect the adherence of staff to applying lung-protective ventilation guidelines by analyzing real-time, continuously monitored ventilation data over a 5-year longitudinal period. <b>Methods:</b> We conducted retrospective cohort and qualitative studies. Subjects with billing code J80 who survived at least 48 h of continuous mandatory ventilation with volume control in critical care settings between January 1, 2018, and December 31, 2022, were eligible. Tidal volume was measured dynamically (1-min resolution) and averaged hourly. The lung-protective ventilation setting studied was ≤6 mL/kg predicted body weight. A subgroup analysis was conducted by considering COVID-19 status. Focus groups of critical-care providers were convened to investigate the possible reasons for the non-utilization of lung-protective ventilation. <b>Results:</b> Among 1,055 subjects, 42.4% were on lung-protective ventilation settings at 48 h. Male sex was correlated with lung-protective ventilation (odds ratio [OR] 1.63, 95% CI 1.08-2.47), whereas age ≥60 y was associated with no lung-protective ventilation use (OR 0.61, 95% CI 0.39-0.94] in the subjects with non-COVID-19 etiologies. Improved staff adherence was observed in the subjects with COVID-19 early in the pandemic when COVID-19 (OR 1.48, 95% CI 1.07-2.04), male sex (OR 2.42, 95% CI 1.79-3.29), and neuromuscular blocking agent use within 48 h (OR 1.69, 95% CI 1.25-2.29) were correlated with staff placing subjects on lung-protective ventilation. However, lung-protective ventilation use occurred less frequently by staff managing subjects with cancer (OR 0.59, 95% CI 0.35-0.99) and hypertension (OR 0.62, 95% CI 0.45-0.85). Focus groups supported these findings and highlighted the need for an accurate height measurement on unit admission to determine the appropriate target tidal volume. <b>Conclusions:</b> Staff are not yet universally adherent to lung-protective ventilation best practices. Strategies, for example, continuous monitoring, with frequent feedback to clinical teams may help.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":"70 1","pages":"17-28"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450091","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}