Revista clinica espanola最新文献

{"title":"Protocolo de actuación básica para el manejo ambulatorio de la insuficiencia cardiaca crónica de la Sociedad Española de Medicina Interna","authors":"J.M. Cerqueiro-González ,&nbsp;A. González-Franco ,&nbsp;J.M. Fernández-Rodríguez ,&nbsp;E. Martínez-Litago ,&nbsp;J. Pérez-Silvestre ,&nbsp;P. Salamanca-Bautista ,&nbsp;L. Morales-Rull ,&nbsp;A. Conde-Martel ,&nbsp;J. Casado ,&nbsp;O. Aramburu-Bodas ,&nbsp;L. Manzano-Espinosa ,&nbsp;ET AL. la relación completa de colaboradores de este artículo se especifica dentro del texto","doi":"10.1016/j.rce.2024.06.015","DOIUrl":"10.1016/j.rce.2024.06.015","url":null,"abstract":"<div><div>Chronic heart failure (CHF) represents a challenge for the healthy system due to its high prevalence, high burden of morbidity and mortality, and high consumption of health resources.</div><div>To address this problem, it is necessary to develop efficient management strategies that include both hospital care and outpatient care. The primary objective is to stabilize the patient and prevent decompensation, with the consequent improvement in quality of life, reduction in hospital admissions and emergency department care, and, consequently, reduction in healthcare costs.</div><div>In this context, the heart failure and atrial fibrilation working group of the Spanish Society of Internal Medicine has developed a protocol for the management of outpatient CHF, that addresses, from the perspective of Internal medicine, all the problems suffered by the patient with CHF.</div><div>This protocol aims to optimize pharmacological treatment, control cardiovascular risk factors and various comorbidities, educate the patient and their environment about the disease, promote adherence to treatment and stablish follow-up adapted to their condition.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 679-693"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757363","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":"Transmisión de un brote de sarampión en la sala de espera de urgencias: el papel de la vacunación","authors":"A. Hernández-Aceituno ,&nbsp;I. Falcón García ,&nbsp;E. Marrero Marichal ,&nbsp;D. Sanabria Curbelo ,&nbsp;Á. Torres Lana ,&nbsp;E. Larumbe-Zabala","doi":"10.1016/j.rce.2024.07.005","DOIUrl":"10.1016/j.rce.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Measles is one of the most contagious infectious diseases. Spain was declared free of endemic measles transmission in 2017. However, less than half of EU/EEA countries have achieved vaccination coverage goals and measles outbreaks have been reported recently, some of them in healthcare facilities. The aim of this study was to present an outbreak in the pediatric emergency (ER) waiting room affecting a vaccinated healthcare worker.</div></div><div><h3>Methods</h3><div>Descriptive study of an outbreak whose transmission occurred in the pediatric ER waiting room of a tertiary level hospital on the island of Tenerife (Canary Islands, Spain) in April 2024.</div></div><div><h3>Results</h3><div>Between April 23 and May 12, 2024, 4<!--> <!-->PCR-confirmed measles cases were identified, resulting in 407 contacts in healthcare center waiting rooms. One of the cases was a 26-year-old male nurse who had been correctly vaccinated with 2<!--> <!-->doses of measles, mumps, and rubella vaccine during childhood. Between May 7 and 10, during his infective period, he took 2<!--> <!-->two-and-a-half-hour flights and lived together with 9<!--> <!-->people during a trip. No evidence of infection has been identified among the individuals with whom he lived neither the passengers and crew of the 2<!--> <!-->flights.</div></div><div><h3>Conclusions</h3><div>In the emergency waiting room, an unvaccinated girl gave measles to 2<!--> <!-->infants who were not yet old enough to be vaccinated and to a nurse who had been properly vaccinated as an infant. Despite generating more than 300 close contacts, the nurse did not infect anyone, suggesting that vaccination may help prevent both infection and transmission of measles.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 646-649"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757358","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":"Abordaje terapéutico de las crisis agudas de porfirias hepáticas","authors":"M. Garrido Montes,&nbsp;R. Pertusa Mataix,&nbsp;J.S. Garcia Morillo","doi":"10.1016/j.rce.2024.07.004","DOIUrl":"10.1016/j.rce.2024.07.004","url":null,"abstract":"<div><div>Acute hepatic porphyria is a genetic disorder affecting enzymes involved in HEME biosynthesis. The most common subtype is acute intermittent porphyria, accounting for 80% of cases. Other types include hereditary coproporphyria, variegate porphyria, and delta-aminolevulinic acid dehydratase deficiency.</div><div>Attacks in acute hepatic porphyria are triggered by the induction of hepatic ALA synthase 1, leading to the accumulation of neurotoxic heme intermediates, delta-aminolevulinic acid, and porphobilinogen. Women experience attacks more frequently than men.</div><div>Acute porphyria attacks are characterized by severe, diffuse abdominal pain, muscle weakness, autonomic neuropathy (including hypertension, tachycardia, nausea, vomiting, and constipation), and changes in mental status. Early recognition of the disease is crucial as it requires urgent medical attention and treatment. Management includes intravenous opioids, glucose, hemin, and the removal of triggering factors.</div><div>Preventive treatment options include hormone suppression therapy, off-label prophylactic hemin, givosiran, and exceptionally liver transplantation.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 664-669"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757361","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":"Características clínicas, manejo en urgencias y mortalidad de los episodios de insuficiencia cardiaca aguda en pacientes con enfermedad pulmonar obstructiva crónica","authors":"N. Ivars ,&nbsp;P. Llorens ,&nbsp;A. Alquézar ,&nbsp;J. Jacob ,&nbsp;B. Rodríguez ,&nbsp;M. Guzmán ,&nbsp;L. Serrano Lázaro ,&nbsp;M.C. Martínez Picón ,&nbsp;L. Cuevas Jiménez ,&nbsp;Ò. Miró ,&nbsp;en representación del grupo de investigación ICA-SEMES","doi":"10.1016/j.rce.2024.07.008","DOIUrl":"10.1016/j.rce.2024.07.008","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to analyse differences in clinical and therapeutic management for patients with chronic obstructive pulmonary disease (COPD) who present to the emergency department with acute heart failure (AHF). Additionally, it examines mortality rates during such episodes.</div></div><div><h3>Method</h3><div>We included patients diagnosed with AHF at 50 Spanish emergency departments from 2012 to 2022 who also had COPD. We compared their baseline characteristics, decompensation episodes, and emergency department management with those of AHF patients without COPD during the same period. We collected data on in-hospital and 30-day all-cause mortality, investigating differences between the two groups using crude and adjusted logistic regression models.</div></div><div><h3>Results</h3><div>A total of 21,694 AHF patients were analysed (median age<!--> <!-->=<!--> <!-->83 years, 56% female), including 4,942 (23%) with COPD. COPD patients were generally younger and more frequently male, with a higher prevalence of comorbidities (excluding valve disease and dementia, which were more common in non-COPD patients). They exhibited a worse respiratory functional class (NYHA) but a better overall functional capacity (Barthel Index). Decompensation in COPD patients was more often triggered by infection and less frequently by tachyarrhythmia, hypertensive crisis, or acute coronary syndrome. While there were differences in clinical findings in the emergency department, the severity assessed by the MEESSI-AHF Scale was similar across both groups. In terms of emergency department management, a higher proportion of COPD patients received oxygen therapy, non-invasive ventilation, bronchodilators, corticosteroids, and antibiotics, while fewer received intravenous nitroglycerin, and they were hospitalized more frequently. In-hospital mortality rates were 8.1% for patients with COPD and 7.5% for those without (OR<!--> <!-->=<!--> <!-->1.088, 95% CI<!--> <!-->=<!--> <!-->0.968-1.224), with 30-day mortality rates of 11.0% and 10.0%, respectively (OR<!--> <!-->=<!--> <!-->1.111, 95% CI<!--> <!-->=<!--> <!-->1.002-1.231). After adjusting for clinical characteristics, decompensation episodes, and emergency department management, these odds ratios decreased to 1.040 (95% CI<!--> <!-->=<!--> <!-->0.905-1.195) and 1.080 (95% CI<!--> <!-->=<!--> <!-->0.957-1.219), respectively.</div></div><div><h3>Conclusion</h3><div>Patients with AHF and COPD exhibit distinct clinical and therapeutic management characteristics in the emergency department and require more frequent hospitalization. Although they show higher crude 30-day mortality, this is attributable to their differing clinical profiles rather than the presence of COPD itself.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 634-645"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757415","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":"Incidencia de embolia pulmonar relacionada con el embarazo en España 2016-2021: un estudio observacional retrospectivo de base poblacional","authors":"J.A. Rueda Camino ,&nbsp;A. Azcoaga-Lorenzo ,&nbsp;R. Noguero Meseguer ,&nbsp;D. Joya Seijo ,&nbsp;M.A. García ,&nbsp;D. Trujillo ,&nbsp;C. Miranda ,&nbsp;R. Barba-Martín","doi":"10.1016/j.rce.2024.06.014","DOIUrl":"10.1016/j.rce.2024.06.014","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to estimate the overall and annual age-standardized incidence of pregnancy-related pulmonary embolism (PE) in Spain from 2016 to 2021, explore the distribution of PE events during pregnancy and the postpartum period, identify potential risk factors, and estimate mortality rates during hospital admission.</div></div><div><h3>Methods</h3><div>In a retrospective, observational, population-based study, data from the Spanish National Hospital Discharge Database were analyzed to identify women with hospital episodes of pregnancy-related-PE. The primary outcome was the overall and annual age-standardized incidence of pregnancy-related-PE, with secondary aims including the distribution of events during pregnancy and postpartum and the calculation of age-standardized mortality rates during admission.</div></div><div><h3>Results</h3><div>Among 2,178,805 births from 2016-2021, 522 women were diagnosed with pregnancy-related PE, yielding an overall age-standardized incidence of 2.83 cases per 10,000 births. A non-significant increasing trend was observed from 2.43 to 4.18 cases per 10,000 births (<em>P</em>=.06). Comorbidities were low, with a notable association between PE and SARS-CoV-2 infection during the last two years. The mortality rate among women with pregnancy-related PE was 2.8%, with a higher incidence of PE reported during the postpartum period.</div></div><div><h3>Conclusion</h3><div>The incidence of pregnancy-related-PE in Spain exhibits a non-significant increasing trend, with a significant risk of mortality. The association with SARS-CoV-2 infection underscores the importance of vigilant monitoring and management of pregnant women, particularly during pandemics. This study contributes specific data on the incidence and characteristics of pregnancy-related-PE in Spain, emphasizing the need to consider PE in the differential diagnosis and management strategies for pregnant and postpartum women.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 553-559"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573114","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":"Documento de posicionamiento sobre la oclusión arterial de la retina. SEMI-SERV","authors":"R. García-Alonso ,&nbsp;L. Arias-Barquet ,&nbsp;L. Castilla Guerra ,&nbsp;M. Martín Asenjo ,&nbsp;A.J. Gómez-Escobar ,&nbsp;E. Gutierrez-Sánchez ,&nbsp;J. Pagán Escribano ,&nbsp;A. Lorenzo Hernández ,&nbsp;O. Madridano Cobo ,&nbsp;F. Jaén Águila ,&nbsp;M.E. Salguero Cámara ,&nbsp;N. Muñoz-Rivas","doi":"10.1016/j.rce.2024.06.012","DOIUrl":"10.1016/j.rce.2024.06.012","url":null,"abstract":"<div><div>The retina is an organ frequently affected by ischemic changes. Retinal arterial occlusion can be considered the equivalent of stroke, in terms of presentation, management and treatment. In addition to a specific ophthalmological treatment systemic management is essential with an appropriate study and control of cardiovascular risk factors considering these patients of a very high cardiovascular risk.</div><div>In this consensus document we aim to provide an update on this relatively frequent pathology in our practices, considering the importance of an early and systematic action.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 588-597"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573505","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":"Retraso diagnóstico y oportunidades perdidas en la detección precoz de la fibrilación auricular: estudio transversal","authors":"F. Richard Espiga ,&nbsp;M. Almendro Delia ,&nbsp;F. Caballero Martínez ,&nbsp;D. Monge Martín ,&nbsp;F. Neria Serrano ,&nbsp;R. Quirós López","doi":"10.1016/j.rce.2024.06.011","DOIUrl":"10.1016/j.rce.2024.06.011","url":null,"abstract":"<div><h3>Introduction</h3><div>We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.</div></div><div><h3>Methods</h3><div>This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.</div></div><div><h3>Results</h3><div>A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1-6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.</div></div><div><h3>Conclusions</h3><div>In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 560-568"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573115","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":"El receptor soluble para productos finales de glicación avanzada se correlacionó positivamente con la lesión renal con la enfermedad coronaria","authors":"L. Chen ,&nbsp;X.-J. Zeng ,&nbsp;X.-Y. Guo ,&nbsp;J. Liu ,&nbsp;F-H. Du ,&nbsp;C-X. Guo","doi":"10.1016/j.rce.2024.06.016","DOIUrl":"10.1016/j.rce.2024.06.016","url":null,"abstract":"<div><h3>Aims</h3><div>Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end-products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.</div></div><div><h3>Materials and methods</h3><div>In this cross-sectional study, sRAGE and urinary albumin to creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.</div></div><div><h3>Results</h3><div>There were 127 CHD patients (mean age: 63.06<!--> <!-->±<!--> <!-->10.93 years, 93 males) in the study, whose sRAGE were 1.83<!--> <!-->±<!--> <!-->0.64<!--> <!-->μg/L. The sRAGE level was higher in kidney injury group (uACR ≥<!--> <!-->30<!--> <!-->mg/g) compared with no kidney injury group (uACR &lt;<!--> <!-->30<!--> <!-->mg/g) [2.08<!--> <!-->±<!--> <!-->0.70 vs. 1.75<!--> <!-->±<!--> <!-->0.61<!--> <!-->μg/L, <em>P</em> <!-->&lt;<!--> <!-->.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (<em>r</em> <!-->=<!--> <!-->0.196, <em>P</em> <!-->&lt;<!--> <!-->.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [odd ratio<!--> <!-->=<!--> <!-->2.62 (1.12-6.15), <em>P</em> <!-->&lt;<!--> <!-->.05]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543-0.778), <em>P</em> <!-->&lt;<!--> <!-->.01].</div></div><div><h3>Conclusions</h3><div>Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 580-587"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573504","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":"Perspectiva clínica de las miopatías necrotizantes inmunomediadas anti-HMG-Co-A-reductasa: análisis de tres casos","authors":"J.P. de la Fuente Peñaloza ,&nbsp;L. Quintana Cabezas ,&nbsp;M.C. Yubini Lagos","doi":"10.1016/j.rce.2024.07.002","DOIUrl":"10.1016/j.rce.2024.07.002","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 623-625"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573507","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":"Anemia de la inflamación y metabolismo del hierro en las enfermedades crónicas","authors":"S. Conde Díez ,&nbsp;R. de las Cuevas Allende ,&nbsp;E. Conde García","doi":"10.1016/j.rce.2024.06.013","DOIUrl":"10.1016/j.rce.2024.06.013","url":null,"abstract":"<div><div>Anemia of inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient's quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 598-608"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573116","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}