Revista clinica espanola最新文献

{"title":"Recomendaciones 2024 de la Sociedad Española de Medicina Interna (SEMI) para el manejo de la trombosis venosa asociada al cáncer","authors":"A. Villalobos ,&nbsp;R. Valle ,&nbsp;J. Pagán-Escribano ,&nbsp;M. Ortiz ,&nbsp;P. Demelo-Rodríguez ,&nbsp;C. Font","doi":"10.1016/j.rce.2024.09.003","DOIUrl":"10.1016/j.rce.2024.09.003","url":null,"abstract":"<div><div>Venous thromboembolic disease (VTD) is a common complication associated to greater mortality in patients with cancer. Its etiology is multifactorial and depends on the characteristics and co-morbidities of the patient, the tumor type and extension, and the oncological treatment. The management of VTD is more complex in patients with cancer due to an increased risk of recurrence and major bleeding complications during anticoagulation compared to the general non-oncological population. The above differences have led to the development of specific clinical trials to assess the efficacy and safety of anticoagulant therapy in patients with cancer. The present clinical guidelines are intended to provide general recommendations on the management of cancer-associated VTD according to updated according to the most recent scientific evidence.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 35-44"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137039","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":"Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardiaca y enfermedad pulmonar obstructiva crónica: programa UMIPIC","authors":"M. Méndez Bailón ,&nbsp;Á. González-Franco ,&nbsp;J.M. Cerqueiro ,&nbsp;J. Pérez-Silvestre ,&nbsp;C. Moreno García ,&nbsp;A. Conde-Martel ,&nbsp;J.C. Arévalo-Lorido ,&nbsp;F. Formiga Pérez ,&nbsp;L. Manzano-Espinosa ,&nbsp;M. Montero-Pérez-Barquero","doi":"10.1016/j.rce.2024.09.002","DOIUrl":"10.1016/j.rce.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) have a high risk of hospital admission and mortality. This study evaluated the benefit of a care model, characterized by comprehensive and continuous care (UMIPIC program) in patients with HF and a history of COPD.</div></div><div><h3>Methods</h3><div>A total of 5644 patients were prospectively recruited, of which 1320 had a history of COPD between March 2008 and March 2020. They were divided into two follow-up groups at the time of discharge, one in follow-up in the UMIPIC program (435 patients) and another treated conventionally (885 patients). The baseline characteristics of each group were analyzed and patients in each group were selected by propensity score matching and admissions and mortality were evaluated during 12 months of follow-up, after an episode of hospitalization for HF.</div></div><div><h3>Results</h3><div>The UMIPIC group, compared to the conventional group in the matched cohort, had a lower rate of admissions for HF (21 vs. 30%, respectively; hazard ratio<!--> <!-->=<!--> <!-->0.64; 95% CI: 0.54–0.84; <em>p</em> <!-->=<!--> <!-->0.002) and mortality (28 vs. 36%, respectively; hazard ratio<!--> <!-->=<!--> <!-->0.68; 95% CI: 0.51–0.90; <em>p</em> <!-->=<!--> <!-->0.008). From a therapeutic point of view, patients with HF and a history of COPD who were followed in the UMIPIC program received a higher percentage of beta-blockers (63.9 vs. 54.2%; <em>p</em> <!-->&lt;<!--> <!-->0.05) and direct-acting anticoagulants (17 vs. 9%; <em>p</em> <!-->&lt;<!--> <!-->0.05) than those followed conventionally.</div></div><div><h3>Conclusions</h3><div>The implementation of the UMIPIC care program for patients with HF and a history of COPD, based on comprehensive and continuous care, reduces both admissions and mortality at one year of follow-up. The prescription of beta-blockers and direct-acting anticoagulants was also higher during follow-up in the UMIPIC program.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137145","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":"Impacto del abandono del hábito de fumar sobre los parámetros metabólicos y la función renal en pacientes con y sin diabetes mellitus","authors":"C.-P. Fu ,&nbsp;P.-K. Fu ,&nbsp;M.-C. Lu ,&nbsp;Y.-Y. Liao ,&nbsp;J.-S. Wang","doi":"10.1016/j.rce.2024.08.003","DOIUrl":"10.1016/j.rce.2024.08.003","url":null,"abstract":"<div><h3>Backgroud and objectives</h3><div>As patients with diabetes are at a significantly higher risk of cardiovascular diseases than those without diabetes, it is important to gain a clinical understanding of the differential effects of smoking cessation on several risk factors between patients with and without diabetes.</div></div><div><h3>Materials and methods</h3><div>Patients who participated in a smoking cessation program received an assessment of the outcomes of interest. The outcomes were changes in metabolic parameters and renal function from baseline to 6-month follow-up after the smoking cessation program.</div></div><div><h3>Result</h3><div>A total of 1,954 patients joined the smoking cessation program, and 1,381 patients were in the smoking cessation failure (SCF) group and 573 were in the smoking cessation success (SCS) group. The decrease in HbA1c after smoking cessation was only observed in patients with diabetes. Smoking cessation was also associated with a significant decrease in LDL cholesterol in patients with diabetes. In terms of renal function, smoking cessation was associated with an improvement in eGFR, and the trend was similar in patients with and without diabetes.</div></div><div><h3>Conclusion</h3><div>Successful smoking cessation was associated with improvement in renal function. Moreover, it was associated with improvements in HbA1c and LDL cholesterol in patients with diabetes, despite significant weight gain.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 16-22"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137172","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":"Anticuerpos anti-NOR90 y su significación clínica: experiencia multicéntrica en el sur de España","authors":"J. Martínez de Victoria Carazo ,&nbsp;D. Fernández Reyes ,&nbsp;F.J. de la Hera Fernández ,&nbsp;T. González Cejudo ,&nbsp;N. Navarrete Navarrete ,&nbsp;J.L. Callejas Rubio","doi":"10.1016/j.rce.2024.08.002","DOIUrl":"10.1016/j.rce.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Anti-NOR90 antibodies were initially described in patients with autoimmune diseases based on staining of a nucleolar region known as the nucleolar organizer region (NOR). This study aims to explore the clinical aspects of anti-NOR90 antibodies in patients with systemic autoimmune diseases.</div></div><div><h3>Methods</h3><div>Observational study of patients with positive anti-NOR90 antibodies using the EUROLINE Systemic Sclerosis profile (IgG) kit (Euroimmun, Germany). Data on demographics, comorbidities, autoimmune diseases, treatment, and clinical manifestations were collected.</div></div><div><h3>Results</h3><div>Fifteen patients with positive anti-NOR90 antibodies were included. Majority were female (86.7%), with median age of 54 years. Most common clinical manifestations were Raynaud's phenomenon, dryness, and interstitial lung disease (ILD). Some patients had hematological or solid organ neoplasms. EPID was prevalent, with one case showing rapid progression requiring aggressive treatment.</div></div><div><h3>Discussion and conclusions</h3><div>This study highlights the association between anti-NOR90 antibodies and systemic autoimmune diseases, particularly SS and ES. EPID was a notable feature, suggesting its consideration in IPAF diagnosis for anti-NOR90 positive patients. Further multicenter studies are needed for better understanding and detection methods optimization.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 51-55"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137173","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":"Sarampión en la sala de urgencias: el enemigo sigue ahí","authors":"J. Ena","doi":"10.1016/j.rce.2024.09.001","DOIUrl":"10.1016/j.rce.2024.09.001","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 650-651"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757359","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":"Resumen ejecutivo del documento de consenso sobre la realización de la ecografía clínica: recomendaciones desde los Grupos de Trabajo de Ecografía Clínica de la SEMI, SEDAR, SEGG, SEMERGEN, SEMES, SEMFYC y SEMG","authors":"Y. Tung-Chen ,&nbsp;J. Short Apellaniz ,&nbsp;R. Alonso Roca ,&nbsp;J.R. Alonso Viladot ,&nbsp;I. Arnanz González ,&nbsp;L. Beltrán Romero ,&nbsp;A. Calvo Cebrián ,&nbsp;R. Campo Linares ,&nbsp;K.A. Foo Gil ,&nbsp;I. García Suárez ,&nbsp;A.D. González Delgado ,&nbsp;A. Hernández Martínez ,&nbsp;M.F. Marchese Ratti ,&nbsp;O. Martínez Villén ,&nbsp;J. Mercadal Mercadal ,&nbsp;E. Minguela Puras ,&nbsp;Maria Ester Montes Belloso ,&nbsp;P.P. Reinoso Párraga ,&nbsp;E. Rodríguez Urteaga ,&nbsp;A. Romero Galán ,&nbsp;Paola Pastora Reinoso Párraga","doi":"10.1016/j.rce.2024.07.006","DOIUrl":"10.1016/j.rce.2024.07.006","url":null,"abstract":"<div><div>Point-of-Care Ultrasound has significantly evolved, establishing itself as an essential tool in daily medical practice, especially in various clinical contexts. This consensus document, supported by several Spanish medical societies, proposes guidelines for the effective integration of ultrasound in healthcare, promoting its standardization and ensuring the quality and systematic application of this technique. The working groups, composed of experts from different specialties, conducted a comprehensive review of the literature in MEDLINE and extensively discussed recommendations to formulate a coherent and practical set of guidelines for different application areas: hospital and out-of-hospital emergencies and critical care, primary care, and outpatient hospital care, hospitalization.</div><div>The methodology included virtual meetings and confidential voting to reach a consensus on the relevant recommendations. Ultrasound was highlighted as fundamental in the initial approach to various pathologies, such as abdominal, thoracic, and musculoskeletal issues, facilitating quick and accurate diagnoses, and reducing the need for unnecessary referrals. Furthermore, this technique has proven valuable in emergencies and critical care, guiding procedures and enhancing the safety and efficiency of clinical interventions.</div><div>These guidelines not only serve as a framework for clinical practice, education, and research but also aim to ensure that professionals are adequately trained and that ultrasound evaluations are performed to a standard of excellence. The purpose of these recommendations is to standardize and facilitate the adoption of this clinical tool in the daily practice of healthcare, thus improving the quality of the services provided in its various possible applications.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 670-678"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757362","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":"Asociación entre enfermedades autoinmnues y enfermedad de Alzheimer: análisis a partir de herramientas de big data","authors":"A.M. Diezma-Martín ,&nbsp;M.I. Morales-Casado ,&nbsp;L. Jiménez-Díaz ,&nbsp;J.D. Navarro-López ,&nbsp;B. Mondéjar-Marín ,&nbsp;J. Parra-Serrano ,&nbsp;A. Vadillo-Bermejo ,&nbsp;C. Marsal-Alonso ,&nbsp;P. Beneyto-Martín","doi":"10.1016/j.rce.2024.07.003","DOIUrl":"10.1016/j.rce.2024.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>The objective is to analyze the prevalence of Alzheimer's disease in patients with and without a diagnosis of different autoimmune diseases and the possible association between both pathologies.</div></div><div><h3>Patients and methods</h3><div>A multicenter, retrospective, cohort study was conducted to study the prevalence of Alzheimer's disease among patients diagnosed with various autoimmune diseases compared to the general population. Data from electronic medical records from the Castilla-La Mancha healthcare system were analyzed using Natural Language Processing through the Savana Manager® artificial intelligence clinical platform. A total of 1,028,356 patients were analyzed, including 28,920 individuals with Alzheimer's disease and 999,436 control patients.</div></div><div><h3>Results</h3><div>Out of the 12 autoimmune diseases analyzed, 5 showed a significant association with Alzheimer's disease with <em>P</em> <!-->.05. Myasthenia gravis had an increased prevalence of AD with OR 1.49 (95% <span>C</span>I 1.11 - 2), systemic lupus erythematosus with OR 2.42 (95% CI 2.02 – 2.88), rheumatoid arthritis with OR 1.38 (95% CI 1.24 – 1.54), polymyalgia rheumatica with OR 2.01 (95% CI 1.08 – 2.23), and pernicious anemia with OR 2.06 (95% CI 1.59 – 2.66). The remaining autoimmune diseases analyzed did not show a higher prevalence of Alzheimer's disease compared to the general population.</div></div><div><h3>Conclusions</h3><div>There may be an association between certain systemic autoimmune diseases and Alzheimer's disease. Further studies are needed to confirm our findings, establish causality, and explore the underlying mechanisms of this association.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 627-633"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757414","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":"Seguimiento y tratamiento de la enfermedad tromboembólica venosa a largo plazo: recomendaciones del Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna 2024","authors":"M. Martín del Pozo ,&nbsp;M. Martín Asenjo ,&nbsp;A.I. Franco Moreno ,&nbsp;E. Usandizaga de Antonio ,&nbsp;F. Galeano Valle","doi":"10.1016/j.rce.2024.07.007","DOIUrl":"10.1016/j.rce.2024.07.007","url":null,"abstract":"<div><div>Venous thromboembolim (VTE) is a highly prevalent condition that requires long-term monitoring and treatment. This monitoring includes: 1) completing the etiological study and determining the risk of VTE recurrence; 2) establishing the optimal duration of anticoagulant treatment, as well as the type of therapy and its dosage; 3) estimating the risk of bleeding, and 4) identifying the occurrence of chronic complications. This consensus document, prepared by the VTE Group of the Spanish Society of Internal Medicine (SEMI), aims to update and establish consensus recommendations on these aspects. The document focuses on four aspects of management: the first includes risk factors for VTE recurrence after an unprovoked VTE episode and describes the predictive scores of VTE recurrence; the second focuses on risk factors for bleeding; the third provides recommendations for long-term follow-up in VTE, addressing specific considerations for screening chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome of the lower limbs; and the fourth provides guidance on the optimal duration of extended anticoagulant treatment, as well as the type of therapy and its dosage;. For each area, an exhaustive literature review was conducted, analyzing the updated VTE clinical guidelines and recent studies. This document is intended to be a guide in the long-term management of VTE based on the most current knowledge.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 652-663"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757360","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":"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}