Seminars in thrombosis and hemostasis最新文献

{"title":"Integrating Next-Generation Sequencing into von Willebrand Disease Diagnostics: Insights from the PCM-EVW-ES Multicenter Project.","authors":"Nina Borràs, Irene Corrales, Francisco Vidal","doi":"10.1055/a-2845-0281","DOIUrl":"10.1055/a-2845-0281","url":null,"abstract":"<p><strong>Abstract: </strong>Von Willebrand disease (VWD) is the most common inherited bleeding disorder, caused by quantitative or qualitative defects in von Willebrand factor (VWF). Diagnosis is challenging and requires integrating bleeding history, VWF antigen and activity measurements, FVIII assays, and specialized phenotyping. Genetic testing is increasingly recognized as a key component. Here, we review current concepts in VWD diagnostics and highlight the Spanish Clinical and Molecular Profile of von Willebrand Disease (PCM-EVW-ES) project as a model for genomics-enabled precision medicine. PCM-EVW-ES is a multicenter initiative involving 48 hospitals, centralized phenotypic testing, and next-generation sequencing of the <i>VWF</i> coding region, enabling definitive classification in 730 individuals with VWD to date. Harmonized recruitment criteria and standardized workflows improve subtype assignment, uncover complex genotypes, refine genotype-phenotype correlations, and facilitate the identification of asymptomatic carriers. The PCM-EVW-ES variant spectrum highlights recurrent disease-causing variants in Spain and underscores the value of coordinated national registries for variant curation. Building on these data, we propose a diagnostic algorithm in which bleeding assessment and first-line VWF/FVIII assays, combined with, early <i>VWF</i> molecular testing increases diagnostic accuracy and guides targeted second-line investigations to confirm and refine VWD subtype classification. We also outline persisting challenges, including the interpretation of variants of uncertain significance and patients without identifiable pathogenic <i>VWF</i> variants, and future directions integrating third-generation sequencing, expanded gene panels, functional studies, and artificial-intelligence-driven multiomic approaches. Together, these advances illustrate how robust multicenter studies can bridge the gap between complex diagnostics and clinical practice in VWD.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"869-880"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal Sepsis-Induced Coagulopathy: An Evolving Frontier at the Crossroads of Inflammation and Hemostasis.","authors":"Rozeta Sokou, Alexandra Lianou, Eleni A Gounari, Andreas G Tsantes, Stefanos Bonovas, Georgios Nikolopoulos, Argirios E Tsantes, Nicoletta Iacovidou","doi":"10.1055/a-2823-8395","DOIUrl":"10.1055/a-2823-8395","url":null,"abstract":"<p><strong>Abstract: </strong>Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host immune response to an infection. Sepsis is often associated with significant hemostatic disorders that may lead to extensive intravascular thrombosis, disseminated intravascular coagulation (DIC), multi-organ dysfunction syndrome (MODS), and increased mortality. Sepsis-induced coagulopathy (SIC) is currently recognized as an early distinct phase of hemostatic derangement caused by sepsis, and a prodrome of overt DIC. SIC is characterized by endovascular clotting activation, hypercoagulability, and consumption of clotting factors and platelets. DIC, traditionally considered the final stage of this process, is now recognized as a part of a continuum of pathophysiological dysregulation with a distinct clinical significance. Despite being extensively studied in the adult population, SIC remains poorly defined in neonates. The distinct characteristics of neonatal hemostasis, coupled with immunological immaturity, pose significant challenges to the direct application of adult diagnostic approaches of SIC in this population. This review focuses on the pathophysiological mechanisms of SIC and the unique characteristics of neonatal hemostasis, summarizes current knowledge regarding the underlying mechanisms of neonatal SIC, and explores the developmental interplay between inflammation and hemostasis. By integrating current evidence, the review aims to establish a conceptual framework that will guide future experimental and clinical studies directed toward improving the management and outcomes of neonates who develop coagulopathy during sepsis.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"837-857"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistance or Resilience? Hemostatic Balance in an FV Leiden Elite Athlete.","authors":"Ciro Miele, Cristina Mennitti, Alessandro Gentile, Mariella Calvanese, Luca Manfredi, Andrea Ruggiero, Immacolata Randa, Ferdinando Cirillo, Giovanni D'Alicandro, Nadia Tinto, Giulia Frisso, Cristina Mazzaccara, Olga Scudiero","doi":"10.1055/a-2681-6784","DOIUrl":"10.1055/a-2681-6784","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"881-885"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Exercise/Sport on Well-Being in von Willebrand Disease and Other Congenital Bleeding Disorders: An Update.","authors":"Anna Chiara Giuffrida, Giorgio Gandini, Daniele Focosi, Massimo Franchini","doi":"10.1055/a-2778-9762","DOIUrl":"10.1055/a-2778-9762","url":null,"abstract":"<p><strong>Abstract: </strong>Worldwide, one in four adults and three in four children fail to meet the physical activity targets recommended by the World Health Organization (WHO). Patients with chronic diseases and disabilities represent some of the least active populations. WHO guidelines encourage regular physical activity for individuals with disabilities, considering functional capacity and clinical status. Recommended interventions include moderate-to-vigorous activity, muscle-strengthening exercises at least twice weekly, and functional balance training at least three times per week, with specialist consultation as needed. Data on physical activity and sports participation in patients with chronic conditions such as inherited bleeding disorders are very limited. This narrative review updates the literature, focusing on von Willebrand disease and rare coagulation defects and highlighting the need for individualized, multidisciplinary recommendations to promote safe physical activity and optimize health outcomes.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"806-815"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145945870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden Cardiac Arrest and Death in Sports: An Updated Overview of Epidemiology, Etiologies, and Prevention Strategies, with Emphasis on Inherited Cardiomyopathies.","authors":"Giorgia Beffagna, Fabian Sanchis-Gomar, Flavio Ribichini, Giuseppe Lippi","doi":"10.1055/a-2664-0950","DOIUrl":"10.1055/a-2664-0950","url":null,"abstract":"<p><strong>Abstract: </strong>Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in sports, although rare, remain pressing concerns with rising global participation in athletics. Recent epidemiological analyses indicate that incidence of SCA/SCD in athletes is low and has remained relatively stable over the past two decades. However, outcomes have improved as survival rates increase, reflecting advances in emergency response. Key risk factors are well-established, such as male athletes face a markedly higher risk than females, older master athletes have higher SCD risk rates than those under 35 years (largely due to acquired coronary artery disease), and certain high-intensity sports (e.g., basketball, American football, soccer, and endurance exercise) present higher SCA/SCD risk. In young competitive athletes, most SCDs are a consequence of undetected hereditary or congenital heart disorders. Predominant causes in this group include structural cardiomyopathies, such as hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy, and primary electrical diseases (channelopathies like long QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia). Contrarily, occult atherosclerotic coronary disease becomes the leading cause of fatal events in master athletes. Multifaceted prevention strategies have expanded in recent years. Pre-participation cardiac screening programs aim to detect at-risk individuals and have successfully prevented SCD. Equally important, widespread implementation of emergency action plans, including on-site automated external defibrillators and cardiopulmonary resuscitation training, has improved resuscitation outcomes. Heightened public awareness, prompted by high-profile on-field cardiac arrests, has catalyzed policy changes that mandate better cardiac screening and emergency preparedness. Collectively, these efforts are shaping a safer sporting environment and reducing the SCA/SCD risk in athletes.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"765-776"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining Fibrinolytic Insufficiency in Sepsis-Associated DIC.","authors":"Toshiaki Iba, Julie Helms, Cheryl L Maier, Ian Roberts","doi":"10.1055/a-2840-5585","DOIUrl":"10.1055/a-2840-5585","url":null,"abstract":"<p><strong>Abstract: </strong>Sepsis disrupts the physiological balance between coagulation and fibrinolysis, resulting in a state in which fibrin formation exceeds fibrin removal and drives microvascular thrombosis, organ failure, and mortality. Although an early burst of endothelial tissue-type plasminogen activator (t-PA) may transiently increase plasmin generation, this phase is rapidly eclipsed by sustained upregulation of plasminogen activator inhibitor-1 (PAI-1), dysregulated activation of thrombin-activatable fibrinolysis inhibitor, depletion of endogenous anticoagulants, and progressive endotheliopathy. Beyond inhibitor excess, emerging evidence indicates that a quantitative defect in plasminogen is a central contributor to fibrinolytic insufficiency. Neutrophil extracellular traps (NETs) contain elastase, which cleaves plasminogen into inactive fragments, reducing functional plasminogen availability and impairing fibrin-bound plasmin generation. When functional plasminogen falls below rate-limiting levels, fibrin surfaces cannot efficiently support plasmin formation, resulting in persistent microvascular fibrin deposition despite elevated D-dimer concentrations. This NET-plasminogen axis links immunothrombosis to the \"fibrinolytic insufficiency phenotype observed in sepsis-induced coagulopathy and overt disseminated intravascular coagulation (DIC).\" Clinically, hypofibrinolysis is characterized by high D-dimers, elevated PAI-1, reduced plasmin generation, and low fibrinolytic activity on viscoelastic testing. Multimodal assessment integrating biomarker panels and viscoelastic assays, including t-PA- or urokinase-challenged protocols, may improve risk stratification. Therapeutic strategies largely targeted coagulation; however, persistent hypofibrinolysis limits their effectiveness. Translational data demonstrate that plasminogen supplementation restores functional plasminogen levels and normalizes plasmin generation in septic patients and in experimental DIC, providing proof of concept for fibrinolysis-directed therapy. Future progress requires standardized definitions, functional fibrinolytic phenotyping, and phenotype-guided clinical trials to restore the coagulo-fibrinolytic balance in sepsis.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"858-868"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity in People with Hemophilia.","authors":"Carlos Cruz-Montecinos, Joaquín Calatayud, Lars Louis Andersen, Carla Daffunchio, Verónica Soto-Arellano, Miguel López, Sofía Pérez-Alenda, Ana Chimeno-Hernández, David Stephensen, Rodrigo Núñez-Cortés","doi":"10.1055/a-2778-9890","DOIUrl":"10.1055/a-2778-9890","url":null,"abstract":"<p><strong>Abstract: </strong>Hemophilia is a rare inherited bleeding disorder associated with recurrent musculoskeletal bleeding, chronic pain, and functional decline. Advances in prophylactic therapies, including extended half-life factors, non-factor therapies like emicizumab, and gene therapies, have fundamentally transformed care, enabling a paradigmatic shift from activity restriction to promotion. This review synthesizes recent evidence to examine the multifaceted role of physical activity (PA) in people with hemophilia (PwH), current challenges, and strategies to optimize health outcomes. PA confers substantial benefits for PwH, improving muscle strength, coordination, bone density, cardiovascular fitness, mental health, and quality of life. It modulates chronic pain through neuroplastic, anti-inflammatory, and neuroendocrine mechanisms, while exercise-derived molecules (exerkines) may directly influence cartilage health. With individualized prophylaxis and structured programming, both resistance and aerobic exercise can be prescribed safely using evidence-based risk stratification (categories I-III) and comprehensive monitoring approaches, including accelerometers, questionnaires, and subjective effort scales. Persistent barriers include chronic pain, fear of injury, insufficient professional guidance, and treatment inequities, while facilitators encompass enjoyment, social support, and adequate prophylactic coverage. Therapies providing continuous hemostatic protection have further expanded safe PA opportunities, supporting participation in previously restricted activities. In this new therapeutic era, PA should be recognized as a fundamental pillar alongside medical care. Not only for musculoskeletal preservation, but also as a strategy promoting metabolic and mental health. Ensuring access for all patients to both advanced therapies and tailored PA prescription, supported by education, enabling policies, and multidisciplinary care, is essential for democratizing active lifestyles within the global hemophilia community.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"790-805"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Platelet Contribution to Clot Strength in Neonates with Perinatal Hypoxia Using Rotational Thromboelastometry.","authors":"Aikaterini Konstantinidi, Rozeta Sokou, Andreas G Tsantes, Maria Lampridou, Georgios Ioakeimidis, Evangelia-Filothei Tavoulari, Vasiliki Mougiou, Zoi Iliodromiti, Argirios E Tsantes, Nicoletta Iacovidou","doi":"10.1055/a-2949-4349","DOIUrl":"https://doi.org/10.1055/a-2949-4349","url":null,"abstract":"<p><strong>Abstract: </strong>The hemostatic derangement of neonates with perinatal hypoxia is of multifactorial origin and may be attributed to ischemic tissue injury, acute blood loss, or disseminated intravascular coagulation. However, the pathophysiological mechanisms of thrombocytopenia, a common hematological finding in neonates with perinatal hypoxia, remain unclear. The aim of the present study was to evaluate the contribution of platelets to clot formation and clot strength in neonates with perinatal hypoxia using rotational thromboelastometry (ROTEM). This prospective cohort study included 139 neonates with perinatal hypoxia and 106 healthy neonates. Demographics and clinical findings were recorded, while hematological and biochemical tests, along with ROTEM, extrinsically activated test (EXTEM), and fibrin clot obtained by platelet inhibition with cytochalasin D (FIBTEM) assays, were performed in all study neonates. ROTEM parameters differed significantly between the two study groups; prolonged clotting time and clot formation time, lower clot amplitude at 10 minutes (A10) and maximum clot firmness (MCF) values, as well as lower PLTEM MCF (the difference between EXTEM MCF and FIBTEM MCF) and PLTEM MCE (the difference between EXTEM MCE and FIBTEM MCE) values were recorded in hypoxic neonates. Neonates with perinatal hypoxia demonstrate a hypocoagulable profile, with decelerated coagulation activation, reduced clot formation and stability, impaired fibrinolysis, and significantly reduced platelet contribution to clot dynamics.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discordance between ABO-Related VWF Reduction and Global Hemostasis in Healthy Greeks: Implications for Assay Selection and the Disease Modifier Role of Blood Group O.","authors":"Eleni Petrou, Sophia Mellou, Stefanos Bonovas, Konstantina Tsante, Evdoxia Rapti, Stavros Tsalas, Nevila Petalari, Rozeta Sokou, Andreas G Tsantes, Styliani Kokoris, Elias Kyriakou, Serena Valsami, Georgios Nikolopoulos, Argirios E Tsantes","doi":"10.1055/a-2949-3643","DOIUrl":"https://doi.org/10.1055/a-2949-3643","url":null,"abstract":"<p><strong>Abstract: </strong>ABO blood group influences plasma levels of von Willebrand factor (VWF) and factor VIII (FVIII), with non-O individuals having higher levels and increased thrombotic risk. The relationship between ABO group and global hemostasis has not been studied in Greece. This study aims to examine the association between ABO blood group and VWF/FVIII levels in healthy Greek adults, and to assess whether ABO-related differences affect global hemostasis by viscoelastic methods. It is a cross-sectional study of 179 healthy blood donors (86 group O, 93 non-O). VWF:Ag, VWF:GPIbM, and FVIII:C were measured. Platelet function was assessed by Platelet Function Analyzer-100 (Col/Epi), and global hemostasis by ROTEM EXTEM. Group O had significantly lower VWF:Ag, VWF:GPIbM, and FVIII than non-O (all <i>p</i> < 0.001). No differences were observed between groups in Platelet Function Analyzer-100 or any ROTEM parameter. Platelet count and fibrinogen, not VWF, drove ROTEM parameters. ABO blood group significantly affects VWF and FVIII levels, but global hemostasis remains uncompromised in healthy individuals. However, as group O has been reported to act as a disease modifier in patients with underlying hemostatic defects, these findings highlight that no single assay can safely capture clinical hemostatic risk, and ABO blood group should be interpreted in clinical context.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related Global Coagulation Changes: From Neonate to Old Age.","authors":"Vincent Lu, Chantal Attard, Vasiliki Karlaftis, Tengyi Cai, Mani Suleiman, Ilaria De Simone, Dana Huskens, Bas De Laat, Denise Jackson, Catherine Itsiopoulos, Paul Monagle, Prahlad Ho, Hui Yin Lim","doi":"10.1055/a-2954-5494","DOIUrl":"https://doi.org/10.1055/a-2954-5494","url":null,"abstract":"<p><strong>Abstract: </strong>Global coagulation assays provide a comprehensive assessment of clotting and fibrinolytic dynamics and have shown potential in predicting bleeding and thrombotic risk. Successful clinical implementation, however, requires understanding of normal age-specific changes, which remains limited. This study aims to evaluate age- and sex-related differences in global coagulation assays from neonates to older adults. A total of 546 citrated plasma samples from 380 healthy pediatric participants (0 to < 18 years) and 166 adults (20-79 years, without known cardiovascular risk factors or medications affecting coagulation) were tested for thrombin generation (CAT-TG), modified overall hemostatic potential (mOHP), and plasmin generation (PG). This study demonstrated that hemostatic capacity was lowest at birth and increased rapidly throughout early childhood, with endogenous thrombin and plasmin potentials peaking in the fourth decade of life. Fibrin generation continued to rise, peaking in the sixth decade, accompanied by a decline in fibrinolytic capacity. Sex differences showed a hypercoagulable shift in females beginning at puberty, peaking during the reproductive years. These sex differences attenuated post-menopause, reflecting the convergence of cardiovascular risk in older age. These findings provide essential normative data to support age- and sex-adjusted interpretation of global coagulation assays. Overall, the most pronounced hemostatic changes occur in early life, consistent with developmental hemostasis. The midlife peak in procoagulant parameters and the decline in fibrinolytic capacity highlight progressive hemostatic changes associated with aging. While sex-related differences underscore the role of endogenous hormones in modulating coagulation, longitudinal studies in healthy and at-risk individuals are warranted to clarify trajectories and inform personalized interventions.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}