Seminars in thrombosis and hemostasis最新文献

{"title":"Comparison of the Coagulation Profile Following Treatment of Major Surgical Haemorrhage with Fresh Frozen Plasma or Fibrinogen Concentrate.","authors":"Ian J B Young, Neill Aitken, Anna Dickson, Julia Anderson, Gary Morrison, Yesim Dargaud, Alastair Nimmo","doi":"10.1055/a-2896-8150","DOIUrl":"10.1055/a-2896-8150","url":null,"abstract":"<p><p>In a parallel-assignment, single-blinded study, we measured the detailed coagulation profile of 20 patients randomized to receive infusions of fresh frozen plasma (FFP) or fibrinogen concentrate during surgery associated with major surgical hemorrhage-Extent 4 Thoraco-abdominal Aortic Aneurysm repair. Ten patients received FFP; 10 fibrinogen concentrate, infused to achieve plasma fibrinogen concentration around 1.5 g/L. There were predefined hemoglobin and ROTEM cut-offs for red cell and platelet administration. Blood samples were taken at up to 12 predefined time points before, during, and after surgery. Measurements included coagulation and anticoagulant factor concentrations, thrombin generation, activated protein C (aPC) concentrations, and thromboelastography. Intraoperative blood loss was between 2,750 and 16,500 mL. During surgery, plasma fibrinogen concentration was slightly lower in the FFP group but maintained or restored to approximately 1.5 g/L. When blood loss exceeded approximately 4,000 mL, most factor concentrations and conventional tests were superior in the FFP group. Mean (standard deviation) prothrombin time (15.8 [2.3] vs. 26.3 [5.1]) and activated partial thromboplastin time (42.8 [8.6] vs. 60.4 [15.8]) seconds; <i>p</i> < 0.001. Protein C and aPC concentrations trended higher in the FFP group: protein C = 59.7 (18.4) versus 30.0 (10.6)% normal; <i>p</i> < 0.001, aPC = 6.9 (5.5) versus 3.1 (2.3) g/L; <i>p</i> = 0.001. Differences in peak thrombin generation 2 hours postoperatively in the FFP group did not meet statistical significance: (224.3 [54.8] vs. 133.0 [66.0]) nM; <i>p</i> = 0.004. In this exploratory cohort, both FFP and fibrinogen concentrate administration achieved low-normal plasma fibrinogen concentrations. Although coagulation factor concentrations and thrombin generation were lower in the fibrinogen concentrate group at blood losses above 4,000 mL, this was not associated with worse surgical hemostasis or observed bleeding complications. · Question: in patients undergoing major surgical hemorrhage during thoracoabdominal aortic aneurysm repair, how does treatment with FFP compare with fibrinogen concentrate in maintaining coagulation profiles?. · Findings: both treatments maintained plasma fibrinogen concentrations, but patients receiving FFP had higher levels of coagulation factors, thrombin generation, and aPC when blood loss exceeded 4,000 mL.. · Meaning: although FFP led to superior laboratory coagulation parameters at high blood loss, in this exploratory cohort with blood losses of up to 16,500 mL, observed hemostasis remained clinically satisfactory when managed by either fibrinogen concentrate or FFP..</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266010","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":"Association between Sex and Platelet Function in Patients with Diabetes Mellitus Type II: A Systematic Review.","authors":"Rebekka Mikkelsen, Julie Brogaard Larsen, Kamille Smidt","doi":"10.1055/a-2891-4643","DOIUrl":"10.1055/a-2891-4643","url":null,"abstract":"<p><strong>Abstract: </strong>Type 2 diabetes mellitus (T2DM) is associated with a significant risk for development of cardiovascular diseases (CVD), in which platelets play a pivotal role. Sex-related differences in CVD exist in terms of prevalence, risk factors, clinical presentation, treatment, outcomes, and prognosis. Platelet activation may contribute to these sex-related differences. The aim of this systematic review was to investigate whether platelet function differs between men and women with T2DM. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Literature searches in PubMed and Embase were performed. We included studies that investigated differences in platelet function parameters, platelet indices, or platelet transcriptomics in patients with T2DM. The risk of bias was assessed according to the National Heart, Lung and Blood Institute. Twenty-six studies were included. No significant differences in platelet activation between men and women with T2DM were consistently reported in the literature, although 7 of the 26 studies found significantly altered platelet indices, higher platelet aggregation, higher P-selectin expression, or higher prevalence of acetylsalicylic acid resistance in women. Two studies reported a significantly higher platelet aggregation in men. None of the included studies investigated the association between sex and platelet function as a primary outcome. A wide range of platelet function methods were employed, which caused considerable heterogeneity and challenged the comparison across the studies. Due to the limited amount of evidence on this topic, further studies are needed to provide insight into sex differences in platelet function in patients with T2DM.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212522","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":"Making Machine Learning Clinically Useful in Thrombosis and Hemostasis: A Roadmap for Diagnostic Translation.","authors":"Michael Nagler, Henning Nilius, Janna Hastings, Christos Nakas","doi":"10.1055/a-2888-3814","DOIUrl":"10.1055/a-2888-3814","url":null,"abstract":"<p><strong>Abstract: </strong>Artificial intelligence (AI), most often in the form of machine learning (ML), attracts high expectations across medicine and is often discussed as a transformative, rapidly evolving topic. In thrombosis and hemostasis, these expectations are reinforced by the nature of clinical decision-making, which rarely hinges on a single definitive test. Instead, clinicians integrate clinical context with laboratory results, imaging, and treatment information. Despite a rapidly expanding literature, translation into routine decision support remains scarce. Most published models are early-stage prototypes and provide limited evidence for transportability, clinical utility, and safe deployment. In this review, we argue that the most practical way to achieve and assess clinical usefulness is to treat ML tools as diagnostic instruments. This framing also clarifies what \"useful\" means at the bedside: improving a specific decision, at a specific moment, for a specific patient. Building on this concept, we provide a roadmap for diagnostic translation, starting with intended use and population definition, then addressing real-world data and reference standards, fit-for-purpose model behavior, phased validation as evidence generation, and the requirements for implementation and lifecycle governance. Two figures summarize the translation roadmap and map ML to laboratory thinking from preanalytics to quality management. A clinically deployable checklist supports structured reading of published studies and helps identify what evidence is missing for implementation. The goal is to help clinicians and laboratory specialists distinguish promising prototypes from tools that are ready for clinical translation and sustainable use. This article is a narrative review. It does not aim to provide a systematic synthesis of all machine learning (ML) studies in the field. Our aim is to provide a practical roadmap for diagnostic translation and two pragmatic tools that help readers assess published studies and plan evidence generation toward clinically deployable ML tools. To do so, we formulated a concept-driven translation framework by combining (1) established principles from diagnostic research and test evaluation, (2) targeted searches for guidance and reporting frameworks relevant to clinical ML and diagnostic translation, and (3) selective review of systematic reviews and meta-research on common sources of bias, external validation, and implementation barriers. Case examples were chosen to illustrate how the framework applies to real tools and to highlight where translation succeeds or stalls.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164428","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":"Pediatric Pulmonary Infarction and Infarction-Like Pulmonary Injury: An Etiology-Oriented Narrative Review.","authors":"Shuxuan Li, Yanran Zhang, Xiangxiang Tian, Wanqing Zhao, Yongsheng Xu","doi":"10.1055/a-2889-7005","DOIUrl":"10.1055/a-2889-7005","url":null,"abstract":"<p><strong>Abstract: </strong>Pulmonary infarction (PI) has traditionally been regarded as a complication of pulmonary embolism (PE). However, increasing evidence suggests that pediatric PI represents a heterogeneous spectrum of ischemic lung injury extending beyond classic thromboembolic disease. This narrative review adopted an etiology-oriented framework to summarize the epidemiology, pathophysiology, imaging features, diagnostic strategies, treatment approaches, prognosis, and follow-up considerations of pediatric PI and infarction-like pulmonary injury. Published pediatric PI-related cases were also descriptively summarized. Pediatric PI remains underrecognized and lacks standardized diagnostic criteria. Compared with adults, children demonstrate greater etiologic heterogeneity, including thromboembolic PE, in situ pulmonary artery thrombosis, congenital pulmonary developmental anomalies, such as extralobar pulmonary sequestration, immune-mediated vascular injury, and infection-related microthrombosis. Imaging findings including Hampton hump, reverse halo sign, and cavitary transformation may suggest PI but have not been systematically validated in children. Imaging evaluation must also balance diagnostic performance with radiation exposure under the \"as low as reasonably achievable\" principle. Treatment strategies differ substantially according to underlying mechanisms: thromboembolic PI generally requires anticoagulation, congenital vascular anomalies are primarily managed surgically, whereas inflammatory and infection-related phenotypes often require immunomodulatory or multidisciplinary management. Evidence regarding long-term pulmonary outcomes and chronic thromboembolic pulmonary hypertension in children remains limited. Pediatric PI and infarction-like pulmonary injury should be considered a heterogeneous ischemic lung injury syndrome rather than a single disease entity. Etiology-oriented classification is critical for diagnosis, individualized treatment, and long-term management. Further multicenter studies are needed to establish standardized pediatric diagnostic and follow-up frameworks.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272860","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":"Laboratory Monitoring of Complement Activation in Gene Therapy: Analytical Pitfalls and Clinical Interpretation.","authors":"Brandon M Henry, Melvin Y Rincon, Giuseppe Lippi, Zoltán Prohászka, Stefanie Benoit","doi":"10.1055/a-2887-9935","DOIUrl":"10.1055/a-2887-9935","url":null,"abstract":"<p><strong>Abstract: </strong>Complement activation is a consistent and predictable biological response to adeno-associated virus gene therapy, particularly after high-dose systemic administration. Early postdose laboratory changes, including mild thrombocytopenia, modest reductions in C3 and C4, and low-level elevations in complement activation markers, are commonly observed and generally reflect expected pharmacodynamic effects rather than toxicity in isolation. However, a subset of individuals progresses to complement-mediated endothelial injury and thrombotic microangiopathy, a rare but potentially severe complication. Despite increasing recognition of complement biology in gene therapy safety, laboratory monitoring practices remain inconsistent, and interpretation of complement biomarkers is often fragmented. Reliance on isolated measurements may obscure early pathologic trajectories, while functional assays are sensitive to preanalytical variability. Emerging data suggest that alternative pathway amplification governs severity across diverse initiating mechanisms and distinguishes self-limited complement activation from sustained endothelial injury. This article proposes a laboratory-centered framework that integrates complement biomarkers with hematologic and renal indices, emphasizing serial trends over isolated values. Standardized interpretation of complement testing is essential for early recognition of pathologic escalation and for maintaining patient safety as gene therapy expands across clinical settings.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158051","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":"Is Vaginal Estrogen Treatment Associated with Risk of Thrombosis in Postmenopausal Women? A Scoping Review.","authors":"Sofie L Juul, Marianne Glavind-Kristensen, Pinar Bor, Mustafa Vakur Bor","doi":"10.1055/a-2882-1241","DOIUrl":"10.1055/a-2882-1241","url":null,"abstract":"<p><strong>Abstract: </strong>Although the thromboembolic risk associated with oral estrogen is recognized, the risk profile of vaginal estrogen treatment remains inconclusive. This scoping review aims to explore available evidence on the association between vaginal estrogen treatment in postmenopausal women and the risk of thrombosis. We conducted a systematic search of PubMed and Embase, investigating vaginal estrogen treatment and thrombosis, for all records up to May 21, 2025. The process was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) and a preregistered protocol (osf.io/hgecd). We excluded systemic estrogen treatments, contraception, fertility treatments, gender-affirming therapies, and hormone treatments other than estrogen. Eligible study designs included clinical trials, randomized controlled trials, observational, case-control, and cohort studies. The search identified 866 articles, whereof 8 were eligible. Manual searching through citations and references yielded 3 additional studies, resulting in 11 included articles, all observational. One study reported a reduced risk of recurrent myocardial infarction (MI) following discontinuation of vaginal estrogen treatment (adjusted hazard ratio [aHR]: 0.54; 95% confidence interval [CI]: [0.34-0.86]). Remaining studies found no thrombosis risk in vaginal estrogen users. For venous thromboembolism (<i>n</i> = 6), effect estimates ranged from null to reduced risk (aHRs: 0.68 [0.36-1.28], to 1.06 [0.58-1.93]), similar for MI (<i>n</i> = 5; aHRs: 0.52 [0.31-0.85] to 0.83 [0.77-0.89]) and stroke (<i>n</i> = 6, aHRs: 0.68 [0.62-0.70] to 0.96 [0.93-0.99]). This scoping review, including studies of generally moderate to high methodological quality, indicates no increased risk of thrombosis associated with vaginal estrogen use in postmenopausal women. Further prospective, high-quality clinical trials, including high-risk populations and women with prior thrombosis, are warranted.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240003","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":"Designing the Future of Hemostasis.","authors":"Thomas D D Kazmirchuk, Jiashu Wang, Janice Corbette, Zein Al Abideen Hammad, Maha Othman, Ashkan Golshani","doi":"10.1055/a-2885-4368","DOIUrl":"10.1055/a-2885-4368","url":null,"abstract":"<p><strong>Abstract: </strong>Bleeding disorders arising from dysfunctional platelet-protein interactions pose a significant clinical challenge due to their heterogeneity and complexity. Primary hemostasis is mediated by von Willebrand factor (VWF) and platelet surface receptors GPIbα and αIIbβ3. This protein triad is central to clot formation, and interfering with their associated activity can cause several primary hemostasis-related disorders. While traditional therapies, including factor replacement and monoclonal antibodies, have improved outcomes, they are often limited by availability, cost, immunogenicity, and inadequate precision. Recent advances in computational biology and peptide engineering now offer potential for improved hematologic therapeutics. This review outlines two major strategies in peptide drug design: Structure-based modeling and small motif-based design. These approaches enable the creation of short, stable peptides capable of targeting disease-specific protein-protein interactions (PPIs) with high specificity. We highlight the recent development of G14-an artificial intelligence (AI)-designed peptide that selectively disrupts the aberrant GPIbα-VWF interaction in platelet-type von Willebrand disease. The peptide demonstrated selective inhibition of the enhanced patient-derived platelet aggregation and VWF binding. By combining systems biology, structural modeling, and AI, peptide design can now yield rapid, scalable, and personalized therapies for bleeding disorders. Thus, the growing adoption and integration of intelligently designed peptides offer a new perspective on precision medicine for thrombosis and hemostasis.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144536","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":"Peripartum Vascular Calamities: Placental Abruption and Amniotic Fluid Emboli.","authors":"Amir Wolfovitz, Benjamin Brenner, Ido Solt","doi":"10.1055/a-2877-3436","DOIUrl":"10.1055/a-2877-3436","url":null,"abstract":"<p><strong>Abstract: </strong>Amniotic fluid embolism (AFE) and placental abruption represent two of the most catastrophic obstetric emergencies, sharing a common pathway of severe coagulopathy while differing fundamentally in their underlying pathophysiology. AFE is characterized by sudden cardiovascular collapse, respiratory distress, and disseminated intravascular coagulation (DIC), likely triggered by an anaphylactoid-like reaction to fetal antigens entering maternal circulation. The condition manifests with both consumptive coagulopathy and hyperfibrinolysis, with platelet counts frequently falling below 50,000/μL and precipitous drops in fibrinogen levels. Management requires immediate advanced cardiac life support and aggressive hemodynamic support, mechanical ventilation, and massive transfusion protocols guided by viscoelastic testing. Emerging therapies include extracorporeal membrane oxygenation for refractory cardiopulmonary collapse and recombinant factor VIIa for intractable hemorrhage. Placental abruption results from premature placental separation and presents vaginal bleeding, abdominal pain, and fetal compromise. The condition arises from chronic uteroplacental ischemia and decidual arteriopathy, with retroplacental hematomas serving as massive sources of tissue factors that trigger the coagulation cascade. Abruption-related DIC primarily manifests consumption coagulopathy. Unlike AFE, urgent delivery of the fetus and placenta can eliminate the source of thromboplastic material, often resolving the coagulopathy. Both conditions demand, among others, institutional preparedness with established massive transfusion protocols and multidisciplinary teams trained in obstetric critical care. While advances in viscoelastic testing, targeted factor concentrates, and life support technologies have improved outcomes, AFE and placental abruption continue to challenge even experienced obstetric teams.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206043","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":"Diagnosis and Management of Recurrent Thrombosis and Pregnancy Loss in a Patient with Multilevel Thrombophilia.","authors":"Maximiliano V M Correa Lara, Jaime García Chavez, Erika Martinez Hernandez","doi":"10.1055/a-2879-8256","DOIUrl":"10.1055/a-2879-8256","url":null,"abstract":"","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176706","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":"Global Hemostasis Testing in Chronic Kidney Disease-Are They Better Predictors of Bleeding and Thrombosis Risk?","authors":"Hui Yin Lim, Eng Soo Yap, Prahlad Ho","doi":"10.1055/s-0045-1809162","DOIUrl":"10.1055/s-0045-1809162","url":null,"abstract":"<p><strong>Abstract: </strong>Chronic kidney disease (CKD) affects over 10% of the global population and significantly increases the risk of cardiovascular disease as well as arising bleeding. There are alterations in hemostasis, which are multifactorial, involving complex interactions between coagulation, platelets, and the vessel wall. Hemostasis evaluation in CKD is critical for the optimal management of patients. However, conventional coagulation testing and renal function do not fully reflect the hemostatic alterations and do not adequately represent the risk of bleeding and/or thrombosis in patients with CKD. Global hemostatic assays, including thrombin and fibrin generation assays, provide a more wholesome assessment of the process, including the interaction between procoagulants, anticoagulants, platelets, and fibrinolysis. This review critically appraises published studies reporting the use of global coagulation assays to evaluate hemostasis in patients with CKD, as well as associated clinical outcomes.</p>","PeriodicalId":21673,"journal":{"name":"Seminars in thrombosis and hemostasis","volume":" ","pages":"391-404"},"PeriodicalIF":4.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080113","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}