Seminars in Dialysis最新文献

{"title":"Prevalence and Risk Factors of Sarcopenia in People Receiving Dialysis: A Systematic Review and Meta-Analysis.","authors":"Joanna Stockings, Susan Heaney, Ginger Chu, Peter Choi, Ritin Fernandez","doi":"10.1111/sdi.70000","DOIUrl":"https://doi.org/10.1111/sdi.70000","url":null,"abstract":"<p><strong>Background: </strong>People receiving dialysis treatment are at higher risk of sarcopenia. This review aimed to determine the global prevalence of sarcopenia in people on peritoneal dialysis and hemodialysis. We investigated whether the prevalence of sarcopenia differs based on assessment criteria, timing of assessment, and measurement tools used and explored the risk factors for sarcopenia in people on dialysis.</p><p><strong>Methods: </strong>This review followed JBI and PRISMA guidelines and included studies assessing sarcopenia in adults aged 18 and older with chronic kidney disease undergoing dialysis. Five databases were searched from inception to November 2022. The JBI SUMARI software was used to perform the meta-analysis. Publication bias and risk factor analysis were performed using STATA (Version 18).</p><p><strong>Results: </strong>A meta-analysis of 62 studies (15,382 participants) found the global prevalence of sarcopenia to be 30.1% (95% CI: 25.6%-39.9%) for hemodialysis and 20.5% (95% CI: 15.1%-26.4%) for peritoneal dialysis. Sarcopenia prevalence ranged between 23.1% and 30.3% in HD and between 6.1% and 26.9% in PD, based on the assessment criteria. Post-dialysis sarcopenia prevalence was higher (33%) than pre-dialysis (24.2%) in hemodialysis patients. Measuring muscle mass after dialysis using dual-energy X-ray assessment yielded a lower prevalence of sarcopenia (22.5%) than bioimpedance analysis or spectroscopy (33%). Risk factors in the HD population included age, sex, diabetes, inflammation markers, nutritional indices, and dialysis vintage, although heterogeneity between studies was high.</p><p><strong>Conclusion: </strong>This study showed a high prevalence of sarcopenia among the dialysis population and identified many risk factors, emphasizing the need for early identification and intervention and standardized assessments.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584727","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":"Method for Predict Stenosis of Arteriovenous Fistula Patients Based on Machine Learning.","authors":"Yunghsin Chen, Wei-Tse Hsu, Christopher Chen, Wei-Ta Chen","doi":"10.1111/sdi.70001","DOIUrl":"https://doi.org/10.1111/sdi.70001","url":null,"abstract":"<p><strong>Objectives: </strong>Arteriovenous fistula (AVF) is the most ideal vascular access for hemodialysis. People with AVF have a longer vascular access survival rate and a lower complication rate. Thrombosis and stenosis are the most common complications of AVF. The annual thrombosis event rate is 10%-50%. Appropriate identification of AVF stenosis and management could reduce the risk of thrombosis and access loss. Guidelines recommended physical examinations as the first line of AVF stenosis monitoring. However, even for health professionals, the diagnosis rate by hearing the bruit varied. The sound waves of AVF can be recorded by electronic stethoscopes and the analysis of the digitalized signal may help predict stenosis of AVF and trigger the next step of management.</p><p><strong>Methods: </strong>From January 1, 2019, to December 31, 2019, all dialysis patients with AVF referred to our angiography laboratory for AVF angiography were enrolled. Significant stenosis was defined as stenosis severity > 70% on angiography. The stenosis severities were measured before and after the angioplasty. Before and after the angioplasty/angiography, the sounds of AVF were digitally recorded by an electrical stethoscope. Two sections longer than 10 s were obtained at different sites for each recording. Seventy percent of all the data was used to train the machine learning algorithm. The other 30% was used for testing. For the output of the algorithm, the AVF stenosis severity was classified into significant stenosis or non-significant stenosis.</p><p><strong>Results: </strong>One hundred ninety-nine patients were enrolled. Ninety-six patients were with significant stenotic AVF and the other 103 patients were with insignificant stenosis. One hundred eighty-nine recording sections for significant stenosis and 511 recording sections for insignificant stenosis were obtained. The machine learning artificial intelligence can classify the input sound waves as significant or insignificant stenosis with a 94.1% sensitivity rate and an 81.7% specificity rate.</p><p><strong>Conclusions: </strong>Artificial intelligence can help predict AVF stenosis by analyzing the digitalized sound waves of AVF. This analysis is convenient and non-invasive. Moreover, this technique can help the development of a remote monitor of AVF stenosis, which is especially important in the era of the COVID-19 pandemic.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Heparin Hemodialysis Catheter Lock on Partial Thromboplastin Time Assays in Inpatients on Therapeutic Intravenous Heparin.","authors":"Thomas S Tuggle, Lama Noureddine, Ryan A Hobbs","doi":"10.1111/sdi.13260","DOIUrl":"https://doi.org/10.1111/sdi.13260","url":null,"abstract":"<p><strong>Objective: </strong>Multiple in vitro and in vivo studies indicate that there is a significant amount of dialysis catheter lock leak with tunneled and nontunneled dual lumen hemodialysis (HD) catheters. The impact of heparin 1000 unit/mL HD catheter lock on outcomes in patients on therapeutic heparin has not been previously reported.</p><p><strong>Methods: </strong>Twenty-nine patients with 42 patient events on HD or continuous renal replacement therapy (CRRT) via double lumen catheters were retrospectively analyzed. Study patients received heparin 1000 unit/mL HD catheter lock while on therapeutic intravenous heparin. All patients had stable activated partial thromboplastin times (PTT) prior to catheter locking and had a PTT drawn within 6 h after administration of the heparin HD catheter lock.</p><p><strong>Results: </strong>The average prelock PTT was 56 s and postlock PTTs increased on average to 85 s (p < 0.0001). PTTs were significantly higher when drawn closer to the administration time of the heparin catheter lock. Major bleeding occurred in many surgical patients after heparin HD catheter lock administration.</p><p><strong>Conclusion: </strong>Citrate or saline HD catheter lock may be preferable to heparin HD catheter lock in patients on intravenous heparin infusions, especially in high-bleed-risk surgical patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235064","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":"Clinical Analysis of Heparin-Induced Thrombocytopenia due to Therapeutic Plasmapheresis With Heparin Anticoagulation.","authors":"Chenling Lv, Hongtao Liang, Fei Tian, Gang Liu, Weibi Chen, Yan Zhang","doi":"10.1111/sdi.13259","DOIUrl":"https://doi.org/10.1111/sdi.13259","url":null,"abstract":"<p><strong>Objective: </strong>We investigated the clinical characteristics and treatment outcomes of heparin-induced thrombocytopenia (HIT) following therapeutic plasma exchange (TPE) with heparin anticoagulation in patients with neurological autoimmune diseases.</p><p><strong>Methods: </strong>Clinical data were prospectively collected from 158 patients (79 males, 79 females; mean age 37.49 ± 16.95 years) with neurological autoimmune diseases who underwent TPE in the neuro-intensive care unit between January 2016 and June 2024. For patients with continuous platelet decline after TPE, the 4Ts score was determined, and platelet factor 4 (PF4) antibody tests were performed. Their platelet counts, clinical complications (thrombosis and bleeding), treatment plans, outcomes, and prognoses before and after TPE were analyzed.</p><p><strong>Results: </strong>One hundred thirty-nine patients experienced at least one significant decrease in platelet count during TPE (average decrease 36.75 ± 19.63%), and the average 4Ts score was 3.55 ± 1.87 points. PF4 antibody testing was conducted on 23 patients with continuous platelet decline and 4Ts scores ≥ 4. Four PF4-positive patients were diagnosed with type II HIT and developed deep vein thrombosis. After heparin withdrawal, the platelet count gradually normalized after intravenous immunoglobulin (IVIG), nonheparin TPE, or argatroban/fondaparinux anticoagulant therapy (mean recovery time 8.17 ± 3.54 days). The platelet counts spontaneously recovered for the remaining 116 patients (mean recovery time 3.88 ± 2.66 days).</p><p><strong>Conclusion: </strong>Platelet counts should be dynamically monitored throughout TPE with heparin anticoagulation. Patients with continually decreasing platelet counts and an intermediate to high 4Ts score should be monitored for HIT. Heparin should be discontinued immediately for patients with type II HIT, and nonheparin anticoagulants, IVIG, or nonheparin TPE may be administered.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151870","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":"On the Cusp-A Questionnaire-Based Assessment of Implementing PIVOTAL Into UK Practice.","authors":"Sebastian Spencer, Samantha Hunter, Sunil Bhandari","doi":"10.1111/sdi.13250","DOIUrl":"10.1111/sdi.13250","url":null,"abstract":"<p><strong>Background: </strong>Anemia is a common occurrence in people with chronic kidney disease and end-stage kidney disease. Intravenous administration of iron is standard treatment for people undergoing maintenance hemodialysis. However, until the recent PIVOTAL randomized control trial, there was uncertainty around clinically effective regimens. This study found that among incident, people receiving hemodialysis in the first year, a proactive high-dose intravenous iron regimen was superior to reactive low-dose regimen, leading to reduced mortality and cardiac events. Our study investigated whether the research and guidelines have been successfully implemented into clinical care across the United Kingdom, identified barriers experienced, and explored our local hemodialysis population's awareness of the treatment they are receiving.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey using a convenient sample of UK-based kidney physicians working in the NHS and local people receiving hemodialysis. Two preconceived, standardized questionnaires were designed.</p><p><strong>Results: </strong>Forty physicians responded. Of these, 40% had implemented a proactive iron protocol, whereas 37.5% had not. Respondents acknowledged concerns about doses of iron and the need for local protocols. Thirty-seven patients responded to the patient questionnaire within our own hemodialysis unit. Fifty-one percent of patients reported to be receiving iron supplementation, of which 84% stated it was intravenous through their dialysis machine.</p><p><strong>Conclusions: </strong>We have not observed a paradigm shift in clinical practice and identified poor patient understanding of their treatment. Strategies to overcome barriers are necessary to introduce treatments that offer both clinical advantages and cost savings. Eliminating futile practice is challenging due to departmental prioritization and economic considerations. Traditionally, efforts to improve care are targeted towards newer therapies; however, there is an opportunity to improve implementation of current evidence.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"214-220"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568065","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":"Kinetic Modeling Programs for Hemodialysis Adequacy Focusing on Urea, Creatinine, Phosphate, and Beta-2-Microglobulin.","authors":"John T Daugirdas","doi":"10.1111/sdi.13252","DOIUrl":"10.1111/sdi.13252","url":null,"abstract":"<p><p>Here we describe six kinetic modeling programs that allow quantification of removal of urea, creatinine, phosphate, and beta-2-microglobulin. They can be used with asymmetric dialysis treatment schedules ranging from one to seven times per week. Once downloaded, the programs can be run locally from a personal computer without requiring connection to the internet. They have been designed to analyze solute removal in a single patient or in thousands of patients. Each program is contained in a single JavaScript-HTML text file, and all of the assumptions and equations used are easily accessible in uncompressed text format and are accompanied by comments and annotations. Inputs are in the form of comma-delimited files which can be imported from spreadsheets. Outputs appear in the form of web pages or as comma-delimited files that can be exported into spreadsheets for graphing and further analysis. This perspective focuses on describing the potential utility of these programs (two pertaining to urea, two to creatinine, one to phosphate, and one to beta-2-microglobulin) as well as two helper calculators, one that computes dialyzer mass transfer area coefficient for urea (K0A) from dialyzer specification chart urea clearance data, and another that can be used to calculate the phosphate binder equivalent dose.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"161-165"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights Into Peritoneal Dialysis Outcomes: An Approach Using Competing Risks Analysis.","authors":"Ana Cunha, Beatriz Gil Braga, Sofia Sousa, António Inácio, Yulia Shilyaeva, Joana Tavares, Maria João Carvalho, Isabel Fonseca, Anabela Rodrigues, Laetitia Teixeira","doi":"10.1111/sdi.13255","DOIUrl":"10.1111/sdi.13255","url":null,"abstract":"<p><p>Peritoneal dialysis (PD) outcomes analysis presents challenges due to heterogeneous outcomes. Our study aims to evaluate mortality, transition to hemodialysis (HD), and kidney transplant (KT) rates and investigate potential baseline patient characteristics influencing these outcomes. We conducted an observational retrospective registry-based single-center cohort study involving 722 incident adult PD patients admitted between 1985 and 2022. Follow-up duration extended from PD initiation to the first occurrence of death (n = 143), transfer to HD (n = 313), or KT (n = 202). Utilizing competitive risks analysis, we calculated cumulative incidence (CI) functions and applied a Fine and Gray model to baseline variables to understand their impact. The majority of patients were female (n = 401; 55.54%), with an average age of 49.64 ± 15.80 years. Transfer to HD had the highest probability (CI of 0.38 at 60 months), followed by KT (CI of 0.27 at 60 months) and death (CI of 0.19 at 60 months). Diabetes correlated solely with death (HR 1.71 (0.18); p = 0.004). PD-first was associated with a lower risk of HD transfer (HR 0.76 (0.13); p = 0.036) and positively influenced KT (HR 1.73 (0.16); p < 0.01). Vascular access as the reason for PD selection was associated with death (HR 2.16 (0.19); p < 0.001). The main risk for PD patients is transitioning to HD, unaffected by baseline patient characteristics. PD-first option positively influences KT access, and mortality rates remain low and unaffected by this option, ensuring the safety of the technique. Vascular access-related PD initiations correlate with increased mortality, potentially due to comorbidities.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"207-213"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Causes of Arteriovenous Fistula Stenosis on the Patency Rate of Arteriovenous Fistula Following Percutaneous Transluminal Angioplasty.","authors":"Min Xia, Qi-En He, Wen-Jing Zhou, Zhu-Jun Wang, Yi-Shu Bao, Xue-Lin He","doi":"10.1111/sdi.13258","DOIUrl":"https://doi.org/10.1111/sdi.13258","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate the impact of the causes of arteriovenous fistula (AVF) stenosis on the 1-year primary patency rate of AVF following percutaneous transluminal angioplasty (PTA) and to identify the independent risk factors that affect vascular access patency post-PTA.</p><p><strong>Methods: </strong>In this investigation, we analyzed the clinical data of 78 patients who underwent successful PTA for dysfunctional autologous AVF in the Nephrology Department of our hospital between January 2020 and September 2022. The primary focus of this study was to observe the postoperative patency rate of AVF in these patients. Subsequently, the patients were categorized based on primary diseases, Charlson comorbidity index (CCI), AVF typing, and causes of AVF stenosis. The postoperative patency rates of AVF were then compared among the respective groups. To further analyze the relevant risk factors influencing vascular access patency following PTA, the Cox proportional hazard model was employed.</p><p><strong>Results: </strong>A total of 78 eligible patients who underwent PTA were included in this study revealing patency rates of 93%, 85%, 80%, and 72% at 3, 6, 9, and 12 months postoperatively, respectively. Analysis using the Kaplan-Meier curve indicated no significant association between the presence of diabetic nephropathy (p = 0.313) and AVF stenosis typing (p = 0.195) with post-PTA patency of AVF. However, the 1-year patency rate demonstrated notable differences, with higher rates observed in the CCI < 7 group compared with the CCI ≥ 7 group and similarly in the simple AVF stenosis group compared with the intimal hyperplasia group (p < 0.001). Furthermore, based on multivariate survival analysis (Cox regression model), the causes of AVF stenosis and CCI index were identified as independent risk factors influencing AVF patency following PTA (p < 0.05).</p><p><strong>Conclusion: </strong>Patients with intimal hyperplasia were found to have a higher likelihood of AVF restenosis compared with those with simple stenosis. Similarly, individuals with a high CCI were more prone to AVF restenosis than those with low CCI. The causes of AVF stenosis and CCI were identified as independent risk factors influencing vascular access patency following PTA.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"38 3","pages":"201-206"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044499","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":"Two Cases of Acquired Reactive Perforating Collagenosis in Hemodialysis Patients.","authors":"Min Xu, Fale Cao, Shumei Shi","doi":"10.1111/sdi.13244","DOIUrl":"10.1111/sdi.13244","url":null,"abstract":"<p><p>Acquired reactive proliferating collagen (ARPC), usually associated with systemic diseases, is a rare skin disease characterized by the elimination of altered dermal collagen through the epidermis. Here, we report two cases of ARPC in maintenance hemodialysis patients, one of which is combined with type 2 diabetes, chronic renal failure, and hypertension and the other is combined with chronic renal failure and hypothyroidism. Two patients were treated with oral thalidomide and ebastine, local application of fluticasone propionate cream, and enhanced dialysis. After treatment, the itching and the rash significantly improved. We report for the first time that ARPC in patients with hemodialysis could be improved by oral thalidomide and antihistamines and local application of steroid. This report provides reference for guiding the understanding of ARPC and the new treatment of ARPC in hemodialysis patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"225-228"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391588","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":"One Nation-One Dialysis: Breaking Barriers, Empowering Lives.","authors":"Sourabh Sharma, Vivek Kute, Narayan Prasad, Sanjay Kumar Agarwal","doi":"10.1111/sdi.13253","DOIUrl":"10.1111/sdi.13253","url":null,"abstract":"<p><p>The objective of India's One Nation One Dialysis (ONOD) program is to remove the barriers that end-stage kidney disease patients face in accessing consistent, quality dialysis services across the nation. A unified and standardized dialysis care approach is what ONOD aims to achieve at a national level. The objective of ONOD is to improve access to, affordability of, and quality in dialysis services for economically weaker segments of society and those living in remote areas of the country by providing dialysis services through public-private partnerships. The ONOD program places a lot of emphasis on the infrastructure development, funding support, skill development, regulatory reforms, and technological integration of dialysis services. By implementing ONOD, India can improve patient outcomes, close the supply-demand gaps for end-stage kidney disease kidney replacement therapy, and create a more balanced and sustainable kidney healthcare ecosystem.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"166-175"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711215","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}