Seminars in Dialysis最新文献

{"title":"Phosphate Kinetic Modeling in Patients Treated With Hemodialysis or Hemodiafiltration: A Prospective, Multicenter, Cross-Sectional Study.","authors":"Jörgen Hegbrant, Amparo Bernat, Rita Simorra, Domingo Del Castillo, Jose Luis Pizarro, Carlos Jarava, Sonia Caparros, Giovanni F M Strippoli, John T Daugirdas","doi":"10.1111/sdi.70029","DOIUrl":"10.1111/sdi.70029","url":null,"abstract":"<p><strong>Background: </strong>Studies suggest increased phosphate removal when using hemodiafiltration (HDF) compared with hemodialysis (HD), but a complete analytic comparison has not been reported.</p><p><strong>Methods: </strong>We analyzed data from a 6-month prospective, multicenter, cross-sectional study that enrolled patients treated with high-flux HD or HDF and in whom residual kidney phosphate clearances (KrPhos) were measured. Modeling data and dietary survey data were available from 115 patients (59 treated with HD and 56 treated with HDF).</p><p><strong>Results: </strong>Predialysis (midweek) serum phosphate values averaged 4.37 ± 1.00 and 4.60 ± 1.18 mg/dL in the HD and HDF groups (p = NS). Mean prescribed phosphate binder equivalent dose (PBED) (including zero values) was 3.33 ± 2.94 g/day in HD and 2.64 ± 2.68 g/day in HDF (p = 0.19). Mean modeled phosphate ingestion was similar in HD and HDF (911 ± 231 vs. 911 ± 300 mg/day, p = NS), but phosphate ingestion by dietary survey was higher in HDF vs. HD (1119 ± 520 vs. 801 ± 420 mg/day, p < 0.001). Mean predialysis serum phosphate values in patients with residual kidney function (defined as KrPhosWater > 1.0 mL/min) and anuric patients were similar (4.43 ± 0.73 vs. 4.50 ± 1.20 mg/dL, respectively), whereas mean prescribed PBED was lower in patients with KrPhosWater > 1.0 mL/min (1.83 ± 2.02 vs. 3.40 ± 2.96 g/day, p < 0.01).</p><p><strong>Conclusions: </strong>Predialysis serum phosphate is not always lower in patients treated with HDF compared with HD, and this can possibly be explained by a trend to a lower prescribed PBED and/or by a higher dietary phosphate intake.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"97-104"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820147","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":"Identification of Predictors of Tunneled Central Venous Catheter Dysfunction in Hemodialysis: A Multicenter Retrospective Cohort With Repeated-Measure Sessions.","authors":"Verónica Gimeno-Hernán, Ana Belén Rivas-Paterna, Carla Pérez-Ingidua, Ana Ascaso-Del-Río, Marina Gómez-Esteban, Ismael Ortuño-Soriano","doi":"10.1111/sdi.70034","DOIUrl":"10.1111/sdi.70034","url":null,"abstract":"<p><strong>Background: </strong>Tunneled central venous catheter dysfunction is a frequent and clinically relevant complication in hemodialysis, with a direct impact on treatment efficacy and vascular access survival. Identifying modifiable risk factors is essential for optimizing prevention strategies and guide clinical decision-making. This study aimed to identify predictors of tunneled central venous catheter dysfunction through a retrospective multicenter cohort of hemodialysis sessions with repeated measures cross-sectional, while other cross-sectional approaches-such as the one presented here-focus on data collected during each HD session to detect early warning signs of dysfunction, following KDOQI 2019 guidelines for vascular access dysfunction definition. The secondary objective was to explore associations.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study with repeated measures was conducted using all hemodialysis sessions performed in 2021 in 18 public hospitals. The unit of analysis was the index session, and the primary outcome was catheter dysfunction in the subsequent session, defined as blood flow < 300 mL/min with associated arterial or venous pressure changes. A mixed-effects logistic regression with a random intercept for each patient was fitted to account for the repeated hemodialysis sessions.</p><p><strong>Results: </strong>Significant associations were found between catheter dysfunction and lower blood flow rates, elevated venous pressures, line inversion, and catheter placement in the left internal jugular vein. Protective factors included urokinase locking and post-dilution hemodiafiltration. Higher risk was also linked to interstitial nephropathies and unknown etiologies, whereas prior vascular access reduced the risk of dysfunction.</p><p><strong>Conclusion: </strong>Tunneled central venous catheter dysfunction is a preventable complication when clinical, technical, and hemodynamic parameters are systematically monitored to identify risk factors and guide catheter management. Continuous session-based monitoring enables early detection and timely intervention. This comprehensive strategy, when combined with pharmacologic management, helps preserve vascular access and enhances treatment outcomes in hemodialysis patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"116-126"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780091","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":"Severe Hematoma Following Initial Arteriovenous Fistula Puncture in a Hemodialysis Patient, Emphasizing Thoracic Outlet Syndrome: A Case Report.","authors":"Yan Zhang, Lin Chen, Xianglei Kong, Sha Sha, Jimei Liu, Lili Wang, Hong Ji","doi":"10.1111/sdi.70023","DOIUrl":"10.1111/sdi.70023","url":null,"abstract":"<p><strong>Background: </strong>Hematoma is a common complication following arteriovenous fistula (AVF) cannulation in hemodialysis patients; however, rapid progression to tension blister formation is rare.</p><p><strong>Case report: </strong>We describe a case involving a 62-year-old male on maintenance hemodialysis, who initially received treatment via a tunneled right internal jugular catheter with a polyester cuff. Approximately 10 weeks after the creation of a right forearm AVF, the patient underwent first-time AVF cannulation. After 2 h, he developed a hematoma at the puncture site, followed by extensive tension blisters the next day. Computed tomography angiography (CTA) revealed significant stenosis of the right subclavian vein. Conservative treatment, including antibiotics, microcirculation enhancement, and wound care, led to recovery. Based on this case, we revised our center's protocol for AVF assessment and early use during the first 3 months post-creation.</p><p><strong>Conclusions: </strong>In patients with newly matured AVFs-particularly those with a history of ipsilateral central venous catheterization-screening for thoracic outlet syndrome should be integrated into pre-cannulation assessments (e.g., AVF blood flow is dynamically evaluated with the arm in multiple positions). Standardizing AVF use during the activation period may reduce complications and help prolong fistula patency.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"127-131"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820212","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":"Development and Validation of a Nomogram to Predict the Difficult Transradial Approach for Percutaneous Transluminal Angioplasty in Radiocephalic Arteriovenous Fistulas.","authors":"Jiali Liu, Kun Zhang, Zhiqiang Duan, Fei Yin, Heping Zhang","doi":"10.1111/sdi.70027","DOIUrl":"10.1111/sdi.70027","url":null,"abstract":"<p><strong>Background: </strong>The transradial approach (TRA) is a critical access method for percutaneous transluminal angioplasty (PTA) in hemodialysis (HD) patients with arteriovenous fistula (AVF) dysfunction, yet its technical challenges remain unaddressed. Currently, no predictive tools exist to assess TRA feasibility. This study aimed to identify risk factors for difficult TRA and develop a predictive nomogram.</p><p><strong>Methods: </strong>We retrospectively analyzed 160 HD patients undergoing ultrasound-guided TRA-PTA across three Chinese hospitals (May 2022-May 2024). A training cohort (n = 110) and validation cohort (n = 50) were established. Independent risk factors were identified via univariate and multivariate logistic regression. A nomogram was constructed and validated using ROC curves, calibration plots, and decision curve analysis (DCA).</p><p><strong>Results: </strong>The cohort had a mean age of 59.7 ± 12.9 years, with 36.9% (59/160) experiencing difficult TRA. Radial artery diameter (OR = 2.1, p = 0.003), calcification (OR = 3.4, p < 0.001), and tortuosity (OR = 2.8, p = 0.002) were independent predictors. The nomogram demonstrated strong discrimination (AUC: 0.902), with sensitivity = 0.907 and specificity = 0.806 at a cutoff of 0.416. Calibration showed excellent agreement (mean absolute error = 0.022), and DCA confirmed clinical utility across threshold probabilities of 0.2-0.8.</p><p><strong>Conclusion: </strong>This nomogram demonstrates that for optimal puncture feasibility, the radial artery diameter should be ≥ 3 mm when both calcification and tortuosity are present, > 2.2 mm if either condition is present, and > 1.5 mm if neither is present. The nomogram effectively predicts difficult TRA during AVF-PTA in HD patients, offering clinicians a practical tool to preoperatively assess procedural feasibility and optimize vascular access planning.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"88-96"},"PeriodicalIF":1.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780108","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":"Prevalence and Correlates of Physical Activity Among Hemodialysis Patients: A Systematic Review and Meta-Analysis.","authors":"Lin-Fan, Hong-Li Li, Jing-Tong Luo, Tian-Ming Song","doi":"10.1111/sdi.70019","DOIUrl":"10.1111/sdi.70019","url":null,"abstract":"<p><p>Physical activity has been recommended as an effective strategy to prevent complications in patients receiving hemodialysis. Multiple guidelines for chronic kidney disease recommend at least 150 min per week of moderate-intensity physical activity. However, the prevalence of meeting recommended physical activity levels among hemodialysis patients remains unclear, and the factors influencing physical activity participation require further investigation. We systematically searched PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, PsycINFO, China National Knowledge Infrastructure, WanFang, Chinese Biomedical Literature Service System, and SPORTDiscus from inception to March 5, 2025. The Agency for Healthcare Research and Quality was used to evaluate the methodological quality of included studies. The pooled prevalence was calculated using a random-effects model. Subgroup analysis was conducted to explore sources of heterogeneity. We screened 24,566 records, reviewed 252 full texts, and included 12 studies (N = 8938). The pooled prevalence of meeting recommended physical activity was 32% (95% CI, 20%-46%). Higher prevalence was observed in studies with shorter dialysis vintage, self-administered PA instruments, smaller sample sizes, and those published before 2020. Factors underlying inactivity were multifactorial, spanning pathophysiological, psychological, and treatment-related domains. This review indicates a low prevalence of meeting recommended physical activity levels among hemodialysis patients, which is influenced by multiple factors. It is recommended that future studies further explore intervention strategies targeting physical activity on dialysis and non-dialysis days, based on factors that influence physical activity, to improve adherence.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"3-14"},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594261","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":"Efficiency and Safety of Different Medium Cut-Off Membranes in Maintenance Hemodialysis Patients.","authors":"Gurkan Yurteri, Ahmet Murt","doi":"10.1111/sdi.70017","DOIUrl":"10.1111/sdi.70017","url":null,"abstract":"<p><strong>Background: </strong>Due to the accumulation of uremic toxins, hemodialysis patients exhibit a variety of symptoms and increased mortality. With their unique pore size and distribution, medium cut-off (MCO) membranes can provide clearance of middle-sized uremic toxins without causing albumin loss. Such a property may decrease overall mortality in hemodialysis patients. This study aims to analyze the effects of MCO membranes on the clearance of β₂-microglobulin, tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) to assess the safety of using these membranes and to compare two different MCO membranes.</p><p><strong>Methods: </strong>This was a prospective observational study. Sixty hemodialysis patients who had been dialyzed thrice weekly via high flux dialyzers were switched to one of two MCO dialyzers (Elisio Hx or Theranova) for 1 month. The mean age was 58.7 ± 13.4 years, and the mean dialysis vintage was 65.8 ± 58.6 months. Serum levels of β₂-microglobulin, TNF-α, and IL-6 were compared by paired-samples t test between the end and the beginning of the study period. Dialysis adequacy, electrolytes, heparin doses, low-density lipoprotein (LDL), hemoglobin, and albumin levels were also compared. In addition, the performance of the two MCO dialyzers was compared using an independent-samples t test.</p><p><strong>Results: </strong>There was a significant decrease in β₂-microglobulin (p = 0.02), LDL (p < 0.01), and albumin levels (p < 0.001) at the end of the study. Dialysis adequacy, hemoglobin, phosphorus, C-reactive protein, IL-6, and TNF-α levels did not change significantly. Among patients receiving standard heparin for anticoagulation, heparin doses had to be increased during MCO membrane use. The performance of the two different dialyzers was not statistically different.</p><p><strong>Conclusions: </strong>MCO membranes provide clearance of middle-sized uremic toxins. This effect is most prominent for β₂-microglobulin and does not differ between the two MCO dialyzers studied. MCO membranes may cause some albumin loss, and heparin requirements may increase during their use.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"26-32"},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221249","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":"Targeted Temporary Tunnel Compression Suture: A Precision Method for Localizing and Controlling Postimplantation Bleeding in Tunneled Dialysis Catheter.","authors":"Subrahmanian Sathiavageesan","doi":"10.1111/sdi.70021","DOIUrl":"10.1111/sdi.70021","url":null,"abstract":"<p><strong>Background: </strong>Tunneled dialysis catheters (TDCs) remain the mainstay of unplanned and urgent start hemodialysis. TDCs are implanted by interventional radiologists, surgeons, or nephrologists, and these clinicians must be familiar with the management of TDC-related complications. Postimplantation bleeding at the exit site of a TDC poses diagnostic and therapeutic challenges.</p><p><strong>Methods: </strong>In this case report, we describe a simple bedside method for precise localization of the bleeding spot and targeted placement of a compression suture to arrest exit site bleeding from a TDC.</p><p><strong>Discussion: </strong>Bleeding at the exit site may be the result of bleeding from a venotomy wound or the tunnel tract or the exit wound itself. Precise localisation of the bleeding spot is an essential first step in achieving secure hemostasis. Currently recommended measures like application of manual compression, compressive dressing, local infiltration of hemostatic agents, and suturing of the exit site are limited by their empirical nature and failure to specifically target the bleeding vessel.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"48-52"},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616472","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":"Advancing Postdilution Hemodiafiltration for Global Sustainability: A Japanese Blueprint.","authors":"Kenji Sakurai, Ikuto Masakane, Akihiro C Yamashita, Hideki Kawanishi, Bernard Canaud","doi":"10.1111/sdi.70018","DOIUrl":"10.1111/sdi.70018","url":null,"abstract":"<p><strong>Background: </strong>Japan leads globally in HDF adoption, with online predilution HDF used in the majority of HDF treatments. Although associated with excellent outcomes, predilution HDF requires large substitution volumes and high dialysate production, raising sustainability concerns.</p><p><strong>Methods: </strong>This study employed a narrative review integrating expert consensus, Japanese registry data (JSDT), dialysis system specifications, and comparative clinical and kinetic literature to contrast predilution and postdilution strategies and derive an implementation pathway.</p><p><strong>Results: </strong>Postdilution HDF provides higher convective efficiency and solute removal per liter of fluid than predilution HDF, enabling comparable performance with lower total fluid requirements when prescriptions are optimized. A stepwise transition strategy is proposed: (1) progressive blood flow optimization; (2) selection of HDF-appropriate dialyzers with strict albumin permeability control; (3) anticoagulation optimization for higher filtration fractions; (4) gradual introduction and escalation of postdilution convection with automated fluid control; (5) dialysate-to-blood flow alignment allowing reduction of total dialysate flow while preserving clearance; and (6) iterative monitoring of efficacy and tolerance using clinical targets and biomarker response.</p><p><strong>Conclusions: </strong>A pragmatic transition toward optimized postdilution HDF can preserve Japan's high-quality dialysis care while improving resource efficiency. Registry-based evaluations and targeted randomized studies are needed to confirm clinical outcomes and quantify economic and environmental benefits.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"33-43"},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271799","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":"Blood Hemoglobin Change During Maintenance Hemodialysis Sessions.","authors":"Hiroyuki Koike, Masayuki Tanemoto","doi":"10.1111/sdi.70020","DOIUrl":"10.1111/sdi.70020","url":null,"abstract":"<p><strong>Background: </strong>Blood hemoglobin (Hb) levels typically increase during maintenance hemodialysis (MHD) sessions. This intradialytic Hb change (ID-HbC) may increase thrombotic risks depending on its magnitude. This study investigated the magnitude.</p><p><strong>Methods: </strong>In 115 MHD sessions with standard hemodialysis modality, relative-ID-HbC, which was calculated from pre- and post-dialysis Hb values, was examined in relation to ultrafiltration volume normalized to dry weight (UFV/DW).</p><p><strong>Results: </strong>Relative-ID-HbC ranged from -0.037 to 0.324, with a median (interquartile range) of 0.104 (0.070-0.177). A significant positive correlation was observed between relative-ID-HbC and UFV/DW (r = 0.50, p < 0.001), with a least-squares regression slope of 3.1. In about 1/3 sessions with UFV/DW > 0.05, relative-ID-HbC exceeded 0.2.</p><p><strong>Conclusion: </strong>More than 20% increase in Hb can occur in sessions with UFV/DW > 0.05, whereas the typical increase is around 3% per 1% increase in UFV/DW. To reduce thrombotic risks, anemia therapy raising pre-dialysis Hb > 10.5 g/dL should preferably be avoided in MHD patients who require UFV/DW > 0.05.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"44-47"},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504698","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":"Tuberculous Peritonitis Diagnosed by Metagenomic Next-Generation Sequencing Progressing to Fatal Encapsulating Peritoneal Sclerosis in a Peritoneal Dialysis Patient: A Case Report.","authors":"Tianjiao Cui, Mingcheng Huang","doi":"10.1111/sdi.70022","DOIUrl":"10.1111/sdi.70022","url":null,"abstract":"<p><p>A 40-year-old woman on peritoneal dialysis for 3 years presented with febrile peritonitis. Metagenomic next-generation sequencing (mNGS) confirmed Mycobacterium tuberculosis complex in ascitic fluid, leading to prompt anti-tuberculosis therapy. She initially improved but developed ultrafiltration failure 15 months later and transitioned to hemodialysis. At 18 months, she developed bowel obstruction, bloody ascites, and characteristic imaging and laparoscopic findings of encapsulating peritoneal sclerosis (EPS). Despite supportive care, she deteriorated and died 30 months after tuberculosis peritonitis diagnosis. This case highlights that mNGS enables rapid diagnosis of tuberculous peritonitis when conventional tests are inconclusive, and that tuberculosis peritonitis may serve as a potent inflammatory trigger for EPS even after peritoneal dialysis cessation. Early recognition and timely intervention may improve outcomes.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"53-56"},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646322","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}