Stroke最新文献

{"title":"Sulcal Vessels Mimic Cerebral Microbleeds in HTRA1-Related CSVD at 7T MRI.","authors":"Yu Guo, Qing Peng, Zihao Zhang, Chen Ling","doi":"10.1161/STROKEAHA.124.048860","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048860","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI-Proven Incident Ischemia: A New Marker of Disease Progression in Small Vessel Diseases.","authors":"Lina Grosset, Ana Dimitrovic, Antoine Guillonnet, Ruben Tamazyan, Joseph Benzakoun, Antoine Dusonchet, Hugues Chabriat, Catherine Oppenheim, Mathieu Zuber, David Calvet, Eric Jouvent","doi":"10.1161/STROKEAHA.124.048046","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048046","url":null,"abstract":"<p><strong>Background: </strong>In ischemic cerebral small vessel diseases (cSVD), recurrent ischemic stroke is rare (2%-3% per year). Because acute ischemia may not always lead to stroke in cSVD due to the small size of lesions, acute stroke may not reliably reflect ischemic activity or the risk of further clinical worsening, as both incident lacunes and incidental diffusion-weighted imaging-positive lesions can occur without stroke symptoms. We aimed to evaluate the total ischemic activity by measuring the incidence of magnetic resonance imaging (MRI)-proven incident ischemia, independent of the presence of stroke symptoms in a large cohort of cSVD.</p><p><strong>Methods: </strong>DHU-LAC is an ongoing French multicenter cohort study of MRI-proven ischemic stroke presumably due to cSVD. We report data on patients recruited between June 2018 and October 2023. In DHU-LAC, patients are enrolled within 15 days of stroke onset and are cared for according to current guidelines. During the first 6 months, patients are systematically reassessed clinically and by brain MRI: (1) at any time if stroke symptoms occur and (2) at the end of the period. We defined MRI-proven incident ischemia as either recurrent ischemic stroke or at least 1 incident lacune or incidental diffusion-weighted imaging-positive lesion on brain MRI at 6 months.</p><p><strong>Results: </strong>Two hundred forty-nine patients were included, of whom 172 had available data at both inclusion and after 6 months. They were aged 63±6 years, 28% were women, and 65% had hypertension. Six (3%) had a recurrent ischemic stroke, but 25 more (15%) had at least 1 incident lacune or incidental diffusion-weighted imaging-positive lesion on brain MRI. MRI-proven ischemia occurs about 5× more frequently than ischemic stroke in cSVD.</p><p><strong>Conclusions: </strong>As data confirming the detrimental clinical effect of both incident lacunes and incidental diffusion-weighted imaging-positive lesions accumulate, MRI-proven incident ischemia may become a plausible outcome for future clinical trials in cSVD.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03552926.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuron-Specific Enolase Levels and Prognosis of Ischemic Stroke: Two Prospective Cohort Studies.","authors":"Pinni Yang, Mengyao Shi, Yang Liu, Xueyu Mao, Zhengbao Zhu, Xuechun Wu, Min Chu, Huicong Niu, Lulu Sun, Xinyue Chang, Yu He, Yi Liu, Daoxia Guo, Yonghong Zhang, Jing Zhao","doi":"10.1161/STROKEAHA.124.048443","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048443","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roadmap for Health Equity: Understanding the Importance of Community-Engaged Research.","authors":"Bernadette Boden-Albala","doi":"10.1161/STROKEAHA.124.046958","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.046958","url":null,"abstract":"<p><p>Achieving health equity in stroke prevention, treatment, and recovery has continued to be a significant challenge. This article highlights the significance of health equity and the role of community-engaged research in addressing stroke disparities, including concepts around health equity as the fair and just opportunity for everyone to attain their highest level of health and well-being. Social determinants impact stroke incidence, prevalence, morbidity, and mortality, which emphasizes the importance of intersectionality and social risk-informed care. A comprehensive roadmap for achieving health equity in stroke through the integration of community-engaged research is presented, including the necessity of community involvement in all aspects of research. Community is defined beyond geographic boundaries, highlighting the importance of shared identities and values. The process of developing targeted goals with communities toward social justice reform is reviewed, including an evolved community engagement framework, emphasizing the need for training to inform about issues and collaborative leadership models. Several stroke disparities intervention studies are highlighted, demonstrating the successful incorporation of community engagement into intervention design and intervention platforms. For enhanced engagement, the use of community health workers and better integration of community health worker models are essential. There may be a critical need for community engagement to optimize inclusion in clinical trials. Finally, acknowledging the complexities of research around decreasing stroke disparities in prevention, treatment, and recovery, this article delves into a framework for understanding the mechanisms by which interventions affect inequities and the need for multifaceted solutions with the community as a partner. Highlighting the roadmap to health equity, this research argues that community engagement is an integral component at all steps along the road to achieving optimum brain health through equitable stroke treatment, prevention, and recovery.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue Stenting for Failed Mechanical Thrombectomy in Acute Basilar Artery Occlusions: Analysis of the PC-SEARCH Registry.","authors":"Santiago Ortega-Gutierrez, Aaron Rodriguez-Calienes, Adam Mierzwa, Milagros Galecio-Castillo, Mahmoud Dibas, Sami Al Kasab, Ashley M Nelson, Ashutosh P Jadhav, Shashvat M Desai, Gabor Toth, Anas Alrohimi, Mohamad Abdalkader, Piers Klein, Thanh N Nguyen, Hisham Salahuddin, Aditya S Pandey, Sravanthi Koduri, Nirav Vora, Nameer Aladamat, Khaled Gharaibeh, Ehad Afreen, Syed F Zaidi, Mouhammad A Jumaa","doi":"10.1161/STROKEAHA.124.047694","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.047694","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate whether rescue stenting (RS) following failed mechanical thrombectomy (MT) for acute basilar artery occlusion (BAO) results in superior functional outcomes and enhanced safety compared to the natural history of failed mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from the PC-SEARCH registry, encompassing eight high-volume centers in the United States and covering the period from 2015 to 2021. Patients with BAO who experienced failed MT (mTICI score of 0-2a after at least one attempt of clot retrieval) were categorized based on whether they received additional intervention with RS. The primary outcome was a shift analysis of the 90-day mRS. Multivariable logistic regression was employed to assess both efficacy and safety outcomes.</p><p><strong>Results: </strong>Of a total of 444 patients, 119 presented failed MT and were included in the analysis. The RS group comprised 65 (14.6%) patients, while the control group consisted of 54 (12.2%) patients. After adjusting, the RS group showed a favorable shift in the overall 90-day mRS distribution (acOR=4.56; 95% CI 1.67-12.45; p=0.003) and higher rates of 90-day 0-3 mRS (RS: 44.6% vs. control: 18.5%, aOR=7.57; 95% CI 1.91-30.12; p = 0.004) compared to the control group. RS also showed lower rates of 90-day mortality (RS: 43.1% vs. control: 64.8%, aOR=0.27; 95% CI 0.09-0.80; p=0.018) and comparable rates of sICH (RS: 3.1% vs. control: 13%, aOR=0.31; 95% CI 0.05-1.95; p=0.214).</p><p><strong>Conclusions: </strong>Our study demonstrated that RS is associated with improved functional outcomes and reduced mortality in BAO patients presenting MT failure. Further randomized trials are needed to validate these findings.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural Evolution of Incomplete Reperfusion in Patients following Endovascular Therapy after Ischemic Stroke.","authors":"Adnan Mujanovic, Daniel Windecker, Petra Cimflova, Thomas R Meinel, David J Seiffge, Elias Auer, Gregoire Boulouis, Marcel Arnold, Bettina L Serrallach, Roman Rohner, Kevin Janot, Tomas Dobrocky, Michael D Hill, Mayank Goyal, Eike Immo Piechowiak, Jan Gralla, Urs Fischer, Johannes Kaesmacher","doi":"10.1161/STROKEAHA.124.049641","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.049641","url":null,"abstract":"<p><strong>Background: </strong>A third of endovascularly treated stroke patients experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, eTICI<3) and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Embase and PubMed up until March 1, 2024 using a predefined strategy. Only full-text English written articles reporting rates of either favorable (i.e., delayed reperfusion or no new infarct) or unfavorable progression (i.e., persistent perfusion deficit or new infarct) of incompletely reperfused tissue were included. Primary outcome was the rate of delayed reperfusion and its association with functional independence (modified Rankin Scale, mRS 0-2) at 90 days post-intervention. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model.</p><p><strong>Results: </strong>Six studies involving 950 patients (50.7% female; median age 71, IQR 60-79) were included. Four studies assessed the evolution of incomplete reperfusion on MRI perfusion imaging, while two studies used DWI and NCCT imaging, where new infarct was used to denote unfavorable progression. Five studies defined incomplete reperfusion as eTICI2b50 or 2c. Delayed reperfusion occurred in 41% (IQR 33%-51%) of cases 24h post-intervention. Achieving delayed reperfusion was associated with higher likelihood of functional independence at 90 days (OR 2.5, 95%CI 1.9-3.4).</p><p><strong>Conclusions: </strong>Nearly half of eTICI<3 patients achieve delayed reperfusion, leading to favorable clinical outcome. This subgroup may derive limited or potentially harmful effects from pursuing additional reperfusion strategies (e.g., intra-arterial lytics or secondary thrombectomy). Accurately predicting the evolution of incomplete reperfusion could optimize patient selection for adjunctive reperfusion strategies at the end of an intervention.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NSAID Allergy Labels Associated With Mortality and Cardiovascular Outcomes in Stroke.","authors":"Cheryl C W Tsui, Hugo W F Mak, William C Y Leung, Kay Cheong Teo, Yuen Kwun Wong, Valerie Chiang, Gary K K Lau, Philip H Li","doi":"10.1161/STROKEAHA.124.047921","DOIUrl":"10.1161/STROKEAHA.124.047921","url":null,"abstract":"<p><strong>Background: </strong>Mislabeled drug allergy can restrict future prescriptions and medication use, but its prevalence and impact among patients with stroke remain unknown. This study investigated the prevalence of the most commonly labeled drug allergies, their accuracy, and their impact among patients with stroke.</p><p><strong>Methods: </strong>In this combined longitudinal and cross-sectional study, we compared the prevalence of allergy labels among the general population and patients with ischemic stroke between 2008 and 2014 from electronic health care records in Hong Kong. Outcomes between patients with stroke with or without the most prevalent labels (ie, NSAID) were compared. Rate of mislabeled NSAID allergy was confirmed by provocation testing.</p><p><strong>Results: </strong>Compared with the general population (n=702 966), patients with stroke had more labels (n=235) to cardiovascular and hematopoietic system (prevalence, 19.5% versus 9.2%; odds ratio [OR], 2.4 [95% CI, 1.74-3.32]; <i>P</i><0.001) and radiographic and diagnostic agents (prevalence, 4.2% versus 0.9%; OR, 4.82 [95% CI, 2.56-9.08]; <i>P</i><0.001). The most common labels were to NSAID (prevalence, 1.8%). Patients with NSAID allergy labels were significantly less likely to be prescribed aspirin after acute stroke (OR, 0.24 [95% CI, 0.09-0.60]; <i>P</i>=0.003) and on follow-up (OR, 0.22 [95% CI, 0.08-0.56]; <i>P</i>=0.002). The median duration of follow-up was 6.7 years (6499±2.49 patient-years). Patients with stroke with NSAID allergy labels also experienced significantly higher mortality (OR, 7.44 [95% CI, 2.44-23.18]; <i>P</i><0.001), peripheral vascular disease (OR, 9.35 [95% CI, 1.95-44.86]; <i>P</i>=0.005), and major adverse cardiovascular events (OR, 6.09 [95% CI, 2.00-18.58]; <i>P</i>=0.001) in the poststroke period. Patients with NSAID allergy labels (who remained alive and could consent) were referred for allergist assessment and offered drug provocation testing. The majority (80%; 4/5) had negative provocation tests and were delabeled.</p><p><strong>Conclusions: </strong>NSAID allergy labels were significantly more prevalent among patients with stroke, associated with excessive mortality, peripheral vascular disease, and major adverse cardiovascular events. Given the high rate of mislabeled allergies, multidisciplinary neuro-allergy interventions could have the potential to improve patient outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Infarct Growth: Pathophysiology, Pragmatic Assessment, and Clinical Implications.","authors":"Umberto Pensato, Andrew M Demchuk, Bijoy K Menon, Thanh N Nguyen, Gabriel Broocks, Bruce C V Campbell, Diego A Gutierrez Vasquez, Peter J Mitchell, Michael D Hill, Mayank Goyal, Johanna M Ospel","doi":"10.1161/STROKEAHA.124.049013","DOIUrl":"10.1161/STROKEAHA.124.049013","url":null,"abstract":"<p><p>Cerebral ischemic injury occurs when blood flow drops below a critical level, resulting in an energy failure. The progressive transformation of hypoperfused viable tissue, the ischemic penumbra, into infarction is a mechanism shared by patients with ischemic stroke if timely reperfusion is not achieved. Yet, the pace at which this transformation occurs, known as the infarct growth rate (IGR), exhibits remarkable heterogeneity among patients, brain regions, and over time, reflecting differences in compensatory collateral flow and ischemic tolerance. We review (1) the pathophysiology of infarct growth, (2) the advantages and pitfalls of different approaches of IGR measurement, (3) research gaps for future studies, and (4) the clinical implications of stroke progressor phenotypes. The estimated average IGR in patients with acute large vessel occlusion stroke is 5.4 mL/h although there is wide variability based on ischemic stroke subtype, occlusion location, presence of collaterals, and patient baseline status. The IGR can be calculated using various pragmatic strategies, mostly either quantifying the extension of the infarct at a particular time and dividing this measure by the time that elapsed from symptom onset to imaging assessment or by using collateral blood flow status as a radiological surrogate marker. The IGR defines a spectrum of clinical stroke phenotypes, often dichotomized into fast and slow progressors. An IGR ≥10 mL/h and the perfusion metric hypoperfusion intensity ratio ≥0.5 are commonly used definitions of fast progressors. A nuanced understanding of the IGR and stroke progressor phenotypes could have clinical implications, including informing prognostication, acute decision-making in peripheral-to-comprehensive transfer patients eligible for thrombectomy, and selection for adjuvant neuroprotective agents.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WMH Contributions to Cognitive Impairment: Rationale and Design of the Diverse VCID Study.","authors":"Charles DeCarli, Kumar B Rajan, Lee-Way Jin, Jason Hinman, David K Johnson, Danielle Harvey, Myriam Fornage","doi":"10.1161/STROKEAHA.124.045903","DOIUrl":"10.1161/STROKEAHA.124.045903","url":null,"abstract":"<p><p>As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequently identify incidental white matter hyperintensities, raising patient concerns about their brain health and future risk for dementia. Moreover, current US demographics indicate that ≈50% of these individuals will be from diverse backgrounds by 2060. Racial and ethnic minority populations bear a disproportionate burden of vascular risk factors magnifying dementia risk. Despite established associations between white matter hyperintensities and cognitive impairment, including dementia, no study has comprehensively and prospectively examined the impact of individual and combined magnetic resonance imaging measures of white matter injury, their risk factors, and comorbidities on cognitive performance among a diverse, nondemented, stroke-free population with cognitive complaints over an extended period of observation. The Diverse VCID (Diverse Vascular Cognitive Impairment and Dementia) study is designed to fill this knowledge gap through 3 assessments of clinical, behavioral, and risk factors; neurocognitive and magnetic resonance imaging measures; fluid biomarkers of Alzheimer disease, vascular inflammation, angiogenesis, and endothelial dysfunction; and measures of genetic risk collected prospectively over a minimum of 3 years in a cohort of 2250 individuals evenly distributed among Americans of Black/African, Latino/Hispanic, and non-Hispanic White backgrounds. The goal of this study is to investigate the basic mechanisms of small vessel cerebrovascular injury, emphasizing clinically relevant assessment tools and developing a risk score that will accurately identify at-risk individuals for possible treatment or clinical therapeutic trials, particularly individuals of diverse backgrounds where vascular risk factors and disease are more prevalent.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menstruation: An Important Indicator for Assessing Stroke Risk and Its Outcomes.","authors":"Alison Seitz, Ami P Raval","doi":"10.1161/STROKEAHA.124.048869","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048869","url":null,"abstract":"<p><p>In recent years, stroke incidence in older adults has declined strikingly, but stroke in younger women has become more common. Abnormalities of menstruation, the shedding of the uterine lining at the beginning of each menstrual cycle, may offer clues about stroke risk in young and midlife women. Endometrial and structural uterine abnormalities are associated with anemia and may be associated with hypercoagulability, possibly increasing stroke risk. Patient factors that influence both menstruation and stroke risk include coagulopathies, polycystic ovarian syndrome, endometriosis, migraine, and other systemic disorders, in addition to menopause. Environmental and iatrogenic factors that influence both menstruation and stroke risk include hormonal contraceptives, nicotine, xenoestrogens, phytoestrogens, oophorectomy, and hysterectomy. Importantly, secondary stroke prevention can affect menstruation. Our current review presents literature supporting the idea that abnormal menstruation may indicate elevated stroke risk in premenopausal women.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}