Strahlentherapie und Onkologie最新文献

{"title":"Use of surface tracking recordings to identify pitfalls during surface-guided radiotherapy.","authors":"G Klumpp, S Baumbach, N Wegner, P Freislederer, L Wagner, K P Aninditha, T Ellethy, M Münter","doi":"10.1007/s00066-024-02331-6","DOIUrl":"https://doi.org/10.1007/s00066-024-02331-6","url":null,"abstract":"<p><strong>Objective: </strong>The precise daily positioning of patients during radiation therapy determines the quality of the entire treatment. To avoid additional radiation exposure from regular cone-beam CT (CBCT) scans, surface-guided radiotherapy systems (SGRT) are increasingly used. The aim of this prospective clinical study was to evaluate the advantages, feasibility, and pitfalls of SGRT using the surface tracking recorder prototype of the camera component of ExacTrac Dynamic (Brainlab AG, Munich, Germany). This system combines both surface-based imaging technology and a thermographic camera that records patients via thermal imaging to accurately measure patient geometry.</p><p><strong>Methods: </strong>The surfaces of patients with various tumor entities and therefore different regions of interest (ROIs) were recorded with the surface camera during positioning and throughout treatment. Subsequently, these surface camera datasets were analyzed to compare the accuracy of patient positioning with the current treatment standard (X-ray-based IGRT). The camera components were used only as an imaging tool and not to correct any deviations. For evaluation of typical pitfalls, errors > 5 mm for extracranial indications and > 2 mm for cranial indications were analyzed using parameters extracted from the surface recordings and the corresponding CBCT shifts.</p><p><strong>Results: </strong>In total, 162 displacement vector datasets for 130 patients were generated and evaluated. The smallest deviations were found in the head and neck regions (mean deviation 1.9 mm/0.8°). The largest mean translational deviation (4.8 mm) and mean rotational deviation (1.1°) were found in the pelvic area. In all regions, most datasets showed clinically acceptable deviations; however, large outliers were observed in some measurements, particularly longitudinally. These outliers are of special interest because they may indicate mistakes in the use of SGRT, and they were therefore analyzed separately in detail. Several reasons for the outliers were identified, and potential solutions to avoid these pitfalls are presented.</p><p><strong>Conclusion: </strong>This observational study demonstrated the advantages and pitfalls of SGRT by using the surface tracking recorder prototype of the camera component of ExacTrac Dynamic. These pitfalls can be avoided through thorough application of SGRT. This study may serve as a practical guide for clinicians already using or introducing SGRT for patient positioning.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MR-guided online adaptive stereotactic body radiotherapy (MRgSBRT) of primary lung tumors and lung oligometastases.","authors":"Gamze Ugurluer, Neris Dincer, Teuta Zoto Mustafayev, Gorkem Gungor, Mehmet Ufuk Abacioglu, Meric Sengoz, Enis Ozyar, Banu Atalar","doi":"10.1007/s00066-024-02328-1","DOIUrl":"https://doi.org/10.1007/s00066-024-02328-1","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic body radiotherapy is pivotal in the treatment of lung tumors, demonstrating effective local control. However, challenges persist with intra-fractional anatomical changes and organs at risk during delivery. Magnetic resonance-guided online adaptive stereotactic body radiotherapy (MRgSBRT) represents a novel technique promising to achieve safe delivery of ablative doses with improved outcomes for primary lung tumors or lung oligometastases.</p><p><strong>Methods: </strong>In this single-institution retrospective analysis, we evaluated 64 patients (92 lesions) with primary lung cancer or lung oligometastases treated with MRgSBRT. Using Kaplan-Meier method and log-rank test; we estimated local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS), and overall survival (OS).</p><p><strong>Results: </strong>A total of 64 patients (92 lesions) treated with MRgSBRT were included comprising 14.1% primary lung cancer lesions and 85.9% lung oligometastases. Median total dose, fraction number, fraction dose and BED₁₀ were 50 Gy (range, 21-70 Gy), 5 (range, 1-10), 10 Gy (range, 6-34 Gy), 100 Gy (range, 48-180.0 Gy) respectively. Of the 420 fractions administered, 88.6% (n = 372) involved on-table adapted plans. Median LPFS was not reached and the 1‑ and 3‑year LPFS rates were 96.3% (95% CI 92.4-100.0%) and 86.4% (95% CI 76.9-95.9%), respectively. No local recurrences were observed post-treatment with a total dose of > 50 Gy, BED10 > 100 Gy, fractional dose of > 10 Gy or a CCI > 0.96.</p><p><strong>Conclusion: </strong>Our study of MRgSBRT in 92 lung lesions revealed a 1-year and 3‑year LPFS rates of 96.3 and 86.4%, respectively without ≥ grade 3 toxicity. Future prospective studies evaluating lung MRgSBRT are awaited.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative radiation therapy for brain metastasis in a pregnant patient: a case report.","authors":"K P Aninditha, S Baumbach, T Ellethy, G Klumpp, A Golle, S Kuhn, N Wegner, O Ganslandt, M W Münter","doi":"10.1007/s00066-024-02239-1","DOIUrl":"10.1007/s00066-024-02239-1","url":null,"abstract":"<p><p>We present the rare case of a 42-year-old woman with oligometastatic lung adenocarcinoma in her first trimester of pregnancy who was treated for brain metastases with metastasectomy and intraoperative radiation therapy (IORT) using the INTRABEAM® system (Zeiss AG, Jena, Germany). This case underscores the potential of IORT in optimizing cancer treatment while safeguarding fetal health in pregnant patients.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1088-1092"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"German radiation oncology's next generation: a web-based survey of young biologists, medical physicists, and physicians-from problems to solutions.","authors":"Thomas Weissmann, Lisa Deloch, Maximilian Grohmann, Maike Trommer, Alexander Fabian, Felix Ehret, Sarah Stefanowicz, Alexander Rühle, Sebastian Lettmaier, Florian Putz, Maya Shariff, Simone Wegen, Johann Matschke, Elena Sperk, Annemarie Schröder","doi":"10.1007/s00066-024-02305-8","DOIUrl":"10.1007/s00066-024-02305-8","url":null,"abstract":"<p><strong>Background: </strong>Radiation science is of utmost significance not only due to its growing importance for clinical use, but also in everyday life such as in radiation protection questions. The expected increase in cancer incidence due to an aging population combined with technical advancements further implicates this importance and results in a higher need for sufficient highly educated and motivated personnel. Thus, factors preventing young scientists and medical personnel from entering or remaining in the field need to be identified.</p><p><strong>Methods: </strong>A web-based questionnaire with one general and three occupation-specific questionnaires for physicians, biologists, and medical physicists working in radiation oncology and research was developed and circulated for 6 weeks.</p><p><strong>Results: </strong>While the overall satisfaction of the 218 participants was quite high, there are some points that still need to be addressed in order to ensure a continuing supply of qualified personnel. Among these were economic pressure, work-life balance, work contracts, protected research time, and a demand for an improved curriculum.</p><p><strong>Conclusion: </strong>Mentoring programs, improved education, and strengthening the value of societies in radiation sciences as well as translational approaches and more flexible working arrangements might ensure a high-quality workforce and thus patient care in the future.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1005-1024"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robust IMPT and follow-up toxicity in skull base chordoma and chondrosarcoma-a single-institution clinical experience.","authors":"Vesna Miladinovic, Yvonne L B Klaver, Augustinus D G Krol, Michiel Kroesen, Berit M Verbist, Steven J M Habraken, Wouter R van Furth, Ida E M Coremans","doi":"10.1007/s00066-024-02280-0","DOIUrl":"10.1007/s00066-024-02280-0","url":null,"abstract":"<p><strong>Background: </strong>Chordomas and chondrosarcomas of the skull base are rare, slowly growing malignant bone neoplasms. Despite their radioresistant properties, proton therapy has been successfully used as an adjunct to resection or as a definitive treatment. Herewith, we present our experience with robustly optimized intensity-modulated proton therapy (IMPT) and related toxicities in skull base chordoma and chondrosarcoma patients treated at HollandPTC, Delft, the Netherlands.</p><p><strong>Methods: </strong>Clinical data, treatment plans, and acute toxicities of patients treated between July 2019 and August 2021 were reviewed. CT and 3.0T MRI scans for treatment planning were performed in supine position in a thermoplastic mold. In total, 21 dose optimization and 28 dose evaluation scenarios were simulated. Acute toxicity was scored weekly before and during the treatment according to the CTCAE v4.0. Median follow-up was 35 months (range 12-36 months).</p><p><strong>Results: </strong>Overall, 9 chordoma and 3 chondrosarcoma patients with 1-3 resections prior to IMPT were included; 4 patients had titanium implants. Brainstem core and surface and spinal cord core and surface were used for nominal plan robust optimization in 11, 10, 8, and 7 patients, respectively. Middle ear inflammation, dry mouth, radiation dermatitis, taste disorder, and/or alopecia of grades 1-3 were noted at the end of treatment among 6 patients without similar complaints at inclusion; symptoms disappeared 3 months following the treatment.</p><p><strong>Conclusion: </strong>Robustly optimized IMPT is clinically feasible as a postoperative treatment for skull base chordoma and chondrosarcoma patients. We observed acceptable early toxicities (grade 1-3) that disappeared within the first 3 months after irradiation.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1066-1073"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Friedrich Dessauer-reflections on his political and personal sacrifices : In reply to: Benzaquen et al. \"Friedrich Dessauer (1881-1963): The forgotten medical physicist, politician, and philosopher\".","authors":"Michael Oertel, Hans Theodor Eich, Oliver Micke","doi":"10.1007/s00066-024-02320-9","DOIUrl":"10.1007/s00066-024-02320-9","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1093-1096"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton therapy reduces the effective dose to immune cells in breast cancer patients.","authors":"Pierre Loap, Jeremi Vu-Bezin, Ludovic De Marzi, Youlia Kirova","doi":"10.1007/s00066-024-02263-1","DOIUrl":"10.1007/s00066-024-02263-1","url":null,"abstract":"<p><strong>Background: </strong>The effective dose to circulating immune cells (EDIC) is associated with survival in lung and esophageal cancer patients. This study aimed to evaluate the benefit of intensity-modulated proton therapy (IMPT) for EDIC reduction as compared to volumetric modulated arc therapy (VMAT) in patients with locally advanced breast cancer (BC).</p><p><strong>Materials and methods: </strong>Ten BC patients treated with locoregional VMAT after breast-conserving surgery were included. Mean dose to the heart (MHD), lungs (MLD), and liver (MlD), as well as the integral dose to the body (ITD), were retrieved, and we calculated EDIC as 0.12 × MLD + 0.08 × MHD + 0.15 × 0.85 × √(n/45) × MlD + (0.45 + 0.35 × 0.85 × √(n/45)) × ITD/(62 × 10³), where n is the number of fractions. EDIC was compared between VMAT and IMPT plans.</p><p><strong>Results: </strong>Median EDIC was reduced from 3.37 Gy (range: 2.53-5.99) with VMAT to 2.13 Gy (1.31-3.77) with IMPT (p < 0.01). For left-sided BC patients, EDIC was reduced from 3.15 Gy (2.53-3.78) with VMAT to 1.65 Gy (1.31-3.77) with IMPT (p < 0.01). For right-sided BC patients, EDIC was reduced from 5.60 Gy (5.06-5.99) with VMAT to 3.38 Gy (3.10-3.77) with IMPT (p < 0.01). Right-sided BC patients had a higher EDIC irrespective of the technique. Integral dose reduction was the main driver of EDIC reduction with IMPT and was associated with lung sparing for left-sided BC patients or liver sparing for right-sided BC patients.</p><p><strong>Conclusion: </strong>IMPT significantly reduced EDIC in BC patients undergoing locoregional adjuvant radiotherapy. Integral total dose reduction, associated with improved lung sparing in left-sided BC patients or liver sparing in right-sided BC patients, mainly drove EDIC reduction with IMPT. The emergence of dynamic models taking into account the circulatory kinetics of immune cells may improve the accuracy of the estimate of the dose received by the immune system compared to calculation of the EDIC, which is based solely on static dosimetric data.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1074-1079"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conversion chemoradiotherapy combined with nab-paclitaxel plus cisplatin in patients with locally advanced borderline-resectable or unresectable esophageal squamous cell carcinoma: a phase i/ii prospective cohort study.","authors":"Nuo Yu, Xiankai Chen, Jiao Li, Xiaozheng Kang, Zhen Wang, Ruixiang Zhang, Jianjun Qin, Yong Li, Qingfeng Zheng, Guojie Feng, Lei Deng, Tao Zhang, Wenqing Wang, Wenyang Liu, Jianyang Wang, Qinfu Feng, Jima Lv, Zongmei Zhou, Zefen Xiao, Nan Bi, Yin Li, Xin Wang","doi":"10.1007/s00066-024-02286-8","DOIUrl":"10.1007/s00066-024-02286-8","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the efficacy and safety of nab-paclitaxel plus cisplatin as the regimen of conversional chemoradiotherapy (cCRT) in locally advanced borderline resectable or unresectable esophageal squamous cell carcinoma (ESCC).</p><p><strong>Methods: </strong>Patients with locally advanced ESCC (cT3‑4, Nany, M0‑1, M1 was limited to lymph node metastasis in the supraclavicular area) were enrolled. All the patients received the cCRT of nab-paclitaxel plus cisplatin. After the cCRT, those resectable patients received esophagectomy; those unresectable patients continued to receive the definitive chemoradiotherapy (dCRT). The locoregional control (LRC), overall survival (OS), event-free survival (EFS), distant metastasis free survival (DMFS), pathological complete response (pCR), R0 resection rate, adverse events (AEs) and postoperative complications were calculated.</p><p><strong>Results: </strong>45 patients with ESCC treated from October 2019 to May 2021 were finally included. The median follow-up time was 30.3 months. The LRC, OS, EFS, DMFS at 1 and 2 years were 81.5%, 86.6%, 64.3%, 73.2 and 72.4%, 68.8%, 44.8%, 52.7% respectively. 21 patients (46.7%) received conversional chemoradiotherapy plus surgery (cCRT+S). The pCR rate and R0 resection rate were 47.6 and 84.0%. The LRC rate at 1 and 2 years were 95.0%, 87.1% in cCRT+S patitents and 69.3%, 58.7% in dCRT patients respectively (HR, 5.14; 95%CI, 1.10-23.94; P = 0.021). The toxicities during chemoradiotherapy were tolerated, and the most common grade 3-4 toxicitiy was radiation esophagitis (15.6%). The most common postoperative complication was pleural effusion (38.1%) and no grade ≥ IIIb complications were observed.</p><p><strong>Conclusion: </strong>nab-paclitaxel plus cisplatin are safe as the regimen of conversional chemoradiotherapy of ESCC.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1038-1046"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Neoadjuvant therapy of locally advanced squamous cell carcinoma of the esophagus : Radiochemotherapy vs. doublet or triplet chemotherapy alone].","authors":"Sophia Drabke, Justus Kaufmann, Heinz Schmidberger","doi":"10.1007/s00066-024-02310-x","DOIUrl":"10.1007/s00066-024-02310-x","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1100-1102"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant (chemo)radiotherapy for patients with head and neck cancer: can comorbidity risk scores predict outcome?","authors":"Sebastian N Marschner, Cornelius Maihöfer, Richard Späth, Erik Haehl, Daniel Reitz, Nora Kienlechner, Lars Schüttrumpf, Philipp Baumeister, Ulrike Pflugradt, Julia Heß, Horst Zitzelsberger, Kristian Unger, Claus Belka, Franziska Walter","doi":"10.1007/s00066-024-02282-y","DOIUrl":"10.1007/s00066-024-02282-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study compares the objective American Society of Anesthesiologists (ASA) and Adult Comorbidity Evaluation-27 (ACE-27) scores with the subjective Eastern Cooperative Oncology Group performance status (ECOG PS) for patient outcome prediction.</p><p><strong>Methods: </strong>We retrospectively analyzed head and neck squamous cell carcinoma patients treated with adjuvant (chemo)radiotherapy at the LMU Munich from June 2008 to June 2015. The study focused on associations between patient outcomes; treatment failures; known risk factors (including human papillomavirus [HPV] status and tumor stage); and the comorbidity indices ECOG-PS, ASA score, and ACE-27. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis and identifying independent risk factors.</p><p><strong>Results: </strong>A total of 302 patients were analyzed, 175 received concurrent chemotherapy. Median follow-up was 61.8 months, and median age at diagnosis was 61 years. The 3‑ and 5‑year overall survival (OS) and disease-free survival (DFS) rates were 70.5%/60.2% and 64.7%/57.6%, respectively. Both ACE-27 and ASA showed significant correlations with OS in univariate and multivariate analyses, while ECOG-PS was significant only in univariate analysis. ASA and ACE-27 scores were also significantly correlated with local and locoregional recurrence, but only HPV status and tumor stage were significant in multivariate models.</p><p><strong>Conclusion: </strong>ACE-27 and ASA score effectively categorize patients' risks in adjuvant radiotherapy for head and neck cancer, proving more predictive of overall survival than ECOG-PS. These results underscore the importance of objective comorbidity assessment and suggest further prospective studies.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"1025-1037"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}