Siraj Mithoowani, Tammy Bungard, Lana Castellucci, Mark Crowther, Kerstin de Wit, Dar Dowlatshahi, Nauzer Forbes, Katie Lin, Deborah M Siegal
{"title":"Multidisciplinary Expert Guidance for the Management of Severe Bleeding on Oral Anticoagulation: An Algorithm for Practicing Clinicians.","authors":"Siraj Mithoowani, Tammy Bungard, Lana Castellucci, Mark Crowther, Kerstin de Wit, Dar Dowlatshahi, Nauzer Forbes, Katie Lin, Deborah M Siegal","doi":"10.1055/a-2464-2887","DOIUrl":"10.1055/a-2464-2887","url":null,"abstract":"<p><p>Bleeding complications associated with oral anticoagulant (OAC) frequently lead to emergency department visits and hospitalization. Short-term all-cause mortality after severe bleeding is substantial ranging from approximately 10% for gastrointestinal bleeding (the most frequent single site) to approximately 50% for intracranial bleeding. A protocol for multidisciplinary approach to bleeding is needed to (i) ensure rapid identification of patients at risk of adverse outcomes, (ii) optimize delivery of supportive measures, (iii) treat the source of bleeding, and (iv) administer anticoagulant reversal or hemostatic therapies judiciously for patients most likely to benefit. We convened a multidisciplinary panel of experts (emergency medicine, gastroenterology, general internal medicine, hematology, neurology, pharmacy, thrombosis) to review the literature and provide practical guidance including a corresponding algorithm for use at the point of care to assist clinicians in the management of patients with acute severe OAC-related bleeding.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Relationship Between Screening-Detected Atrial Fibrillation and Blood Pressure Levels in Elderly Hypertensive Patients: The OMRON Heart Study.","authors":"Keitaro Senoo, Mitsuko Nakata, Arito Yukawa, Kohei Kawai, Jun Munakata, Masahiro Makino, Nobunari Tomura, Hibiki Iwakoshi, Tetsuro Nishimura, Satoshi Shimoo, Hirokazu Shiraishi, Satoshi Teramukai, Satoaki Matoba","doi":"10.1055/a-2484-0641","DOIUrl":"10.1055/a-2484-0641","url":null,"abstract":"<p><strong>Background: </strong> Hypertension is a well-known risk factor for atrial fibrillation (AF) and strokes, but studies assessing screening-detected AF in hypertensive populations and its relationship to the blood pressure (BP) are scarce.</p><p><strong>Method: </strong> We prospectively recruited hypertensive patients (aged ≥60 years) from all over Japan in a decentralized clinical trial. Participants were asked to measure their electrocardiogram (ECG) and BP at home for 3 months with a BP monitor equipped with ECG.</p><p><strong>Results: </strong> Between April 2022 and July 2023, 4,078 hypertensive patients from across the country participated in this study. The mean age was 66.3 ± 5.5 years, and the male proportion was 80.3%. After excluding those with no measurement data (<i>n</i> = 258), AF detection was 5.8% (<i>n</i> = 220/3,820), and the time to AF detection was 3 to 109 days (median 28 days). The mean BP at baseline was 133 ± 14/85 ± 9 mmHg in the morning and 125 ± 14/79 ± 9 mmHg in the evening. AF detection did not significantly differ between the baseline BP categories (log rank test, <i>p</i> = 0.54), with hazard ratios (95% confidence interval) of 0.83 (0.57-1.19), 0.79 (0.55-1.14), and 0.99 (0.59-1.68) for systolic BP (SBP) 135 to 144 and/or diastolic BP (DBP) 85 to 89, SBP 145 to 159 and/or DBP 90 to 99, and SBP ≥ 160 and/or DBP ≥ 100, respectively (SBP ≤ 134 and DBP ≤ 84 as a reference). The results did not change when taking into account the impact of the measurement rates and antihypertensive drugs on AF detection during the observation period.</p><p><strong>Conclusion: </strong> Detection of undiagnosed AF was 5.8% in elderly hypertensives, with no significant differences between the baseline BP categories and no effect of the measurement rate or antihypertensive drugs.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of Apixaban and Aspirin in Preventing Portal Vein Thrombosis after Laparoscopic Splenectomy for Cirrhotic Hypersplenism.","authors":"Zhaobao Shi, Kunqing Xiao, Tianming Gao, Shengjie Jin, Chi Zhang, Baohuan Zhou, Dousheng Bai, Guoqing Jiang","doi":"10.1055/a-2484-0747","DOIUrl":"https://doi.org/10.1055/a-2484-0747","url":null,"abstract":"<p><strong>Background: </strong> Portal vein system thrombosis (PVST) is a frequent and possibly fatal concurrent disorder following splenectomy. The optimal anticoagulant to prevent PVST following splenectomy remains unclear.</p><p><strong>Objectives: </strong> The purpose of this study was to compare the safety and efficacy of apixaban versus aspirin in preventing PVST after laparoscopic splenectomy (LS) for cirrhotic hypersplenism.</p><p><strong>Methods: </strong> In this single-center randomized controlled trial, 80 patients with liver cirrhosis who received LS were randomly allocated to two treatment arms that were treated with apixaban or aspirin for 6 months. The primary effectiveness outcome was PVST formation after LS.</p><p><strong>Results: </strong> We excluded four patients who withdrew from the study. The dynamic incidence of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in the 6 postoperative months were all significantly lower in the apixaban treatment arm compared to the aspirin treatment arm (all <i>P</i> <0.001). Significantly lower incidences of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in apixaban treatment arm started from postoperative day 7, month 1, and day 7 compared to the aspirin treatment arm respectively (all <i>P</i> <0.05). Multiple logistic regression analysis revealed that apixaban was an independent protective factor for PVST at postoperative month 3, as compared with aspirin (relative risk, 0.057; 95% confidence interval, 0.013-0.248; <i>P</i> <0.001).</p><p><strong>Conclusion: </strong> Compared with aspirin, apixaban could earlier and more effectively prevent PVST following LS for cirrhotic hypersplenism. Apixaban can be chosen as a priority treatment option versus aspirin, contributing to a lower risk of PVST.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeong Yoon Jang, Yu Ga-In, Ahn Jongwha, Jae Seok Bae, Cho Yun-Ho, Min Gyu Kang, Jin Sin Koh, Young-Hoon Jeong, Lee Sang Yeup, Kim Byeong-Keuk, Joo Hyung Joon, Lim Do-Sun, Kiyuk Chang, Young Bin Song, Ahn Sung Gyun, Jung-Won Suh, Cho Jung Rae, Hyo-Soo Kim, Moo Hyun Hyun Kim, Eun Seok Shin, Yongwhi Park
{"title":"Optimal Long-term Antiplatelet Regimen for Patients with High Ischaemic and Bleeding Risks After Percutaneous Coronary Intervention.","authors":"Jeong Yoon Jang, Yu Ga-In, Ahn Jongwha, Jae Seok Bae, Cho Yun-Ho, Min Gyu Kang, Jin Sin Koh, Young-Hoon Jeong, Lee Sang Yeup, Kim Byeong-Keuk, Joo Hyung Joon, Lim Do-Sun, Kiyuk Chang, Young Bin Song, Ahn Sung Gyun, Jung-Won Suh, Cho Jung Rae, Hyo-Soo Kim, Moo Hyun Hyun Kim, Eun Seok Shin, Yongwhi Park","doi":"10.1055/a-2499-5458","DOIUrl":"https://doi.org/10.1055/a-2499-5458","url":null,"abstract":"<p><p>Aim To assess an optimal long-term antiplatelet strategy in patients at both high ischaemic and bleeding risks after percutaneous coronary intervention (PCI). Methods and results Patients both at high ischaemic and bleeding risks were eligible for inclusion. We excluded patients with any ischaemic and major bleeding complications during the mandatory period of dual antiplatelet therapy (DAPT). Clinical outcomes were evaluated in three groups of regimen, in terms of, clopidogrel monotherapy (CLPD), aspirin monotherapy (ASA) and DAPT group. The primary endpoint was a composite of all-cause death, myocardial infarction, stroke or major bleeding for 12-month follow-up period. To balance characteristics according to antiplatelet strategies, stabilized inverse probability treatment weighting (IPTW) was conducted. After IPTW adjustment, CLPD group (N=916) showed the significantly lower rate of primary endpoint than DAPT group (N=949) (Hazard Ratio [HR]=2.09, 95% confidence interval (CI)= 1.22 - 3.60, p=0.008], but there was no statistical difference between CLPD and ASA (N=838) groups (HR=1.46, 95% CI=0.83-2.54, p=0.187). Clinical benefits of CLPD over DAPT was mainly driven by the lower incidence of ischaemic events (HR = 2.51, 95% CI 1.37-4.61; p = 0.003). Incidence of major bleeding did not differ among groups, but there was an increased bleeding tendency in DAPT group compared to CLPD group (HR=2.51, 95% CI=0.85-7.41, p=0.096). Conclusion For patients at high bleeding and ischaemic risk especially undergoing complex PCI, clopidogrel monotherapy demonstrated a significant net clinical benefit compared to DAPT. Clopidogrel monotherapy showed numerical reductions of bleeding and ischaemic event rates compared to aspirin monotherapy.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tatjana Potpara, Marek Grygier, Karl Georg Haeusler, Jens Erik Nielsen-Kudsk, Sergio Berti, Simonetta Genovesi, Eloi Marijon, Serge Boveda, Apostolos Tzikas, Giuseppe Boriani, Lucas V A Boersma, Claudio Tondo, Tom De Potter, Gregory Y H Lip, Renate B Schnabel, Rupert Bauersachs, Marco Senzolo, Carlo Basile, Stefano Bianchi, Pavel Osmancik, Boris Schmidt, Ulf Landmesser, Wolfram Doehner, Gerhard Hindricks, Jan Kovac, A John Camm
{"title":"An International Consensus Practical Guide on Left Atrial Appendage Closure for the Non-implanting Physician: Executive Summary.","authors":"Tatjana Potpara, Marek Grygier, Karl Georg Haeusler, Jens Erik Nielsen-Kudsk, Sergio Berti, Simonetta Genovesi, Eloi Marijon, Serge Boveda, Apostolos Tzikas, Giuseppe Boriani, Lucas V A Boersma, Claudio Tondo, Tom De Potter, Gregory Y H Lip, Renate B Schnabel, Rupert Bauersachs, Marco Senzolo, Carlo Basile, Stefano Bianchi, Pavel Osmancik, Boris Schmidt, Ulf Landmesser, Wolfram Doehner, Gerhard Hindricks, Jan Kovac, A John Camm","doi":"10.1055/a-2469-4896","DOIUrl":"https://doi.org/10.1055/a-2469-4896","url":null,"abstract":"<p><p>Many patients with atrial fibrillation (AF) who are in need of stroke prevention are not treated with oral anticoagulation or discontinue treatment shortly after its initiation. Despite the availability of direct oral anticoagulants (DOACs), such undertreatment has improved somewhat but is still evident. This is due to continued risks of bleeding events or ischemic strokes while on DOAC, poor treatment compliance, or aversion to anticoagulant therapy. Because of significant improvements in procedural safety over the years left atrial appendage closure (LAAC), using a catheter-based, device implantation approach, is increasingly favored for the prevention of thromboembolic events in AF patients who cannot have long-term oral anticoagulation. This article is an executive summary of a practical guide recently published by an international expert consensus group, which introduces the LAAC devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. This practical guide, aligned with published guideline/guidance, is aimed at those non-implanting physicians who may need to refer patients for consideration of LAAC.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"De-escalation of DAPT-A Potential Strategy for Treating Ticagrelor-Related Dyspnea?","authors":"Tobias Geisler","doi":"10.1055/a-2420-0381","DOIUrl":"10.1055/a-2420-0381","url":null,"abstract":"","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"1162-1163"},"PeriodicalIF":5.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hao Xiang, Mengyi Liu, Chun Zhou, Yu Huang, Yuanyuan Zhang, Panpan He, Ziliang Ye, Sisi Yang, Yanjun Zhang, Xiaoqin Gan, Xianhui Qin
{"title":"Tea Consumption, Milk or Sweeteners Addition, Genetic Variation in Caffeine Metabolism, and Incident Venous Thromboembolism.","authors":"Hao Xiang, Mengyi Liu, Chun Zhou, Yu Huang, Yuanyuan Zhang, Panpan He, Ziliang Ye, Sisi Yang, Yanjun Zhang, Xiaoqin Gan, Xianhui Qin","doi":"10.1055/s-0044-1786819","DOIUrl":"10.1055/s-0044-1786819","url":null,"abstract":"<p><strong>Objective: </strong> The association between tea consumption and venous thromboembolism (VTE) remains unknown. We aimed to evaluate the association between tea consumption with different additives (milk and/or sweeteners) and incident VTE, and the modifying effects of genetic variation in caffeine metabolism on the association.</p><p><strong>Methods: </strong> A total of 190,189 participants with complete dietary information and free of VTE at baseline in the UK Biobank were included. The primary outcome was incident VTE, including incident deep vein thrombosis and pulmonary embolism.</p><p><strong>Results: </strong> During a median follow-up of 12.1 years, 4,485 (2.4%) participants developed incident VTE. Compared with non-tea drinkers, tea drinkers who added neither milk nor sweeteners (hazard ratio [HR]: 0.85; 95% confidence interval [95% CI]: 0.76-0.94), only milk (HR: 0.86; 95% CI: 0.80-0.93), and both milk and sweeteners to their tea (HR: 0.90; 95% CI: 0.81-0.99) had a lower risk of VTE, while those who added only sweeteners to their tea did not (HR: 0.94; 95% CI: 0.75-1.17). Moreover, there was an L-shaped relationship between tea consumption and incident VTE among tea drinkers who added neither milk nor sweeteners, only milk, and both milk and sweeteners to their tea, respectively. However, a nonsignificant association was found among tea drinkers who added only sweeteners to their tea. Genetic variation in caffeine metabolism did not significantly modify the association (<i>p</i>-interaction = 0.659).</p><p><strong>Conclusion: </strong> Drinking unsweetened tea, with or without added milk, was associated with a lower risk of VTE. However, there was no significant association between drinking tea with sweeteners and incident VTE.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"1143-1151"},"PeriodicalIF":5.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leander Reinshagen, Vanasa Nageswaran, Harald Heidecke, Kai Schulze-Forster, Anne-Christin Beatrice Wilde, Pegah Ramezani Rad, Wolfgang Poller, Erik Asmus, Szandor Simmons, Wolfgang M Kuebler, Martin Witzenrath, Lajos Markó, Kai Jakobs, Marianna Puccini, David M Leistner, Ursula Rauch-Kröhnert, Nicolle Kränkel, Sofia K Forslund, Ulf Landmesser, Dominik N Müller, Arash Haghikia
{"title":"Protease-Activated Receptor-1 IgG Autoantibodies in Patients with COVID-19.","authors":"Leander Reinshagen, Vanasa Nageswaran, Harald Heidecke, Kai Schulze-Forster, Anne-Christin Beatrice Wilde, Pegah Ramezani Rad, Wolfgang Poller, Erik Asmus, Szandor Simmons, Wolfgang M Kuebler, Martin Witzenrath, Lajos Markó, Kai Jakobs, Marianna Puccini, David M Leistner, Ursula Rauch-Kröhnert, Nicolle Kränkel, Sofia K Forslund, Ulf Landmesser, Dominik N Müller, Arash Haghikia","doi":"10.1055/a-2205-0014","DOIUrl":"10.1055/a-2205-0014","url":null,"abstract":"","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"1164-1166"},"PeriodicalIF":5.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"NLRP3: More than an Inflammasome?","authors":"Gabrielle J Pennings","doi":"10.1055/a-2413-4672","DOIUrl":"10.1055/a-2413-4672","url":null,"abstract":"","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"1114-1116"},"PeriodicalIF":5.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle Carole Roy, Tzu-Fei Wang, Ronda Lun, Amin Zahrai, Ranjeeta Mallick, Dylan Burger, Gabriele Zitikyte, Steven Hawken, Philip Wells
{"title":"Circulating Blood Biomarkers and Risk of Venous Thromboembolism in Cancer Patients: A Systematic Review and Meta-Analysis.","authors":"Danielle Carole Roy, Tzu-Fei Wang, Ronda Lun, Amin Zahrai, Ranjeeta Mallick, Dylan Burger, Gabriele Zitikyte, Steven Hawken, Philip Wells","doi":"10.1055/a-2330-1371","DOIUrl":"10.1055/a-2330-1371","url":null,"abstract":"<p><strong>Background: </strong> Cancer patients have an increased risk of venous thromboembolism (VTE). Currently, the availability of highly discriminatory prediction models for VTE in cancer patients is limited. The implementation of biomarkers in prediction models might lead to refined VTE risk prediction. In this systematic review and meta-analysis, we aimed to evaluate candidate biomarkers and their association with cancer-associated VTE.</p><p><strong>Methods: </strong> We searched Medline, EMBASE, and Cochrane Central for studies that evaluated biomarkers in adult cancer patients from inception to September 2022. We included studies reporting on VTE after a cancer diagnosis with biomarker measurements performed at a defined time point. Median/mean differences (for continuous measures) and odds ratios (for dichotomous measures) with 95% confidence intervals were estimated and pooled using random-effects models.</p><p><strong>Results: </strong> We included 113 studies in the systematic review. Of these, 50 studies were included in the meta-analysis. We identified two biomarkers at cancer diagnosis (factor VIII and time to peak thrombin), three biomarkers pre-chemotherapy (D-dimer, fibrinogen, and mean platelet volume), and one biomarker preoperatively (platelet count) that had significant median or mean differences. Additionally, we found that hemoglobin <100 g/L and white blood count >11 × 10<sup>9</sup>/L were significantly associated with future VTE risk only when measured at cancer diagnosis. Pre-chemotherapy neutrophil-to-lymphocyte ratio ≥3 and preoperative platelet count ≥400 × 10<sup>9</sup>/L were also found to be associated with future VTE risk.</p><p><strong>Conclusion: </strong> In conclusion, this study identified nine candidate blood biomarkers that may help in optimizing VTE prediction in cancer patients that should be further explored in future studies.</p>","PeriodicalId":23036,"journal":{"name":"Thrombosis and haemostasis","volume":" ","pages":"1117-1133"},"PeriodicalIF":5.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}