Thoracic and Cardiovascular Surgeon最新文献

{"title":"Natural Sequential Collapse Method: A Common Technique to Identify the Intersegmental Plane.","authors":"Yuanlin Deng, Yilin Luo, Min Zhang, Mingjian Ge","doi":"10.1055/a-2246-3927","DOIUrl":"10.1055/a-2246-3927","url":null,"abstract":"<p><p>The natural sequential collapse method (NSCM) can be employed during surgery to reduce the duration of segmentectomy. This method avoids inflating the lung by rapidly blocking vessels within the tumor basin. It is important to note that the color of the lungs should be used to determine the surgical procedure. The NSCM is efficient and straightforward in revealing the intersegmental plane.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478176","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":"Risk Factor Analysis for 30-day Mortality After Surgery for Infective Endocarditis.","authors":"Jill Jussli-Melchers, Christine Friedrich, Kira Mandler, Mohamad Hosam Alosh, Mohamed Ahmed Salem, Jan Schoettler, Jochen Cremer, Assad Haneya","doi":"10.1055/s-0044-1779709","DOIUrl":"https://doi.org/10.1055/s-0044-1779709","url":null,"abstract":"<p><strong>Background: </strong> Infective endocarditis (IE) remains a challenging disease associated with high mortality. Several scores have been suggested to assess surgical risk. None was sufficiently adequate. We therefore analyzed risk factors for 30-day mortality.</p><p><strong>Methods: </strong> A total of 438 consecutive patients had surgery for IE in our department between 2002 and 2020. Patients were divided into two groups, one consisting of 30-day survivors (362 patients; 82.6%) and one of nonsurvivors (76 patients; 17.4%). Logistic regression analysis on pre- and intraoperative risk factors was performed and the groups were compared by univariable analyses.</p><p><strong>Results: </strong> Patients in mortality group were older (69 [58, 77] vs. 63 [50, 72] years; <i>p</i> < 0.001), EuroSCORE II was higher (24.5 [12.1, 49.0] vs. 8.95 [3.7, 21.2]; <i>p</i> < 0.001) and there were more females. More frequently left ventricular function (below 30%), preoperative acute renal insufficiency, chronic dialysis, insulin-dependent diabetes mellitus, NYHA-class IV (New York Heart Association heart failure class IV), and cardiogenic shock occurred. Patients in the mortality group were often intensive care unit patients (40.8 vs. 22.4%; <i>p</i> < 0.001) or had a preoperative stroke (26.3 vs. 16.0%; <i>p</i> = 0.033). In the nonsurvivor group <i>Staphylococcus aureus</i> was prevalent. <i>Streptococcus viridans</i> was common in the survivor group as was isolated aortic valve endocarditis (32.9 vs. 17.1%; <i>p</i> = 0.006). Prosthetic valve endocarditis (PVE) and abscesses occurred more often in nonsurvivors. In the logistic regression analysis, female gender, chronic dialysis, cardiogenic shock, and NYHA IV and from intraoperative variables PVE, cardiopulmonary bypass time, and mitral valve surgery were the strongest predictors for 30-day mortality.</p><p><strong>Conclusion: </strong> This study indeed clearly indicates that significant risk factors for 30-day mortality cannot be changed. Nevertheless, they should be taken into account for preoperative counselling, and they will alert the surgical team for an even more careful management.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906513","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":"Comparison of different surgical approaches for treating aortic graft infections.","authors":"Yu Xia, Lizhong Sun, Kaitao Jian, Hao Peng, Yi Lin, Wei Liu","doi":"10.1055/a-2266-7574","DOIUrl":"https://doi.org/10.1055/a-2266-7574","url":null,"abstract":"<p><strong>Background: </strong>There is still no guideline or consensus on the treatment of aortic graft infection. This study reported and compared conservative and surgical treatment and different surgical methods for aortic graft infection.</p><p><strong>Methods: </strong>Data from aortic graft infections treated at our institution between February 2017 and June 2022 were retrospectively analyzed. Clinical data and surgical approaches were evaluated.</p><p><strong>Results: </strong>This article retrospectively analyzed the treatment and prognosis of 48 patients (43 males) with aortic graft infection. The patients were divided into conservative treatment group (n = 15) and surgical treatment group (n = 33). During follow-up, the mortality rate of the conservative treatment group was significantly higher than that of the surgical treatment group (P<0.05). The survival curve also showed that the survival time of the surgical treatment group was longer than that of the conservative treatment group (P<0.05). The surgical treatment group included local treatment (n=5), in situ replacement (n=8) and bypass surgery (n=20) groups. There was no significant difference in the mortality rate at 1 month or final follow-up among the local treatment, in situ replacement and bypass surgery groups.</p><p><strong>Conclusion: </strong>Surgical treatment is the optimal option for treating aortic graft infections compared to conservative treatment.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724094","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":"Sex Differences in the Histopathology of Acute Type A Aortic Dissections.","authors":"Nimrat Grewal, Onur Baris Dolmaci, Robert Jm Klautz, Robert E Poelmann","doi":"10.1055/a-2239-1741","DOIUrl":"10.1055/a-2239-1741","url":null,"abstract":"<p><strong>Background: </strong> Although sex-related differences in cardiovascular surgery outcomes have increasingly garnered attention in the past decades, knowledge about sex disparities in the pathophysiology of acute type A aortic dissections (ATAADs) remains sparse. In this study, we evaluate the histopathologic and atherosclerotic lesions in female and male ATAAD patients.</p><p><strong>Methods: </strong> A total of 68 patients were studied: 51 ATAAD patients (mean age: 62.5 ± 10.8 years; 49% women) and 17 control patients (mean age: 63 ± 5.5 years; 53% women). Cardiovascular risk factors were assessed clinically. Intimal and medial histopathological features were systematically evaluated in all.</p><p><strong>Results: </strong> Compared to the control group, all ATAAD patients showed significantly more elastic fiber pathology, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration (<i>p</i> < 0.0001). The tunica intima was significantly thinner in the ATAAD patients than in the control group (<i>p</i> < 0.023), with the latter exhibiting significantly more progressive atherosclerotic lesions than the former. No difference in medial vessel wall pathology was seen between female and male patients. As compared to male ATAAD patients, atherosclerotic lesions were more severe in female ATAAD patients, independent of age and the cardiovascular risk factor hypertension.</p><p><strong>Conclusion: </strong> All ATAAD patients had a significantly thinner tunica intima and significantly diseased tunica media compared to the control patients. Our results suggest that the severity of medial aortic pathology is not sex specific in ATAAD patients. Intimal differences between females and males could, however, be considered a potential risk factor for the development of an aortic dissection.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139106722","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":"Concomitant Surgical Ablation for Treatment of Atrial Fibrillation in Patients Undergoing Minimally Invasive Mitral Valve Surgery: A Single-Center Experience in Vietnam.","authors":"Pham Tran Viet Chuong, Phan Quang Thuan, Vu Tri Thanh, Nguyen Hoang Dinh","doi":"10.1055/s-0044-1779622","DOIUrl":"https://doi.org/10.1055/s-0044-1779622","url":null,"abstract":"<p><strong>Background: </strong> This study presents the early and midterm outcomes of combining atrial fibrillation (AF) treatment with minimally invasive mitral valve surgery (MIMVS) at our center.</p><p><strong>Methods: </strong> From January 2017 to June 2022, our center treated a total of 86 patients with both MIMVS and surgical AF ablation. The patient cohort included 62 women (72.1%) and 24 men (27.9%). The average EuroScore II was 2.64 ± 1.49%, and the patients were followed up for an average period of 46.31 ± 9.84 months.</p><p><strong>Results: </strong> Postoperatively, 95.3% of patients experienced a change in sinus rhythm, and 86.2% were discharged in sinus rhythm. The hospital's mortality rate was 2.3%, with a late mortality rate of 3.5%. Survival analysis revealed an atrial fibrillation-free 5-year follow-up rate of 59.1 ± 9.1%. The 5-year survival rate was 92.7 ± 3.3%.</p><p><strong>Conclusion: </strong> Our 5-year experience demonstrates that the combination of MIMVS and surgical AF ablation can be routinely performed with favorable peri- and postoperative outcomes. This reflects our hospital's culture and guidance on patient selection, particularly when adopting minimally invasive approaches for multiple procedures.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713137","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":"New Insights into Mortality-Related Risk Factors in Infective Endocarditis: Results from the Brandenburg State Endocarditis Register.","authors":"Roya Ostovar, Filip Schroeter, Frarzane Seifi Zinab, Dirk Fritzsche, Hans-Heinrich Minden, Nirmeen Lasheen, Martin Hartrumpf, Oliver Ritter, Gesine Dörr, Johannes Maximilian Albes","doi":"10.1055/a-2199-2344","DOIUrl":"10.1055/a-2199-2344","url":null,"abstract":"<p><strong>Objective: </strong> Endocarditis as a potentially life-threatening disease with high complication and mortality rates. In recent years, an increase in the incident of endocarditis has been reported throughout Europe. In the aging society, successful treatment is complex and challenging owing to the high rate of multimorbidity.</p><p><strong>Methods: </strong> We initiated a statewide prospective multicenter endocarditis registry in 2020. Perioperative risk factors, comorbidities, microbiological, laboratory and imaging diagnostics, complications, and mortality including 1-year follow-up were collected. The present midterm analysis includes factors influencing mortality in the first 313 patients.</p><p><strong>Result: </strong> In-hospital mortality and 1-year mortality were 28.4 and 40.9%, respectively. Preoperative risk factors include age (<i>p</i> < 0.001), EuroSCORE II (<i>p</i> < 0.001), coronary artery disease (<i>p</i> = 0.022), pacemaker probe infection (<i>p</i> = 0.033), preoperative left ventricular ejection fraction (LVEF), systemic inflammatory response syndrome (SIRS), pulmonary edema, heart failure, septic emboli, acute renal failure, impaired coagulation, hypalbuminemia (<i>p</i> < 0.001), and N-terminal prohormone of brain natriuretic peptide (NTproBNP) (<i>p</i> = 0.001). The presence of peri-annular abscess, perforation, and shunt were associated with increased mortality (<i>p</i> = 0.004, 0.001, and 0.004, respectively). In addition, cardiopulmonary bypass time influenced mortality (<i>p</i> = 0.002). The main postoperative causes of death were multi-organ failure, renal failure, vasoplegia, and low-output syndrome (<i>p</i> < 0.001). Previous endocarditis was 7.7%, while 35.5% were prosthetic valve recipients and 33.6% were redo surgeries.</p><p><strong>Conclusion: </strong> Our first registry data show the complexity of endocarditis patients and the challenging treatment. Some risk factors can be treated preoperatively. For instance, hypalbuminemia and the duration of the procedure can be controlled with adequate albumin substitution and carefully planned procedures restricted to the essential requirements, that is, hybrid approaches with consecutive interventions.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54231055","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":"Meta-analysis: Bilateral and Unilateral Cerebral Perfusion in Type A Dissection.","authors":"Noritsugu Naito, Hisato Takagi","doi":"10.1055/s-0044-1779263","DOIUrl":"https://doi.org/10.1055/s-0044-1779263","url":null,"abstract":"<p><strong>Background: </strong> This meta-analysis compared the outcomes of bilateral cerebral perfusion (BCP) and unilateral cerebral perfusion (UCP) in aortic surgery for acute type A aortic dissection.</p><p><strong>Methods: </strong> A systematic literature search identified 12 studies involving 4,547 patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative neurological complications.</p><p><strong>Results: </strong> No significant differences were found between the BCP and UCP groups in terms of cardiopulmonary bypass time, aortic cross clamp time, lowest body temperature, and lower body circulatory arrest time. Short-term mortality rates (OR [95% CI] = 0.87 [0.64-1.19], <i>p</i> = 0.40) and permanent neurological deficits (OR [95% CI] = 1.01 [0.69-1.47], <i>p</i> = 0.96) were comparable between the groups. However, subgroup analysis of studies exclusively involving total arch replacement showed a lower short-term mortality rate (OR [95% CI] = 0.42 [0.28-0.63], <i>p</i> < 0.01) and permanent neurological deficits (OR [95% CI] = 0.53 [0.30-0.92], <i>p</i> = 0.03) in the BCP group. The BCP group also had a lower rate of temporary neurological deficits (OR [95% CI] = 0.70 [0.53-0.93], <i>p</i> = 0.01), particularly in studies exclusively involving total arch replacement (OR [95% CI] = 0.58 [0.40-0.85], <i>p</i> < 0.01).</p><p><strong>Conclusion: </strong> This meta-analysis suggests that BCP and UCP yield comparable outcomes. However, BCP may be associated with lower short-term mortality rates and reduced incidence of neurological complications, particularly in cases requiring total arch replacement. BCP should be considered as a preferred cerebral perfusion in specific patient populations.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642954","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":"Trilateral versus Bilateral Antegrade Cerebral Perfusion in Frozen Elephant Trunk: A Propensity Score Analysis.","authors":"Razan Salem, Arnaud Van Linden, Jan Hlavicka, Afsaneh Karimian-Tabrizi, Ina Ischewski, Thomas Walther, Tomas Holubec","doi":"10.1055/a-2228-7189","DOIUrl":"10.1055/a-2228-7189","url":null,"abstract":"<p><strong>Objective: </strong> Spinal cord injury (SCI) with subsequent paraplegia and/or stroke after arch repair with frozen elephant trunk (FET) remain the most devastating complications. In this study, we aim to examine the impact of different cerebral perfusion strategies on the neurological outcome comparing bilateral antegrade cerebral perfusion (bACP) and trilateral antegrade cerebral perfusion (tACP).</p><p><strong>Methods: </strong> Between 2009 and 2021, 88 patients underwent total arch replacement using a hybrid prosthesis in FET technique for acute (40.4%) and chronic (59.6%) aortic pathologies. After excluding 14 patients who underwent FET with unilateral ACP the remaining 74 patients were divided into two groups. Propensity score matching was performed based on pre- and perioperative patient characteristics resulting in 22 patients in each group. The primary endpoint was a combination of major cerebral event and SCI. Secondary end point was all-cause mortality.</p><p><strong>Results: </strong> Major cerebral events occurred in 9% of the patients in bACP versus 13.6% in tACP group (<i>p</i> = 0.63). No postoperative SCI was observed in patients with bACP and only one patient suffered SCI with tACP (<i>p</i> = 0.31). There was no significant difference in 30-day mortality between the two groups (22.7% in bACP vs. 13.6% in tACP; <i>p</i> = 0.43).</p><p><strong>Conclusion: </strong> In patients undergoing total aortic arch repair using FET technique, both perfusion strategies (bilateral and trilateral ACP) are safe and effective. The rates of neurological complications as well as mortalities are acceptably low in both groups. Further studies with larger patient cohorts are warranted.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138802884","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":"Fecal Occult Blood Screening before Cardiac Surgery.","authors":"Yoshiyuki Takami, Atsuo Maekawa, Koji Yamana, Kiyotoshi Akita, Kentaro Amano, Yusuke Sakurai, Yasushi Takagi","doi":"10.1055/a-2052-8912","DOIUrl":"10.1055/a-2052-8912","url":null,"abstract":"<p><strong>Background: </strong>Concerns of gastrointestinal (GI) bleeding after cardiac surgery are increasing with increased use of antiplatelets and anticoagulants. We investigated the roles of preoperative screening for fecal occult blood by fecal immunochemical test (FIT) widely used to detect GI bleeding and cancer.</p><p><strong>Methods: </strong>A retrospective review was done in 1,663 consecutive patients undergoing FIT before cardiac surgery between years 2012 and 2020. One or two rounds of FIT were performed 2 to 3 weeks before surgery, when antiplatelets and anticoagulants were not suspended yet.</p><p><strong>Results: </strong>Positive FIT (> 30 μg of hemoglobin/g of feces) was observed in 227 patients (13.7%). Preoperative risk factors for positive FIT included age > 70 years, anticoagulants, and chronic kidney disease. Of those with positive FIT, 180 patients (79%) received preoperative endoscopy, including gastroscopy (<i>n</i> = 139), colonoscopy (<i>n</i> = 9), and both (<i>n</i> = 32), with no findings of bleeding. The most common finding of gastroscopy was atrophic gastritis (36%) while early gastric cancer was detected in 2 patients. The most common finding of colonoscopy was colon polyps (42%) while colorectal cancer was detected in 5 patients. Of 180 FIT-positive patients receiving endoscopy, 8 (4.4%) underwent preoperative GI treatment, while postoperative GI events were documented in 28 (15.6%). Of 1,436 with negative FIT, 21 (1.5%) presented GI complications after surgery.</p><p><strong>Conclusion: </strong>Preoperative FIT, which is influenced by anticoagulant use, has little impacts on identification of GI bleeding sites. However, it may be useful to detect GI malignant lesions, potentially impacting operative risks, surgical strategies, and postoperative management.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9389054","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":"Tranexamic Acid and the Risk of Delirium after Off-Pump Surgery.","authors":"Nikolai Hulde, Armin Zittermann, Marcus-Andre Deutsch, Jan F Gummert, Vera von Dossow, Andreas Koster","doi":"10.1055/s-0042-1745811","DOIUrl":"10.1055/s-0042-1745811","url":null,"abstract":"<p><p>We investigated whether in patients undergoing off-pump coronary artery bypass grafting surgery a single bolus of 1 g tranexamic acid (TXA) impacts the risk of postoperative delirium using the propensity score matching approach. In 2,757 pairs, the risk of delirium was 4.2% (TXA group) and 5.0% (non-TXA group), with a relative risk in the TXA versus the non-TXA group of 0.83 (95% confidence interval: 0.65-1.07; <i>p</i> = 0.16). There was no significant interaction between TXA administration and renal function on the risk of delirium (<i>p</i> = 0.12). Data indicate that a single bolus of 1 g TXA does not increase the risk of delirium in patients undergoing off-pump surgery.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42608525","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}