Transfusion最新文献

{"title":"The feasibility of monitoring trauma patients with a wireless, wearable Doppler ultrasound.","authors":"Luis Da Luz, Sarah Atwi, Lowyl Notario, Rachael Irvine, Diane Farah, Delaney Johnston, Jon-Emile S Kenny, Joseph K Eibl, Dylan Pannell","doi":"10.1111/trf.18241","DOIUrl":"https://doi.org/10.1111/trf.18241","url":null,"abstract":"<p><strong>Background: </strong>Early detection of reduced stroke volume (SV) or cardiac output (CO) may expedite resuscitative interventions during traumatic hemorrhage; corrected carotid artery flow time (ccFT) has been proposed as a surrogate for SV during blood volume loss.</p><p><strong>Study design and methods: </strong>We conducted a prospective cohort study to assess the feasibility of using a wireless, wearable Doppler ultrasound capable of measuring ccFT in traumatically injured patients at a level 1 trauma center. A convenience sample of 33 patients was enrolled. We assessed device placement, data transfer and capture, and signal quality by assessing the ability to capture at least 15 consecutive cardiac cycles in the minute prior to blood pressure monitor cycling. A post hoc analysis examined ccFT variations between transfused and non-transfused patients.</p><p><strong>Results: </strong>Device placement succeeded in 94% of patients (n = 31) and the data were captured and transferred from all 31. The consecutive cardiac cycles before blood pressure measurement exceeded 15 (p = .015) in 93% of patients (n = 28). We observed ccFT below 270 ms and longer time spent under this threshold during resuscitation in transfused patients. Patients with low ccFT experienced more severe injuries and longer hospital and ICU stays.</p><p><strong>Discussion: </strong>This is the first study that demonstrates the feasibility of using a wearable Doppler ultrasound in trauma patients on admission to the trauma bay. Although findings suggest that ccFT could serve as an early marker of hemodynamic compromise, further large-scale, multicenter studies are needed to validate its predictive value and clinical utility in guiding trauma resuscitation.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812570","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":"Neonatal trauma resuscitation: Successful use of low-titer O+ whole blood in a 4-day-old infant with hemorrhagic shock.","authors":"Renee W Green, Bryan A Cotton","doi":"10.1111/trf.18233","DOIUrl":"https://doi.org/10.1111/trf.18233","url":null,"abstract":"<p><strong>Background: </strong>Neonatal trauma resuscitation is particularly challenging in cases of profound hemorrhagic shock. Low-titer group O+ whole blood (LTOWB+) has emerged as a potentially effective option in pediatric trauma, but its use in neonates is debated due to risks such as D-alloimmunization. In life-threatening emergencies, decisions must carefully balance immediate survival benefits against long-term risks.</p><p><strong>Study design and methods: </strong>We present a case report of a 4-day-old neonate transported as a Level 1 trauma following a dog attack to the head, resulting in hemorrhagic shock and cardiac arrest. Upon arrival to the trauma bay, the patient was pulseless, with unsuccessful intraosseous and intravenous vascular access attempts. Access was eventually achieved using an umbilical venous catheter, enabling administration of LTOWB+.</p><p><strong>Results: </strong>Administration of LTOWB+ resulted in the return of spontaneous circulation, improved perfusion, and hemodynamic stabilization. The patient remained alive at the 6-month follow-up. LTOWB+ facilitated rapid correction of hemorrhagic shock with no immediate complications observed.</p><p><strong>Discussion: </strong>This case underscores the challenges of neonatal trauma resuscitation, including vascular access and the use of LTOWB+. LTOWB+ proved lifesaving, enabling rapid correction of acidosis and an improved outcome. Although concerns persist regarding LTOWB+ administration, the immediate survival benefits outweigh the risks, supported by evidence demonstrating its efficacy and safety. This case highlights the need for adaptability and a systematic approach to managing complex neonatal trauma scenarios. We argue that LTOWB+ is poised to become a pillar of pediatric resuscitation, providing a lifesaving, efficient, and safe option even in the newborn.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812569","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":"How do we leverage implementation science to support and accelerate uptake of clinical practice guidelines in transfusion medicine.","authors":"Jacob Crawshaw, Jeannie Callum, Sophie Chargé, Fabiana Lorencatto, Justin Presseau, Sheharyar Raza, Nicole Relke, Abby Wolfe, Simon Stanworth","doi":"10.1111/trf.18234","DOIUrl":"https://doi.org/10.1111/trf.18234","url":null,"abstract":"<p><strong>Background: </strong>Developing and disseminating clinical practice guidelines is a common strategy used to inform practice and address evidence-to-practice gaps that are prominent in transfusion medicine. Despite a highly systematic method for synthesizing evidence into guideline recommendations, comparatively little attention is paid to the real-world implementation of the recommendations in routine practice. A more scientific approach drawing on learnings from the field of implementation science is therefore warranted.</p><p><strong>Study design and methods: </strong>In this article, we propose a methodological roadmap to embed implementation science principles, frameworks, and methods to facilitate the development and uptake of transfusion medicine guidelines. We draw upon research undertaken in partnership with the International Collaboration of Transfusion Medicine Guidelines (ICTMG) to illustrate the roadmap in action.</p><p><strong>Results: </strong>The methodological roadmap constitutes five steps which have been matched to existing processes for developing and implementing clinical practice guidelines: (1) environmental scan; (2) detailing who needs to do what differently, per guideline recommendation; (3) barriers and enablers assessment; (4) tailoring implementation strategies to identified barriers and enablers; and (5) implementation and evaluation of implementation strategies. For each step, we define the key concepts and methods involved, and share examples from work done with ICTMG to support transfusion medicine guideline implementation.</p><p><strong>Discussion: </strong>We intend this methodological roadmap for clinicians, researchers, and organizations involved in supporting clinical practice guideline use. Informed by principles, frameworks, and methods from implementation science, the roadmap can provide a more structured, transparent, and replicable approach to improve the implementation of guideline recommendations in transfusion medicine.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812556","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":"Estimating the prevalence of preoperative iron deficiency and its impact on red blood cell transfusion in adolescents undergoing scoliosis surgery: A pilot study.","authors":"Annie Qiu, Daysha Fliginger, Yona Feit, Fthimnir Hassan, Lawrence G Lenke, Guohua Li, Eldad A Hod, Lisa Eisler","doi":"10.1111/trf.18246","DOIUrl":"https://doi.org/10.1111/trf.18246","url":null,"abstract":"<p><strong>Background: </strong>Iron deficiency (ID) is the leading cause of anemia, contributes to reduced physical and cognitive performance, and increases the likelihood of red blood cell (RBC) transfusion in surgical patients. Adolescents undergoing scoliosis surgery are not routinely screened for ID, though they are at heightened risk of anemia and other adverse effects.</p><p><strong>Study design and method: </strong>Patients aged 11-18 years undergoing scoliosis surgery from September 2021 through August 2023 at our institution were approached for participation in a pilot study examining iron and hematologic parameters from the preoperative period through surgical recovery and their association with RBC transfusion.</p><p><strong>Results: </strong>Clinical and laboratory data were obtained from a convenience sample of 46 adolescents (33 females, 13 males), of whom 17.4% (8/46) were anemic and 33.3% (14/42) were iron deficient. ID was more common in female patients (p = .017). RBC transfusions were given in 10.9% (5/46) of patients, more often in those with ID than without (28.6% vs. 3.6%, respectively, p = .018). At a clinic visit several weeks after surgery, 50% (12/24) of patients tested were anemic, while 74% (17/23) had low iron stores.</p><p><strong>Conclusions: </strong>Findings from this pilot study suggest that ID is present in over 30% of adolescents undergoing scoliosis surgery and is associated with a greater likelihood of receiving an RBC transfusion, while most patients had low iron stores during surgical recovery. Larger studies are needed to confirm the extent to which preoperative ID impacts the likelihood of RBC transfusion and to evaluate the benefit of iron supplementation.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796340","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":"PF4-dependent P-selectin expression assay in comparison to the heparin-induced platelet activation assay for the diagnosis of heparin-induced thrombocytopenia.","authors":"Romy T Meier, Anne-Tess Jolink, Michelle Kempe, Brian R Curtis, Suzanne Hofstede-van Egmond, Masja de Haas, Leendert Porcelijn, Rick Kapur","doi":"10.1111/trf.18242","DOIUrl":"https://doi.org/10.1111/trf.18242","url":null,"abstract":"<p><strong>Background: </strong>Heparin-induced thrombocytopenia (HIT) is a severe complication characterized by thrombocytopenia and thrombosis. The presence of antibodies against heparin/platelet factor 4 (PF4) complexes is a key indicator for HIT. Diagnostic laboratory testing generally includes detection of anti-heparin/PF4 and/or functional testing such as the heparin-induced platelet activation assay (HIPAA). However, current functional tests are time-consuming and require specific technical skills. The PF4-dependent P-selectin expression assay (PEA) is a flow cytometry-based test that evaluates activation of donor platelets in the presence of HIT patient serum.</p><p><strong>Methods: </strong>We conducted the PEA with 23 patient sera that were positive in both the anti-PF4/heparin enzyme-linked immunosorbent assay (ELISA) and HIPAA and 26 sera that tested negative in the anti-PF4/heparin ELISA. We next compared the PEA to the HIPAA using a retrospective clinical cohort of 195 sera of suspected HIT patients and tested the reproducibility of the PEA.</p><p><strong>Results: </strong>The PEA was found to have a sensitivity of 73.9% and a specificity of 73.1% compared to the HIPAA. In our retrospective clinical cohort, we found that 74.4% (145 out of 195 samples) had identical results in both the HIPAA and PEA, with a specificity of 64.94% and sensitivity of 80.51% for the PEA compared to the HIPAA. Reproducibility testing of the PEA across three independent runs demonstrated consistent results in 83.3% (30 out of 36 samples).</p><p><strong>Discussion: </strong>These findings suggest that the PEA is a promising functional test for HIT laboratory diagnostics based on the relatively high sensitivity; however, further studies are needed to validate its clinical applicability.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796345","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":"Adverse outcomes after red blood cell transfusion in very low birth weight infants in a resource-restricted hospital.","authors":"Ashish Madhou, Lizel G Lloyd, Nadia Mundey, Erica-Mari Nell, Lizelle van Wyk","doi":"10.1111/trf.18244","DOIUrl":"https://doi.org/10.1111/trf.18244","url":null,"abstract":"<p><strong>Background: </strong>Red blood cell transfusions (RBCTs) in preterm infants are associated with various adverse outcomes including transfusion-associated necrotizing enterocolitis (TANEC) and transfusion-related late-onset sepsis (TR-LOS). This study aimed to determine the adverse outcomes of RBCTs in very low birth weight infants (VLBWI) at a resource-restricted hospital in Cape Town, South Africa.</p><p><strong>Study design and methods: </strong>A retrospective descriptive analysis of all VLBWI who received a RBCT in 2020 was performed. Univariate and multivariate logistic regression were performed to determine the association of adverse events after single, multiple, early, and late RBCTs.</p><p><strong>Results: </strong>The study cohort included 178 VLBWI, representing a RBCT prevalence of 22.2%. The mean gestational age was 28 weeks and the mean birth weight was 0.99 kg. The first RBCT occurred at a mean of 27 days and at an Hb <8 g/dL, differing significantly between single, multiple early, and late RBCT groups. After adjusting for confounders, multiple RBCTs showed a strong association with TR-LOS within 3 days (aOR 9.22, 95th CI 2.30; 36.91, p = .002), TR-LOS within 7 days (aOR 8.39, 95th CI 2.72; 25.89, p < .001), any NEC ≥ Bell stage 2 (aOR 2.34, 95th CI 1.66; 11.78, p = .026), BPD (aOR 3.62, 95th CI 1.37; 9.54, p = .009) and mortality (aOR 3.58, 95th CI 1.39; 9.22, p = .008). After adjusting for confounders, early RBCTs were strongly associated with mortality (aOR 2.47, 95th CI 1.28; 8.90, p = .013).</p><p><strong>Discussion: </strong>Multiple RBCTs may be associated with TR-related sepsis. This requires more research in resource-restricted areas with a high burden of disease.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796334","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":"Apheresis collection parameters for approved CAR T-cell products need to be standardized.","authors":"Theodros Mamo, Linda Meulners, Andrew Johnson, Suzanne Thibodeaux, David McKenna","doi":"10.1111/trf.18216","DOIUrl":"https://doi.org/10.1111/trf.18216","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796336","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":"Nationwide trends in prehospital blood product use after injury 2020-2023.","authors":"Christine Carico, Chandler Annesi, N Clay Mann, Matthew J Levy, Pawan Acharya, Timothy Hurson, Daniel Lammers, Jan O Jansen, Jeffrey D Kerby, John B Holcomb, Zain G Hashmi","doi":"10.1111/trf.18221","DOIUrl":"https://doi.org/10.1111/trf.18221","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital blood transfusion improves survival after injury. Understanding potential demand for and usage of prehospital blood transfusion is important to help improve supply and utilization of this prehospital intervention. The primary objective of this study is to describe potential current demand for prehospital blood product in adults after blunt and penetrating injury from 2020 to 2023. We also estimate the extent to which this potential demand is being met.</p><p><strong>Methods: </strong>Patients ≥16 years with blunt/penetrating injuries included in the National Emergency Medical Services Information System (NEMSIS) from 2020 to 2023 were identified. Patients were classified into Cohort 1 (systolic blood pressure (SBP) <90 and heart rate (HR) >108 or SBP <70) and Cohort 2 (shock index ≥1), and total numbers in each cohort were reported. Additionally, the number and percentage of patients who were potentially eligible for and who received prehospital blood transfusion were calculated and trended over time.</p><p><strong>Results: </strong>After exclusions, 20.4 million trauma patients were included. A total of 262,761 Cohort 1 patients and 1,227,556 Cohort 2 patients were potentially eligible for transfusion. Estimated demand for blood transfusion increased from 2020 to 2023 (p < 0.001) in both cohorts. Cohort 1 had the highest estimated proportion of patients (0.9%, n = 2,289) who received transfusion, demonstrating that few potentially eligible adult trauma patients received blood product.</p><p><strong>Conclusions: </strong>Altogether, 1.2 million hemodynamically unstable trauma patients were potentially eligible for prehospital blood transfusion after injury during 2020-2023, yet less than 1% received this intervention. These data underscore the need to evaluate and resolve barriers to wider use of prehospital blood transfusions.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789121","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":"Low rate of hepatitis Delta virus co-infection in first-time blood donors diagnosed with chronic hepatitis B virus infection in the Netherlands.","authors":"Thijs J W van de Laar, Lesley A Patmore, Michel M Molier, Milan J Sonneveld, Jolanda J C Voermans, Ed Slot, Mariet C W Feltkamp, Annemiek A van der Eijk, Hans L Zaaijer","doi":"10.1111/trf.18238","DOIUrl":"https://doi.org/10.1111/trf.18238","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis Delta virus (HDV) requires co-infection with hepatitis B virus (HBV) and increases the risk of hepatitis-related morbidity and mortality compared to HBV mono-infection. HBV/HDV co-infected patients will likely benefit from new HDV antiviral drugs, but reliable estimates of co-infection rates are lacking due to limited HDV testing of HBV-infected patients.</p><p><strong>Study design and methods: </strong>First-time blood and bone tissue donors in the Netherlands (2006-2023) with a newly diagnosed chronic HBV infection were retrospectively tested for HDV antibodies, and for HDV RNA if HDV antibodies were detected. HBV genotyping using phylogenetic analysis was performed to determine the most likely origin of HBV infection.</p><p><strong>Results: </strong>HBV-DNA was detected in 254/758.081 (0.034%) first-time donors in the Netherlands. HBsAg-positive first-time donors had a median age of 43 years (IQR: 33-52), were predominantly male (67%), mostly first- or second-generation migrants (76%) and HBV (sub)genotype strongly correlated with the country of birth. HDV testing was performed for 200 first-time donors with chronic (HBsAg-positive) HBV infection: 5 donors (2.5%) had HDV antibodies, and 1 donor (0.5%) also had detectable HDV RNA. None of the 17 donors with occult (HBsAg-negative) HBV infection had experienced HDV infection.</p><p><strong>Discussion: </strong>Chronic HBV/HDV co-infection in first-time donors in the Netherlands is extremely rare, affecting 0.00013% of all first-time donors, and only 0.5% of HBsAg-positive first-time donors consisting predominantly of migrants from high(er) HDV-endemic countries. Despite low HBV/HDV co-infection rates, a one-time HDV reflex testing strategy for HBsAg-positive patients remains essential to identify patients and to initiate antiviral treatment if needed to reduce the risk of serious liver disease.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789118","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":"Potential military applications for a new freeze-dried plasma.","authors":"Anthony E Pusateri, Adam J Kishman, Mohamad Azlan Bin Ariffin, Sarah Watts, Emrys Kirkman, Richard B Weiskopf, Brendan S O'Brien, Sandy J Snyder, Sylvain Cardin, Ewell M Hollis, Oliver Hegener","doi":"10.1111/trf.18213","DOIUrl":"https://doi.org/10.1111/trf.18213","url":null,"abstract":"<p><p>Hemorrhage is a leading cause of potentially preventable death in both military and civilian trauma. Current resuscitation approaches minimize crystalloids and emphasize plasma and other blood components to achieve a balanced transfusion as early as possible after injury. Owing to the nature of military operations, military medical systems must contend with great distances, degraded infrastructure, and harsh environments, as well as combat and humanitarian assistance and disaster relief (HADR) scenarios. These factors limit both patient movement and the ability to deliver blood products to the point of need. Current projections are that future military scenarios will have longer times to reach a medical treatment facility than experienced in recent conflicts, increasing the need for logistically efficient blood products. Freeze-dried plasma (FDP) is rapidly available, easy to use, and shelf-stable at room temperature, making it easier to deliver at the point of need in challenging military environments. For the past 30 years, FDP has been available in only a few countries. Where it has been available, it has become the preferred plasma for austere or military expeditionary settings. Recently, a new FDP, OctaplasLG Powder, was approved in 17 countries worldwide and for emergency use by the Canadian and United States militaries. It is expected that FDP will soon become available to many more militaries. This review discusses the importance of plasma, reassesses the potential military uses of FDP across the range of military operations, and provides a brief discussion of OctaplasLG Powder.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781253","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}