World neurosurgery最新文献

{"title":"Socioeconomic Disparities in the Presentation, Management, and Outcomes of Cerebrospinal Fluid Diversion Procedures","authors":"Hailey D. Reisert ,&nbsp;Emery Buckner-Wolfson ,&nbsp;Geena Jung ,&nbsp;Serena Zhang ,&nbsp;Jason Yu ,&nbsp;Maya Jurgens ,&nbsp;Genesis Liriano ,&nbsp;Andrew J. Kobets","doi":"10.1016/j.wneu.2025.124469","DOIUrl":"10.1016/j.wneu.2025.124469","url":null,"abstract":"<div><h3>Objective</h3><div>We examined the relationship between socioeconomic status (SES) and features of cerebrospinal fluid (CSF) diversion at our academic center in a socially disadvantaged urban setting.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 303 surgeries among 229 patients (0.01–89 years), grouped according to median household income for zip-code (i.e., &lt;$40,000, $40,000–$70,000, $70,000–$100,000, and &gt;$100,000) and insurance type.</div></div><div><h3>Results</h3><div>The median age at surgery was significantly younger for publicly insured patients compared to privately insured patients, despite the 65-year age requirement for Medicare eligibility. Pathology necessitating CSF diversion differed across income quartiles; communicating hydrocephalus was most common in the highest group and congenital hydrocephalus was most common in the lowest income group (<em>P</em> &lt; 0.05). Publicly insured patients were 3.86 times more likely to present with altered mental status than privately insured patients (95% confidence interval [CI]: 1.75–8.49; <em>P</em> &lt; 0.001). Procedure duration and post-operative length-of-stay were longer for publicly than privately insured patients.</div></div><div><h3>Conclusions</h3><div>Despite previously reported associations between SES and surgical outcomes, we did not observe a statistically significant difference in post-operative issues, discharge disposition, or number of procedures per patient across two SES metrics. Physicians should prioritize educating patients about symptoms of elevated intracranial pressure and encourage prompt evaluation when these symptoms arise.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124469"},"PeriodicalIF":2.1,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070612","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 Single Antiplatelet Therapy and Dual Antiplatelet Therapy in the Treatment of Intracranial Aneurysms with Surface-Modified Flow Diverters: A Systematic Review and Meta-Analysis","authors":"Xinyu Wang,&nbsp;Huiwei Liu,&nbsp;Zihao Song,&nbsp;Xin Su,&nbsp;Xiangyu Li,&nbsp;Yongjie Ma","doi":"10.1016/j.wneu.2025.124454","DOIUrl":"10.1016/j.wneu.2025.124454","url":null,"abstract":"<div><h3>Objective</h3><div>Surface-modified flow diverters enable application of single antiplatelet therapy (SAPT) for intracranial aneurysms (IAs) treatment. This study systematically evaluated the feasibility of SAPT as an alternative to dual antiplatelet therapy (DAPT).</div></div><div><h3>Methods</h3><div>PubMed, Scopus, and Web of Science were searched for surface-modified flow diverter studies. Two reviewers independently assessed eligibility. Study quality was evaluated using NIH tools and Egger's test. Outcomes were pooled via Freeman-Tukey arcsine transformation, with heterogeneity assessed by I².</div></div><div><h3>Results</h3><div>The analysis included 6 SAPT studies (200 patients, 243 aneurysms) and 18 DAPT studies (1553 patients, 1728 aneurysms). All efficacy and safety outcomes—including 6-month complete occlusion rates (77.1% vs. 72.2%), 6-month adequate occlusion rates (86.9% vs. 86.6%), all-cause mortality (0.2% vs. 0.3%), treatment-related mortality (0% vs. 0.1%), morbidity (0% vs. 0.4%), ischemic complications (1.7% vs. 4.6%), thrombosis formation (1.3% vs. 2.3%), and intracranial hemorrhage rates (0% vs. 0.9%)—exhibited no significant differences. For p48/64 MW HPC specifically, the remaining outcomes also exhibited no significant differences, with the exception of lower 6-month adequate occlusion rates in the SAPT group (85.5% vs. 93.8%, <em>P</em> <!-->=<!--> <!-->0.03). Compared to prasugrel monotherapy and DAPT regimens, aspirin was more economical yet poses higher safety risk.</div></div><div><h3>Limitations</h3><div>Limitations include the limited sample size of the SAPT group, the retrospective design of most included studies, and significant heterogeneity.</div></div><div><h3>Conclusions</h3><div>SAPT shows comparable efficacy and safety to DAPT. Prasugrel monotherapy is a more preferable option compared with aspirin. SAPT may be a viable alternative, particularly for high-hemorrhage-risk patients.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124454"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065811","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":"Procrastination and the Art of Avoidance","authors":"Ed Benzel","doi":"10.1016/j.wneu.2025.124480","DOIUrl":"10.1016/j.wneu.2025.124480","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124480"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065806","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 clinical features and surgical outcomes of cystic and solid vestibular schwannoma.","authors":"Longmin Zhou, Zhengjun Wang, XiaoFang Hu, Dexiao Yang, Zhaocong Zheng","doi":"10.1016/j.wneu.2025.124470","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124470","url":null,"abstract":"<p><strong>Background: </strong>Whether surgical intervention is optimal for the treatment of cystic vestibular schwannoma (CVS) remains an area of debate and active clinical research. This study aimed to compare the surgical outcomes between CVSs and solid vestibular schwannoma (SVS) to support clinical decision-making.</p><p><strong>Methods: </strong>In this retrospective study, a total of 165 patients with VS who admitted in a tertiary hospital for microsurgery via the retrosigmid approach were included. Extent of resection, facial nerve function, and major complications, as documented in medical records and analyzed.</p><p><strong>Results: </strong>Patients with CVSs had significantly larger tumor sizes, as indicated by maximal diameter (P = 0.001), a higher rate of tumor with a maximum diameter ≥ 3 cm (P = 0.030), and a lower rate of internal auditory canal enlargement (P = 0.004), compared with patients with SVSs. Additionally, patients with CVSs had a significantly lower rate of favorable facial nerve function outcomes (House-Brackmann grade I or II) at 3 months postoperatively compared with those with SVS (74.1% vs. 81.4%, P = 0.033). However, when stratified by tumor size (≥ 3 cm: P = 0.613; < 3 cm: P = 0.592), the difference in facial nerve function outcomes between CVSs and SVSs groups was no longer significant. Logistic regression analysis indicated that tumor size was the only factor significantly associated with unfavorable facial nerve function outcomes (P = 0.005).</p><p><strong>Conclusion: </strong>Tumor size, rather than the cystic presentation, was a more significant predictor of postoperative facial nerve function outcomes in patients undergoing microsurgery.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124470"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065787","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":"Modified far lateral approach for a 4th ventricular tumor with CPA extension: Illustrative teaching case.","authors":"Sravani Kondapavulur, Roberto Rodriguez Rubio, John M Bernabei, Edward F Chang, Ramin A Morshed","doi":"10.1016/j.wneu.2025.124466","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124466","url":null,"abstract":"<p><p>A 56-year old female presented with several months of nausea, imbalance, and gait instability. Imaging demonstrated a 4^th ventricular lesion extending toward the left cerebello-pontine angle (CPA). Here we describe how a modified far lateral approach with C1 laminectomy is an alternative approach to such a lesion, providing circumferential visualization for resection. IRB approval was not needed due to descriptive approach, and the patient consented to research. The patient was positioned 3/4 prone with left side up, and an incision was made to expose the mastoid, occipital bone, C1, and C2. After the corresponding myocutaneous flap was raised, the vertebral artery was identified with Doppler, and a left far lateral craniotomy spanning from right of midline to the left sigmoid sinus was created. Additionally, we completed a left C1 laminectomy and drilled bone along the lateral foramen magnum up to the condyle without condylectomy. The dura was opened with exposure of the obex to the left CPA. The intertonsillar and left vermus-tonsillar planes were dissected to identify the lesion, overlying PICA was released from the lesion, and the left tonsil was elevated for tumor exposure. The tumor was then debulked superficial-to-deep, followed by lateral-to-medial, prior to closing. A gross total resection was achieved without surgical complications. At two-week follow-up, the patient was ambulating with a walker, incisional pain was improving, and nausea was resolved. A modified far lateral approach provides an alternative to midline suboccipital and retrosigmoid craniotomies for 4^th ventricular tumors that extend laterally towards the CPA.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124466"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065825","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":"Three-Dimensional Radiomics and Machine Learning for Predicting Postoperative Outcomes in Laminoplasty for Cervical Spondylotic Myelopathy: A Clinical-Radiomics Model","authors":"Bin Zheng ,&nbsp;Zhenqi Zhu ,&nbsp;Ke Ma ,&nbsp;Yan Liang ,&nbsp;Haiying Liu","doi":"10.1016/j.wneu.2025.124464","DOIUrl":"10.1016/j.wneu.2025.124464","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to explore a method based on three-dimensional cervical spinal cord reconstruction, radiomics feature extraction, and machine learning to build a postoperative prognosis prediction model for patients with cervical spondylotic myelopathy (CSM). It also evaluates the predictive performance of different cervical spinal cord segmentation strategies and machine learning algorithms.</div></div><div><h3>Methods</h3><div>A retrospective analysis is conducted on 126 CSM patients who underwent posterior single-door laminoplasty from January 2017 to December 2022. Three different cervical spinal cord segmentation strategies (narrowest segment, surgical segment, and entire cervical cord C1–C7) are applied to preoperative magnetic resonance imaging images for radiomics feature extraction. Good clinical prognosis is defined as a postoperative Japanese Orthopaedic Association (JOA) recovery rate ≥50%. By comparing the performance of 8 machine learning algorithms, the optimal cervical spinal cord segmentation strategy and classifier are selected. Subsequently, clinical features (smoking history, diabetes, preoperative JOA score, and cervical sagittal vertical axis (cSVA) are combined with radiomics features to construct a clinical-radiomics prediction model.</div></div><div><h3>Results</h3><div>Among the three cervical spinal cord segmentation strategies, the support vector machine model based on the narrowest segment performed best (area under the curve [AUC] = 0.885). Among clinical features, smoking history, diabetes, preoperative JOA score, and cSVA are important indicators for prognosis prediction. When clinical features are combined with radiomics features, the fusion model achieved excellent performance on the test set (accuracy = 0.895, AUC = 0.967), significantly outperforming either the clinical model or the radiomics model alone.</div></div><div><h3>Conclusions</h3><div>This study validates the feasibility and superiority of three-dimensional radiomics combined with machine learning in predicting postoperative prognosis for CSM. The combination of radiomics features based on the narrowest segment and clinical features can yield a highly accurate prognosis prediction model, providing new insights for clinical assessment and individualized treatment decisions. Future studies need to further validate the stability and generalizability of this model in multicenter, large-sample cohorts.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124464"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065839","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":"Age and Time as Predictors of Outcome in Patients Undergoing Decompressive Craniectomy for Traumatic Brain Injury","authors":"Dag Ferner Netteland ,&nbsp;Pål Andre Rønning ,&nbsp;Tor Brommeland ,&nbsp;Vidar Stenset ,&nbsp;Cathrine Tverdal ,&nbsp;Mads Aarhus ,&nbsp;Eirik Helseth","doi":"10.1016/j.wneu.2025.124471","DOIUrl":"10.1016/j.wneu.2025.124471","url":null,"abstract":"<div><h3>Background</h3><div>Evidence to support the benefit of decompressive craniectomy (DC) in traumatic brain injury (TBI) is diverging. Moreover, in the context of an aging population, there is a notable lack of direct evidence supporting the efficacy of DC in older age groups. In this study, we evaluate the impact of age on outcome after DC for TBI in a single-center cohort. Additionally, we explore the effect of time from injury to DC on outcome.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study based on prospectively collected data from the Oslo TBI Registry Neurosurgery, we included TBI patients of any age admitted to Oslo University Hospital from 2015 to 2023 who had undergone DC. Dichotomized 6-month Glasgow Outcome Scale was analyzed for the whole cohort and stratified by patient age and time from TBI to DC in both univariable and multivariable analyses.</div></div><div><h3>Results</h3><div>Eighty-six patients were included. Median age was 41 years (range 2–79 years), and the median time from injury to DC was 7 hours (interquartile range 3–35 hours). Unfavorable outcome (Glasgow Outcome Scale 1–3) varied significantly according to both age group (≥60 years: 92%, 40–59 years: 67%, 20–39 years: 46%, and 0–19 years: 50%; <em>P</em> = 0.022) and whether the patient required early or later DC (DC ≤ 6 hours: 74%, DC &gt; 6 hours: 50%; <em>P</em> = 0.023). In multivariable logistic regression, age (β 0.09, 95% confidence interval 0.03–0.14; <em>P</em> = 0.003) and time from injury to DC (β −0.02, 95% confidence interval −0.03 to 0.00; <em>P</em> = 0.02) remained associated with unfavorable outcome.</div></div><div><h3>Conclusions</h3><div>Older age and requiring DC earlier rather than later were associated with unfavorable outcomes after DC for TBI.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124471"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065672","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":"Cerebral Microbleeds are Associated with Post-Stroke Dysphagia in Spontaneous Intracerebral Hemorrhage Patients.","authors":"Shu-Mei Yang, Yen-Heng Lin, Ting-Ju Lai, Ya-Chu Hsu, You-Lin Lu, Chueh-Hung Wu, Tyng-Guey Wang, Meng-Ting Lin","doi":"10.1016/j.wneu.2025.124465","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.124465","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral microbleeds (CMBs) are markers of small vessel disease in patients with intracerebral hemorrhage (ICH) and may impact recovery. Post-stroke dysphagia (PSD) is a significant complication of ICH. This study investigates the association between CMBs and PSD in patients with spontaneous ICH.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with acute spontaneous ICH who underwent magnetic resonance imaging (MRI) for lobar CMB assessment between June 2019 and June 2023. Lobar CMBs were defined based on susceptibility-weighted MRI interpreted by a board-certificated neuroradiologist. PSD was assessed with nasogastric (NG) tube retention and Functional Oral Intake Scale (FOIS) levels at the 1^st, 4^th, and 12^th week after ICH. Logistic regression was performed to evaluate the association between lobar CMBs and PSD.</p><p><strong>Results: </strong>A total of 187 patients were included, of whom 61.5% presented with lobar CMBs. The NG tube retention rate was significantly higher in ICH patients with lobar CMB compared to those without at 4 (47.8% vs. 22.2%, p = 0.0004) and 12 weeks (42.6% vs. 9.7%, p < 0.0001). FOIS levels were significantly lower in ICH patients with lobar CMBs at 4 weeks (5.0 vs. 5.7, p = 0.0449). ICH patients with lobar CMBs showed a significant association with prolonged NG tube retention at 4 and 12 weeks.</p><p><strong>Conclusions: </strong>Lobar CMBs were associated with prolonged PSD in patients with spontaneous ICH. CMBs may serve as predictive markers for post-ICH dysphagia outcomes. Early identification of CMBs may aid in personalizing rehabilitation strategies to improve swallowing recovery in ICH patients.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124465"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065834","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":"Surgical Strategy for Superior Cerebellar Peduncle Lesions: Utility of the Subtemporal Transtentorial Approach","authors":"Ryotaro Imai ,&nbsp;Dai Kamamoto ,&nbsp;Masateru Katayama ,&nbsp;Sadao Suga ,&nbsp;Kazunari Yoshida ,&nbsp;Takuya Furuta ,&nbsp;Hadzki Matsuda ,&nbsp;Hikaru Sasaki","doi":"10.1016/j.wneu.2025.124467","DOIUrl":"10.1016/j.wneu.2025.124467","url":null,"abstract":"<div><h3>Background</h3><div>Tumors involving the superior cerebellar peduncle (SCP) are rare and pose considerable surgical challenges due to their deep and complex location. While the supracerebellar infratentorial approach has been the most frequently described strategy, it may be insufficient for lesions extending along the entire SCP. We present 2 cases of SCP tumors to highlight the utility of the subtemporal transtentorial approach.</div></div><div><h3>Methods</h3><div>Case 1 was a 28-year-old woman with a hemorrhagic SCP tumor extending into the fourth ventricle. Resection was performed in 2 stages using the trans-cerebellomedullary fissure and occipital transtentorial approaches, but the central SCP remained inaccessible. In case 2, a 33-year-old man with an enlarging lesion encompassing nearly the entire SCP underwent surgery. Based on simulation and prior experience, the subtemporal transtentorial approach was selected for its potential to provide a panoramic view of the SCP.</div></div><div><h3>Results</h3><div>In case 1, volumetric analysis demonstrated a resection rate of 90.1% achieved through staged approaches, with no postoperative neurological deficits. The Karnofsky Performance Status score remained at 90 at 21 months after surgery. Pathology confirmed pilocytic astrocytoma. In case 2, the subtemporal transtentorial approach enabled 79.0% resection while preserving cerebellar and cranial nerve function, with a Karnofsky Performance Status score of 100 at 18 months. Pathology revealed dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease).</div></div><div><h3>Conclusions</h3><div>The subtemporal transtentorial approach offers a direct and linear trajectory to lesions extending along the entire SCP, allowing substantial resection while minimizing functional morbidity. Although experience remains limited, this approach should be considered for surgical access to the SCP.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124467"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065794","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":"The Hidden Challenge: Building Datasets for Artificial Intelligence-Based Intracranial Pressure Prediction","authors":"Dimitrios Theodoropoulos ,&nbsp;Kostas Marias ,&nbsp;Antonios Vakis ,&nbsp;Efrosini Papadaki ,&nbsp;Dimitrios A. Karabetsos","doi":"10.1016/j.wneu.2025.124483","DOIUrl":"10.1016/j.wneu.2025.124483","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"204 ","pages":"Article 124483"},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058463","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}