Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Operating Room Versus Intensive Care Unit Extubation Within 6 Hours After On-Pump Cardiac Surgery: Early Results and Hospital Costs","authors":"Andrew D. Hawkins MD ,&nbsp;Raymond J. Strobel MD, MSc ,&nbsp;J. Hunter Mehaffey MD, MSc ,&nbsp;Robert B. Hawkins MD, MSc ,&nbsp;Evan P. Rotar MD, MS ,&nbsp;Andrew M. Young MD ,&nbsp;Leora T. Yarboro MD ,&nbsp;Kenan Yount MD, MBA ,&nbsp;Gorav Ailawadi MD, MBA ,&nbsp;Mark Joseph MD ,&nbsp;Mohammed Quader MD ,&nbsp;Nicholas R. Teman MD","doi":"10.1053/j.semtcvs.2022.09.013","DOIUrl":"10.1053/j.semtcvs.2022.09.013","url":null,"abstract":"<div><p><span>Time-directed extubation<span> (fast-track) protocols may decrease length of stay and cost but data on operating room (OR) extubation is limited. The objective of this study was to compare the outcomes of extubation in the OR versus fast-track extubation within 6 hours of leaving the operating room. Patients undergoing nonemergent STS index cases (2011–2021) who were extubated within 6 hours were identified from a regional STS quality collaborative. Patients were stratified by extubation in the OR versus fast track. Propensity score matching (1:n) was performed to balance baseline differences. Of the 24,962 patients, 498 were extubated in the OR. After matching, 487 OR extubation cases and 899 fast track cases were well balanced. The rate of reintubation was higher for patients extubated in the OR [21/487 (4.3%) vs 16/899 (1.8%), </span></span><em>P</em><span> = 0.008] as was the incidence of reoperation for bleeding [12/487 (2.5%) vs 8/899 (0.9%), </span><em>P</em> = 0.03]. There was no significant difference in the rate of any reoperation [16/487 (3.3%) vs 15/899 (1.6%), <em>P</em><span> = 0.06] or operative mortality [4/487 (0.8%) vs 6/899 (0.6%), </span><em>P</em> = 0.7]. OR extubation was associated with shorter hospital length of stay (5.6 vs 6.2 days, <em>P</em> &lt; 0.001) and lower total cost of admission ($29,602 vs $31,565 <em>P</em> &lt; 0.001). OR extubation is associated with a higher postoperative risk of reintubation and reoperation due to bleeding, but lower resource utilization.Future research exploring predictors of extubation readiness may be required prior to widespread adoption of this practice.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9539405","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":"Closure of Left Atrial Appendage Has no Effect on Thromboembolic Rates after Mitral Valve Repair in Patients in Sinus Rhythm","authors":"Maria Ascaso MD,&nbsp;Carolyn M. David BN,&nbsp;Chun-Po Steve Fan PhD,&nbsp;Sudipta Saha PhD,&nbsp;Tirone E. David MD","doi":"10.1053/j.semtcvs.2022.10.008","DOIUrl":"10.1053/j.semtcvs.2022.10.008","url":null,"abstract":"<div><p><span><span>Closure of the left atrial appendage (LAA) reduces the rates of TIA/stroke in patients in atrial fibrillation (AF) but its role in patients in </span>sinus rhythm<span> who undergo mitral valve repair (MV) for leaflet prolapse remains unknown. This study examined the effects of closing the LAA in TIA/stroke after MV repair. Our database on patients who had MV repair for leaflet prolapse from 2000 through 2019 was reviewed. After excluding patients at higher risk of TIA/stroke, 1050 patients in sinus rhythm were entered into the study: 781 with open LAA and 269 with surgically closed LAA. Using a propensity score analysis to compensate from clinical differences, 267 pairs of patients with open and closed LAA were matched. Follow-up was truncated at 5 years because routine closure of the LAA was performed only during recent years. The cumulative incidence of TIA/stroke at 5 years in the entire cohort was 2.7% [95% CI 1.9, 4.0]; it was 2.9% [95% CI 1.9, 4.4] in patients with open LAA,and 1.8% [95% CI 0.7, 4.9] in patients with closed LAA (</span></span><em>P</em> = 0.53). In the matched cohorts, the cumulative incidences of TIA/stroke did not differ significantly (match-adjusted HR [95% CI] = 0.80 [0.21, 2.98], <em>P</em><span> = 0.74), and multivariable Cox proportional hazard regression analysis also confirmed no difference in the risk of TIA/stroke between the 2 groups (regression-adjusted HR [95% CI] = 0.58 [0.12, 2.9], </span><em>P</em> = 0.47). This study failed to show a reduction in the risk of TIA/stroke by closing the LAA in patients in sinus rhythm (Figure 6). Closure of the LAA during MV repair warrants a larger and more rigorous study.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662810","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":"Discrepancy Between Radiological and Pathological Tumor Size in Early-Stage Non-Small Cell Lung Cancer: A Multicenter Study","authors":"Atsushi Kamigaichi MD ,&nbsp;Yasuhiro Tsutani MD, PhD ,&nbsp;Takahiro Mimae MD, PhD ,&nbsp;Yoshihiro Miyata MD, PhD ,&nbsp;Hiroyuki Adachi MD, PhD ,&nbsp;Yoshihisa Shimada MD, PhD ,&nbsp;Yukio Takeshima MD, PhD ,&nbsp;Hiroyuki Ito MD, PhD ,&nbsp;Norihiko Ikeda MD, PhD ,&nbsp;Morihito Okada MD, PhD","doi":"10.1053/j.semtcvs.2022.12.001","DOIUrl":"10.1053/j.semtcvs.2022.12.001","url":null,"abstract":"<div><p><span><span>Discrepancies between radiological whole tumor size (RTS) and pathological whole tumor size (PTS) are sometimes observed. Unexpected pathological upsize may lead to insufficient margins during procedures like sub lobar resections. Therefore, this study aimed to investigate the current status of these discrepancies and identify factors resulting in pathological upsize in patients with early-stage non-small cell lung cancer (NSCLC). Data from a multicenter database of 3092 patients with clinical stage 0-IA NSCLC who underwent </span>pulmonary resection<span> were retrospectively analyzed. Differences between the RTS and PTS were evaluated using Pearson's correlation analysis and Bland-Altman plots. Unexpected pathological upsize was defined as an upsize of ≥1 cm when compared to the RTS, and the predictive factors of this upsize were identified based on multivariable analyses. The RTS and PTS showed a positive linear relationship (</span></span><em>r</em><span> = 0.659), and the RTS slightly overestimated the PTS. The Bland-Altman plot showed 131 of 3092 (5.2%) cases were over the upper 95% limits of agreement. In multivariable analyses, a maximum standardized uptake value (SUV</span>_max) of the primary tumor on 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (odds ratio [OR], 1.070; 95% confidence interval [CI], 1.035−1.107; <em>P</em> &lt; 0.001) and the adenocarcinoma histology (OR, 1.899; 95% CI, 1.071−3.369; <em>P</em> =0.049) were independent predictors of unexpected pathological upsize. More of the adenocarcinomas with pathological upsize were moderately or poorly differentiated, when compared to those without. The RTS tends to overestimate the PTS; however, care needs to be taken regarding unexpected pathological upsize, especially in adenocarcinomas with a high SUV_max.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10492897","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":"Shift in the Future of Cardiothoracic Surgery Applications: Holistic or Too Optimistic?","authors":"Ariadna Marrero BA ,&nbsp;Lin Chen BA ,&nbsp;Tara Karamlou MD, MSc ,&nbsp;Alejandro Bribriesco MD","doi":"10.1053/j.semtcvs.2022.08.015","DOIUrl":"10.1053/j.semtcvs.2022.08.015","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458872","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":"Ultra-Hybrid Repair: Open Thoracoabdominal Completion After Descending Stent Grafting","authors":"Matthew A. Thompson BS, BA ,&nbsp;Ashley M. Lowry MS, MEd ,&nbsp;Francis Caputo MD ,&nbsp;Douglas R. Johnston MD ,&nbsp;Christopher Smolock MD ,&nbsp;Patrick Vargo MD ,&nbsp;Eugene H. Blackstone MD ,&nbsp;Eric E. Roselli MD ,&nbsp;Collaborators in the Cleveland Clinic Aorta Center","doi":"10.1053/j.semtcvs.2022.10.004","DOIUrl":"10.1053/j.semtcvs.2022.10.004","url":null,"abstract":"<div><p><span>To characterize patient risk profiles and outcomes associated with staged ultra-hybrid repair of extensive aortic disease<span>, in which open thoracoabdominal completion was performed after thoracic stent grafting. From 1/2006 to 1/2021, 92 patients underwent open thoracoabdominal repair of chronic dissection (n=58, 63%), degenerative aneurysm (n=28, 30%), endoleak (n=4, 4.3%), or symptomatic acute type B dissection (n=2, 2.2%) after descending thoracic stent grafting (69, 75%), frozen elephant trunk (5, 5%), or both (18, 20%). The surgical graft was sewn to the distal endovascular device </span></span><em>in situ</em><span>, reducing the extent of the open procedure and eliminating the need for hypothermic circulatory arrest. Mean age was 58±13 years, 89 (97%) were hypertensive, 38 (43%) had chronic obstructive pulmonary disease<span><span>, 63 (72%) were smokers, 20 (24%) had a prior stroke, and 33 (36%) had a suspected or confirmed heritable aortic condition. Hospital mortality was 7.6% (n=7). Complications included dialysis (16, 20%), tracheostomy (8, 8.7%), stroke (5, 5.7%), and permanent paralysis (6, 6.9%). Survival at 1, 3, and 5 years was 80%, 71%, and 66%, respectively. Mortality was associated with higher </span>blood urea nitrogen and longer distance between the distal endograft edge and proximal patent visceral vessel (</span></span><em>P</em><span>=0.004 and .01, respectively). Patients with extensive aortic disease undergoing open aortic repair after thoracic stent grafting are often young with chronic dissection, multiple comorbidities, or a heritable aortic condition. Success of staged ultra-hybrid operations demonstrates open and endovascular repair strategies are complementary, even when performed in a high-risk patient population.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512118","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":"Fate of the Right Ventricular Outflow Tract Following Valve-Sparing Repair of Tetralogy of Fallot","authors":"Omar Toubat PhD ,&nbsp;Winfield J. Wells MD ,&nbsp;Vaughn A. Starnes MD ,&nbsp;Subramanyan Ram Kumar MD, PhD","doi":"10.1053/j.semtcvs.2022.12.002","DOIUrl":"10.1053/j.semtcvs.2022.12.002","url":null,"abstract":"<div><p><span><span>Valve-sparing repair (VSR) of tetralogy of Fallot<span> (TOF) tends to result in higher residual right ventricular outflow tract (RVOT) gradients. We evaluated the progression and clinical implications of RVOT gradients following VSR of TOF. Demographic, clinical, and operative data were retrospectively collected from consecutive TOF patients who underwent VSR at our institution between 01/2010 and 06/2021. RVOT gradient, </span></span>pulmonary valve annulus (PVA) diameter and Boston Z-scores were recorded from serial </span>echocardiograms<span><span>. Data are presented as median and interquartile range or number and percentage. A total of 156 children (boys 92, 59%) underwent VSR at 6.5 (4.9-8.4) months of age and 6.6 kg (5.6- 7.7) weight. There was 1 (0.6%) operative mortality. The remaining 155 patients were followed for 69.4 months (4-106.2). RVOT gradient was 2.4m/s (1.7-2.9) at discharge. It transiently increased, then declined and stabilized during follow-up. PVA Z-score was -1.7 (-3.1 to 0.5) at discharge and ‘grew’ to -0.8 (-1.7 to 0.4) at last follow-up. Freedom from RVOT re-intervention was 97%, 94% and 91% at 1, 5 and 10-year follow-up. Among 67 (43%) patients with PVA Z-score &lt; -2, a similar RVOT gradient pattern was observed and freedom from RVOT re-intervention was 97%, 95% and 95% at 1, 5 and 8-year follow-up. Following VSR of TOF, RVOT gradients transiently increase and then fall as PVA </span>growth catches up<span>, resulting in durable intermediate outcomes. Patients with PVA Z-score &lt; -2 demonstrated a similar pattern of hemodynamics in the RVOT and excellent freedom from reintervention.</span></span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10061142","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":"Reply: A Paradigm Shift is Starting Point","authors":"Edgar Aranda-Michel PhD ,&nbsp;Lena Trager BA ,&nbsp;Jason Han MD ,&nbsp;Ibrahim Sultan MD","doi":"10.1053/j.semtcvs.2022.09.001","DOIUrl":"10.1053/j.semtcvs.2022.09.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458873","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":"Prognostic Impact of Very Small Ground-Glass Opacity Component in Stage IA Solid Predominant Non-small Cell Lung Cancer","authors":"Aritoshi Hattori MD ,&nbsp;Takeshi Matsunaga MD ,&nbsp;Mariko Fukui MD ,&nbsp;Kazuhiro Suzuki MD ,&nbsp;Kazuya Takamochi MD ,&nbsp;Kenji Suzuki MD","doi":"10.1053/j.semtcvs.2022.09.006","DOIUrl":"10.1053/j.semtcvs.2022.09.006","url":null,"abstract":"<div><p><span>We evaluated the prognostic role of the presence of a very small ground glass opacity<span> (GGO) component in stage IA solid-predominant non-small cell lung cancer (NSCLC). We evaluated surgically resected 1471 patients diagnosed with stage IA solid-predominant NSCLC. They were classified into 3 groups; that is, GGO group (0.5&lt;CTR&lt;0.9), Very small GGO group (0.9≤CTR&lt;1.0), and the Solid group (CTR = 1.0). The prognostic influence of a very small GGO component was evaluated using the Cox proportional hazards model. Overall survival (OS) was estimated using the Kaplan-Meier method with a log-rank test. In total, 523 GGO groups, 91 Very small GGO groups, and 857 Solid groups were identified. The median CTR of the Very small GGO group was 0.92 ± 0.02 (range, 0.90–0.97). Both the pathological characteristics and survival outcome was similar between GGO group and Very small GGO group (5 year-OS, 91.7% Vs 89.8%, </span></span><em>P</em> = 0.374). However, several pathological findings including nodal involvement (8% Vs 20%, <em>P</em> = 0.004), lymphatic (12% Vs 27%, <em>P</em> = 0.003) or vascular (18% Vs 37%, <em>P</em> &lt; 0.001) invasion or spread through alveolar space (9% Vs 23%, <em>P</em> = 0.004) were significantly different in comparison between Very small GGO and Solid group. Accordingly, the 5-year OS significantly differed between the groups (89.8% Vs 72.5%, <em>P</em> &lt; 0.001), which was also demonstrated in the propensity score-matched cohort (89.4% Vs 79.2%; <em>P</em> = 0.019). Prognostic impact of a very small GGO component is relevant in stage IA solid-predominant NSCLC. In the future, it is necessary to confirm these data using larger multi-institutional datasets that are more appropriately powered.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386501","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":"Cardioprotective Effects of Glucose-Insulin-Potassium Infusion in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis","authors":"Andres Hagerman MD ,&nbsp;Raoul Schorer MD ,&nbsp;Alessandro Putzu MD ,&nbsp;Gleicy Keli-Barcelos MD, PhD ,&nbsp;Marc Licker MD","doi":"10.1053/j.semtcvs.2022.11.002","DOIUrl":"10.1053/j.semtcvs.2022.11.002","url":null,"abstract":"<div><p>The infusion of glucose-insulin-potassium (GIK) has yielded conflicting results in terms of cardioprotective effects. We conducted a meta-analysis to examine the impact of perioperative GIK infusion in early outcome after cardiac surgery. Randomized controlled trials (RCTs) were eligible if they examined the efficacy of GIK infusion in adults undergoing cardiac surgery. The main study endpoint was postoperative myocardial infarction (MI) and secondary outcomes were hemodynamics, any complications and hospital resources utilization. Subgroup analyses explored the impact of the type of surgery, GIK composition and timing of administration. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated with a random-effects model. Fifty-three studies (n=6129) met the inclusion criteria. Perioperative GIK infusion was effective in reducing MI (k=32 OR 0.66[0.48, 0.89] <em>P</em>=0.0069), acute kidney injury (k=7 OR 0.57[0.4, 0.82] <em>P</em>=0.0023) and hospital length of stay (k=19 MD -0.89[-1.63, -0.16] days <em>P</em>=0.0175). Postoperatively, the GIK-treated group presented higher cardiac index (k=14 MD 0.43[0.29, 0.57] L/min <em>P</em>&lt;0.0001) and lesser hyperglycemia (k=20 MD -30[-47, -13] mg/dL <em>P</em>=0.0005) than in the usual care group. The GIK-associated protection for MI was effective when insulin infusion rate exceeded 2 mUI/kg/min and after coronary artery bypass surgery. Certainty of evidence was low given imprecision of the effect estimate, heterogeneity in outcome definition and risk of bias. Perioperative GIK infusion is associated with improved early outcome and reduced hospital resource utilization after cardiac surgery. Supporting evidence is heterogenous and further research is needed to standardize the optimal timing and composition of GIK solutions.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1043067922002623/pdfft?md5=57e71c6e09516cef281a90c26872c501&pid=1-s2.0-S1043067922002623-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40456167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: A Tale of Two Operations","authors":"Omar M. Sharaf BS ,&nbsp;Gilbert R. Upchurch MD ,&nbsp;Thomas M. Beaver MD, MPH","doi":"10.1053/j.semtcvs.2022.10.006","DOIUrl":"10.1053/j.semtcvs.2022.10.006","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673676","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}