Female Pelvic Medicine and Reconstructive Surgery最新文献

{"title":"Characterizing Adverse Events Reporting for an Over-the-Counter Disposable Intravaginal Support Device for Stress Urinary Incontinence.","authors":"Stephanie A Sansone,&nbsp;Michelina D Stoddard,&nbsp;Ahra Cho,&nbsp;Tirsit S Asfaw,&nbsp;Art Sedrakyan,&nbsp;Bilal Chughtai","doi":"10.1097/SPV.0000000000001109","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001109","url":null,"abstract":"<p><strong>Objectives: </strong>In recent years, new intravaginal support devices for stress urinary incontinence have been introduced to the market. Although studies have demonstrated their safety and efficacy, few studies have examined adverse events attributed to their use. The objective of this study was to characterize reported adverse events for an over-the-counter intravaginal support device and determine whether further medical treatment was necessary to manage the adverse event.</p><p><strong>Methods: </strong>We searched the Manufacturer and User Device Experience database from January 2015 to September 2020 for pertinent reported adverse events, which included the unique report key, event date, report date, event text descriptions, and resulting course of treatment. Per Manufacturer and User Device Experience database mandatory requirements, all reports were submitted by the manufacturer within 30 days of receiving the consumer's voluntary submission.</p><p><strong>Results: </strong>A total of 257 reports were included for analysis. The most common reported adverse event was related to the string of the device, which broke with either removal or insertion of the device (230 of 257 [89.5%]). The majority of patients who required medical attention (133 of 257 [51.8%]) were evaluated and managed in the office setting (85 of 133 [63.9%]), whereas 37% (95 of 257) of patients were able to self-treat.</p><p><strong>Conclusions: </strong>Most complications attributed to device use were self-managed or managed in the outpatient setting. No emergent hospitalizations or deaths were attributed to their use, supporting their generally low-risk profile and high tolerability. Limitations of this review include the inability to decipher a denominator for these reported adverse events and the potential bias attributed to voluntary consumer reporting.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 5","pages":"300-303"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9352207","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":"Pelvic Floor Support and Symptoms 1 Year Postpartum in Relation to Excess Body Habitus Before, During and After First Vaginal Birth.","authors":"Xiaoming Sheng, Jie Wang, Janet M Shaw, Maureen A Murtaugh, Ingrid E Nygaard","doi":"10.1097/SPV.0000000000001150","DOIUrl":"10.1097/SPV.0000000000001150","url":null,"abstract":"<p><strong>Importance: </strong>Obesity may be a modifiable risk factor for pelvic floor disorders.</p><p><strong>Objectives: </strong>The objective of this study is to determine associations between weight, weight changes, and cumulative exposure to excess body mass index (BMI) from prepregnancy to 1 year postpartum on pelvic floor support and symptoms 1 year after first vaginal birth.</p><p><strong>Study design: </strong>In 645 primiparous women who gave birth vaginally, we assessed anatomic pelvic floor support, pelvic floor symptoms and BMI at the third trimester, 5 - 10 weeks, and 1 year postpartum; we also assessed BMI prepregnancy and predelivery. Using multivariable models, we determined associations between pelvic floor outcomes 1 year postpartum and BMI quartiles at different timepoints, gestational weight gain, and postpartum weight retention. We evaluated associations between stress urinary incontinence (SUI) and moderate/severe urinary incontinence (UI) 1 year postpartum and cumulative excess BMI from prepregnancy to 1-year postpartum (BMI1year).</p><p><strong>Results: </strong>Body mass index was not associated with anatomic support, composite symptom burden, overactive bladder, anal incontinence, or constipation at any timepoint. Gestational weight gain and postpartum weight retention were not associated with any 1-year outcome. Body mass index at every timepoint was positively associated with SUI and moderate/severe UI; BMI1year was most predictive. Cumulative excess BMI was positively associated with SUI and moderate/severe UI but only slightly more predictive of these outcomes than BMI1year alone.</p><p><strong>Conclusions: </strong>Body mass index over the pregnancy trajectory was not associated with outcomes other than UI. The small advantage of cumulative exposure to excess BMI over BMI1year in predicting SUI and moderate/severe UI suggests that BMI1year adequately captures risk of these 1-year outcomes.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 5","pages":"273-279"},"PeriodicalIF":1.4,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9090944/pdf/nihms-1765772.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9435628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Trial of Social Media Versus Search Engine Advertising to Increase Awareness of Treatments for Female Stress Urinary Incontinence.","authors":"Alaina T Bennett, Emily R Boniface, Alaina Spiers, W Thomas Gregory, Sara B Cichowski","doi":"10.1097/SPV.0000000000001187","DOIUrl":"10.1097/SPV.0000000000001187","url":null,"abstract":"<p><strong>Importance: </strong>Outreach based on user characteristics through social media advertising is significantly more effective than outreach based on user interests with search engine advertising for female stress urinary incontinence.</p><p><strong>Objective: </strong>The aim of the study was to compare the effectiveness of 2 online outreach platforms to engage women at risk of stress urinary incontinence with a high-quality patient education website.</p><p><strong>Study design: </strong>A geographic randomized trial was performed comparing online advertising on Facebook, a social media site, versus Google Ads, a search engine, to direct viewers to VoicesForPFD.org. Advertisements were developed using health communication theory and pretested before the randomized trial. Counties in the Pacific Northwest were grouped into approximately equal populations, called \"supercounties,\" and randomized to advertisement platforms. Educational website views resulting from each campaign, called sessions, were measured using Google Analytics; the primary outcome was the number of sessions per supercounty. County characteristics were obtained from national survey data. Effectiveness of the advertising platforms was compared between randomization arms using Welch's unequal variances t test, and crude and adjusted linear regression models.</p><p><strong>Results: </strong>Mean user sessions were significantly higher in areas randomized to Facebook advertising (470 sessions) compared with areas randomized to Google Ads advertising [44 sessions; mean, 426 session difference (95% confidence interval, 199-653 sessions); P = 0.001]. After accounting for adult female population and rurality, randomization to Facebook instead of Google Ads still resulted in 409 additional sessions (95% confidence interval, 317-501 sessions; P < 0.001).</p><p><strong>Conclusions: </strong>Social media was 10 times more effective (470 versus 44 mean sessions per supercounty) than search engine outreach advertising and should be prioritized in outreach efforts. Future work is needed on engagement and behavior change with online outreach.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"293-299"},"PeriodicalIF":1.4,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44772697","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":"How Does the Urethra Respond to Bladder Filling in Continent and Incontinent Women?","authors":"Julia Geynisman-Tan, Tsung Mou, Margaret G Mueller, Kimberly Kenton","doi":"10.1097/SPV.0000000000001125","DOIUrl":"10.1097/SPV.0000000000001125","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to describe mean urethral pressure (MUP) during filling cystometry in continent and incontinent women.</p><p><strong>Methods: </strong>Incontinent women were recruited from a urogynecology clinic if they answered \"sometimes\" or \"always\" to 1 of the items on the Medical, Epidemiologic, and Social Aspects of Aging questionnaire. Participants were categorized by Medical, Epidemiologic, and Social Aspects of Aging scores into stress urinary incontinence (SUI) or urgency urinary incontinence (UUI) groups. Continent women were recruited from the community. Multichannel urodynamics were performed using microtip catheters. Urethral pressure profiles were obtained with an empty bladder and at 100-mL increments during filling. Data were analyzed in SPSS. Continuous variables were compared with independent t test or analysis of variance, categorical variables with the χ2 test, and multivariable comparisons were made with linear regression.</p><p><strong>Results: </strong>Eighty-six women (30 continent, 56 incontinent: 37 SUI, 19 UUI) with a mean ± SD age of 48 ± 15 years and a body mass index (BMI) of 31 ± 9 participated. Sixty-nine percent were White, 43% were postmenopausal, and 80% were parous. Continent women were younger (P < 0.001) and had a lower BMI (P = 0.004). Mean cystometric capacity was higher in women with SUI and continent women than in women with UUI (430 ± 142, 448 ± 101, and 332 ± 160, P = 0.04). Continent women had higher MUP at baseline when controlling for age, BMI, and parity (84 ± 35 cmH2O vs 62 ± 28 cmH2O; aR2 = 0.2, P = 0.02) compared with incontinent women. During filling, MUP in continent women was 20-30 cmH2O higher at all bladder volumes than incontinent women. Mean urethral pressure increased significantly between baseline and 300 mL in continent women (P < 0.005) and women with SUI (P = 0.04), but not in women with UUI (P = 0.48).</p><p><strong>Conclusions: </strong>Continent women have greater baseline MUP and greater increases in MUP during bladder filling than incontinent women.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 5","pages":"321-324"},"PeriodicalIF":1.4,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169549/pdf/nihms-1747165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9370996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Pelvic Anatomy iOS and Android Applications for Obstetricians and Gynecologists","authors":"K. Menhaji, S. Holtzman, B. Roser, A. Hardart, Katherine T. Chen","doi":"10.1097/SPV.0000000000001179","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001179","url":null,"abstract":"Importance Resources for learning and enhancing knowledge in medicine, such as mobile applications (apps), have dramatically increased in recent years; however, there is lack of a valid source for identifying the best and most reliable mobile apps. Objectives The goal of this study was to identify the highest scoring available pelvic anatomy apps based on quality, content, and functionality for obstetrician-gynecologists using a validated tool. Study Design This was a systematic evaluation of anatomy apps in the Apple iTunes (iOS) and Google Play (Android) stores. Exclusions included apps that had nonhuman, nonanatomy content, did not include female pelvic anatomy or were deemed inappropriate for postgraduate level. The validated Mobile App Rating Scale (MARS), a mobile-health (mHealth) app scoring system was used to evaluate apps based on both objective and subjective quality. The authors' MARS scores for each variable were compiled, and the objective, subjective, and overall scores were calculated. Results The search criteria yielded 2,432 apps: 952 (39%) Apple iTunes store and 1,480 (60.8%) Google Play Store apps. After applying the exclusion criteria, 35 (14 iOS, 8 Android, and 13 iOS/Android) apps were included for evaluation using the MARS system. “Complete Anatomy” app, available for both iOS and Android systems, obtained the highest objective, subjective, and overall MARS score. Conclusions Although there are numerous anatomy apps available, only a few meet prespecified criteria for functionality, content, quality, and are appropriate for obstetrician-gynecologists. Using a validated scoring system, we present a scored list of female pelvic anatomy apps most appropriate for obstetrician-gynecologists.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e179 - e194"},"PeriodicalIF":1.6,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41767190","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":"Prevalence of Pelvic Floor Disorders in United States Active-Duty Service Women Seeking Medical Care","authors":"J. Wheat, Munziba Khan, Amanda Banaag, C. Vaccaro, J. Greer, Tracey P Koehlmoos, L. Hamlin","doi":"10.1097/SPV.0000000000001183","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001183","url":null,"abstract":"Importance In the United States, pelvic floor disorders affect 25% of women. Despite facing unique occupational risk factors that may increase the risk of pelvic floor disorders, there is little research on the prevalence of these disorders in active-duty service women. Objectives This study sought to identify the prevalence of and risk factors for pelvic floor disorders in active-duty service women in the United States from diagnostic codes through service utilization. Study Design Utilizing the Military Health System Data Repository, a cross-sectional study was conducted of all active-duty service women in the United States Army, Air Force, Navy, and Marine Corps during fiscal years 2010 to 2019. Results This study identified 497,255 active-duty service women of whom 9.93% had pelvic floor disorders. Adjusted regression model analyses indicated increasing parity and body mass index significantly affect the risk of pelvic floor disorders. Active-duty women with 3 or more births were 3 times more likely to have pelvic floor disorders compared with the nulliparous group. Finally, subset analysis indicates the risk of pelvic floor disorders were increased 250% in obese women and decreased 20% for underweight women. The rate of pelvic floor disorders appears to be increasing among active-duty women. Conclusions Active-duty service women have significantly lower rates of pelvic floor disorders compared with the general population, possibly due to the protective effects of improved weight management and physical fitness requirements for their job performance. However, pelvic floor disorders may be uptrending and need continued monitoring.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e195 - e200"},"PeriodicalIF":1.6,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43655519","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":"Long-Term Outcomes After Vaginal and Laparoscopic Mesh Hysteropexy for Uterovaginal Prolapse: A Parallel Cohort Study (eVAULT)","authors":"J. Fitzgerald, E. Sokol, C. Rardin, G. Cundiff, M. Paraiso, Jiling Chou, R. Gutman","doi":"10.1097/SPV.0000000000001188","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001188","url":null,"abstract":"Importance Data on long-term mesh hysteropexy outcomes are limited. This study provides 7-year data from the original VAULT (Vaginal and Laparoscopic Mesh Hysteropexy for Uterovaginal Prolapse Trial) study. Objective The aim of this study was to compare long-term outcomes and success for laparoscopic sacral hysteropexy (LSHP) and vaginal mesh hysteropexy (VMHP). Study Design This multicenter, prospective parallel cohort was an extension to the initial VAULT study. Subjects were contacted, and informed consent was obtained. We collected baseline demographics and the latest Pelvic Organ Prolapse–Quantification examination data from chart review and conducted telephone interviews to update demographic information and collect Pelvic Floor Distress Inventory Short-Form, Patient Global Impression of Improvement, prolapse reoperation/pessary use, and complications. Surgical success was defined as no bulge symptoms, satisfaction score of “very much better” or “much better,” and no reoperation/pessary use. Results Five of 8 original sites enrolled 53 subjects (LSHP n = 34 and VMHP n = 19). The LSHP group was younger (67 vs 74, P < 0.01), but there were no differences in parity, body mass index, menopause, race, insurance, tobacco use, or Charlson Comorbidity Index. The median subjective follow-up was 7.3 ± 0.9 years. Composite success was 82% LSHP versus 74% VMHP. Pelvic Floor Distress Inventory Short-Form composite scores were similar at baseline and improved for both groups (P < 0.01) with lower bother observed in the LSHP group (20.8 vs 43.8, P = 0.01). There were no differences in complications. Conclusions Over 7 years after surgery, LSHP and VMHP have high success, low retreatment, and low complication rates that did not differ between groups. Although there is a trend toward better anatomic support in the LSHP group, these findings were not significant and we are underpowered to detect a difference.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e215 - e221"},"PeriodicalIF":1.6,"publicationDate":"2022-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42617023","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":"Bladder Eversion Through a Vesicovaginal Fistula in a Patient With Uterine Procidentia: A Case Report","authors":"Nikki Fennimore, S. Boyles, M. Denman","doi":"10.1097/SPV.0000000000001176","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001176","url":null,"abstract":"V esicovaginal fistulas (VVFs) are uncommon with an incidence in developed countries of 0.3% to 2.0%. Complete bladder eversion through a VVF is even more rare. Given this, treatment options vary based on the patient's characteristics and treating health care provider's preferences. The first surgical attempt at repair has the highest probability of success and, thus, attention to good surgical technique is paramount. We present a patient who presented with complete bladder eversion through a VVF and resultant renal failure and anemia. We describe a multistep approach in regards to repair of the bladder eversion andVVF, aswell as definitive surgical management of her procidentia, resulting in improved renal function and no requirement for urinary diversion.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e231 - e232"},"PeriodicalIF":1.6,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42214552","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 Impact of Local Estrogen on the Urogenital Microbiome in Genitourinary Syndrome of Menopause: A Randomized-Controlled Trial","authors":"J. Lillemon, L. Karstens, Rahel Nardos, B. Garg, E. Boniface, W. Gregory","doi":"10.1097/SPV.0000000000001170","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001170","url":null,"abstract":"Importance The postmenopausal urinary bladder microbiome is not well defined. Objectives The aims of this study were to characterize the effect of vaginal estrogen on the vaginal and urinary bladder microbiome in postmenopausal women and describe any clinical associations with the symptoms of genitourinary syndrome of menopause. Study Design This was a participant-masked, randomized controlled trial comparing the effect of a 12-week course of an estrogen-containing vaginal ring to a placebo vaginal ring. Standardized evaluations were performed at baseline and 12 weeks. Vaginal samples were obtained for pH, vaginal maturation index, and microbiome analysis. Concomitant catheterized urine samples were obtained for microbiome analysis. 16S ribosomal RNA gene sequencing was performed to characterize the resident microbial communities, with Lactobacillus relative abundance as the primary outcome variable. Genitourinary syndrome of menopause symptoms was measured using validated questionnaires (Pelvic Floor Distress Inventory–Short Form, Female Sexual Function Index, Vulvovaginal Symptoms Questionnaire). Results Of the 39 postmenopausal women randomized, baseline characteristics were similar between arms, with a mean age of 62 years and mean vaginal pH of 5.0. Using intention-to-treat analysis, there were no significant changes in vaginal or urinary Lactobacillus relative abundance. Two participants in each arm removed their ring prior to the end of the study. Eighty percent of participants experienced at least 1 bothersome genitourinary syndrome of menopause symptom. Vulvovaginal dryness and urinary frequency were most common at baseline, whereas painful intercourse and urinary urgency were most common at the final visit, none of which were statistically significant. Conclusions Our study did not show a significant change in the bacterial composition of the vaginal or urinary bladder microbiome after either vaginal ring in this relatively asymptomatic postmenopausal population.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e157 - e162"},"PeriodicalIF":1.6,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49645274","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 Siege of Ayder Hospital: A Cri de Coeur From Tigray, Ethiopia","authors":"L. Wall","doi":"10.1097/SPV.0000000000001181","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001181","url":null,"abstract":"The use of rape, starvation, and the destruction of healthcare infrastructure by the Ethiopian government violates the laws of war and the Geneva Conventions.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e137 - e141"},"PeriodicalIF":1.6,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47736346","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}