Perfusion-Uk最新文献

{"title":"Letter re: Reduction of the inflammatory response triggered by sanguineous priming of the cardiopulmonary bypass circuit.","authors":"Vitor Mendes, François Verdy, Amir-Reza Hosseinpour","doi":"10.1177/02676591251313974","DOIUrl":"https://doi.org/10.1177/02676591251313974","url":null,"abstract":"","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591251313974"},"PeriodicalIF":1.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957848","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":"Del Nido versus conventional blood cardioplegia in tetralogy of fallot repair: A systematic review and meta-analysis of randomized controlled trials.","authors":"Leo Noanh Consoli, Ilias Georgios Koziakas, Meletios Kanakis","doi":"10.1177/02676591241312380","DOIUrl":"https://doi.org/10.1177/02676591241312380","url":null,"abstract":"<p><strong>Objectives: </strong>Compare outcomes of Del Nido (DN) versus conventional blood cardioplegia (BC) in the surgical repair of Tetralogy of Fallot (ToF).</p><p><strong>Methods: </strong>Medical databases were searched to identify relevant clinical trials. Meta-analysis was conducted for primary (cardiopulmonary bypass [CPB] and aortic cross-clamp [ACC] times, hospital and intensive care unit [ICU] length of stay [LOS], mechanical ventilation time) and secondary (adverse events, lactate levels, volume of additional cardioplegia) endpoints. Analysis was conducted for DN versus conventional blood cardioplegia, and we performed sensitivity analysis with leave one-out analysis for the primary outcome.</p><p><strong>Results: </strong>4 randomized controlled trials were included (<i>n</i> = 275). Mean differences (MD) with 95% confidence intervals (CI) were calculated with a random-effects model. Groups had similar CPB (MD -5.76 minutes; [-23.32 to 11.80]; <i>p</i> = 0.52) and ACC (MD 3.06 minutes; [-13.64 to 7.52]; <i>p</i> = 0.57) times, ICU (MD -6.42 hours; [-25.62 to 12.78]; <i>p</i> = 0.51) LOS and additional cardioplegia volume (MD -195.18 mL; [-434.19 to 43.82]; <i>p</i> = 0.11). The DN group had shorter hospital LOS (MD -0.81 days; [-1.25 to -0.36]; <i>p</i> = 0.0003) and time under mechanical ventilation (MD -4.57 hours; [-8.73 to -0.42]; <i>p</i> = 0.03). There was no difference in mortality.</p><p><strong>Conclusions: </strong>DN cardioplegia has similar clinical outcomes and operative times compared to conventional blood cardioplegia in ToF surgery.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241312380"},"PeriodicalIF":1.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933261","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":"Factors associated with activated clotting time following heparin administration in pediatric cardiopulmonary bypass: A retrospective study.","authors":"Mizuho Hida, Koichi Kashiwa, Hideo Kurosawa, Mai Takahashi, Saori Fujiya, Kazuki Fujishiro, Junpei Shimoda, Hitoshi Kubo, Ryota Inokuchi, Kent Doi, Yasutaka Hirata","doi":"10.1177/02676591241311724","DOIUrl":"https://doi.org/10.1177/02676591241311724","url":null,"abstract":"<p><strong>Introduction: </strong>The recently recommended activated clotting time (ACT) to be maintained at the initiation of and during cardiopulmonary bypass (CPB) is ≥480 s. However, the post-unfractionated heparin (UFH) administration ACT occasionally does not exceed 480 s. Therefore, in this study, we retrospectively evaluated the factors influencing post-heparin administration ACT before initiating CPB.</p><p><strong>Methods: </strong>In this retrospective study, patients aged <7 years who had undergone open-heart surgery with CPB between August 2021 and June 2023 were investigated. Those who lacked preoperative data or received antithrombin or fresh frozen plasma preparations prior to undergoing CPB were excluded. Multiple regression analysis was performed using the initial ACT as the dependent variable and preoperative covariates as independent variables.</p><p><strong>Results: </strong>This retrospective study included 91 patients. The median age of the patients was 265 (interquartile range [IQR]: 127-750) days. The median initial ACT was 589 (IQR: 506-713) s. In 17 (19%) patients, the initial ACT was <480 s. Multiple regression analysis revealed a statistically significant association between the platelet count and initial ACT, with a regression coefficient of -5.26 (95% confidence interval [-8.56 to -1.95]) and standard regression coefficient of -0.39 (<i>p</i> = .002).</p><p><strong>Conclusion: </strong>A high preoperative platelet count was associated with a reduced heparin response. Nevertheless, the platelet count cannot solely elucidate the heparin response, and further investigations are required to determine the predictive factors affecting this response.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241311724"},"PeriodicalIF":1.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933265","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":"Outcomes of acute type A aortic dissection repair in patients under the age of 75 versus 75 and older.","authors":"Reyna Jones, Sarah Yousef, James A Brown, Derek Serna-Gallegos, Danial Ahmad, Jianhui Zhu, Kathirvel Subramaniam, Rama Joshi, Theresa Gelzinis, Julie Phillippi, Pyongsoo Yoon, Johannes Bonatti, David Kaczorowski, Danny Chu, Ibrahim Sultan","doi":"10.1177/02676591241313170","DOIUrl":"https://doi.org/10.1177/02676591241313170","url":null,"abstract":"<p><strong>Objective: </strong>Elderly patients are less likely to undergo surgery for an acute type A aortic dissection (ATAAD). This study aims to understand the risks of surgical treatment in patients 75 and older.</p><p><strong>Methods: </strong>This was a retrospective study using an institutional database of patients who underwent ATAAD repair from 2007 to 2021. Outcomes were compared between patients <75 and patients <math><mrow><mo>≥</mo></mrow></math> 75. Logistic regression was performed for operative mortality, and Cox regression was performed for long-term mortality.</p><p><strong>Results: </strong>A total of 601 patients underwent surgery for ATAAD, 112 (18.6%) of whom were ≥75. Patients ≥75 were significantly more likely to undergo hemiarch replacement (vs total arch replacement) and concomitant CABG. Operative mortality was 16.1% in patients ≥75 versus 10.2% in those <75 (<i>p</i> = 0.078). On multivariable logistic regression, age ≥75 was not significantly associated with operative mortality (<i>p</i> = 0.068). Effect of age on long-term mortality was time-dependent: on Cox regression, being 75 or older and within one-year post-discharge was significantly associated with an increased hazard of death (time-dependent HR 4.56; 95% CI, 2.31-9.06; <i>p</i> < 0.001), while age was not associated with an increased hazard of death after the first postoperative year (<i>p</i> = 0.779).</p><p><strong>Conclusion: </strong>Despite reduced survival during the first postoperative year among patients 75 years and older, operative mortality and late survival were similar across each group. By implication, age alone should not be a deterrent to operative intervention in ATAAD patients, even though further investigation is needed to determine opportunities for improving survival during the first postoperative year after ATAAD repair.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"2676591241313170"},"PeriodicalIF":1.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923482","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 coronary angioplasty of both coronary ostia after chest radiotherapy. Is it good alternative to conventional coronary bypass surgery?","authors":"Arslan Mamedov, Eglė Rumbinaitė, Dainius Karčiauskas, Gabrielė Jakuškaitė, Audronė Veikutienė, Povilas Jakuška, Rimantas Benetis","doi":"10.1177/02676591231221707","DOIUrl":"10.1177/02676591231221707","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated coronary ostial stenosis of both ostia is a rare, potentially life-threatening condition, occurring in 0.1%-0.2% of patients undergoing coronary angiography.</p><p><strong>Case report: </strong>We present a case of a 69-year-old woman with a past medical history of breast cancer, who had been treated with radiotherapy, which most likely caused significant stenosis of both coronary ostia and likely accelerated aortic stenosis. Surgical angioplasty with autopericardium patch reconstruction of the left main coronary artery and right coronary arteries due to proximal stenotic disease was performed instead of venous or arterial bypasses with concomitant aortic valve replacement. The postoperative course was uneventful. There were no cardiovascular events 5 years after operation, and the patient remained free of any symptoms.</p><p><strong>Conclusions: </strong>Surgical coronary angioplasty offers an alternative to conventional coronary artery bypass grafting in isolated coronary ostial lesions and is advantageous in restoring more physiological myocardial perfusion, especially in those cases when conduits are suspected to be fibrotic, scarred or stenosed after radiation therapy or if there is the need to preserve conduits for future myocardial revascularisation in young patients.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"247-250"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801141","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":"Thromboelastography versus thromboelastometry for unfractionated heparin monitoring in adult patients on extracorporeal membrane oxygenation.","authors":"Ellen B Yin, Arthur W Bracey, Subhasis Chatterjee","doi":"10.1177/02676591241232513","DOIUrl":"10.1177/02676591241232513","url":null,"abstract":"<p><p><i>Background</i>: Monitoring the anticoagulant effect of unfractionated heparin (UFH) in extracorporeal membrane oxygenation (ECMO) patients is complex but critically important to balance the risks of treatment related bleeding and circuit thrombosis. While guidelines recommend using more than one method to monitor UFH activity, the use of thromboelastometry (ROTEM) to monitor UFH in ECMO patients has not been investigated in detail.<i>Methods</i>: This is an observational, single-center retrospective study looking at adult ECMO patients on UFH that had ROTEM and thromboelastography (TEG) tests obtained concurrently. A total of 20 samples were obtained from nine patients during the study period, seven of which were on veno-arterial (VA) ECMO and two of which were on veno-venous (VV) ECMO.<i>Results</i>: Under institutional standard operating practice, when TEG and/or activated partial thromboplastin time (aPTT) were considered therapeutic, intrinsic thromboelastometry clotting time (INTEM CT) was only 1.2 times higher than the normal range. TEG based monitoring compared to aPTT based monitoring tended to result in lower anti-Xa levels and less intensive anticoagulation. For the total cohort, bleeding events, driven by the need for blood transfusions, were more common compared to ischemic events (77% vs 11%; <i>p</i> = 0.02).<i>Conclusion</i>: INTEM CT tended to be less sensitive to lower doses of UFH with a value of 1.2 times higher than the normal range when aPTT and/or TEG were considered therapeutic. Due to the relative insensitivity of ROTEM, our institution decided to continue to use TEG instead of ROTEM. Larger, multicenter trials may be helpful to validate these findings.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"235-242"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913955","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":"Impact of thrombocytopenia on short-term outcomes in patients undergoing mobile extracorporeal membrane oxygenation support.","authors":"Ihor Krasivskyi, Clara Großmann, Wasil Aswadi, Borko Ivanov, Stephen Gerfer, Christopher Gaisendrees, Ahmed Elderia, Mariya Mihaylova, Kaveh Eghbalzadeh, Antje-Christin Deppe, Anton Sabashnikov, Parwis Baradaran Rahmanian, Navid Mader, Thorsten Wahlers, Ilija Djordjevic","doi":"10.1177/02676591231224635","DOIUrl":"10.1177/02676591231224635","url":null,"abstract":"<p><strong>Introduction: </strong>The prolonged use of extracorporeal membrane oxygenation (ECMO) support is associated with increased consumption of platelets and hemolysis. The prognostic impact of thrombocytopenia prior to and during ECMO support on patient's short-, mid- and long-term outcomes has been critically evaluated and discussed over the last years. However, only few data have been published on thrombocytopenia caused by mobile ECMO support. The aim of this study was to evaluate the impact of thrombocytopenia on short-term outcomes and predictors of in-hospital mortality in patients supported by mobile ECMO for transportation and subsequent weaning in a tertiary centre.</p><p><strong>Methods: </strong>This retrospective single-centre study analyzed a total of 117 patients requiring mobile veno-arterial (va) ECMO support and subsequent transportation from referral hospitals to our department from January 2015 until December 2021. A total of 15 patients had to be excluded from the analysis for missing data regarding baseline platelet count. Patients were divided into two groups: thrombocytopenia group (<130 × 109/L, <i>n</i> = 44) and non-thrombocytopenia group (≥130 × 109/L, <i>n</i> = 58). The primary outcome was in-hospital mortality. Secondary outcomes were successful ECMO-weaning, and the incidence of associated complications (bleeding, acute hepatic failure, acute renal failure, dialysis, and septic shock).</p><p><strong>Results: </strong>The dialysis rate before ECMO initiation was significantly higher (<i>p</i> = .041) in the thrombocytopenia group compared to the non-thrombocytopenia group. The rates of bleeding complications (<i>p</i> = .032) and limb ischemia (<i>p</i> = .003) were significantly higher in patients with low platelet count. Moreover, complication rates of acute hepatic failure (<i>p</i> < .001), acute renal failure (<i>p</i> < .001) and dialysis (<i>p</i> = .033) were significantly higher in the thrombocytopenia group. Also, in-hospital mortality was significantly higher (<i>p</i> = .002) in patients with low platelet count before initiation of ECMO support.</p><p><strong>Conclusion: </strong>Based on the results of the present study, patients with thrombocytopenia prior to mobile vaECMO support may be at significantly higher risk for associated complications and short-term mortality.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"140-147"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038085","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 correlation of non-invasive hemoglobin testing and lab hemoglobin in surgical patients: A systematic review and meta-analysis.","authors":"Jamil Kazma, Megan Ebner, James Slota, Jeffery S Berger, Fouzia Farooq, Emily Smith, Homa K Ahmadzia","doi":"10.1177/02676591241226465","DOIUrl":"10.1177/02676591241226465","url":null,"abstract":"<p><strong>Background: </strong>The decision regarding intraoperative transfusion has traditionally been based on hemodynamic instability and estimated blood loss. We performed a systematic review to determine the validity of the oximetry method compared to standard of care for hemoglobin measurement.</p><p><strong>Methods: </strong>A systematic literature review was conducted, and several libraries were searched from inception to March 31,2023. The primary outcome was comparing the mean difference between laboratory-derived hemoglobin and non-invasive, point-of-care hemoglobin measurement. Subgroup analysis included comparing the mean difference in the pediatric population and among female patients.</p><p><strong>Results: </strong>A total of 276 studies were identified, and 37 were included. We found that the pooled mean difference varied qualitatively between adult and pediatric population (<i>p</i> value for heterogeneity <0.001). In adult populations, lab hemoglobin measurements were on average slightly higher than non-invasive measurements (mean difference = 0.23; 95% CI -0.13, 0.59), though there was greater heterogeneity across studies (I2 = 97%, <i>p</i> value = <0.001). In the pediatric population, most studies showed lab hemoglobin to be slightly lower (mean difference = -0.42; 95% CI -0.87 to 0.03).</p><p><strong>Conclusions: </strong>In general, there was no clinically significant difference in mean hemoglobin among adult and pediatric populations. The percentage of female participants had no effect on the mean difference in hemoglobin.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"61-68"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486672","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":"Does early exposure to cardiothoracic surgery increase interest in the specialty?","authors":"Karan Punjabi, Ahmad Almohtadi, Ayushi Singh, Ishan Singh, Ahmad Salha, Golnoush Seyedzenouzi","doi":"10.1177/02676591231223076","DOIUrl":"10.1177/02676591231223076","url":null,"abstract":"<p><strong>Introduction: </strong>The number of applications for cardiothoracic surgery has been steadily dropping over the past decades. We aim to assess whether a 1-day cardiothoracic surgical skills conference could increase interest into the speciality.</p><p><strong>Methods: </strong>Participants included in the study had to be medical students or junior doctors. Out of 57 delegates that attended the conference, 52 were enrolled in the study, and completed the pre-conference and post-conference questionnaires. Three introductory lectures were delivered by consultants in cardiothoracic surgery or cardiology in the morning, followed by three practical surgical workshops. We assessed demographics, confidence in and knowledge of procedures, and the change in participants' interest in the speciality pre- and post-conference. This study was conducted at St George's University of London.</p><p><strong>Results: </strong>The interest to pursue a career in cardiothoracic surgery increased by 23% post-conference (<i>p</i> = .035). Confidence and knowledge in all procedures taught improved significantly after the conference (<i>p</i> < .05), with the highest increase seen in anastomosis of vessels (<i>p</i> < .0001). Preclinical students made up 57.7% of participants, majority of whom had not seen more than three surgical procedures.</p><p><strong>Conclusion: </strong>Our conference has shown to increase interest in cardiothoracic surgery and improve exposure to surgical skills, especially to those in early years of medical school. The surgical workshops improved student confidence and knowledge in procedures used within the field and the use of animal tissue improved participant experience. Further research is needed at other medical schools to assess whether a change in surgical skills teaching should be made to medical school curriculums.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"132-139"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800149","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":"Improving the effectiveness of CPR during interventional procedures.","authors":"Christopher Gaisendrees, Kaveh Eghbalzadeh, Matti Adam, Ilija Djordjevic, Oliver Mehler, Thorsten Wahlers, Elmar W Kuhn","doi":"10.1177/02676591241232279","DOIUrl":"10.1177/02676591241232279","url":null,"abstract":"<p><strong>Introduction: </strong>The number of interventional procedures, such as transcatheter aortic valve replacements or thoracic endovascular aortic repairs, is on the rise. Intraprocedural cardiac arrest is a rare occurrence during high-risk procedures. Modern hybrid-operating tables may adversely affect chest compression quality due to their flexibility. To investigate this relationship, we analyzed the blood pressure generated during chest compressions at different degrees of table extension and assessed the effect of an additional stabilization bar to secure the table.</p><p><strong>Methods: </strong>A CPR manikin was connected to online blood pressure monitoring on a hybrid operating table. Chest compressions were administered using a mechanical device (at 100 bpm and 80 bpm). Hemodynamic effects were evaluated at various degrees of table extension (0%, 50%, 100% table extension) and with the addition of a stabilization bar.</p><p><strong>Results: </strong>A greater degree of table extension was associated with lower diastolic blood pressure. The addition of a stabilization bar alleviated this drop in diastolic blood pressure and enabled the generation of higher mean arterial pressures at 50% and 100% table extension during chest compressions.</p><p><strong>Conclusion: </strong>The flexibility of a hybrid operating table adversely impacts the hemodynamic effect of chest compressions. This effect may be mitigated by using a stabilization bar. These results may be relevant for providing further recommendations for CPR guidelines in hybrid OR settings.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"229-234"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673424","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}