Neurologist最新文献

{"title":"Development and Application of a Machine Learning-Based Predictive Model for Carotid Restenosis After Interventional Surgery in Elderly Ischemic Stroke Patients.","authors":"Xianmei Wu, Xiaoyang Wang, Hongmei Lin, Yanbo Zhang, Yanchun Jiang, Bangzhi Jiang","doi":"10.1097/NRL.0000000000000627","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000627","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to develop a machine learning-based risk prediction model for carotid restenosis in elderly ischemic stroke patients after interventional surgery.</p><p><strong>Methods: </strong>We collected clinical data from 371 elderly ischemic stroke patients who underwent carotid interventional surgery between January 2020 and December 2023, as training dataset. Various machine learning methods were applied to analyze and compare the predictive performance of different models. In addition, data from 75 cases collected between January and June 2024 was as a validation set to assess model applicability.</p><p><strong>Results: </strong>Six factors influencing carotid restenosis were identified: homocysteine (Hcy), platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), Interleukin-6 (IL-6), and C-reactive protein (CRP). Machine learning models were developed, with the Gradient Boosting Machine showing the best performance (AUROC=0.969). Other models included support vector machine (AUROC=0.962), logistic regression (AUROC=0.945), decision tree (AUROC=0.885), and extreme gradient boosting (AUROC=0.753). The GBM model's predictive variable ranking was Hcy, IL-6, CRP, PDW, PLT, and MPV. In the validation set, the GBM model demonstrated excellent performance, with an AUC 0.939, sensitivity 0.909, specificity 0.969, accuracy 0.960, negative predictive value 0.984, and positive predictive value 0.833.</p><p><strong>Conclusion: </strong>Our research showed that compared with other machine learning algorithms, the GBM model demonstrates the best accuracy and stability in predicting the risk of carotid restenosis after interventional surgery in elderly ischemic stroke patients, and it has high clinical application value.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267820","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":"Current Approach to Perioperative Evaluation of Neurological Diseases.","authors":"Özdem Ertürk Çetin, Özlem Totuk, İpek Güngör Doğan, Gözde Eryiğit Baran, Beril Taşdelen, Didem Darici, Efe Erci, Güldeniz Çetin Erci, Damla Çetinkaya Tezer, Pinar Bekdik, Esra Adiyeke, Serkan Demir, Şevki Şahin","doi":"10.1097/NRL.0000000000000632","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000632","url":null,"abstract":"<p><strong>Background: </strong>The perioperative period refers to the 3 phases of the surgical procedure: preoperative, intraoperative, and postoperative. Proper management of chronic diseases in the perioperative period plays a critical role in improving patient outcomes and requires a multidisciplinary approach. Perioperative management of neurological diseases can be challenging due to their chronic nature and the necessity for multiple drug use in neurological disorders, which may potentially interact with anesthetics.</p><p><strong>Review summary: </strong>This review summarizes the perioperative management of various neurological disorders, including epilepsy, dementia, acute confusional state, movement disorders, stroke, demyelinating diseases, neuromuscular disorders, sleep disorders, and headache.</p><p><strong>Conclusion: </strong>Perioperative management of patients with neurological diseases requires a comprehensive, multidisciplinary approach tailored to the specific needs of each condition. Adherence to evidence-based guidelines not only ensures patient safety but also enhances recovery, reducing morbidity and mortality in this vulnerable patient population.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217392","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":"Determinants of the Recommendation of High-Resolution Vessel Wall Imaging for Young Patients With Posterior Circulation Ischemic Strokes.","authors":"Mei Li, Yi Liu, Fei Zhou, Yun Xu, Jiahui Zhang, Shuwei Qiu","doi":"10.1097/NRL.0000000000000631","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000631","url":null,"abstract":"<p><strong>Objectives: </strong>High-resolution vessel wall imaging (HRVWI) has emerged as a crucial diagnostic method for improving the etiological classification of ischemic strokes, especially in younger patients. This study seeks to identify the factors that influence neurologists' decisions to recommend HRVWI for young individuals experiencing posterior circulation strokes.</p><p><strong>Methods: </strong>In this retrospective study, we assessed the effect of HRVWI on the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification among patients aged 45 years or younger with acute ischemic strokes in the posterior circulation. Logistic regression analysis was performed to determine the factors that predict HRVWI recommendations.</p><p><strong>Results: </strong>Among 135 young stroke patients, 57 underwent HRVWI. The patients who received HRVWI were slightly younger (mean age 35.75 vs. 37.85 y; P=0.07). The use of HRVWI significantly changed the TOAST classification, increasing the identification of strokes attributed to other determined causes (ODC) from 28.2% to 50.9% and decreasing strokes of undetermined causes (UDC) from 18.0% to 7.0%. Notably, vertebrobasilar artery dissections (VBADs) were more frequently detected in the HRVWI group (82.8%) compared with the non-HRVWI group (21.1%). Multivariate logistic regression identified younger age, vertebrobasilar artery tortuosity, and stenosis or occlusion as significant predictors for HRVWI scans (age: P=0.044; tortuosity: P=0.006; stenosis or occlusion: P=0.021; respectively).</p><p><strong>Conclusions: </strong>HRVWI may be considered for young stroke patients with abnormal arterial structures in the posterior circulation, as it significantly enhances the etiological classification of ischemic strokes.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217393","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":"Feasibility and Implementation of Wake-Up Stroke Protocol for Treatment of Acute Ischemic Stroke in a Rural Stroke Network of the Midwest.","authors":"Andrea Loggini, Karam Dallow, Jessie Henson, Jonatan Hornik, Amber Schwertman, Alejandro Hornik","doi":"10.1097/NRL.0000000000000630","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000630","url":null,"abstract":"<p><strong>Objectives: </strong>The indication for thrombolytic therapy in \"wake-up strokes\" based on diffusion-positive and FLAIR-negative lesions on MRI has been introduced in the most recent AHA/ASA stroke guidelines. While this protocol is well established in urban centers, rural hospitals often face challenges due to limited resources and the availability of MRI scanners in the emergency department (ED). Here, we report on the successful implementation of the wake-up stroke protocol within our stroke network, highlighting the planning and execution process, its safety, and outcomes.</p><p><strong>Methods: </strong>After 2 months of planning, involving neurology, ED, radiology, and nursing leadership, the \"wake-up stroke\" protocol was implemented in our rural stroke network system in September 2022. Consecutive patients who received thrombolytics by the protocol were reviewed. For each patient, variables regarding demographics, relevant medical comorbidities and medications, clinical presentation, laboratory values, relevant timing of stroke metrics, complications of thrombolytic therapy, and mRS at 30 days were collected. The group was compared with a randomly severity-matched group of patients who received thrombolytic therapy by standard treatment (within 4.5 h from last known well).</p><p><strong>Results: </strong>Five consecutive acute ischemic stroke patients treated with thrombolytic therapy were identified. Mean age ± SD was 71.2 ± 7.2 years. Of the patients, 60% were males (n = 3). The most common reason for unknown time of symptom onset was nighttime sleep in 60% (n = 3) of the cohort. The median NIHSS (IQR) was 7 (6 to 13). Of the patients, 60% (n = 3) had a M2 occlusion on MR angiogram. The median interval between LKW and needle treatment was 11.68 (IQR: 5.32 to 13.23) hours. Compared with standard treatment, the wake-up stroke group had similar rate of complications (none in each group) and similar rate of mRS <2 at 1 month (60% vs 80%, P = 0.49).</p><p><strong>Conclusions: </strong>The implementation of the wake-up stroke protocol in our network was feasible, with the safety and outcomes of thrombolytics delivered by the protocol comparable to standard treatment. This study supports the utilization of the wake-up stroke protocol in real-world rural practice, highlighting its potential to improve access to high-quality stroke care in underserved areas.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200643","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":"Isolated Foot Drop: An Unusual Presentation of a Disabling NIHSS 0 Stroke.","authors":"Rosa Couto, Ana Lúcia Oliveira, Mariana Diogo, Miguel Rodrigues","doi":"10.1097/NRL.0000000000000620","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000620","url":null,"abstract":"","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200644","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":"Efficacy of Human Urinary Kallidinogenase in Real-world Patients With Acute Ischemic Stroke: A Matched Comparison.","authors":"Yue Zhang, Xintong Luo, Xiujuan Song, Jiamin Li, Yonggang Liu, Lina Wang, Guojun Tan","doi":"10.1097/NRL.0000000000000623","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000623","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to investigate the efficacy and safety of human urinary kallidinogenase (HUK) in real-world patients with acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>AIS patients with prospective follow-up between April 2019 and June 2022 were enrolled in this study. Based on their treatment, the eligible patients were separated into 2 groups: the HUK group and the non-HUK group. Propensity score matching (PSM) analysis was used to reduce the biases from the unequal distribution of initial characteristics. The validated clinical composite scoring system was used to evaluate the neurological recovery. The safety outcomes include stroke recurrence, all-cause mortality, and major complications.</p><p><strong>Results: </strong>A total of 312 patients were enrolled in each of the 2 groups, and there were no significant differences in baseline characteristics between them. After treatment, both groups of AIS patients achieved favorable neurological outcomes. The National Institute of Health Stroke Scale (NIHSS) scores at discharge (3.47±3.41 vs. 4.37±2.85) demonstrated better neurological recovery in the HUK group. At the 90-day assessment, patients in the HUK group exhibited a higher incidence of favorable functional outcome (modified Rankin Scale score of 0 to 2, 74.68% vs. 60.58%), and lower risk of stroke recurrence (2.88% vs. 6.73%). The all-cause mortality (1.60% vs. 2.24%) was not significantly different between both groups.</p><p><strong>Conclusions: </strong>HUK improved neurological and functional outcomes in patients with AIS in a large real-world population and had an acceptable safety profile.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095464","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":"Embolic Hippocampal Infarct From Ipsilateral Tandem Carotid Stenosis: A Case Report and Lesson on Hippocampal Dual Vascular Supply.","authors":"Samantha J Brown, Jennifer Nikolova, Monica Nitu, Justin Cramer, Oana Dumitrascu","doi":"10.1097/NRL.0000000000000610","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000610","url":null,"abstract":"<p><strong>Introduction: </strong>Although primarily supplied by the vertebrobasilar system, the hippocampus is partially supplied by ipsilateral carotid artery branches through the anterior choroidal artery or a prominent posterior communicating artery. We report a patient with acute hippocampus infarction likely due to symptomatic ipsilateral tandem carotid stenosis and discuss acute vascular-mediated hippocampal injury.</p><p><strong>Case report: </strong>An 80-year-old female with obesity, dyslipidemia, hypertension, alcohol use disorder, history of breast cancer on letrozole, and traumatic brain injury was brought into our emergency department for 24 hours of confusion. On examination, she exhibited limited registration, recall, and executive dysfunction with otherwise normal language, visuo-spatial orientation, and praxis. Brain MRI showed a small area of diffusion restriction in the anterior right hippocampus with matched FLAIR hyperintensity, consistent with acute infarction. Computed tomography angiogram head and neck showed 90% stenosis of the proximal right internal carotid artery (ICA), <50% narrowing of the proximal left ICA, and moderate bilateral narrowing of the paraclinoid ICAs, all due to calcific atheromatous plaques. The etiology of the hippocampal infarction was suspected embolism from the ipsilateral severe carotid stenosis. Planning for right cervical carotid revascularization ensued.</p><p><strong>Conclusion: </strong>This case highlights the dual hippocampal vascular supply and that hippocampal embolic infarcts could be a sign of a symptomatic severe carotid artery stenosis that may require urgent revascularization for stroke secondary prevention.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057084","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":"Atypical Frontal Release Signs in Acute Anterior Cerebral Artery Infarction and Striatal Dopaminergic Dysfunction: A Case Report.","authors":"Gohei Yamada, Takanari Toyoda, Tomoyuki Kuno, Eiichi Katada, Noriyuki Matsukawa","doi":"10.1097/NRL.0000000000000628","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000628","url":null,"abstract":"<p><strong>Introduction: </strong>Dystonic hand postures are uncommon in patients with frontal lobe infarction. Here, we report the first case of a patient with frontal lobe infarction presenting with unique dystonic hand postures-specifically, a pointing gun posture and full-finger extension posture-in combination with frontal release signs.</p><p><strong>Case report: </strong>A 68-year-old man with a prior diagnosis of probable Parkinson disease acutely developed speech and communication impairment, along with reduced voluntary motor function in the right lower extremity. Neurological examination revealed apathy, motor and sensory aphasia, and flaccid paralysis of the right lower limb. Brain magnetic resonance imaging showed an ischemic stroke involving the left superior frontal gyrus, cingulate gyrus, and corpus callosum. Dopamine transporter single-photon emission computed tomography revealed reduced tracer accumulation in the left striatum. Ten days after stroke onset, the patient exhibited a pointing gun posture in the right hand. A repeat neurological examination revealed a grasp reflex. Removing grasped objects led to a transient index finger extension with flexion of the other fingers or a transient full extension of all fingers. The former resembled a pointing gun posture, while the latter, a newly described phenomenon, was termed the full-finger extension posture. In addition, groping movements with the pointing gun posture were observed.</p><p><strong>Conclusion: </strong>Atypical frontal release signs, including the pointing gun posture and full-finger extension posture, may reflect specific thalamocortical excitation resulting from a combination of contralateral striatal dopaminergic denervation and frontal lobe infarction involving the supplementary motor area.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023110","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":"Involvement of Posterior Circulation Accounts for Higher Disability in Ischemic Strokes With NIHSS ≤3 But Not With NIHSS 4-5.","authors":"Maurizio Giorelli, Ruggiero Leone, Sergio Altomare, Anna Digiovanni","doi":"10.1097/NRL.0000000000000615","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000615","url":null,"abstract":"<p><strong>Objectives: </strong>Minor strokes are defined as ischemic cerebrovascular accidents that present with mild symptoms scoring ≤5 on the National Institute of Health Stroke Scale (NIHSS). We aimed to investigate whether features related to stroke characteristics, location, severity, or symptoms could predict the risk of disability after minor strokes.</p><p><strong>Methods: </strong>Minor strokes (105) were divided into 2 subgroups: those with baseline NIHSS ≤3 and those with baseline NIHSS 4-5. Comorbidities, occurrence of disability, stroke location, etiology, and outcomes were examined in the 2 subgroups and in those who developed a modified Rankin scale (mRs) of 0 to 1 or mRs >1.</p><p><strong>Results: </strong>No-IVT minor strokes in the NIHSS 4-5 subgroup were associated with more disability compared with the NIHSS ≤3 subgroup (P>0.05). Residual disability (mRS >1) was associated with a higher incidence of posterior circulation strokes (PCS) (P=0.0015), large vessel stenosis (P=0.01), and PCS-related symptoms (imbalance, gait ataxia, and eye movement disorders) not accounted for by NIHSS, in strokes with baseline NIHSS ≤3. Disability (mRS >1) was associated with baseline disabling symptoms, which NIHSS effectively and reliably captured in patients with stroke with NIHSS 4-5.</p><p><strong>Conclusions: </strong>Symptoms that might predict unfavorable outcomes are not well captured by the available clinical instruments that are usually used to evaluate and score acute ischemic stroke at onset. When deciding on the management of minor stroke, clinicians must consider and judge all potentially disabling deficits, in addition to the pure scores of the adopted evaluation scales.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056506","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":"Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review.","authors":"Jing Bai, Yusheng Zhao, Zihe Wang, Peng Qin, Jingjie Huang, Yupei Cheng, Chaoran Wang, Yuyan Chen, Longxiao Liu, Yuxing Zhang, Bangqi Wu","doi":"10.1097/NRL.0000000000000626","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000626","url":null,"abstract":"<p><strong>Background: </strong>Stroke-associated pneumonia (SAP), a highly lethal complication following stroke, is closely linked to dysregulation of the \"brain-gut-lung axis.\" Accumulating evidence indicates that stroke triggers intestinal alterations through the brain-gut axis, while multiple studies confirm that gut-derived changes can mediate pneumonia through the gut-lung axis. However, the mechanisms connecting stroke-induced intestinal dyshomeostasis to SAP remain incompletely elucidated, and the multiorgan interaction mechanisms of the \"brain-gut-lung axis\" in SAP pathogenesis require further exploration.</p><p><strong>Review summary: </strong>This systematic literature review systematically searched databases, including PubMed, using the keywords \"stroke,\" \"gastrointestinal microbiome,\" and \"bacterial pneumonia,\" incorporating 80 mechanistic studies. Key findings reveal that stroke initiates a cascade of \"neuro-microbial-immune\" pathway interactions along the brain-gut-lung axis, leading to intestinal dyshomeostasis characterized by microbiota and metabolite alterations, barrier disruption, immune dysregulation, inflammatory responses, and impaired gut motility. These intestinal perturbations ultimately disrupt pulmonary immune homeostasis, promoting SAP development. In addition, stroke directly induces vagus nerve injury through the brain-gut axis, resulting in impaired swallowing and cough reflexes that exacerbate aspiration-related pulmonary infection risks.</p><p><strong>Conclusions: </strong>Elucidating the role of the brain-gut-lung axis in SAP pathogenesis provides critical insights into its underlying mechanisms. This paradigm highlights intestinal homeostasis modulation and vagus nerve stimulation as promising therapeutic strategies for SAP prevention and management, advancing a multitargeted approach to mitigate poststroke complications.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028641","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}