Laryngoscope最新文献

{"title":"Unveiling the Aggressiveness of Cholesteatoma: Associating MERI with miRNA-21 & IL-6 Expression.","authors":"Karthikeyan M, Vishudh Mohan, Purvi Purohit, Vidhu Sharma, Kapil Soni, Bikram Choudhury, Mithu Banerjee, Poonam Elhence, Amit Goyal","doi":"10.1002/lary.31737","DOIUrl":"https://doi.org/10.1002/lary.31737","url":null,"abstract":"<p><strong>Background: </strong>Cholesteatoma, a destructive middle ear condition, poses challenges due to its variable clinical presentation and propensity for recurrence. Understanding its molecular underpinnings could enhance prognostication and guide therapeutic interventions. This study investigates the association between cholesteatoma aggressiveness, as assessed by the Middle Ear Risk Index (MERI), and the expression of miRNA-21 and IL-6 genes.</p><p><strong>Methods: </strong>A cross-sectional observational study involving 30 patients with cholesteatoma undergoing tympanomastoid exploration was conducted. MERI scores were calculated preoperatively, and cholesteatoma tissue was analyzed for miRNA-21 and IL-6 gene expression using RT-PCR. Statistical analysis was performed to correlate MERI scores with gene expression levels.</p><p><strong>Results: </strong>The majority (80%) of patients exhibited severe MERI scores, correlating with extensive middle ear pathology and necessitating canal wall-down (CWD) mastoidectomy. Higher miRNA-21 and IL-6 gene expression levels were observed in cholesteatoma tissues, indicating local aggressiveness and inflammatory activity. Significant moderate correlations were found between MERI scores and miRNA-21 (Pearson correlation = 0.579, p = 0.001) and IL-6 gene expression (Pearson correlation = 0.388, p = 0.034). Patients with severe MERI scores had elevated miRNA-21 and IL-6 levels, suggesting a more aggressive disease phenotype.</p><p><strong>Conclusion: </strong>MERI scores demonstrated utility in predicting cholesteatoma aggressiveness, with higher scores correlating with elevated miRNA-21 and IL-6 expression. These findings suggest a potential role for MERI in guiding surgical decision-making and prognostication. Future research on targeted therapies based on molecular mechanisms holds promise for improving cholesteatoma management.</p><p><strong>Level of evidence: </strong>3 Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401797","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":"Novel Image-Guided Simulator for Transcervical Intralaryngeal Injection Training.","authors":"Zane Kaiser, Abdullah Zeatoun, Rupali Shah, Robert Buckmire","doi":"10.1002/lary.31835","DOIUrl":"https://doi.org/10.1002/lary.31835","url":null,"abstract":"<p><strong>Objective(s): </strong>To assess the impact of a novel 3D-printed simulation model with Brainlab Image Guidance on enhancing otolaryngology residents' skills and confidence in performing transcervical intralaryngeal injection (TII) compared with conventional training methods.</p><p><strong>Methods: </strong>Utilizing a 3D-printed larynx model derived from computed tomography (CT) scans, this study involved 16 otolaryngology residents divided into two groups for TII training: one with Brainlab Image Guidance (LMIG) and the other without (LM). Pre- and post-training evaluations measured participants' confidence while the Brainlab system measured the accuracy of their needle placements.</p><p><strong>Results: </strong>After training, participants exhibited a significant increase in confidence with an average rise from 1.56 to 2.75 on a 5-point scale. The LMIG group outperformed the LM group in accuracy achieving statistically significant reductions in target distances after training (3.5 mm right, 3.6 mm left). The LMIG also demonstrated a significantly greater increase in procedural confidence over the LM group after training.</p><p><strong>Conclusion: </strong>The TII laryngeal model with Brainlab Image Guidance significantly improves procedural confidence and accuracy among otolaryngology residents, signifying potential advantage over a more conventional training approach. The model's realistic tactile and live instrument positioning feedback augments the process of surgical skill refinement in a controlled, risk-free, simulation environment.</p><p><strong>Level of evidence: </strong>NA Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401795","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":"EAONO/JOS, STAMCO, ChOLE & Potsic Staging of 271 Pediatric Cholesteatoma: Evidence-Based Mod-Pot Staging System.","authors":"Gauthier Marchand, Florian Chatelet, Sarah Atallah, Charlotte Célérier, Nicolas Leboulanger, Vincent Couloigner, Natalie Loundon, Erea-Noël Garabédian, Françoise Denoyelle, François Simon","doi":"10.1002/lary.31837","DOIUrl":"https://doi.org/10.1002/lary.31837","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to assess Potsic, EAONO/JOS, STAMCO, and ChOLE cholesteatoma staging systems in a large homogenous pediatric cohort with long-term follow-up and propose an evidence-based improved version.</p><p><strong>Study design: </strong>Cohort study.</p><p><strong>Setting: </strong>Retrospective study in a tertiary referral center.</p><p><strong>Methods: </strong>Children with congenital or acquired cholesteatoma who underwent surgery between 2008 and 2015 and had a minimum of five years follow-up were included. ROC areas under curve (AUCs) were performed for the residual disease proportion, total number of surgeries, hearing, and C-index for recurrence proportion at the last follow-up.</p><p><strong>Results: </strong>Data from 271 ears with cholesteatoma were collected. Mean age at diagnosis was 7.9 years and 77 (28%) were congenital. Almost all patients (99%) had a canal wall up approach. The mean follow-up was 97.8 months. The Potsic classification, initially designed for congenital cholesteatoma, had the highest AUCs for residual disease rate and for number of surgeries outcomes (respectively 0.73 [0.67-0.78] and 0.71 [0.66-0.77]). For recurrence rate, all the classifications' C-index were low (<0.7). For postoperative hearing, STAMCO ossicular subscore had the highest AUC (0.73 [0.67-0.79]). The Mod-Pot staging system (modified Potsic), including stapes superstructure status and anterior epitympanum or supratubal involvement, improved the Potsic performance especially for postoperative hearing with AUC 0.73 [0.67-0.80], p < 0.001.</p><p><strong>Conclusion: </strong>The Potsic, ChOLE, EAONO/JOS, and STAMCO cholesteatoma classifications may be used in children, but in this specific population, their contribution remains limited to predict outcome. The Mod-Pot classification improved the performance of pediatric cholesteatoma classification while remaining simple and intuitive.</p><p><strong>Level of evidence: </strong>3 Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479198","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":"Gender and Racial Demographic Trends in the US Laryngology Workforce (1993-2022).","authors":"Neil Parikh, Elizabeth Shuman, Michael Johns, Albert Merati, Melissa Zheng","doi":"10.1002/lary.31819","DOIUrl":"https://doi.org/10.1002/lary.31819","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze demographic trends in laryngology fellowship training in the United States from 1993 to 2022, comparing periods before and after formalization of the fellowship within the National Resident Matching Program (NRMP) in 2012.</p><p><strong>Methods: </strong>A national database of fellowship-trained laryngologists (FTLs) and non-fellowship-trained laryngologists (nFTLs) practicing primarily laryngology was created by methodically compiling laryngologists via Internet search, with corroboration by regional laryngologists and vetting by senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, gender, race and ethnicity inferred through individuals' photos and surnames. NRMP match data from 2012 to 2022 were obtained from the American Laryngological Association.</p><p><strong>Results: </strong>An average of 21 programs offered 23 positions in the NRMP match, with 14 programs (66.4%) filling 16 positions (68.8%) from 2012 to 2022. The 10-year FTL growth rate decreased from 25.4% (1993-2002) to 10.5% and 6.6% in subsequent periods. In May 2023, there were 349 active laryngologists, including 303 FTLs, in the United States. A total of 189 (62.4%) FTLs were men, 114 (37.6%) were women; 201 (66.2%) were White, 102 (33.8%) were non-White. Between the pre-NRMP and post-NRMP periods, the percentage of male FTLs decreased from 71.5% to 55.5%, female FTLs increased from 28.5% to 44.5%, and White FTLs decreased from 69.2% to 64.2%. Chi-squared analysis yielded a statistically significant association between gender and training period for FTLs (p = 0.004), but no statistically significant difference between race and training period.</p><p><strong>Conclusions: </strong>The post-NRMP period saw an expansion of laryngology fellowships and workforce diversification, reflecting trends observed in otolaryngology and medicine overall.</p><p><strong>Level of evidence: </strong>NA Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394793","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":"Endoscopic and Open Treatment Techniques for Posterior Glottic Stenosis in Children: A Systematic Review and Meta-Analysis.","authors":"Evan S Chernov, Alejandro Marrero-Gonzalez, Shaun A Nguyen, Anthony Ghanem, David R White","doi":"10.1002/lary.31829","DOIUrl":"https://doi.org/10.1002/lary.31829","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the outcomes of open and endoscopic posterior cricoid split grafting and mucosal flaps for the treatment of pediatric posterior glottic stenosis (PGS).</p><p><strong>Data sources: </strong>COCHRANE Library, CINAHL, PubMed, and Scopus databases.</p><p><strong>Methods: </strong>Studies were grouped by treatment method. Outcomes included decannulation rate, improvement in airway obstruction, remaining vocal symptoms, and subsequent airway procedures. A meta-analysis of continuous measures and proportions (%) with 95% confidence interval (CI) was conducted.</p><p><strong>Results: </strong>Nineteen studies with 223 patients were included, with 72 patients having isolated PGS. Twelve studies (n = 23) reported endoscopic repair (group 1), while seven studies (n = 49) reported open techniques (group 2). Most patients in group 1 and group 2 had grade IV PGS (55.9% [26.1%-83.5%] and 56.9% [30.5%-80.8%], respectively). Post-operatively, 70.8% [43.5%-91.7%] of group 1 patients had tracheostomies with 83.4% [62.1%-95.5%] subsequently being decannulated, whereas 97.3% [89.1%-99.8%] of group 2 patients had tracheostomies post-operatively with 90.2% [79.2%-96.5%] subsequently being decannulated. Group 1 and group 2 had 87.1% [70.5%-96.3%] and 84.4% [64.9%-95.5%] improvement in airway obstruction, respectively.</p><p><strong>Conclusion: </strong>There are multiple open and endoscopic surgical options for pediatric PGS. Posterior cricoid split with cartilage graft and mucosal advancement flaps can be performed for high PGS grades. Endoscopic and open techniques are efficacious with high decannulation rates and improvement in airway obstruction, with endoscopic surgeries offering a less invasive approach. Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394792","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":"Viability of Free Bone Graft in Combination With Free Tissue Transfer and Post-Operative RT in Orbital Floor Reconstruction.","authors":"Swagnik Chakrabarti, Avadhut Tukaram Phad, Chaitra Shetty, Abhishek Ghosh","doi":"10.1002/lary.31834","DOIUrl":"https://doi.org/10.1002/lary.31834","url":null,"abstract":"<p><strong>Objectives/aim: </strong>Orbital floor reconstruction post cancer ablation is challenging especially when associated with extensive soft tissue defects. Due consideration is to be given to the possible toxicities of adjuvant radiotherapy as well. Free bone-soft tissue flaps are ideally suited in such situations. However, a single flap may fall inadequate for large defects. Using two free flaps in combination increases operating time and donor site morbidities. Non-vascularized bone grafts combined with large soft tissue flaps harbor the risk of bone resorption and osteo-radio necrosis. Alloplastic implants can lead to exposure and infection. We conducted a study researching the outcome of non-vascularized cortico-cancellous iliac bone graft (NVCIBG) used in orbital floor reconstruction along with free anterolateral thigh (FALT) flap in subjects undergoing extensive surgical ablation and adjuvant radiotherapy.</p><p><strong>Materials and methods: </strong>Ten consecutive subjects who underwent maxillo-mandibular resection with or without skin were included in the study. The parameters assessed were diplopia, ectropion, bone viability, and osteointegration. Subjects were assessed in the immediate post-operative period, 1 month after surgery, and after 1 year of radiotherapy.</p><p><strong>Results: </strong>The size of iliac bone harvested ranged from 3 to 5.5 cm (mean 4.8 cm). Forty percent subjects complained of binocular diplopia in the initial post-operative period which subsided subsequently. Thirty percent subjects developed ectropion all of whom required external skin reconstruction. None developed osteoradionecrosis.</p><p><strong>Conclusion: </strong>NVCIBG along with FALT flap is an excellent reconstructive option for orbital floor defects. It can withstand the toxicities of adjuvant radiotherapy and avoids the need for double free flap reconstruction.</p><p><strong>Level of evidence: </strong>4 Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394800","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":"Upper Airway Stimulation for Children and Adolescents with Down Syndrome: Long-Term Follow-Up.","authors":"Danielle R Larrow, Kathryn S Marcus, Kevin Gipson, Brian G Skotko, Cristina M Baldassari, David F Smith, Christine H Heubi, Allison Tobey, Raol Nikhila, Mark Vangel, Christopher J Hartnick","doi":"10.1002/lary.31828","DOIUrl":"https://doi.org/10.1002/lary.31828","url":null,"abstract":"<p><strong>Objective(s): </strong>Hypoglossal nerve stimulation (HGNS) is safe and effective for patients with Down syndrome (DS) and severe persistent obstructive sleep apnea (OSA). Long-term outcomes for this patient population have not been evaluated.</p><p><strong>Methods: </strong>A prospective single-group multicenter cohort study with 1-year follow-up was conducted between 2015 and 2021 among 42 adolescent patients with DS and severe persistent OSA. Here, we evaluate long-term outcomes in this patient cohort. Patients were evaluated with polysomnogram (PSG) at three timepoints: pre-implantation (timepoint 1), 1-year post-implantation (timepoint 2), and long-term follow-up (timepoint 3).</p><p><strong>Results: </strong>Long-term follow-up data were available for 33 of 42 patients. Mean (SD) of timepoint 3 was 4.0 (1.9) years after implantation. Using a therapy response definition of a 50% decrease in Apnea Hypopnea INdez (AHI) from timepoint 1, the response rate was 69.7% (23/33) at timepoint 2 and 87.9% (29/33) at timepoint 3. From timepoint 1, there was a mean (SD) decrease in AHI of 12.7 (13.4) events/h at timepoint 2 and 15.7 (13.1) events/h at timepoint 3. The mean percentage change in AHI between timepoints 1 and 2 was -51.1% (95% CI: -32.8% to -69.3%) and between timepoints 1 and 3 was -59.6% (95% CI: -42.0% to -77.3%).</p><p><strong>Conclusion: </strong>Patients with DS and severe persistent OSA who undergo HGNS implantation may continue to experience improvement in PSG parameters at long-term follow-up. Future studies are needed to assess additional long-term outcomes in this patient population, including neurocognition and quality of life.</p><p><strong>Level of evidence: </strong>3 Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394799","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":"Management of Pediatric Tracheocutaneous Fistulae.","authors":"Matthew Maksimoski, Daniel Choo","doi":"10.1002/lary.31830","DOIUrl":"https://doi.org/10.1002/lary.31830","url":null,"abstract":"<p><p>Pediatric tracheocutaneous fistulae are best managed initially with secondary closure techniques. This procedure can be performed twice before significant further evaluation should be undertaken. Further studies are still needed with larger patient volumes to power management minutiae for pediatric tracheocutaneous fistulae.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394797","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":"In Reference to The Association Between Choroidal Thickness and Meniere's Disease: A Cross-Sectional Study.","authors":"Alfonso Scarpa, Pietro De Luca, Martina De Luca, Pasquale Viola, Federico Maria Gioacchini, Emilio Avallone","doi":"10.1002/lary.31820","DOIUrl":"https://doi.org/10.1002/lary.31820","url":null,"abstract":"","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394794","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":"Incidence of Pediatric to Adult Transition Among Tracheotomy Patients.","authors":"Rebecca Lee, Stephen R Chorney, Yann Fuu Kou, Cynthia S Wang, Rebecca Brooks, Romaine F Johnson","doi":"10.1002/lary.31826","DOIUrl":"https://doi.org/10.1002/lary.31826","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the incidence and identify predictors of pediatric tracheostomy patients who transition into adulthood with a tracheostomy.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of pediatric tracheostomy patients treated at a single tertiary care pediatric hospital between 2009 and 2022. Patient demographics, comorbidities, tracheostomy outcomes, including decannulation and mortality rates, and the status of those alive with a tracheostomy at adulthood were compared.</p><p><strong>Results: </strong>Of the 663 children who underwent a tracheostomy, 103 (15.5%) would have surpassed 18 years by September 1, 2023. Detailed breakdown: 26 (25%) were alive with a tracheostomy, 35 (34%) had been decannulated, 25 (24%) had passed away, and 17 (16.5%) were lost to follow-up. Patients who retained their tracheostomies into adulthood were more likely to be older at tracheostomy placement (mean age 14.3 vs. 1.7 years, p < 0.001), Hispanic (43.7% vs. 30.5%, p = 0.003), not ventilated at initial discharge (41% vs. 24%, p < 0.001), and have severe neurocognitive disabilities (72% vs. 53%, p < 0.001). Logistic regression identified older age at tracheostomy placement (OR = 1.35, 95% CI [1.24-1.48]) and severe neurocognitive disability (OR = 6.20, 95% CI [2.13-18.09]) as significant predictors of maintaining a tracheostomy into adulthood.</p><p><strong>Conclusions: </strong>Older age at tracheostomy placement and severe neurocognitive disabilities significantly predict the transition of pediatric tracheostomy patients to adult care with their tracheostomies. These findings highlight the need for specialized transition programs tailored to the needs of this unique population.</p><p><strong>Level of evidence: </strong>IV Laryngoscope, 2024.</p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394796","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}