Journal of Vestibular Research-Equilibrium & Orientation最新文献

{"title":"Assessing gait variability concurrently with dynamic visual acuity on a treadmill in people with bilateral vestibulopathy.","authors":"Christopher McCrum, Meichan Zhu, Paul Willems, Ivar Visser, Melina Kastrinou, Raymond van de Berg, Kenneth Meijer, Ann Hallemans, Nolan Herssens","doi":"10.1177/09574271251313806","DOIUrl":"10.1177/09574271251313806","url":null,"abstract":"<p><p>BackgroundGait variability is increased in people with bilateral vestibulopathy (BVP). Since dedicated gait analysis can be resource-intensive, concurrent assessment with another vestibular function test, dynamic visual acuity (DVA), is worth consideration.ObjectiveTo assess comparability of results from a combined gait and DVA assessment with results from a previous dedicated gait analysis.Methods15 participants (4 women) with BVP were analysed. The DVA test assessed visual acuity during stance and during treadmill walking at 2, 4 and 6 km/h. An 8-camera motion capture system measured spatiotemporal gait parameters (step length, step time, step width and double support time; means and coefficients of variation [CoV]). The walking speed effect was assessed by mixed-effects models, and results were visually compared to previous results.ResultsWalking speed affected the means of step length, step time and double support time (<i>p</i> < .0001) but not step width (<i>p</i> = .373) and significantly affected the CoV of all parameters (<i>p</i> < .01). These values, as well as speed-related changes, were comparable between contexts.ConclusionsConcurrent DVA and gait assessment seems promising as an assessment method in people with BVP. Test-retest reliability, clinically feasible motion capture solutions and sensitivity to change following interventions should be further investigated.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"113-120"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460280","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":"Vestibular asymmetry in caloric and video head impulse testing: Do we interpret it correctly?","authors":"Maja Striteska, David Wexler, Ondrej Tichacek, Alfarghal Mohamad, Martin Chovanec, Erich Schneider","doi":"10.1177/09574271251336143","DOIUrl":"10.1177/09574271251336143","url":null,"abstract":"<p><p>Caloric and video head impulse tests (vHITs) are essential for vestibular diagnostics, both employing Jongkees' formula (JF) to quantify asymmetry. JF calculates unilateral weakness (UW) by subtracting the weaker ear (WE) response from the stronger ear (SE) and using the sum of both responses as a reference. However, the result is unwieldy and may mislead clinicians if interpreted as an indication of how much weaker the response of the WE is compared to the contralateral SE as a percentage. Through mathematical analysis, we examined what question JF answers and explored, for each vestibular test, alternative asymmetry equations for a more meaningful assessment of vestibular asymmetry. JF has three key limitations. First, its nonlinear nature leads to an underestimation of paresis, particularly when the WE response is near 41% of SE, where the calculated UW is capped at 18%. Second, JF derives the asymmetry from a \"symmetry point\", splitting the difference between both sides, with the average response in the middle, rather than directly quantifying UW as clinicians understand it. Instead, JF answers two separate questions: \"How much is the WE response below the average\" and \"How much is the SE response above the average.\" To address these issues, a linear paresis calculation using only the SE response as a reference was later introduced. However, this approach did not resolve JF's third limitation: artificially inflated values and sensitivity to small variations in WE when both ears are affected. Unlike the caloric test, the vHIT already relies on head velocity as an absolute reference for gain calculation, eliminating the need for SE in asymmetry calculation. Employing an ideal gain of 1, asymmetry can be expressed as a simple side-to-side gain difference, preventing inflated results in bilateral deficits and easing clinical calculation.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251336143"},"PeriodicalIF":2.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030255","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":"Can numerical modeling help us understanding hydrops in Menière's disease? A PRISMA scoping review.","authors":"Stéphane Gargula, Dario Ebode, Antonino Maniaci, Thomas Radulesco, Giannicola Iannella, Ralph Haddad, Justin Michel","doi":"10.1177/09574271251335956","DOIUrl":"https://doi.org/10.1177/09574271251335956","url":null,"abstract":"<p><p>BackgroundThe pathophysiology of Meniere's disease (MD) is complex and intertwined with endolymphatic hydrops. Available experimental models have limitations.ObjectiveThis study aimed to analyze the impact of endolymphatic hydrops on cochleovestibular hydrodynamics through numerical simulations.MethodsA comprehensive literature review was conducted following PRISMA guidelines for Scoping Reviews. Articles were sourced in June 2024 from PubMed and Google Scholar using a combination of MESH terms related to hydrodynamics, numerical simulation, and MD. Studies involving numerical simulations of hydrops in the vestibule, cochlea, or both were included.ResultsEight studies on hydrodynamics in hydrops using numerical simulations were included. In cochlear models, hydrops affect basilar membrane mechanics, causing low-frequency hearing loss, auditory distortions, and frequency shifts. Vestibular models revealed increased static pressure in the horizontal semicircular canal, explaining abnormal vHIT findings in hydrops patients. Models also suggested chaotic fluid dynamics in dilated labyrinthine structures during caloric tests. The reviewed studies underscore the utility of numerical models in understanding the mechanics of MD; however, significant limitations were identified.ConclusionsNumerical modeling offers valuable insights into the hydrodynamic changes caused by endolymphatic hydrops in MD, but future work should address the current limitations by incorporating more accurate anatomical features and chronic progression in simulations.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251335956"},"PeriodicalIF":2.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059424","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":"Transcranial magnetic stimulation use with chronic vestibular disorders: A scoping review.","authors":"Elizabeth Cornforth, Devashish Tiwari, Teresa Jacobson Kimberley","doi":"10.1177/09574271251334012","DOIUrl":"https://doi.org/10.1177/09574271251334012","url":null,"abstract":"<p><p>BackgroundTranscranial magnetic stimulation (TMS) is extensively studied as a neuromodulation tool in neurological disorders. However, its use with the central vestibular disorders is limited.ObjectiveTo evaluate the utility of TMS as an assessment and treatment of chronic vestibular disorders and propose recommendations for future work.MethodsA comprehensive search of four electronic databases (PubMed, CINAHL, PsycINFO, and Rehabilitation and Sports Medicine Source) identified 206 records of which 16 studies were included.ResultsOne study used TMS as a neurophysiological assessment tool and 15 used repetitive TMS (rTMS) as a neuromodulatory intervention. Mal de Debarquement syndrome was the most frequently explored diagnosis. Dorsolateral prefrontal cortex and the cerebellum were the most frequent sites for rTMS application. Statistically significant improvements were noted on the Dizziness Handicap Inventory (3/7 studies) but clinically significant improvements were not observed. Postural control (7/7 studies) showed improvements along with VOR gain (1/1 studies).ConclusionsTMS shows promise as both a neurophysiological assessment tool and a neuromodulatory intervention for chronic vestibular disorders. Methodological limitations of the studies warrant caution while interpreting the results. Larger sample sizes, control groups, optimal neuroanatomical targeting, and dosing along with active rehabilitation are required to determine effectiveness in chronic vestibular disorders.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251334012"},"PeriodicalIF":2.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058555","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":"Methods and clinical outcomes in vestibular implantation - A systematic literature review.","authors":"Jonathan Olsgård Hansen, Hjalte Christian Reeberg Sass, Niels Cramer West, Per Cayé-Thomasen","doi":"10.1177/09574271251332157","DOIUrl":"https://doi.org/10.1177/09574271251332157","url":null,"abstract":"<p><p>BackgroundThe vestibular implant is an experimental device that may provide treatment to patients suffering from bilateral vestibulopathy who do not benefit from standard vestibular rehabilitation.ObjectiveThe objective is to identify the various methodology regarding device designs and surgical approaches in addition to assessing subjective and objective vestibular and clinical outcomes in order to evaluate the future and possible limitations of the vestibular implant.MethodsA systematic search of Medline and Embase was conducted according to the PRISMA guidelines using pre-defined inclusion and exclusion criteria. 350 hits were found, which after 2 rounds of screening by 2 independent reviewers resulted in 21 studies eligible for full-text review.ResultsA total of 36 recipients of a vestibular implant across four centres world-wide were identified. Both surgical approach and devices as well as vestibular and functional outcomes varied greatly across centres and from patient to patient, evaluated using a variety of objective and subjective tests.ConclusionSeveral promising results in vestibular implantation were found using both subjective and objective measurements. However, some questions with regards to hearing preservation and long-term, continuous use of the vestibular implant remain to be answered, and more studies are needed to assess the efficacy and cost-utility of the implant.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251332157"},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744187","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":"Effect of viewing distance on dynamic visual acuity.","authors":"Lien Van Laer, Allison Nogi, Jorge Serrador, Michael C Schubert","doi":"10.1177/09574271251327957","DOIUrl":"https://doi.org/10.1177/09574271251327957","url":null,"abstract":"<p><p>BackgroundPatients with dizziness and unsteadiness are commonly prescribed gaze stability exercises at varying target distances to manage vestibular impairments but lack objective tools to monitor progress. Maintaining gaze stability during head motion at near distances demands greater eye velocity relative to head velocity due to vergence and increased translational eye rotation demands.ObjectivesThis study compared dynamic visual acuity (DVA) during yaw and pitch at both near and far distances in patients and healthy controls.MethodsThis study includes individuals with unilateral vestibular deafferentation (UVD), veterans with dizziness yet healthy vestibular function, and healthy controls. The computerized DVA at near (50 cm) and far (200 cm) distances were collected. Data analysis included comparisons of near and far DVA in yaw and pitch planes.ResultsA total of 94 participants (34 UVD, 24 veterans with dizziness, 36 controls) were included. Near-distance DVA was significantly worse than far-distance DVA for the entire sample and within each group (<i>p</i> < 0.001).ConclusionsNear-distance DVA is more challenging than far-distance DVA across populations and planes of head rotation. Near-distance DVA may serve as a robust measure of vestibulo-ocular reflex function and offers a practical means for patients to self-monitor the effects of gaze stability training.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251327957"},"PeriodicalIF":2.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659490","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":"High prevalence of sleep disorders in Ménière's disease: Interplay between vestibular function and sleep.","authors":"Arnaud Petry, Manuela Leuzzi, Claire Thibault, Henri Comtet, Ulker Kilic-Huck, Patrice Bourgin, Anne Charpiot, Elisabeth Ruppert","doi":"10.1177/09574271251328339","DOIUrl":"https://doi.org/10.1177/09574271251328339","url":null,"abstract":"<p><p>BackgroundIn Ménière's disease (MD), impaired sleep worsens the quality of life and triggers episodes, perpetuating a vicious cycle. The intricate connection between vestibular function and sleep regulation is poorly understood.ObjectiveWe aimed to investigate this link by studying sleep in confirmed MD patients.MethodsIn a single-center observational study, 26 consecutive patients with MD were enrolled. Sleep characterization included thorough symptom inquiry, questionnaires (PSQI, ESS, PFS, STOP-Bang, and AAO-HNS), and respiratory polygraphy (RP) or polysomnography (PSG).ResultsDespite 42% of patients reporting overall sleep satisfaction, further inquiry revealed 76% experiencing sleep disturbances per PSQI. STOP-Bang indicated 56% with a moderate-to-severe risk of OSAS. OSAS defined by apnea hypopnea index (AHI) ≥ 5/h was present in 75%. OSAS severity was categorized as mild (5/h ≤ AHI < 15/h, 33%), moderate (15/h ≤ AHI < 30/h, 21%), and severe (AHI ≥ 30/h, 21%). In patients with AAO-HNS score >3, migraines and insomnia were more prevalent. Patients with moderate-to-severe OSAS had poorer hearing. All recently diagnosed patients with moderate-to-severe OSAS had undergone more than one medical treatment compared to others (32%).ConclusionsThe high prevalence of sleep disorders in MD patients underscores the need for thorough screening, even without spontaneous complaints. Instrumental sleep exploration via RP or PSG is essential, as OSAS treatment could aid vestibular function.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251328339"},"PeriodicalIF":2.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651693","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":"Clinical features of secondary BPPV: A nation-wide multicenter study.","authors":"Seunghee Na, Eun-Ju Jeon, Min-Beom Kim, Jung-Yup Lee, Chang-Hee Kim, Sung Il Nam, Hyun Ah Kim, Hyung Lee, Ji-Soo Kim, Jeong-Yoon Choi, Min-Ku Kim, Ji-Yun Park, Jeon Mi Lee, Eunjin Kwon, Seong-Hae Jeong, Sung-Kwang Hong, Hyo-Jeong Lee, Jae-Yong Byun, Myung Hoon Yoo, Seok Min Hong, Tae-Kyeong Lee, Sangwoo Lee, Yun Ji Lee, Kyu-Sung Kim, Jae-Hyun Seo, Sun-Uk Lee, Eek-Sung Lee, Hong Ju Park","doi":"10.1177/09574271251319775","DOIUrl":"https://doi.org/10.1177/09574271251319775","url":null,"abstract":"<p><p>BackgroundBenign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and its prevalence is substantial. While primary BPPV has been well studied, the understanding of secondary BPPV is still limited.ObjectiveTo investigate the prevalence and clinical characteristics of secondary BPPV in a national multicenter retrospective analysis.MethodsThe study involved a retrospective analysis of medical records from 17 institutions across South Korea, between January and June 2022. We evaluated clinical features, presumed etiologies, involvement of semicircular canals, response to canalith repositioning procedures (CRPs), presence of residual dizziness, recurrence, and results of auditory and vestibular function tests for both primary and secondary BPPV cases.ResultsOf the total 1363 BPPV cases, 14.5% (198 patients) were categorized as secondary BPPV. The most prevalent etiology for secondary BPPV was head trauma. Secondary BPPV was associated with a higher prevalence of comorbidities including diabetes and inner ear diseases. Patients with secondary BPPV demonstrated more frequent involvement of multiple semicircular canals, necessitated a greater number of CRPs for resolution, and experienced a higher incidence of residual dizziness compared to primary BPPV cases. Furthermore, secondary BPPV patients exhibited more frequent abnormalities in auditory and vestibular function tests.ConclusionsSecondary BPPV accounts for a significant proportion of BPPV cases, with distinct clinical characteristics compared to primary BPPV.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251319775"},"PeriodicalIF":2.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631006","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":"The effect of using virtual reality on balance in people with persistent postural-perceptual dizziness: A randomized controlled trial.","authors":"Madlien M Al-Omari, Sawsan M Abuzaid, Hamzeh J Khair, Haidzir Manaf, Alia A Alghwiri","doi":"10.1177/09574271251326587","DOIUrl":"https://doi.org/10.1177/09574271251326587","url":null,"abstract":"<p><p>BackgroundPersistent postural-perceptual dizziness (PPPD) represents a relatively new vestibular diagnosis that has garnered attention within the medical community. Consequently, there is a pressing demand for efficacious management strategies.ObjectiveTo assess the comparative effectiveness of virtual reality (VR) versus vestibular rehabilitation therapy (VRT) in improving PPPD symptoms.MethodsWe randomly assigned a cohort of 42 individuals conclusively diagnosed with PPPD to two distinct groups. The experimental group included 21 participants who received a combination of VR and optokinetic stimulation in addition to VRT, while the control group, also made up of 21 individuals, only received optokinetic stimulation in conjunction with VRT. We administered the intervention sessions twice weekly over a span of 6 weeks, resulting in a total of 10-intervention sessions. Additionally, baseline, post-intervention, and follow-up assessments were conducted.ResultsOur analysis revealed that participants in both groups significantly improved with no significant differences between the groups. Individuals undergoing VR interventions demonstrated marked improvements across all of the assessed parameters including the primary outcome measure that were reduced from 41.55 (11.87) to 23.40 (14.17) (<i>p</i><0.001). Moreover, participants in the control group also displayed notable enhancements in select outcome measures post-intervention including the primary outcome measure that were reduced from 43.60 (12.75) to 26.10 (16.25) (<i>p</i> = 0.001). All participants in both groups maintained significant improvement in the severity of PPPD after 1 year of the. However, the study cannot determine if this change was definitely from the treatment because there was no non-treatment control group.ConclusionsThe study found that the addition of VR to a well-structured VRT did not significantly improve clinical outcomes, indicating a need for further investigation into more effective approaches to yield meaningful clinical benefits. Moreover, adding a control group with no intervention would help revealing a real effect of the intervention.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"9574271251326587"},"PeriodicalIF":2.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631007","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":"Microsaccades during video head impulse test in normal subjects.","authors":"Mingwei Xu, Qin Zhang, Yuan Yao, Qiong Wu, Jun Yang, Yulian Jin, Qing Zhang","doi":"10.1177/09574271241299310","DOIUrl":"10.1177/09574271241299310","url":null,"abstract":"<p><p>ObjectiveThis study aimed to quantitatively analyze the characteristics of saccades in normal subjects during video head impulse test (vHIT), to establish a reference for clinical practice.MethodsA cohort of 20 healthy individuals (40 ears) was recruited and compared with a matched group of 20 patients (20 ears) suffering from vestibular neuritis (VN), utilizing vHIT to evaluate the functionality of all three semicircular canals (SCCs). This study analyzed the quantitative characteristics of saccades observed in healthy individuals and patients with VN.ResultsSignificant differences were observed between both groups in terms of lateral saccade frequency, latency, peak velocity, and duration for both the first and second saccades (all <i>p</i> < 0.05, with age as a covariate). Similarly, significant differences were found in vertical SCCs between groups for the frequency, latency, peak velocity, and duration of the first saccade (all <i>p</i> < 0.05, with age as a covariate). However, no significant differences were found in Perez-Rey (PR) scores either in lateral (<i>p</i> = 0.259) or vertical (<i>p</i> = 0.102) SCCs. Within the healthy group, significant differences were observed in the frequency, peak velocity, and duration of the first saccade in lateral and vertical SCCs (all <i>p</i> < 0.05). However, the latency (<i>p</i> = 0.827) and PR scores (<i>p</i> = 0.552) exhibited no significant variation.ConclusionsMicrosaccades characterized by prolonged latency and reduced amplitude can occur in healthy individuals during vHIT and are distinct from the saccades seen in patients with VN due to vestibular impairment. This highlights the need to carefully identify and interpret relevant saccades during clinical assessments.</p>","PeriodicalId":49960,"journal":{"name":"Journal of Vestibular Research-Equilibrium & Orientation","volume":" ","pages":"64-72"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442467","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}