Journal of Clinical Sleep Medicine最新文献

{"title":"Evaluating the potential of metabolic drugs in obstructive sleep apnea and obesity: a narrative review.","authors":"Beyza Sevencan, Nele Steenackers, Amar Daniël Emanuel van Laar, Sofía Pazmiño Lucio, Bertien Buyse, Alexandros Kalkanis, Dries Testelmans, Bart Van der Schueren","doi":"10.5664/jcsm.11682","DOIUrl":"10.5664/jcsm.11682","url":null,"abstract":"<p><strong>Study objectives: </strong>To assess the effectiveness of sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dual gastric inhibitory polypeptide/GLP-1 receptor agonists in the treatment of obstructive sleep apnea.</p><p><strong>Methods: </strong>A comprehensive literature search was performed across multiple medical databases, including Embase, Medline, and Cochrane to look for English articles on interventions with SGLT2 inhibitors, GLP-1, and dual gastric inhibitory polypeptide/GLP-1 receptor agonists in people living with sleep apnea and overweight or obesity.</p><p><strong>Results: </strong>Emerging evidence indicates that SGLT2 inhibitors, GLP-1, and dual gastric inhibitory polypeptide/GLP-1 receptor agonists are beneficial for treating obesity in combination with sleep apnea. Although these medications have shown promise in weight reduction, with GLP-1 receptor agonists slightly outperforming SGLT2 inhibitors, their effect on sleep apnea extends beyond mere weight loss. Preliminary studies suggest a beneficial role in obstructive sleep apnea management with reductions in the apnea-hypopnea index and potential improvements in other sleep-related outcomes.</p><p><strong>Conclusions: </strong>There is a need for more therapeutic options to treat sleep apnea as adherence with current treatment options remains a struggle for many patients. According to preliminary research, SGLT2 inhibitors, GLP-1 and dual gastric inhibitory polypeptide/GLP-1 receptor agonists are promising candidates because they do show beneficial effects on apnea-hypopnia index and weight. Nevertheless, large-scale clinical trials are needed to assess their clinical potential and risk balance in more detail.</p><p><strong>Citation: </strong>Sevencan B, Steenackers N, van Laar ADE, et al. Evaluating the potential of metabolic drugs in obstructive sleep apnea and obesity: a narrative review. <i>J Clin Sleep Med</i>. 2025;21(8):1433-1444.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1433-1444"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregivers' outcome prioritization for home positive airway pressure in children: a mixed-methods study.","authors":"Vanessa C Dannenberg, Daniel Ofosu, Ella Milne, Deborah L Olmstead, Mathieu Chalifour, Shannon Scott, Maria L Castro-Codesal","doi":"10.5664/jcsm.11708","DOIUrl":"10.5664/jcsm.11708","url":null,"abstract":"<p><strong>Study objectives: </strong>We sought to determine caregiver-reported priorities regarding the benefits, challenges, and further insights on home positive airway pressure (PAP) for children.</p><p><strong>Methods: </strong>With this mixed-methods study we analyzed responses to an online survey by parents/caregivers of children (< 18 years of age) using home PAP for at least 3 months. A semistructured anonymous survey comprising multiple-choice and open-ended questions was used to assess caregivers' priorities for PAP outcomes and their perspectives on future research directions. Descriptive statistics were used to summarize caregiver and children demographics, as well as responses to multiple-choice questions. Thematic analysis was employed to synthesize the qualitative data from open-endend responses.</p><p><strong>Results: </strong>Seventy-three caregivers completed the survey, 82% of whom were mothers. Over 90% rated improved sleep, rest, daytime energy levels, and breathing during sleep as very important or important benefits of PAP. A commonly reported challenge was children becoming dependent on PAP for sleep, which 76% of caregivers rated as a very important or important concern. For research priorities, improved breathing during sleep (77%) and reduced frequency of respiratory illness (73%) were the most commonly endorsed benefits. Key challenges identified as research priorities included mask-related issues (72%) and PAP dependency (57%). Four themes emerged from open-ended questions: (1) better nights and days, (2) adapting to home PAP, (3) finding the right mask, and (4) the importance of a team approach.</p><p><strong>Conclusions: </strong>Caregivers identified both well-established respiratory benefits of PAP-such as improved breathing-and less frequently reported non-respiratory outcomes, including broader family well-being. Challenges such as mask-related issues and PAP dependency highlight areas where further research is needed.</p><p><strong>Citation: </strong>Dannenberg VC, Ofosu D, Milne E, et al. Caregivers' outcome prioritization for home positive airway pressure in children: a mixed-methods study. <i>J Clin Sleep Med.</i> 2025;21(8):1407-1415.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1407-1415"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home sleep testing in children: we probably can, but should we?","authors":"Lee J Brooks","doi":"10.5664/jcsm.11792","DOIUrl":"10.5664/jcsm.11792","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1333-1334"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of mailed versus in-person PAP initiation in the Veterans Affairs' TeleSleep program.","authors":"Alexander Gomez, Kathleen F Sarmiento, Connor Smith, Michael Mitchell, Diane Lee, Annette Totten, Elizabeth Sanders, Armand M Ryden, Jiyeon Seo, Sarathi Bhattacharyya, Brian Harris, Roberto Mempin, Isabel Moghtaderi, Yameena Jawed, Nikita Jambulingam, Jennifer Martin, Michelle Zeidler","doi":"10.5664/jcsm.11692","DOIUrl":"10.5664/jcsm.11692","url":null,"abstract":"<p><strong>Study objectives: </strong>This study sought to evaluate whether telehealth setup was noninferior to in-person setup for veterans initiating positive airway pressure (PAP) therapy.</p><p><strong>Methods: </strong>PAP setups before and after the COVID-19 pandemic were identified at 2 Veterans Affairs health systems. Telehealth PAP setups occurred between March 2020 and December 2021. The in-person PAP setups occurred between January and December 2019. PAP data were extracted for days 1-30 (month 1) and 60-90 (month 3). PAP use was compared between in-person and telemedicine using hours used per night, days used (out of 30 days), and residual apnea-hypopnea index (among adherent users). Noninferiority analyses were performed, using the following noninferiority margins: 45 minutes for hours used, 4 days for days of usage, and 5 events/h for residual apnea-hypopnea index.</p><p><strong>Results: </strong>A total of 432 Veterans Affairs patients (93.5% male) who underwent PAP setup were included (224 in-person; 208 telehealth). Noninferiority was established for PAP usage at month 1 (90% confidence interval [CI] = -0.31, 0.53) and month 3 (90% CI = -0.18, 0.71), days used at month 1 (90% CI = -2.28, 1.33) and month 3 (90% CI = -1.75, 2.20), and residual apnea-hypopnea index at month 1 (90% CI = -0.40, 1.62) and month 3 (90% CI = -0.69, 2.30).</p><p><strong>Conclusions: </strong>Initiation of PAP therapy via telehealth was noninferior to in-person setup visits in terms of PAP adherence among veterans who use Veterans Affairs care.</p><p><strong>Citation: </strong>Gomez A, Sarmiento KF, Smith C, et al. Effectiveness of mailed versus in-person PAP initiation in the Veterans Affairs' TeleSleep program. <i>J Clin Sleep Med.</i> 2025;21(8):1379-1387.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1379-1387"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive modeling of obstructive sleep apnea using pharyngeal magnetic resonance imaging radiomics and clinical data.","authors":"Yibin Chen, Heng Xiao, Min Huang, Yingying Zheng, Xiaoyu Dong, Guohao Chen","doi":"10.5664/jcsm.11706","DOIUrl":"10.5664/jcsm.11706","url":null,"abstract":"<p><strong>Study objectives: </strong>This study aims to assess the predictive performance of models combining pharyngeal magnetic resonance imaging radiomics and clinical data for distinguishing severe and nonsevere obstructive sleep apnea.</p><p><strong>Methods: </strong>A total of 106 patients were included in the study, with 48 patients having an apnea-hypopnea index < 30 events/h and 58 patients having an apnea-hypopnea index ≥ 30 events/h. Radiomics features were extracted from magnetic resonance imaging images. After applying minimum redundancy and maximum relevance and least absolute shrinkage and selection operator with cross-validation for dimensionality reduction, radiomics models were developed using logistic regression, support vector machine, random forest, and gradient boosting machine. Age and body mass index were used as clinical features to construct a combined model with radiomics features. The performance of the models was evaluated using F1 scores and the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>A total of 129 radiomics features were extracted from magnetic resonance imaging images. Following dimensionality reduction and feature selection, 2 radiomics features with significant predictive value were identified. The combined model, incorporating support vector machine (AUC = 0.78, F1 = 0.75), random forest (AUC = 0.78, F1 = 0.74), gradient boosting machine (AUC = 0.79, F1 = 0.75), and logistic regression (AUC = 0.82, F1 = 0.80), demonstrated superior performance compared to models based solely on radiomics features. The radiomics-only models included support vector machine (AUC = 0.76, F1 = 0.72), random forest (AUC = 0.73, F1 = 0.67), gradient boosting machine (AUC = 0.76, F1 = 0.73), and logistic regression (AUC = 0.78, F1 = 0.76). Among the combined models, logistic regression achieved the highest predictive accuracy and classification performance.</p><p><strong>Conclusions: </strong>The combined model, integrating radiomics features with clinical characteristics, demonstrates a superior ability to distinguish between severe and nonsevere obstructive sleep apnea. This approach offers a noninvasive and effective new perspective for clinical decision-making.</p><p><strong>Citation: </strong>Chen Y, Xiao H, Huang M, Zheng Y, Dong X, Chen G. Predictive modeling of obstructive sleep apnea using pharyngeal magnetic resonance imaging radiomics and clinical data. <i>J Clin Sleep Med</i>. 2025;21(8):1363-1369.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1363-1369"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological management of sleep apnea and obesity, a new frontier.","authors":"Pahnwat Tonya Taweesedt, Nnamdi Orakpo, Rafael Pelayo","doi":"10.5664/jcsm.11798","DOIUrl":"10.5664/jcsm.11798","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1339-1340"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When legs move and airways close: kicking up an old controversy.","authors":"Brian B Koo","doi":"10.5664/jcsm.11794","DOIUrl":"10.5664/jcsm.11794","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1337-1338"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep and arousal in adults who recall chronic childhood trauma.","authors":"Albe Sin-Ying Ng, Wai Sze Chan","doi":"10.5664/jcsm.11684","DOIUrl":"10.5664/jcsm.11684","url":null,"abstract":"<p><p>Subjective sleep disturbance is commonly reported by childhood trauma survivors. However, evidence for objective sleep disturbance and its association with arousal is limited, especially in individuals without posttraumatic stress disorder. This study investigated subjective and objective measures of sleep and arousal in 50 adults who recalled having chronic childhood trauma and were free of posttraumatic stress disorder and 50 age- and sex-matched controls. We found that individuals who recalled childhood trauma had poorer subjective sleep quality and longer diary-assessed sleep onset latency and wakefulness after sleep onset than controls, even after controlling for psychological distress. Differences in objective sleep parameters measured by polysomnography were not found. The childhood trauma group also had higher presleep arousal and lower high-frequency heart rate variability at rest and under distress. High-frequency heart rate variability under distress was found to be correlated with most subjective sleep parameters and objective wakefulness after sleep onset. Findings highlighted the need to investigate the potential role of dysregulation in parasympathetic activity in subjective sleep disturbance in adults recalling chronic childhood trauma.</p><p><strong>Citation: </strong>Ng AS-Y, Chan WS. Sleep and arousal in adults who recall chronic childhood trauma. <i>J Clin Sleep Med.</i> 2025;21(8):1487-1490.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1487-1490"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of psychological interventions on sleep in children and adolescents with chronic pain: a systematic review with meta-analysis of randomized controlled trials.","authors":"Tanya L Thwaite, Emma A Craige, Niamh Mundell, Daniel L Belavy, Scott D Tagliaferri, Kate Vincent, Sally A Ferguson, Madeline Sprajcer, Patrick J Owen, Grace E Vincent","doi":"10.5664/jcsm.11678","DOIUrl":"10.5664/jcsm.11678","url":null,"abstract":"<p><strong>Study objectives: </strong>Chronic pain and comorbid sleep difficulties impact many children and adolescents. This study aimed to evaluate the efficacy of psychological interventions on sleep in children and adolescents with chronic pain.</p><p><strong>Methods: </strong>Five databases (PubMed, CINAHL, APA PsychInfo, Embase, CENTRAL) were searched from inception to April 17, 2023, for randomized controlled trials examining the effects of psychological interventions on sleep in participants aged ≤ 19 years with pain persisting for ≥ 12 weeks. Six studies (participants, n = 686; 78.43% female) were included. Cochrane Risk-of-Bias 2 and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria were employed.</p><p><strong>Results: </strong>Pairwise random-effects restricted maximum likelihood meta-analysis demonstrated no effect of psychological interventions on sleep (<i>g</i> [95% confidence interval]: -0.04 [-0.19, 0.11], <i>P</i> = .613, GRADE: high), pain intensity (0.05 [-0.17, 0.27], <i>P =</i> .563, GRADE: high), depressive symptomatology (0.17 [-0.27, 0.62], <i>P =</i> .304, GRADE: moderate), or anxious symptomatology (<i>g</i>: 0.13 [-0.32, 0.57], <i>P</i> = .351, GRADE: moderate). Subjective outcomes may limit clinical utility, and risk of bias (some concern for all studies) decreased confidence in effect estimates.</p><p><strong>Conclusions: </strong>Development and evaluation of psychological interventions specifically tailored to address comorbidities of sleep difficulties in child and adolescent chronic pain populations is warranted.</p><p><strong>Systematic review registration: </strong>Registry: PROSPERO; Name: Efficacy of Psychological Interventions for Sleep in Children and Adolescents with Chronic Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials; URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023454620; Identifier: CRD42023454620.</p><p><strong>Citation: </strong>Thwaite TL, Craige EA, Mundell N, et al. Efficacy of psychological interventions on sleep in children and adolescents with chronic pain: a systematic review with meta-analysis of randomized controlled trials. <i>J Clin Sleep Med</i>. 2025;21(8):1445-1461.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1445-1461"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do children living with a chronic disease have more disturbed sleep than their healthy peers?","authors":"Cecilie Paulsrud, Steffen U Thorsen, Pernille Helms, Mia Sofie F Weis, Ajenthen G Ranjan, Poul J Jennum, Nanette Mol Debes, Jannet Svensson","doi":"10.5664/jcsm.11686","DOIUrl":"10.5664/jcsm.11686","url":null,"abstract":"<p><strong>Study objectives: </strong>Living with a chronic disease (LCD) may impact sleep in children. We aimed to compare sleep in children LCD and healthy peers.</p><p><strong>Methods: </strong>Design: Prospective study. Children and adolescents aged 6-17 years old answered the Sleep Screening Questionnaire Children and Adolescents twice and wore actigraphy (AG) for 7 nights and at-home polysomnography for 1 night. Statistics: Unpaired 2-sampled <i>t</i> tests and correlation tests.</p><p><strong>Results: </strong>We included 65 LCD and 63 healthy age-matched children. Compared to the healthy peers, the 6-12 year olds LCD showed a clear tendency toward shorter total sleep time: AG: 16.1 minutes (95% confidence interval -0.3, 32.6), Sleep Screening Questionnaire Children and Adolescents: 19.9 minutes (-0.7 to 40.5), later chronotype and chronotype score: AG: 00:25 (-00:07, 00:57) and significantly longer objectively measured sleep latency (<i>P</i> = .02). Except for a higher sleep and feeling safe subscale score, no major differences in either Sleep Screening Questionnaire Children and Adolescents or AG measures were seen between the adolescent groups (13-17 year olds). In children with type 1 diabetes, inverse correlations between total sleep time and glycated hemoglobin (AG: <i>r</i> = -.49, <i>P</i> = .01; Sleep Screening Questionnaire Children and Adolescents: <i>r</i> = -.40, <i>P</i> = .01) were evident. Further, in children with tension-type headache, a strong inverse correlation between total sleep time and monthly headache attacks (AG: <i>r</i> = -.79, <i>P</i> = .04) was also found.</p><p><strong>Conclusions: </strong>Children LCD present more sleep disturbances than healthy peers, especially in the 6-12 year olds. Sleep evaluation should be considered as part of the clinical evaluation.</p><p><strong>Citation: </strong>Paulsrud C, Thorsen SU, Helms P, et al. Do children living with a chronic disease have more disturbed sleep than their healthy peers? <i>J Clin Sleep Med</i>. 2025;21(8):1417-1424.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":"1417-1424"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}