Colombia Medica最新文献

{"title":"Damage Control in Penetrating Liver Trauma: Fear of the Unknown.","authors":"Carlos A Ordoñez,&nbsp;Michael W Parra,&nbsp;Mauricio Millán,&nbsp;Yaset Caicedo,&nbsp;Mónica Guzmán-Rodríguez,&nbsp;Natalia Padilla,&nbsp;Juan Carlos Salamea-Molina,&nbsp;Alberto García,&nbsp;Adolfo González-Hadad,&nbsp;Luis Fernando Pino,&nbsp;Mario Alain Herrera,&nbsp;Fernando Rodríguez-Holguín,&nbsp;José Julián Serna,&nbsp;Alexander Salcedo,&nbsp;Gonzalo Aristizábal,&nbsp;Claudia Orlas,&nbsp;Ricardo Ferrada,&nbsp;Thomas Scalea,&nbsp;Rao Ivatury","doi":"10.25100/cm.v51i4.4422.4365","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4422.4365","url":null,"abstract":"<p><p>The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f6/1b/1657-9534-cm-51-04-e4134365.PMC7968427.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamically unstable pelvic fracture: A damage control surgical algorithm that fits your reality.","authors":"David Mejia,&nbsp;Michael W Parra,&nbsp;Carlos A Ordoñez,&nbsp;Natalia Padilla,&nbsp;Yaset Caicedo,&nbsp;Salin Pereira Warr,&nbsp;Paula Andrea Jurado-Muñoz,&nbsp;Mauricio Torres,&nbsp;Alfredo Martínez,&nbsp;José Julián Serna,&nbsp;Fernando Rodríguez-Holguín,&nbsp;Alexander Salcedo,&nbsp;Alberto García,&nbsp;Mauricio Millán,&nbsp;Luis Fernando Pino,&nbsp;Adolfo González Hadad,&nbsp;Mario Alain Herrera,&nbsp;Ernest E Moore","doi":"10.25100/cm.v51i4.4510","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4510","url":null,"abstract":"<p><p>Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/48/1657-9534-cm-51-04-e4214510.PMC7968423.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25541320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Damage control surgery: a constant evolution.","authors":"Rao Ivatury,&nbsp;David V Feliciano,&nbsp;Juan P Herrera-Escobar","doi":"10.25100/cm.v51i4.4422","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4422","url":null,"abstract":"The story of trauma resuscitation is similar to that of many other advances in medicine: described, forgotten, reinvented, ridiculed, and finally accepted. Even after acceptance, the concepts go through periods of neglect and indifference before they are tried and enhanced, till the next advance.\u0000\u0000Damage control, a strategy for management of critically injured or ill patients, is a prime example of this phenomenon. It reminds us of the famous words of Oliver Goldsmith in 1761: “for he who fights and runs away, will live to fight another day, but he who is in battle slain, will never rise and fight again”. Damage control was based on the recognition of the lethal triad of hypothermia, acidosis, and a coagulopathy resulting from massive blood loss, large-volume resuscitation and ischemia-reperfusion. It was an approach that J. Hogarth Pringle from Glasgow, Scotland, suggested in 1908 with his principles of compression and hepatic packing for control of venous hemorrhage from the injured liver: temporary, expeditious and effective. Packing, however, was rarely utilized during World War II and the Vietnam War because of the presumed risk of rebleeding with removal of the packs. The ever-difficult challenge of “non-surgical bleeding” from a coagulopathy due to massive hepatic injuries did, eventually, lead to a resurrection of the concept of perihepatic packing in the 1980s in civilian centers and became one of the initial steps in damage control for patients with severe and/or multiple intra-abdominal injuries.","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/d9/1657-9534-cm-51-04-e1014422.PMC7968432.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25539862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19: The Ivermectin African Enigma.","authors":"Rodrigo Guerrero,&nbsp;Luis Eduardo Bravo,&nbsp;Edgar Muñoz,&nbsp;Elvia Karina Grillo Ardila,&nbsp;Esteban Guerrero","doi":"10.25100/cm.v51i4.4613","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4613","url":null,"abstract":"<p><strong>Introduction: </strong>The low frequency of cases and deaths from the SARS-CoV-2 COVID-19 virus in some countries of Africa has called our attention about the unusual behavior of this disease. The ivermectin is considered a drug of choice for various parasitic and viral diseases and shown to have in vitro effects against SARS-CoV-2.</p><p><strong>Aims: </strong>Our study aimed to describe SARS-CoV2 infection and death rates in African countries that participated in an intensive Ivermectin mass campaign carried out to control onchocerciasis and compare them with those of countries that did not participate.</p><p><strong>Methods: </strong>Data from 19 countries that participated in the World Health Organization (WHO) sponsored African Programme for Onchocerciasis Control (APOC), from 1995 until 2015, were compared with thirty-five (Non-APOC), countries that were not included. Information was obtained from https://www.worldometers.info/coronavirus/ database. Generalized Poisson regression models were used to obtain estimates of the effect of APOC status on cumulative SARS-CoV-2 infection and mortality rates.</p><p><strong>Results: </strong>After controlling for different factors, including the Human Development Index (HDI), APOC countries (vs. non-APOC), show 28% lower mortality (0.72; 95% CI: 0.67-0.78) and 8% lower rate of infection (0.92; 95% CI: 0.91-0.93) due to COVID-19.</p><p><strong>Conclusions: </strong>The incidence in mortality rates and number of cases is significantly lower among the APOC countries compared to non-APOC countries. That a mass public health preventive campaign against COVID-19 may have taken place, inadvertently, in some African countries with massive community ivermectin use is an attractive hypothesis. Additional studies are needed to confirm it.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/81/1657-9534-cm-51-04-e2014613.PMC7968425.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Damage Control: The Management of Volume, Temperature… and Bleeding!","authors":"Juan José Meléndez-Lugo,&nbsp;Yaset Caicedo,&nbsp;Mónica Guzmán-Rodríguez,&nbsp;José Julián Serna,&nbsp;Juliana Ordoñez,&nbsp;Edison Angamarca,&nbsp;Alberto García,&nbsp;Luis Fernando Pino,&nbsp;Laureano Quintero,&nbsp;Michael W Parra,&nbsp;Carlos A Ordoñez","doi":"10.25100/cm.v51i4.4486","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4486","url":null,"abstract":"<p><p>Damage control resuscitation should be initiated as soon as possible after a trauma event to avoid metabolic decompensation and high mortality rates. The aim of this article is to assess the position of the Trauma and Emergency Surgery Group (CTE) from Cali, Colombia regarding prehospital care, and to present our experience in the implementation of the \"Stop the Bleed\" initiative within Latin America. Prehospital care is phase 0 of damage control resuscitation. Prehospital damage control must follow the guidelines proposed by the \"Stop the Bleed\" initiative. We identified that prehospital personnel have a better perception of hemostatic techniques such as tourniquet use than the hospital providers. The use of tourniquets is recommended as a measure to control bleeding. Fluid management should be initiated using low volume crystalloids, ideally 250 cc boluses, maintaining the principle of permissive hypotension with a systolic blood pressure range between 80- and 90-mm Hg. Hypothermia must be management using warmed blankets or the administration of intravenous fluids warmed prior to infusion. However, these prehospital measures should not delay the transfer time of a patient from the scene to the hospital. To conclude, prehospital damage control measures are the first steps in the control of bleeding and the initiation of hemostatic resuscitation in the traumatically injured patient. Early interventions without increasing the transfer time to a hospital are the keys to increase survival rate of severe trauma patients.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/0a/1657-9534-cm-51-04-e4024486.PMC7968431.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic damage control: the pancreas is simple don't complicate it.","authors":"Carlos A Ordoñez, Michael W Parra, Mauricio Millán, Yaset Caicedo, Natalia Padilla, Mónica Guzmán-Rodríguez, Fernando Miñan-Arana, Alberto García, Adolfo González-Hadad, Luis Fernando Pino, Fernando Rodríguez-Holguin, José Julián Serna, Alexander Salcedo, Ricardo Ferrada, Rao Ivatury","doi":"10.25100/cm.v51i4.4361","DOIUrl":"10.25100/cm.v51i4.4361","url":null,"abstract":"<p><p>Pancreatic trauma is a rare but potentially lethal injury because often it is associated with other abdominal organ or vascular injuries. Usually, it has a late clinical presentation which in turn complicates the management and overall prognosis. Due to the overall low prevalence of pancreatic injuries, there has been a significant lack of consensus among trauma surgeons worldwide on how to appropriately and efficiently diagnose and manage them. The accurate diagnosis of these injuries is difficult due to its anatomical location and the fact that signs of pancreatic damage are usually of delayed presentation. The current surgical trend has been moving towards organ preservation in order to avoid complications secondary to exocrine and endocrine function loss and/or potential implicit post-operative complications including leaks and fistulas. The aim of this paper is to propose a management algorithm of patients with pancreatic injuries via an expert consensus. Most pancreatic injuries can be managed with a combination of hemostatic maneuvers, pancreatic packing, parenchymal wound suturing and closed surgical drainage. Distal pancreatectomies with the inevitable loss of significant amounts of healthy pancreatic tissue must be avoided. General principles of damage control surgery must be applied when necessary followed by definitive surgical management when and only when appropriate physiological stabilization has been achieved. It is our experience that viable un-injured pancreatic tissue should be left alone when possible in all types of pancreatic injuries accompanied by adequate closed surgical drainage with the aim of preserving primary organ function and decreasing short and long term morbidity.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/7b/1657-9534-cm-51-04-e4164361.PMC7968433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25541319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Damage control resuscitation: REBOA as the new fourth pillar.","authors":"Carlos A Ordoñez,&nbsp;Michael W Parra,&nbsp;José Julián Serna,&nbsp;Fernando Rodríguez-Holguin,&nbsp;Alberto García,&nbsp;Alexander Salcedo,&nbsp;Yaset Caicedo,&nbsp;Natalia Padilla,&nbsp;Luis Fernando Pino,&nbsp;Adolfo González Hadad,&nbsp;Mario Alain Herrera,&nbsp;Mauricio Millán,&nbsp;Laureano Quintero-Barrera,&nbsp;Fabian Hernández-Medina,&nbsp;Ricardo Ferrada,&nbsp;Megan Brenner,&nbsp;Todd Rasmussen,&nbsp;Thomas Scalea,&nbsp;Rao Ivatury,&nbsp;John B Holcomb","doi":"10.25100/cm.v51i4.4353","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4353","url":null,"abstract":"<p><p>Damage Control Resuscitation (DCR) seeks to combat metabolic decompensation of the severely injured trauma patient by battling on three major fronts: Permissive Hypotension, Hemostatic Resuscitation, and Damage Control Surgery (DCS). The aim of this article is to perform a review of the history of DCR/DCS and to propose a new paradigm that has emerged from the recent advancements in endovascular technology: The Resuscitative Balloon Occlusion of the Aorta (REBOA). Thanks to the advances in technology, a bridge has been created between Pre-hospital Management and the Control of Bleeding described in Stage I of DCS which is the inclusion and placement of a REBOA. We have been able to show that REBOA is not only a tool that aids in the control of hemorrhage, it is also a vital tool in the hemodynamic resuscitation of a severely injured blunt and/or penetrating trauma patient. That is why we propose a new paradigm \"The Fourth Pillar\": Permissive Hypotension, Hemostatic Resuscitation, Damage Control Surgery and REBOA.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/3a/1657-9534-cm-51-04-e4014353.PMC7968430.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-body computed tomography is safe, effective and efficient in the severely injured hemodynamically unstable trauma patient.","authors":"Carlos A Ordoñez,&nbsp;Michael W Parra,&nbsp;Alfonso Holguín,&nbsp;Carlos García,&nbsp;Mónica Guzmán-Rodríguez,&nbsp;Natalia Padilla,&nbsp;Yaset Caicedo,&nbsp;Claudia Orlas,&nbsp;Alberto García,&nbsp;Fernando Rodríguez-Holguín,&nbsp;José Julián Serna,&nbsp;Carlos Serna","doi":"10.25100/cm.v51i4.4362","DOIUrl":"https://doi.org/10.25100/cm.v51i4.4362","url":null,"abstract":"<p><p>Trauma is a complex pathology that requires an experienced multidisciplinary team with an inherent quick decision-making capacity, given that a few minutes could represent a matter of life or death. These management decisions not only need to be quick but also accurate to be able to prioritize and to efficiently control the injuries that may be causing impending hemodynamic collapse. In essence, this is the cornerstone of the concept of damage control trauma care. With current technological advances, physicians have at their disposition multiple diagnostic imaging tools that can aid in this prompt decision-making algorithm. This manuscript aims to perform a literature review on this subject and to share the experience on the use of whole body computed tomography as a potentially safe, effective and efficient diagnostic tool in cases of severely injured trauma patients regardless of their hemodynamic status. Our general recommendation is that, when feasible, perform a whole body computed tomography without interrupting ongoing hemostatic resuscitation in cases of severely injured trauma patients with or without signs of hemodynamic instability. The use of this technology will aid in the decision-making of the best surgical approach for these patients without incurring any delay in definitive management and/or increasing significantly their radiation exposure.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/f3/1657-9534-cm-51-04-e4054362.PMC7968424.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25540295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internal carotid artery thrombosis in COVID 19.","authors":"Yadira Álvarez Moreno, Janeth Bú Figueroa, Efraín Bú Figueroa, Marco Soto Fonseca, Javier Escober Torres","doi":"10.25100/cm.v51i3.4560","DOIUrl":"10.25100/cm.v51i3.4560","url":null,"abstract":"<p><strong>Case description: </strong>37-year-old female with PCR-RT swab for COVID-19 positive, with neurological manifestation as a result of internal carotid artery occlusion.</p><p><strong>Clinical findings: </strong>Nasal congestion and sneezing of 5 days duration; pulsatile headache in the left hemicranium 3 days prior to admission, with intensity 6/10 according to the visual analogue scale, accompanied by phosphenes, photophobia and diplopia; with subsequent developing right hemiparesis over a 26-hour period.</p><p><strong>Treatment and result: </strong>She was given medical management with oral antiplatelet agents and anticoagulants (subcutaneous and oral) during his hospitalization, it was not possible to perform thrombolysis and thrombectomy due to the high risk of complications. He was discharged at 14 days, without functional limitation, symmetrical strength in upper and lower limbs, bilateral visual acuity 20/20, denying headache.</p><p><strong>Clinical relevance: </strong>The case presented here describes a pattern in how data supporting an association between COVID-19 and stroke in young populations with or without typical vascular risk factors, sometimes with only mild respiratory symptoms, is increasing. Prospective studies are required to further evaluate this association, as well as anticoagulation studies to prevent these potentially life-threatening events.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/ab/1657-9534-cm-51-03-e504560.PMC7744109.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38786525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pandemics and the development of scientific methods in the history of epidemiology.","authors":"Alfredo Morabia","doi":"10.25100/cm.v50i3.4556","DOIUrl":"https://doi.org/10.25100/cm.v50i3.4556","url":null,"abstract":"","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/92/1657-9534-cm-51-03-e104564.PMC7744110.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38784636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}