Circulation Journal最新文献

{"title":"Complete Low-Voltage Area Ablation in Persistent Atrial Fibrillation　- Post Hoc Subanalysis of the SUPPRESS-AF Trial.","authors":"Yasuharu Matsunaga-Lee, Yasuyuki Egami, Masaru Abe, Hiroaki Nohara, Shodai Kawanami, Koji Yasumoto, Naotaka Okamoto, Masamichi Yano, Masami Nishino, Masaharu Masuda, Akihiro Sunaga, Nobuaki Tanaka, Tetsuya Watanabe, Hitoshi Minamiguchi, Takafumi Oka, Tomoko Minamisaka, Takashi Kanda, Masato Okada, Masato Kawasaki, Yasuhiro Matsuda, Koji Tanaka, Nobuhiko Makino, Hirota Kida, Shungo Hikoso, Tomoharu Dohi, Koichi Inoue, Yohei Sotomi, Yasushi Sakata","doi":"10.1253/circj.CJ-26-0033","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0033","url":null,"abstract":"<p><strong>Background: </strong>Incomplete low-voltage area (LVA) ablation may confound evaluation of its true efficacy in persistent atrial fibrillation (AF). This post hoc subanalysis of the multicenter randomized SUPPRESS-AF trial assessed the impact of complete LVA ablation.</p><p><strong>Methods and results: </strong>Patients with persistent AF and a left atrial (LA) LVA ≥5 cm²after pulmonary vein isolation were randomized to LVA ablation or no additional ablation. The primary endpoint was freedom from AF or atrial tachycardia recurrence, assessed by 24-h Holter and twice-daily electrocardiogram recordings. Outcomes were compared among 3 groups: no LVA ablation; complete LVA ablation; and incomplete LVA ablation. Among 341 patients, 170 underwent LVA ablation, including 37 with incomplete. LVA size was significantly larger in the incomplete than complete ablation group (22.0 vs. 12.2 cm²; P<0.001). Incomplete LVA ablation was not associated with increased arrhythmia recurrence. Arrhythmia-free survival did not differ significantly between the complete and no LVA ablation groups (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.56-1.13), including after propensity score matching (HR 0.76; 95% CI 0.51-1.15). However, a trend towards greater benefit of complete LVA ablation was observed with increasing LA diameter (P_interaction=0.099).</p><p><strong>Conclusions: </strong>Leaving LVA ablation incomplete to avoid complications appears reasonable. Although complete LVA ablation showed no overall superiority, LA enlargement may represent a clinically relevant factor for patient stratification.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845591","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":"Interhospital Image Sharing for Cardiovascular Emergencies　- Results of a Nationwide Survey on Current Adoption.","authors":"Nobuyoshi Azuma, Hitoshi Yokoyama, Mitsuaki Isobe, Yasushi Sakata, Shigeki Kushimoto, Naoto Morimura, Takashi Hasegawa, Kenichi Tsujita, Yoshikatsu Saiki, Noboru Motomura, Yoshihiro Morino, Shungo Hikoso, Katsuki Okada, Hitoshi Ogino, Shinji Miyamoto, Hiroyuki Kamiya, Kazuhiro Sase, Hiroshi Ohtsu, Noriyasu Morikage, Kimihiro Komori, Yuichi Ueda","doi":"10.1253/circj.CJ-25-1153","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-1153","url":null,"abstract":"<p><strong>Background: </strong>The use of information and communication technology (ICT) as a strategy to improve the quality of emergency medical care is gaining attention. A survey was conducted to investigate the extent to which ICT is being used in cardiovascular emergencies.</p><p><strong>Methods and results: </strong>A web-based questionnaire survey targeting cardiovascular surgery, cardiology, and emergency medicine departments at 320 facilities was conducted. The survey questions focused primarily on the presence and effectiveness of image sharing between hospitals and information sharing with emergency technicians using ICT, challenges in the use of ICT, and barriers hindering ICT adoption. The adoption rates of ICT for image sharing in cardiovascular surgery and electrocardiogram transmission in cardiology were 24% and 28%, respectively. ICT implementation was evaluated as being highly useful not only for reducing time to treatment but also for improving collaboration between medical professionals both within and outside the hospital. In emergency medicine, ICT collaboration with emergency technicians was implemented at 38% of hospitals, with image sharing at the emergency scene being prevalent. In cardiovascular surgery, 29% of facilities reported that the number of non-urgent transfers decreased or decreased significantly due to ICT implementation.</p><p><strong>Conclusions: </strong>Although ICT utilization remains at 20-25%, expectations for its widespread adoption are extremely high. Conversely, concerns about the costs and differences in ICT platforms are common, and there is a desire to adopt compatible systems.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845599","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":"Sinus Rhythm Maintenance After Pulsed-Field Ablation Is Associated With Improved Right Ventricular-Pulmonary Artery Coupling Without Significant Increase in Pulmonary Artery Pressure.","authors":"Akio Chikata, Takeshi Kato, Shuhei Fujita, Kazuo Usuda, Michiro Maruyama, Kan-Ichi Otowa, Takashi Kusayama, Kenshi Hayashi, Masayuki Takamura","doi":"10.1253/circj.CJ-26-0044","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0044","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is associated with disrupted right ventricular-pulmonary artery (RV-PA) coupling. Pulsed-field ablation (PFA) is less likely to induce an increase in pulmonary arterial pressure; however, changes in RV-PA coupling following AF ablation using PFA remain unclear.</p><p><strong>Methods and results: </strong>We retrospectively analyzed consecutive patients who underwent AF ablation using PFA. RV-PA coupling was assessed using the echocardiographic tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio before and 3 months after ablation. In all, 103 patients were included in this study: 46 with paroxysmal AF (PAF) and 57 with persistent AF (PeAF), with 41 PeAF patients maintaining sinus rhythm (SR) at 3 months. The TAPSE/PASP ratio improved significantly after AF ablation using PFA in the overall cohort (mean [±SD] 0.794±0.313 vs. 0.906±0.294; P=0.009) and in PeAF patients (0.740±0.343 vs. 0.887±0.282, P=0.01); however, no significant change was observed in PAF patients (P=0.26). PASP did not increase after ablation in any group. Among PeAF patients maintaining SR at 3 months, baseline mean heart rate during AF showed a weak association with changes in the TAPSE/PASP ratio.</p><p><strong>Conclusions: </strong>AF ablation using PFA was associated with an improvement in RV-PA coupling without an increase in pulmonary arterial pressure, particularly in patients with PeAF in whom SR was maintained at 3 months.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787835","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":"Mac-2 Binding Protein Glycosylation Isomer (M2BPGi) Reflects Global Pathophysiology and Predicts All-Cause Morbidity and Mortality in Patients With Fontan Circulation.","authors":"Hideo Ohuchi, Aki Mori, Yoshihito Morimoto, Yoshiaki Kato, Kazuto Fujimoto, Toru Iwasa, Isao Shiraishi, Kenichi Kurosaki, Michikazu Nakai","doi":"10.1253/circj.CJ-25-1183","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-1183","url":null,"abstract":"<p><strong>Background: </strong>Mac-2 binding protein glycosylation isomer (M2BPGi) is a validated biomarker for liver fibrosis in chronic liver disease. We investigated the clinical significance of serum M2BPGi concentrations in patients with Fontan circulation.</p><p><strong>Methods and results: </strong>We prospectively measured serum M2BPGi concentrations in 426 consecutive Fontan patients (mean [±SD] age 23±10 years) and analyzed their associations with patients' pathophysiology, including Fontan-associated liver disease (FALD), as well as all-cause unplanned hospitalization (UPH) and mortality. M2BPGi concentrations were associated with a wide range of Fontan-related pathophysiological features, including characteristic Fontan hemodynamics, total bile acid concentrations, FALD indices such as hepatic fibrosis markers and ultrasonographic image abnormalities, and impaired renal function. Among these variables, older age at Fontan operation, hypoxemia, C-reactive protein, total bile acid levels, and indices of hepatic fibrosis were independently associated with higher M2BPGi concentrations (P<0.05-0.001). During follow-up after the M2BPGi evaluation, 68 patients experienced UPH and 14 patients died. Elevated M2BPGi concentrations were associated with a higher risk of UPH and all-cause mortality (P<0.0001 for both), independent of elevated B-type natriuretic peptide levels.</p><p><strong>Conclusions: </strong>Serum M2BPGi concentrations reflect both FALD pathophysiology and hemodynamic burden, serving as a strong prognostic biomarker. M2BPGi can be a valuable tool for risk stratification in patients with Fontan failure, including those with FALD.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788098","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":"Prediction of Atrial Fibrillation Using Artificial Intelligence-Enhanced Electrocardiography　- Does Left Atrial Size Matter?","authors":"Naomi Hirota, Shinya Suzuki, Jun Motogi, Tsuneo Takayanagi, Takuya Umemoto, Hiroshi Nakai, Takuto Arita, Naoharu Yagi, Mikio Kishi, Hiroto Kano, Shunsuke Matsuno, Yuko Kato, Takayuki Otsuka, Junji Yajima, Tokuhisa Uejima, Yuji Oikawa, Takeshi Yamashita","doi":"10.1253/circj.CJ-25-1151","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-1151","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence-enhanced electrocardiography (AI-ECG) for detecting atrial fibrillation (AF) using sinus rhythm ECGs has shown promise. However, even when AI-ECG results are positive, ECG confirmation of AF may not always be obtained immediately. Repeat testing may be required, particularly in patients with a dilated left atrium, who may warrant more intensive monitoring. We aimed to investigate whether newly detected AF was frequent in patients with both high risk on AI-ECG evaluation and dilated left atrium.</p><p><strong>Methods and results: </strong>We used a convolutional neural network-based ECG algorithm to predict AF using data (2010-2022) from the Shinken database (n=12,595 patients without a prior AF event). The 3-year incidence of newly detected AF was compared across 3 left atrial diameter (LAD) categories: <35, 35-39, and ≥40 mm (small, middle, and large, respectively). Patients were stratified by the AI-ECG-generated diagnostic probability of AF (AIECG-AF-DP). The incidence of newly detected AF increased according to LAD category among patients with high (≥0.8) vs. low (<0.8) AIECG-AF-DP: 3.2 vs. 0.5%/year for small; 6.1 vs. 0.6%/year for middle, and 11.6 vs. 1.5%/year for large, respectively (all P<0.001). Although the area under the receiver operating characteristic curve was similar across LAD categories of <35, 35-39, and ≥40 mm (0.770, 0.753, and 0.784, respectively), the area under the precision-recall curve differed markedly (0.083, 0.114, and 0.236, respectively).</p><p><strong>Conclusions: </strong>Newly detected AF was particularly frequent in patients with both high AIECG-AF-DP and large LAD, suggesting repeated AF screening may be warranted in this population.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788149","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":"End-Diastolic vs. 1-mm Analysis in Serial Intravascular Ultrasound Studies　- Accuracy or Efficiency?","authors":"Shinnosuke Kikuchi, Kiyoshi Hibi","doi":"10.1253/circj.CJ-26-0207","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0207","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788140","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":"Prognostic Value of Mid-Range QRS Duration in Patients With Heart Failure With Reduced Ejection Fraction.","authors":"Shota Saito, Taro Temma, Toshiyuki Nagai, Motoki Nakao, Isao Yokota, Atsushi Tada, Taro Koya, Suguru Ishizaka, Yoshifumi Mizuguchi, Fusako George, Yoshiya Kato, Yuki Takahashi, Shogo Imagawa, Ko Motoi, Yusuke Tokuda, Junichi Matsumoto, Masashige Takahashi, Hiroshi Okamoto, Masaharu Machida, Takahiko Saito, Toshihiro Shimizu, Toshihisa Anzai","doi":"10.1253/circj.CJ-25-1084","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-1084","url":null,"abstract":"<p><strong>Background: </strong>Prolonged QRS is an established marker of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic significance of modest QRS prolongation (120-149 ms; mid-range QRS) remains unclear, especially in patients without cardiac implantable electronic devices (CIEDs). This study assessed the natural prognosis associated with mid-range QRS compared with narrow QRS (<120 ms) in a recent Asian cohort of patients with HFrEF.</p><p><strong>Methods and results: </strong>We analyzed patients with HFrEF from the Epidemiological Multicenter Study for Tailored Treatment in Heart Failure (ELMSTAT-HF; January 2020-October 2023). QRS was measured from 12-lead electrocardiograms. Patients with wide QRS (≥150 ms) or CIEDs were excluded. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations. Multivariable Cox models adjusted for the MAGGIC risk score and log-transformed N-terminal pro B-type natriuretic peptide were used. Among 415 patients, 328 had narrow QRS and 87 had mid-range QRS. Over a median follow-up of 547 days, the primary outcome occurred more frequently in the mid-range QRS group (34.5% vs. 12.5%; P<0.001). Mid-range QRS remained independently associated with adverse outcomes (hazard ratio 3.12; 95% confidence interval 1.91-5.11), consistent across non-left bundle branch block (LBBB) and LBBB subgroups.</p><p><strong>Conclusions: </strong>Mid-range QRS is an independent predictor of adverse outcomes in HFrEF, even in the absence of LBBB.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787622","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":"Cardiovascular, Kidney, and Metabolic Network Medicine　- Past, Present, and Future Challenges and Directions.","authors":"Atsushi Tanaka","doi":"10.1253/circj.CJ-26-0129","DOIUrl":"10.1253/circj.CJ-26-0129","url":null,"abstract":"<p><p>Over the past decade, there have been significant advances in pharmacotherapy for cardiovascular diseases and related health conditions. In particular, numerous large-scale clinical trials have been conducted internationally, and remarkable progress has been made in several disease-modifying medications for diabetes, chronic kidney disease, and heart failure. These research trends have driven dynamic changes in treatment guidelines and clinical practice. At the same time, this era has given rise to the concept of cardiovascular-kidney-metabolic (CKM) syndrome, which represents a transformative shift in understanding the complex pathophysiology and therapeutics of relevant health conditions. Positioning this framework as part of a unified disease continuum could promote early intervention, multidisciplinary care, and more effective prevention and treatment strategies. Although challenges remain in validating the CKM syndrome framework and implementing the care model in Japan, this concept may provide a unique clinical tool for addressing the globally increasing burden of cardiovascular, kidney, and metabolic health issues. This review discusses the current understanding of CKM syndrome and introduces the author's research contributions related to CKM network medicine.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"449-457"},"PeriodicalIF":3.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500435","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":"Non-Home Discharge After Endovascular Therapy for Chronic Limb-Threatening Ischemia　- Insights From a Japanese Nationwide Registry.","authors":"Yosuke Hata, Osamu Iida, Mitsuyoshi Takahara, Shun Kohsaka, Takuya Haraguchi, Kazunori Horie, Toshiaki Mano, Tetsuya Amano, Ken Kozuma","doi":"10.1253/circj.CJ-25-0698","DOIUrl":"10.1253/circj.CJ-25-0698","url":null,"abstract":"<p><strong>Background: </strong>Non-home discharge (NHD) after endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI) signals frailty and higher healthcare costs.</p><p><strong>Methods and results: </strong>The nationwide J-EVT Registry (2021-2023) captured data for 31,025 patients with CLTI who underwent EVT. NHD, defined as transfer to chronic-care hospitals, occurred in 12.9%. Independent predictors of NHD were age ≥70 years, non-ambulatory status, and perioperative complications.</p><p><strong>Conclusions: </strong>Because 1 in 8 Japanese CLTI patients required NHD after EVT, risk stratification and minimizing procedural invasiveness are essential to improve home-discharge rates.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"559-561"},"PeriodicalIF":3.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558125","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":"Lipid Variability and the Risk of Incident Peripheral Artery Disease.","authors":"Ying-Chang Tung, Tsung-Han Tsai, Yu-Jui Hsieh, Tzyy-Jer Hsu, Fu-Chih Hsiao, Chia-Pin Lin, Pao-Hsien Chu","doi":"10.1253/circj.CJ-25-0504","DOIUrl":"10.1253/circj.CJ-25-0504","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence highlights the clinical significance of lipid variability in cardiovascular disease and adverse outcomes. This study investigated the relationship between lipid variability and incident peripheral artery disease (PAD) risk.</p><p><strong>Methods and results: </strong>We identified 93,948 patients in the Chang Gung Research Database in Taiwan who had been diagnosed with hyperlipidemia between 2007 and 2013 and had annual lipid measurements over 4 consecutive years. Lipid levels, including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides, as well as their visit-to-visit variability, were assessed over the 4-year period. Patients were followed until December 31, 2019 for incident PAD development. Over a mean 5.9-year follow-up, 2,735 patients (2.5%) developed PAD. Mean lipid levels were significantly associated with incident PAD. Of note, the average real variability (ARV) in HDL-C was independently associated with increased PAD risk (adjusted hazard ratio 1.13; 95% confidence interval 1.004-1.27 for highest vs. lowest quartile of HDL-C ARV; P for trend=0.002). Sensitivity analysis using variability independent of the mean as the HDL-C variability index confirmed this finding. Consistency was observed across all subgroup analyses.</p><p><strong>Conclusions: </strong>In this multi-institutional database analysis, visit-to-visit variability in HDL-C was significantly associated with the risk of incident PAD, independent of traditional risk factors for atherosclerosis, mean lipid levels, and the use of lipid-lowering therapy.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"502-512"},"PeriodicalIF":3.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507921","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}