Neurochirurgie最新文献

{"title":"Rethinking age barriers in Parkinson’s disease for deep brain stimulation","authors":"Roberto M. Franco ,&nbsp;Carolina Soares ,&nbsp;Ana Oliveira ,&nbsp;Rui Vaz ,&nbsp;Maria J. Rosas","doi":"10.1016/j.neuchi.2025.101665","DOIUrl":"10.1016/j.neuchi.2025.101665","url":null,"abstract":"<div><h3>Background</h3><div>The age cutoff for subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) has been a contentious issue. Typically, it is offered to patients younger than 70 years. This study, however, aims to compare DBS efficacy outcomes between patients with age ≥70 years and those aged &lt;70 years, potentially paving the way for a more inclusive approach to DBS in PD treatment.</div></div><div><h3>Methods</h3><div>This study is a retrospective, cross-sectional cohort study of PD patients who underwent STN-DBS between 2002 and 2019. The analysis included a comprehensive range of sociodemographic and clinical variables. The primary outcome was the reduction in Movement Disorder Society - Unified Parkinson's Disease Rating Scale part III (MDS-UDPRSIII). The secondary outcome was reduced levodopa equivalent daily dose (LEDD). The statistical analysis was performed in SPSS-25, with a stringent threshold of <em>p</em> &lt; 0.05, to reject the null hypothesis, ensuring the robustness of our findings.</div></div><div><h3>Results</h3><div>From a cohort of 360 patients with PD who underwent STN-DBS, we included 15 patients 70 years or older with a mean age of 70.4 ± 0.9 years, a mean disease duration of 13.0 ± 2.8 years, and 61 patients younger than 70 years old with a mean age of 61.2 ± 6.6 years; median disease duration of 13.0 [IQR:10.0]. No significant statistical differences were found in the MDS-UPDRS-III score on both groups at the at baseline (<em>p</em> = 0.480), at one year (<em>p</em> = 0.341) and at three years of follow-up (<em>p</em> = 0.117). In both groups, postoperative reduction of LEDD was similar (35.7 [IQR: 33.91] vs 31.6 ± 18.3); (<em>p</em> = 0.960) in patients with age 70 years or older and those younger than 70 years respectively; nevertheless, patients with 70 years or older had higher LEDD at three years (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Our study found no significant differences in the MDS-UPDRS-III in groups younger and older than 70 at baseline, at one year and at three years of follow-up. However, higher LEDD was necessary in the elderly group. This highlights the urgent need for more inclusive research to better understand the cost-effectiveness of DBS in this population. By conducting such research, we can ensure that all PD patients, regardless of age, have access to the most effective treatments.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101665"},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of parenchymal collaterals in patients with meningioma using contrast-enhanced T1 MPRAGE sequence","authors":"Elif Gozgec ,&nbsp;Hayri Ogul ,&nbsp;Ibrahim Feyyaz Naldemir ,&nbsp;Zakir Sakci ,&nbsp;Mecit Kantarci","doi":"10.1016/j.neuchi.2025.101664","DOIUrl":"10.1016/j.neuchi.2025.101664","url":null,"abstract":"<div><h3>Background</h3><div>Post-contrast T1-MPRAGE sequence has been used in routine tumor imaging at many centers for decades. Meningiomas may be accompanied by leptomeningeal as well as parenchymal collaterals. In this study, we aimed to demonstrate the collaterals that may accompany meningiomas on postcontrast T1-MPRAGE imaging and to investigate their relationship with location, size, histologic features, adjacent bone, and parenchymal changes.</div></div><div><h3>Methods</h3><div>In this study, postcontrast T1-MPRAGE images of 326 meningiomas from 259 patients were independently analyzed by two observers. The presence of parenchymal collaterals and unilateral, contralateral or bilateral localization were determined. Meningiomas' diameters, locations, presence of dural sinus invasion, associated parenchymal changes and bony changes were determined. Histologic grades were determined if applicable. The data obtained were analyzed statistically.</div></div><div><h3>Results</h3><div>Parenchymal collaterals were demonstrated in 25% of meningiomas (66/259). Of these, 65% were unilateral, 12% contralateral and 23% bilateral. There was a significant correlation between malignancy and the presence of collaterals in histologically diagnosed meningiomas (77%, <em>p</em> = 0.01). The presence of collaterals was also significantly higher in meningiomas with sinus invasion and bone destruction (<em>p</em> &lt; 0.001). As tumor size increased, unilateral and bilateral collateral development increased (<em>p</em> &lt; 0.001, <em>p</em> = 0.008, respectively), but it was not significant in contralateral cases. There was significant concordance between the observers in terms of the presence of collaterals (kappa: 0.773).</div></div><div><h3>Conclusions</h3><div>Meningiomas may be accompanied by parenchymal collaterals. WHO grade 3 histologic type, sinus invasion, bone destruction and size increase are predictors of collateral development.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101664"},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repairment of an interrupted oculomotor nerve in the cavernous sinus","authors":"Zhongding Zhang ,&nbsp;Yinda Tang ,&nbsp;Hua Zhao,&nbsp;Shiting Li","doi":"10.1016/j.neuchi.2025.101660","DOIUrl":"10.1016/j.neuchi.2025.101660","url":null,"abstract":"<div><div>Oculomotor nerve palsy following head trauma can cause eye movement disorders and severe visual problems, but it was considered to have a poor prognosis with a wide range of interventions in the past. However, we performed neuroanastomosis in a patient with isolated oculomotor nerve injury and obtained a satisfactory long-term recovery, although the short-term effect was not obvious. The clinical presentation, surgical management, and functional rehabilitation of this patient are discussed.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101660"},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of MRI in intra-operative findings for spinal meningeal diseases","authors":"Gabriele Capo ,&nbsp;Francesco Calvanese ,&nbsp;Nadim Tahhan ,&nbsp;Donato Creatura ,&nbsp;Ismail Zaed ,&nbsp;Emilia Bellina ,&nbsp;Ali Baram ,&nbsp;Francois Cotton ,&nbsp;Cédric Y. Barrey","doi":"10.1016/j.neuchi.2025.101661","DOIUrl":"10.1016/j.neuchi.2025.101661","url":null,"abstract":"<div><h3>Background</h3><div>A large variety of spinal meningeal diseases have been described in the literature, and differential diagnosis is often complex, requiring a good knowledge of the different entities and accurate neuroimaging. The purpose of this article was to depict the most relevant diagnostic features on the commonly utilized MRI sequences for the main and most frequent pathologies of the spinal arachnoid and to correlate them with intraoperative findings.</div></div><div><h3>Material and methods</h3><div>Five cases harboring each different spinal meningeal diseases were analyzed, illustrated, extensively described, and discussed: arachnoid web, arachnoiditis, idiopathic spinal cord herniation, intradural arachnoid cyst, extradural arachnoid cyst. All the cases were surgically treated in the same institution (Neurological Hospital, Lyon, France). We underlined imaging clues for differential diagnosis to help physicians to elaborate the right diagnosis and guide the surgical management.</div></div><div><h3>Results</h3><div>MRI was efficient to determine the nature of the arachnoid or/and dural disease as well as to predict precisely the intra-operative findings. Six key-radiological features were selected, helping differential diagnosis: localization (intra/extradural/both), aspect of the spinal cord (compressive effect/displacement/scalpel sign), arachnoid bride, CSF turbulent flow, vertebral scalloping, absence of gadolinium-enhancement.</div></div><div><h3>Conclusion</h3><div>MRI demonstrated excellent correlation with intra-operative findings for all the five spinal meningeal diseases analyzed. Although rare, these pathologies must be recognized by clinicians considering that appropriate treatment most often permit to relieve the symptoms.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101661"},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic transorbital approach for the management of spheno-orbital meningiomas: A systematic review and meta-analysis","authors":"Filipe Virgilio Ribeiro ,&nbsp;Marcelo Porto Sousa ,&nbsp;Bernardo Vieira Nogueira ,&nbsp;Helvécio Neves Feitosa Filho ,&nbsp;Laura Mora Montecino ,&nbsp;Lucca B. Palavani ,&nbsp;Filipi Fim Andreão ,&nbsp;Christian Ken Fukunaga ,&nbsp;Ary Rodrigues Neto ,&nbsp;Guilherme Cristiano Garcia ,&nbsp;Marcio Yuri Ferreira ,&nbsp;Herika Negri Brito ,&nbsp;Allan Dias Polverini","doi":"10.1016/j.neuchi.2025.101659","DOIUrl":"10.1016/j.neuchi.2025.101659","url":null,"abstract":"<div><h3>Introduction</h3><div>Meningioma is the most common benign tumor in the central nervous system and may arise from the sphenoid wing region. The tumor can involve the cavernous sinus medially, periorbital and orbital apex structures anteriorly, and infratemporal fossa inferiorly. Surgical approaches more currently used include the fronto-temporal approach, the pterional approach, and even the frontotemporal-orbitozygomatic approach. The results of safety and efficacy of Transorbital neuroendoscopic surgery for these cases are still unclear, with scarce literature on the subject.</div></div><div><h3>Objective</h3><div>We assessed the safety and efficacy of Endoscopic Transorbital Approach (TOA) for the Management of Spheno-Orbital Meningiomas (SOMs).</div></div><div><h3>Methods</h3><div>We searched Medline, Embase, Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95% confidence intervals under a random-effects model, I² to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥4 patients treated with endoscopic transorbital approach for the management of spheno-orbital meningioma.</div></div><div><h3>Results</h3><div>Of the 3520 studies initially identified, 9 were selected, involving 216 patients, with a median follow-up of 20 months. For subtotal resection, pooled analysis confirmed a rate of 40% (CI: 24% to 57%) and a total resection rate of 46% (CI: 27% to 65%). The analysis also confirmed a rate of visual deficits of 10% (CI: 0% to 24%). The rate of cerebrospinal fluid leak was 2% (CI: 0% to 5%), and diplopia occurred in 8% of cases (CI: 0% to 18%).</div></div><div><h3>Conclusion</h3><div>ETOA is a safe and minimally invasive approach for spheno-orbital meningiomas, with low complication rates and effective cranial nerve preservation. However, its tumor resection efficacy is inferior to non-minimally invasive techniques, potentially affecting long-term outcomes. Further studies are needed to clarify its role and optimize tumor control in selected cases.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101659"},"PeriodicalIF":1.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual reality in neurosurgery training: A tool for honing skills or a hindrance to real-world preparation?","authors":"Gonzalo Callahuanca-Flores ,&nbsp;Johnny Mendoza-Riega ,&nbsp;Cesar Guzman-Carrasco ,&nbsp;Adrian Mendoza-Perez","doi":"10.1016/j.neuchi.2025.101653","DOIUrl":"10.1016/j.neuchi.2025.101653","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 2","pages":"Article 101653"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rise of gamification in neurosurgical training","authors":"Gonzalo Callahuanca-Flores ,&nbsp;Johnny Mendoza-Riega ,&nbsp;Cesar Guzman-Carrasco ,&nbsp;Adrian Mendoza-Perez","doi":"10.1016/j.neuchi.2025.101654","DOIUrl":"10.1016/j.neuchi.2025.101654","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 2","pages":"Article 101654"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of primary decompressive craniectomy in ruptured middle cerebral artery aneurysms with intraparenchymal hematoma","authors":"Thomas Metayer ,&nbsp;Charles-Henry Mallereau ,&nbsp;Charles Peltier ,&nbsp;Chloe Dumot ,&nbsp;Florian Bernard ,&nbsp;Pierre-Jean Le Reste ,&nbsp;Anne-Laure Bernat ,&nbsp;Helene Cebula ,&nbsp;Caroline le Guerinel ,&nbsp;Denis Vivien ,&nbsp;Michel Piotin ,&nbsp;Evelyne Emery ,&nbsp;Vianney Gilard ,&nbsp;Omer Eker ,&nbsp;Roberto Riva ,&nbsp;Arthur Leclerc ,&nbsp;Elsa Magro ,&nbsp;Francois Proust ,&nbsp;Isabelle Pelissou-Guyotat ,&nbsp;Stephane Derrey ,&nbsp;Thomas Gaberel","doi":"10.1016/j.neuchi.2025.101656","DOIUrl":"10.1016/j.neuchi.2025.101656","url":null,"abstract":"<div><h3>Background</h3><div>Ruptured middle cerebral artery aneurysm (MCAa) with intraparenchymal hematoma (IPH) can benefit at the same time from evacuation of the hematoma and exclusion of the aneurysm of a decompressive craniectomy (DC). To date, there are no clear recommendations for performing a DC in such cases.</div></div><div><h3>Methods</h3><div>We retrospectively collected data from nine French neurosurgical units from January 1, 2013 to December 31, 2020. All MCAa patients with IPH requiring evacuation of the IPH were included in this study. Poor outcomes were defined by an mRs score of 3–6 at 6 months. Propensity score matching was used to analyze the potential effects of DC.</div></div><div><h3>Results</h3><div>Between January 2013 and December 2020, 198 MCAa ruptured with IPH were treated, including 162 MCAa requiring evacuation of the IPH. 50 were treated with DC and 112 without DC. After matching 72 patients, poor neurological prognosis was observed in 27/36 patients (75%) in the DC group versus 18/36 (50%) in the non-DC group (p = 0.026).</div></div><div><h3>Conclusion</h3><div>Primary decompressive craniectomy in patients with ruptured MCAa and IPH requiring surgical evacuation increases the risk of poor neurological outcome. RCT are needed to confirm this hypothesis.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 2","pages":"Article 101656"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive outcome factors in the treatment of subarachnoid hemorrhage with hematoma caused by ruptured anterior circulation aneurysms: A monocentric experience","authors":"Antoine Devalckeneer ,&nbsp;Pierre Haettel ,&nbsp;Philippe Poidevin ,&nbsp;Martin Bretzner ,&nbsp;Théo Dufresne ,&nbsp;Alexandre Poulain ,&nbsp;Tomas Menovsky ,&nbsp;Nadira Delhem ,&nbsp;Rabih Aboukaïs","doi":"10.1016/j.neuchi.2025.101655","DOIUrl":"10.1016/j.neuchi.2025.101655","url":null,"abstract":"<div><h3>Introduction</h3><div>Intracranial aneurysm (IA) rupture accounts for 3% of strokes and is associated with a concerning mortality rate. Subarachnoid hemorrhage with cerebral hematoma (CSAH) often results in a higher mortality rate; however, the optimal treatment approach remains unclear. This study aims to identify factors predicting poor outcomes and mortality in cases of CSAH due to ruptured aneurysms in the anterior cerebral circulation.</div></div><div><h3>Methods</h3><div>This study retrospectively included 102 patients with anterior circulation aneurysm ruptures, treated between 2017 and 2019. A multidisciplinary team determined the treatment strategies. Statistical analyses were performed to assess outcomes.</div></div><div><h3>Results</h3><div>In the bivariate analysis of CSAH related to anterior circulation aneurysm rupture, significant factors associated with morbidity (mRS &gt;2 at one year follow-up) and mortality were: WFNS score severity, mydriasis, Tako-Tsubo, and the presence of hydrocephalus. In the multivariate analysis, significant factors for mortality were hydrocephalus (p &lt; 0.01) and Tako-Tsubo (p &lt; 0.001), while significant factors for morbidity were hydrocephalus (p &lt; 0.01) and hematoma volume (p = 0.012).</div></div><div><h3>Conclusion</h3><div>Our study analyzed a series of cases involving CSAH from anterior circulation aneurysms. We emphasize the importance of prompt treatment for hydrocephalus and suggest that the diagnosis of Tako-Tsubo should delay but not prevent treatment. Depending on local ethical standards, treatment abstention could be considered in patients with severe WFNS scores, the presence of mydriasis, hematoma &gt;45 mL, and hydrocephalus. Our findings indicate that life-threatening hematomas are best managed surgically, while smaller, non-life-threatening cases may benefit from endovascular treatment, though further randomized trials are needed for validation.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101655"},"PeriodicalIF":1.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520612","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":"Translation and interrater reliability of the structured interview for the extended glasgow outcome scale among Moroccan patients with traumatic brain injury","authors":"Younes Iderdar,&nbsp;Soumia Marzouk,&nbsp;Nadia Al Wachami,&nbsp;Maryem Arraji,&nbsp;Karima Boumendil,&nbsp;Yassmine Mourajid,&nbsp;Amina Aquil,&nbsp;Elmadani Saad,&nbsp;Mohamed Chahboune","doi":"10.1016/j.neuchi.2025.101658","DOIUrl":"10.1016/j.neuchi.2025.101658","url":null,"abstract":"<div><h3>Objective</h3><div>The Extended Glasgow Outcome Scale (GOSE) is a commonly used assessment tool to evaluate the outcome following traumatic brain injury (TBI). This study aims to evaluate the applicability of the GOSE structured interview in the Moroccan context and to examine its reliability.</div></div><div><h3>Methods</h3><div>In this prospective validation study, we assessed the inter-rater reliability of GOSE scoring for 123 TBI patients who attended Avicenna University Hospital's outpatient unit. Interrater agreement of the GOSE was assessed, with Cohen's weighted κ, between the rater with the structured interview and the rater without the structured interview and between the rater specialized in TBI and the non-specialized rater.</div></div><div><h3>Results</h3><div>The findings demonstrated a high level of agreement (weighted kappa = 0.96) between the rater specialized in TBI and the non-specialized rater with (p &lt; 0.001) and a high level of agreement (weighted kappa = 0.85) between the rater with the structured interview and the neurosurgeon without the structured interview. The Moroccan version is capable of assessing the GOSE Score at a level similar to the original version.</div></div><div><h3>Conclusion</h3><div>The use of this version has the potential to expedite the process of evaluating outcomes in patients with TBI in both clinical practice and research settings.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 3","pages":"Article 101658"},"PeriodicalIF":1.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}