Operative Neurosurgery最新文献

{"title":"Endoscopic-Assisted Microsurgical Removal of a Tectal Plate Pilocytic Astrocytoma Through the Occipital Inter Hemispheric Transtentorial Approach: 2-Dimensional Operative Video.","authors":"Sorin Aldea, Samiya Abi Jaoudé, Caroline Le Guérinel","doi":"10.1227/ons.0000000000001271","DOIUrl":"10.1227/ons.0000000000001271","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":"28 3","pages":"439"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416125","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":"Interhemispheric Transcallosal Approach for Resection of a Pineal Region Third Ventricular to Brainstem Tumor: 2-Dimensional Operative Video.","authors":"Xiaopeng Guo, Mitali Bose, Matthew Toczylowski, Adriana Fonseca, Wenya Linda Bi","doi":"10.1227/ons.0000000000001517","DOIUrl":"https://doi.org/10.1227/ons.0000000000001517","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469977","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":"Acute Venous Outflow Obstruction After Coil Embolization of Giant Cavernous Carotid Aneurysm: 2-Dimensional Operative Video.","authors":"Andrew M Falzon, Ahmed Abdelghafar, Roshawn Jamasi, Timo Krings","doi":"10.1227/ons.0000000000001513","DOIUrl":"https://doi.org/10.1227/ons.0000000000001513","url":null,"abstract":"<p><strong>Background and importance: </strong>Endovascular treatment of giant carotid cavernous aneurysms (GCCAs) may be associated with complications including rapid intrasaccular thrombosis, embolic ischemic stroke, and caroticocavernous fistula.</p><p><strong>Clinical presentation: </strong>A female in her 6th decade presented with a chronic, right partial abducens nerve palsy. Magnetic resononance angiography demonstrated a 25-mm right GCCA causing mass effect on the right cavernous sinus. Coil embolization of the aneurysm and parent vessel was performed after passing a balloon test occlusion. Final angiography demonstrated complete embolization of the aneurysm, however, absent ipsilateral cavernous sinus drainage, which was present previously. Intraprocedurally, the patient had ipsilateral proptosis and chemosis. Once extubated, urgent ophthalmology review documented preserved and symmetrical visual acuity with both pupils reactive to light. Intraocular pressure was 19-mm and 11-mm Hg in the right and left eye, respectively. The right eye had -2 abduction with otherwise intact extraocular movements. Acute management included a total of 16-mg IV dexamethasone on day 1, followed by a course of oral steroids and prophylactic low molecular weight heparin. Postprocedure computed tomography of the head demonstrated periorbital soft tissue edema and dilatation of the right superior ophthalmic vein, which peaked at 6 hours postprocedure. The patients' ocular findings and visual disturbances subsided within 36 hours postprocedure. The chronic partial abducens nerve palsy remained.</p><p><strong>Conclusion: </strong>Acute proptosis, chemosis, and visual disturbances may occur from mass effect on the cavernous sinus with venous outflow obstruction after GCCA embolization. This is thought to be secondary to increased mass effect from intrasaccular thrombosis and the large coil mass.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469903","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":"How Good is Neurosurgical Training? Validation of a Perfused Microsurgical Aneurysm Training Simulator Using a Modified Objective Structured Assessment of Aneurysm Clipping Skills Score and Indocyanine Green Angiography.","authors":"Julius Reiser, Amir Amini, Vanessa M Swiatek, Firat Taskaya, Sifian Al-Hamid, Klaus-Peter Stein, Ali Rashidi, I Erol Sandalcioglu, Belal Neyazi","doi":"10.1227/ons.0000000000001515","DOIUrl":"https://doi.org/10.1227/ons.0000000000001515","url":null,"abstract":"<p><strong>Background and objectives: </strong>The training of cerebrovascular neurosurgeons faces significant challenges, particularly due to the decreasing volume of aneurysm clipping procedures. Traditional training methods rely heavily on clinical case availability, which limits skill development. This study aimed to implement and validate a Microsurgical Aneurysm Training Simulator (MATS) that offers a comprehensive, realistic, and cost-effective solution for neurosurgical training.</p><p><strong>Methods: </strong>MATS was designed using semiautomated algorithms and additive manufacturing to replicate a bifurcation aneurysm of the middle cerebral artery. The simulator includes a pulsatile perfusion system and is compatible with indocyanine-green angiography. The simulation was evaluated by medical students, residents, and experienced neurosurgeons through face, content, and construct validity assessments. Performance was measured using a modified Objective Structured Assessment of Aneurysm Clipping Skills.</p><p><strong>Results: </strong>MATS demonstrated high face and content validity, particularly in replicating the visual and procedural aspects of aneurysm clipping. Participants across all experience levels showed significant improvements in modified Objective Structured Assessment of Aneurysm Clipping Skills scores, with medical students displaying the most pronounced learning curve. The simulators compatibility with indocyanine green angiography was confirmed, though limitations were noted in replicating physiological perfusion pressures and the visual impact of subarachnoid hemorrhage during aneurysm rupture simulations.</p><p><strong>Conclusion: </strong>MATS is a validated, cost-effective, and reproducible tool that significantly enhances neurosurgical training by improving technical skills, especially in inexperienced participants. While the simulator effectively mimics key aspects of aneurysm surgery, further research is needed to assess its predictive validity and its potential impact on actual surgical outcomes.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469974","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":"Augmentation of Ipsilateral Middle Meningeal Artery Embolization After Unilateral Chronic Subdural Hematoma Evacuation Using a Contralateral Approach: A Case Series of 26 Consecutive Patients.","authors":"Jessica K Campos, Benjamen M Meyer, Fahad J Laghari, David A Zarrin, M Waqas Khan, Jonathan Collard de Beaufort, Gizal Amin, Ashish Ramesh, Narlin B Beaty, Shuichi Suzuki, Matthew T Bender, Geoffrey P Colby, Alexander L Coon","doi":"10.1227/ons.0000000000001525","DOIUrl":"https://doi.org/10.1227/ons.0000000000001525","url":null,"abstract":"<p><strong>Background and objectives: </strong>After surgical drainage of a chronic subdural hematoma (cSDH), middle meningeal artery (MMA) embolization aids in preventing the revascularization of the cSDH membranes at the capillary level and, in turn, reaccumulation. With the MMA circulation ipsilateral to the surgical side often being disrupted, there is recruitment of collaterals from the contralateral MMA tree to the ipsilateral cSDH membranes. The aim of this study was to demonstrate the ability of additive contralateral liquid embolic (LE) injection after ipsilateral surgery to augment MMA embolization. We hypothesized that contralateral LE injection may provide additional MMA embolization to the affected ipsilateral side and increase response to treatment.</p><p><strong>Methods: </strong>Consecutive cases of unilateral cSDH surgery with ipsilateral MMA embolization and additive contralateral LE injection were retrospectively identified from a prospectively maintained database of the senior authors.</p><p><strong>Results: </strong>Over the study period, 26 consecutive cases of recurrent cSDH after unilateral surgery were identified. There was an average age of 73 ± 2.7 years (range 27-90 years), and 14 patients (54%) were female. All 26 patients (100%) had previous burr holes or a craniotomy. The average cSDH thickness after surgery and before embolization was 10 ± 0.3 mm, and the average midline shift was 3.5 ± 0.7 mm. Of the 26 patients who underwent bilateral MMA embolization, 96% had over-the-top contralateral-to-ipsilateral LE injection and penetration, providing additional embolization to membranes of the index ipsilateral cSDH. The average cSDH thickness on follow-up was 4 ± 5 mm and midline shift of 0.2 ± 0.7 mm. Complete cSDH resolution was achieved in 7 patients (39%). Two patients had cSDH recurrence, one of which required reoperation. There were no LE or catheter-related complications.</p><p><strong>Conclusion: </strong>Contralateral MMA embolization in patients who have undergone ipsilateral cSDH evacuation and traditional ipsilateral MMA embolization allows for over-the-top LE penetration of cSDH membranes, thereby further augmenting the desired ipsilateral MMA embolization.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469914","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":"Bow Hunter's Syndrome: Illustrative Notes and Anatomical Considerations for Surgical Management in a Pediatric Patient: 2-Dimensional Operative Video.","authors":"Lucinda Chiu, Jillian Plonsker, Ali Shaibani, Megan Barry, Jonathan Scoville, Sandi Lam","doi":"10.1227/ons.0000000000001531","DOIUrl":"https://doi.org/10.1227/ons.0000000000001531","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469969","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":"Comparison of Sagittal Plane Correction With \"Bullet\" Versus \"Banana\" Type Transforaminal Lumbar Interbody Fusion Devices.","authors":"Zach Pennington, Abdelrahman Hamouda, Michael Martini, Rahul Kumar, Anthony L Mikula, Maria Astudillo Potes, Mohamad Bydon, Michelle J Clarke, William E Krauss, Ahmad N Nassr, Brett A Freedman, Arjun S Sebastian, Jeremy L Fogelson, Benjamin D Elder","doi":"10.1227/ons.0000000000001518","DOIUrl":"https://doi.org/10.1227/ons.0000000000001518","url":null,"abstract":"<p><strong>Background and objectives: </strong>Transforaminal lumbar interbody fusion (TLIF) allows for direct and indirect decompression and segmental lordosis in sagittal plane correction. This study compares the effectiveness of \"Bullet\" type and \"Banana\" type devices for sagittal plane correction.</p><p><strong>Methods: </strong>Patients who underwent 1-level or 2-level TLIF for degenerative pathology at a single tertiary care center were identified. Details were extracted on demographics, interbody dimensions, and preoperative and postoperative lumbopelvic parameters from upright radiographs. Cages were categorized as \"Bullet\" or \"Banana\" type based on morphology and manufacturer description of optimal position. Univariable comparisons between levels treated with \"Bullet\" and \"Banana\" type interbodies were performed. Multivariable linear regression was performed to identify independent predictors of postoperative segmental lordosis and change in segmental lordosis.</p><p><strong>Results: </strong>One hundred and ninety eight unique patients (median 66.6 years; [IQR 59.5, 73.7]; 56.6% female) were included with 241 levels treated, of which 114 (52.7%) were treated with \"Banana\" type interbodies and 127 (47.3%) with \"Bullet\" type. \"Banana\" type interbodies afforded both greater postoperative segmental lordosis (8.1 [6.2, 10.7] vs 7.5 [5.2, 9.6]; P = .048) and greater increase in segmental lordosis (3.3 [0.7, 7.0] vs 2.3 [0.1, 4.2]; P = .015). On multivariable linear regression, only preoperative segmental lordosis (β = 0.322 per degree; [0.244, 0.399]; P < .001), implant listed lordosis (β = 0.146 per degree; 95% CI [0.048, 0.244]; P = .004), preoperative pelvic incidence (0.072 per degree; [0.034, 0.111]; P < .001), and use of bilateral TLIF windows (β = 3.133; [1.213, 5.053]; P = .001) were predictive of postoperative segmental lordosis.</p><p><strong>Conclusion: </strong>The present analysis suggests that baseline lumbopelvic anatomy, interbody lordosis, and the use of bilateral TLIF windows are the most important predictors of postoperative segmental lordosis. Use of \"Banana\" vs \"Bullet\" type interbodies was not predictive of segmental lordosis achieved on immediate postoperative upright radiographs. Further work is merited to determine whether the 2 interbody types demonstrate differences regarding subsidence risk or maintenance of correction.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460749","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":"Management of Major Arterial Injuries: A Critical Complication of Endoscopic Endonasal Surgery.","authors":"Atakan Emengen, Eren Yilmaz, Aykut Gokbel, Ayse Uzuner, Ozgur Cakir, Ercument Ciftci, Bedrettin Ozsoy, Anil Ergen, Melih Caklili, Burak Cabuk, Ihsan Anik, Savas Ceylan","doi":"10.1227/ons.0000000000001507","DOIUrl":"https://doi.org/10.1227/ons.0000000000001507","url":null,"abstract":"<p><strong>Background and objectives: </strong>Endoscopic endonasal surgery (EES) is the preferred approach for treating sellar and parasellar lesions due to its panoramic view and detailed anatomical definition. This study aims to review major arterial injuries during EES, a rare but critical complication associated with high mortality and morbidity rates.</p><p><strong>Methods: </strong>A retrospective analysis was conducted, including 15 patients from 5640 EES procedures performed between August 1997 and February 2024 at in our center/Department of Neurosurgery. The study focuses on perioperative and postoperative management strategies, highlighting the use of oxidized regenerated cellulose (Surgicel®)/gelatin-thrombin matrix (Floseal®) and multidisciplinary collaboration to achieve hemostasis.</p><p><strong>Results: </strong>The incidence of major arterial injury was 0.2%, with a mean patient age of 38.4 years and a female-to-male ratio of 10:5. The most common tumors were adenomas (n = 7) and chordomas (n = 5). The most commonly bleeding arteries in 6 patients each are the cavernous segment of the internal carotid artery and the paraclival carotid artery. Low-flow bleeding was observed in 10 of our patients, while high-flow bleeding was seen in 5 patients, 4 of whom were recurrent cases (P < .05). In 3 patients with high-flow bleeding from segments of the carotid artery, digital subtraction angiography was performed for stent placement or coil embolization, while in 1 patient with high-flow bleeding, digital subtraction angiography was used for monitoring cerebral blood flow. One of our patients died of a myocardial infarction at the 14th month of follow-up and 1 of our patients developed left-hemiparesis.</p><p><strong>Conclusion: </strong>The study underscores the importance of preoperative planning, surgical expertise, and multidisciplinary teamwork in managing major arterial injuries during EES. The authors advocate for the development of standardized treatment algorithms to improve outcomes in these patients. The findings contribute to the limited literature on managing internal carotid artery injuries in EES, emphasizing the need for ongoing research and algorithm development.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460754","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":"Deep Brain Stimulation Electrode Deviations are Associated With Brain Stiffness Interfaces Measured by Magnetic Resonance Elastography.","authors":"Chengyuan Wu, Mahdi Alizadeh, Mary K Kramer, Matthew B Kroen, Robert Ziechmann, Feroze B Mohamed, Qianhong Wu, Curtis L Johnson","doi":"10.1227/ons.0000000000001523","DOIUrl":"10.1227/ons.0000000000001523","url":null,"abstract":"<p><strong>Background and objectives: </strong>The efficacy of deep brain stimulation (DBS) relies on accurate electrode placement. Unfortunately, electrode deviation poses a persistent problem, with most electrodes demonstrating some degree of bending. Although such bending does not always result in target deviation, an estimated 3% to 8% of patients still require revision surgery to address suboptimal electrode placement. DBS electrode deviation may occur at mechanical tissue interfaces, with denser internal capsule (IC) fibers being the most likely factor. Based on basic principles of physics, we hypothesized that the angle of a planned trajectory relative to tissue interfaces created by the IC induces deviation.</p><p><strong>Methods: </strong>Ten patients with Parkinson disease scheduled for DBS surgery underwent preoperative 3T magnetic resonance elastography (MRE) using synchronized external vibrations to measure brain tissue stiffness. The IC stiffness interface (ICSI) was defined as the transition between the corona radiata and IC on MRE. The rate of transition was calculated as the change in stiffness across the ICSI. Postoperative computed tomography was used to measure target deviation. The angle of approach was calculated as the angle between the planned trajectory and the normal vector to the ICSI. Pearson correlations and t-tests were performed to evaluate associations between the angle of approach and target deviation.</p><p><strong>Results: </strong>Twenty-one electrode trajectories were analyzed. The mean electrode deviation was 1.27 ± 0.63 mm. A significant correlation (r = 0.57, 95% CI [0.18, 0.80], P = .007) was found between angle of approach and target deviation, with larger angles associated with greater deviations. The rate of transition did not correlate with deviation (P = .874).</p><p><strong>Conclusion: </strong>MRE effectively quantifies in vivo brain tissue stiffness in Parkinson disease. The angle between the planned trajectory and the ICSI correlates with target deviation, supporting the hypothesis that tissue mechanics influence electrode bending. MRE has potential to quantify the likelihood of DBS electrode deviation, which could reduce revision surgeries and enhance clinical outcomes.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460752","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":"Training on a 3D-Printed Simulation Model Improves Accuracy in External Ventricular Drain Placement.","authors":"Michael Kosterhon, Merih Ö Turgut, Matthias Gielisch, Julian Graef, Florian Ringel","doi":"10.1227/ons.0000000000001491","DOIUrl":"https://doi.org/10.1227/ons.0000000000001491","url":null,"abstract":"<p><strong>Background and objectives: </strong>External ventricular drain (EVD) placement is a critical, lifesaving procedure in cranial neurosurgery, often performed manually using anatomical landmarks that vary between individuals. This study evaluates the efficacy of a 3-dimensional (3D)-printed EVD training model designed to improve the accuracy of this procedure.</p><p><strong>Methods: </strong>Computed tomography scans from 3 patients were used to create 3D-printed head models with narrow, wide, and normal ventricles. Twenty-five neurosurgeons participated in a three-round training protocol: pre-training, training with neuronavigation and a standardized protocol, and post-training. The accuracy of EVD placement was measured using an optical navigation system, and participants' confidence levels were assessed through questionnaires.</p><p><strong>Results: </strong>Training significantly enhanced EVD placement accuracy. Pre-training, only 55.3% of placements were intraventricular (Kakarla grade 1), which increased to 84.0% post-training (P < .001). The distance to the ideal entry point improved from 5.8 mm (SD, ±3.7 mm) to 4.1 mm (SD, ±1.5 mm), and the distance to the target point improved from 12.6 mm (SD, ±5.8 mm) to 8.3 mm (SD, ±4.0 mm) (P < .001 for both). The time to identify entry points and puncture the ventricles also improved significantly. Left-sided EVDs were more frequently misplaced. In addition, right-handed participants (n = 24) performed better when placing left-sided EVDs with their right hand. Participants with more than 6 years of experience were more likely to misplace the EVD and overestimate their placement accuracy compared with less experienced participants. Post-training, both experienced and less experienced neurosurgeons achieved similar success rates. Confidence in EVD placement and puncture direction significantly increased post-training.</p><p><strong>Conclusion: </strong>A standardized training protocol using a 3D-printed model significantly improves the accuracy and confidence of neurosurgeons in EVD placement. Regular training is recommended to maintain high clinical performance, emphasizing the need for standardized procedures and the use of neuronavigation for complex cases.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442533","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}