Revista Do Instituto De Medicina Tropical De Sao Paulo最新文献

{"title":"Intrauterine fetal death due to Brucella melitensis infection: a case report and literature review.","authors":"Minxue Liu, Lina Zhou, Jiahui Liang, Linlin Li, Liying Huang, Huan Zhang","doi":"10.1590/S1678-9946202567056","DOIUrl":"https://doi.org/10.1590/S1678-9946202567056","url":null,"abstract":"<p><p>Brucellosis is a zoonotic disease caused by Brucella species In pregnant women, this disease may lead to adverse obstetric outcomes, such as abortion, preterm delivery, intrauterine fetal death (IUFD), and congenital brucellosis. However, only a few studies have reported IUFD due to Brucella. In our case, one woman residing in Guangxi Province, China-a non-endemic region-developed symptoms 11 months after exposure. The disease manifested during her pregnancy-Brucella melitensis was identified via blood culture and confirmed by MALDI-TOF mass spectrometry. Despite receiving antibiotic treatment for brucellosis, she subsequently experienced IUFD. Additionally, we reviewed cases of IUFD secondary to brucellosis in the literature published until December 2024. Only three cases from the literature were enrolled in this study, which demonstrates that Brucella-related IUFD can occur in non-endemic zones, underscoring the need for increased clinical awareness.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e56"},"PeriodicalIF":1.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979122","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":"Clinical, epidemiological, and laboratory analysis of hospitalized and fatal COVID-19 cases in the first fully vaccinated municipality in Northeast Brazil.","authors":"Lourrany Borges Costa, Arina Peixoto Nobre, Maria Eduarda Soares Dos Santos, Luís Arthur Brasil Gadelha Farias, Magda Moura de Almeida, Antonia Luciana Souza Bekman, Silvana Soares de Souza, Francisca Kalline de Almeida Barreto, Ana Carolina Barjud Marques Máximo, Debora Bezerra Silva, Roberto Wagner Júnior Freire de Freitas, Luciano Pamplona de Góes Cavalcanti","doi":"10.1590/S1678-9946202567050","DOIUrl":"https://doi.org/10.1590/S1678-9946202567050","url":null,"abstract":"<p><p>Guaramiranga, Ceara State, Brazil, a tourist city 105.5 km from the capital Fortaleza, was a pilot site for vaccinating 100% of its 4,002 adult population with the first dose against COVID-19. The city received 3,328 CoronaVac, 1,685 AstraZeneca, and 174 Pfizer-BioNTech doses (5,187 in total). Vaccination with the first dose occurred from January 20, 2021 to April 1, 2022. This study analyzed hospitalized patients' epidemiological, clinical, and laboratory characteristics and deaths from COVID-19 in Guaramiranga from March 2020 to December 2022. In total, nine cases required hospitalization, seven of which resulted in death. Patients' median age at death equaled 87 (64-95) years. Only one was male, and five had incomplete vaccination schedules before their hospitalization. Hypertension and diabetes configured the most frequent comorbidities, whereas common symptoms at admission included fever (four cases), cough (four cases), and dyspnea (five cases). Of these nine patients, 4 received anticoagulants and corticosteroids; 6, oxygen supplementation; 2, oseltamivir; and 3, empirical antibiotic for pneumonia. The mean interval between the last vaccine dose and hospitalization totaled 128 days (28-326; SD 137). These findings highlight incomplete vaccination, a prolonged interval since last doses, comorbidities, and advanced age as key factors associated with severe cases and deaths and emphasize the protective role of high vaccination coverage.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e50"},"PeriodicalIF":1.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979054","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":"Behçet's disease and tuberculosis: unmasking infection behind a suspected flare.","authors":"Jobson Lopes de Oliveira, Igor Albuquerque Nogueira, Maurício Catunda Pinheiro Jucá, Afonso Rocha Eisele, Luís Arthur Brasil Gadelha Farias, Diana Arrais de Souza Rangel","doi":"10.1590/S1678-9946202567052","DOIUrl":"https://doi.org/10.1590/S1678-9946202567052","url":null,"abstract":"<p><p>Behçet's disease (BD) is a chronic and multisystem disorder characterized by recurrent oral and genital ulcers, along with ocular, cutaneous, vascular, gastrointestinal, and neurologic manifestations. The etiology is thought to involve an autoimmune response triggered by infectious or environmental factors in genetically predisposed individuals. Mycobacterium tuberculosis has been proposed as a potential trigger for BD, although this association remains rarely reported. We show a compelling case of a patient with BD diagnostic criteria who subsequently developed mediastinal tuberculous lymphadenitis, which was initially suspected as disease activity. This case underscores the importance of considering tuberculosis in BD patients with new or worsening symptoms despite appropriate therapy.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e52"},"PeriodicalIF":1.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979058","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":"High resolution capillary western blot analysis of antibody reactivity in human visceral leishmaniasis.","authors":"Marcos Vinicius da Silva, Aldo Matos, Rafael Faria de Oliveira, Juliana Reis Machado E Silva, Malu Mateus Santos-Obata, Luciana de Almeida Silva-Teixeira, Dalmo Correa-Filho, Denise Bertulucci Rocha Rodrigues, Virmondes Rodrigues Junior","doi":"10.1590/S1678-9946202567048","DOIUrl":"10.1590/S1678-9946202567048","url":null,"abstract":"<p><p>Visceral leishmaniasis (VL) is a potentially fatal disease, occurring in 76 countries, 12 of which are located in the Americas, with approximately 3,500 new cases annually registered in Brazil. Active visceral leishmaniasis is characterized by an intense inflammatory reaction with a low cell-mediated immune response and a high production of specific and non-specific antibodies. Antibodies are not associated with effective protective mechanisms but have been used widely in diagnostic tests. In this study, we analyzed the immunoglobulin G (IgG) response against crude antigens of Leishmania infantum by using automated western capillary blot in patients with active and clinically cured VL, individuals residing in an endemic area and patients with Chagas disease. The method allowed an accurate analysis of the antibody response. Our results demonstrated that antibody reactivity to L. infantum antigens in the 20-142 kDa range effectively distinguished active VL from clinically cured cases and Chagas disease, although these antigens were not exclusively recognized by patients with active VL. The automated western capillary blot proved to be a useful tool for differentiating patients with active VL from individuals living in endemic areas and those with Chagas disease, highlighting its potential application in serological diagnostics.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e48"},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692473","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":"Multi systemic compromise due to Bartonella henselae in a child.","authors":"Thiago Jessé Kucarz, Cintia Avila Souza, Simone Aiko Hatanaka, Elisa Nunes Secamilli, Marina Rovani Drummond, Marcos Tadeu Nolasco da Silva, Rafael Fantelli Stelini, Maria Leticia Cintra, Paulo Eduardo Neves Ferreira Velho","doi":"10.1590/S1678-9946202567047","DOIUrl":"10.1590/S1678-9946202567047","url":null,"abstract":"<p><p>Currently, at least 22 species of Bartonella are known to cause diseases in humans, with Bartonella henselae being the main one. Among the clinical manifestations associated with bartonellosis, cutaneous vasculitis is rare, but it can be severe. We report the case of a 9-year-old child who presented with cervical lymphadenopathy, arthritis, epididymitis, and cutaneous vasculitis as clinical manifestations of systemic bartonellosis, with positive detection of B. henselae in blood and skin fragment using species-specific conventional polymerase chain reaction (PCR) techniques. Vasculitis caused by Bartonella spp. occurs due to the endothelial tropism of the bacteria and can mimic systemic vasculitis with positive anti-neutrophil cytoplasmic antibodies (ANCA). Furthermore, we found just one previous report about epididymitis related to B. henselae infection, and arthritis is also considered an unusual manifestation of the infection. This case emphasizes the need to consider bartonellosis among differential diagnoses when faced with presentations of purpura, cutaneous vasculitis, arthritis, or epididymitis.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e47"},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692474","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":"Candidemia caused by Candida haemulonii: a case report and literature review in neonates.","authors":"Minxue Liu, Chunyun Fu, Xingchun Chen","doi":"10.1590/S1678-9946202567042","DOIUrl":"10.1590/S1678-9946202567042","url":null,"abstract":"<p><p>Candidemia poses a significant challenge for hospitalized neonates with an increase in morbidity and mortality. However, candidemia caused by Candida haemulonii in newborns is rare but fatal. We report such a case in China and performed a literature review. A neonate with a gestational age of 31+6 weeks and a birth weight of 1,420g was diagnosed with C. haemulonii candidemia. The infectious agent was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and sequencing of the internal transcribed spacer region. The in vitro antifungal susceptibility testing indicated high minimal inhibitory concentrations for fluconazole (>128 µg/mL), voriconazole (>8 μg/mL), and amphotericin B (>4 µg/mL). Fortunately, the newborn was successfully treated with fluconazole. After a literature review of C. haemulonii candidemia, we found that the risk factors of the candidemia might involve premature, low birth weight, invasive therapeutic devices, broad-spectrum antimicrobial agents, and parenteral nutrition infusion. This study will broaden our knowledge on neonatal candidemia caused by C. haemulonii.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e42"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610333","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":"Osteomyelitis and aortic arteritis with thrombosis as primary manifestations of severe paracoccidioidomycosis: a case report.","authors":"Amaro Nunes Duarte-Neto, Katia Cristina Dantas, Suzete Cleusa F Spina Lombardi, Roseli Santos de Freitas-Xavier, Adriana P Vicentini, Alfredo Mendroni Junior, Simon Claros Claros, Luiz Fernando Ferraz da Silva, Paulo Hilário Nascimento Saldiva, Marisa Dolhnikoff, Marielton Dos Passos Cunha, Thais Mauad","doi":"10.1590/S1678-9946202567044","DOIUrl":"10.1590/S1678-9946202567044","url":null,"abstract":"<p><p>Paracoccidioidomycosis (PCM) configures a deep mycosis caused by Paracoccidioides spp., a neglected tropical disease. We describe a fatal case of PCM that manifested itself as osteomyelitis with thrombosis in the iliac artery in a man with frequent contact with an endemic region in Sao Paulo, Brazil. A 67-year-old man living in an endemic area presented with osteomyelitis of the femur and iliac artery thrombosis on admission to the hospital. Computed tomography of the chest showed multiple cavitated pulmonary nodules. The patient rapidly progressed to irreversible respiratory failure. The autopsy showed disseminated PCM and iliac artery thrombosis. Laboratory investigation confirmed P. brasiliensis infection with a strain identified in Sao Paulo as P. brasiliensis complex by phylogenetic analysis. Atypical PCM remains a diagnostic challenge. Increased awareness of the sites of infection and its clinical presentations will improve patient management.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e44"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610335","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":"Expression of inflammatory factors and distribution of pathogens in patients with septic shock and their correlation with prognosis: a cross-sectional study.","authors":"Jialin Chen, Mengzhu Tan, Tao Xiang","doi":"10.1590/S1678-9946202567045","DOIUrl":"10.1590/S1678-9946202567045","url":null,"abstract":"<p><p>This study aimed to investigate the relationship between inflammatory factors, pathogen distribution, and prognosis in patients with septic shock admitted to the emergency department of internal medicine. A total of 140 patients with septic shock admitted to the emergency department of The Third People's Hospital of Chengdu, China, from January 2021 to January 2023 were selected for analysis of the distribution of pathogens and infection sites. Patients were divided into death (36 cases) and survival groups (104 cases) based on their condition after 28 days of treatment. A total of 174 pathogenic bacteria strains were cultured, including 124 Gram-negative bacteria (71.26%) and 43 Gram-positive bacteria (24.71%). The main infection sites were the lungs (33.57%) and the abdominal and gastrointestinal tracts (25.00%). The distribution of pathogens and infection sites in the survival and death groups were compared (P > 0.05). The regression equation predicted patient mortality, with the area under the ROC curve of 0.860 (95% CI: 0.792-0.929; P < 0.05), and sensitivity and specificity of 88.90% and 73.10%, respectively. Pathogen distribution in patients with septic shock in the internal medicine emergency department was not related to prognosis; however, inflammatory factors such as CRP and PCT were predictive of outcomes. Along with age, APACHE II score, and SOFA score, they demonstrated significant prognostic value for patient mortality.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e45"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610334","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":"The application of metagenomics in the detection of arboviruses in mosquitoes (Diptera: Culicidade): a systematic review.","authors":"Everson Dos Santos David, Shirley Vasconcelos Komninakis, Erique da Costa Fonseca, Anne Caroline da Silva Soledade, Karen Carmo Dos Santos, Raimundo Nonato Picanço Souto","doi":"10.1590/S1678-9946202567046","DOIUrl":"10.1590/S1678-9946202567046","url":null,"abstract":"<p><p>Advances in deforestation and climate change directly cause changes in habits and the distribution of Culicidae across the globe, especially mosquitoes of medical importance and the main vectors of arboviruses. The viral metagenomics technique can be an important tool in characterizing viral diversity in mosquitoes. Thus, this study aimed to identify evidence of the effectiveness of the viral metagenomics technique in detecting arboviruses in mosquitoes. This is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 protocol. The research was carried out using five electronic databases: LILACS, PubMed, SciELO, Scopus, and Web of Science, and included studies published in health and interdisciplinary fields, as well as complementary research on Google Scholar. Studies that used the viral metagenomics approach for the genomic evaluation of arboviruses found in mosquito samples were included; the results demonstrated the presence of viral diversity and the identification of the genome of probable pathogenic viruses. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform under the number CRD42024484713. Thus, 249 studies were identified via searches on electronic databases. According to the inclusion/exclusion criteria, only 23 studies met the objectives for the systematic review. In all studies, genomic sequencing was applied to detect viruses, mainly those related to insect-specific viruses (ISV) and arboviruses known to infect humans and animals, belonging to various viral families. Despite the challenges reagrdingthe absence of reference sequences in genomic databases, the effectiveness of the metagenomics technique in characterizing the mosquito virome is clear from the studies, which broadens the understanding of viral diversity.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e46"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610337","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":"Serology survey of chikungunya virus in high-risk pregnant women and placental tissue findings.","authors":"Thamirys Cosmo Grillo Fajardo, Antonio Carlos de Quadros Junior, Clóvis Antonio Lopes Pinto, Geovane Ribeiro Dos Santos, Andrea Cristina Botelho da Silva, Daniel Thome Catalan, Ana Paula Antunes Pascalicchio Bertozzi, Rosa Estela Gazeta, Antonio Fernandes Moron, Saulo Duarte Passos, Alexandra Siqueira Mello, Antoni Soriano-Arandes, Ana Alarcon, Alfredo Garcia-Alix, Alify Bertoldo da Silva, Dora Fix Ventura, Danielle Bruna Leal de Oliveira, Danilla Soares Tambalo, Diego da Silva Lima, Dirce Takako Fujiwara, Edison Luiz Durigon, Eduardo Roberto Bagne, Fernanda Guerra Velasco, Luiz Claudio Portnoi Baran, Fernando Novo Arita, Francisco Del Moral Hernandez, Juliana Paula Gomes de Almeida, Karen Richter Camandulli, Lucas Pires de Castro, Márcia Borges Machado, Mayana Zatz, Maria Manoela Duarte Rodrigues, Maria de Fátima Valente Rizzo, Maria Amélia Farrão, Mirella Nayane Barbosa Leite, Nemésio Florence Filho, Patrícia Carvalho Loiola, Raquel Prestes, Rita de Cássia Aguirre Dezena, Sandra Helena Alves Bonon, Sergio Vranjac, Sérgio Rosemberg, Stephanno Gomes Pereira Sarmento, Steven Sol Witkinchi, Tathiana Ghisi de Souza, Viviane Cristina Martori Pandini, Viviam Paschoarelli Paiva","doi":"10.1590/S1678-9946202567043","DOIUrl":"10.1590/S1678-9946202567043","url":null,"abstract":"<p><p>Evidence suggests a risk of maternal transmission of chikungunya virus (CHIKV) during the first and third trimesters, potentially leading to miscarriage or neurological consequences for the fetus. This study aimed to conduct a serological survey for CHIKV among women with high-risk pregnancies and analyze neonatal variables and placental tissue alterations. From March 2016 to April 2021, serological, histological, and molecular tests for CHIKV were performed. Blood samples were analyzed for anti-CHIKV IgG and IgM antibodies, and placental tissue was examined for CHIKV RNA and histological changes. Among pregnant patients, 1.33% (7/526) had reactive IgG, and 0.38% (2/526) had IgM/IgG-type antibodies during delivery. Although placental histology of CHIKV disease showed alterations, no viral genetic material was identified in the analyzed tissues. Therefore, further research is needed, including the use of complementary diagnostic techniques, to better understand the impact of this relatively new disease among high-risk pregnant women and newborns.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e43"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610336","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}