American Journal of Emergency Medicine最新文献

{"title":"Emergency physician-performed ultrasound-guided nerve blocks: A scoping review of the published literature.","authors":"Richard J Gawel, Jennifer X Hong, Jennifer Lege-Matsuura, David S Vonderheide, Michael Gottlieb, Jeffrey A Kramer, Michael Shalaby","doi":"10.1016/j.ajem.2025.07.068","DOIUrl":"10.1016/j.ajem.2025.07.068","url":null,"abstract":"<p><strong>Objective: </strong>Ultrasound-guided nerve blocks (UGNBs) continue to grow within the practice of emergency medicine. The purpose of this scoping review was to summarize the existing literature reporting UGNBs performed by emergency physicians (EPs) to identify trends in the literature and directions for future research.</p><p><strong>Methods: </strong>Utilizing PRISMA-ScR guidelines, we electronically searched the PubMed, Scopus, Embase, and Cochrane libraries from database inception to May 12, 2025, to identify clinical studies reporting on outcomes of EP-performed UGNBs. Records were screened in duplicate, and data was extracted from each included article for quantitative and qualitative synthesis, adhering to best practice guidelines.</p><p><strong>Results: </strong>From an initial database search of 4821 records, 238 articles were included consisting of 9055 individual UGNB encounters. There were 34 randomized clinical trials (14 %) and 30 non-randomized prospective studies (13 %), while the rest (73 %) were retrospective studies and case reports. The first report on EP-performed UGNB was published in 2003, and nearly two-thirds of included articles were published since 2020. Overall, 52 different types of UGNBs have been performed by EPs. Lower extremity blocks were most frequently reported (97 articles, 41 %). Publications of truncal blocks (77 articles, 30 %), especially the erector spinae plane block (43 articles, 18 %), have seen a rapid increase over the past 5 years. Complications occurred in 0.89 % of blocks, including three cases (0.03 %) of local anesthetic systemic toxicity.</p><p><strong>Conclusions: </strong>Published reports of EP-performed UGNBs continue to increase, with many UGNB techniques having been performed for the first time for novel indications in the ED. This scoping review summarized the existing published literature on EP-performed UGNBs to map the current scope of practice and highlight areas for future research.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"200-206"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800993","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":"Risk factors associated with return sepsis admission following emergency department discharge with infection.","authors":"Alice Y Chen, Matthew Allison, Michael Puskarich, Gary M Vilke, Pam Taub, Michael H Criqui, Gabriel Wardi, Victor Nizet, JoAnn Trejo, Edward M Castillo, Jesse Brennan, Christopher Coyne","doi":"10.1016/j.ajem.2025.07.059","DOIUrl":"10.1016/j.ajem.2025.07.059","url":null,"abstract":"<p><strong>Introduction: </strong>Despite sepsis having growing awareness nationally, efforts to reduce the public health impact of sepsis have lagged. Although there are known pathophysiologic mechanisms and preventive strategies, sepsis is rarely approached as a predictable or preventable condition. Predicting who will develop sepsis in patients with infection still remains a challenge. This study examined modifiable and nonmodifiable risk factors associated with patients initially discharged home with an infection and had future sepsis-related admissions within 7 days of the index Emergency Department (ED) visit.</p><p><strong>Methods: </strong>We conducted a multi-center retrospective cohort analysis of adults presenting to two university hospital EDs. The inclusion criteria encompassed adult patients who were discharged from the ED at their index visit with discharge diagnosis (ICD 10-CM code) of pneumonia, urinary tract infection (UTI), and/or cellulitis and who returned for hospital admission within 7 days of the index visit due to sepsis, severe sepsis without septic shock, and/or septic shock. Using multivariate regression, risk factors that predict return sepsis admission within 7 days of ED index visit were evaluated, and a 7-day return sepsis admission model was constructed. The predictive power of the model was measured by c-statistic.</p><p><strong>Results: </strong>Among 10,179 unique ED patients, return sepsis admissions within 7 days occurred in 113 visits (1.11 % of discharged patients). Statistically significant risk factors among patients with infection associated with subsequent sepsis admission in the chosen model were Cardiovascular Disease (OR 2.07 95 % CI 1.26-3.42), Hypertension (OR 2.21 95 % CI 1.37-3.56), Chronic Kidney Disease (OR 1.80 95 % CI 1.11-2.91), Cancer (OR 2.22 95 % CI 1.43-3.45), Male (OR 1.67 95 % CI 1.13-2.45), arriving in an ambulance (vs. walk in OR 2.55 95 % CI 1.46-4.44), higher heart rate (OR 1.29 95 % CI 1.16-1.45), and higher temperature (OR 1.23 95 % CI 1.05-1.45), Hyperlipidemia was protective (OR 0.56 95 %CI 0.34-0.91). The c-statistic of our chosen model was 0.77 (95 % CI 0.73-0.81). The Hosmer-Lemeshow test for our logistic regression model resulted in a chi-square value of 7.23 with 8 degrees of freedom with a p-value of 0.51. This suggests that our model fits the data well.</p><p><strong>Conclusion: </strong>Our findings may be used to risk stratify and guide outpatient disposition decisions for ED patients with infection and to determine which patients need to be more closely monitored in the outpatient setting following ED discharge.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"207-215"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805291","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":"Droperidol vs. haloperidol for abdominal pain.","authors":"Sebastian Gilt, Brock R Townsend, Andrea E Nisly, Sean G Di Paola, Aaron P Lentz, Dylan R Luyten, Brian W Gilbert","doi":"10.1016/j.ajem.2025.08.008","DOIUrl":"10.1016/j.ajem.2025.08.008","url":null,"abstract":"<p><strong>Introduction: </strong>Haloperidol and droperidol are antipsychotic medications with multimodal pharmacodynamic effects making them useful in the emergency department (ED). Data suggests that droperidol and haloperidol may reduce morphine milliequivalents (MME) administered when used for undifferentiated abdominal pain (UAP) in the ED. However, there is a paucity of data comparing the two agents in this cohort. The purpose of this study was to assess the efficacy of haloperidol versus droperidol in reducing MME requirements for UAP in the ED.</p><p><strong>Methods: </strong>This retrospective, single-center study included patients ≥18 years old who presented to the ED for UAP. Patients were excluded if they required urgent surgery or received haloperidol or droperidol for agitation. The primary outcome was the difference in MME administered in the ED between patients who received haloperidol versus droperidol. Secondary outcomes included rates of rescue antiemetics, rescue analgesics, admission to the hospital, hospital length of stay, and adverse effects.</p><p><strong>Results: </strong>A total of 100 patients were evaluated, with 50 patients receiving haloperidol and 50 patients receiving droperidol. Patients in the haloperidol group received a lower median MME compared to those in the droperidol group (0 MME [IQR 0-10] vs 10 MME [IQR 0-20], p-value 0.033). There was no statistical difference between secondary outcomes evaluated, including safety events.</p><p><strong>Conclusion: </strong>Haloperidol was associated with a significant reduction in MME administration compared to droperidol for UAP in the ED. Large high-quality data sets are needed to confirm haloperidol's role in multimodal pain management of UAP compared to droperidol.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"233-236"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812707","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":"Emergency response in resource-constrained settings: A scoping review of prehospital trauma care in LMICs.","authors":"Kholisah Widiyawati, Retno Lestari, Suryanto","doi":"10.1016/j.ajem.2025.08.005","DOIUrl":"10.1016/j.ajem.2025.08.005","url":null,"abstract":"<p><p>Trauma is a leading cause of mortality in low- and middle-income countries (LMICs), where effective prehospital care can significantly improve survival. However, the development of robust prehospital systems is hindered by systemic barriers, including fragmented services, inadequate resources, and undertrained personnel. This study aimed to systematically map the evidence on these challenges and the solutions being implemented to overcome them. We conducted a scoping review following the PRISMA-ScR guidelines. A scoping search was conducted in PubMed, ScienceDirect, and EBSCO databases was performed to identify primary research studies focused on prehospital trauma care in LMICs. After screening, a total of 23 articles met the inclusion criteria. Data related to barriers and facilitators were extracted, charted, and synthesized using a thematic analysis approach. Four key themes of barriers were consistently identified across the 23 studies: deficits in provider training and continuous education; inadequate infrastructure, physical resources, and communication systems; fragmented governance and a lack of standardized clinical protocols; and significant sociocultural obstacles, including a lack of public awareness and fear of legal repercussions for providing aid. Conversely, effective facilitators centered on context-specific training for both lay and professional responders; community-based initiatives that empower local volunteers as first responders; the application of low-cost, appropriate technology for communication and dispatch; and the establishment of supportive policy and legal frameworks. Strengthening prehospital trauma care in LMICs requires a paradigm shift away from simply attempting to replicate resource-intensive models from high-income countries. The evidence synthesized in this review strongly suggests that the most effective and sustainable pathway lies in fostering context-specific, community-driven solutions. Investing in lay responder training and low-cost technological innovations, all supported by clear national governance, represents a powerful strategy to reduce the burden of preventable death and disability in these settings.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"220-226"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812708","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":"U-shaped relationship between sodium levels and short-term mortality in Sepsis.","authors":"Süleyman Alpar, Ali Cankut Tatlıparmak","doi":"10.1016/j.ajem.2025.08.003","DOIUrl":"10.1016/j.ajem.2025.08.003","url":null,"abstract":"<p><strong>Background: </strong>Dysnatremia is a common electrolyte disturbance among critically ill patients and may have important prognostic implications in the context of sepsis. This study aims to investigate the independent association between admission serum sodium abnormalities and 30-day mortality in patients with sepsis, and to evaluate the mortality risk across the full spectrum of sodium levels at emergency department (ED) presentation.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients diagnosed with sepsis in the ED of a tertiary care hospital between January 1, 2022, and January 1, 2025. Dysnatremia was defined as serum sodium <135 or > 145 mmol/L at admission. The primary outcome was 30-day all-cause mortality. Multivariate logistic regression and generalized additive modeling (GAM) were used to evaluate the association between serum sodium and mortality, adjusting for relevant clinical and laboratory covariates.</p><p><strong>Results: </strong>A total of 793 patients were included in the final analysis. The overall 30-day mortality rate was 23.0 %. Dysnatremia was independently associated with increased risk of 30-day mortality (adjusted OR: 4.06, 95 % CI: 1.67-10.19, p = 0.002). Additional predictors included elevated lactate, hsCRP, procalcitonin, and SOFA scores. The association between serum sodium and mortality exhibited a non-linear pattern, with both hypo- and hypernatremic extremes showing higher mortality compared to the normonatremic range. The GAM model demonstrated strong discriminative performance (ROC-AUC: 0.893).</p><p><strong>Conclusion: </strong>Abnormal serum sodium levels at presentation were independently associated with short-term mortality in patients with sepsis. These findings support the inclusion of sodium measurements in early clinical assessment and risk stratification of septic patients in the ED.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"227-232"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805292","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":"Artificial intelligence as author: Can scientific reviewers recognize GPT-4o-generated manuscripts?","authors":"Ahmet Öztürk, Anılcan Tahsin Karahan, Serkan Günay, Abdul Samed Erdal, Seval Komut, Erdal Komut, Yavuz Yiğit","doi":"10.1016/j.ajem.2025.07.034","DOIUrl":"10.1016/j.ajem.2025.07.034","url":null,"abstract":"<p><strong>Introduction: </strong>Chat Generative Pre-Trained Transformer (ChatGPT) is a natural language processing model. It can be argued that ChatGPT has recently begun to assume the role of a technological assistant capable of supporting academics in the process of scientific writing. ChatGPT may contribute to the spread of incorrect or incomplete information within academic literature, leading to conceptual confusion and potential academic misconduct. The aim of this study is to determine whether a scientific article entirely generated by an AI application such as ChatGPT can be detected by an academic journal editor or peer reviewer.</p><p><strong>Methods: </strong>This study was conducted between November 1, 2024, and December 1, 2024. GPT-4o, was utilized in this study. ChatGPT was instructed to write a scientific article focused on predicting mortality and return of spontaneous circulation (ROSC) in OHCA cases. The manuscript written by ChatGPT-4o was sent to 14 different reviewers who had previously served as reviewers or editors. The reviewers were asked to evaluate the manuscript as if they were an SCI-E journal editor or peer reviewer. The reviewers were informed that the article had been written by ChatGPT and were asked whether they had identified this during their review.</p><p><strong>Results: </strong>Among the reviewers, 42.9 % (n = 6) decided to reject the manuscript at the editorial stage, whereas another 42.9 % (n = 6) opted to forward it to a peer reviewer. During the peer review stage, 42.9 % (n = 6) of the reviewers recommended rejection, while 28.6 % (n = 4) suggested major revisions. 78.6 % (n = 11) of the reviewers did not realize that the manuscript had been generated by an artificial intelligence model.</p><p><strong>Conclusion: </strong>The findings of our study highlight the necessity for journal editors and peer reviewers to be well-informed about ChatGPT and to develop systems capable of identifying whether a manuscript has been written by a human or generated by artificial intelligence.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"216-219"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805290","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":"Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysis.","authors":"Satheesh Gunaga, Abe Al-Hage, Alyssa Buchheister, Harish Neelam, Jessica Corcoran, Michael Welchans, Kirby Swan, Mahmoud Awada, Joseph Miller, Fabrice Mowbray","doi":"10.1016/j.ajem.2025.08.001","DOIUrl":"10.1016/j.ajem.2025.08.001","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. Early access to HPC improves outcomes, aligns care with patient goals, and reduces costs. However, incorporating primary and specialized palliative care resources in the ED remains inconsistent, and utilization trends are not well understood. Our study evaluates the incidence and trends of ED-initiated HPC consults over 8 years within a large metropolitan health system.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of electronic health records from 5 EDs between 2016 and 2023. Our cohort included all ED visits where HPC consults were ordered. We examined the annual number of HPC consults, patient demographics, and health outcomes. A subgroup analysis evaluated HPC consults per 1000 ED patients aged 60 or older admitted for inpatient care.</p><p><strong>Results: </strong>A total of 8055 HPC consults were ordered for 6370 unique patients. The average age was 78.1 years, with 56.4 % female and 75.0 % White. Of the cohort, 91.7 % were admitted, 5.3 % discharged home, and 53.2 % died in-hospital. HPC consults increased from 369 in 2016 to 1355 in 2023 (367 % increase, p < 0.001). The ratio of hospice to palliative care consults reversed from 1.5:1 in 2016 to 1:1.9 in 2023. Post-COVID-19, daily HPC consults rose by 173.6 % compared to pre-pandemic levels.</p><p><strong>Conclusions: </strong>ED-initiated HPC consults increased significantly over time, suggesting an evolving role for EDs in delivering primary palliative care. Further research is needed to determine national trends and identify barriers to broader implementation.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"237-243"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812709","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":"Corrigendum to \"Impact of time to revascularization on outcomes in patients after out-of-hospital cardiac arrest with STEMI\" [The American Journal of Emergency Medicine, 79 (2024) 136-143].","authors":"Satoshi Nakajima, Tasuku Matsuyama, Kenji Kandori, Asami Okada, Yohei Okada, Tetsuhisa Kitamura, Bon Ohta","doi":"10.1016/j.ajem.2025.09.048","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.048","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259999","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":"Factors associated with corrective actions, remediation, and employment termination of emergency physicians","authors":"Lyndsay Tyler MPH ,&nbsp;Yachana Bhakta MPH ,&nbsp;Michael Gottlieb MD ,&nbsp;Chadd K. Kraus DO, DrPH ,&nbsp;Terry Kowalenko MD ,&nbsp;Yvette Calderon MD, MS ,&nbsp;Samuel M. Keim MD, MSc ,&nbsp;Diane L. Gorgas MD ,&nbsp;Deborah B. Diercks MD, MSc, MBA ,&nbsp;Lewis S. Nelson MD","doi":"10.1016/j.ajem.2025.10.009","DOIUrl":"10.1016/j.ajem.2025.10.009","url":null,"abstract":"<div><h3>Objective</h3><div>Medical professionalism is fundamental to the delivery of high-quality patient care. There is a paucity of data to describe behaviors associated with negative professional and employment outcomes. This study examines common factors leading to corrective actions, remediation, and termination of emergency physicians (EPs).</div></div><div><h3>Methods</h3><div>This was a cross-sectional survey sent to academic chairs in emergency medicine to identify factors for corrective actions, remediation, or termination of EPs. Survey items were piloted and response process validity gathered prior to administration. Data are reported as descriptive statistics.</div></div><div><h3>Results</h3><div>60 of 167 (36 %) members of the Association of Academic Chairs in Emergency Medicine (AACEM) completed the survey. Most respondents were male (75 %), at least 45 years of age (93 %), had been in practice for at least 20 years (85 %), had 5 or more years' experience as an academic chair (63 %), and had served as chair for more than 60 EPs (70 %). Respondents reported providing corrective action for approximately 700 EPs, remediation for 371 EPs, and termination for 132 EPs. Corrective actions were most common for: disrespecting others (82 %), poor working relationships with nursing (77 %), and insufficient academic output (70 %). Remediation was most common for: disrespecting others (47 %), substandard patient care (43 %), and poor working relationships with nursing staff (42 %). Termination was most common for: substandard patient care (32 %), disrespecting others (23 %), and conviction for illegal activity (22 %).</div></div><div><h3>Conclusion</h3><div>In this survey of academic chairs in emergency medicine, the most common factors of employment-related corrective actions, remediation, and termination among EPs were related to issues of professionalism. There may be opportunities to address these issues prior to employment termination. Future studies should be expanded to include survey respondents who are not academic chairs in emergency medicine.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 232-236"},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268923","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":"TOC","authors":"","doi":"10.1016/S0735-6757(25)00615-1","DOIUrl":"10.1016/S0735-6757(25)00615-1","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Pages A3-A7"},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265490","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}