American Journal of Emergency Medicine最新文献

{"title":"Effect of timing of advanced life support on out-of-hospital cardiac arrests at home: do not mix time and place!","authors":"Romain Jouffroy, Benoît Vivien","doi":"10.1016/j.ajem.2024.09.030","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.030","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301787","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":"Drones reduce the time to defibrillation in a highly visited non-urban area: A randomized simulation-based trial","authors":"Michiel J. van Veelen ,&nbsp;Giovanni Vinetti ,&nbsp;Tomas Dal Cappello ,&nbsp;Frederik Eisendle ,&nbsp;Abraham Mejia-Aguilar ,&nbsp;Riccardo Parin ,&nbsp;Rosmarie Oberhammer ,&nbsp;Marika Falla ,&nbsp;Giacomo Strapazzon","doi":"10.1016/j.ajem.2024.09.036","DOIUrl":"10.1016/j.ajem.2024.09.036","url":null,"abstract":"<div><h3>Introduction</h3><p>Out-of-hospital cardiac arrest (OHCA) has a high global incidence and mortality rate, with early defibrillation significantly improving survival. Our aim was to assess the feasibility of autonomous drone delivery of automated external defibrillators (AED) in a non-urban area with physical barriers and compare the time to defibrillate (TTD) with bystander retrieval from a public access defibrillator (PAD) point and helicopter emergency medical services (HEMS) physician performed defibrillation.</p></div><div><h3>Methods</h3><p>This randomized simulation-based trial with a cross-over design included bystanders performing AED retrievals either delivered by automated drone flight or on foot from a PAD point, and simulated HEMS interventions. The primary outcome was the time to defibrillation, with secondary outcomes comparing workload, perceived physical effort, and ease of use.</p></div><div><h3>Results</h3><p>Thirty-six simulations were performed. Drone-delivered AED intervention had a significantly shorter TTD [2.2 (95 % CI 2.0–2.3) min] compared to PAD retrieval [12.4 (95 % CI 10.4–14.4) min] and HEMS [18.2 (95 % CI 17.1–19.2) min].</p><p>The self-reported physical effort on a visual analogue scale for drone-delivered AED was significantly lower versus PAD [2.5 (1 – 22) mm vs. 81 (65–99) mm, <em>p</em> = 0.02]. The overall mean workload measured by NASA-TLX was also significantly lower for drone delivery compared to PAD [4.3 (1.2–11.7) vs. 11.9 (5.5–14.5), <em>p</em> = 0.018].</p></div><div><h3>Conclusion</h3><p>The use of drones for automated AED delivery in a non-urban area with physical barriers is feasible and leads to a shorter time to defibrillation. Drone-delivered AEDs also involve a lower workload and perceived physical effort than AED retrieval on foot.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272886","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":"Low-dose ketamine for acute pain: A narrative review","authors":"Robert G. Fuller ,&nbsp;Evan M. Kikla ,&nbsp;Andrew P.W. Fawcett ,&nbsp;John D. Hesling ,&nbsp;Sean Keenan ,&nbsp;Kathleen M. Flarity ,&nbsp;Michael S. Patzkowski ,&nbsp;Michael D. April ,&nbsp;Vikhyat S. Bebarta ,&nbsp;Steven G. Schauer","doi":"10.1016/j.ajem.2024.09.033","DOIUrl":"10.1016/j.ajem.2024.09.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute pain management is a critical component of prehospital and emergency medical care. Opioids are effective; however, the risks and side-effects of opioids have led providers to use low-dose ketamine (LDK) for safe and effective treatment of acute pain.</div></div><div><h3>Methods</h3><div>We conducted a scoping narrative review to explore the efficacy of LDK for the treatment of acute pain in the prehospital setting and emergency department (ED) setting. The prehospital review includes studies evaluating the use of LDK in both civilian and military settings. We utilized PubMed to identify prospective and retrospective clinical studies related to this topic. We limited study inclusion to quality prospective and retrospective clinical and observational studies published in the English language prior to January 30, 2024. We did not limit study inclusion based on patient population or mode of administration. We utilized the PRISMA-ScR checklist to conduct this review.</div></div><div><h3>Results</h3><div>Using our methodology, we found 249 publications responsive to our search strategy. Of these, 178 publications were clearly outside inclusion criteria based on abstract review. Seventy-one studies were sought for retrieval and more detailed review. Of these, 22 records were excluded after review and 43 met initial inclusion criteria. An additional 22 studies were found via snowballing. In total, 64 studies met inclusion criteria for this analysis. 21 studies related to the treatment of acute pain in the prehospital setting, four of which were randomized clinical trials (RCTs). Forty-three studies evaluate the treatment of acute pain in the ED. This included 28 RCTs. Taken together, the studies suggest that LDK is non-inferior to opioids when used alone. When used as an adjunct to opioid therapy, LDK can provide an opioid-sparing effect. Ketamine doses &lt;0.5 mg/kg were not associated with significant side effects.</div></div><div><h3>Conclusions</h3><div>LDK is a safe and effective option for acute pain treatment. It can be used as an alternative therapy to opioids or used in conjunction with them to reduce opioid exposure through its opioid-sparing effect. Importantly, LDK is available in a variety of formulations including intramuscular, intravenous, and intranasal, making it an effective acute pain treatment option in both the prehospital and ED settings. LDK holds promise as an emergency treatment in the evolving landscape of acute pain management.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318683","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":"Comment on \"The accuracy of Gemini, GPT-4, and GPT-4o in ECG analysis: A comparison with cardiologists and emergency medicine specialists\".","authors":"Haihua Wang, Ji Lan","doi":"10.1016/j.ajem.2024.09.041","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.041","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333041","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":"Effects of Low Dose High-frequency Triage Education on Knowledge, Attitude, and Practices of Healthcare Professionals.","authors":"Jamal Hussain, Gideon Victor, Khair Ul Nisa Ajani, Changaiz Dil Essa","doi":"10.1016/j.ajem.2024.09.040","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.09.040","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301788","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":"Adult skateboarding and motorized board injuries: A comparative analysis","authors":"Kola George M.D, M.P.H,&nbsp;Mark Kouame B.S,&nbsp;Gabriella Rivas M.D,&nbsp;Paul Pottanat M.D,&nbsp;Langdon Hartsock M.D,&nbsp;Kristoff Reid M.D","doi":"10.1016/j.ajem.2024.09.037","DOIUrl":"10.1016/j.ajem.2024.09.037","url":null,"abstract":"<div><h3>Objectives</h3><div>Skateboarding and motorized boards are popular as a recreational activity and mode of transportation. Prior studies have investigated injury patterns from these activities in the pediatric population, but there is little data in the adult population. This study aims to investigate and compare the type and severity of injuries associated with skateboarding and motorized boards.</div></div><div><h3>Methods</h3><div>Retrospective analysis of injury data collected from the NIESS (National Electronic Injury Surveillance system) database, including cases of fractures involving skateboards or motorized boards from 2018 to 2022. Data collected was demographic information, injury characteristics (e.g., body region affected, injury type), environmental factors, mechanism of injury, and hospital treatment and disposition. Statistical analysis including chi-square and independent <em>t</em>-test were employed to determine significant differences in injury pattern.</div></div><div><h3>Results</h3><div>A total of 104,301 cases were included for analysis. 73.0 % of patients were male. 61.8 % of injuries were to the upper extremity. The most common fractures were of the wrist (20.2 %) and ankle (12.4 %). Patients injured on motorized boards were more likely to be older (40.0 ± 15.4 years) than those injured on skateboards (27.8 ± 9.8 years; <em>p</em> &lt; 0.001). 13.9 % of fractures required hospital admission. Skateboard accidents were more likely to present with lower extremity fractures (<em>p</em> &lt; 0.001), despite upper extremity injuries being the majority in both groups. There was a significant association between motorized board injuries and multiple fractures (<em>p</em> &lt; 0.001, OR = 1.2), and hospital admission (p &lt; 0.001, OR = 1.7).</div></div><div><h3>Discussion</h3><div>Our study shows a high prevalence of upper extremity injuries, regardless of board type. Motorized boards are associated with a higher risk of multiple fractures and hospital admission. Motorized boards likely have increased risk due to their ability to sustain elevated speeds.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417767","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":"Test results pending at discharge among emergency department patients experiencing homelessness","authors":"Kathleen Joseph MD ,&nbsp;Fanni Cardenas MD MPH ,&nbsp;Risa Brudney MD ,&nbsp;Jason Haukoos MD MSc ,&nbsp;Lance Ray PharmD ,&nbsp;Jennifer Whitfield MD MPH","doi":"10.1016/j.ajem.2024.09.028","DOIUrl":"10.1016/j.ajem.2024.09.028","url":null,"abstract":"<div><h3>Background</h3><p>Persons experiencing homelessness (PEH) are vulnerable emergency department (ED) patients due to high rates of multi-comorbidity and mortality, as well as a lack of follow up care. Communication of test results pending at discharge (TPAD) is an important area of post-ED follow up care. We examined phone access, successful contact, and change in treatment among PEH and non-PEH with TPAD from the ED.</p></div><div><h3>Methods</h3><p>We performed a retrospective cohort study and included all abnormal TPAD and patient telephone notes regarding TPAD over 7 months extracted from the electronic health record of a single, high-volume, urban, safety-net hospital in Denver, Colorado. Two investigators reviewed all data to determine phone access, successful contact, and recommended treatment change. Descriptive statistics were calculated for all variables and compared between PEH and non-PEH. We assessed associations between homelessness and successful contact and phone access while adjusting for age and sex using multivariable logistic regression.</p></div><div><h3>Results</h3><p>A total of 940 patient encounters with TPAD were included. 142 telephone notes regarding abnormal TPAD were included, of which 33 (23 %) were to PEH. Compared to PEH, housed patients were significantly more likely to have access to a phone (+31 %, 95 % CI: 14–48 %), have an active phone (+46 %, 95 % CI: 29–64 %), and be successfully contacted (+42 %, 95 % CI: 24–60 %), but were less likely to have a recommended change in treatment (−14 %, 95 % CI: −24 to −5 %). Homelessness was significantly associated with decreased successful contact (odds ratio [OR] 0.16, 95 % CI: 0.07–0.38) and decreased phone access (OR 0.11, 95 % CI: 0.04–0.33) after adjusting for age and sex. In the subgroup of patients with phone access (<em>n</em> = 124), homelessness was significantly associated with decreased successful contact (OR 0.26, 95 % CI: 0.10–0.70) after adjusting for age and sex.</p></div><div><h3>Conclusion</h3><p>PEH are less likely to have phone access and be successfully contacted regarding TPAD, resulting in untreated or improperly treated infectious disease. Thus, EDs and hospital systems should explore innovative communication solutions, such as shared responsibility models and partnerships with shelters and healthcare for the homeless clinics to improve successful contact with PEH regarding TPAD.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142232738","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":"Correlates of improved outcomes in patients with COVID-19 treated in US emergency departments","authors":"Wendy S. Slutske PhD ,&nbsp;Julie M. Kirsch PhD ,&nbsp;Thomas M. Piasecki PhD ,&nbsp;Karen L. Conner MPH ,&nbsp;Brian Williams MD ,&nbsp;Michael C. Fiore MD, MPH, MBA ,&nbsp;Steven L. Bernstein MD","doi":"10.1016/j.ajem.2024.09.035","DOIUrl":"10.1016/j.ajem.2024.09.035","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic was managed in part by the rapid development of vaccines, diagnostics, and therapeutics including antiviral agents and advances in emergency airway and ventilatory management. The impact of these therapeutic advances on clinically pertinent metrics of emergency care have not been well-studied.</p></div><div><h3>Methods</h3><p>We abstracted data from emergency department (ED) visits made to 21 US health systems during the first two years of the pandemic, from February 1, 2020 to January 31, 2022. These health systems were participants in the NIH-supported COVID EHR Cohort, in which the University of Wisconsin served as the coordinating site. Limited patient-level data files were submitted monthly. Data elements included demographic and clinical variables, as well as standard measures of ED outcomes including 72-h returns, 72-h returns leading to readmission, and in-hospital mortality. Multivariable models were fitted to identify correlates of each of the dependent variables. A test for trend was used to detect changes in outcomes over time.</p></div><div><h3>Results</h3><p>During the two-year period, 150,357 individuals aged 18 years or older visited the ED. The median age was 45.4 years (IQR 27), 58.1 % were female, 49 % were White, 18.3 % Hispanic/Latino, and 45 % were publicly insured or uninsured. The prevalence of 72-h ED returns, readmissions, and in-hospital mortality significantly declined across the two-year period. SARS-CoV-2 vaccination was associated with reduced ED returns and mortality. Therapeutic agents were associated with increased mortality risk but were likely confounded by unmeasured covariates.</p></div><div><h3>Conclusions</h3><p>Operational and clinical outcomes of ED-based treatment of individuals with COVID-19 improved in the first two years of the pandemic. This improvement is likely multifactorial and includes the development and deployment of SARS-CoV-2-specific vaccines, therapeutic agents, and improved healthcare delivery in the ED and elsewhere addressing management of airway and ventilatory status, as well as increased innate immunity in the general population.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272887","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":"Psychedelic mushroom-containing chocolate exposures: Case series","authors":"Hayley T. Gartner PharmD ,&nbsp;Herbert Z. Wan PharmD ,&nbsp;Reeves E. Simmons PharmD ,&nbsp;Dawn R. Sollee PharmD ,&nbsp;Sophia Sheikh MD","doi":"10.1016/j.ajem.2024.09.038","DOIUrl":"10.1016/j.ajem.2024.09.038","url":null,"abstract":"<div><h3>Introduction</h3><p>The recreational use of psilocybin or psilocin-containing products, a chemical found naturally in certain mushroom species, is on the rise across the United States. Several cases of serious clinical effects related to mushroom-containing products have recently been reported to the Food and Drug Administration (FDA). The emergence of these new products and their health consequences are not yet well understood. This case series aims to characterize exposures to mushroom-containing chocolate products, including patient characteristics, clinical effects, treatment(s), and clinical outcome severity, reported to a poison center network.</p></div><div><h3>Material and methods</h3><p>This was a retrospective case series conducted in patients exposed to mushroom-containing chocolate products across three poison centers between January 2023 to August 2024. Patients were identified via a database search of ToxSentry®. Patients were included if they were exposed to a mushroom-containing chocolate product. Patients were excluded if they ingested an unrelated product or if there was insufficient information documented within ToxSentry®. The primary endpoint was to describe clinical outcome severity after exposure to mushroom-containing chocolate products.</p></div><div><h3>Results</h3><p>A query of ToxSentry® identified 164 cases; 36 cases met study criteria. The median age of patients in this case series was 17 years old. For most patients (23, 64 %), the reason for the exposure was intentional, with 20 reporting intentional abuse or misuse of the product. Common clinical effects reported included mental status changes (26, 76 %), paranoia/hallucinations (10, 28 %), dysrhythmias (7, 19 %) and gastrointestinal discomfort (6, 17 %). There was one report of seizure. Most clinical effects lasted between 3 and 24 h after ingestion (29, 81 %). Intravenous fluids (18, 50 %) and benzodiazepines (7, 19 %) were the most common treatments given. No fatalities were reported.</p></div><div><h3>Discussion</h3><p>While most patients in this series experienced minor clinical effects, some developed serious effects after ingestion of a mushroom-containing chocolate product. Findings from this study further characterize the limited patient demographics, clinical effects, and outcomes published thus far. Further characterization in a larger cohort of patients could expand on our initial findings and is needed to better identify factors that may influence clinical outcomes.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142242691","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":"The perception of gender and the approach taken towards female physicians","authors":"Gülşah Çıkrıkçı Işık MD ,&nbsp;Ayşe Şahin MD ,&nbsp;Betül Karagöz MD ,&nbsp;Yunsur Çevik MD","doi":"10.1016/j.ajem.2024.09.029","DOIUrl":"10.1016/j.ajem.2024.09.029","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study is to evaluate gender perception among patients in the emergency department (ED) and to examine the effect of gender perception on patients' preference of physician's gender.</div></div><div><h3>Methods</h3><div>This was a cross-sectional survey study. The survey comprised three sections. The first section collected general information, while the second section inquired about patients' preferences for physicians' gender in the ED, in general examinations, and regarding “sensitive” medical issues. The third section of the survey, entitled the “Perception of Gender Scale,” comprised a series of questions designed to assess the participants' perceptions of gender. The scale employed a Likert-type response format, with scores ranging from 25 to 125. Higher scores indicated a more egalitarian gender perception.</div></div><div><h3>Results</h3><div>The number of participants in the study was 431, with 194 males and 237 females. The median age of the participants was 38.5 years (interquartile range [IQR] 28–48). Over half of the participants had completed university education. The study population exhibited a Perception of the Gender Scale (PGS) score of 96 (IQR 78.5–109). With regard to the patient's preference for physicians' gender, in emergency settings (ES) and in general examinations (GE), over three-quarters of the participants indicated that they do not have a preference. However, for sensitive medical issues (SMI), the proportion of participants indicating no preference decreased to 45 %. Among those with the lowest quartile of PGS scores, the percentage of individuals who expressed no gender preference in ES, GE and SMI was 65 %, 60 %, 26 % and who expressed a preference for male physicians was 13 %, 19 %, 43 % respectively. In contrast, of those with the highest quartile of PGS scores, the percentages of those who had no gender preference were 86 %, 90 %, 68 %, while the percentages of those who preferred male physicians were 1.9 %, 1 %, and 4.8 %, respectively.</div></div><div><h3>Conclusion</h3><div>In the context of emergency settings and general examinations, approximately three-quarters of the participants indicated no preference regarding the gender of the physician. However, in the case of sensitive medical issues, the proportion of participants with no gender preference was less than half. For patients with a gender preference for their physician, perception of gender is a significant predictor.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269446","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}