Journal of Nippon Medical School最新文献

{"title":"Accuracy and Clinical Utility of Spot-Check Noninvasive Hemoglobin Monitoring: A Preliminary Study.","authors":"Ichiro Kamiya, Chol Kim, Makiko Yamamoto, Yuki Genda, Hiroshi Mase, Masashi Ishikawa","doi":"10.1272/jnms.JNMS.2026_93-211","DOIUrl":"10.1272/jnms.JNMS.2026_93-211","url":null,"abstract":"<p><strong>Introduction: </strong>Hemoglobin (Hb) monitoring is essential for perioperative management, particularly for detecting anemia and guiding transfusion decisions. Conventional invasive methods provide accurate results but are limited by delays, intermittent sampling, and iatrogenic blood loss. Noninvasive spot-check Hb (SpHb) monitoring offers rapid assessment, but its accuracy is unclear. This study thus evaluated agreement between SpHb obtained with the Rad-67 and invasive Hb measurements in anesthetized patients.</p><p><strong>Methods: </strong>This single-center, prospective, observational study enrolled 25 adults who underwent gastrointestinal surgery under general anesthesia between June 2023 and March 2024. After induction and stabilization, SpHb was recorded simultaneously with arterial blood sampling. Reference Hb was measured with an automated hematology analyzer (XN-9100), an arterial blood gas analyzer (LC-661), and a portable spectrophotometric device (HemoCue). Correlation was assessed by Pearson's coefficient, and agreement by Bland-Altman analysis.</p><p><strong>Results: </strong>The cohort comprised 18 men (72.0%) with a mean (±SD) age of 66.8 ± 13.4 years and body mass index of 22.9 ± 3.2 kg/m². Mean Hb was 12.6 ± 1.7 g/dL (SpHb), 11.1 ± 1.8 g/dL (XN-9100), 11.4 ± 1.8 g/dL (LC-661), and 11.4 ± 1.8 g/dL (HemoCue). Strong correlations were observed (r = 0.931, 0.930, 0.841; p < 0.001 for all). Bland-Altman analysis showed fixed positive biases of +1.47 g/dL (XN-9100) and +1.19 g/dL (LC-661, HemoCue), without proportional error.</p><p><strong>Conclusions: </strong>SpHb correlated strongly with invasive Hb but consistently overestimated values by 1-1.5 g/dL. While unsuitable as a direct substitute, SpHb may serve as a bias-aware screening tool that reduces unnecessary phlebotomy.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"173-178"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846703","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":"Comprehensive Assessment of Kounis Syndrome Secondary to Carboplatin Chemotherapy: A Case Report.","authors":"Seungmin Back, Wonsang Chu, Soohyung Park, Eun Jin Park, Cheol Ung Choi, Dong Oh Kang","doi":"10.1272/jnms.JNMS.2026_93-101","DOIUrl":"10.1272/jnms.JNMS.2026_93-101","url":null,"abstract":"<p><p>Allergic reactions during chemotherapy can lead to a rare condition known as Kounis syndrome, characterized by the simultaneous occurrence of coronary ischemia and allergic manifestations. Herein, we present a case of a 75-year-old woman who developed carboplatin-induced coronary vasospasm, highlighting the importance of comprehensive clinical and immunological evaluations for an accurate diagnosis. During carboplatin infusion, the patient exhibited typical symptoms, including chest pain and electrocardiographic changes. Subsequent investigations revealed elevated serum tryptase and total immunoglobulin E levels along with normal-looking coronary arteries, confirming a diagnosis of Type I Kounis syndrome. Following a safe recovery from the acute anaphylactic episode, the patient's treatment plan was adjusted accordingly based on this definitive diagnosis. Our findings emphasize the significance of recognizing and documenting immune responses in the diagnosis of Kounis syndrome; this can inform therapeutic strategies and improve patient outcomes.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 1","pages":"95-100"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437955","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":"Bone Marrow Exposure during Minor Amputation for Diabetic Foot Gangrene: A Single-Center Retrospective Study.","authors":"Yuki Tone, Toshihiko Hoashi, Saki Otani, Kanto Hoshikawa, Naoko Kanda, Hidehisa Saeki","doi":"10.1272/jnms.JNMS.2026_93-108","DOIUrl":"10.1272/jnms.JNMS.2026_93-108","url":null,"abstract":"<p><strong>Background: </strong>The incidence of diabetic gangrene is increasing because patients are living longer with diabetes.</p><p><strong>Methods: </strong>Data from 27 Japanese adults with diabetic foot gangrene were analyzed. All affected sites, including bones, were surgically excised. Amputation was performed at the toe or metatarsal bones, and bone marrow was adequately exposed. This retrospective review investigated the results of this therapy.</p><p><strong>Results: </strong>Healing was satisfactory for 26 of the 27 (96.3%) patients. Recurrence was noted in 4 (14.8%) of the 27 patients, the median number of operations was 1 (range, 1-3), and 1 (3.7%) patient required reconstructive surgery. White blood cell (WBC) count and C-reactive protein (CRP) level were significantly higher in recurrent cases than in non-recurrent cases (p = 0.009 and p = 0.001, respectively; Wilcoxon rank sum test). The cutoff values for WBC count and CRP level were 17,300/μL (specificity 100%; sensitivity 75%) and 10.23 mg/dL (specificity 81.8%; sensitivity 100%), respectively, using the Youden index. WBC count and CRP level also significantly positively associated with the number of operations (p = 0.018 and p = 0.018, respectively; Jonckheere-Terpstra trend test).</p><p><strong>Conclusions: </strong>A higher WBC count and CRP level may predict recurrence and number of operations. Therapy using bone marrow exposure is simple and useful for diabetic foot gangrene. Thus, minor amputation with bone marrow exposure may be an effective treatment for diabetic foot gangrene.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 1","pages":"17-24"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437941","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":"Tau Accumulation and Dopamine Transporter Availability in Elderly Adults with Depression.","authors":"Shotaro Uchiyama, Ryosuke Arakawa, Takeshi Sakayori, Tsuyoshi Nogami, Tomoyuki Ohya, Makoto Higuchi, Amane Tateno","doi":"10.1272/jnms.JNMS.2026_93-308","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-308","url":null,"abstract":"<p><strong>Background: </strong>Depression in later life is associated with dopaminergic dysfunction and increased risk of neurodegenerative disorders, although the relationship between dopamine transporter (DAT) availability and tau accumulation remains unclear. Although previous studies have linked tau and DAT in neurodegenerative diseases, evidence related to depression is limited. Therefore, this study used positron emission tomography (PET) to investigate the association between tau pathology and DAT availability in elderly adults with depression.</p><p><strong>Methods: </strong>Six patients diagnosed with depression according to ICD-10 criteria underwent PET scans with PET radioligands that enable accurate in vivo assessment, namely, florzolotau (18F) for tau and [¹⁸F]FE-PE2I for DAT. Clinical assessments using the Mini-Mental State Examination (MMSE) and Hamilton Depression Rating Scale (HAM-D) were performed for all patients. Tau standardized uptake value ratios (SUVR) in the striatal and cortical regions and DAT binding potentials (BP_ND) in the striatum were calculated.</p><p><strong>Results: </strong>Tau SUVR in all regions was negatively correlated with DAT BP_ND in the striatum, suggesting that greater tau burden may be linked to dopaminergic dysfunction. Tau SUVR in the striatum was negatively correlated with MMSE, indicating that tau accumulation may be related to subtle cognitive decline. DAT BP_ND in the striatum was not correlated with HAM-D.</p><p><strong>Conclusions: </strong>These preliminary results suggest a link between tau pathology and dopaminergic dysfunction in elderly adults with depression.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 3","pages":"236-243"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347591","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":"Comment on \"Predictive Postoperative Inflammatory Response Indicators of Infectious Complications Following Gastrectomy for Gastric Cancer\".","authors":"Satoru Morita, Koji Okabayashi, Yuko Kitagawa","doi":"10.1272/jnms.JNMS.2026_93-304","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-304","url":null,"abstract":"","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 3","pages":"284-285"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347593","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":"Oncologic Outcomes of Fertility-Sparing Surgery versus Radical Surgery for Stage I Epithelial Ovarian Cancer.","authors":"Yumene Kubota, Masafumi Toyoshima, Akiko Sakata, Mariko Ikeda, Akihito Yamamoto, Rieko Kawase, Keisuke Kurose, Shunji Suzuki","doi":"10.1272/jnms.JNMS.2026_93-114","DOIUrl":"10.1272/jnms.JNMS.2026_93-114","url":null,"abstract":"<p><strong>Background: </strong>Epithelial ovarian cancer (EOC) is increasingly affecting women of reproductive age. Fertility-sparing surgery (FSS) is an option for patients with early EOC who want to preserve their fertility, but the oncologic safety of FSS requires rigorous evaluation. This study retrospectively compared the oncologic outcomes of FSS with those of radical surgery (non-FSS) for patients with FIGO 2014 Stage I EOC at our institution.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of patients younger than 45 years diagnosed with FIGO 2014 Stage I EOC (April 2010-June 2024). Patients were categorized into FSS (n=11) and non-FSS (n=9) groups. Baseline characteristics, recurrence rates, progression-free survival (PFS), and overall survival (OS) were compared.</p><p><strong>Results: </strong>Twenty patients were included. The FSS group was significantly younger (median age 29.2 vs 40.8 years, p=0.043). Recurrence was more frequent in the FSS group (36.4% vs 11.1%), although this difference was not significant (p=0.077). Kaplan-Meier analysis showed no significant difference in PFS (HR 3.24, 95% CI: 0.56-18.74, p=0.19) or OS (HR 1.78, 95% CI: 0.18-16.9, p=0.63).</p><p><strong>Conclusion: </strong>In this small cohort, FSS for Stage I EOC yielded a higher recurrence rate, but no significant difference in survival, as compared with radical surgery. Because of the small size and inherent stage-migration bias from incomplete surgical staging in the FSS group, these findings should be interpreted with extreme caution. Careful patient selection, thorough staging, and strict surveillance are crucial when implementing FSS.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 1","pages":"72-79"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438002","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":"Development and Clinical Application of a Deep Learning-Based AI Support Model for Endometrial Cancer Cytology.","authors":"Ichito Shimokawa, Mika Terasaki, Shun Tanaka, Etsuko Toda, Shoichiro Takakuma, Yusuke Kajimoto, Shinobu Kunugi, Akira Shimizu, Yasuhiro Terasaki","doi":"10.1272/jnms.JNMS.2026_93-115","DOIUrl":"10.1272/jnms.JNMS.2026_93-115","url":null,"abstract":"<p><strong>Background: </strong>The global increase in endometrial cancer, including in Japan, and a shortage of pathologists and cytotechnologists have increased the diagnostic burden, emphasizing the need for an AI-based diagnostic support model that uses deep learning. We evaluated the clinical application of an improved AI-supported endometrial cytology model.</p><p><strong>Methods: </strong>Using YOLOv5x and YOLOv7 models evaluated by mean average precision (mAP), we compared two datasets-one annotated for both benign and malignant cell clusters, and one for malignant only. In addition, using the Two One-Sided Tests (TOST) procedure, we assessed the correlation between AI diagnostic accuracy and the level of difficulty perceived by human diagnosticians. Finally, we used Gradient-weighted Class Activation Mapping (Grad-CAM) to visualize and enhance the interpretability of the AI model's decision-making process.</p><p><strong>Results: </strong>The YOLOv5x model with both benign and malignant annotations had the highest malignant mAP, 0.798, as compared with YOLOv7. The TOST analysis showed no significant difference in perceived diagnostic difficulty between cases that were correctly and incorrectly diagnosed by the AI model, indicating consistent AI accuracy regardless of case difficulty. Grad-CAM visualizations clarified the AI model's decision-making basis; in some cases, the model appeared to focus on regions that differed from those typically attended to by human diagnosticians.</p><p><strong>Conclusion: </strong>The AI support model showed high and consistent accuracy in endometrial cytological analysis, regardless of diagnostic difficulty as perceived by human diagnosticians. Grad-CAM visualizations revealed diagnostic patterns, and the AI occasionally focused on regions different from those emphasized by human diagnosticians. This study advanced a real-time microscope-integrated AI system toward clinical application.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 1","pages":"80-94"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437983","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":"Midazolam and Dexmedetomidine Promoted Migration of Human Lung Adenocarcinoma A549 Cells.","authors":"Anna Ishikawa, Masae Iwasaki, Masahiro Tomihari, Makiko Yamamoto, Masashi Ishikawa","doi":"10.1272/jnms.JNMS.2026_93-210","DOIUrl":"10.1272/jnms.JNMS.2026_93-210","url":null,"abstract":"<p><strong>Background: </strong>The numerous studies of the effects of intravenous anesthetics on cancer have suggested potential effects on cell migration and postoperative outcomes. This study compared the direct effects of midazolam and dexmedetomidine on A549 human lung adenocarcinoma cells.</p><p><strong>Methods: </strong>A549 cells were exposed for 2 hr to midazolam (5, 10, 15, 20 μM), dexmedetomidine (1, 10, 100 nM), or medium alone as a naïve control. Cell viability changes were assessed with a wound healing assay, adenosine triphosphate (ATP) analysis, and cell counting kit-8 (CCK) assay. Tumor metastasis-related gene expression was assessed by a polymerase chain reaction (PCR) array and qRT-PCR. Hypoxia-inducible factor (HIF-1α), angiotensin-converting enzyme 2 (ACE2), matrix metalloproteinase (MMP9), and β-catenin expressions were assessed by immunofluorescence staining.</p><p><strong>Results: </strong>Midazolam treatments promoted cell migration and metabolism but suppressed cell proliferation, whereas D treatments promoted cell migration only and had no effect on metabolism or cell proliferation. The PCR array of cancer-related genes revealed that five genes were upregulated by midazolam treatment relative to naïve controls: Frizzled-1 (FZD1), AKT serine/threonine kinase 2 (AKT2), E2F transcription factor 1 (E2F1), Fos proto-oncogene, AP-1 transcription factor subunit (FOS), and tumor protein p53 (TP53). Two genes were upregulated in the dexmedetomidine group: the CRK proto-oncogene, adaptor protein (CRK) and FZD1.</p><p><strong>Conclusions: </strong>These findings clarify how dexmedetomidine and midazolam treatments affect lung cancer prognoses. Our data suggest that midazolam rather than dexmedetomidine should be recommended for lung cancer surgery.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"161-172"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846283","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":"Lipoma of the Infrapatellar Fat Pad: A Report of Three Cases.","authors":"Yasuyuki Kitagawa, Kazuma Miura, Daisuke Fukuhara, Naoto Kotani, Shoko Sasaki, Yosuke Shinozuka, Ryu Tsunoda, Tokifumi Majima","doi":"10.1272/jnms.JNMS.2026_93-103","DOIUrl":"10.1272/jnms.JNMS.2026_93-103","url":null,"abstract":"<p><p>Although lipoma is the most common soft tissue tumor, lipoma in the infrapatellar fat pad (IFP) is rare. Herein, we report three cases of lipoma in the IFP that penetrated the joint capsule and extended subcutaneously. All patients presented with unusual MRI findings. Patients 1, 2, and 3 were 63, 74, and 64 years old, respectively, and all were female. Their chief complaint was a knee mass; however, they did not experience pain or limitations in range of motion. The interval from initial awareness of the mass to first consultation was long (3, 8, and 13 years, respectively). MRI revealed that the mass had extended subcutaneously from the IFP through the lateral, medial, and bilateral joint capsules of the patellar tendon, respectively. On MRI, the masses appeared as lipomatous tumors with scattered low signal areas on T1-weighted imaging. The tumors excised after biopsy had long axes of approximately 6, 7, and 7 cm, respectively. Histological examination revealed lipomas with partial fibrosis in all three tumors and cartilage metaplasia in the tumor from patient 3. Lipomas in IFPs often exhibit secondary changes, such as fibrosis and cartilage metaplasia, resulting in MRI findings that differ from those of typical lipomas. In the present cases, biopsy was necessary to differentiate them from atypical lipomatous tumors or Hoffa disease.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 1","pages":"106-112"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437945","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":"Symptom Improvement after Surgery for Tarsal Tunnel Syndrome.","authors":"Minoru Ideguchi, Kyongsong Kim, Satoshi Yamaguchi, Toyohiko Isu, Hiroyuki Dan, Riku Mihara, Kenta Koketsu, Yasuo Murai","doi":"10.1272/jnms.JNMS.2026_93-410","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-410","url":null,"abstract":"<p><strong>Background: </strong>Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve in the tarsal tunnel. Patients with TTS exhibit plantar symptoms, including numbness, foreign body sensation, and cold/burning sensation. We investigated postoperative improvement of symptoms and the association of preoperative symptoms with surgical outcomes in patients with idiopathic TTS.</p><p><strong>Methods: </strong>We enrolled 17 consecutive patients (21 sides) with idiopathic TTS (mean age 68.6 years). The presence and severity of symptoms were evaluated before and 6 months after surgery and recorded on a numeric rating scale (NRS). Major preoperative symptoms noted were numbness in 14 patients, foreign body sensation in 13 patients, and cold/burning sensation in 5 patients. Some patients had multiple major symptoms. Patient satisfaction was recorded on an NRS at 6 months postoperatively.</p><p><strong>Results: </strong>Postoperative patient satisfaction was 7.0. Improvement in foreign body sensation was weakest, although the difference as compared with other symptoms was not significant. Patients with foreign body sensation and at least one other major symptom reported significantly lower symptom improvement and treatment satisfaction. There was no significant difference in perceived improvement between those reporting numbness and cold/burning sensation as major symptoms and those who did not.</p><p><strong>Conclusions: </strong>Patients reporting foreign body sensation as a major symptom were significantly less satisfied with the outcome of surgery than other patients. Our findings may help predict satisfaction with surgical outcomes in patients with idiopathic TTS.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 4","pages":"318-322"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833986","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}