Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2025-01-15DOI: 10.1080/00016489.2024.2447564
Kristi Kaveri Dutta, Anjana Rajesh, C S Vanaja
{"title":"Can switching stimulus polarity identify Meniere's disease? A preliminary investigation on ABR.","authors":"Kristi Kaveri Dutta, Anjana Rajesh, C S Vanaja","doi":"10.1080/00016489.2024.2447564","DOIUrl":"10.1080/00016489.2024.2447564","url":null,"abstract":"<p><strong>Background: </strong>Meniere's disease (MD) affects 0.2% to 0.5% of the global population, with regional variations. Standard diagnostic methods, including the glycerol test and EcochG, show variable sensitivity and specificity, highlighting the need for more reliable diagnostic approaches.</p><p><strong>Objective: </strong>This study aims to investigate latency differences in wave V of the Auditory Brainstem Response (ABR) by comparing waveforms for rarefaction and condensation clicks to identify MD.</p><p><strong>Materials and methods: </strong>The study analyzed latency differences in wave V of the ABR using condensation and rarefaction clicks in 15 ears diagnosed with MD. The control groups included 10 ears with sensorineural hearing loss (SNHL) [non-MD ears] and 20 ears with normal hearing sensitivity.</p><p><strong>Results: </strong>MD patients exhibited a significant wave V latency shift between rarefaction and condensation stimuli, suggesting altered cochlear dynamics due to endolymphatic hydrops. No such shift was observed in normal hearing or SNHL ears. Patients with definite MD showed a greater latency difference than those with probable MD, possibly reflecting varying endolymphatic pressure.</p><p><strong>Discussion: </strong>These findings suggest that ABR testing with opposite polarity stimuli could serve as an adjunctive diagnostic tool for MD, particularly in differentiating the severity of the condition but further research is needed to validate these preliminary.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"156-163"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982472","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}
Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2025-01-17DOI: 10.1080/00016489.2025.2451092
Oguz Kuscu, Enes Dogan, Erim Pamuk
{"title":"Transoral robotic surgery in otolaryngology practice: a single institutional experience.","authors":"Oguz Kuscu, Enes Dogan, Erim Pamuk","doi":"10.1080/00016489.2025.2451092","DOIUrl":"10.1080/00016489.2025.2451092","url":null,"abstract":"<p><strong>Background: </strong>Transoral robotic surgery (TORS) has emerged as a minimally invasive technique for managing head and neck pathologies, offering reduced morbidity and improved surgical precision. Despite its growing popularity, institutional experiences with TORS remain limited.</p><p><strong>Objectives: </strong>This study aimed to evaluate the outcomes of TORS for oncological and obstructive sleep apnoea syndrome (OSAS) cases, focusing on efficacy, safety and complications.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 61 patients who underwent TORS at a single institution between 2018 and 2024. Demographic, surgical and postoperative data were collected, including histopathological findings, complications and hospitalization duration. Statistical analyses were performed using SPSS software (SPSS, Chicago, IL, USA), with significance set at <i>p</i> < .05.</p><p><strong>Results: </strong>Of the 61 patients, 67.2% were male, with a mean age of 57.25 years. TORS was performed for oncological purposes in 72.1% of cases and OSAS in 27.9%. The most common surgical procedure was base-of-tongue resection (42.6%). Postoperative bleeding occurred in 11.4% of cases, all oncological, with two mortalities due to haemorrhage. Hospital readmission within 30 days occurred in 13.1% of patients. OSAS cases demonstrated shorter hospital stays and lower complication rates than oncological cases.</p><p><strong>Conclusions: </strong>TORS is a safe and effective technique for both oncological and OSAS cases, offering significant benefits in reducing morbidity. However, complications, particularly bleeding in oncological cases, remain a challenge, highlighting the need for careful patient selection and perioperative management.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"181-185"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998220","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}
Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2024-12-30DOI: 10.1080/00016489.2024.2445746
Burak Hazır, Çetin Şahutoğlu, Mustafa Çolak, Ağah Yeniçeri, Nagihan Gülhan Yaşar, Aykut İkincioğulları, Hacı Hüseyin Dere
{"title":"Audiological outcomes and their association with quality of life in patients undergoing stapedotomy.","authors":"Burak Hazır, Çetin Şahutoğlu, Mustafa Çolak, Ağah Yeniçeri, Nagihan Gülhan Yaşar, Aykut İkincioğulları, Hacı Hüseyin Dere","doi":"10.1080/00016489.2024.2445746","DOIUrl":"10.1080/00016489.2024.2445746","url":null,"abstract":"<p><strong>Background: </strong>Some preoperative and postoperative audiological outcomes may be associated with quality of life (QoL) in stapedotomy patients.</p><p><strong>Aims: </strong>The aim of this study is to determine which frequencies and conduction pathways improve following this surgery and to assess their effects on QoL.</p><p><strong>Material and methods: </strong>Cases who underwent small fenestra stapedotomy were retrospectively reviewed. Preoperative and postoperative pure tone audiometry were evaluated. The Glasgow Benefit Inventory (GBI) questionnaire was also administered to assess the impact of the operation on their QoL. The relationship between audiologic results and QoL was also examined.</p><p><strong>Results: </strong>A total of 45 ears from 41 patients were included in the study. There is a statistically significant improvement in postoperative mean air conduction (AC), bone conduction (BC) and air-bone gap (ABG) values compared to preoperative values (<i>p</i> < .001). A significant moderate correlation was found between preoperative mean ABG and GBI scores, and between postoperative improvements in AC thresholds and ABG at all frequencies (500, 1,000, 2,000 and 4,000 Hz) and GBI scores (0.3<<i>r</i> < 0.7, <i>p</i> < .05). Among the postoperative BC thresholds, only the improvement at 2,000 Hz was found to have an effect on the GBI score (<i>r</i> = .309, <i>p</i> = .049).</p><p><strong>Conclusions and significance: </strong>Audiological outcomes following stapedotomy had an impact on QoL. Preoperative ABG can be used as an indicator of postoperative QOL.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":"145 2","pages":"128-133"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373443","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}
Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2025-01-11DOI: 10.1080/00016489.2024.2448823
Henrik M Sjöblom, Jenny C Knubb, Tommi Kauko, Jaakko Pulkkinen, Jaakko M Piitulainen
{"title":"Incidence of adult tonsillectomy for hypertrophic indications in Southwest Finland.","authors":"Henrik M Sjöblom, Jenny C Knubb, Tommi Kauko, Jaakko Pulkkinen, Jaakko M Piitulainen","doi":"10.1080/00016489.2024.2448823","DOIUrl":"10.1080/00016489.2024.2448823","url":null,"abstract":"<p><strong>Background: </strong>Large palatine tonsils cause a variety of symptoms including obstructive sleep apnea and snoring. In adults, the prevalence of tonsillar hypertrophy remains uncertain.</p><p><strong>Aims: </strong>We estimated the incidence of tonsillectomy for adult palatine tonsillar hypertrophy using population data and retrospective patient charts.</p><p><strong>Material and methods: </strong>Patient data were retrospectively collected between 2004 and 2018 in the Hospital District of Southwest Finland. Adult patients with tonsil hypertrophy, obstructive sleep apnea or mouth breathing/snoring as an indication for surgery were included. Data were verified from patient charts. To determine in adults the incidence of tonsillectomy for tonsillar hypertrophy, the number of surgeries was compared to population data.</p><p><strong>Results: </strong>The incidence of tonsillectomy for adult tonsillar hypertrophy was 8.49 per 100000 person-years. In our hospital district, 9.5% of adults who underwent tonsil surgery had tonsillar hypertrophy. The incidence rate reduced with age. The most common indication for surgery of hypertrophic tonsils was snoring (30.8%). In this study, 12.7% of patients with asymmetric tonsils had malignancy with the most common being lymphoma.</p><p><strong>Conclusions and significance: </strong>Symptomatic adult tonsil hypertrophy remains rare. In adults, tonsil asymmetry should invoke a suspicion of lymphoma. Even during adulthood, as age increases, tonsillar hypertrophy becomes less common.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"176-180"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963535","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}
Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2025-01-15DOI: 10.1080/00016489.2025.2450222
Ping Guo, Fenghua Qin, Lei Ye, Huawei Li, Wenyan Li
{"title":"The role of audiological features and horizontal semicircular canal function at various frequencies in vestibular migraine and Menière's disease.","authors":"Ping Guo, Fenghua Qin, Lei Ye, Huawei Li, Wenyan Li","doi":"10.1080/00016489.2025.2450222","DOIUrl":"10.1080/00016489.2025.2450222","url":null,"abstract":"<p><strong>Background: </strong>Vestibular migraine (VM) and Menière's disease (MD) have numerous overlapping symptoms. Distinguishing the two common recurrent vestibulopathies was challenging.</p><p><strong>Objectives: </strong>To assess the characteristics of hearing loss and the horizontal semicircular canal function in VM and MD.</p><p><strong>Materials and methods: </strong>Various frequency horizontal semicircular canal function tests, including caloric test, video head impulse test (vHIT), and rotatory chair test, as well as multifrequency audiological test with pure-tone average (PTA), were carried out.</p><p><strong>Results: </strong>The hearing threshold of all frequencies in VM is lower than that of MD (<i>p</i> < .05). The phase shift at 0.01 Hz, 0.02 Hz, 0.04 Hz, 0.08 Hz and 0.64 Hz was significantly different in VM and MD patients. The gain at 0.01 Hz differed between VM and MD (<i>p</i> < .05); the time constant (RTc) in VM patients was longer than that of MD patients (<i>p</i> < .05). The incidence of caloric test abnormality was 40% in VM patients and 68.3% in MD patients. The abnormal rate of horizontal semicircular canal vHIT was 3.2% in VM and 5.8% in the MD, and the rates of overt/cover saccades were 9.7% and 17.6%, respectively.</p><p><strong>Conclusions: </strong>The degree and type of hearing loss were conducive to distinguishing between VM and MD, and the rotatory chair test was a necessary supplement.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"115-122"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982474","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}
Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2025-01-15DOI: 10.1080/00016489.2024.2445738
Guowei Qi, Jinge Tang, Handai Qin, Runnan Han, Qingqing Jiang, Ning Yu, Shiming Yang, Dongyi Han
{"title":"Metabolome modification and underlying biomarker of noise-induced hearing loss Guinea pig cochlear fluid.","authors":"Guowei Qi, Jinge Tang, Handai Qin, Runnan Han, Qingqing Jiang, Ning Yu, Shiming Yang, Dongyi Han","doi":"10.1080/00016489.2024.2445738","DOIUrl":"10.1080/00016489.2024.2445738","url":null,"abstract":"<p><strong>Background: </strong>Noise-induced hearing loss (NIHL) is a kind of acquired sensorineural hearing loss and has shown an increasing incidence in recent years. Hence, elucidating the exact pathophysiological mechanisms and proposing effective treatment and prevention methods become the top priority. Though a great number of researches have been carried out on NIHL, few of them were focused on metabolites.</p><p><strong>Aims/objectives: </strong>To reveal the metabolomic changes in cochlear fluid after noise injury and search for underlying inner ear biomarkers of NIHL.</p><p><strong>Material and methods: </strong>In this study, cochlea fluid extracted from guinea pigs after impulse noise exposure were subjected to GC-MS and LC-MS untargeted metabolomics analysis.</p><p><strong>Results: </strong>After impulse noise exposure, 62 significantly changed metabolites in guinea pig cochlea fluid were screened out and deoxyribose 1-phosphate was selected as the key metabolite and underlying biomarker for NIHL. KEGG pathway analysis showed that oxidative phosphorylation, glycerophospholipid metabolism, pyrimidine metabolism and pentose phosphate pathway were significantly changed at all observed time points after noise.</p><p><strong>Conclusions and significance: </strong>This study effectively promoted the application of metabolomics in hearing research. The pathophysiology process of NIHL in the inner ear was closely connected with oxidative phosphorylation, glycerophospholipid metabolism, pyrimidine metabolism and pentose phosphate pathway and deoxyribose 1-phosphate could be the biomarker for NIHL.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"101-114"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982473","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}
Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2024-12-30DOI: 10.1080/00016489.2024.2437687
Ling Lu, Andra Lazar, Jun Yang, Maoli Duan
{"title":"Say No to deafness: perspective of gene therapy for sensorineural hearing loss.","authors":"Ling Lu, Andra Lazar, Jun Yang, Maoli Duan","doi":"10.1080/00016489.2024.2437687","DOIUrl":"10.1080/00016489.2024.2437687","url":null,"abstract":"","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"150-155"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deep learning multi-classification of middle ear diseases using synthetic tympanic images.","authors":"Yoshimaru Mizoguchi, Taku Ito, Masato Yamada, Takeshi Tsutsumi","doi":"10.1080/00016489.2024.2448829","DOIUrl":"10.1080/00016489.2024.2448829","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in artificial intelligence have facilitated the automatic diagnosis of middle ear diseases using endoscopic tympanic membrane imaging.</p><p><strong>Aim: </strong>We aimed to develop an automated diagnostic system for middle ear diseases by applying deep learning techniques to tympanic membrane images obtained during routine clinical practice.</p><p><strong>Material and methods: </strong>To augment the training dataset, we explored the use of generative adversarial networks (GANs) to produce high-quality synthetic tympanic images that were subsequently added to the training data. Between 2016 and 2021, we collected 472 endoscopic images representing four tympanic membrane conditions: normal, acute otitis media, otitis media with effusion, and chronic suppurative otitis media. These images were utilized for machine learning based on the InceptionV3 model, which was pretrained on ImageNet. Additionally, 200 synthetic images generated using StyleGAN3 and considered appropriate for each disease category were incorporated for retraining.</p><p><strong>Results: </strong>The inclusion of synthetic images alongside real endoscopic images did not significantly improve the diagnostic accuracy compared to training solely with real images. However, when trained solely on synthetic images, the model achieved a diagnostic accuracy of approximately 70%.</p><p><strong>Conclusions and significance: </strong>Synthetic images generated by GANs have potential utility in the development of machine-learning models for medical diagnosis.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"134-139"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963534","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}
Acta Oto-LaryngologicaPub Date : 2025-02-01Epub Date: 2025-01-16DOI: 10.1080/00016489.2024.2442412
Said Sönmez, Kadir Serkan Orhan
{"title":"Analysis and long-term outcomes of spontaneous cerebrospinal otorrhea repair via the middle cranial fossa approach.","authors":"Said Sönmez, Kadir Serkan Orhan","doi":"10.1080/00016489.2024.2442412","DOIUrl":"10.1080/00016489.2024.2442412","url":null,"abstract":"<p><strong>Background: </strong>The incidence of spontaneous CSF otorrhea is increasing and knowledge about treatment management is growing.</p><p><strong>Objectives: </strong>To analyse the cases operated <i>via</i> the middle cranial fossa approach (MCFA) for spontaneous CSF otorrhea in our clinic and to evaluate the long-term surgical results in the light of the literature.</p><p><strong>Methods: </strong>Demographic data, presenting complaints, complications, hearing outcomes, recurrence rates and long-term success of patients operated with MCFA between 2012 and 2022 in our tertiary care centre were evaluated.</p><p><strong>Results: </strong>The mean age of the 12 patients who met the inclusion criteria was 58.3 ± 13.4 years. Hearing loss and ear fullness in five patients and persistent otorrhea after ventilation tube insertion in three patients were the most common symptoms. The mean body mass index (BMI) was 35.03 ± 3.39. More than one defect was detected in seven patients. No perioperative or postoperative complications were observed in any patient. The mean airway hearing threshold (ASH)±SD was 40.6 ± 13 preoperatively and 24.4 ± 6.3 postoperatively, a statistically significant decrease (<i>p</i> = 0.003). The mean follow-up period was 80.8 ± 32.5 months and no recurrence was observed in any patient.</p><p><strong>Conclusion: </strong>Our experience and results support the use of MCFA in the repair of spontaneous CSF otorrhea as safe, highly successful, and beneficial.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"144-149"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998247","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}
Júlia Belobradová, Arnošt Onderka, Juraj Timkovič, Viktoria Hranková, Štefan Reguli, Adéla Kondé, Rudolf Karas, Jiří Stránský, Jan Štembírek, Claretta Bianchi
{"title":"Possible complications of frontal sinus fractures after conservative or surgical treatment: retrospective study.","authors":"Júlia Belobradová, Arnošt Onderka, Juraj Timkovič, Viktoria Hranková, Štefan Reguli, Adéla Kondé, Rudolf Karas, Jiří Stránský, Jan Štembírek, Claretta Bianchi","doi":"10.1080/00016489.2025.2454481","DOIUrl":"https://doi.org/10.1080/00016489.2025.2454481","url":null,"abstract":"<p><strong>Background: </strong>Frontal sinus fractures are rare. Although they can manifest as isolated fractures, they mostly occur as a part of larger panfacial injuries of the facial bones.</p><p><strong>Objective: </strong>Considering the relative rarity of this type of fracture, we decided to perform a retrospective analysis of patients with this type of injury at our institution, focusing on post-injury complications.</p><p><strong>Material and methods: </strong>We retrospectively evaluated 26 patients with frontal sinus fracture (isolated or as a part of a complex injury to the facial skeleton) treated and subsequently followed up at our institution between 2016 and 2022.</p><p><strong>Results: </strong>The most common complication was trigeminal nerve hypersensitivity, occurring in 7 patients (47% of patients with any complication). All patients with this complication were treated conservatively. Four patients developed cerebrospinal fluid leak, of which three were treated conservatively and one surgically. Four more patients developed a deformity, of which 3 patients underwent surgery and one was treated conservatively.</p><p><strong>Conclusion and significance: </strong>The therapeutic goal is to restore the conditions of the mucosa and to preserve the drainage of the frontal sinus.</p>","PeriodicalId":6880,"journal":{"name":"Acta Oto-Laryngologica","volume":" ","pages":"1-5"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073435","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}