American journal of perinatology最新文献

{"title":"Association of pre-pregnancy obesity versus excessive gestational weight gain with adverse neonatal outcomes in the United States.","authors":"Rodney McLaren, Deepa Rastogi, Shantanu Rastogi","doi":"10.1055/a-2565-1687","DOIUrl":"https://doi.org/10.1055/a-2565-1687","url":null,"abstract":"<p><strong>Objective: </strong>Pre-pregnancy obesity (PPO) and excessive gestational weight gain (eGWG) during pregnancy, both are associated with adverse neonatal outcomes. The objective of this study was to compare the independent associations of PPO and eGWG with adverse neonatal outcomes.</p><p><strong>Methods: </strong>This was a retrospective cohort study of singleton, live births in the United States in 2018 using National Vital Statistics System data. These were divided into four groups: 1) normal pre-pregnancy BMI and normal GWG, 2) normal pre-pregnancy BMI and eGWG, 3) pre-pregnancy BMI >30 kg/m2 (PPO) and normal GWG and 4) PPO and eGWG. The adverse neonatal outcomes, including preterm delivery, large for gestational age (LGA) infants, assisted neonatal ventilation, low 5-minute Apgar scores, neonatal intensive care unit (NICU) admissions, and surfactant use were studied. These outcomes were compared among groups using ANOVA and multivariable analyses.</p><p><strong>Results: </strong>Of the 1,477,062 births included, 21.8%, 41.6%, 10.4% and 26.3% were in Groups 1-4 respectively. With Group 1 as the reference group after correcting for significant factors, groups 2-4 had higher risk (aOR with 95% CI), for preterm delivery of <37 weeks 1.17 (1.14-1.20), 1.05 (1.02-1.09) and 1.14 (1.11-1.18) and for LGA infants 2.38 (2.31-2.44), 2.37 (2.29-2.45), 3.91 (3.80-4.02) in groups 2-4 respectively. Further, patients with PPO with and without eGWG also had increased risk of immediate assisted neonatal ventilation 1.07 (1.02-1.12) and 1.16 (1.12-1.218), for 5-minute Apgar score <3 1.40 (1.19-1.65), 1.38 (1.20-1.58), and for NICU admission in 1.04, (1.01-1.08), 1.12 (1.09-1.15) for Groups 3 and 4 respectively.</p><p><strong>Conclusion: </strong>Both PPO and eGWG were independently associated with preterm delivery and LGA infants. PPO with or without excessive GWG was also associated with low Apgar scores, more NICU admission and higher need for immediate ventilatory support. This data supports the importance of pre-pregnancy weight loss to prevent or decrease adverse neonatal outcomes.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708178","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":"Improving Understanding of Macrosomia with a Graphics-Based Educational Tool: A Randomized Controlled Trial (MATE).","authors":"Kristen Cagino, Myra Kurjee, Emily Hyde, Han-Yang Chen, Hector Mendez-Figueroa, Suneet P Chauhan","doi":"10.1055/a-2565-1836","DOIUrl":"https://doi.org/10.1055/a-2565-1836","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to determine if a graphics-based education tool (GBET) leads to improved macrosomia knowledge on risk factors/complications (RF/C) and management options (MO) for macrosomia among pregnant individuals compared to routine care.</p><p><strong>Study design: </strong>We conducted a randomized control trial (NCTO6281301). Inclusion criteria were individuals at 18-55 years, with singleton pregnancy delivering at > 36 weeks. After consent, participants were randomized to either routine care or GBET. To assess knowledge of macrosomia, a questionnaire consisting of 17 questions relating to the RF/C (11 questions) and MO (6 questions) of suspected macrosomic fetuses was administered to participants one time either directly after consent (if routine care) or directly following review of GBET. The primary outcome was the overall score on the questionnaire. Secondary outcomes were summary scores on the RF/C and MO. Descriptive statistics were used for baseline characteristics and outcomes. Chi-squared test or Fisher's exact test was used to compare categorical variables and Student's t-test for continuous variables.</p><p><strong>Results: </strong>From January to July 2023, 232 eligible individuals were approached and 196 (84%) agreed to participate; of them, 98 received the GBET, while 98 received routine care. Baseline demographics were similar. The majority (42%) of respondents were non-Hispanic Black, 60% were employed, 56% had some level of college education, and 30% lived below the poverty line. There were 41% nulliparous, 67% with a BMI > 30 kg/m2 and 16% with diabetes. The primary outcome was significantly higher in those who received the GBET (70% versus 64%, p <0.001). The RF/C scores were also higher in the GBET group (72% versus 63%, p = 0.001); however, the MO scores were similar between groups (65% versus 68%, p=0.084).</p><p><strong>Conclusion: </strong>In our population, a graphics-based education tool improved participant knowledge on the risk factors / complications for macrosomia, but not their management options.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708127","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":"The Impact of Universalizing Aspirin Prophylaxis on Treatment Provision for High-Risk Pregnant Patients.","authors":"Adina Rachel Kern-Goldberger, Kirat Sandhu, Cara D Dolin, Antonio Bajan, Elizabeth Raiff, Justin R Lappen","doi":"10.1055/a-2565-9272","DOIUrl":"https://doi.org/10.1055/a-2565-9272","url":null,"abstract":"<p><p>Low-dose aspirin is an established preventive strategy for reducing risk of preeclampsia in patients with designated risk factors. This prospective observational study evaluated trends in aspirin prescription rates in a multi-hospital health system over a 10-month period during which a policy to offer low dose aspirin universally was instituted. 11,382 patients were included and interrupted time series was used to analyze rates of aspirin prescriptions ordered by 16w0d before and after implementation of the universal policy. There were statistically significant increases in aspirin prescription rates for the entire cohort (incidence rate ratio [IRR] of 2.93, 95% CI 2.13-4.04) and for a high-risk sub-cohort including patients with chronic hypertension, pre-gestational diabetes, and/or multiple gestation (IRR 1.48, 95% CI 1.26-1.76).</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708190","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":"Gut-Brain Axis in Preterm Infants with Surgical Necrotizing Enterocolitis.","authors":"Parvesh Mohan Garg, Jeffrey Shenberger, Mckenzie Ostrander, Terrie Inder, Padma Parvesh Garg","doi":"10.1055/a-2563-0878","DOIUrl":"10.1055/a-2563-0878","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) affects 5-10% of very-low-birth-weight infants and remains a leading cause of mortality and long-term morbidity. Preterm infants with NEC, especially those requiring surgery, have higher inflammatory markers in the blood, severe white matter abnormalities on brain imaging, and adverse neurodevelopmental outcomes. This review presents current evidence regarding the clinical factors associated with brain injury in preterm infants with necrotizing enterocolitis needing surgical intervention. Studies that evaluate neuroprotective strategies to prevent brain injury are greatly needed to improve neurodevelopmental outcomes in high-risk preterm infants with NEC.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668857","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":"FETAL TEI INDEX IN PREGNANCIES WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY: A CASE-CONTROL STUDY.","authors":"Manuel Guerra, Maria Haye, Ignacio Montaño, Victoria Toro, Nerea Maiz","doi":"10.1055/a-2555-3684","DOIUrl":"10.1055/a-2555-3684","url":null,"abstract":"<p><strong>Objectives: </strong>First, to explore differences in fetal cardiac function in patients with and without intrahepatic cholestasis of pregnancy (ICP) based on the TEI index. Second, to explore a potential correlation between TEI index and bile acid levels in pregnant women with ICP. Thirdly, to study changes in the TEI index of fetuses from pregnant women with ICP after administration of ursodeoxycholic acid (UDCA).</p><p><strong>Methods: </strong>This is a prospective observational case-control study conducted at Hospital Clínico San José and Clínica RedSalud Vitacura, both in Santiago, Chile, between April 2018 and October 2020. ICP was defined as palmar-plantar pruritus of nocturnal predominance for more than one week associated with a total bile acid level above 10 μmol/L. Control cases were women with pregnancies scheduled for induction or elective cesarean section between 37 and 40 weeks of gestation according to current protocols. Differences in the TEI index between cases and controls were assessed by the Wilcoxon test. The correlation between the TEI index and bile acid levels was assessed by the Spearman correlation test. Changes in TEI index before and after administration of UDCA were analyzed by the paired samples Wilcoxon test.</p><p><strong>Results: </strong>One hundred and ten women with ICP and 72 controls were included in the Sstudy. Median gestational age at inclusion was 35.9 weeks. Median TEI index was 0.31 (IQR, 0.29-0.36),; this was significantly longer in fetuses of women with ICP ((0.34 vs 0.30, p<0.001). There was a significant correlation between bile acid levels and TEI index (0.584, p<0.001). In 21 fetuses the median TEI index decreased significantly following UDCA administration ((0.40 ms before treatment vs 0.33 after treatment, p=0.001).</p><p><strong>Conclusions: </strong>The TEI index is increased in fetuses of women with ICP. TEI index was significantly correlated with bile acid levels, and administration of UDCA significantly reduced the TEI index.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668790","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":"The Sound of Comfort - Neonatal Healthcare Professionals' Perspectives on Music and Other Comfort Measures during Targeted Neonatal Echocardiography.","authors":"Joshua Hazan Mea, Daniela Villegas Martinez, Stephanie Mardakis, Elissa Remmer, Tíscar Cavallé-Garrido, Gabriel Altit","doi":"10.1055/a-2562-1538","DOIUrl":"10.1055/a-2562-1538","url":null,"abstract":"<p><strong>Objective: </strong>Assess healthcare professionals' perspectives on how implemented measures impact patient comfort during targeted neonatal echocardiography (TNE).</p><p><strong>Study design: </strong>Survey distributed to neonatal healthcare professionals at the Montreal Children's Hospital NICU. Responses were collected for four weeks, anonymized and analyzed using descriptive statistics.</p><p><strong>Results: </strong>Of 110 respondents, most believed that scans in general disturbed infants (71%) by increasing the risk of hypothermia (75%) and lability (67%). Key comfort measures identified were warm gel (85%), bundling (80%), and a focused exam (<30 minutes) (80%). Neoclassical music recordings were valued for their calming effect on the infant (73%), parent (44%), and sonographer (39%). Respondents preferred recorded music over other forms of music delivery (53%).</p><p><strong>Conclusion: </strong>Healthcare workers generally agree that scans disturb newborns and that implementing comfort measures, such as music and the cost-efficient bundle used in our NICU, may enhance patient comfort. Further objective studies are needed to validate these findings and assess their impact on neonatal care outcomes Keywords: music, targeted neonatal echocardiography, ultrasound, comfort, neonatology.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668860","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":"The Yield of Amnioinfusion in the Prevention of Postpartum Hemorrhage.","authors":"Keren Zloto, Eyal Sivan, Rakefet Yoeli-Ullman, Shali Mazaki-Tovi, Suneet P Chauhan, Michal Fishel Bartal","doi":"10.1055/a-2535-8109","DOIUrl":"10.1055/a-2535-8109","url":null,"abstract":"<p><p>Although amnioinfusion decreases the rate of uterine atony, its effect on postpartum hemorrhage (PPH) is uncertain. This study aimed to assess whether amnioinfusion reduces the risk of PPH in laboring individuals.A retrospective study of all laboring singletons at a tertiary center between January 2013 and December 2022 at ≥34 weeks. Individuals with known major fetal anomalies, stillbirths, or missing delivery records were excluded. The primary outcome was PPH. Neonatal and secondary maternal outcomes were also explored. Adjusted odds ratios (aOR) were estimated using multivariable regression models.Out of 113,816 deliveries during the study period, 83,152 (77.1%) met inclusion criteria, and among them 4,597 (4.03%) had amnioinfusion. Laboring individuals with amnioinfusion were more commonly nulliparous, had more polyhydramnios, oligohydramnios, preeclampsia, gestational diabetes, and fetal growth restriction. Furthermore, individuals with amnioinfusion had a higher rate of labor induction (54.54 vs. 27.8%; <i>p</i> < 0.01) and a higher cesarean rate (36.9 vs. 9.5%; <i>p</i> < 0.01). Following multivariable regression, there was no significant difference in the rate of PPH among individuals who had an amnioinfusion (2.6%) versus those who did not (3.1%; aOR: 0.95, 95% confidence interval [CI]: 0.87, 1.27). The rates of endometritis (aOR: 1.4; 95% CI: 1.04-1.89) and postpartum fever (aOR: 1.70; 95% CI: 1.36-2.12) were higher in those who had amnioinfusion compared with those that did not.Among laboring individuals ≥ 34 weeks, intrapartum amnioinfusion was not associated with a reduction in the rate of PPH and was associated with a higher likelihood of infectious morbidity. · PPH stands as the foremost contributor to maternal mortality.. · There is limited information regarding the yield of amnioinfusion in the reduction of PPH.. · We evaluate whether amnioinfusion reduces the rate of PPH in laboring individuals ≥ 34 weeks..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389613","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":"Evaluation of First-Trimester Low Percentile Nuchal Translucency Association with Adverse Perinatal Outcomes and Fetal Congenital Anomalies.","authors":"Mefkure Eraslan Sahin, Erdem Sahin, Mehmet M Kirlangic, Seyma Daglituncezdi Cam, Serhan Kutuk, Havva Can Ozdemir, Emre Genc","doi":"10.1055/a-2544-9078","DOIUrl":"10.1055/a-2544-9078","url":null,"abstract":"<p><p>This study aimed to evaluate the association of first-trimester low percentile nuchal translucency (NT) thickness values with adverse perinatal outcomes and fetal congenital anomalies.In this retrospective study, 2,150 pregnant women who screened first trimester NT and delivered at Kayseri City Hospital were divided into three groups based on their fetal NT thickness percentiles as follows: third percentile NT group (<i>n</i>: 101), 3rd to 10th percentile NT group (<i>n</i>: 242), and 10th to 90th percentile NT group (<i>n</i>: 1,807).First-trimester NT thickness was analyzed in 5 mm intervals according to gestational age, and the mean NT value was 0.76 mm in the third percentile, 0.95 mm in the 3rd to 10th percentile, 1.51 mm in the 50th percentile, and 2.36 mm in the 90th percentile. Fetal birth weight was significantly decreased in the third percentile NT group and 3rd to 10th percentile NT group compared with the 10 to 90th percentile NT group. Small for gestational age, intrauterine growth restriction with abnormal Doppler value and second-trimester spontaneous abortion rates were significantly increased in the third percentile NT group and the 3rd to 10th percentile NT group compared with the 10th to 90th percentile NT group. The study did not find an increased risk for fetal congenital anomalies in the third percentile group or the 3rd to 10th percentile group.The results indicated that first-trimester NT thickness values below the 10th percentile were associated with low fetal birth weight and adverse perinatal outcomes. Additionally, low percentile first-trimester NT thickness was not a risk factor for fetal congenital abnormalities. · First trimester NT screening is a well-explained phenomenon.. · There is little information regarding decreased NT below the 10th percentile.. · NT thickness values below the 10th percentile were associated with adverse perinatal outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656028","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":"Reoperation following Cesarean Birth: An Analysis of Incidence, Indications, and Procedures Using a National Surgical Database.","authors":"Luke P Burns, Jourdan E Triebwasser, Christopher X Hong","doi":"10.1055/a-2542-9318","DOIUrl":"10.1055/a-2542-9318","url":null,"abstract":"<p><p>This study aimed to determine the incidence of reoperation after uncomplicated cesarean birth, describe the types of procedures and indications for reoperation, and identify risk factors associated with reoperation using a national surgical database.A retrospective cross-sectional study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database, encompassing data from January 1, 2019, to December 31, 2021. A total of 43,492 patients who underwent cesarean birth were included. Patients who underwent concurrent nongynecologic procedures or hysterectomies were excluded. The primary outcomes measured were the incidence of unplanned reoperation within 30 days of cesarean birth, types of reoperative procedures, indications for reoperation, and associated risk factors. Statistical analyses included Student's <i>t</i>-test, Wilcoxon rank-sum test, chi-squared test, and multivariable logistic regression.Out of 43,492 cesarean deliveries, 397 (0.9%) required unplanned reoperation. Significant risk factors for reoperation included smoking (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.49-1.56), hypertension (aOR: 1.83, 95% CI: 1.27-2.62), bleeding disorders (aOR: 2.11, 95% CI: 1.15-3.89), American Society of Anesthesiologists (ASA) class > 3 (aOR: 2.23, 95% CI: 1.29-3.84), and concurrent myomectomy (aOR: 4.39, 95% CI: 1.06-18.2). The most common indications for reoperation were postpartum hemorrhage (47%), wound disruption or infection (18%), and hematoma or hemoperitoneum (14%). The most frequently performed reoperative procedures were exploratory laparotomy without hysterectomy (27%), uterine curettage (23%), and wound debridement or drainage (22%).Reoperation following cesarean birth is a relatively uncommon but significant event, occurring in 0.9% of cases. Key risk factors include smoking, hypertension, bleeding disorders, ASA class > 3, and concurrent myomectomy. This study provides comprehensive data on the clinical characteristics and indications for reoperation following cesarean birth in a diverse, multi-institutional US cohort. The findings highlight the need for enhanced perioperative monitoring and targeted interventions for high-risk patients to improve maternal outcomes. · In this retrospective cross-sectional study of 43,492 cesarean deliveries, the incidence of unplanned reoperation was found to be 0.9%.. · Significant risk factors for reoperation included smoking, hypertension, bleeding disorders, American Society of Anesthesiologists (ASA) class > 3, and concurrent myomectomy at the time of cesarean birth.. · The most common indications for reoperation were postpartum hemorrhage, wound disruption or infection, and hematoma or hemoperitoneum.. · The most common reoperative procedures were exploratory laparotomy without hysterectomy, uterine curettage, and wound debridement or drainage..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466552","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 \"Surgical Morbidity following Planned Hysterectomy versus Conservative Management for Placenta Accreta Spectrum: A Systematic Review and Meta-analysis\".","authors":"Lakshmi Thangavelu","doi":"10.1055/a-2523-2247","DOIUrl":"10.1055/a-2523-2247","url":null,"abstract":"","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027732","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}