American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Survey of Fleas and Ticks for Rickettsia rickettsii and Rickettsia typhi in the El Paso Community and Other Areas in Texas, New Mexico, and Ciudad Juarez, Mexico.","authors":"Karen R Valdez, Nicole L Mendell, Angélica María Escárcega-Ávila, Antonio de la Mora-Covarrubias, Florinda Jiménez-Vega, Kenneth A Waldrup, Veronica Suarez, John C Morrill, Caroline T Weldon, Donald H Bouyer, David H Walker, Scott C Weaver, Lucas S Blanton, Pedro M Palermo, Douglas M Watts","doi":"10.4269/ajtmh.24-0709","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0709","url":null,"abstract":"<p><p>This survey was conducted with the aim of determining the public health risk of Rocky Mountain spotted fever and murine typhus in the urban and peri-urban areas of El Paso, as well as other areas in Texas, southern New Mexico, and Ciudad Juarez, Mexico. The approach was to assess the diversity of tick and flea species, determine if the ticks and fleas were infected with Rickettsia rickettsii and Rickettsia typhi (R. typhi), respectively, and assess previous human infection with Rickettsia species. Ticks and fleas were collected from domestic and wild animals and tested using a nested polymerase chain reaction assay. Human plasma samples were also tested for antibodies using an indirect fluorescence assay. Among 203 fleas, including Pulex irritans, Echidnophaga gallinacea, and Ctenocephalides felis (C. felis), collected from wild and domestic small mammals, only one pool of four C. felis collected from a dog in the El Paso community was positive for Rickettsia felis. All 194 Rhipicephalus sanguineus ticks collected from stray and domestic dogs in the El Paso community, southern Doña Ana County, and Ciudad Juarez were negative for Rickettsia spp. In Travis County, Texas, a total of 207 ticks collected from white-tailed deer, including 196 Ixodes scapularis and 11 Dermacentor albipictus, were negative for Rickettsia spp. pathogens. Among 375 archived human plasma samples collected in the El Paso community, only two were positive for R. typhi antibodies. These preliminary findings suggested that tick- and flea-borne diseases were not a major health risk in the El Paso community or the other areas included in this survey.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315763","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":"Modern Surgical Approaches to Pulmonary Hydatidosis.","authors":"Anne Spichler-Moffarah, Joseph M Vinetz","doi":"10.4269/ajtmh.25-0251","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0251","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315675","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 of an Immunochromatographic Test to Detect Antibodies in Simulated Whole-Blood Samples for the Diagnosis of Intestinal Capillariasis.","authors":"Lakkhana Sadaow, Patcharaporn Boonroumkaew, Rutchanee Rodpai, Oranuch Sanpool, Pewpan M Intapan, Wanchai Maleewong","doi":"10.4269/ajtmh.25-0212","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0212","url":null,"abstract":"<p><p>Intestinal capillariasis is a zoonotic parasitic disease caused by Capillaria philippinensis, a fish-borne nematode. Patients present with clinical symptoms that include borborygmus chronic diarrhea, intermittent abdominal pain, weight loss, and several degrees of painless lower-leg edema. Atypical clinical manifestations and diagnostic confusion with diarrhea caused by gastrointestinal cancer, HIV infection, giardiasis, and hyperthyroidism may occur. Misdiagnosis and improper treatment can be fatal. Parasite eggs and larvae are passed intermittently in feces, rendering fecal examination insensitive. Serological methods can serve as a supportive diagnostic tool. In this study, we developed a simple and rapid antibody detection lateral-flow immunochromatographic test (ICT) as a point-of-care diagnostic tool. A new ICT format using a Trichinella spiralis larval extract antigen for antibody detection in simulated whole-blood samples (WBSs) was evaluated, and the results were compared with those obtained using serum samples. The sensitivity, specificity, and accuracy of IgG antibody detection in simulated WBSs were 100%, 94.3%, and 95.7%, whereas in serum samples, these values were 100%, 91.5%, and 93.5%, respectively. The results between simulated WBSs and serum samples did not differ significantly, with a concordance of 97.8%, yielding a Cohen's kappa of 0.95 (P <0.001). The ICT is easy to implement and can provide supportive diagnosis at the bedside or in local and remote hospitals with limited facilities.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315669","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":"Low Prevalence of Middle East Respiratory Syndrome Coronavirus Infection in Camel-Exposed Patients Presenting with Respiratory Symptoms in Northern Kenya.","authors":"Andrew Karani, Isaac Ngere, Cynthia Ombok, Deepti Singh, Walter Jaoko, M Kariuki Njenga, Guy H Palmer","doi":"10.4269/ajtmh.25-0098","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0098","url":null,"abstract":"<p><p>Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus that causes acute respiratory disease after transmission via close contact with camels. In contrast to the incidence of MERS-CoV human infections in the Middle East, MERS-CoV infections in the Horn of Africa have been rarely reported despite the high number of camels and common camel-human interactions in the area. Whether passive cross-sectional sampling misses active human cases is a significant gap in our understanding of MERS-CoV epidemiology and its impact in the Horn of Africa. To address this gap, we conducted a prospective cross-sectional study at Laisamis Catholic Hospital in northern Kenya's camel pastoralist community. A total of 942 patients with acute respiratory symptoms were enrolled over 18 months (August 2022-February 2024); 54% of these individuals reported frequent contact with camels and consumption of camel products. Testing via reverse transcriptase - polymerase chain reaction (RT-PCR) revealed that all patients (N = 942) had negative results for MERS-CoV RNA on either nasopharyngeal or oropharyngeal swabs at the time of presentation. Because polymerase chain reaction testing may only detect active cases with higher levels of viral shedding, serology was also performed on a randomly selected subset of 297 individuals from the total sample pool to detect IgG antibodies. Only eight individuals (2.7%) exhibited positive results by serology; accounting for the test specificity of 99.8%, the 95% CI for true MERS-CoV seropositivity was 0.72-4.27%. Despite frequent camel interactions, MERS-CoV seroprevalence was low, suggesting limited zoonotic transmission in this setting and highlighting the need for more comprehensive diagnostics to identify prevalent causes of acute respiratory illness in pastoralist communities.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315673","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":"Effectiveness of Personal Protective Equipment against Coronavirus Disease 2019 Transmission: A Case-Control Study.","authors":"Vikash Mahla, Alpana Raizada, Vrinda Goel, Rahul Sharma, Monica Lobo, Dhawani Julka, Ashish Goel","doi":"10.4269/ajtmh.23-0270","DOIUrl":"https://doi.org/10.4269/ajtmh.23-0270","url":null,"abstract":"<p><p>Several health care workers (HCWs) succumbed to infection during the recent coronavirus disease 2019 (COVID-19) pandemic. In some cases, HCWs were even blamed for ignorance of standard operating procedures while using personal protective equipment (PPE). This case-control study evaluated the effectiveness of PPE in prevention of transmission by comparing attitudes toward use of PPE. In a retrospective 1:1 case-control design, HCWs who contracted COVID-19 infection were identified as cases and telephonically contacted. Those HCWs who were working in the same patient care area but were not COVID-19 positive before nor at that point in time when the paired case had tested positive were included as controls. Responses around the use of PPE were collected on an indigenously developed questionnaire on a Likert scale using a mix of questions. Those infected with COVID-19 (cases) were younger, felt that single gloves were sufficient, believed that full PPE was not as effective in preventing infection, and did not prefer using a face shield when in comparison with the controls who believed otherwise. The cases reported greater discomfort while using PPE and were more likely to remove protective equipment because of discomfort. The controls were more likely to be vaccinated and be following the WHO protocol for hand hygiene, although these differences were not statistically significant. The differences in attitudes and practices between cases and controls revealed characteristics that could be associated with transmission. Vaccination, improved hand-hygiene practices, and an emphasis on eye protection with face shields might ensure a healthier frontline workforce.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315671","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":"Malaria Parasitemia after Mass Distribution of Azithromycin to Prevent Child Mortality in Burkina Faso: Results from a Cluster Randomized Trial.","authors":"Boubacar Coulibaly, Ali Sié, Mamadou Ouattara, Mamadou Bountogo, Guillaume Compaoré, Adama Compaoré, Moustapha Nikiema, Nestor Dembélé Sibiri, Jérôme Nankoné Tiansi, Elodie Lebas, Ian Fetterman, Huiyu Hu, Thuy Doan, Benjamin F Arnold, Thomas M Lietman, Catherine E Oldenburg","doi":"10.4269/ajtmh.25-0093","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0093","url":null,"abstract":"<p><p>The twice-yearly mass distribution of azithromycin to children aged 1-59 months reduces all-cause child mortality. It has been suggested in some studies that mass azithromycin distributions may reduce malaria mortality and parasitemia; however, these studies have been conducted in the absence of seasonal malaria chemoprevention (SMC). Here, we evaluate malaria parasitemia in a cluster randomized trial of azithromycin versus a placebo in Burkina Faso, where SMC was being administered. Thin and thick smears were taken from a random sample of 15 children per cluster in 40 clusters that had been receiving twice-yearly azithromycin or a placebo for 36 months (six distributions). We found no evidence of a difference in malaria parasitemia between children in the azithromycin and placebo clusters (mean difference -6% prevalence; 95% CI -17% to 6%; P = 0.33). These results suggest that reductions in malaria parasitemia may not be a major contributor to the effect of azithromycin on child mortality in settings in which SMC is administered.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315674","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":"Radiological Findings in Imported Schistosomiasis at an International Health Unit in Barcelona, Spain.","authors":"Marcos Marqués-Sorinas, Fernando Salvador, Cristina Bocanegra, Elena Sulleiro, Derlis Duarte-Zoilan, Adrián Sánchez-Montalvá, Núria Serre-Delcor, Pau Bosch-Nicolau, Maria Luisa Aznar, Lidia Goterris, Diana Pou, Joan Martínez-Campreciós, Juan Espinosa-Pereiro, Inés Oliveira-Souto, Francesc Zarzuela, Israel Molina","doi":"10.4269/ajtmh.25-0085","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0085","url":null,"abstract":"<p><p>Schistosomiasis is a parasitic disease caused by trematodes of the genus Schistosoma. It is classified as a neglected tropical disease by the WHO and has the second highest morbidity of a parasitic disease after malaria. Our objective with this study was to describe radiological findings in patients diagnosed with imported schistosomiasis among migrants and international travelers seen at an international health unit. This is a descriptive, observational, single-center, retrospective study conducted at the International Health Unit, Vall d'Hebron-Drassanes, in which we analyze the radiological findings in patients diagnosed with schistosomiasis. Among the 671 individuals treated for schistosomiasis between 2014 and 2022, 132 (19.7%) underwent a radiological test, 39 (29.5%) were diagnosed with confirmed urinary schistosomiasis, 25 (18.9%) were diagnosed with intestinal schistosomiasis, and 68 (51.5%) were classified as probable cases (positive serology). In all cases, an abdominal ultrasound was performed, and eight patients (6%) also underwent an abdominal computed tomography scan. Abnormalities were found in 19 (14.4%) patients, with the most frequent findings being splenomegaly (nine cases) and bladder wall thickening (five cases). Radiological tests, especially ultrasounds, are highly useful in assessing the severity of the disease and identifying associated lesions.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265105","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":"Completion of Multidose COVID-19 Vaccination Among Adolescents and Adults in Urban Informal Settlements in Nairobi, Kenya.","authors":"Maurine Ng'oda, Jonathan Izudi, Collins Otieno, Daniel Mwanga, Richard E Sanya, Abdhalah Ziraba","doi":"10.4269/ajtmh.24-0737","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0737","url":null,"abstract":"<p><p>Completion of vaccine doses is essential for robust immunity and long-term protection against specific diseases. This study aimed to investigate factors associated with the completion of multidose coronavirus disease 2019 (COVID-19) vaccines (MDVs) among adolescents and adults in two informal urban settlements in Nairobi, Kenya. We analyzed data from the Kenya Multisite Integrated Serosurveillance project. We defined completion of MDV as receiving an additional COVID-19 vaccine dose between weeks 6 and 8 after the first COVID-19 vaccination shot. We applied the modified Poisson regression model with robust standard errors to determine the factors that were independently associated with the completion of MDV. We analyzed data from 402 individuals aged 14-90 years and found that the completion rate for MDV was 85.3%. In the adjusted analysis, participants aged ≥60 years (adjusted prevalence risk ratio [aPR] 1.30, 95% CI 1.05-1.60) and those who recommended the COVID-19 vaccine to others (aPR 1.40, 95% CI 1.00-1.96) were significantly more likely to complete MDV. Individuals aged 25-59 years (aPR 1.22, 95% CI 0.99-1.50), those who perceived themselves as being at risk for COVID-19 (aPR 1.09, 95% CI 0.99-1.19), and those who had access to healthcare during the pandemic tended to have a higher completion of MDV. Overall, the MDV completion rate is relatively high; however, public health interventions should endeavor to target those being left behind such as younger individuals and those hesitant about vaccination.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265058","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":"Analyzing Transmission Patterns of Two Dengue Virus Serotypes during the 2023 Outbreak in Mali, West Africa.","authors":"Fousseyni Kane, Yacouba Cissoko, John Collins, Dramane Diallo, Bassirou Diarra, Amadou Kone, Djeneba K Dabitao, Oumar Sako, Tenin A Coulibaly, Daouda Keita, Antieme Combo Georges Togo, Gagni Coulibaly, Cheick O Tangara, Mahamadou Diakite, Issa Konate, Xiang-Jun Lu, Thomas Briese, W Ian Lipkin, D Camila Odio, C Leah Katzelnick, Jamila Aboulhab, Esther Akpa, Karine Fouth-Tchos, Aaron T Neal, Kathryn Shaw-Saliba, Sounkalo Dao, Ray Y Chen, J Kenneth Wickiser, Seydou Doumbia","doi":"10.4269/ajtmh.25-0113","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0113","url":null,"abstract":"<p><p>Dengue fever, a vector-borne disease caused by four serotypes of dengue virus (DENV), ranges from asymptomatic to severe illness, including hemorrhagic fever and shock syndrome. A 2023 outbreak (August 2023-May 2024) in Mali affected six districts in Bamako, causing 1,422 confirmed cases with a 2.7% fatality rate. In this study, viral sequencing provided insights into the molecular epidemiology and transmission dynamics of this outbreak. From September to October 2023, 23 of 42 suspected cases detected through national dengue surveillance activities were tested using the pan-vertebrate virus metagenomics method (virome capture sequencing platform for vertebrate viruses [VirCapSeq-VERT]). Sequencing data were analyzed using the Rapid Identification of Microbes pipeline, and Bayesian phylogenetic inference with Monte Carlo methods was used to assess viral genomic evolution. Among 23 patients, 61% were male, and the median age was 37 years (range: 20-74). The most common symptoms were fever (93.1%), headache (56.5%), and asthenia (47.8%). The largest proportion experienced dengue with warning signs (65.2%), followed by dengue without warning signs (30.4%) and severe dengue (4.4%). The successful sequencing of 19 samples revealed dengue virus serotype 3 (DENV-3; genotype III) in 15 (65.21%) samples and dengue virus serotype 1 (DENV-1; genotype III) in 4 (17.39%) samples. The DENV-1 sequences were analogous to West African sequences, and the DENV-3 were clustered with West African, Asian, and Caribbean sequences. In this study of DENV in Mali, we offer insights into the molecular epidemiology of the virus and underscore the benefits of the genomic surveillance of arboviruses in West Africa.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265055","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":"Elizabethkingia anophelis Infection in Intensive Care Unit Patients at a Tertiary Care Center in North India: A Retrospective Study.","authors":"Shailesh Sengar, Gerlin Varghese, Ashima Jamwal, Deepika Sarawat, Nidhi Tejan, Surbhi Singh, Sangram Singh Patel, Chinmoy Sahu","doi":"10.4269/ajtmh.24-0550","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0550","url":null,"abstract":"<p><p>Elizabethkingia anopheles has recently been recognized as an emerging pathogen linked to neonatal meningitis and bacteremia. In this study, we aimed to evaluate the demographic patterns, clinical presentation, and sensitivity patterns of Elizabethkingia anophelis (E. anophelis) isolates at our institution. This retrospective observational study was conducted from 2021 to 2024 at a tertiary care center in Uttar Pradesh. All patients admitted to the intensive care unit who were diagnosed with microbiologically confirmed E. anophelis infection were included in the study. Samples such as blood, bronchoalveolar lavage fluid, ascitic fluid, endotracheal aspirate, wound pus, and cerebrospinal fluid were sent to the Microbiology laboratory for culture and sensitivity testing. Clinical histories of the patients and details regarding bacterial culture and antibiotic sensitivity results were extracted from the Hospital Information System. A total of 48 inpatients with E. anophelis infection were included. Most of the patients presented with a diagnosis of bacteremia (n = 20; 42%), followed by pneumonia (n = 18; 37.5%). Among the patients with bacteremia (n = 20), 12 (60%) had a catheter in situ at the time of infection and were diagnosed with catheter-related bloodstream infection. The most common risk factor was diabetes mellitus (52%), followed by endotracheal intubation (43.7%) and hypertension (41.7%). The overall 30-day mortality among patients with E. anophelis infection was 21%. The increased prevalence and mortality rates among patients with E. anophelis infection emphasize that timely diagnosis and appropriate treatment can help clinicians reduce mortality in these patients.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265104","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}