Annals of Intensive Care最新文献

{"title":"Characteristics of SARS-CoV-2-associated severe episodes of monoclonal gammopathy-associated capillary leak syndrome (Clarkson disease).","authors":"Nissim Grinberg, Maddalena Alessandra Wu, Quentin Moyon, Sybille Merceron, Yannick Fedun, Marie Gousseff, Romain Sonneville, François Lhote, Elie Azoulay, Jean-Herlé Raphalen, David Saadoun, Ygal Benhamou, Jean-Paul Mira, Guillaume Dumas, Pierre Bay, Jérôme Devaquet, Laurent Argaud, Marc Lambert, Avinash Aujayeb, Basile Henriot, Amandine Bichon, Thomas Bocar, John Harty, Remo Melchio, Franck Leibinger, Laure Calvet, Tomas Urbina, Laurent Bodson, Jean-Marie Tonnelier, Danielle Reuter, Emmanuel Canet, Gilles Blaison, Julien Maizel, Nicholas Sedillot, Laurence Dangers, Vincent Eble, Franco Verlicchi, Stanislas Faguer, Jonathan Montomoli, Geoffroy Dingemans, Marc Mikulski, Jonas Pochard, Fabrice Uhel, Fleur Cohen-Aubart, Charles-Edouard Luyt, Alexis Mathian, Alain Combes, Riccardo Colombo, Zahir Amoura, Marc Pineton de Chambrun","doi":"10.1186/s13613-025-01483-7","DOIUrl":"10.1186/s13613-025-01483-7","url":null,"abstract":"<p><strong>Background: </strong>Monoclonal gammopathy-associated capillary leak syndrome (MG-CLS) is a rare condition characterized by recurrent episodes of hypovolemic shock caused by a sudden increase in capillary permeability. The COVID-19 pandemic has been associated with a rise in MG-CLS episodes and increased mortality. We aimed to explore the association between MG-CLS and SARS-CoV-2 infection. We conducted a multicenter retrospective observational study involving MG-CLS patients who were admitted to the intensive care unit (ICU). The primary endpoint was 28-day mortality according to whether SARS-CoV-2 was identified as a trigger.</p><p><strong>Results: </strong>The study included 84 patients (44% women) with a median age of 55 years [IQR 46-62], accounting for 127 ICU admissions. Most patients (88%) had monoclonal gammopathy, predominantly with an IgG heavy chain (98%). A trigger was identified in 63% of cases, primarily suspected or confirmed viral infections, including 26 episodes of SARS-CoV-2 infection. Within 28 days of ICU admission, 32% of patients died. Episodes triggered by SARS-CoV-2 were associated with a higher need for mechanical ventilation (69% vs. 38%, p = 0.004), renal replacement therapy (54% vs. 31%, p = 0.03), and increased 28-day mortality (42% vs. 17%, p = 0.005). Multivariable analysis revealed that SARS-CoV-2 infection was independently associated with 28-day mortality (OR 4.67 [1.08-20.1], p = 0.04). The use of intravenous immunoglobulins did not improve 28-day survival.</p><p><strong>Conclusion: </strong>In this large cohort of MG-CLS episodes requiring ICU admission, SARS-CoV-2as a trigger was associated with significantly higher 28-day mortality compared to other triggers. Further research is essential to elucidate the specific mechanisms by which SARS-CoV-2 impacts MG-CLS patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"72"},"PeriodicalIF":5.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response letter to \"Confounding by indication and exposure misclassification may undermine corticosteroid effect estimates in ICU patients with alcohol-related hepatitis\".","authors":"Guillaume Dumas, Maxime Gasperment, Hafid Ait-Oufella","doi":"10.1186/s13613-025-01487-3","DOIUrl":"10.1186/s13613-025-01487-3","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"70"},"PeriodicalIF":5.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between ventilation-perfusion matching improvement during initial prone positioning and ICU mortality in patients with moderate to severe ARDS: a prospective two-center study.","authors":"Rui Wang, Wancong Wang, Xiao Tang, Zhenyuan Qi, Ting Li, Yalan Liu, Hongju Li, Jican Yan, Hua Yang, Wenrui Lyu, Zhaohong Li, Bing Sun, Guifen Gan","doi":"10.1186/s13613-025-01489-1","DOIUrl":"10.1186/s13613-025-01489-1","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning (PP) is widely used in patients with moderate to severe acute respiratory distress syndrome (ARDS) to reduce mortality by mitigating the risk of ventilation-induced lung injury (VILI) and enhancing ventilation-perfusion (V/Q) matching. However, patient responses to PP are variable, and the relationship between V/Q matching improvement during PP and clinical outcomes remains unclear. This study aimed to test the hypothesis that improvements in V/Q matching 4 h within the first PP are associated with reduced intensive care unit (ICU) mortality.</p><p><strong>Methods: </strong>In this two-center, prospective, observational study, regional ventilation and perfusion changes in patients with moderate to severe ARDS were evaluated using electrical impedance tomography (EIT) during the first PP session. Patients were categorized as responders or non-responders based on whether V/Q matching improved by ≥ 10% within 4 h of the first PP. The primary endpoint was ICU mortality, and the secondary endpoint was ventilator-free days at day 28.</p><p><strong>Results: </strong>A total of 77 patients were included in the study, with 46 (59.7%) classified as responders and 31 (40.3%) as non-responders. EIT revealed significant improvements in V/Q matching during PP, primarily through reduced dorsal shunt and ventral dead space. These improvements were partially sustained after resupination. Responders showed significantly lower ICU mortality (28.3% vs. 51.6%; P = 0.038) and more ventilator-free days at day 28 (16 [range, 0-21] days vs. 9 [0-15] days; P = 0.024) than non-responders. Multivariate analysis confirmed enhanced V/Q matching as an independent protective factor against mortality (OR, 0.790; 95% CI, 0.681-0.917; P = 0.002).</p><p><strong>Conclusions: </strong>Improvement in V/Q matching 4 h within the first PP is associated with lower ICU mortality in patients with moderate to severe ARDS. These findings underscore the importance of PP in ARDS management and highlight the potential of V/Q responsiveness in guiding individualized PP strategies.</p><p><strong>Trial registration: </strong>ClinicalTrials.Gov: NCT05765760. Registered 28 February 2023.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"69"},"PeriodicalIF":5.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical insights for intensivists on Guillain-Barré syndrome.","authors":"Nicolas Weiss, Clémence Marois, Loic Le Guennec, Benjamin Rohaut, Sophie Demeret","doi":"10.1186/s13613-025-01464-w","DOIUrl":"10.1186/s13613-025-01464-w","url":null,"abstract":"<p><p>Guillain-Barré Syndrome (GBS) is a leading cause of acute flaccid tetraplegia worldwide, with an incidence of 1-2 cases per 100,000 people per year. Characterized by an immune-mediated polyneuropathy, GBS often follows infections or immunological triggers, including vaccinations. The syndrome is classified into three main subtypes based on electrophysiological findings: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). The pathophysiology of GBS involves molecular mimicry between microbial antigens and nerve structures, particularly affecting gangliosides and myelin proteins. Diagnosis primarily relies on clinical history, with lumbar puncture and electroneuromyogram used to confirm and differentiate subtypes. Treatment includes intravenous immunoglobulins or therapeutic plasma exchange associated with symptomatic treatment, especially mechanical ventilation if needed. Prognosis is generally favorable with a low mortality rate (< 5%) overall, but neurological sequelae can occur. Current research continues to explore novel therapeutic approaches, including complement-targeted therapies. Despite advancements, progress in specific treatments has been limited, and ongoing evaluation of potential biomarkers such as neurofilament light chains may enhance prognosis prediction and management strategies.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"67"},"PeriodicalIF":5.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of metformin administration after septic shock with short-term and long-term survival in septic shock patients with diabetes.","authors":"Bo-Yeong Jin, Sukyo Lee, Woosik Kim, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sejoong Ahn","doi":"10.1186/s13613-025-01490-8","DOIUrl":"10.1186/s13613-025-01490-8","url":null,"abstract":"<p><strong>Background: </strong>In addition to glycemic control, the anti-inflammatory effects and protective effect of metformin on sepsis have been reported in animal studies, which may be beneficial for patients with septic shock. Few observational studies have evaluated metformin administration after sepsis or bacteremia; however, these studies did not specifically analyze septic shock or long-term outcomes. Therefore, this study aimed to evaluate the associations between metformin administration after septic shock and the short- and long-term survival in septic shock patients with type 2 diabetes mellitus.</p><p><strong>Method: </strong>This retrospective observational study used data from a prospectively collected sepsis registry. From October 2016 to June 2022, adult septic shock patients with type 2 diabetes mellitus were included in this study. The variable of interest was metformin administration within 48 h after diagnosis of septic shock. The 90-day mortality and 365-day mortality were evaluated as outcomes. A multivariable Cox proportional hazards model was conducted.</p><p><strong>Results: </strong>A total of 320 patients were included in the study. Metformin administration within 48 h after diagnosis of septic shock was associated with lower 90-day mortality (13.0% vs. 39.8%, P < 0.001), 365-day mortality (23.3% vs. 48.3%, P = 0.001), and in-hospital mortality (9.3% vs. 28.6%, P = 0.002) than those who did not administer metformin within 48 h. Metformin administration within 48 h was independently associated with decreased 90-day mortality (adjusted hazard ratio [aHR]: 0.371, 95% confidence interval [CI]: 0.153-0.900, P = 0.028) and 365-day mortality (aHR 0.453, 95% CI 0.219-0.937, P = 0.033) after adjusting for potential confounders. Similar results were found for metformin administration within 72 h after septic shock (aHR 0.433, 95% CI 0.235-0.797, P = 0.007 for 90-day mortality and aHR 0.450, 95% CI 0.264-0.767, P = 0.003 for 365-day mortality).</p><p><strong>Conclusions: </strong>In septic shock patients with type 2 diabetes mellitus, metformin administration within 48 h was associated with lower 90-day and 365-day mortality. While these findings suggest potential benefits of metformin administration after septic shock, further large, multicenter studies are warranted.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"68"},"PeriodicalIF":5.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confounding by indication and exposure misclassification may undermine corticosteroid effect estimates in ICU patients with alcohol-related hepatitis.","authors":"Dongxu Mao, Min Li","doi":"10.1186/s13613-025-01486-4","DOIUrl":"10.1186/s13613-025-01486-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"66"},"PeriodicalIF":5.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High flow nasal therapy versus noninvasive ventilation for AECOPD with acute hypercapnic respiratory failure: a meta-analysis of randomized controlled trials.","authors":"Jinlv Qin, Guizuo Wang, Yixing Liao, Wenli Shang, Dong Han","doi":"10.1186/s13613-025-01480-w","DOIUrl":"10.1186/s13613-025-01480-w","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend the use of noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC) in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic acute respiratory failure (ARF). It is unclear whether HFNC is noninferior to NIV in terms of the rate of tracheal intubation or mortality. This meta-analysis aimed to compare the efficacy of HFNC and NIV in patients with AECOPD and hypercapnic ARF.</p><p><strong>Methods: </strong>A systematic search was made of PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on treatment of hypercapnic AECOPD with HFNC, compared with NIV, were reviewed. Estimated effects of included studies were pooled as risk ratios (RRs), with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Four RCTs (enrolling 486 patients) met the inclusion criteria. There was no statistically significant difference in all-cause mortality (RR 0.97, 95% CI 0.56 to 1.68), and intubation rate (RR 1.67, 95% CI 0.99 to 2.83) between the two groups. The treatment switch rate (RR 2.60, 95% CI 1.54 to 4.38) and treatment failure rate (RR 1.64, 95% CI 1.04 to 2.60) were significantly lower in NIV groups.</p><p><strong>Conclusions: </strong>Compared with NIV, HFNC was not associated with increased mortality and intubation rate. More patients receiving HFNC oxygen therapy experienced treatment failure and switched to NIV, which may mask the fact that HFNC is inferior to NIV in patients with AECOPD and hypercapnic ARF.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"64"},"PeriodicalIF":5.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate or delayed initiation of renal replacement therapy in patients with leptospirosis and acute kidney injury: a target trial emulation.","authors":"Marie Julien, Cédric Rafat, Loïc Raffray, Henri Vacher-Coponat, Nicolas Allou, Jérôme Allyn, Julien Jabot, Yannis Lombardi","doi":"10.1186/s13613-025-01477-5","DOIUrl":"https://doi.org/10.1186/s13613-025-01477-5","url":null,"abstract":"<p><strong>Background: </strong>Anecdotal evidence suggests that early renal replacement therapy (RRT) may improve the mortality associated with acute kidney injury (AKI) in patients with leptospirosis. Conversely, several randomized controlled trials (RCTs) conducted in intensive care units have refuted the positive impact of early RRT on mortality in patients with AKI and other causes of sepsis.</p><p><strong>Methods: </strong>In this emulated RCT utilizing a propensity score-weighted logistic regression performed in the two academic centers on the island of La Réunion, France, between 2010 and 2020, we evaluated the impact of the timing of RRT on a composite outcome of mortality or new-onset or worsening chronic kidney disease (CKD) within a year, in patients hospitalized with leptospirosis, Stage 3 AKI, and no immediate need for RRT.</p><p><strong>Results: </strong>We included 295 consecutive patients with leptospirosis and Stage 3 AKI: 82 (28%) began RRT within 48 h of admission (\"early\" group), 213 (72%) did not start RRT within 48 h (\"delayed\" group). In the delayed group, 53/213 (25%) patients eventually required RRT. 59/295 patients (20%) met the primary outcome: 32 (15%) in the delayed group and 27 (33%) in the early group. The odds ratio (OR) for primary outcome occurrence before weighing was 2.78 (95% confidence interval CI 1.53 to 5.01, p < 0.001; reference: delayed group) and after weighting was 2.08 (95% CI: 1.01 to 4.26, p = 0.046). In secondary analyses, there was a significantly higher probability of CKD occurrence in the early group (OR 2.74, 95% CI 1.25 to 6.0, p = 0.012). Mortality at 1 year did not differ between groups (OR 0.76, 95% CI 0.21 to 2.68, p = 0.666).</p><p><strong>Conclusion: </strong>Early initiation of RRT may be associated with an increased risk of death and development of CKD within 1 year in patients with leptospirosis and Stage 3 AKI.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"65"},"PeriodicalIF":5.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of substance use disorders on critical care management and health outcomes in septic adolescents.","authors":"Havell Markus, Gary D Ceneviva, Neal J Thomas, Conrad Krawiec","doi":"10.1186/s13613-025-01482-8","DOIUrl":"https://doi.org/10.1186/s13613-025-01482-8","url":null,"abstract":"<p><strong>Background: </strong>Adult septic patients with substance abuse disorder (SUD) are at increased risk of poor outcomes, but the impact on adolescents is unknown. We aimed to determine if pre-existing SUD is associated with increased adverse outcomes and critical care resources in critically ill adolescents hospitalized with sepsis. We hypothesize that SUD is associated with increased risk of adverse outcomes and usage of critical care resources in this adolescent patient population.</p><p><strong>Methods: </strong>This was a retrospective cohort study utilizing the TriNetX© electronic health record (EHR) database, which consists of EHR from participating healthcare organizations predominantly in the United States. Critically ill adolescents with sepsis aged 12-21 years were divided into two groups (SUD history and no-SUD history). Data related to demographics, diagnostic, procedural, and medication codes were analyzed. The primary outcomes were organ dysfunction, critical care therapies, and all-cause 1-year mortality.</p><p><strong>Results: </strong>We included 5,436 critically ill adolescents with sepsis [730 (13.43%) SUD history and 4706 (86.57%) no-SUD history]. SUD history was associated with increased odds of organ dysfunction (adjusted odds ratio [aOR] 1.84; 95% confidence interval [CI] 1.56-2.16; p < 0.001), vasoactive/inotropic drug usage (aOR 1.29; 95% CI 1.10-1.52; p = 0.002), mechanical ventilation (aOR 2.19; 95% CI 1.85-2.59; p < 0.001), but not mortality (aOR 1.03; 95% CI 0.76-1.41; p = 0.83).</p><p><strong>Conclusions: </strong>Our retrospective analysis suggests history of SUD in critically ill septic adolescent patients is associated with increased utilization of critical care resources and organ dysfunction. Further study is needed to determine if substance abuse represents a potentially modifiable risk factor for critical illness in adolescent patients.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"63"},"PeriodicalIF":5.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right atrial presssure and intra-abdominal pressure: the elephant in the room.","authors":"Ngan Hoang Kim Trieu","doi":"10.1186/s13613-025-01478-4","DOIUrl":"https://doi.org/10.1186/s13613-025-01478-4","url":null,"abstract":"","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"62"},"PeriodicalIF":5.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}