Blood Purification最新文献

{"title":"Impact of Fluid Management on Outcomes in Sequential Extracorporeal Support: A Post Hoc Analysis.","authors":"Lucia Cattin, Sergio Lassola, Eleonora Balzani, Maria Salinas Rojo, Nicola Marchionna, Anna Lorenzin, Massimo De Cal, Monica Zanella, Claudio Ronco, Vinicio Danzi, Silvia De Rosa","doi":"10.1159/000545728","DOIUrl":"10.1159/000545728","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a life-threatening condition characterized by dysregulated inflammatory responses, often leading to multiple organ dysfunction and high mortality rates. Continuous renal replacement therapy (CRRT) and extracorporeal blood purification therapies have emerged as vital adjuncts to manage fluid overload and modulate immune responses in septic shock. This study evaluates the impact of daily fluid balance variation on 90-day mortality and hospital length of stay in ICU patients undergoing CRRT for septic shock with endotoxin activity.</p><p><strong>Methods: </strong>A post hoc analysis of the EUPHAS 2 project was conducted on 61 ICU patients with nonresponsive endotoxin shock at San Bortolo Hospital (2016-2021). Bayesian joint models assessed the relationship between fluid balance and mortality. Mediation analysis explored the impact of CRRT on mechanical ventilation duration and hospital stay.</p><p><strong>Results: </strong>Fluid overload and excessive ultrafiltration were associated with prolonged mechanical ventilation and extended hospital stays. Targeted fluid balance management reduced 90-day mortality risk by 50%. CRRT reduced hospital length of stay directly by 5.31 days but indirectly extended it by 11.78 days due to mechanical ventilation. Optimal fluid balance was critical for minimizing mortality and complications.</p><p><strong>Conclusions: </strong>Careful and tailored fluid management in CRRT is essential for improving survival rates and clinical outcomes in septic shock patients. Continuous monitoring of fluid dynamics is necessary to optimize hemodynamic stability and avoid complications. Future multicenter studies are needed to validate these findings and refine fluid management protocols.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complexities in Interpretation of Elevated Serum Creatinine.","authors":"Abutaleb Ahsan Ejaz, Ami M Patel, Maria C Browne, Evan I Fisher, Kamyar Pournazari, Stephen L Seliger","doi":"10.1159/000545122","DOIUrl":"10.1159/000545122","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-6"},"PeriodicalIF":2.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Trial of Pharmacist Integration in Haemodialysis Teams: Effects on Phosphorus Control and Patient Outcomes.","authors":"Xin Jiang, Xiaolan Ye, Haihong Lin, Junfen Guo, Yaoqin Huang, Zhenzhen Lin, Liangliang Xu, Xuefeng Li, Chen Chen, Linying Kong, Cheng Jiang","doi":"10.1159/000545475","DOIUrl":"10.1159/000545475","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the limited historical engagement of hospital pharmacists in managing blood phosphorus levels, their involvement in this aspect of care for haemodialysis patients remains an underexplored yet potentially promising and effective approach that warrants further investigation.</p><p><strong>Methods: </strong>A prospective, randomized controlled clinical trial was conducted to compare a control group receiving standard care from doctors and nurses with a test group that, in addition to standard care, received medication education and health promotion interventions from pharmacists. This trial is registered at chictr.org.cn, ChiCTR2100044887, and is complete.</p><p><strong>Results: </strong>The test group demonstrated a significant reduction in blood phosphorus levels (p = 0.0056) and an improvement in blood calcium levels (p = 0.0238), whereas the control group showed no significant changes. The study also identified several potential major epidemiological characteristics for chronic kidney disease, including rural residence (72% of the patients), hypertension (84%), low educational attainment (84%), occupation as farmers or labourers (92%), and low- to middle-income levels (52%). Conversely, factors such as smoking, alcohol consumption, and marital status were not found to be major epidemiological characteristics. The impact of varying health promotion methodologies on biochemical indicators and blood pressure was minimal.</p><p><strong>Conclusion: </strong>The integration of pharmacists into the clinical team appeared to contribute to the reduction of blood phosphorus levels and healthcare expenditures, highlighting their pivotal role in the cost-effective, multidisciplinary management of haemodialysis patients. This finding underscores the significant economic and clinical importance of considering pharmacists as valuable members of the healthcare team in efforts to optimize patient outcomes.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-13"},"PeriodicalIF":2.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dialysis vintage is partially associated with sarcopenia in patients on hemodialysis.","authors":"Dario R Mondini, Marvery P Duarte, Maryanne Zilli Canedo Silva, Henrique Santos Disessa, Maristela Bohlke, Angélica N Adamoli, Rodrigo R Krug, Maria C K Panno, Daiana C Bundchen, Luiz A R Medina, Antônio J Inda-Filho, Jacyara Santos de Oliveira, Barbara P Vogt, Maycon M Reboredo, Marco C Uchida, Heitor S Ribeiro","doi":"10.1159/000545258","DOIUrl":"https://doi.org/10.1159/000545258","url":null,"abstract":"<p><strong>Introduction: </strong>Dialysis-related factors may contribute to sarcopenia, but this has yet to be explored. We investigated the association between dialysis vintage and sarcopenia in patients on hemodialysis.</p><p><strong>Methods: </strong>A cross-sectional analysis of the SARC-HD study. Sarcopenia was assessed according to the revised EWGSOP2 criteria using handgrip strength and calf circumference measurements. We considered sarcopenia as confirmed and severe stages. Patients were stratified into groups according to the quintiles of dialysis vintage months: 3-11; 12-24; 25-43; 44-76; and ≥77. The 12-24 months group was adopted as reference in adjusted binary logistic regressions.</p><p><strong>Results: </strong>983 patients from 19 dialysis centers were included (67% male, median age 59 years). The median dialysis vintage was 33 months [interquartile range: 14-67], 31% were receiving hemodiafiltration, and 29% had a short daily weekly frequency (≥4 sessions/week). Probable sarcopenia was found in 12%, confirmed in 9%, and severe in 5%. Probable sarcopenia was higher in the 3-11 months group (p=0.045). In the overall analysis, no significant association was found between dialysis vintage and sarcopenia. However, in sensitivity exploratory analyses excluding patients on hemodiafiltration, the shortest (adjusted odds ratio [aOR] = 2.95, 95% confidence interval [CI]: 1.24-7.00) and longest (OR=3.02, 95%CI: 1.22-7.44) dialysis vintage groups showed higher odds of sarcopenia compared to the 12-24 months group. A similar pseudo-U-shaped association was found among patients on conventional weekly frequency (excluding short daily), where the shortest (aOR=2.88, 95%CI: 1.23-6.74) and longest (aOR=2.77, 95%CI: 1.17-6.55) dialysis vintage groups were associated with higher odds of sarcopenia.</p><p><strong>Conclusion: </strong>In conclusion, the association between dialysis vintage and sarcopenia was observed in conventional hemodialysis regimens. This association seems to be pseudo-U-shaped in the shortest and longest dialysis vintage groups. Future studies should examine how pre-dialysis care and dialysis regimens affect sarcopenia development or progression.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of Waste Mass in Used Hemodialysis Circuits by Quality Control Circle Activity.","authors":"YingYan Liang, Ni Xu, YongXiao Zhang, MeiXia Wu, QiuQin Ding, Jing Yin, JieEr Guo, QiongQiong Yang, Hao Li, XiaoMei Li","doi":"10.1159/000545400","DOIUrl":"10.1159/000545400","url":null,"abstract":"<p><strong>Introduction: </strong>The improvement of waste management constitutes a critical component of green nephrology initiatives. Hemodialysis circuits represent a substantial proportion of medical waste generated in dialysis units, yet standardized industry protocols for optimizing the disposal of discarded hemodialysis circuits remain underdeveloped. This study aimed to validate the effectiveness of Quality Control Circle (QCC) methodology in reducing the total mass of discarded hemodialysis circuits.</p><p><strong>Methods: </strong>A multidisciplinary QCC task force was established with the explicitly defined objective: \"reduce residual fluid volume in discarded hemodialysis circuits.\" The QCC methodology was systematically implemented to drive process improvements. Residual fluid mass from decommissioned hemodialysis circuits served as the primary quality metric, with comparative analyses conducted pre- and post-intervention.</p><p><strong>Results: </strong>Implementation of QCC interventions resulted in a 29.7% reduction in mean circuit mass, decreasing from 0.64 ± 0.015 kg to 0.45 ± 0.012 kg (p < 0.01) across the sampled hemodialysis apparatus.</p><p><strong>Conclusion: </strong>The implementation of QCC activities has significantly reduced residual waste from hemodialysis circuits, leading to environmental conservation and lower waste disposal costs. QCC serves as an effective management tool for hemodialysis units to promote the concept of green nephrology.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Extracorporeal Renal Replacement Therapies: Balancing Budgetary Considerations with Ethical Implications.","authors":"Gonzalo Ramírez-Guerrero, Fiammetta Zanetti, Akash Nayak Karopadi, Claudio Ronco","doi":"10.1159/000545389","DOIUrl":"10.1159/000545389","url":null,"abstract":"<p><strong>Background: </strong>Evaluating extracorporeal therapies for end-stage kidney disease (ESKD) requires balancing cost-effectiveness with patient-centered care. With dialysis costs exceeding EUR 2 billion annually in Italy and USD 29 billion in the USA, assessing the economic implications of emerging technologies against their clinical benefits is crucial. Cost-effectiveness analysis (CEA) and health technology assessment (HTA) are widely used to evaluate healthcare interventions, yet they often fail to capture qualitative improvements in patients' quality of life. Additionally, ethical considerations remain underrepresented in these frameworks, despite their importance in guiding equitable resource allocation.</p><p><strong>Summary: </strong>This manuscript examines the landscape of extracorporeal therapies within the healthcare systems of Italy and the USA, highlighting the economic and ethical challenges in their evaluation. A novel two-dimensional framework is introduced, integrating bioethical principles - such as justice, equality, and equity - into CEA to ensure that interventions are assessed not only for their financial sustainability but also for their societal and ethical impact. By incorporating ethical considerations into CEA, the framework offers a more comprehensive approach to decision-making in healthcare resource allocation.</p><p><strong>Key messages: </strong>(1) Traditional CEA and HTA methods often overlook qualitative improvements in patient quality of life. (2) Ethical considerations, including justice and equity, should be integrated into economic evaluations of healthcare interventions. (3) A two-dimensional framework is proposed to balance economic viability with patient-centered outcomes. (4) Incorporating ethics into CEA enhances healthcare decision-making, fostering innovation and equitable patient care.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vitro Assessment of Drug Adsorption Profiles during Hemoadsorption Therapy.","authors":"Andreas Körtge, Christoph Kamper, Gerd Klinkmann, Reinhold Wasserkort, Steffen Mitzner","doi":"10.1159/000545120","DOIUrl":"10.1159/000545120","url":null,"abstract":"<p><strong>Introduction: </strong>The use of hemoadsorption devices is increasingly gaining impact as an adjunct therapy for various critical conditions in ICU patients, including systemic hyperinflammation, cytokine release syndrome, sepsis, and more. A key concern in this therapy is its impact on the plasma levels of concurrently administered drugs, which could potentially be reduced to subtherapeutic levels, affecting patient care. The present study investigates the adsorption behavior of various drugs in an in vitro hemoadsorption model using human whole blood, aiming to provide insights for optimizing drug dosing during hemoadsorption therapy.</p><p><strong>Methods: </strong>The study assessed the removal rates and clearances of several drugs, namely, apixaban, argatroban, carbamazepine, oxcarbazepine, lamotrigine, phenytoin, valproate, levosimendan, methylene blue, and metformin, by circulating the blood through CytoSorb adsorbers in an in vitro setup.</p><p><strong>Results: </strong>Significant removal (75 to 100% of the initial concentration) and high initial plasma clearances (approximately 10-25 mL/min) were observed for most of the tested drugs within the first 30-60 min of recirculation. Lower removal rates and clearances were noted for valproate (approximately 40% and 5 mL/min) and metformin (approximately 15% and 1 mL/min).</p><p><strong>Conclusion: </strong>The findings indicate considerable differences in the adsorption of the tested drugs and should be confirmed by additional in vivo studies with careful monitoring of drug levels throughout the course of therapy. Understanding the in vivo dynamics is crucial for adjusting dosages appropriately during hemoadsorption use to ensure therapeutic efficacy and patient safety.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Risk Prediction Model for Citrate Accumulation in Patients Undergoing Continuous Renal Replacement Therapy with Regional Citrate Anticoagulation.","authors":"Yi Zheng, Zhiwen Chen, Xiankun Sun, Fang Wang, Xue Tang, Li Lin, Yanyan Wang, Ling Zhang","doi":"10.1159/000545291","DOIUrl":"10.1159/000545291","url":null,"abstract":"<p><strong>Introduction: </strong>Regional citrate anticoagulation (RCA) is now recommended as the first choice of anticoagulation for continuous renal replacement therapy (CRRT). However, impaired citrate metabolism can lead to citrate accumulation (CA), resulting in severe metabolic acidosis and hypocalcemia, which poses a challenge for clinicians when making decision about the use of RCA.</p><p><strong>Methods: </strong>In this retrospective cohort study performed in West China Hospital of Sichuan University, we evaluated patients who underwent RCA-CRRT from 2021 to 2023. Participants were randomly allocated into training and validation groups at a 7:3 ratio. In the training group, significant risk factors for CA were determined by a binary logistic regression analysis and established a risk prediction model, and the validation group validated and evaluated the model. A nomogram was constructed to visualize the prediction model, calibration and receiver operating characteristic (ROC) curves were used to evaluate the prediction accuracy, and decision curve analysis (DCA) was used to evaluate the clinical effectiveness.</p><p><strong>Results: </strong>Of the 1,259 patients with RCA-CRRT, 882 were randomly stratified into the training group and 377 into the validation group. CA was reported in 16.2% and 16.7%, respectively. We developed and validated a nomogram to predict the risk of CA, incorporating significant factors including male, age, body surface area, citrate concentration, systolic blood pressure, lactate, total bilirubin, and international normalized ratio. The area under the ROC curve of the nomogram was 0.760 (95% CI, 0.737-0.765) and 0.752 (95% CI, 0.744-0.787) in both groups. The calibration curve further confirmed its effective discrimination and calibration abilities. DCA analysis emphasized its clinical utility when the CA probability threshold for intervention is between 11% and 76%.</p><p><strong>Conclusion: </strong>We developed and validated a prediction model for CA in critically ill patients who received RCA-CRRT, providing a basis for clinicians to develop individualized anticoagulation protocols.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-14"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blueprint for a Catalan Apheresis Database Initiative: The Catalan Apheresis Therapeutics Network and Its Role in Supporting Health Administration Planning.","authors":"Joan Cid, Eva Rodríguez, Sandra Ortega, Anna M Garcia, Jordi Comas, Paola Charry, Miquel Lozano, Rosa Ramos","doi":"10.1159/000545202","DOIUrl":"10.1159/000545202","url":null,"abstract":"<p><p>The Therapeutic Apheresis Database in the Catalan Region (AfTerCat) was developed to consolidate and standardize data collection for therapeutic apheresis procedures across public and private institutions in Catalonia. Covering procedures performed from 2019 to 2023 in 21 apheresis units, the registry captures data on plasma treatments, cell therapies, and cytapheresis procedures, with over 26,000 recorded entries. Variations in workload across public and private institutions were noted, influencing resource needs and operational costs. By streamlining manual data collection and planning future automation, the AfTerCat registry aims to provide crucial insights for healthcare administrators in optimizing resource allocation, managing procedure costs, and supporting evidence-based policy decisions. The registry's integration into the Organització Catalana de Trasplantaments (OCATT) digital transformation initiative highlights its potential to impact health policy through improved data centralization and real-time analysis. This project serves as a foundational step toward efficient health system planning and cost management in the growing field of therapeutic apheresis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability and Compatibility of Amikacin and Its Combination Antibiotics in 7.5% Icodextrin Peritoneal Dialysis Solution.","authors":"Haishan Wu, Pengchao Fang, Zhihao Liu, Haiping Mao, Wei Chen, Xiao Yang, Haiyan Hu, Qunying Guo","doi":"10.1159/000545085","DOIUrl":"10.1159/000545085","url":null,"abstract":"<p><strong>Introduction: </strong>The study aimed to evaluate the stability and compatibility of diverse antibiotics in 7.5% icodextrin peritoneal dialysis (PD) solution, subjected to various temperatures over a span of 14-day period.</p><p><strong>Methods: </strong>Antibiotics, namely, amikacin, imipenem, ciprofloxacin, vancomycin, and cefazolin, were incorporated into 7.5% icodextrin solution and subsequently stored at various temperature and period. The concentrations of these antibiotics were measured using high-performance liquid chromatography. Stability of antibiotics is defined as the remaining drug concentration >90% of the initial one throughout the test period.</p><p><strong>Results: </strong>Ciprofloxacin and amikacin were demonstrated stable for a period of 14 days in icodextrin solution across all tested temperatures. Amikacin retained over 90% of its initial concentration when combined with either vancomycin, cefazolin, or ciprofloxacin at various temperatures for 14 days. In combination with amikacin, ciprofloxacin maintained stability for 14 days at all tested temperatures, while vancomycin maintained stability for 14 days at both 4°C and 25°C, and 7 days at 37°C. Cefazolin, however, only exhibited stability for 8 h at 37°C and 7 days at both 4°C and 25°C. The stability of imipenem in icodextrin solution was notably low, remaining stable for a maximum 6 h at 4°C.</p><p><strong>Conclusion: </strong>Ciprofloxacin, amikacin, as well as combinations of amikacin and vancomycin, amikacin and cefazolin, amikacin and ciprofloxacin, can be added to icodextrin solution for treatment of PD-associated peritonitis because they maintain stability for a minimum of 7 days at the temperatures of 4°C and 25°C, and 8 h at 37°C.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}