{"title":"Locoregional breast cancer hypofractionated radiotherapy: How should doses to organs at risk (OAR) be evaluated?","authors":"S Allali, P Loap, J Vu-Bezin, Y Kirova","doi":"10.1093/bjr/tqaf155","DOIUrl":"https://doi.org/10.1093/bjr/tqaf155","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with locally advanced breast cancer with lymph node involvement may be eligible for hypofractionated locoregional treatment. However, studies conducted thus far have not provided constraints for hypofractionated locoregional radiotherapy with an integrated boost. We propose a framework that allows healthcare professionals to perform extended hypofractionated radiotherapy to include lymph node areas, with an integrated boost.</p><p><strong>Methods: </strong>We reviewed and analyzed published studies on hypofractionation, focusing on the proposed constraints and dose equivalencies for critical organs during breast irradiation. The feasibility of the proposed constraints was assessed both in real-life clinical practice and dosimetrically on 70 patients treated with hypofractionated radiotherapy to the breast and associated lymph node areas, along with an integrated boost.</p><p><strong>Results: </strong>A thorough analysis of the literature and dose equivalencies allowed us to propose constraints for organs at risk during hypofractionated locoregional breast irradiation. Seventy patients were evaluated dosimetrically, ensuring that the proposed constraints were met. The various doses received by the organs at risk were reported individually and analyzed based on the different radiotherapy modalities and treatment volumes.</p><p><strong>Conclusions: </strong>Hypofractionated radiotherapy extended to lymph node areas, has become the standard of care for patients with locally advanced breast cancer. This article provides constraints based on the literature and dose equivalencies for healthcare professionals wishing to implement this type of protocol.</p><p><strong>Advance in knowledge: </strong>there are no established dose constraints for locoregional breast irradiation with an integrated boost. This study offers an initial framework, based on clinical practice, for managing organs at risk in this form of irradiation.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641866","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}
George Ninkovic-Hall, Anna Chapman, Athanasios Saratzis, Raghu Lakshminarayan, Dan Carradice, Kaji Sritharan
{"title":"A Survey of UK Standards of Radiation Protection amongst Orthopaedic Surgeons.","authors":"George Ninkovic-Hall, Anna Chapman, Athanasios Saratzis, Raghu Lakshminarayan, Dan Carradice, Kaji Sritharan","doi":"10.1093/bjr/tqaf162","DOIUrl":"https://doi.org/10.1093/bjr/tqaf162","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate training in radiation protection, awareness of local policies, and current practices regarding safe working with ionising radiation among UK orthopaedic surgeons.</p><p><strong>Methods: </strong>A 37-question online survey was distributed to UK orthopaedic trainees and consultants through social media platforms. The survey assessed demographics, use of radiation-guided procedures, training, knowledge of safety policies, access to and use of personal protective equipment, and monitoring of radiation exposure. Data were analysed using Stata software and Pearson's Chi-squared test.</p><p><strong>Results: </strong>28 consultants and 79 trainees responded, comprising 0.4% and 5.3% of the orthopaedic workforce, respectively. Consultants were more likely to have completed formal radiation safety training (93% versus 38%; p < 0.001) and were more aware of local safety policies (56% versus 9%; p < 0.001). Access to dosimeters was limited (32% of consultants versus 6% of trainees; p < 0.005), with few receiving exposure feedback (20% of consultants versus 3% of trainees; p < 0.005). Awareness and application of the \"as low as reasonably achievable\" principles were poor, with 33% of trainees unfamiliar compared to 4% of consultants (p < 0.005). Personal protective equipment use was inconsistent; 64% of consultants and 41% of trainees never used radiation protection glasses, and only 12% of consultants and 1.4% of trainees had custom-fitted lead aprons (p < 0.05).</p><p><strong>Conclusion: </strong>This study underscores deficiencies in radiation protection for UK orthopaedic surgeons, particularly trainees, highlighting the urgent need for mandatory radiation safety training, improved PPE provision, and monitoring of radiation exposure with regular exposure feedback.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641864","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}
D Kifjak, R Mura, N Khenkina, S Pochepnia, B Heidinger, I-R Milos, L Beer, H Prosch
{"title":"Something old something new-introduction to the ninth edition TNM classification of lung cancer.","authors":"D Kifjak, R Mura, N Khenkina, S Pochepnia, B Heidinger, I-R Milos, L Beer, H Prosch","doi":"10.1093/bjr/tqaf161","DOIUrl":"https://doi.org/10.1093/bjr/tqaf161","url":null,"abstract":"<p><p>The TNM classification system is fundamental for describing the anatomical extent of lung cancer, encompassing the primary tumor (T), lymph node involvement (N), and distant metastases (M). It is crucial for patient stratification, treatment planning, and survival prognosis. Clinical staging (cTNM) relies on imaging and physical exams, while pathological staging (pTNM) uses surgical specimens. Advances in tumor biology, imaging, surgery, and treatments necessitate periodic updates to ensure the system reflects current knowledge and practices effectively. The International Association for the Study of Lung Cancer (IASLC), alongside the American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC), updates the system through a global, multidisciplinary approach supported by international data and statistical analysis. The ninth edition of the TNM classification, effective January 1, 2025, introduces revisions to the N and M categories while the T categories remain identical. N2 (ipsilateral mediastinal nodal disease) is now divided into N2a (single lymph node station involvement) and N2b (multiple N2 stations involvement). Similarly, M1c category is split into M1c1 (metastases confined to one organ system) and M1c2 (metastases involving multiple organ systems). These updates aim to improve the accuracy and utility of lung cancer staging in clinical practice and research.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636275","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}
Chhavi Gupta C G, Anupama Tandon A T, Chander Grover C G, Shuchi Bhatt S B
{"title":"Spectrum of ultrasonography findings in nail unit disorders: a pictorial review.","authors":"Chhavi Gupta C G, Anupama Tandon A T, Chander Grover C G, Shuchi Bhatt S B","doi":"10.1093/bjr/tqaf153","DOIUrl":"https://doi.org/10.1093/bjr/tqaf153","url":null,"abstract":"<p><p>Nail unit is affected by a variety of disorders. Diagnosis of nail disorders relies largely on clinical examination, supplemented by biopsy/scrapings of the nail. Imaging such as ultrasound and MRI can aid in better lesion characterization, accurate diagnosis, guiding biopsies and in follow up. Ultrasound is a lucrative modality for nail unit assessment as it is non-invasive, low cost, readily available, can demonstrate all components of the nail unit in high resolution and is real time. MRI on the other hand is expensive, has limited availability and cannot assess multiple nails. This pictorial essay elaborates on the technique of nail ultrasound, anatomy of the nail unit and sonographic appearance of various nail disorders like infections, inflammation, tumors, systemic and rheumatic disorders. The nail plate and nail bed thickness was increased in psoriasis and onychomycosis with increased thickness of extensor tendon and enthesopathies in psoriasis. Glomus tumors appeared as ill-defined, hypoechoic lesions in subungual region with intense color flow. Myxoid cysts were well defined, anechoic, avascular lesions in the proximal nail fold. Periungual fibroma appeared as oval, hypoechoic lesions in subungual region. Onychomatricoma showed interplate echogenicities and increased nail bed thickness.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625396","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":"Imaging and Endovascular Interventions in Renal Arteriovenous Shunts.","authors":"Divij Agarwal, Sanchita Gupta, Chandan J Das, Pradeep Hatimota, Sai Krishna Gadwal","doi":"10.1093/bjr/tqaf154","DOIUrl":"https://doi.org/10.1093/bjr/tqaf154","url":null,"abstract":"<p><p>Renal arteriovenous shunts are rare vascular anomalies that develop due to aberrant communication between the renal arteries and veins, bypassing intervening capillaries. They fall into the broad categories of arteriovenous malformations (usually congenital) and, more commonly, arteriovenous fistula (usually acquired). When symptomatic, they can lead to the development of hematuria, high-output cardiac failure, hypertension, renal impairment or retroperitoneal hematoma. Imaging techniques, such as Doppler ultrasound, Digital subtraction angiography, CT angiography, and MR angiography, can help accurately identify and categorize these renal arteriovenous shunts. While open surgery was once the standard of care, endovascular embolization has gained popularity due to its efficacy and minimally invasive nature. Embolization of these lesions is tailored to the type, severity, and flow dynamics of the shunt. Detailed imaging assessment and meticulous pre-procedural planning are critical for optimal management, including preservation of residual renal function. This article describes the causes, classification, imaging findings and endovascular management of renal arteriovenous shunts.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625395","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":"Intravascular Ultrasound (IVUS) in Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation: A Systematic Review and Meta-Analysis Comparing Conventional TIPS with IVUS-Guided TIPS.","authors":"Pooya Torkian, Reza Talaie, Siobhan Flanagan, Ashkan Heshmatzadeh Behzadi","doi":"10.1093/bjr/tqaf158","DOIUrl":"https://doi.org/10.1093/bjr/tqaf158","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review and meta-analysis evaluate the clinical and procedural benefits of intravascular ultrasound (IVUS)-guided portal vein access during transjugular intrahepatic portosystemic shunt (iTIPS) creation compared to the conventional TIPS (cTIPS) technique.</p><p><strong>Methods: </strong>A comprehensive search of Medline and Google Scholar through August 30, 2024, was conducted to identify retrospective studies comparing iTIPS and cTIPS. A total of six studies, involving 418 patients (180 undergoing iTIPS and 238 undergoing cTIPS), met inclusion criteria. Matched comparison groups were used to analyze outcomes.</p><p><strong>Results: </strong>Technical success rates were similar between iTIPS and cTIPS groups. One study reported a significantly lower complication rate with iTIPS, while three studies found no differences in complications. Notably, iTIPS significantly reduced fluoroscopy time by 9.74 minutes (p < 0.001) and radiation exposure by 583.4 mGy (p < 0.001) compared to cTIPS. The total procedure time and portal venous access time were shorter by 21 minutes (p < 0.001) and 15.49 minutes (p < 0.001), respectively, with IVUS guidance. Additionally, contrast agent use was 69.62 cc lower (p < 0.001) in iTIPS cases.</p><p><strong>Conclusion: </strong>Although based on a limited number of studies, these findings support IVUS-guided TIPS as a superior technique for improving procedural efficiency and reducing radiation exposure, procedure times, and contrast agent usage without compromising success rates. Its benefits are particularly pronounced in patients with complex anatomy or heightened risk factors.</p><p><strong>Advances in knowledge: </strong>IVUS-guided TIPS demonstrates potential procedural and safety advantages over conventional techniques, particularly in anatomically complex or high-risk patients. These findings support further investigation and prospective validation.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616301","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}
Hira A Awan, Muhammad F A Chaudhary, Joseph M Reinhardt
{"title":"Seeing is Believing-On the Utility of CT in Phenotyping COPD.","authors":"Hira A Awan, Muhammad F A Chaudhary, Joseph M Reinhardt","doi":"10.1093/bjr/tqaf160","DOIUrl":"https://doi.org/10.1093/bjr/tqaf160","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with complicated structural and functional impairments. For decades now, chest computed tomography (CT) has been used to quantify various abnormalities related to COPD. More recently, with the newer data-driven approaches, biomarker development and validation have evolved rapidly. Studies now target multiple anatomical structures including lung parenchyma, the airways, the vasculature, and the fissures to better characterize COPD. This review explores the evolution of chest CT biomarkers in COPD, beginning with traditional thresholding approaches that quantify emphysema and airway dimensions. We then highlight some of the texture analysis efforts that have been made over the years for subtyping lung tissue. We also discuss image registration-based biomarkers that have enabled spatially-aware mechanisms for understanding local abnormalities within the lungs. More recently, deep learning has enabled automated biomarker extraction, offering improved precision in phenotype characterization and outcome prediction. We highlight the most recent of these approaches as well. Despite these advancements, several challenges remain in terms of dataset heterogeneity, model generalizability, and clinical interpretability. This review lastly provides a structured overview of these limitations and highlights future potential of CT biomarkers in personalized COPD management.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616302","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":"Hybrid Procedure Suites: Combining Computed Tomography and Conventional Angiography.","authors":"Yasuaki Arai","doi":"10.1093/bjr/tqaf151","DOIUrl":"https://doi.org/10.1093/bjr/tqaf151","url":null,"abstract":"<p><p>The effectiveness of a combined computed tomography and angiography system in interventional radiology was evaluated based on imaging information required at each step. During the planning phase, three-dimensional visualisation of the target and surrounding organs is essential, making computed tomography superior to X-ray fluoroscopy and ultrasound. Real-time imaging with high spatial resolution is crucial for target access; however, X-ray fluoroscopy, ultrasound, and computed tomography alone cannot fully meet these requirements. When manipulating interventional radiology devices, high spatial resolution and real-time capabilities are essential, making X-ray fluoroscopy the preferred modality. To confirm the outcome of the procedure, three-dimensional imaging without hidden areas is necessary with computed tomography being the most suitable option. In conclusion, although no single imaging modality is ideal for all steps of interventional radiology, considering the mobility of US, angiography-computed tomography system, which integrates angiography and CT on a single table, is useful for accurately carrying out various treatments in interventional radiology.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616299","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}
Gokoulakrichenane Loganadane, Pierre Loap, Sofiane Allali, Jihane Bouziane, Kim Cao, Ryan Bouaita, Jeremi Vu-Bezin, Youlia Kirova
{"title":"Hypofractionated whole-breast radiation therapy with simultaneous integrated boost after breast conserving surgery: preliminary real-life experience of the Radiation Therapy Oncology Group (RTOG) 1005 trial.","authors":"Gokoulakrichenane Loganadane, Pierre Loap, Sofiane Allali, Jihane Bouziane, Kim Cao, Ryan Bouaita, Jeremi Vu-Bezin, Youlia Kirova","doi":"10.1093/bjr/tqaf157","DOIUrl":"https://doi.org/10.1093/bjr/tqaf157","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to report cosmetic and oncological outcomes for patients who underwent adjuvant hypofractionated whole-breast radiation therapy (WBRT) (40Gy in 15 fractions) with simultaneous integrated boost (SIB) (48Gy) using IMRT (Intensity Modulated Radiation Therapy) or VMAT (Volumetric Modulated Arc Therapy) after breast-conserving surgery at our institution as per the experimental arm of the RTOG 1005 trial.</p><p><strong>Materials and methods: </strong>170 patients who underwent adjuvant moderate hypofractionated WBRT with SIB after breast-conserving surgery were identified between 29 July 2019 and 22 September 2024.</p><p><strong>Results: </strong>The median age was 57 (range: 33-84). The pTstage distribution was as follows: Tis: 18.2%, T0: 9.4%, T1: 57.1%, T2: 14.1% and T3: 1.2%. pN0: 82.9% and pN1mic: 17.1%. Neoadjuvant/adjuvant chemotherapy and adjuvant endocrine therapy were administered in 17.6%, 26.5% and 58.2% of cases respectively. IMRT and VMAT techniques were used in 79.4% and 20.6% of cases respectively. The median mean heart dose was 0.9Gy (0,2-4,7). The median V16 and V8 of the ipsilateral lung were 12.8% (0-60.5) and 19.1% (0-63). Grade 1 and grade 2 radiodermitis and edema were reported in 58.8%, 4.7%, 3.5% and 0.6% of cases respectively. With a median follow-up of 14 months (0-55), the one-year local relapse free survival (LRFS), the locoregional relapse free survival (LRRFS), the metastases recurrence free survival (MRFS) and overall survival were all 100%.</p><p><strong>Conclusion: </strong>Our preliminary data suggests that routine use of SIB with WBRT using IMRT or VMAT was feasible with a favorable risk-benefit ratio. Longer follow-up can confirm the safety of this approach.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616300","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":"Suspected infection of unclear origin at the emergency department: diagnostic yield of thoraco-abdominal-pelvic CT in non-severe patients.","authors":"Marine Dumon, Sybille Fotso Tambue, Ingrid Millet, Thibaut Markarian, Xavier Bobbia, Fanchon Herman, Patrice Taourel, Juliette Coutureau","doi":"10.1093/bjr/tqaf150","DOIUrl":"https://doi.org/10.1093/bjr/tqaf150","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the diagnostic yield of thoraco-abdominal-pelvic CT (TAP-CT) in suspected infection of unclear origin in the Emergency Department (ED) and identify predictive factors for normal TAP-CT to optimize its use.</p><p><strong>Methods: </strong>We retrospectively categorized 517 TAP-CT studies of adult patients with non-severe infection of unclear origin based on the presence of an infectious focus or significant findings, such as neoplasia or thrombosis. Descriptive analysis, correspondence assessment between CT results and final diagnosis, and statistical modeling were performed to identify predictors of normal TAP-CT.</p><p><strong>Results: </strong>An infectious focus was identified in 55% TAP-CT scans, mainly pulmonary (46%), bilio-digestive (25%), and genitourinary (23%). Significant noninfectious findings were detected in 20%, including thrombosis (7%) and neoplasia (12%). TAP-CT showed a sensitivity of 73%, specificity of 88%, PPV of 94%, and NPV of 57%, with moderate agreement (Kappa= 0.53) between TAP-CT findings and final diagnosis. Overall, 67% of patients had an identifiable cause for infection-like symptoms. Although C-reactive protein <128 mg/L was associated with normal TAP-CT, no model reliably predicted a normal scan.</p><p><strong>Conclusions: </strong>TAP-CT identified a relevant finding in over two-thirds of cases, reinforcing its role in diagnosing both infectious and mimicking conditions. No specific criteria could safely exclude TAP-CT, making it a valuable tool for managing patients with suspected infections of unclear origin.</p><p><strong>Advances in knowledge: </strong>This study is the first to assess TAP-CT's value in suspected non-severe infections of unclear origin in the ED, highlighting its role in detecting infectious and noninfectious conditions and optimizing diagnostic strategies.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599457","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}