Cardiology in the Young最新文献

{"title":"Arterial thromboembolism, antithrombotic therapy, and risk of recurrent thromboembolism in children with CHD undergoing cardiac surgery.","authors":"Amy L Kiskaddon, Nhue L Do, Ernest K Amankwah, Daniel M Witt, Vera Ignjatovic, Therese M Giglia, Gary M Woods, Hilary B Whitworth, Arabela C Stock, Neil A Goldenberg","doi":"10.1017/S1047951125001271","DOIUrl":"10.1017/S1047951125001271","url":null,"abstract":"<p><strong>Introduction: </strong>Data on arterial thromboembolism in children undergoing cardiac surgery are limited. We sought to characterise, and estimate rates of, incident and recurrent arterial thromboembolism, and describe antithrombotic therapies for treatment in a large multinational population of children with CHD undergoing cardiac surgery.</p><p><strong>Methods: </strong>We queried the TriNetX global electronic health record (derived real-world data research platform) from 2017 to 2024 for patients less than 18 years of age and an index arterial thromboembolism within 1 year of congenital cardiac surgery. Data were descriptively analysed.</p><p><strong>Results: </strong>Of 20,102 children who underwent an index cardiac surgery for CHD, 206 (1.1%) developed an index arterial thromboembolism within 1 year of surgery: 111 (53.9%) had only arterial thromboembolism and 95 (46.1%) had concomitant venous thromboembolism. The most common anatomic site for arterial thromboembolism was the lower extremity (<i>n</i> = 141, 68.4%), and the most common surgery was the Glenn procedure (<i>n</i> = 35, 17%). Unfractionated heparin was utilised in 136 (67 %) and aspirin in 91 (44.2%) patients. Recurrent thromboembolism occurred in 36 (17.5%) patients within 1 year of the index thromboembolism.</p><p><strong>Conclusions: </strong>Among children undergoing congenital cardiac surgery, arterial thromboembolism was rare (1% of patients), but the 1-year risk of recurrent thromboembolism was high, at 17.5%. Multicentre prospective cohort studies are warranted to further evaluate risk factors for recurrent thromboembolism, to facilitate future risk-stratified interventional trials designed to reduce the high thromboembolism recurrence risk in these children.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"679-682"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514815","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":"Wake-up call: paediatric cardiac intensive care nurse and advanced practice provider well-being and intent to vacate.","authors":"Casey N Bor, Gyasi Moscou-Jackson, Christopher W Mastropietro, Sandra L Staveski","doi":"10.1017/S1047951125000599","DOIUrl":"10.1017/S1047951125000599","url":null,"abstract":"<p><p>This study aimed to assess Well-Being Index scores in paediatric cardiac ICU (PCICU) registered nurses and advanced practice providers. Secondary objectives included identifying factors correlating with at-risk Well-Being Index scores and exploring predictors of these scores, with attention to the impact of the coronavirus disease 2019 pandemic. A multicentre electronic survey was conducted between October 2021 and January 2022. Registered nurses and advanced practice providers working in PCICUs at US centres participating in the Collaborative Research from the Pediatric Cardiac Intensive Care Society were included.The survey included the nine-item Well-Being Index and questions about demographics and factors influencing well-being, such as coronavirus disease 2019. The Well-Being Index is a validated tool to predict workforce distress and well-being. Out of 218 participants (180 registered nurses, 38 advanced practice providers), 137 registered nurses (76%) and 15 advanced practice providers (39%) had at-risk Well-Being Index scores. A total of 61% of nurses and 34% of advanced practice providers reported an intent to leave. Intent to leave was significantly linked to lower well-being for registered nurses (<i>p</i> = 0.002). Leadership support reduced registered nurses' distress risk by 68% compared to no support (<i>p</i> = 0.04). Increased stress since coronavirus disease 2019 raised registered nurses' poor well-being risk by four times (<i>p</i> = 0.001). PCICU registered nurses and advanced practice providers are at risk for poor well-being, exacerbated by the pandemic. Those with poor well-being may be more likely to leave. Leadership support is vital for nurses' well-being. Further research is needed to establish baseline well-being.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"661-667"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584766","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":"Interstage feeding and caregiver impact on single ventricle patients.","authors":"Nashifa H Momin, Jennifer L Nelson, Camille Steiden, Nicole Coolidge, Alaa Aljiffry, Meg Simione","doi":"10.1017/S1047951125000423","DOIUrl":"10.1017/S1047951125000423","url":null,"abstract":"<p><strong>Background: </strong>The interstage period is a critical phase for single ventricle infants due to their fragile cardiovascular state. Infants often experience medical and feeding challenges during this period, resulting in caregiver stress. We completed a quality improvement project at Children's Healthcare of Atlanta to understand these challenges to inform targeted interventions.</p><p><strong>Methods: </strong>This single-center project included a medical chart review and a cross-sectional caregiver survey. Data were collected on patient and caregiver demographics and clinical variables. Feeding outcomes were assessed using the Pediatric Functional Oral Intake Scale. Caregiver impact was measured using the Feeding/Swallowing Impact Survey.</p><p><strong>Results: </strong>The project included 15 single ventricle patients with a mean (standard deviation) age of 151.73(25.92) days at the time of the second-stage palliation. Forty percent of patients experienced at least one readmission, primarily due to feeding intolerance (20%) and desaturations (26.7%). Milk protein allergy (26.9%) was the most common medical complication, followed by interstage unplanned reinterventions. Pediatric Functional Oral Intake Scale scores demonstrated that 33% consumed minimal volumes or no oral intake at the time of the bidirectional Glenn, and 93.3% of patients did not receive outpatient feeding services during the interstage. Caregiver stress scores resulted in mean scores (standard deviation) of 2.23(1.54), with the highest impact on daily activities. All caregivers affirmed the need for a dedicated multidisciplinary clinic.</p><p><strong>Conclusion: </strong>The interstage period for single ventricle patients poses significant medical and feeding challenges, resulting in caregiver stress. Comprehensive, multidisciplinary feeding support during the interstage period may improve patient outcomes and alleviate caregiver burden.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"695-701"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482267","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":"Performance against standardization recommendations for outpatient care of common forms of congenital heart disease.","authors":"Sara F Morehous, Jeffrey B Anderson, Eunice Hahn, Nicholas J Ollberding, Christopher J Statile","doi":"10.1017/S1047951125001246","DOIUrl":"10.1017/S1047951125001246","url":null,"abstract":"<p><strong>Background: </strong>The American College of Cardiology has published clinical practice algorithms for common congenital heart lesions, including atrial septal defect, patent ductus arteriosus, valvar pulmonary stenosis, aortic coarctation, and ventricular septal defect. The purpose of this study was to define the current practice patterns in the management of these lesions and describe the impact of departure from these recommendations.</p><p><strong>Methods: </strong>This was a retrospective analysis of the most recent 100 outpatient appointments for each lesion at our centre. Electronic medical records were queried to determine whether the scheduling, testing, and follow-up plan for each appointment were consistent with the published algorithms.</p><p><strong>Results: </strong>A total of 500 visits were evaluated (150 new visits; 350 follow-up visits); 32% (<i>n</i> = 162) of encounters did not receive appropriate testing, 37% (<i>n</i> = 186) departed from recommended follow-up plans, and of the 350 follow-up visits, 45% (<i>n</i> = 156) departed from scheduling guidelines. Impact of these departures was quantified in reference to over- or under-expenditure of clinical resources. Of the aberrant testing encounters, 60% (<i>n</i> = 97) saw too few tests. Of the deviant follow-up plans created, 74% (<i>n</i> = 138) brought patients back to clinic too soon.</p><p><strong>Conclusion: </strong>This study explores the deviation between current practice patterns and published clinical care guidelines. There is considerable variation across domain of analysis, diagnosis, and encounter type, resulting in uneven resource utilisation. Standardisation of care in these areas will improve utilisation and can be a starting point for improvement work.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"812-817"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623622","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":"Severe conduction block and cardiomyopathy associated with desminopathy.","authors":"Ningning Sun, Chunli Wang, Shiwei Yang","doi":"10.1017/S1047951125000125","DOIUrl":"10.1017/S1047951125000125","url":null,"abstract":"<p><p>Desminopathy is a rare heritable cardiac and skeletal muscle disease caused by variants in the <i>DES</i> gene, which encodes the primary muscle-specific intermediate filament protein, known as desmin. Childhood-onset is commonly associated with severe early-onset myopathy and early death. Here, we reported an 11-year-old Chinese girl presenting with complete atrioventricular block and cardiomyopathy, without skeletal muscle involvement. Genetic analysis identified a <i>de novo</i> variant (c.152C > T/p.Ser51Phe) in the <i>DES</i> gene.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"850-852"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623624","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":"Virtual cardiac models as a teaching tool for cardiac morphology.","authors":"Shelby Scola, Ryan Moore, Jeffrey Cimprich, Matthew Nelson, Albert Chen, Meryl Cohen, Jill Savla, Lindsay Rogers","doi":"10.1017/S1047951125000071","DOIUrl":"10.1017/S1047951125000071","url":null,"abstract":"<p><strong>Background: </strong>Understanding complex three-dimensional cardiac structures is the key to knowing CHD. Many learners have limited access to cadaveric specimens, and most alternative teaching modalities are two-dimensional. Therefore, we have developed virtual cardiac models using photogrammetry of actual heart specimens to address this educational need.</p><p><strong>Methods: </strong>A descriptive study was conducted at a single institution during a week-long cardiac morphology conference in October 2022 and 2023. Conference attendees viewed virtual cardiac models via laptop screen and virtual reality headset. Learners were surveyed on their opinions of the virtual models and their perceived effectiveness compared to existing educational materials.</p><p><strong>Results: </strong>Forty-six learners completed the survey. Participants reported the virtual cardiac models to be more effective than textbook diagrams (60%), and equally or more effective compared to didactic teaching (78%) and specimen videos (78%). Approximately half of participants (54%) found the virtual models to be less effective than hands-on cadaveric specimen inspection. Attitudes towards the virtual specimens were overall positive with most responders finding the tool engaging (87%) and enjoyable (85%). A majority reported that the models deepened their understanding of cardiac morphology (79%) and that they would recommend them to other trainees (87%).</p><p><strong>Conclusions: </strong>This study demonstrates that a novel teaching tool, virtual cardiac specimens, is equivalent to or more effective than many current materials for learning cardiac morphology. While they may not replace direct cadaveric specimen review, virtual models are an engaging alternative with the ability to reach a wider audience.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"818-823"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662559","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":"Achieving caloric goal in postoperative management of CHD surgery.","authors":"Murat Tanyildiz, Selin Ece Erden, Asli Ece Yakici, Omer Ozden, Ipek Otrav, Mehmet Bicer, Atif Akcevin, Ender Odemis","doi":"10.1017/S1047951125000484","DOIUrl":"10.1017/S1047951125000484","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the prevalence of malnutrition, time to achieve caloric goals, and nutritional risk factors after surgery for CHD in a cardiac ICU.</p><p><strong>Method: </strong>This retrospective study included patients with CHD (1 month-18 years old) undergoing open-heart surgery (2021-2022). We recorded nutritional status, body mass index-for-age z-score, weight-for-length/height z-score, cardiopulmonary bypass and aortic cross-clamp time, Paediatric Risk of Mortality-3 score, Paediatric Logistic Organ Dysfunction-2 score, vasoactive inotropic score, total duration of mechanical ventilation, length of stay in the cardiac ICU, mortality, and time to achieve caloric goals.</p><p><strong>Results: </strong>Of the 75 included patients, malnutrition was detected in 17% (<i>n</i>= 8) based on the body mass index-for-age z-score and in 35% (<i>n</i>= 10) based on the weight-for-length/height z-score. Sex, mortality, cardiopulmonary bypass and aortic cross-clamp time, Paediatric Risk of Mortality-3, Paediatric Logistic Organ Dysfunction-2, and vasoactive inotropic score, duration of mechanical ventilation, and length of cardiac ICU stay were similar between patients with and without malnutrition. Patients who achieved caloric goals on the fourth day and those who achieved them beyond the fourth day showed statistical differences in mortality, maximum vasoactive inotropic score, duration of mechanical ventilation, cardiopulmonary bypass and aortic cross-clamp time, Paediatric Risk of Mortality-3, Paediatric Logistic Organ Dysfunction-2, and length of cardiac ICU and hospital stay (<i>p</i>< 0.05). Logit regression analysis indicated that the duration of mechanical ventilation, Paediatric Logistic Organ Dysfunction-2 and Paediatric Risk of Mortality-3 score was a risk factor for achieving caloric goals (<i>p</i>< 0.05).</p><p><strong>Conclusions: </strong>Malnutrition is prevalent in patients with CHD, and concomitant organ failure and duration of mechanical ventilation play important roles in achieving postoperative caloric goals.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"668-678"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514809","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":"Transcatheter closure of a huge complex pulmonary arteriovenous malformation with four devices: a case report.","authors":"Utku Pamuk, Harun Terin, Hazim Alper Gursu","doi":"10.1017/S1047951125000575","DOIUrl":"10.1017/S1047951125000575","url":null,"abstract":"<p><p>Pulmonary arteriovenous malformations are abnormal vascular connections between pulmonary arteries and veins, often causing right-to-left shunting. In this report, a 4-year-old boy with low oxygen saturation was diagnosed with a large, complex pulmonary arteriovenous malformation involving four feeding arteries. Percutaneous transcatheter closure was performed using four devices to occlude the major feeding arteries, resulting in increased arterial oxygen saturation from 72 to 98%. This report depicts the successful use of multiple devices for percutaneous closure of a complex pulmonary arteriovenous malformation in a child and highlights the minimally invasive and effective nature of this approach.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"860-862"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536696","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":"Cardiopulmonary resuscitation training decreases anxiety levels in parents of infants with congenital heart disease.","authors":"Desiree S Machado, Zasha Vazquez-Colon, Victoria Botelho, Cynthia Garvan, Dalia Lopez-Colon, Daniel Rodriguez, Leah Breault, Joseph Philip, Laurel Barwick, Jennifer Munoz Pareja, Camila Melchior, Estela Azeka, Erica Cascio","doi":"10.1017/S1047951124026441","DOIUrl":"10.1017/S1047951124026441","url":null,"abstract":"<p><strong>Introduction: </strong>Fear of cardiac arrest among parents of infants with heart disease can cause stress and anxiety. Literature is scarce on the effects of cardiopulmonary resuscitation training (CPRt) on anxiety and stress of parents. We analysed the impact of CPRt on anxiety, stress, and comfort levels on parents of infants with heart disease.</p><p><strong>Methods: </strong>Cardiopulmonary resuscitation (CPR) and choking relief manoeuvre (CRM) comfort level, Parental State-Trait Anxiety Inventory (STAI), and Parenting Stress Index (PSI) scores were prospectively collected pre-, immediately post-, and 3 months post-CPRt.</p><p><strong>Results: </strong>There were 97 participants: 80% (<i>n</i> = 78) mothers/grandmothers and 20% (<i>n</i> = 19) fathers. The mean (SD) age of participants was 28.7 (5.6) years old. There was a significant decrease in STAI across the three time points collected; STAI decreased by 12% from baseline to immediately post-CPRt and 19% from baseline to 3 months post-CPRt (<i>p</i> < .0001). There were no significant changes in PSI across the time points. Baseline to immediately post-teaching, we found that CPRt significantly increased comfort performing CPR, CRM, and comfort in knowing what to do (<i>p</i>=< .001, <i>p</i>=< .001, <i>p</i>=< .001, respectively). Comfort levels persisted elevated when comparing pre- to 3 months post-CPRt (<i>p</i>=< .001, <i>p</i>= .002, <i>p</i>= .001, respectively), maintaining at least a 177% average increase up to 3 months post-CPRt for all aspects.</p><p><strong>Conclusion: </strong>CPRt can aid in improving anxiety and comfort levels of parents of infants with heart disease around hospital discharge. Parental preparedness and reassurance to know what to do in emergency situations can be enhanced by a simple intervention such as CPRt.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"732-737"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514820","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":"Physical activity and cardiac function in patients with Duchenne muscular dystrophy.","authors":"Mary Killian, Jaclyn Tamaroff, Karry Su, Kimberly Crum, Kristen George-Durrett, Larry W Markham, Maciej Buchowski, Thomas Donnelly, W Bryan Burnette, Jonathan H Soslow","doi":"10.1017/S1047951125000162","DOIUrl":"10.1017/S1047951125000162","url":null,"abstract":"<p><strong>Background: </strong>Cardiomyopathy is the leading cause of death in patients with Duchenne muscular dystrophy. The relationship between cardiac and skeletal muscle progression is unclear. The objective of this study was to evaluate the correlation between muscle activity and cardiomyopathy. We hypothesised that cardiomyopathy and skeletal muscle activity are directly related.</p><p><strong>Methods: </strong>Physical activity was assessed with accelerometers worn for 7 days. Average activity (vector magnitude/min) and percentage of time in different activities were reported. Cardiac MRI was used to assess left ventricular ejection fraction, global circumferential strain (Ecc), late gadolinium enhancement, and cardiac index. Associations were assessed between physical activity and cardiac variables using a Spearman correlation.</p><p><strong>Results: </strong>Duchenne muscular dystrophy subjects (<i>n</i> = 46) with an average age of 13 ± 4 years had a mean left ventricular ejection fraction of 57 ± 8%. All physical activity measures showed significant correlations with left ventricular ejection fraction (rho = 0.38, <i>p</i> = 0.01) and left ventricular cardiac index (rho = 0.51, <i>p</i> < 0.001). Less active subjects had lower left ventricular ejection fraction (<i>p</i> = 0.10) and left ventricular cardiac index (<i>p</i> < 0.01). Non-ambulatory patients (<i>n</i> = 29) demonstrated a stronger association between physical activity and left ventricular ejection fraction (rho = 0.40, <i>p</i> = 0.03) while ambulatory patients demonstrated a stronger association between physical activity and left ventricular cardiac index (rho = 0.53, <i>p</i> = 0.03). Ecc did not associate with physical activity in either cohort.</p><p><strong>Conclusion: </strong>Physical activity correlates with left ventricular ejection fraction and left ventricular cardiac index and is modified by ambulation. Future analysis should assess the temporal relationship between physical activity and cardiomyopathy.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"688-694"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514840","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}