Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

{"title":"Barriers to vision care among older adults experiencing homelessness: a qualitative study.","authors":"Afreen Ahmad, Chris Choi, Shayaan Kaleem, Hashim Hameed, Victoria Leung, Runjie Bill Shi, Victoria Wylson, Gareth Mercer, Myrna Lichter","doi":"10.1016/j.jcjo.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.008","url":null,"abstract":"<p><strong>Objective: </strong>To characterize self-rated eye health, quality of life, access to care, and lived experiences of older adults experiencing homelessness in the Greater Toronto and Hamilton area.</p><p><strong>Design: </strong>Qualitative framework analysis of semistructured interviews.</p><p><strong>Participants: </strong>Ninety-nine seniors (aged ≥50 years) experiencing homelessness and 2 frontline shelter staff (a registered nurse and case manager) who were recruited from inner-city shelters and transitional housing programs.</p><p><strong>Methods: </strong>Individual semistructured interviews were conducted on-site between November 2024 and June 2025, alongside clinical surveys and ocular examinations. Field notes and verbatim excerpts were analysed using the framework method, with triangulation of participant and staff perspectives.</p><p><strong>Results: </strong>Mean self-rated quality of life was 5.62 of 10 (SD 2.40) and vision quality was 5.84 of 10 (SD 2.01). Participants described homelessness as compounding physical, emotional, and environmental burdens that eroded eye health: 45.5% had glasses that were lost, stolen, or broken, and unsafe shelter environments contributed to ocular injury. Barriers to eye care existed at the individual level (competing survival priorities, mental health and substance use, older age, language) and system level (being turned away, fragmented referrals, financial cost, transportation). Despite these barriers, participants demonstrated resilience, and supportive caseworker relationships facilitated access. Staff recommended decentralizing care through shelter-embedded, on-site vision services and guaranteed transportation.</p><p><strong>Conclusions: </strong>Older adults experiencing homelessness face compounding, intersecting barriers to eye care across individual, provider, and system levels. Findings support shifting toward shelter-embedded, integrated models of vision care to improve access for this vulnerable population.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191418","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":"Correlation between the dysfunctional lens index and subjective grading for different types of cataracts.","authors":"Mohammed Khan, Nastaran Hajizadeh Bastani, Irina Dinu, M Hermina Strungaru","doi":"10.1016/j.jcjo.2026.09.011","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.011","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the dysfunctional lens index scale (DLI) measured by iTrace is a valuable and objective measurement for evaluating the severity of cataract.</p><p><strong>Design: </strong>Single-centre, retrospective, noninterventional observational study.</p><p><strong>Participants: </strong>Participants seen at the Eye Physicians and Surgeons' clinic from January 2023 to January 2024 were included.</p><p><strong>Methods: </strong>All patients underwent a comprehensive ophthalmologic examination by a single surgeon. This included DLI measurement via the ray-tracing aberrometry system (iTrace Visual Function Analyzer by Tracey Technologies) and an eye examination after pupil dilation and classification of the type of cataracts on the basis of the Lens Opacification Classification System II (LOCS II). Inclusion criteria included a clinical diagnosis of any cataract type, age ≥18 years, and healthy eyes with only cataracts. Participants were excluded if they had a previous history of ocular trauma, ocular surgery, including laser refractive treatment, irregular corneal astigmatism, corneal opacity, scarring, or dystrophies, ocular diseases other than age-related cataract, and pupil diameters of <4.0 mm in the dark.</p><p><strong>Results: </strong>We included 165 eyes from 99 patients comprising of 69 females and 30 males with a mean age of 68.72 years ± 8.82 (range 39-89 years). The DLI was significantly correlated with the severity of nuclear cataract (P = 0.0002) and severity of posterior subcapsular cataract (P = 0.0129). When the DLI increased, the severity of nuclear cataract and posterior subcapsular cataract decreased. There was no statistically significant difference between the mean DLI and the severity of anterior cortical cataract (P = 0.7119). There was a significant correlation (-0.5149) between DLI and best-corrected visual acuity (P = 2.368^e-12); when DLI increased, best-corrected visual acuity decreased. The optimal DLI cut-off for predicting cataract surgery was 8.01, yielding a sensitivity of 0.83, specificity of 0.81, and an area under the curve of 0.82. Values below this threshold were associated with a greater likelihood of requiring surgery.</p><p><strong>Conclusions: </strong>The DLI can be a valuable objective measurement for the severity of nuclear and posterior subcapsular cataracts but not for anterior cortical cataract. A DLI threshold of 8.01 demonstrated moderate discriminative ability for surgical status in this cohort; however, given the retrospective design, DLI should be considered an adjunctive or confirmatory measure rather than an independent criterion for cataract surgery. This study highlights the transformative potential of objective metrics like the DLI, offering significant advancements in identifying visually significant cataracts and their management.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179436","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":"Patient-reported outcome measures in cataract surgery: systematic review and meta-analysis of visual function and quality of life.","authors":"Leon Zhong, Maximilian Wu, Emma Anwar, Brian Yu, Amit X Garg, Cindy M L Hutnik, Monali Malvankar","doi":"10.1016/j.jcjo.2026.07.001","DOIUrl":"10.1016/j.jcjo.2026.07.001","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the improvement in vision-related quality of life, as measured by validated patient-reported outcome measures (PROMs) (NEI-VFQ-14, NEI-VFQ-25) after cataract surgery, and to explore sources of variability in outcomes.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and CINAHL were searched, with supplementary grey‑literature screening, for primary studies reporting preoperative and postoperative PROM scores following cataract surgery. Eligible instruments were the Visual Function Index (NEI-VFQ-14), National Eye Institute Visual Function Questionnaire (NEI‑VFQ‑25/‑14), Catquest‑9SF, and related tools. Two reviewers independently performed study selection, data extraction, and risk‑of‑bias assessment using design‑specific CLARITY/U.S. National Institutes of Health frameworks. Random-effects meta-analyses pooled mean change scores for NEI-VFQ-14 and NEI-VFQ-25. Heterogeneity (τ², I²), 95% prediction intervals, small-study effects (Egger's test), and trim-and-fill were assessed. Risk of bias used design-specific CLARITY/NIH tools.</p><p><strong>Results: </strong>From 3473 records, 122 studies met inclusion criteria. Forty‑seven were prospective cohorts, 9 were randomized controlled trials, and 38 were case series; 52% were judged at moderate risk of bias. Fifty-six NEI-VFQ-14 cohorts (k = 56) and 33 NEI-VFQ-25 cohorts (k = 33) were pooled. Mean improvements were +21.8 points (95% CI: 17.4-26.3; I² = 99.9%; PI: -11.3 to 54.9) for NEI-VFQ-14 and +19.3 points (95% CI: 17.0-21.6; I² = 99.4%; PI: 6.5-32.1) for NEI-VFQ-25. For NEI-VFQ-25, Egger's test suggested small-study effects (p = .002); trim-and-fill imputed 3 studies, yielding +18.2 (95% CI: 16.0-20.4).</p><p><strong>Conclusions: </strong>Cataract extraction consistently enhances patient‑perceived visual function and quality of life. Unfortunately, high heterogeneity limits precision and suggests that gains in PROM score may vary by patient and procedural factors, and small-study effects may overestimate the true benefit recorded by NEI-VFQ-25. Routine integration of validated PROMs into cataract pathways will better capture outcomes that matter to patients, given that the very high heterogeneity, standardized reporting, and longer follow‑up are priorities.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879005","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":"Association of glaucoma diagnosis with sex hormone-related diagnoses and hormone-replacement therapy within a national U.S. database.","authors":"Sarah Atta, Priya Eppel, Matthew Russell, Sindhu Kosuru, Olivia Asimakis, Marjan Attaran, Katherine E Talcott, Rishi P Singh, David C Kaelber, Ang Li","doi":"10.1016/j.jcjo.2026.09.012","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.012","url":null,"abstract":"<p><strong>Objective: </strong>To understand the potential influence of gonadocorticoids on glaucoma susceptibility.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using TriNetX, a multicentre federated health research network, to create cohorts of patients with sex hormone-related diagnoses, including those that lead to increased or decreased estrogen or testosterone states. These were compared with corresponding propensity score-matched control cohorts. Associations between sex hormone states and glaucoma diagnoses/procedures were assessed using standardized differences to identify imbalance. Glaucoma diagnoses were divided into 3 categories: glaucoma suspect, open-angle glaucoma, and narrow-angle glaucoma. Resulting risk ratios, 95% confidence intervals, and P values are reported. A significance level of 0.05 was assumed.</p><p><strong>Results: </strong>Estrogen-deficient states (including bilateral oophorectomy, primary ovarian failure, and early menopause) showed mixed results. Bilateral oophorectomy (n = 24 798) was associated with a lower risk of glaucoma (P < 0.001), primary ovarian failure (n = 23 853) was not associated with risk of glaucoma, and early menopause (n = 256 043) was associated with an increased risk of glaucoma (P < 0.001). A testosterone-deficient state (male hypogonadism, n = 90 752) was not associated with risk of glaucoma. Increased estrogen (hormone-replacement therapy) (n = 41 144) and long-term estrogen use (n = 39 202) showed decreased risk of glaucoma diagnosis (P < 0.001). Long-term oral contraceptive use (n = 5795) was associated with a lower risk of glaucoma suspect diagnosis (P < 0.001). Increased testosterone (polycystic ovarian syndrome, n = 9181) was not associated with a diagnosis of glaucoma.</p><p><strong>Conclusions: </strong>Estrogen- and testosterone-deficient states in this study did not show a consistent pattern with glaucoma risk, whereas estrogen-replacement therapy and long-term estrogen use may confer protective effects.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164736","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":"Arteriovenous malformation of the optic nerve leading to diagnosis of Wyburn-Mason syndrome.","authors":"Reut Shor, Mariam Issa, Edward Margolin","doi":"10.1016/j.jcjo.2026.07.014","DOIUrl":"10.1016/j.jcjo.2026.07.014","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944223","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":"Atypical cranio-orbital perineural cysts in autosomal-dominant polycystic kidney disease.","authors":"Athithan Ambikkumar, Suresh Subramaniam, Fiona Costello","doi":"10.1016/j.jcjo.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.007","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of selective laser trabeculoplasty in lowering intraocular pressure in pseudoexfoliative glaucoma: a systematic review.","authors":"Abu Bakar Butt, Anita Chander, Asma Bilgasem, David J Mathew","doi":"10.1016/j.jcjo.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.010","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with pseudoexfoliative glaucoma (PXG).</p><p><strong>Methods: </strong>A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with International Prospective Register of Systematic Reviews (CRD420251271861). Ovid MEDLINE, Embase, and the Cochrane Library were searched from inception to December 26, 2025 for studies evaluating SLT in PXG. Randomized controlled trials and observational studies reporting IOP outcomes were included. Data regarding IOP reduction, treatment success, durability, and adverse events were narratively synthesized.</p><p><strong>Results: </strong>Fourteen studies comprising 752 eyes were included. Follow-up ranged from 1 to 49 months. Most studies reported clinically meaningful IOP reduction after SLT, with mean reductions ranging from 2.8 to 8.1 mm Hg and percentage reductions ranging from 18.4% to 36.0%. Several studies demonstrated reductions exceeding 25% at 1 year. Although some studies demonstrated sustained efficacy up to 21-30 months, others reported rapid attenuation of effect, including return to pretreatment IOP within approximately 1 month. Treatment success rates ranged from 40.0% to 78.4%. Transient post-SLT IOP spikes occurred in 11.6%-28.0% of patients, with inflammation and ocular discomfort commonly reported. Most studies were judged to have moderate-to-serious risk of bias.</p><p><strong>Conclusions: </strong>SLT provides clinically meaningful but variably durable IOP reduction in PXG. Given inconsistent durability and relatively common transient IOP spikes, it is best used with close follow-up rather than as a guaranteed long-term solution. Long-term prospective studies are needed to clarify its durability and optimal role in PXG management.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104791","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":"Comparative quantitative analysis of choroidal abnormalities in patients with type 1 neurofibromatosis using multimodal retinal imaging.","authors":"Federica Fossataro, Claudia Fossataro, Gilda Cennamo, Alfonso Maria Ponsiglione, Iris Scala, Shilo Voichanski, Ciro Costagliola, David Sarraf","doi":"10.1016/j.jcjo.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.009","url":null,"abstract":"<p><strong>Objective: </strong>To characterize and compare, using multimodal imaging, the qualitative and quantitative features of choroidal abnormalities (CAs) in patients with neurofibromatosis type 1 (NF1).</p><p><strong>Design: </strong>Observational, multicentre, retrospective study.</p><p><strong>Participants: </strong>Patients with NF1 and at least 1 CA in the macular region were included.</p><p><strong>Methods: </strong>Multimodal imaging, including multicolour (MC), near-infrared (NIR), and en face OCT, was collected. CAs were classified into type 1 and type 2, according to scientific literature, on the basis of their size, shape, and pattern. A qualitative assessment of lesion conspicuity was performed using a 3-point Likert scale, as well as a quantitative analysis of lesion area. Statistical analysis was applied to evaluate inter- and intramodality reliability and correlations.</p><p><strong>Results: </strong>Among the 35 CAs analysed across MC, NIR, and en face OCT, the median conspicuity rating was \"medium\" and en face OCT showed the greatest conspicuity (42.9% of CAs) The intermodality reliability was fair to moderate (intraclass correlation coefficient = 0.426). Type 1 lesions were more easily identifiable across all modalities. En face OCT provided the greatest sensitivity of detection of type 2 CAs. Quantitative assessment revealed no significant difference in the area of the CAs across the 3 modalities (P = 0.131), with excellent reliability (intraclass correlation coefficient = 0.960), high correlation (r > 0.95), and no significant relationship between lesion type and area.</p><p><strong>Conclusions: </strong>En face OCT demonstrated better detection of CAs compared with MC and NIR imaging. In addition, lesion area measurements were consistent across all 3 modalities, highlighting their reliability in characterizing CAs in patients with NF1.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104698","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":"Long-term outcomes after Descemet membrane endothelial keratoplasty: cumulative transplant burden and visual outcomes.","authors":"Dana Barequet, Mobin Abdi, Nir Sorkin, Ae Ra Kee, Marcela Huertas-Bello, Noa Kapelushnik, Shaikhah Abohaimed, Clara C Chan, David S Rootman","doi":"10.1016/j.jcjo.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.006","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate long-term outcomes after Descemet membrane endothelial keratoplasty (DMEK), focusing on cumulative transplant burden, time-to-event outcomes, and visual acuity (VA).</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Participants: </strong>A total of 320 eyes from 246 patients undergoing DMEK with ≥5 years of follow-up (with 25% of patients having ≥10 years of follow-up).</p><p><strong>Methods: </strong>Clinical data were reviewed to assess graft failure, repeat corneal transplantation, cumulative transplant burden, VA, and endothelial cell density (ECD). Kaplan-Meier and Cox proportional hazards models were used for time-dependent outcomes. Multivariable logistic regression identified predictors of VA.</p><p><strong>Results: </strong>Sixty-six eyes (20.6%) required ≥1 additional corneal transplant. Eyes with bullous keratopathy (BK) had a greater transplant burden than Fuchs endothelial dystrophy (p < .001). Kaplan-Meier analysis showed reduced graft failure-free and transplant-free survival in BK eyes (both p < .001). In Cox models, BK was independently associated with graft failure (hazard ratio [HR] 4.67; p = .001) and repeat transplantation (HR 3.41; p = .019). VA improved from 0.82 to 0.44 logMAR at 1 year (p < .001), with favourable observed outcomes at longer follow-up. Greater transplant burden was associated with worse final VA (p < .001); however, only the 2-transplant category reached statistical significance after adjustment (adjusted odds ratio 2.35; p = .045). ECD declined predictably over time, with greater loss in BK eyes (p = .001).</p><p><strong>Conclusions: </strong>DMEK provides substantial long-term visual improvement; however, outcomes extend beyond graft survival. Eyes with BK and ocular complexity have higher transplant burden and risk of failure. Increasing transplant burden is associated with worse visual outcomes, highlighting the importance of individualized long-term management and counseling.</p>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073205","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":"Hidden Angle Melanocytoma in a Patient with Refractory Open-Angle Glaucoma.","authors":"Salaam Botros, Antonio Bechara Ghobril, Carol L Shields","doi":"10.1016/j.jcjo.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.jcjo.2026.09.005","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058523","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}