Child's Nervous System最新文献

{"title":"Selective dorsal rhizotomy outcomes in mixed spasticity and dystonia cases.","authors":"Ahmed Aly, Mostafa Elmaghraby, Andrew Dapaah, Benjamin Hall, Christine Sneade, Benedetta Pettorini","doi":"10.1007/s00381-024-06720-1","DOIUrl":"https://doi.org/10.1007/s00381-024-06720-1","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated the effects of selective dorsal rhizotomy (SDR) on dystonia and dystonic posture in patients with cerebral palsy (CP) presenting with mixed spasticity and dystonia.</p><p><strong>Method: </strong>A prospective, single-centre study was conducted at a UK supra-regional centre from May 2013 to September 2022. All children with spasticity, dystonia and/or dystonic posture undergoing SDR were included. The primary outcome measure was pre- and postoperative assessment of dystonic posture. Dystonia severity was measured using the Barry-Albright dystonia (BAD) scale.</p><p><strong>Results: </strong>Two hundred and fifty-seven patients (aged 3-18 years) underwent SDR. Forty-three patients had dystonia and 52 exhibited dystonic posture without dystonia. At 3-month follow-up (n = 29), GMFCS levels tended to decrease, returning to baseline at 6 months (n = 25). Two patients required medication adjustments post-surgery. Dystonia levels remained unchanged in the dystonia group. In the dystonic posture group, 33 patients showed no change, while 21 improved.</p><p><strong>Conclusion: </strong>SDR may be beneficial for carefully selected patients with dystonia or dystonic posture, without worsening these conditions. Optimal patient selection, clear communication of surgical goals and multidisciplinary involvement are crucial.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"61"},"PeriodicalIF":1.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845786","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":"Successful endoscopic third ventriculostomy in a patient with 40 years of ventriculoperitoneal shunt dependency since infancy: a case report.","authors":"Daisuke Kita, Yasuhiro Aida, Fumihide Enkaku","doi":"10.1007/s00381-024-06724-x","DOIUrl":"https://doi.org/10.1007/s00381-024-06724-x","url":null,"abstract":"<p><p>Ventriculoperitoneal shunt malfunction is a common complication in patients with lifelong hydrocephalus. We present a case of a 40-year-old man who successfully underwent endoscopic third ventriculostomy (ETV) for shunt malfunction following neonatal meningitis. Despite long-term shunt dependency and an infectious etiology, ETV effectively managed his hydrocephalus, probably due to aqueductal stenosis and preserved cerebrospinal fluid absorption. This suggests that ETV is a viable option for adult hydrocephalus patients experiencing shunt malfunction, even those with lifelong shunt dependency and a history of infectious etiology.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"60"},"PeriodicalIF":1.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845789","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":"Endoscopic-assisted versus open fronto-orbital distraction for unicoronal craniosynostosis: morphometric and technique considerations.","authors":"Meagan Wu, Connor S Wagner, Dillan F Villavisanis, Jinggang J Ng, Benjamin B Massenburg, Dominic J Romeo, Gregory G Heuer, Scott P Bartlett, Jordan W Swanson, Jesse A Taylor","doi":"10.1007/s00381-024-06662-8","DOIUrl":"10.1007/s00381-024-06662-8","url":null,"abstract":"<p><strong>Introduction: </strong>In an effort to maximize benefit and minimize morbidity when performing fronto-orbital distraction osteogenesis (FODO) for unilateral coronal synostosis (UCS), we have transitioned to an endoscopic-assisted approach (\"endo-FODO\"). This study compares photogrammetric outcomes of patients who underwent FODO via an endoscopic-assisted versus open approach.</p><p><strong>Methods: </strong>We retrospectively reviewed patients treated for UCS from 2013 to 2023. Photogrammetric outcomes at one to three years postoperatively were compared between patients who underwent endo-FODO and age- and sex-matched controls who underwent open FODO. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, and orbital dystopia angle (ODA) were calculated.</p><p><strong>Results: </strong>Twenty patients (ten per group) underwent surgery at a mean age of 6.1 ± 1.8 and 5.4 ± 1.1 months (p = 0.426) and were photographed at 1.6 ± 0.9 and 1.8 ± 0.9 years (p = 0.597) postoperatively in the endo-FODO and open FODO groups, respectively. Patients who underwent endo-FODO demonstrated significant improvements in margin-reflex distance 1 (MRD1) symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.004), canthal tilt symmetry (p = 0.020), and ODA (p = 0.009). Patients who underwent open FODO likewise demonstrated significant improvements in MRD1 symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.033), and ODA (p = 0.004). All postoperative measurements as well as degrees of improvement were similar between groups (p > 0.05).</p><p><strong>Conclusions: </strong>Endo- and open FODO were associated with significant and comparable improvements in soft tissue periorbital symmetry and orbital dystopia at nearly two years postoperatively. While continued follow-up until cranial maturity is needed to assess the durability of aesthetic results, these data support a minimally invasive, endoscopic alternative to fronto-orbital distraction.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"59"},"PeriodicalIF":1.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bedside transfontanelle drain placement reduces the need for operative intervention in infants with subdural fluid collections.","authors":"Julia Pazniokas, William Harris, Mohammed Alshareef, Allyson L Alexander, Todd C Hankinson, Michael H Handler, C Corbett Wilkinson, Derek C Samples","doi":"10.1007/s00381-024-06712-1","DOIUrl":"https://doi.org/10.1007/s00381-024-06712-1","url":null,"abstract":"<p><strong>Objective: </strong>Subdural fluid collection is a common neurosurgical condition in the pediatric population. Patients requiring surgical intervention have historically been managed with subdural drains, subdural-subgaleal shunting, subdural-peritoneal shunting, and mini-craniotomies. An alternative procedure for patients with an open anterior fontanelle is bedside transfontanelle drainage. This study aims to evaluate the efficacy of the transfontanelle angiocatheter drain placement including complications and the need for any further surgery.</p><p><strong>Methods: </strong>We performed a single-center retrospective review of all patients who underwent placement of transfontanelle drain to treat subdural fluid collections from January 2013 to June 2023. Data points collected included demographics, comorbidities, mechanism of subdural collection, neurologic status on presentation, subdural size, amount of drainage, complications, and need for further intervention.</p><p><strong>Results: </strong>We identified 28 patients who underwent bedside transfontanelle subdural angiocatheter placement between January 2013 and June 2023. The patient age range was 0-11 months (avg 3.96). Twenty-three patients were male (82%). Nineteen patients (68%) had new seizures on presentation or during hospitalization. Eighteen patients (64%) suffered non-accidental trauma. The subdural on the side of the drainage ranged from 4 to 18 mm in size. On average, a total of 590 mL (22-1648) of fluid was drained over 3.5 (1-9) days. One medically complex patient on aspirin for cardiac comorbidities had post-procedural complication of new hemorrhage and one patient developed meningitis. Nineteen patients did not require any further treatment. Six patients underwent subsequent subdural-peritoneal shunting, two required subsequent placement of surgical subdural drains, and one underwent bilateral burr hole craniotomies with subdural drain placement. Patients who suffered NAT were more likely to not need further intervention than those with other mechanisms of subdural fluid collections.</p><p><strong>Conclusions: </strong>This retrospective review demonstrates that bedside transfontanelle drain placement is an effective practice to reduce the need for operative intervention in infants with an open anterior fontanelle. The procedure can be performed expeditiously in the emergency room, ICU, or floor setting without the need for general anesthesia. While future larger prospective studies are warranted, our series documented this practice to be performed safely.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"55"},"PeriodicalIF":1.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827398","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":"Does new research address persistent questions since the publication of the CDC's 2018 pediatric mTBI guideline.","authors":"Rebecca Dann, Ankita Das, Alexandria Naftchi, Brinda Raval, Eris Spirollari, OluwaToba Akinleye, Sima Vazquez, Allison Zhong, Jose F Dominguez, Jared Pisapia, Carrie Muh, Rachana Tyagi","doi":"10.1007/s00381-024-06706-z","DOIUrl":"10.1007/s00381-024-06706-z","url":null,"abstract":"<p><strong>Background and objective: </strong>Due to the potential debilitating sequelae following pediatric mTBI, the CDC published the Guideline on the Diagnosis and Management of mTBI Among Children in 2018. However, the guideline identified several key gaps in our clinical knowledge to support several clinical recommendations. The objective of this review is to evaluate if subsequent research has addressed these gaps in clinical practice recommendations.</p><p><strong>Methods: </strong>A literature review was conducted in PubMed using keywords from the CDC guidelines for the years of July 2015-January 2021. Articles were screened by title and abstract so only studies with children < 18 years of age and those focusing on mTBI were included.</p><p><strong>Results: </strong>A total of 531 articles were identified after screening. Forty-three percent was prospective; 24% were case reports, literature reviews, comments, or protocols; 19% were retrospective, 7% were cross-sectional, 4% were RCTs, and 4% were systematic reviews/meta-analyses. Forty-nine percent focused on diagnosis, 17% on prognosis, and 34% on treatment. The four most published topics were neuropsychological tools (28%), risk factors for intracranial injury and computed tomography (11%), cognitive/physical rest (11%), and return to school (10%).</p><p><strong>Conclusion: </strong>Since the release of the 2018 CDC guidelines, the majority of publications addressing pediatric mTBI have been prospective studies evaluating the clinical application of neuropsychological tools in concussion management. While these studies do address several of the clinical gaps noted by the CDC regarding the diagnosis and prognosis of pediatric mTBI, there remains a lack of high-quality studies focused on improving pediatric concussion treatment and outcomes.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"54"},"PeriodicalIF":1.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827456","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":"Spinal intradural malignant peripheral nerve sheath tumor at the foramen magnum in a non-neurofibromatosis child.","authors":"Madhivanan Karthigeyan, Goutham Varma, Debajyoti Chatterjee, Sai Shiva Tadakamalla, Pravin Salunke, Rajeev Goel","doi":"10.1007/s00381-024-06719-8","DOIUrl":"https://doi.org/10.1007/s00381-024-06719-8","url":null,"abstract":"<p><p>Primary spinal intradural malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, especially in children with a non-neurofibromatosis background. Scarce pediatric data exist with regard to such tumors. A 4-year-old child with a history of spastic limb weakness was operated for a foramen magnum spinal lesion (intradural and extradural) with imaging suggestive of schwannoma; the histopathology, however, was that of a MPNST. He underwent redo-surgery for recurrent infiltrating lesion, became ventilator dependent, and expired. Along with this case, we briefly discuss the relevant literature on pediatric primary spinal MPNSTs. The report represents an unusual site for spinal MPNST in a child with dual components. It is important for clinicians to consider such malignant lesions among the differentials of paediatric spinal intradural/ extradural lesions. Compared to that of adults and other regions, the prognosis for spinal intradural MPNSTs in children remains grim.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"52"},"PeriodicalIF":1.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827587","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":"Traumatic pediatric cervical spine injury-a proposed clearance algorithm incorporating a 24-h time delay.","authors":"Victoria E Fischer, Vaidehi M Mahadev, Jacob A Bethel, Jaime A Quirarte, Robert J Hammack, Cristian Gragnaniello, Izabela Tarasiewicz","doi":"10.1007/s00381-024-06716-x","DOIUrl":"https://doi.org/10.1007/s00381-024-06716-x","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric cervical spine injury (pCSI) is rare. Physiological differences necessitate alternate management from adults. Yet, no standardized pediatric protocols exist. Previous investigations applying adult-validated clinical decision rules (CDRs)-NEXUS Criteria (NX) and Canadian C-spine Rules (CCR)-to children are mixed. We hypothesized a combined NX + CCR approach applied at a delayed 24-h time point would enhance screening efficacy in select patients.</p><p><strong>Methods: </strong>We conducted a retrospective review of a prospectively-collected database over 15 months at a pediatric-capable Level-1 trauma center. Age and mechanism determined initial inclusion. NX and CCR criteria were collected and retroactively applied on arrival (T0) and 24 h later (T1). Statistical analyses were performed in SPSS.</p><p><strong>Results: </strong>A total of 306 patients met inclusion. Current practices compel computed tomography (CT) overuse for craniocervical evaluations: 298 (97.4%) underwent ≥ 1 CT. Of cervical spines imaged (n = 175), 161 (92.0%) underwent CT while 74 (42.3%) underwent magnetic resonance imaging with 14 (18.9%) completed after 72 h. Of collars placed on arrival (n = 181), 136 (75.1%) were cleared before discharge with 86 (63.2%) CTs denoting preferred clearance modality; CT utilization was unchanged when stratified by age < 5 years (p = 0.819). Notably, we found more patients met NX + CCR criteria at T1 versus T0 (p = 0.008) without missed pCSI resulting in imaging overutilization in 15 (8.6%) patients.</p><p><strong>Conclusion: </strong>We showed incorporating a 24-h time delay before a second CDR reapplication may enhance screening efficacy in pCSI. Our new algorithm combines these findings with other literature-based recommendations and may represent a standardizable option for evaluating pCSI in the acute trauma setting.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"58"},"PeriodicalIF":1.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834339","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":"Open versus endoscopic surgery with helmet molding therapy in non-syndromic patients with craniosynostosis: an updated systematic review and meta-analysis of clinical outcomes and treatment-related costs.","authors":"Omar R Ortega-Ruiz, Mauricio Torres-Martínez, Mariana Villafranca-Cantú, Rebeca Alejandra Ávila-Cañedo, Emilio Piñeyro-Cantú, Eduardo Menchaca-Welsh, Nir Shimony, George I Jallo, Javier Terrazo-Lluch, J Javier Cuéllar-Hernández","doi":"10.1007/s00381-024-06692-2","DOIUrl":"10.1007/s00381-024-06692-2","url":null,"abstract":"<p><strong>Objective: </strong>There is an ongoing debate regarding the optimal treatment for craniosynostosis as diverse factors influence the election between endoscopic and open surgery. Previous evidence favors endoscopic procedures. However, evidence remains unfulfilled by a limited number of patients and clustered in very few centers worldwide making it difficult to define it as a replicable technique in different populations. In recent years, evidence regarding endoscopic-assisted procedures has gone through a considerable spurt showing an increased interest among surgeons globally showing optimal outcomes in different populations and centers. In this systematic review and meta-analysis, we performed an updated analysis of previous reviews, including only non-syndromic patients. We also seek to provide a summary of the tendency of treatment observed in the literature. Similarly, this is the first study to include total costs within its analysis.</p><p><strong>Material and methods: </strong>Three previous meta-analyses published in 2018 yielded 11 eligible papers. We performed a systematic review and meta-analysis of the literature in MEDLINE and EMBASE databases through PubMed, Scopus, and Ovid to fill the gap of information between 2018 and 2024. Twenty-three total articles were included in the final analysis.</p><p><strong>Results: </strong>Variables analyzed were baseline characteristics, length of stay, blood loss, transfusion rates and volume, operative time, and costs. The analysis of data concluded a younger age at surgery in patients undergoing endoscopic surgery (p ≤0.00001). Blood loss, transfusion rates, and volumes depicted favored outcomes for endoscopy with less blood loss during surgery (p ≤0.00001), operative time (p ≤0.00001), and transfusion rates (p ≤0.00001) as well as lower transfused volumes (p ≤0.00001).</p><p><strong>Conclusion: </strong>Endoscopic surgery carries fewer complications than open surgery. Treatment-related costs are highly decreased in endoscopic procedures after including costs related to outpatient care. Open surgery can be considered in older children if no endoscope or experienced surgeons in endoscopic procedures are available.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"53"},"PeriodicalIF":1.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827583","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":"Mechanisms of hydrocephalus after intraventricular haemorrhage: a review.","authors":"Wenchao Wu, Qingsong Li","doi":"10.1007/s00381-024-06711-2","DOIUrl":"10.1007/s00381-024-06711-2","url":null,"abstract":"<p><p>Intraventricular haemorrhage (IVH) is bleeding within the ventricular system, which in adults is usually mainly secondary to cerebral haemorrhage and subarachnoid haemorrhage. Hydrocephalus is one of the most common complications of intraventricular haemorrhage, which is characterised by an increase in intracranial pressure due to an increased accumulation of cerebrospinal fluid within the ventricular system, and is closely related to the patient's prognosis. Surgical methods such as shunt surgery have been used to treat secondary hydrocephalus in recent years and have been effective in improving the survival and prognosis of patients with hydrocephalus. However, complications such as shunt blockage and intracranial infection are often faced after surgery. Moreover, little is known about the mechanism of hydrocephalus secondary to intraventricular haemorrhage. This review discusses the mechanisms regarding the occurrence of secondary hydrocephalus after intraventricular haemorrhage in adults in terms of blood clot obstruction, altered cerebrospinal fluid dynamics, inflammation, and blood composition.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"49"},"PeriodicalIF":1.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827463","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":"Subarachnoid puncture via the anterior fontanelle with intrathecal vancomycin for refractory purulent meningitis: a pediatric case report.","authors":"Yan Li, Xinghui Yang, Yongping Xie, Guolan Huang, Xiaohui Fang, Lisu Huang","doi":"10.1007/s00381-024-06668-2","DOIUrl":"10.1007/s00381-024-06668-2","url":null,"abstract":"<p><p>This case report presents a novel treatment approach for refractory purulent meningitis in a 1-month-old infant caused by penicillin-sensitive group B Streptococcus. Despite initial treatment with intravenous antibiotics, including penicillin and vancomycin, the infant experienced persistent symptoms and bilateral subdural effusions. Conventional therapies failed to resolve these issues, leading to the use of a new technique: subarachnoid puncture via the anterior fontanelle combined with intrathecal vancomycin administration. This minimally invasive procedure allowed for targeted antibiotic delivery, significantly reducing subdural effusions and improving cerebrospinal fluid parameters. The infant showed substantial clinical improvement and was discharged after 68 days with no complications during a 3-month follow-up. This approach offers a promising alternative to more invasive treatments such as craniotomy or subdural external drainage, though further research is needed to confirm its efficacy and safety in broader clinical contexts.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"50"},"PeriodicalIF":1.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}