Pub Date : 2024-09-01Epub Date: 2024-06-26DOI: 10.1097/JU.0000000000003978
Farnoosh Nik-Ahd, Shoujun Zhao, W John Boscardin, Lufan Wang, Kenneth Covinsky, Anne M Suskind
Purpose: Bladder outlet obstruction (BOO) is common in older adults. Many older adults who pursue surgery have additional vulnerabilities affecting surgical risk, including frailty. A clinical tool that builds on frailty to predict surgical outcomes for the spectrum of BOO procedures would be helpful to aid in surgical decision-making but does not currently exist.
Materials and methods: Medicare beneficiaries undergoing BOO surgery from 2014 to 2016 were identified and analyzed using the Medicare MedPAR, Outpatient, and Carrier files. Eight different BOO surgery categories were created. Baseline frailty was calculated for each beneficiary using the Claims-Based Frailty Index (CFI). All 93 variables in the CFI and the 17 variables in the Charlson Comorbidity Index were individually entered into stepwise logistic regression models to determine variables most highly predictive of complications. Similar and duplicative variables were combined into categories. Calibration curves and tests of model fit, including C statistics, Brier scores, and Spiegelhalter P values, were calculated to ensure the prognostic accuracy for postoperative complications.
Results: In total, 212,543 beneficiaries were identified. Approximately 42.5% were prefrail (0.15 ≤ CFI < 0.25), 8.7% were mildly frail (0.25 ≤ CFI < 0.35), and 1.2% were moderately-to-severely frail (CFI ≥0.35). Using stepwise logistic regression, 13 distinct prognostic variable categories were identified as the most reliable predictors of postoperative outcomes. Most models demonstrated excellent model discrimination and calibration with high C statistic and Spiegelhalter P values, respectively, and high accuracy with low Brier scores. Calibration curves for each outcome demonstrated excellent model fit.
Conclusions: This novel risk assessment tool may help guide surgical prognostication among this vulnerable population.
目的:膀胱出口梗阻(BOO)在老年人中很常见。许多接受手术治疗的老年人都有影响手术风险的其他弱点,包括体弱。以虚弱程度为基础来预测各种膀胱出口梗阻手术结果的临床工具将有助于帮助做出手术决策,但目前尚不存在:使用医疗保险 MedPAR、门诊病人和承保人文件对 2014 年至 2016 年期间接受 BOO 手术的医疗保险受益人进行识别和分析。创建了八个不同的 BOO 手术类别。使用基于索赔的虚弱指数(CFI)计算每位受益人的基线虚弱程度。将 CFI 中的所有 93 个变量和 Charlson 生病指数中的 17 个变量分别输入逐步逻辑回归模型,以确定对并发症最具预测性的变量。相似和重复的变量被合并成不同的类别。计算校准曲线和模型拟合测试,包括 C 统计量、Brier 评分和 Spiegelhalter P 值,以确保术后并发症预后的准确性:共确定了 212,543 名受益人。约42.5%的人属于前期体弱(0.15≤CFI<0.25),8.7%的人属于轻度体弱(0.25≤CFI<0.35),1.2%的人属于中度至重度体弱(CFI≥0.35)。通过逐步逻辑回归,13 个不同的预后变量类别被确定为最可靠的术后预后预测因子。大多数模型都表现出极佳的模型区分度和校准度,分别具有较高的 C 统计量和 Spiegelhalter P 值,以及较低的 Brier 分数和较高的准确度。每种结果的校准曲线都显示出了极佳的模型拟合度:这一新型风险评估工具可为这一弱势群体的手术预后提供指导。
{"title":"Development of the UroARC Surgical Calculator: A Novel Risk Calculator for Older Adults Undergoing Surgery for Bladder Outlet Obstruction.","authors":"Farnoosh Nik-Ahd, Shoujun Zhao, W John Boscardin, Lufan Wang, Kenneth Covinsky, Anne M Suskind","doi":"10.1097/JU.0000000000003978","DOIUrl":"10.1097/JU.0000000000003978","url":null,"abstract":"<p><strong>Purpose: </strong>Bladder outlet obstruction (BOO) is common in older adults. Many older adults who pursue surgery have additional vulnerabilities affecting surgical risk, including frailty. A clinical tool that builds on frailty to predict surgical outcomes for the spectrum of BOO procedures would be helpful to aid in surgical decision-making but does not currently exist.</p><p><strong>Materials and methods: </strong>Medicare beneficiaries undergoing BOO surgery from 2014 to 2016 were identified and analyzed using the Medicare MedPAR, Outpatient, and Carrier files. Eight different BOO surgery categories were created. Baseline frailty was calculated for each beneficiary using the Claims-Based Frailty Index (CFI). All 93 variables in the CFI and the 17 variables in the Charlson Comorbidity Index were individually entered into stepwise logistic regression models to determine variables most highly predictive of complications. Similar and duplicative variables were combined into categories. Calibration curves and tests of model fit, including C statistics, Brier scores, and Spiegelhalter <i>P</i> values, were calculated to ensure the prognostic accuracy for postoperative complications.</p><p><strong>Results: </strong>In total, 212,543 beneficiaries were identified. Approximately 42.5% were prefrail (0.15 ≤ CFI < 0.25), 8.7% were mildly frail (0.25 ≤ CFI < 0.35), and 1.2% were moderately-to-severely frail (CFI ≥0.35). Using stepwise logistic regression, 13 distinct prognostic variable categories were identified as the most reliable predictors of postoperative outcomes. Most models demonstrated excellent model discrimination and calibration with high C statistic and Spiegelhalter <i>P</i> values, respectively, and high accuracy with low Brier scores. Calibration curves for each outcome demonstrated excellent model fit.</p><p><strong>Conclusions: </strong>This novel risk assessment tool may help guide surgical prognostication among this vulnerable population.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11343443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-12DOI: 10.1097/JU.0000000000004099
Maria B Antony, Zach Kozel, Nikhil Gopal, Lauren Loebach, Adam R Metwalli, Sandeep Gurram, W Marston Linehan, Mark W Ball
Purpose: Reoperative partial nephrectomy (RePN) offers several advantages for the treatment of recurrent, multifocal renal masses. RePN has been previously demonstrated to be technically feasible and delay the need for renal replacement therapy. However, there is still inherent complexity and known risks to reoperative nephrectomy. We studied the largest population of RePNs to characterize renal functional outcomes and the likelihood of intra- and postoperative complications.
Materials and methods: Query of an institutional surgical registry was conducted. Demographic data, serum creatinine for estimated glomerular filtration rate (eGFR), and protein dipstick results were assessed within 1 week prior to surgery, and postoperative function assessments were studied within a year of surgery. RePN was defined as serial surgical resection of the ipsilateral renal unit.
Results: A total of 1131 partial nephrectomies performed on 663 patients at a single center were retrospectively evaluated. In reoperative cases, median number of operations per renal unit was 2 (range: 2-6). There was a stepwise decline in eGFR with an average decline of 6.1 with each RePN. With each subsequent nephrectomy, surgical duration, estimated blood loss, and incidence of preoperative anemia increased. Postoperative eGFR showed a significant positive association with preoperative eGFR, while negative associations were found with age, number of previous ipsilateral partial nephrectomies, number of tumors, and largest tumor size. High-grade complications were associated with the number of ipsilateral partial nephrectomies, tumor count, and tumor size. Robotic or laparoscopic procedures exhibited a likelihood of grade 3 or greater complications compared to open surgery.
Conclusions: RePN contributes to renal dysfunction and an increased risk of surgical complications. Intraoperative blood loss and surgical duration increase with subsequent nephrectomy. Such risks are dependent on the number of prior operative interventions on the kidney, suggesting a stepwise progression of surgical morbidity.
{"title":"Cumulative Impact of Serial Partial Nephrectomy for the Treatment of Recurrent Renal Masses.","authors":"Maria B Antony, Zach Kozel, Nikhil Gopal, Lauren Loebach, Adam R Metwalli, Sandeep Gurram, W Marston Linehan, Mark W Ball","doi":"10.1097/JU.0000000000004099","DOIUrl":"10.1097/JU.0000000000004099","url":null,"abstract":"<p><strong>Purpose: </strong>Reoperative partial nephrectomy (RePN) offers several advantages for the treatment of recurrent, multifocal renal masses. RePN has been previously demonstrated to be technically feasible and delay the need for renal replacement therapy. However, there is still inherent complexity and known risks to reoperative nephrectomy. We studied the largest population of RePNs to characterize renal functional outcomes and the likelihood of intra- and postoperative complications.</p><p><strong>Materials and methods: </strong>Query of an institutional surgical registry was conducted. Demographic data, serum creatinine for estimated glomerular filtration rate (eGFR), and protein dipstick results were assessed within 1 week prior to surgery, and postoperative function assessments were studied within a year of surgery. RePN was defined as serial surgical resection of the ipsilateral renal unit.</p><p><strong>Results: </strong>A total of 1131 partial nephrectomies performed on 663 patients at a single center were retrospectively evaluated. In reoperative cases, median number of operations per renal unit was 2 (range: 2-6). There was a stepwise decline in eGFR with an average decline of 6.1 with each RePN. With each subsequent nephrectomy, surgical duration, estimated blood loss, and incidence of preoperative anemia increased. Postoperative eGFR showed a significant positive association with preoperative eGFR, while negative associations were found with age, number of previous ipsilateral partial nephrectomies, number of tumors, and largest tumor size. High-grade complications were associated with the number of ipsilateral partial nephrectomies, tumor count, and tumor size. Robotic or laparoscopic procedures exhibited a likelihood of grade 3 or greater complications compared to open surgery.</p><p><strong>Conclusions: </strong>RePN contributes to renal dysfunction and an increased risk of surgical complications. Intraoperative blood loss and surgical duration increase with subsequent nephrectomy. Such risks are dependent on the number of prior operative interventions on the kidney, suggesting a stepwise progression of surgical morbidity.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11309881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-07DOI: 10.1097/JU.0000000000004081
Badar M Mian, Ronald P Kaufman, Adrien Berstein, Hugh A G Fisher
{"title":"Letter: Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial.","authors":"Badar M Mian, Ronald P Kaufman, Adrien Berstein, Hugh A G Fisher","doi":"10.1097/JU.0000000000004081","DOIUrl":"10.1097/JU.0000000000004081","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-08DOI: 10.1097/JU.0000000000004110
{"title":"<i>The Journal of Urology</i><sup>®</sup> Home Study Course 2024 Volume 211/212: Erratum.","authors":"","doi":"10.1097/JU.0000000000004110","DOIUrl":"10.1097/JU.0000000000004110","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-20DOI: 10.1097/JU.0000000000004109
Landon Trost, John Mulhall, Wayne Hellstrom
{"title":"Reply by Authors.","authors":"Landon Trost, John Mulhall, Wayne Hellstrom","doi":"10.1097/JU.0000000000004109","DOIUrl":"10.1097/JU.0000000000004109","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-31DOI: 10.1097/JU.0000000000004044
Dean G Assimos
{"title":"Endourology and Nephrolithiasis.","authors":"Dean G Assimos","doi":"10.1097/JU.0000000000004044","DOIUrl":"10.1097/JU.0000000000004044","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-05DOI: 10.1097/JU.0000000000004075
Christoph Würnschimmel, Christian D Fankhauser, Agostino Mattei
{"title":"Editorial Comment.","authors":"Christoph Würnschimmel, Christian D Fankhauser, Agostino Mattei","doi":"10.1097/JU.0000000000004075","DOIUrl":"10.1097/JU.0000000000004075","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-12DOI: 10.1097/JU.0000000000004087
Benjamin T Ristau
{"title":"Editorial Comment.","authors":"Benjamin T Ristau","doi":"10.1097/JU.0000000000004087","DOIUrl":"10.1097/JU.0000000000004087","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-05-24DOI: 10.1097/JU.0000000000004049
Jacqueline Zillioux, Fabian T Camacho, Roger T Anderson, Wen You, David E Rapp
Purpose: Cognitive ability and manual dexterity sufficient to operate an artificial urinary sphincter (AUS) are critical for device function and safety. We aimed to define the incidence of cognitive and/or dexterity disorders among men after AUS. We secondarily aimed to assess for association between these disorders and postimplant complications.
Materials and methods: This is a retrospective cohort study using the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database (2000-2018). We included men ≥ 66 years diagnosed with prostate cancer between 2001 to 2015 who subsequently underwent AUS placement. We excluded patients with < 1-year continuous fee-for-service Medicare enrollment or cognitive and/or manual dexterity disorder diagnoses prior to AUS implant. Subsequent cognitive/dexterity disorders and implant-related complications were queried using appropriate ICD (International Classification of Diseases)-9/10 and/or CPT (Current Procedural Terminology) codes. Associations between cognitive/dexterity disorders and postimplant complications were assessed using extended Cox proportional hazards modeling. Secondary analysis focused on serious complications (device revision/removal, Fournier's gangrene, urethral erosion).
Results: We identified 1560 men who underwent AUS who met inclusion criteria. Median age was 73.0 (IQR 70-77) years. Cumulative incidence function analysis estimated 44% and 17% incidence of cognitive and manual dexterity disorder, respectively, at 15 years post-AUS. Presence of cognitive with/without manual dexterity disorder was associated with increased hazard of any, but not serious, complication during follow-up.
Conclusions: A significant proportion of patients develop cognitive and/or manual dexterity disorders following AUS. These data support the need for close longitudinal monitoring after implant.
目的:足以操作人工尿道括约肌(AUS)的认知能力和手部灵活性对于设备的功能和安全性至关重要。我们旨在确定人工尿道括约肌术后男性认知和/或灵活性障碍的发生率。其次,我们还旨在评估这些障碍与植入后并发症之间的关联:这是一项使用 SEER 医疗保险链接数据库(2000-2018 年)进行的回顾性队列研究。我们纳入了 2001-2015 年间确诊为前列腺癌且随后接受了 AUS 植入术的年龄≥ 66 岁的男性患者。我们排除了连续参加医疗保险付费服务 < 1 年的患者,或在植入 AUS 之前诊断出认知和/或手部灵活性障碍的患者。使用适当的 ICD9/10 和/或 CPT 编码查询了随后出现的认知/灵活性障碍和植入相关并发症。认知/灵活性障碍与植入后并发症之间的关系采用扩展的 Cox 比例危险度模型进行评估。二次分析的重点是严重并发症(装置翻修/移除、Fournier坏疽、尿道侵蚀):我们确定了 1560 名符合纳入标准的男性 AUS 患者。中位年龄为 73.0(IQR 70-77)岁。累积发病率功能分析估计,在 AUS 术后 15 年,认知障碍和手部灵活性障碍的发病率分别为 44% 和 17%。认知障碍和/或手部灵活性障碍的存在与随访期间发生任何并发症(但非严重并发症)的风险增加有关:结论:AUS术后有相当一部分患者会出现认知障碍和/或手部灵活性障碍。这些数据支持了在植入后进行密切纵向监测的必要性。
{"title":"Prevalence of Cognitive and Manual Dexterity Disorders Among Men Following Artificial Urinary Sphincter Placement.","authors":"Jacqueline Zillioux, Fabian T Camacho, Roger T Anderson, Wen You, David E Rapp","doi":"10.1097/JU.0000000000004049","DOIUrl":"10.1097/JU.0000000000004049","url":null,"abstract":"<p><strong>Purpose: </strong>Cognitive ability and manual dexterity sufficient to operate an artificial urinary sphincter (AUS) are critical for device function and safety. We aimed to define the incidence of cognitive and/or dexterity disorders among men after AUS. We secondarily aimed to assess for association between these disorders and postimplant complications.</p><p><strong>Materials and methods: </strong>This is a retrospective cohort study using the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database (2000-2018). We included men ≥ 66 years diagnosed with prostate cancer between 2001 to 2015 who subsequently underwent AUS placement. We excluded patients with < 1-year continuous fee-for-service Medicare enrollment or cognitive and/or manual dexterity disorder diagnoses prior to AUS implant. Subsequent cognitive/dexterity disorders and implant-related complications were queried using appropriate ICD (International Classification of Diseases)-9/10 and/or CPT (Current Procedural Terminology) codes. Associations between cognitive/dexterity disorders and postimplant complications were assessed using extended Cox proportional hazards modeling. Secondary analysis focused on serious complications (device revision/removal, Fournier's gangrene, urethral erosion).</p><p><strong>Results: </strong>We identified 1560 men who underwent AUS who met inclusion criteria. Median age was 73.0 (IQR 70-77) years. Cumulative incidence function analysis estimated 44% and 17% incidence of cognitive and manual dexterity disorder, respectively, at 15 years post-AUS. Presence of cognitive with/without manual dexterity disorder was associated with increased hazard of any, but not serious, complication during follow-up.</p><p><strong>Conclusions: </strong>A significant proportion of patients develop cognitive and/or manual dexterity disorders following AUS. These data support the need for close longitudinal monitoring after implant.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-06-11DOI: 10.1097/JU.0000000000004077
Trisha U Nguyen, Artenisa Kulla, John Michael DiBianco
{"title":"Letter: Miniaturized Percutaneous Nephrolithotomy With Vacuum-Assisted Access Sheaths for Treatment of Nephrolithiasis.","authors":"Trisha U Nguyen, Artenisa Kulla, John Michael DiBianco","doi":"10.1097/JU.0000000000004077","DOIUrl":"10.1097/JU.0000000000004077","url":null,"abstract":"","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}