Pub Date : 2024-06-01Epub Date: 2024-04-18DOI: 10.1016/S1474-4422(24)00096-6
<p><strong>Background: </strong>The highest priority uncertainty for people with symptomatic cerebral cavernous malformation is whether to have medical management and surgery or medical management alone. We conducted a pilot phase randomised controlled trial to assess the feasibility of addressing this uncertainty in a definitive trial.</p><p><strong>Methods: </strong>The CARE pilot trial was a prospective, randomised, open-label, assessor-blinded, parallel-group trial at neuroscience centres in the UK and Ireland. We aimed to recruit 60 people of any age, sex, and ethnicity who had mental capacity, were resident in the UK or Ireland, and had a symptomatic cerebral cavernous malformation. Computerised, web-based randomisation assigned participants (1:1) to medical management and surgery (neurosurgical resection or stereotactic radiosurgery) or medical management alone, stratified by the neurosurgeon's and participant's consensus about the intended type of surgery before randomisation. Assignment was open to investigators, participants, and carers, but not clinical outcome event adjudicators. Feasibility outcomes included site engagement, recruitment, choice of surgical management, retention, adherence, data quality, clinical outcome event rate, and protocol implementation. The primary clinical outcome was symptomatic intracranial haemorrhage or new persistent or progressive non-haemorrhagic focal neurological deficit due to cerebral cavernous malformation or surgery during at least 6 months of follow-up. We analysed data from all randomly assigned participants according to assigned management. This trial is registered with ISRCTN (ISRCTN41647111) and has been completed.</p><p><strong>Findings: </strong>Between Sept 27, 2021, and April 28, 2023, 28 (70%) of 40 sites took part, at which investigators screened 511 patients, of whom 322 (63%) were eligible, 202 were approached for recruitment, and 96 had collective uncertainty with their neurosurgeon about whether to have surgery for a symptomatic cerebral cavernous malformation. 72 (22%) of 322 eligible patients were randomly assigned (mean recruitment rate 0·2 [SD 0·25] participants per site per month) at a median of 287 (IQR 67-591) days since the most recent symptomatic presentation. Participants' median age was 50·6 (IQR 38·6-59·2) years, 68 (94%) of 72 participants were adults, 41 (57%) were female, 66 (92%) were White, 56 (78%) had a previous intracranial haemorrhage, and 28 (39%) had a previous epileptic seizure. The intended type of surgery before randomisation was neurosurgical resection for 19 (26%) of 72, stereotactic radiosurgery for 44 (61%), and no preference for nine (13%). Baseline clinical and imaging data were complete for all participants. 36 participants were randomly assigned to medical management and surgery (12 to neurosurgical resection and 24 to stereotactic radiosurgery) and 36 to medical management alone. Three (4%) of 72 participants withdrew, one was lost to follow-up, a
{"title":"Medical management and surgery versus medical management alone for symptomatic cerebral cavernous malformation (CARE): a feasibility study and randomised, open, pragmatic, pilot phase trial.","authors":"","doi":"10.1016/S1474-4422(24)00096-6","DOIUrl":"10.1016/S1474-4422(24)00096-6","url":null,"abstract":"<p><strong>Background: </strong>The highest priority uncertainty for people with symptomatic cerebral cavernous malformation is whether to have medical management and surgery or medical management alone. We conducted a pilot phase randomised controlled trial to assess the feasibility of addressing this uncertainty in a definitive trial.</p><p><strong>Methods: </strong>The CARE pilot trial was a prospective, randomised, open-label, assessor-blinded, parallel-group trial at neuroscience centres in the UK and Ireland. We aimed to recruit 60 people of any age, sex, and ethnicity who had mental capacity, were resident in the UK or Ireland, and had a symptomatic cerebral cavernous malformation. Computerised, web-based randomisation assigned participants (1:1) to medical management and surgery (neurosurgical resection or stereotactic radiosurgery) or medical management alone, stratified by the neurosurgeon's and participant's consensus about the intended type of surgery before randomisation. Assignment was open to investigators, participants, and carers, but not clinical outcome event adjudicators. Feasibility outcomes included site engagement, recruitment, choice of surgical management, retention, adherence, data quality, clinical outcome event rate, and protocol implementation. The primary clinical outcome was symptomatic intracranial haemorrhage or new persistent or progressive non-haemorrhagic focal neurological deficit due to cerebral cavernous malformation or surgery during at least 6 months of follow-up. We analysed data from all randomly assigned participants according to assigned management. This trial is registered with ISRCTN (ISRCTN41647111) and has been completed.</p><p><strong>Findings: </strong>Between Sept 27, 2021, and April 28, 2023, 28 (70%) of 40 sites took part, at which investigators screened 511 patients, of whom 322 (63%) were eligible, 202 were approached for recruitment, and 96 had collective uncertainty with their neurosurgeon about whether to have surgery for a symptomatic cerebral cavernous malformation. 72 (22%) of 322 eligible patients were randomly assigned (mean recruitment rate 0·2 [SD 0·25] participants per site per month) at a median of 287 (IQR 67-591) days since the most recent symptomatic presentation. Participants' median age was 50·6 (IQR 38·6-59·2) years, 68 (94%) of 72 participants were adults, 41 (57%) were female, 66 (92%) were White, 56 (78%) had a previous intracranial haemorrhage, and 28 (39%) had a previous epileptic seizure. The intended type of surgery before randomisation was neurosurgical resection for 19 (26%) of 72, stereotactic radiosurgery for 44 (61%), and no preference for nine (13%). Baseline clinical and imaging data were complete for all participants. 36 participants were randomly assigned to medical management and surgery (12 to neurosurgical resection and 24 to stereotactic radiosurgery) and 36 to medical management alone. Three (4%) of 72 participants withdrew, one was lost to follow-up, a","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":" ","pages":"565-576"},"PeriodicalIF":46.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/S1474-4422(24)00179-0
Sabine Voigt, Marieke J H Wermer
{"title":"Stopping haematoma growth: the search for the right time, place, and agent.","authors":"Sabine Voigt, Marieke J H Wermer","doi":"10.1016/S1474-4422(24)00179-0","DOIUrl":"10.1016/S1474-4422(24)00179-0","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 6","pages":"547-548"},"PeriodicalIF":46.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-04-20DOI: 10.1016/S1474-4422(24)00128-5
Nawaf Yassi, Henry Zhao, Leonid Churilov, Teddy Y Wu, Henry Ma, Huy-Thang Nguyen, Andrew Cheung, Atte Meretoja, Duy Ton Mai, Timothy Kleinig, Jiann-Shing Jeng, Philip M C Choi, Phuc Dang Duc, Helen Brown, Annemarei Ranta, Neil Spratt, Geoffrey C Cloud, Hao-Kuang Wang, Rohan Grimley, Karim Mahawish, Der-Yang Cho, Darshan Shah, Thai My Phuong Nguyen, Gagan Sharma, Vignan Yogendrakumar, Bernard Yan, Emma L Harrison, Michael Devlin, Dennis Cordato, Nicolas Martinez-Majander, Daniel Strbian, Vincent Thijs, Lauren M Sanders, David Anderson, Mark W Parsons, Bruce C V Campbell, Geoffrey A Donnan, Stephen M Davis
<p><strong>Background: </strong>Tranexamic acid, an antifibrinolytic agent, might attenuate haematoma growth after an intracerebral haemorrhage. We aimed to determine whether treatment with intravenous tranexamic acid within 2 h of an intracerebral haemorrhage would reduce haematoma growth compared with placebo.</p><p><strong>Methods: </strong>STOP-MSU was an investigator-led, double-blind, randomised, phase 2 trial conducted at 24 hospitals and one mobile stroke unit in Australia, Finland, New Zealand, Taiwan, and Viet Nam. Eligible participants had acute spontaneous intracerebral haemorrhage confirmed on non-contrast CT, were aged 18 years or older, and could be treated with the investigational product within 2 h of stroke onset. Using randomly permuted blocks (block size of 4) and a concealed pre-randomised assignment procedure, participants were randomly assigned (1:1) to receive intravenous tranexamic acid (1 g over 10 min followed by 1 g over 8 h) or placebo (saline; matched dosing regimen) commencing within 2 h of symptom onset. Participants, investigators, and treating teams were masked to group assignment. The primary outcome was haematoma growth, defined as either at least 33% relative growth or at least 6 mL absolute growth on CT at 24 h (target range 18-30 h) from the baseline CT. The analysis was conducted within the estimand framework with primary analyses adhering to the intention-to-treat principle. The primary endpoint and secondary safety endpoints (mortality at days 7 and 90 and major thromboembolic events at day 90) were assessed in all participants randomly assigned to treatment groups who did not withdraw consent to use any data. This study was registered with ClinicalTrials.gov, NCT03385928, and the trial is now complete.</p><p><strong>Findings: </strong>Between March 19, 2018, and Feb 27, 2023, 202 participants were recruited, of whom one withdrew consent for any data use. The remaining 201 participants were randomly assigned to either placebo (n=98) or tranexamic acid (n=103; intention-to-treat population). Median age was 66 years (IQR 55-77), and 82 (41%) were female and 119 (59%) were male; no data on race or ethnicity were collected. CT scans at baseline or follow-up were missing or of inadequate quality in three participants (one in the placebo group and two in the tranexamic acid group), and were considered missing at random. Haematoma growth occurred in 37 (38%) of 97 assessable participants in the placebo group and 43 (43%) of 101 assessable participants in the tranexamic acid group (adjusted odds ratio [aOR] 1·31 [95% CI 0·72 to 2·40], p=0·37). Major thromboembolic events occurred in one (1%) of 98 participants in the placebo group and three (3%) of 103 in the tranexamic acid group (risk difference 0·02 [95% CI -0·02 to 0·06]). By 7 days, eight (8%) participants in the placebo group and eight (8%) in the tranexamic acid group had died (aOR 1·08 [95% CI 0·35 to 3·35]) and by 90 days, 15 (15%) participants in the pl
背景：氨甲环酸是一种抗纤维蛋白溶解剂，可减轻脑内出血后血肿的生长。我们的目的是确定与安慰剂相比，在脑内出血后 2 小时内静脉注射氨甲环酸是否会减少血肿的生长：STOP-MSU是一项由研究者主导的双盲随机2期试验，在澳大利亚、芬兰、新西兰、台湾和越南的24家医院和1个移动中风治疗单位进行。符合条件的参与者均为急性自发性脑内出血，经非对比CT确诊，年龄在18岁或18岁以上，可在中风发生后2小时内接受研究产品治疗。采用随机排列的区块（区块大小为4）和隐蔽的预随机分配程序，参与者被随机分配（1:1）接受静脉注射氨甲环酸（10分钟内1克，随后8小时内1克）或安慰剂（生理盐水；配对给药方案），从症状出现后2小时内开始。参与者、研究人员和治疗小组均被蒙蔽，不知道分组情况。主要结果是血肿增大，其定义是与基线 CT 相比，24 小时（目标范围为 18-30 小时）CT 上的血肿相对增大至少 33%，或绝对增大至少 6 毫升。分析在 "估计 "框架内进行，主要分析遵循 "意向治疗 "原则。对随机分配到治疗组且未撤回使用任何数据同意书的所有参与者进行了主要终点和次要安全性终点（第7天和第90天的死亡率以及第90天的主要血栓栓塞事件）评估。该研究已在 ClinicalTrials.gov 注册，编号为 NCT03385928，目前试验已完成：2018年3月19日至2023年2月27日期间，共招募了202名参与者，其中一人撤回了使用任何数据的同意书。其余201名参与者被随机分配至安慰剂（98人）或氨甲环酸（103人；意向治疗人群）。中位年龄为 66 岁（IQR 55-77），82 名女性（41%）和 119 名男性（59%）；未收集种族或民族数据。3名参与者（安慰剂组1名，氨甲环酸组2名）基线或随访时的CT扫描结果缺失或质量不佳，被视为随机缺失。安慰剂组97名可评估参与者中有37人（38%）出现血肿增大，氨甲环酸组101名可评估参与者中有43人（43%）出现血肿增大（调整赔率[aOR] 1-31 [95% CI 0-72 to 2-40]，P=0-37）。安慰剂组98人中有1人（1%）发生重大血栓栓塞事件，氨甲环酸组103人中有3人（3%）发生重大血栓栓塞事件（风险差异为0-02 [95% CI -0-02至0-06]）。到7天时，安慰剂组有8人（8%）死亡，氨甲环酸组有8人（8%）死亡（aOR 1-08 [95% CI 0-35 to 3-35]）；到90天时，安慰剂组有15人（15%）死亡，氨甲环酸组有19人（18%）死亡（aOR 1-61 [95% CI 0-65 to 3-98]）：静脉注射氨甲环酸不会减少脑出血症状出现后2小时内血肿的生长。对其他影像学终点、功能结果或安全性没有观察到影响。根据我们的研究结果，氨甲环酸不应作为原发性脑出血的常规用药，尽管正在进行的三期试验结果将为这些研究结果提供进一步的背景资料：澳大利亚政府医学研究未来基金。
{"title":"Tranexamic acid versus placebo in individuals with intracerebral haemorrhage treated within 2 h of symptom onset (STOP-MSU): an international, double-blind, randomised, phase 2 trial.","authors":"Nawaf Yassi, Henry Zhao, Leonid Churilov, Teddy Y Wu, Henry Ma, Huy-Thang Nguyen, Andrew Cheung, Atte Meretoja, Duy Ton Mai, Timothy Kleinig, Jiann-Shing Jeng, Philip M C Choi, Phuc Dang Duc, Helen Brown, Annemarei Ranta, Neil Spratt, Geoffrey C Cloud, Hao-Kuang Wang, Rohan Grimley, Karim Mahawish, Der-Yang Cho, Darshan Shah, Thai My Phuong Nguyen, Gagan Sharma, Vignan Yogendrakumar, Bernard Yan, Emma L Harrison, Michael Devlin, Dennis Cordato, Nicolas Martinez-Majander, Daniel Strbian, Vincent Thijs, Lauren M Sanders, David Anderson, Mark W Parsons, Bruce C V Campbell, Geoffrey A Donnan, Stephen M Davis","doi":"10.1016/S1474-4422(24)00128-5","DOIUrl":"10.1016/S1474-4422(24)00128-5","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid, an antifibrinolytic agent, might attenuate haematoma growth after an intracerebral haemorrhage. We aimed to determine whether treatment with intravenous tranexamic acid within 2 h of an intracerebral haemorrhage would reduce haematoma growth compared with placebo.</p><p><strong>Methods: </strong>STOP-MSU was an investigator-led, double-blind, randomised, phase 2 trial conducted at 24 hospitals and one mobile stroke unit in Australia, Finland, New Zealand, Taiwan, and Viet Nam. Eligible participants had acute spontaneous intracerebral haemorrhage confirmed on non-contrast CT, were aged 18 years or older, and could be treated with the investigational product within 2 h of stroke onset. Using randomly permuted blocks (block size of 4) and a concealed pre-randomised assignment procedure, participants were randomly assigned (1:1) to receive intravenous tranexamic acid (1 g over 10 min followed by 1 g over 8 h) or placebo (saline; matched dosing regimen) commencing within 2 h of symptom onset. Participants, investigators, and treating teams were masked to group assignment. The primary outcome was haematoma growth, defined as either at least 33% relative growth or at least 6 mL absolute growth on CT at 24 h (target range 18-30 h) from the baseline CT. The analysis was conducted within the estimand framework with primary analyses adhering to the intention-to-treat principle. The primary endpoint and secondary safety endpoints (mortality at days 7 and 90 and major thromboembolic events at day 90) were assessed in all participants randomly assigned to treatment groups who did not withdraw consent to use any data. This study was registered with ClinicalTrials.gov, NCT03385928, and the trial is now complete.</p><p><strong>Findings: </strong>Between March 19, 2018, and Feb 27, 2023, 202 participants were recruited, of whom one withdrew consent for any data use. The remaining 201 participants were randomly assigned to either placebo (n=98) or tranexamic acid (n=103; intention-to-treat population). Median age was 66 years (IQR 55-77), and 82 (41%) were female and 119 (59%) were male; no data on race or ethnicity were collected. CT scans at baseline or follow-up were missing or of inadequate quality in three participants (one in the placebo group and two in the tranexamic acid group), and were considered missing at random. Haematoma growth occurred in 37 (38%) of 97 assessable participants in the placebo group and 43 (43%) of 101 assessable participants in the tranexamic acid group (adjusted odds ratio [aOR] 1·31 [95% CI 0·72 to 2·40], p=0·37). Major thromboembolic events occurred in one (1%) of 98 participants in the placebo group and three (3%) of 103 in the tranexamic acid group (risk difference 0·02 [95% CI -0·02 to 0·06]). By 7 days, eight (8%) participants in the placebo group and eight (8%) in the tranexamic acid group had died (aOR 1·08 [95% CI 0·35 to 3·35]) and by 90 days, 15 (15%) participants in the pl","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":" ","pages":"577-587"},"PeriodicalIF":46.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/S1474-4422(24)00161-3
Gabriël J E Rinkel
{"title":"Cerebral cavernous malformations: to operate or not?","authors":"Gabriël J E Rinkel","doi":"10.1016/S1474-4422(24)00161-3","DOIUrl":"10.1016/S1474-4422(24)00161-3","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 6","pages":"546-547"},"PeriodicalIF":46.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01Epub Date: 2024-04-10DOI: 10.1016/S1474-4422(24)00166-2
Mathias Toft
{"title":"New gene involved in the pathogenesis of Parkinson's disease.","authors":"Mathias Toft","doi":"10.1016/S1474-4422(24)00166-2","DOIUrl":"10.1016/S1474-4422(24)00166-2","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":" ","pages":"550-552"},"PeriodicalIF":48.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S1474-4422(24)00076-0
Michael C Ferraro, Neil E O'Connell, Claudia Sommer, Andreas Goebel, Janet H Bultitude, Aidan G Cashin, G Lorimer Moseley, James H McAuley
Complex regional pain syndrome (CRPS) is a rare pain disorder that usually occurs in a limb after trauma. The features of this disorder include severe pain and sensory, autonomic, motor, and trophic abnormalities. Research from the past decade has offered new insights into CRPS epidemiology, pathophysiology, diagnosis, and treatment. Early identification of individuals at high risk of CRPS is improving, with several risk factors established and some others identified in prospective studies during the past 5 years. Better understanding of the pathophysiological mechanisms of CRPS has led to its classification as a chronic primary pain disorder, and subtypes of CRPS have been updated. Procedures for diagnosis have also been clarified. Although effective treatment of CRPS remains a challenge, evidence-based integrated management approaches provide new opportunities to improve patient care. Further advances in diagnosis and treatment of CRPS will require coordinated, international multicentre initiatives.
{"title":"Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment.","authors":"Michael C Ferraro, Neil E O'Connell, Claudia Sommer, Andreas Goebel, Janet H Bultitude, Aidan G Cashin, G Lorimer Moseley, James H McAuley","doi":"10.1016/S1474-4422(24)00076-0","DOIUrl":"https://doi.org/10.1016/S1474-4422(24)00076-0","url":null,"abstract":"<p><p>Complex regional pain syndrome (CRPS) is a rare pain disorder that usually occurs in a limb after trauma. The features of this disorder include severe pain and sensory, autonomic, motor, and trophic abnormalities. Research from the past decade has offered new insights into CRPS epidemiology, pathophysiology, diagnosis, and treatment. Early identification of individuals at high risk of CRPS is improving, with several risk factors established and some others identified in prospective studies during the past 5 years. Better understanding of the pathophysiological mechanisms of CRPS has led to its classification as a chronic primary pain disorder, and subtypes of CRPS have been updated. Procedures for diagnosis have also been clarified. Although effective treatment of CRPS remains a challenge, evidence-based integrated management approaches provide new opportunities to improve patient care. Further advances in diagnosis and treatment of CRPS will require coordinated, international multicentre initiatives.</p>","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 5","pages":"522-533"},"PeriodicalIF":48.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/S1474-4422(24)00124-8
Agneta Nordberg
{"title":"Insights into the progression of genetic Alzheimer's disease from tau PET.","authors":"Agneta Nordberg","doi":"10.1016/S1474-4422(24)00124-8","DOIUrl":"https://doi.org/10.1016/S1474-4422(24)00124-8","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 5","pages":"453-454"},"PeriodicalIF":48.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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