Therapeutic Apheresis and Dialysis最新文献_第9页

Successful pregnancy in a hemodialysis patient with primary hyperoxaluria type 1. 1型原发性高草酸尿血液透析患者妊娠成功。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13995

Franka Zuban, Ranko Ladavac, Nikolina Basic-Jukic

Dear Editor Better dialysis technique has contributed to improved outcomes of pregnancies in hemodialysis patients. However, conception rates are still limited and pregnancies are associated with a high risk of complications. Primary hyperoxalurias (PH) are a group of rare diseases caused by a genetic abnormality that results in excessive oxalate production. The most severe form, PH1, is caused by a mutation in alanine-glyoxylate aminotransferase gene which leads to progression to end-stage kidney disease by age of 60 years in 88% of patients [1, 2]. We present a case of a 25-year-old woman with chronic kidney disease secondary to PH1, diagnosed at the age of three when she presented with nephrolithiasis. The genetic analysis detected two mutations in the homozygous state in an AGTX gene: AGTX NM_000030.3:c.33dupC, p.(Lys12FInfs*156). Her parents were not blood relatives. She underwent multiple lithotripsies for the treatment of nephrolithiasis but was not in regular follow-ups due to noncompliance. In March 2020, she presented at the Emergency Department Unit in the terminal stage of kidney failure with the need for hemodialysis. The chronic hemodialysis protocol included four sessions weekly lasting for 4.5 h. Her menstrual cycles were irregular. On September 13, 2022, she reported amenorrhea. A gynecological workup revealed that she was approximately 24 weeks pregnant. She did not undergo genetic counseling before conception nor received any new medications. The hemodialysis program was intensified to five sessions per week, increasing dialysis time to 5 h. A Theranova 400 membrane (Baxter) was used and a dialysate bath was adjusted depending on laboratory results. Nadroparin was administered as an anticoagulant agent at a dose of 0.4 mL per session. She received paricalcitol, vitamin B6 3 50 mg, folic acid, pantoprazole 20 mg, and an oral nutritional supplement. Predialysis urea levels were maintained below 12.5 mmol/L. We also aimed to maintain normal calcium levels and hemoglobin concentration at approximately 110 g/L. Her dry weight was increased by 500 mg every 7 days corresponding to an increase in weight during normal pregnancies. The patient was hospitalized at 37 weeks of gestation and gave birth to a healthy 2450-g male baby 2 days later by Cesarean section. The postpartum course was uneventful. Her regular hemodialysis has been continued four times weekly. She is waiting for simultaneous liver–kidney transplantation and the approval of the use of lumasiran, with the skin ulcer on her leg indicating systemic oxalosis. Current treatment options for PH1 are limited. Simultaneous liver–kidney transplantation is used for patients with end-stage kidney failure [2]. Lumasiran is a novel liver-directed RNA interference therapeutic agent. It reduces hepatic oxalate production and increases concentrations of glycolate in patients with PH1, by degrading the messenger RNA that encodes glycolate oxidase, an enzyme upstream of alanineglyoxylate a

{"title":"Successful pregnancy in a hemodialysis patient with primary hyperoxaluria type 1.","authors":"Franka Zuban, Ranko Ladavac, Nikolina Basic-Jukic","doi":"10.1111/1744-9987.13995","DOIUrl":"https://doi.org/10.1111/1744-9987.13995","url":null,"abstract":"Dear Editor Better dialysis technique has contributed to improved outcomes of pregnancies in hemodialysis patients. However, conception rates are still limited and pregnancies are associated with a high risk of complications. Primary hyperoxalurias (PH) are a group of rare diseases caused by a genetic abnormality that results in excessive oxalate production. The most severe form, PH1, is caused by a mutation in alanine-glyoxylate aminotransferase gene which leads to progression to end-stage kidney disease by age of 60 years in 88% of patients [1, 2]. We present a case of a 25-year-old woman with chronic kidney disease secondary to PH1, diagnosed at the age of three when she presented with nephrolithiasis. The genetic analysis detected two mutations in the homozygous state in an AGTX gene: AGTX NM_000030.3:c.33dupC, p.(Lys12FInfs*156). Her parents were not blood relatives. She underwent multiple lithotripsies for the treatment of nephrolithiasis but was not in regular follow-ups due to noncompliance. In March 2020, she presented at the Emergency Department Unit in the terminal stage of kidney failure with the need for hemodialysis. The chronic hemodialysis protocol included four sessions weekly lasting for 4.5 h. Her menstrual cycles were irregular. On September 13, 2022, she reported amenorrhea. A gynecological workup revealed that she was approximately 24 weeks pregnant. She did not undergo genetic counseling before conception nor received any new medications. The hemodialysis program was intensified to five sessions per week, increasing dialysis time to 5 h. A Theranova 400 membrane (Baxter) was used and a dialysate bath was adjusted depending on laboratory results. Nadroparin was administered as an anticoagulant agent at a dose of 0.4 mL per session. She received paricalcitol, vitamin B6 3 50 mg, folic acid, pantoprazole 20 mg, and an oral nutritional supplement. Predialysis urea levels were maintained below 12.5 mmol/L. We also aimed to maintain normal calcium levels and hemoglobin concentration at approximately 110 g/L. Her dry weight was increased by 500 mg every 7 days corresponding to an increase in weight during normal pregnancies. The patient was hospitalized at 37 weeks of gestation and gave birth to a healthy 2450-g male baby 2 days later by Cesarean section. The postpartum course was uneventful. Her regular hemodialysis has been continued four times weekly. She is waiting for simultaneous liver–kidney transplantation and the approval of the use of lumasiran, with the skin ulcer on her leg indicating systemic oxalosis. Current treatment options for PH1 are limited. Simultaneous liver–kidney transplantation is used for patients with end-stage kidney failure [2]. Lumasiran is a novel liver-directed RNA interference therapeutic agent. It reduces hepatic oxalate production and increases concentrations of glycolate in patients with PH1, by degrading the messenger RNA that encodes glycolate oxidase, an enzyme upstream of alanineglyoxylate a","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"817-818"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9758457","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}

引用次数: 0

Effect of Ramadan fasting on chronic inflammation markers and gut bacterial endotoxins among Egyptian hemodialysis patients. 斋月禁食对埃及血液透析患者慢性炎症标志物和肠道细菌内毒素的影响。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13988

Emad Samaan, Ahmed A Eldeeb, Ahmed B Ibrahim, Mohammed Erman, Alaa A Sabry, Mostafa A Mahmoud

Background: Chronic kidney disease (CKD) is associated with a state of chronic inflammation. This study aimed to investigate effects of Ramadan fasting on the markers of chronic inflammation and gut bacterial endotoxin levels in maintenance hemodialysis.

Method: A prospective self-controlled observational study included 45 patients. Serum levels of High Sensitive CRP (hsCRP), indoxyl sulfate, and trimethylamine-n-levels were measured within a week before and a week after Ramadan fasting.

Results: Twenty-seven patients have fasted more than 15 days (29 ± 2.2 days). The levels of high sensitive C-reactive protein (hsCRP) (median of 62 mg/L vs. 91 mg/L), trimethylamine-n-oxide (TMAO) (median of 4.5 μmoL/L vs. 17 μmoL/L), platelet-to-lymphocyte ratio (PLR) (mean of 98.9 mg/L vs. 111.8 mg/L) and neutrophil-to-lymphocyte ratio (NLR) (median of 1.56 vs. 1.59) were significantly lower after Ramadan fasting with p < 0.001, p < 0.001, p < 0.001, and p = 0.04, respectively.

Conclusion: A beneficial effect of Ramadan fasting on levels of bacterial endotoxins and markers of chronic inflammation in hemodialysis patients was observed.

背景:慢性肾脏疾病(CKD)与慢性炎症状态相关。本研究旨在探讨斋月禁食对维持性血液透析患者慢性炎症标志物和肠道细菌内毒素水平的影响。方法:采用前瞻性自我对照观察性研究，纳入45例患者。在斋月禁食前一周和禁食后一周内测定血清中高敏CRP (hsCRP)、硫酸吲哚酚和三甲胺n水平。结果:27例患者禁食超过15天(29±2.2天)。斋月禁食后，高敏感c反应蛋白(hsCRP)水平(中位数为62 mg/L vs. 91 mg/L)、三甲胺-氧化三甲胺(TMAO)水平(中位数为4.5 μmoL/L vs. 17 μmoL/L)、血小板-淋巴细胞比率(PLR)水平(平均为98.9 mg/L vs. 111.8 mg/L)和中性粒细胞-淋巴细胞比率(NLR)水平(中位数为1.56 vs. 1.59)均显著降低，p < 0.05。观察到斋月禁食对血液透析患者细菌内毒素水平和慢性炎症标志物的有益影响。

{"title":"Effect of Ramadan fasting on chronic inflammation markers and gut bacterial endotoxins among Egyptian hemodialysis patients.","authors":"Emad Samaan, Ahmed A Eldeeb, Ahmed B Ibrahim, Mohammed Erman, Alaa A Sabry, Mostafa A Mahmoud","doi":"10.1111/1744-9987.13988","DOIUrl":"https://doi.org/10.1111/1744-9987.13988","url":null,"abstract":"Background: Chronic kidney disease (CKD) is associated with a state of chronic inflammation. This study aimed to investigate effects of Ramadan fasting on the markers of chronic inflammation and gut bacterial endotoxin levels in maintenance hemodialysis.Method: A prospective self-controlled observational study included 45 patients. Serum levels of High Sensitive CRP (hsCRP), indoxyl sulfate, and trimethylamine-n-levels were measured within a week before and a week after Ramadan fasting.Results: Twenty-seven patients have fasted more than 15 days (29 ± 2.2 days). The levels of high sensitive C-reactive protein (hsCRP) (median of 62 mg/L vs. 91 mg/L), trimethylamine-n-oxide (TMAO) (median of 4.5 μmoL/L vs. 17 μmoL/L), platelet-to-lymphocyte ratio (PLR) (mean of 98.9 mg/L vs. 111.8 mg/L) and neutrophil-to-lymphocyte ratio (NLR) (median of 1.56 vs. 1.59) were significantly lower after Ramadan fasting with p < 0.001, p < 0.001, p < 0.001, and p = 0.04, respectively.Conclusion: A beneficial effect of Ramadan fasting on levels of bacterial endotoxins and markers of chronic inflammation in hemodialysis patients was observed.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"655-660"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9741240","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}

引用次数: 0

The association between geriatric nutritional risk index variability and mortality in peritoneal dialysis patients. 老年营养风险指数变异性与腹膜透析患者死亡率之间的关系。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13984

Filiz Yıldırım, Ozcan Uzun, Guler Nasuhbeyoglu, Aslihan Narlioglu, Yelda Deligöz Bildacı, Caner Cavdar, Serpil Muge Deger

Background: The objective of this study is to examine the association between the Geriatric Nutritional Risk Index (GNRI) and overall mortality in this population.

Methods: GNRI values were calculated by using the serum albumin levels and body weight and the GNRI variability reflects the changes in GNRI change slopes in the follow-up.

Results: GNRI values showed a decrease from the median baseline GNRI of 106.3 (IQR, 95.0,113.4) to 98.4 (interquartile range [IQR], 91.9108.9) (p < 0.001). The median GNRI variability was 4.7 (IQR, 2.5, 10.3). Both baseline GNRI levels (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93, 0.99, p = 0.04) and more profoundly GNRI variability (adjusted OR: 1.23, 95% CI: 1.01, 1.44, p = 0.03) were independently associated with mortality.

Conclusion: The monitorization of the changes in GNRI values as a variability index is an easy tool that might improve the predictive accuracy of mortality in peritoneal dialysis patients.

背景:本研究的目的是研究老年营养风险指数(GNRI)与该人群总死亡率之间的关系。方法:采用血清白蛋白水平和体重计算GNRI值，GNRI变异性反映随访期间GNRI变化斜率的变化。结果:GNRI值从基线GNRI的中位数106.3 (IQR, 95.0113.4)下降到98.4(四分位间距[IQR]， 91.9108.9) (p)。结论:监测GNRI值的变化作为变变性指标是一种简便的工具，可以提高腹膜透析患者死亡率的预测准确性。

{"title":"The association between geriatric nutritional risk index variability and mortality in peritoneal dialysis patients.","authors":"Filiz Yıldırım, Ozcan Uzun, Guler Nasuhbeyoglu, Aslihan Narlioglu, Yelda Deligöz Bildacı, Caner Cavdar, Serpil Muge Deger","doi":"10.1111/1744-9987.13984","DOIUrl":"https://doi.org/10.1111/1744-9987.13984","url":null,"abstract":"Background: The objective of this study is to examine the association between the Geriatric Nutritional Risk Index (GNRI) and overall mortality in this population.Methods: GNRI values were calculated by using the serum albumin levels and body weight and the GNRI variability reflects the changes in GNRI change slopes in the follow-up.Results: GNRI values showed a decrease from the median baseline GNRI of 106.3 (IQR, 95.0,113.4) to 98.4 (interquartile range [IQR], 91.9108.9) (p < 0.001). The median GNRI variability was 4.7 (IQR, 2.5, 10.3). Both baseline GNRI levels (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93, 0.99, p = 0.04) and more profoundly GNRI variability (adjusted OR: 1.23, 95% CI: 1.01, 1.44, p = 0.03) were independently associated with mortality.Conclusion: The monitorization of the changes in GNRI values as a variability index is an easy tool that might improve the predictive accuracy of mortality in peritoneal dialysis patients.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"752-759"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797393","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}

引用次数: 0

Guillain-Barré syndrome following SARS-CoV-2 infection in kidney transplant recipient successfully treated with therapeutic plasma exchange. 治疗性血浆置换成功治疗肾移植受者SARS-CoV-2感染后吉兰-巴罗综合征。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13972

Ivana Juric, Nikolina Basic-Jukic

Dear Editor, Guillain–Barré syndrome (GBS) is post-infectious immune-mediated acute onset polyradiculoneuropathy typically presenting with ascending paralysis and sensory deficits. The diagnosis relies on typical clinical presentation, electrophysiological studies, and cerebrospinal fluid (CSF) examination. Evidence suggests an association between SARS-CoV-2 infection and the development of GBS [1]. We report the first case of GBS after SARSCoV-2 infection in a kidney transplant recipient successfully treated with therapeutic plasma exchange (TPE). A 60-year-old male received a kidney from a deceased donor. Primary graft function was established with no posttransplant complications. Thirteen months after transplantation and 2 months after receiving mRNA vaccine he presented with severe SARS-CoV-2 infection. Fifteen days after the SARS-CoV-2 infection symptoms onset, he presented with ascending leg weakness progressing to tetraparesis. CSF analysis revealed elevated protein levels with normal cell count. Electrophysiological studies were not available to perform due to the limitations of the pandemic setting. Based on clinical presentation and CSF finding GBS was diagnosed. At the time of diagnosis, our country was facing an intravenous immunoglobulin (IVIG) shortage, and the treatment of choice was TPE. The patient was treated with seven courses of TPE, followed by physical therapy. The outcome was complete neurological recovery. Graft function remained stable. GBS usually occurs sporadically. However, evidence suggests increased incidence related to various epidemics worldwide. Numerous case reports and reviews report on GBS related to SARS-CoV-2 infection during the pandemic's peak. Several potential mechanisms are associated with the pathogenesis of GBS after SARS-CoV-2 infection. Present findings suggest post-infectious immune-mediated mechanisms rather than direct induction by the virus [2, 3]. The reported time between SARS-CoV-2 symptoms and GBS onset ranges between 2 and 33 days. The average age of affected patients is 55 years with male predominance. Most of the patients had symptomatic SARS-CoV-2 infection; however, asymptomatic cases were also reported. According to the current data relationship between the severity of the disease and the outcome is unclear. Most patients presented with the classical sensorimotor and demyelining form, although some variants of GBS have also been reported [3]. At the time of diagnosis, our patient was 61 years old, presenting with GBS 15 days after the SARS-CoV-2 infection diagnosis. The ongoing SARS-CoV-2 pandemic forced healthcare systems worldwide to face many challenges and adjust to new realities including shortage of drugs, diagnostic and therapeutical procedures and medical staff. Most reported patients with GBS related to SARS-CoV-2 infection were treated with IVIG, with favorable outcomes in 70% of them [3]. TPE is a treatment option, but in the setting of the COVID pandemic potential problems

{"title":"Guillain-Barré syndrome following SARS-CoV-2 infection in kidney transplant recipient successfully treated with therapeutic plasma exchange.","authors":"Ivana Juric, Nikolina Basic-Jukic","doi":"10.1111/1744-9987.13972","DOIUrl":"https://doi.org/10.1111/1744-9987.13972","url":null,"abstract":"Dear Editor, Guillain–Barré syndrome (GBS) is post-infectious immune-mediated acute onset polyradiculoneuropathy typically presenting with ascending paralysis and sensory deficits. The diagnosis relies on typical clinical presentation, electrophysiological studies, and cerebrospinal fluid (CSF) examination. Evidence suggests an association between SARS-CoV-2 infection and the development of GBS [1]. We report the first case of GBS after SARSCoV-2 infection in a kidney transplant recipient successfully treated with therapeutic plasma exchange (TPE). A 60-year-old male received a kidney from a deceased donor. Primary graft function was established with no posttransplant complications. Thirteen months after transplantation and 2 months after receiving mRNA vaccine he presented with severe SARS-CoV-2 infection. Fifteen days after the SARS-CoV-2 infection symptoms onset, he presented with ascending leg weakness progressing to tetraparesis. CSF analysis revealed elevated protein levels with normal cell count. Electrophysiological studies were not available to perform due to the limitations of the pandemic setting. Based on clinical presentation and CSF finding GBS was diagnosed. At the time of diagnosis, our country was facing an intravenous immunoglobulin (IVIG) shortage, and the treatment of choice was TPE. The patient was treated with seven courses of TPE, followed by physical therapy. The outcome was complete neurological recovery. Graft function remained stable. GBS usually occurs sporadically. However, evidence suggests increased incidence related to various epidemics worldwide. Numerous case reports and reviews report on GBS related to SARS-CoV-2 infection during the pandemic's peak. Several potential mechanisms are associated with the pathogenesis of GBS after SARS-CoV-2 infection. Present findings suggest post-infectious immune-mediated mechanisms rather than direct induction by the virus [2, 3]. The reported time between SARS-CoV-2 symptoms and GBS onset ranges between 2 and 33 days. The average age of affected patients is 55 years with male predominance. Most of the patients had symptomatic SARS-CoV-2 infection; however, asymptomatic cases were also reported. According to the current data relationship between the severity of the disease and the outcome is unclear. Most patients presented with the classical sensorimotor and demyelining form, although some variants of GBS have also been reported [3]. At the time of diagnosis, our patient was 61 years old, presenting with GBS 15 days after the SARS-CoV-2 infection diagnosis. The ongoing SARS-CoV-2 pandemic forced healthcare systems worldwide to face many challenges and adjust to new realities including shortage of drugs, diagnostic and therapeutical procedures and medical staff. Most reported patients with GBS related to SARS-CoV-2 infection were treated with IVIG, with favorable outcomes in 70% of them [3]. TPE is a treatment option, but in the setting of the COVID pandemic potential problems ","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"821-822"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9971407","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}

引用次数: 0

The effect of therapeutic plasma exchange therapy on veno-venous ECMO weaning success in severe COVID-19 ARDS patients. 治疗性血浆交换治疗对重症COVID-19 ARDS患者静脉-静脉ECMO脱机成功率的影响

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13979

Murat Aslan, Rabia Yılmaz, Murat Doğan, Zafer Çukurova

Introduction: Primarily, this study aimed to investigate the effect of TPE (therapeutic plasma exchange) treatment on successful ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.

Methods: The study was applied retrospectively on patients over the age of 18 who were hospitalized in the ICU between January 1, 2020 and March 1, 2022.

Results: The study was performed on 33 patients, 36.3% (n: 12) of whom received TPE treatment. The rate of successful ECMO weaning was statistically higher in the TPE treatment group (without TPE: 14.3% [n: 3], with TPE: 50% [n: 6], p = 0.044). The 1-month mortality was also statistically lower in the TPE treatment group (p = 0.044). In the logistic analysis, It was found that the risk of unsuccessful ECMO weaning increased 6 times in those who did not receive TPE treatment (OR; 6.0, 95% CI; 1.134-31.735, p = 0.035).

Conclusion: TPE treatment may increase the success rate of V-V ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.

本研究旨在探讨TPE(治疗性血浆置换)治疗对V-V ECMO治疗的重症COVID-19 ARDS患者ECMO成功脱机的影响。方法:回顾性分析2020年1月1日至2022年3月1日在ICU住院的18岁以上患者。结果:研究共纳入33例患者，其中36.3% (n: 12)的患者接受了TPE治疗。TPE治疗组ECMO脱机成功率高于无TPE组(14.3% [n: 3]， TPE组:50% [n: 6]， p = 0.044)。TPE治疗组的1个月死亡率也有统计学意义(p = 0.044)。在logistic分析中发现，未接受TPE治疗的患者(OR;6.0, 95% ci;1.134-31.735, p = 0.035)。结论:TPE治疗可提高V-V ECMO治疗的重症COVID-19 ARDS患者V-V ECMO脱机成功率。

{"title":"The effect of therapeutic plasma exchange therapy on veno-venous ECMO weaning success in severe COVID-19 ARDS patients.","authors":"Murat Aslan, Rabia Yılmaz, Murat Doğan, Zafer Çukurova","doi":"10.1111/1744-9987.13979","DOIUrl":"https://doi.org/10.1111/1744-9987.13979","url":null,"abstract":"Introduction: Primarily, this study aimed to investigate the effect of TPE (therapeutic plasma exchange) treatment on successful ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.Methods: The study was applied retrospectively on patients over the age of 18 who were hospitalized in the ICU between January 1, 2020 and March 1, 2022.Results: The study was performed on 33 patients, 36.3% (n: 12) of whom received TPE treatment. The rate of successful ECMO weaning was statistically higher in the TPE treatment group (without TPE: 14.3% [n: 3], with TPE: 50% [n: 6], p = 0.044). The 1-month mortality was also statistically lower in the TPE treatment group (p = 0.044). In the logistic analysis, It was found that the risk of unsuccessful ECMO weaning increased 6 times in those who did not receive TPE treatment (OR; 6.0, 95% CI; 1.134-31.735, p = 0.035).Conclusion: TPE treatment may increase the success rate of V-V ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"780-789"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9732772","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}

引用次数: 0

Skin microcirculation significantly increases after lipoprotein apheresis. 脂蛋白分离后皮肤微循环明显增加。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13976

Francesco Sbrana, Beatrice Dal Pino, Tiziana Sampietro

Dear Editor, Lipoprotein apheresis (LA) is the therapeutic “last chance saloon” for inherited dyslipidemias resistant/intolerant to lipid lowering drugs [1]. High plasma cholesterol per se may be a sufficient stimulus to upregulate endothelial adhesiveness, phenomenon that can be acutely “restored,” by LA [2]. That is why heterozygous Familial Hypercholesterolemia (HeFH) patients under LA care are a good clinical model to study the effects of cholesterol modulation on the endothelial function. Aim of this pilot study was to evaluate, in patients with HeFH and ischemic heart disease, the impact of a single LA on skin microcirculation evaluated by Doppler flowmetry. We enrolled 8 male HeFH (mean age 59 ± 8 years), without relevant comorbidity; written informed consent was obtained from all patients and our procedures adhered to the Declaration of Helsinki. All patients are on chronic LA treatment because, despite the maximal lipid lowering therapies (atorvastatin/ezetimibe 20/10 mg daily), do not archives the target lipid levels. LA treatments were performed according manufacturer's instructions (1.5–2.5 plasma volume patient/session) by dextran-sulfate absorption from plasma (Liposorber-LA MA-03 systems; Kaneka, Osaka, Japan). To evaluate the effect of LA treatment on skin microcirculation, laser Doppler flowmetry was performed before LA, immediately after LA, at Days 2 and 6 after the treatment. Skin blood flow was measured using PeriFlux laser Doppler flowmetry (Periflux PF4001 Master, Perimed, Sweden) on the left index toe and a thermostatic probe (PF 4005, Perimed, Sweden) was placed on the distal phalanx. The perfusion measured, in arbitrary perfusion units (PU), was evaluated baseline (39 C) and after heated (44 C). Skin blood flow significantly improves after heated in all the evaluations time. Moreover, skin blood flow was evaluated in a control group matched for age and sex. The LA treatment significantly improve atherogenic lipid profile (total cholesterol 74%, Low Density Lipoprotein LDL cholesterol 83%, triglycerides 59%, Apo B lipoprotein 79%, Lp(a) 88%; p < 0.05; High Density

{"title":"Skin microcirculation significantly increases after lipoprotein apheresis.","authors":"Francesco Sbrana, Beatrice Dal Pino, Tiziana Sampietro","doi":"10.1111/1744-9987.13976","DOIUrl":"https://doi.org/10.1111/1744-9987.13976","url":null,"abstract":"Dear Editor, Lipoprotein apheresis (LA) is the therapeutic “last chance saloon” for inherited dyslipidemias resistant/intolerant to lipid lowering drugs [1]. High plasma cholesterol per se may be a sufficient stimulus to upregulate endothelial adhesiveness, phenomenon that can be acutely “restored,” by LA [2]. That is why heterozygous Familial Hypercholesterolemia (HeFH) patients under LA care are a good clinical model to study the effects of cholesterol modulation on the endothelial function. Aim of this pilot study was to evaluate, in patients with HeFH and ischemic heart disease, the impact of a single LA on skin microcirculation evaluated by Doppler flowmetry. We enrolled 8 male HeFH (mean age 59 ± 8 years), without relevant comorbidity; written informed consent was obtained from all patients and our procedures adhered to the Declaration of Helsinki. All patients are on chronic LA treatment because, despite the maximal lipid lowering therapies (atorvastatin/ezetimibe 20/10 mg daily), do not archives the target lipid levels. LA treatments were performed according manufacturer's instructions (1.5–2.5 plasma volume patient/session) by dextran-sulfate absorption from plasma (Liposorber-LA MA-03 systems; Kaneka, Osaka, Japan). To evaluate the effect of LA treatment on skin microcirculation, laser Doppler flowmetry was performed before LA, immediately after LA, at Days 2 and 6 after the treatment. Skin blood flow was measured using PeriFlux laser Doppler flowmetry (Periflux PF4001 Master, Perimed, Sweden) on the left index toe and a thermostatic probe (PF 4005, Perimed, Sweden) was placed on the distal phalanx. The perfusion measured, in arbitrary perfusion units (PU), was evaluated baseline (39 C) and after heated (44 C). Skin blood flow significantly improves after heated in all the evaluations time. Moreover, skin blood flow was evaluated in a control group matched for age and sex. The LA treatment significantly improve atherogenic lipid profile (total cholesterol 74%, Low Density Lipoprotein LDL cholesterol 83%, triglycerides 59%, Apo B lipoprotein 79%, Lp(a) 88%; p < 0.05; High Density","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"823-824"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10134476","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}

引用次数: 1

Immunocompromised states caused the prolonged duration of viral shedding in middle-aged and elderly hemodialysis patients infected with the Omicron variant of COVID-19. 免疫受损状态导致感染新冠肺炎奥密克戎变异株的中老年血液透析患者的病毒脱落持续时间延长。

IF 1.2 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 Epub Date: 2023-02-08 DOI: 10.1111/1744-9987.13969

Xianwen Zhang, Linli Zhang, Kun Zhang, Yiping Chen, Lin Wang

Introduction: To evaluate the impact of hemodialysis on the duration of viral shedding in middle-aged and elderly patients with the Omicron variant of COVID-19.

Methods: The study was a descriptive, paired cohort study. Hemodialysis participants (the HD group) aged 45-99 years infected with the Omicron variant of COVID-19 were matched (in a 1:2 ratio) with patients not undergoing hemodialysis (the non-HD group) according to age, gender, vaccination doses, and comorbidity. The duration of viral shedding and clinical data were collected.

Results: Ninety-nine patients met the inclusion criteria. The duration of recovery was significantly longer for HD patients than for non-HD patients (p < 0.05). Lower counts for CD45+ cells and lymphocytes, along with lower levels of albumin and hemoglobin were associated with a longer duration of viral shedding (p < 0.05).

Conclusion: Hemodialysis patients with immunocompromised state, anemia, and hypoalbuminemia might lead to prolongation of the duration of viral shedding.

简介：评估血液透析对新冠肺炎奥密克戎变异株中老年患者病毒脱落持续时间的影响。方法：该研究是一项描述性配对队列研究。45-99岁的血液透析参与者（HD组）根据年龄、性别、疫苗接种剂量和合并症，将感染新冠肺炎奥密克戎变异株的年份与未接受血液透析的患者（非HD组）进行匹配（比例为1:2）。收集病毒脱落的持续时间和临床数据。结果：99例患者符合入选标准。HD患者的恢复时间明显长于非HD患者（p 结论：免疫功能低下、贫血和低蛋白血症的血液透析患者可能导致病毒脱落时间延长。

{"title":"Immunocompromised states caused the prolonged duration of viral shedding in middle-aged and elderly hemodialysis patients infected with the Omicron variant of COVID-19.","authors":"Xianwen Zhang, Linli Zhang, Kun Zhang, Yiping Chen, Lin Wang","doi":"10.1111/1744-9987.13969","DOIUrl":"10.1111/1744-9987.13969","url":null,"abstract":"Introduction: To evaluate the impact of hemodialysis on the duration of viral shedding in middle-aged and elderly patients with the Omicron variant of COVID-19.Methods: The study was a descriptive, paired cohort study. Hemodialysis participants (the HD group) aged 45-99 years infected with the Omicron variant of COVID-19 were matched (in a 1:2 ratio) with patients not undergoing hemodialysis (the non-HD group) according to age, gender, vaccination doses, and comorbidity. The duration of viral shedding and clinical data were collected.Results: Ninety-nine patients met the inclusion criteria. The duration of recovery was significantly longer for HD patients than for non-HD patients (p < 0.05). Lower counts for CD45+ cells and lymphocytes, along with lower levels of albumin and hemoglobin were associated with a longer duration of viral shedding (p < 0.05).Conclusion: Hemodialysis patients with immunocompromised state, anemia, and hypoalbuminemia might lead to prolongation of the duration of viral shedding.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"720-725"},"PeriodicalIF":1.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101090","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}

引用次数: 0

The predictive markers of severity and mortality in hospitalized hemodialysis patients with COVID-19 during Omicron epidemic. Omicron流行期间住院血液透析患者COVID-19严重程度和死亡率的预测指标

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13970

Masataka Banshodani, Hideki Kawanishi, Takayuki Hirai, Yusuke Kawai, Shinji Hashimoto, Sadanori Shintaku, Misaki Moriishi, Seiji Marubayashi, Shinichiro Tsuchiya

Introduction: Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) during the Omicron epidemic.

Methods: We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID-19 (n = 102) at two centers between January and April 2022.

Results: The 30-day mortality rate was higher in moderate-critical group (n = 43) than mild group (n = 59) (16.3% vs. 1.7%; p = 0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0 pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p = 0.03). In multivariate analyses, a low CCL17 level (p = 0.003) was associated with moderate-critical conditions, and moderate-critical conditions (p = 0.04) were associated with 30-day mortality, whereas CCL17 was not associated with 30-day mortality.

Conclusions: COVID-19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic.

导语:在欧米克隆流行期间，2019冠状病毒病(COVID-19)住院血液透析(HD)患者的预测指标和预后尚不清楚。方法:我们评估了2022年1月至4月期间在两个中心住院的HD合并COVID-19患者(n = 102)的特征、实验室参数和结局。结果:中度危重症组(n = 43) 30天死亡率高于轻度危重症组(n = 59) (16.3% vs. 1.7%;p = 0.007)，而C - C趋化因子配体17 (CCL17)水平较低的患者则更高(结论:COVID-19仍然是一种致命的并发症，CCL17是Omicron流行期间住院HD患者严重程度的预测指标。

{"title":"The predictive markers of severity and mortality in hospitalized hemodialysis patients with COVID-19 during Omicron epidemic.","authors":"Masataka Banshodani, Hideki Kawanishi, Takayuki Hirai, Yusuke Kawai, Shinji Hashimoto, Sadanori Shintaku, Misaki Moriishi, Seiji Marubayashi, Shinichiro Tsuchiya","doi":"10.1111/1744-9987.13970","DOIUrl":"https://doi.org/10.1111/1744-9987.13970","url":null,"abstract":"Introduction: Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) during the Omicron epidemic.Methods: We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID-19 (n = 102) at two centers between January and April 2022.Results: The 30-day mortality rate was higher in moderate-critical group (n = 43) than mild group (n = 59) (16.3% vs. 1.7%; p = 0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0 pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p = 0.03). In multivariate analyses, a low CCL17 level (p = 0.003) was associated with moderate-critical conditions, and moderate-critical conditions (p = 0.04) were associated with 30-day mortality, whereas CCL17 was not associated with 30-day mortality.Conclusions: COVID-19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"701-710"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101093","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}

引用次数: 1

Effect of ticagrelor on the function of tunneled cuffed catheter in maintenance hemodialysis patients. 替格瑞洛对维持性血液透析患者套管导管功能的影响。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13980

Jianming Shen, Yanyan Deng, Liping Wang, Fei Zha

Objective: To observe the effect of ticagrelor on the function of a tunneled cuffed catheter (TCC) in maintenance hemodialysis (MHD) patients.

Methods: Eighty MHD patients (control group: 39 cases, observation group: 41 cases) using TCC as vascular access were enrolled from January 2019 to October 2020 in this prospective study. Patients in the control group were routinely treated with aspirin for antiplatelet therapy, while patients in the observation group were treated with ticagrelor. The catheter life time, catheter dysfunction, coagulation function, and antiplatelet drug-related adverse events of the two groups were recorded.

Results: The median life time of TCC in the control group was significantly higher than that in the observation group. Moreover, the log rank test showed that the difference was statistically significant (p < 0.001).

Conclusion: Ticagrelor may reduce the incidence of catheter dysfunction and prolong the life time of the catheter by preventing and reducing the thrombosis of TCC in MHD patients, without obvious side effects.

目的:观察替格瑞洛对维持性血液透析(MHD)患者隧道导管(TCC)功能的影响。方法:2019年1月至2020年10月，采用TCC作为血管通路的80例MHD患者(对照组39例，观察组41例)进行前瞻性研究。对照组患者给予常规阿司匹林抗血小板治疗，观察组患者给予替格瑞洛治疗。记录两组患者的导管寿命、导管功能障碍、凝血功能及抗血小板药物相关不良事件。结果:对照组TCC的中位生存时间显著高于观察组。经log rank检验，差异有统计学意义(p)。结论:替格瑞洛可通过预防和减少MHD患者TCC血栓形成，降低导管功能障碍发生率，延长导管寿命，无明显副作用。

{"title":"Effect of ticagrelor on the function of tunneled cuffed catheter in maintenance hemodialysis patients.","authors":"Jianming Shen, Yanyan Deng, Liping Wang, Fei Zha","doi":"10.1111/1744-9987.13980","DOIUrl":"https://doi.org/10.1111/1744-9987.13980","url":null,"abstract":"Objective: To observe the effect of ticagrelor on the function of a tunneled cuffed catheter (TCC) in maintenance hemodialysis (MHD) patients.Methods: Eighty MHD patients (control group: 39 cases, observation group: 41 cases) using TCC as vascular access were enrolled from January 2019 to October 2020 in this prospective study. Patients in the control group were routinely treated with aspirin for antiplatelet therapy, while patients in the observation group were treated with ticagrelor. The catheter life time, catheter dysfunction, coagulation function, and antiplatelet drug-related adverse events of the two groups were recorded.Results: The median life time of TCC in the control group was significantly higher than that in the observation group. Moreover, the log rank test showed that the difference was statistically significant (p < 0.001).Conclusion: Ticagrelor may reduce the incidence of catheter dysfunction and prolong the life time of the catheter by preventing and reducing the thrombosis of TCC in MHD patients, without obvious side effects.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"694-700"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742509","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}

引用次数: 0

The effect of the time from diagnosis to induction therapy on prognosis in patients with acute leukemia undergoing leukapheresis for symptomatic hyperleukocytosis. 急性白血病患者因症状性白细胞增多而行白细胞摘除术，从诊断到诱导治疗时间对预后的影响。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13990

İbrahim Ethem Pınar, Vildan Özkocaman, Tuba Ersal, Mehmet Emin Dağtekin, Cumali Yalçın, Bedrettin Orhan, Ömer Candar, Sinem Çubukçu, Tuba Güllü Koca, Vildan Gürsoy, Fahir Özkalemkaş

Introduction: Our study investigated leukapheresis's effect on delayed induction therapy outcomes in patients with acute leukemia presenting with symptomatic hyperleukocytosis.

Methods: This retrospective cohort study included 30 adult patients diagnosed with acute leukemia who underwent leukapheresis for leukostasis. The patients were divided into the first 24 h and >24 h groups, according to the time from diagnosis to induction therapy (TDT).

Results: There was no significant difference between the TDT groups regarding complete remission (CR), 4-week mortality, and overall survival (OS) at a median follow-up of 409 days. Tumor lysis syndrome, disseminated intravascular coagulation, and hemoglobin levels were significant in early mortality. In univariate analysis, age, hemoglobin levels, patients' eligibility for intensive chemotherapy, and achieving CR were critical factors for OS.

Conclusion: The study findings suggest that waiting for the clinical and laboratory results may be a safe and reasonable approach before assigning patients the best treatment option with leukapheresis.

摘要:本研究探讨白细胞分离对急性白血病伴症状性白细胞增多患者延迟诱导治疗结果的影响。方法:本回顾性队列研究纳入了30例诊断为急性白血病的成年患者，他们因白细胞淤积而接受了白细胞摘除术。根据从诊断到诱导治疗(TDT)的时间将患者分为前24 h组和>24 h组。结果:在中位409天的随访中，TDT组在完全缓解(CR)、4周死亡率和总生存(OS)方面没有显著差异。肿瘤溶解综合征、弥散性血管内凝血和血红蛋白水平是早期死亡率的重要因素。在单因素分析中，年龄、血红蛋白水平、患者是否有资格接受强化化疗以及是否达到CR是OS的关键因素。结论:研究结果提示等待临床和实验室结果可能是一种安全合理的方法，然后再为患者分配最佳治疗方案。

{"title":"The effect of the time from diagnosis to induction therapy on prognosis in patients with acute leukemia undergoing leukapheresis for symptomatic hyperleukocytosis.","authors":"İbrahim Ethem Pınar, Vildan Özkocaman, Tuba Ersal, Mehmet Emin Dağtekin, Cumali Yalçın, Bedrettin Orhan, Ömer Candar, Sinem Çubukçu, Tuba Güllü Koca, Vildan Gürsoy, Fahir Özkalemkaş","doi":"10.1111/1744-9987.13990","DOIUrl":"https://doi.org/10.1111/1744-9987.13990","url":null,"abstract":"Introduction: Our study investigated leukapheresis's effect on delayed induction therapy outcomes in patients with acute leukemia presenting with symptomatic hyperleukocytosis.Methods: This retrospective cohort study included 30 adult patients diagnosed with acute leukemia who underwent leukapheresis for leukostasis. The patients were divided into the first 24 h and >24 h groups, according to the time from diagnosis to induction therapy (TDT).Results: There was no significant difference between the TDT groups regarding complete remission (CR), 4-week mortality, and overall survival (OS) at a median follow-up of 409 days. Tumor lysis syndrome, disseminated intravascular coagulation, and hemoglobin levels were significant in early mortality. In univariate analysis, age, hemoglobin levels, patients' eligibility for intensive chemotherapy, and achieving CR were critical factors for OS.Conclusion: The study findings suggest that waiting for the clinical and laboratory results may be a safe and reasonable approach before assigning patients the best treatment option with leukapheresis.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"802-812"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742530","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}

引用次数: 1