Pub Date : 2025-10-14DOI: 10.1186/s13017-025-00653-z
Yingjian Ye, Yan Hu, Xianqun Ji, Junyan Zhang, Hui Xu, Peng An
This prospective multinational substudy of the AMESI project provides critical insights into managing acute SMA occlusion. By comparing endovascular versus surgical revascularization, the authors demonstrate that baseline illness severity, reflected by elevated lactate levels and mechanical ventilation requirements, dominates prognostic outcomes, with adjusted analyses confirming no independent mortality effect from treatment modality (surgery OR 1.59, 95% CI 0.57–4.37). Notably, unadjusted mortality rates varied substantially (endovascular-effective: 2.9% vs. surgical: 45.8%), primarily attributable to patient selection bias toward higher disease severity in the surgical cohort. The inability to identify reliable thresholds for endovascular efficacy underscores the necessity of individualized decision-making based on etiology and physiological status, challenging time-based intervention paradigms.
这项前瞻性的跨国亚研究AMESI项目为管理急性SMA闭塞提供了关键的见解。通过比较血管内与手术血运重建术,作者证明,乳酸水平升高和机械通气需求反映的基线疾病严重程度主导了预后结果,调整分析证实治疗方式没有独立的死亡率影响(手术OR 1.59, 95% CI 0.57-4.37)。值得注意的是,未经调整的死亡率差异很大(血管内有效:2.9% vs.手术:45.8%),主要归因于手术队列中患者选择偏向于更高疾病严重程度。无法确定血管内疗效的可靠阈值强调了基于病因和生理状态的个性化决策的必要性,挑战了基于时间的干预范式。
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Pub Date : 2025-10-10DOI: 10.1186/s13017-025-00649-9
Hannah M. Thomas, Huthayfa Kahf, Benjamin Bush, Jeffry Nahmias, Philip K. Lim
Tranexamic acid (TXA) is a well-known antifibrinolytic agent with increasing evidence supporting its use in trauma patients. This review evaluates the current available literature regarding TXA and its potential use to improve patient survival and reduce transfusion needs across multiple trauma surgical subspecialties and contexts. A literature review was conducted on the efficacy and safety of tranexamic acid in trauma surgical specialties using PubMed (MEDLINE) and Google Scholar from database inception to October 2024. Selected articles were written in the English language and encompassed reviews, experimental studies, and basic science articles. There is conflicting evidence on the mortality benefit of TXA, particularly in the prehospital setting. However, multiple large, high-quality studies have shown that TXA is an effective agent to reduce bleeding after trauma. Extensive evidence exists that TXA is a safe medication, with numerous studies demonstrating no increased risk of thromboembolic events after administration of TXA in trauma settings. Additionally, multiple cost-effectiveness studies conducted in several countries have found TXA to be a highly cost-effective intervention following trauma. TXA is a safe, effective, and cost-effective medication to reduce bleeding after trauma. Future research on TXA is needed to elucidate the potential benefit of TXA after traumatic brain and spine injury and the optimal dose and route of administration of TXA.
{"title":"Use of tranexamic acid in trauma surgical specialties: a narrative review","authors":"Hannah M. Thomas, Huthayfa Kahf, Benjamin Bush, Jeffry Nahmias, Philip K. Lim","doi":"10.1186/s13017-025-00649-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00649-9","url":null,"abstract":"Tranexamic acid (TXA) is a well-known antifibrinolytic agent with increasing evidence supporting its use in trauma patients. This review evaluates the current available literature regarding TXA and its potential use to improve patient survival and reduce transfusion needs across multiple trauma surgical subspecialties and contexts. A literature review was conducted on the efficacy and safety of tranexamic acid in trauma surgical specialties using PubMed (MEDLINE) and Google Scholar from database inception to October 2024. Selected articles were written in the English language and encompassed reviews, experimental studies, and basic science articles. There is conflicting evidence on the mortality benefit of TXA, particularly in the prehospital setting. However, multiple large, high-quality studies have shown that TXA is an effective agent to reduce bleeding after trauma. Extensive evidence exists that TXA is a safe medication, with numerous studies demonstrating no increased risk of thromboembolic events after administration of TXA in trauma settings. Additionally, multiple cost-effectiveness studies conducted in several countries have found TXA to be a highly cost-effective intervention following trauma. TXA is a safe, effective, and cost-effective medication to reduce bleeding after trauma. Future research on TXA is needed to elucidate the potential benefit of TXA after traumatic brain and spine injury and the optimal dose and route of administration of TXA.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"122 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255797","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}
Intra-abdominal pressure (IAP) critically drives organ failure progression in severe acute pancreatitis (SAP). However, traditional static IAP monitoring inadequately captures dynamic injury evolution. This study aimed to assess the impact of cumulative IAP exposure (CumIAP) and dynamic trajectories on the prognosis of SAP. This retrospective cohort study analyzed 1,008 ICU-admitted SAP patients from the Jiangxi cohort (2005–2023) and 83 from MIMIC-IV (2008–2019). CumIAP was quantified via time-weighted integration of serial IAP measurements. Multivariate Cox regression models and restricted cubic splines (RCS) were established to analyze the dose–response relationships between CumIAP and death, infectious pancreatic necrosis (IPN), and persistent multiple organ failure (PMOF). Mediation analysis evaluated CumIAP’s role in albumin (ALB)- and acute necrotic collection (ANC)-associated outcomes. Latent class growth mixture model (LCGMM) was employed to identify dynamic IAP trajectory subtypes, and the associations between each trajectory group and poor prognosis were analyzed. Over a median inpatient follow-up of 17 days in the Jiangxi cohort, 200 (19.8%) patients died in hospital, while 208 (20.6%) and 329 (32.6%) developed IPN and PMOF, respectively. Regression analysis revealed that for each standard deviation increase in CumIAP, the risks of in-hospital death and PMOF increased by 37% and 86%, respectively, and there was a U-shaped association with the risk of IPN (P for nonlinearity = 0.004). Mediation analysis showed that CumIAP mediated 24.26% and 33.76% of the associations between ALB, ANC, and the risk of in-hospital death, respectively. Three IAP trajectories were identified by LCGMM: the high-pressure rapid decline group (HRD-T1), the low-pressure gradual decline group (LGD-T2), and the low-pressure progressive increase group (LPI-T3). Among them, compared with HRD-T1 and LGD-T2, the subjects in the LPI-T3 group had a significantly increased risk of adverse clinical outcomes. This is the first study to revealed that CumIAP is linearly positively correlated with death and PMOF, while exhibits a U-shaped relationship with IPN. Notably, patients with low baseline IAP and a rising trajectory exhibited worse outcomes than those with high baseline IAP and a declining trend. This is the first study to introduce CumIAP as a quantitative metric to assess the early IAP burden and its prognostic significance in SAP, overcoming the limitations of static IAP monitoring. RCS and regression analyses revealed a positive linear association between CumIAP and in hospital mortality/PMOF, and a U-shaped relationship with IPN, suggesting the possible presence of a risk threshold. LCGMM identified three IAP trajectory patterns; the "low baseline with rising trend" group (LPI-T3) had the worst outcomes, underscoring the value of dynamic over static IAP monitoring. Mediation analysis showed that CumIAP partly mediated the effects of hypoalbuminemia and ANC on o
腹内压(IAP)是严重急性胰腺炎(SAP)患者器官衰竭进展的关键驱动因素。然而,传统的静态IAP监测无法充分捕捉到损伤的动态演变。本研究旨在评估累积IAP暴露(CumIAP)和动态轨迹对SAP预后的影响。本回顾性队列研究分析了来自江西队列(2005-2023)的1008例icu住院SAP患者和来自MIMIC-IV(2008-2019)的83例患者。通过一系列IAP测量的时间加权积分来量化CumIAP。建立多变量Cox回归模型和限制性三次样条(RCS)分析CumIAP与死亡、感染性胰腺坏死(IPN)和持续性多器官衰竭(PMOF)之间的剂量-反应关系。中介分析评估了CumIAP在白蛋白(ALB)和急性坏死收集(ANC)相关结果中的作用。采用潜类生长混合模型(Latent class growth mixture model, LCGMM)识别IAP动态轨迹亚型,并分析各轨迹组与不良预后的关系。在江西队列中位17天的住院随访中,200例(19.8%)患者在医院死亡,208例(20.6%)和329例(32.6%)患者分别发生IPN和PMOF。回归分析显示,CumIAP每增加一个标准差,院内死亡和PMOF的风险分别增加37%和86%,与IPN的风险呈u型相关(非线性P = 0.004)。中介分析显示,CumIAP分别介导了24.26%和33.76%的ALB、ANC与院内死亡风险之间的关联。LCGMM识别出三种IAP轨迹:高压快速下降组(HRD-T1)、低压逐渐下降组(LGD-T2)和低压逐渐增加组(LPI-T3)。其中,与HRD-T1和LGD-T2相比,LPI-T3组受试者出现临床不良结局的风险显著增加。这是首次发现CumIAP与死亡和PMOF呈线性正相关,而与IPN呈u型关系。值得注意的是,基线IAP低且呈上升趋势的患者比基线IAP高且呈下降趋势的患者表现出更差的结果。这是首次引入CumIAP作为定量指标来评估SAP早期IAP负担及其预后意义的研究,克服了静态IAP监测的局限性。RCS和回归分析显示,CumIAP与院内死亡率/PMOF呈正线性关系,与IPN呈u型关系,表明可能存在风险阈值。LCGMM确定了三种IAP轨迹模式;“低基线有上升趋势”组(LPI-T3)的结果最差,强调了动态IAP监测比静态IAP监测的价值。中介分析显示,CumIAP在一定程度上介导了低白蛋白血症和ANC对预后的影响,表明IAP可能是SAP的一个重要中介途径和治疗靶点。
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Pub Date : 2025-09-29DOI: 10.1186/s13017-025-00648-w
Jiaqi Lou, Ziyi Xiang, Xiaoyu Zhu, Jingyao Song, Neng Huang, Jiliang Li, Guoying Jin, Youfen Fan, Shengyong Cui
Severe burn injuries induce hypermetabolism, leading to protein catabolism, impaired wound healing, and increased infection risk. Burn patients often experience androgen depletion, exacerbating these issues. Oxandrolone, a synthetic anabolic steroid, has shown promise in counteracting these metabolic disturbances. This updated meta-analysis evaluates the efficacy and safety of oxandrolone in burn patients, incorporating recent studies, pediatric populations, long-term outcomes, and combination therapies. This PRISMA 2020-compliant systematic review searched 9 databases (PubMed, Embase, Cochrane, WOS, WHO-ICTRP, CNKI, VIP, Wanfang, CBMdisc) for RCTs published between 2005 and 2025 using validated strategies combining controlled vocabulary (MeSH/Emtree) and free-text terms for burn/trauma AND androgen analogs (e.g., oxandrolone, nandrolone). Included trials compared androgen analogs vs. controls (placebo/standard care) in burn patients, reporting ≥ 1 predefined outcome: (1) Lean body mass (recovery phase, ≥ 14 days post-burn); (2) Mild side effects (hepatic dysfunction [ALT/AST ≥ 2 × ULN] or edema); (3) Infections; (4) Mortality; (5) Surgical procedures; (6) LOS/TBSA; (7) Absolute LOS. Dual-independent screening, data extraction, and risk-of-bias assessment (Cochrane RoB 2.0 per outcome) were performed. Random-effects meta-analyses generated standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% CIs. Fourteen RCTs (2005–2025; n = 2822 patients: 1203 intervention vs. 1619 controls) demonstrated significant reductions in surgical procedures (SMD = − 1.25; 95% CI − 2.45 to − 0.04; p = 0.04; I2 = 97.2%) and length of stay normalized to TBSA (LOS/TBSA) (SMD = − 1.07; 95% CI − 2.43 to 0.29; p = 0.007; I2 = 98.1%), alongside enhanced anabolic recovery evidenced by increased weight gain (SMD = 0.58; 95% CI − 1.21 to 2.38; p < 0.001) and lean mass (SMD = 1.30; 95% CI − 0.47 to 3.24; p < 0.001; I2 ≥ 95.0%). However, no mortality benefit was observed (RR = 1.04; 95% CI 0.47–2.32; p = 0.913; I2 = 66.5%), with unchanged infection rates (RR = 0.83; 95% CI 0.67–1.02; p = 0.639) and no improvement in donor site healing (SMD = − 1.48; 95% CI − 2.18 to 0.77; p = 0.116). Safety analysis revealed a non-significant increase in treatment-related side effects (hepatic dysfunction/edema; RR = 1.82; 95% CI 0.52–6.42; p = 0.34), notably higher transaminase elevations in adults (19% vs. 5% placebo; p = 0.002). Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden (SMD = − 1.25; p = 0.04), shortening hospitalization (LOS/TBSA SMD = − 1.07; p = 0.007), and enhancing anabolic recovery (weight gain SMD = 0.58; lean mass SMD = 1.30; both p < 0.001). However, extreme heterogeneity (I2 ≥ 95.0%) and temporal limitations necessitate cautious interpretation. Critically, it confers no mortality benefit (RR = 1.04; p = 0.913), fails to reduce infections (RR = 0.83; p = 0.639), an
严重烧伤诱导高代谢,导致蛋白质分解代谢,伤口愈合受损,感染风险增加。烧伤患者经常经历雄激素消耗,加剧了这些问题。奥雄龙,一种合成的合成代谢类固醇,已经显示出对抗这些代谢紊乱的希望。这项最新的荟萃分析评估了奥胺龙在烧伤患者中的疗效和安全性,结合了最近的研究、儿科人群、长期结果和联合治疗。这项符合PRISMA 2020标准的系统评价检索了9个数据库(PubMed、Embase、Cochrane、WOS、WHO-ICTRP、CNKI、VIP、万方、CBMdisc),检索了2005年至2025年间发表的随机对照试验,使用了有效的策略,结合了烧伤/创伤和雄激素类似物(如oxandronone、nandronone)的控制词汇(MeSH/Emtree)和自由文本术语。纳入的试验比较了烧伤患者的雄激素类似物与对照组(安慰剂/标准治疗),报告了≥1个预定义结果:(1)瘦体重(恢复阶段,烧伤后≥14天);(2)轻微副作用(肝功能障碍[ALT/AST≥2 × ULN]或水肿);(3)感染;(4)死亡率;(五)外科手术;(6)洛杉矶/回溯;(7)绝对LOS。进行了双独立筛选、数据提取和偏倚风险评估(每个结果的Cochrane RoB 2.0)。随机效应荟萃分析产生了连续结局的标准化平均差异(SMD)和95% ci的二分类结局的风险比(RR)。十四相关(2005 - 2025年;n = 2822例:1203 1619年干预与控制)证明显著减少外科手术(SMD =−1.25;95%可信区间2.45−−0.04;p = 0.04; I2 = 97.2%)和滞留时间规范化回溯(洛杉矶/回溯)(SMD =−1.07;95%可信区间2.43−0.29;p = 0.007; I2 = 98.1%),与增强合成代谢恢复就是增加体重增加(SMD = 0.58; 95%可信区间1.21−2.38;p < 0.001)和精益质量(SMD = 1.30; 95%可信区间0.47−3.24;p < 0.001;i2≥95.0%)。然而,没有观察到死亡率的改善(RR = 1.04; 95% CI 0.47-2.32; p = 0.913; I2 = 66.5%),感染率不变(RR = 0.83; 95% CI 0.67-1.02; p = 0.639),供体部位愈合无改善(SMD = - 1.48; 95% CI - 2.18 - 0.77; p = 0.116)。安全性分析显示治疗相关副作用(肝功能障碍/水肿;RR = 1.82; 95% CI 0.52-6.42; p = 0.34)无显著增加,成人转氨酶升高明显(19% vs 5%安慰剂;p = 0.002)。奥胺龙在烧伤治疗中具有临床应用价值,可显著减轻手术负担(SMD = - 1.25, p = 0.04),缩短住院时间(LOS/TBSA SMD = - 1.07, p = 0.007),促进合成代谢恢复(体重增加SMD = 0.58,瘦质量SMD = 1.30, p均< 0.001)。然而,极端异质性(I2≥95.0%)和时间限制需要谨慎解释。关键的是,它没有死亡率方面的益处(RR = 1.04; p = 0.913),不能减少感染(RR = 0.83; p = 0.639),并增加成人的肝毒性风险(19% vs. 5%; p = 0.002)。这些发现支持其在代谢康复中的辅助作用,但要求风险分层实施。
{"title":"Oxandrolone for burn patients: a systematic review and updated meta-analysis of randomized controlled trials from 2005 to 2025","authors":"Jiaqi Lou, Ziyi Xiang, Xiaoyu Zhu, Jingyao Song, Neng Huang, Jiliang Li, Guoying Jin, Youfen Fan, Shengyong Cui","doi":"10.1186/s13017-025-00648-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00648-w","url":null,"abstract":"Severe burn injuries induce hypermetabolism, leading to protein catabolism, impaired wound healing, and increased infection risk. Burn patients often experience androgen depletion, exacerbating these issues. Oxandrolone, a synthetic anabolic steroid, has shown promise in counteracting these metabolic disturbances. This updated meta-analysis evaluates the efficacy and safety of oxandrolone in burn patients, incorporating recent studies, pediatric populations, long-term outcomes, and combination therapies. This PRISMA 2020-compliant systematic review searched 9 databases (PubMed, Embase, Cochrane, WOS, WHO-ICTRP, CNKI, VIP, Wanfang, CBMdisc) for RCTs published between 2005 and 2025 using validated strategies combining controlled vocabulary (MeSH/Emtree) and free-text terms for burn/trauma AND androgen analogs (e.g., oxandrolone, nandrolone). Included trials compared androgen analogs vs. controls (placebo/standard care) in burn patients, reporting ≥ 1 predefined outcome: (1) Lean body mass (recovery phase, ≥ 14 days post-burn); (2) Mild side effects (hepatic dysfunction [ALT/AST ≥ 2 × ULN] or edema); (3) Infections; (4) Mortality; (5) Surgical procedures; (6) LOS/TBSA; (7) Absolute LOS. Dual-independent screening, data extraction, and risk-of-bias assessment (Cochrane RoB 2.0 per outcome) were performed. Random-effects meta-analyses generated standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% CIs. Fourteen RCTs (2005–2025; n = 2822 patients: 1203 intervention vs. 1619 controls) demonstrated significant reductions in surgical procedures (SMD = − 1.25; 95% CI − 2.45 to − 0.04; p = 0.04; I2 = 97.2%) and length of stay normalized to TBSA (LOS/TBSA) (SMD = − 1.07; 95% CI − 2.43 to 0.29; p = 0.007; I2 = 98.1%), alongside enhanced anabolic recovery evidenced by increased weight gain (SMD = 0.58; 95% CI − 1.21 to 2.38; p < 0.001) and lean mass (SMD = 1.30; 95% CI − 0.47 to 3.24; p < 0.001; I2 ≥ 95.0%). However, no mortality benefit was observed (RR = 1.04; 95% CI 0.47–2.32; p = 0.913; I2 = 66.5%), with unchanged infection rates (RR = 0.83; 95% CI 0.67–1.02; p = 0.639) and no improvement in donor site healing (SMD = − 1.48; 95% CI − 2.18 to 0.77; p = 0.116). Safety analysis revealed a non-significant increase in treatment-related side effects (hepatic dysfunction/edema; RR = 1.82; 95% CI 0.52–6.42; p = 0.34), notably higher transaminase elevations in adults (19% vs. 5% placebo; p = 0.002). Oxandrolone demonstrates clinical utility in burn management by significantly reducing surgical burden (SMD = − 1.25; p = 0.04), shortening hospitalization (LOS/TBSA SMD = − 1.07; p = 0.007), and enhancing anabolic recovery (weight gain SMD = 0.58; lean mass SMD = 1.30; both p < 0.001). However, extreme heterogeneity (I2 ≥ 95.0%) and temporal limitations necessitate cautious interpretation. Critically, it confers no mortality benefit (RR = 1.04; p = 0.913), fails to reduce infections (RR = 0.83; p = 0.639), an","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188597","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 : 2025-09-02DOI: 10.1186/s13017-025-00643-1
Vladimir Sergeevich Gordeev, Esubalew Assefa, Rupert Pearse, Mark Edwards, Borislava Mihaylova
Patients’ survival and quality of life are key factors in assessing value of treatments. However, limited evidence exists about the trajectory and key determinants of patients’ health-related quality of life (QoL) following emergency abdominal surgery. Using the Enhanced Peri-Operative Care for High-risk patients study with measured QoL during eight months follow-up using the EQ-5D-3L questionnaire, we summarise the trajectory of patients’ QoL after emergency abdominal surgery and use multivariable regression models to relate patients’ demographic and clinical characteristics, pre-surgery characteristics, and time elapsed since surgery with their QoL. In further analysis we assess the contribution of post-surgery patient characteristics. Data from 686 patients undergoing emergency abdominal surgery (50.4% female; mean age 66.6 (standard deviation (SD) 12.8) years; 50.1% with intestinal obstruction as indication for surgery), with QoL measurements were analysed. Shortly after surgery (mean days 7.59 (SD 7.48)), the mean EQ-5D-3L QoL utility score was 0.21 (SD 0.46), which improved among survivors to 0.74 (SD 0.31) in the medium- to long-term (i.e., three to eight months) following surgery. Patient’s sex and preoperative risk of mortality were key determinants of QoL shortly after surgery. In addition to time since surgery, patient’s sex, Charlson Comorbidity index, ASA physical status and indication for surgery were key pre-surgery predictors of QoL in the medium- to long-term post-surgery. From post-surgery characteristics, duration of hospital admission for index surgery and further days in hospital within 30 days prior to QoL measurement were key further determinants of QoL in the medium- to long-term. Individual patient, surgery, and recovery characteristics determine QoL post-emergency abdominal surgery and can help inform clinician-patient discussions and assessments of value of abdominal surgery interventions.
{"title":"Health-related quality of life after emergency abdominal surgery","authors":"Vladimir Sergeevich Gordeev, Esubalew Assefa, Rupert Pearse, Mark Edwards, Borislava Mihaylova","doi":"10.1186/s13017-025-00643-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00643-1","url":null,"abstract":"Patients’ survival and quality of life are key factors in assessing value of treatments. However, limited evidence exists about the trajectory and key determinants of patients’ health-related quality of life (QoL) following emergency abdominal surgery. Using the Enhanced Peri-Operative Care for High-risk patients study with measured QoL during eight months follow-up using the EQ-5D-3L questionnaire, we summarise the trajectory of patients’ QoL after emergency abdominal surgery and use multivariable regression models to relate patients’ demographic and clinical characteristics, pre-surgery characteristics, and time elapsed since surgery with their QoL. In further analysis we assess the contribution of post-surgery patient characteristics. Data from 686 patients undergoing emergency abdominal surgery (50.4% female; mean age 66.6 (standard deviation (SD) 12.8) years; 50.1% with intestinal obstruction as indication for surgery), with QoL measurements were analysed. Shortly after surgery (mean days 7.59 (SD 7.48)), the mean EQ-5D-3L QoL utility score was 0.21 (SD 0.46), which improved among survivors to 0.74 (SD 0.31) in the medium- to long-term (i.e., three to eight months) following surgery. Patient’s sex and preoperative risk of mortality were key determinants of QoL shortly after surgery. In addition to time since surgery, patient’s sex, Charlson Comorbidity index, ASA physical status and indication for surgery were key pre-surgery predictors of QoL in the medium- to long-term post-surgery. From post-surgery characteristics, duration of hospital admission for index surgery and further days in hospital within 30 days prior to QoL measurement were key further determinants of QoL in the medium- to long-term. Individual patient, surgery, and recovery characteristics determine QoL post-emergency abdominal surgery and can help inform clinician-patient discussions and assessments of value of abdominal surgery interventions.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144928038","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 : 2025-08-30DOI: 10.1186/s13017-025-00645-z
Chi Peng, Yibin Guo, Fan Yang, Qi Chen, Lei Li, Faran Bokhari, Zhichao Jin, Shuogui Xu
Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions. This retrospective, multicenter study used 2014–2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7). Primary outcomes: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events. Among 9,330 patients (median age 37 (26–54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42–0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62–0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings. In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.
{"title":"High platelet-to-red blood cell ratio and outcomes in trauma patients requiring massive transfusions","authors":"Chi Peng, Yibin Guo, Fan Yang, Qi Chen, Lei Li, Faran Bokhari, Zhichao Jin, Shuogui Xu","doi":"10.1186/s13017-025-00645-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00645-z","url":null,"abstract":"Uncontrolled bleeding contributes to 40% of trauma deaths. While higher platelet-to-red blood cell (PLT/RBC) transfusion ratios may improve outcomes, the optimal ratio remains unclear. This study aimed to determine the threshold of PLT/RBC ratio and its impact on in-hospital mortality in trauma patients requiring massive transfusions. This retrospective, multicenter study used 2014–2018 National Trauma Database (NTDB) data. Adult patients admitted to Level I/II trauma centers with massive transfusions within 24 h of emergency department (ED) admission were included. Patients were divided into high-PLT group (PLT/RBC ratio > 0.7) and low-PLT group (ratio ≤ 0.7). Primary outcomes: 24-hour and 30-day mortality; secondary outcomes: transfusion-related adverse events. Among 9,330 patients (median age 37 (26–54) years; 78.9% male), 46.1% had a high PLT/RBC ratio. Restricted cubic spline analysis revealed a nonlinear relationship: mortality dropped significantly at > 0.7 and stabilized above 1.5. After inverse probability treatment weighting, the high-PLT group showed lower 24-hour mortality (OR, 0.45; 95% CI, 0.42–0.48) and 30-day mortality (OR, 0.66; 95% CI, 0.62–0.70). However, the high ratio group experienced higher rates of adverse events, including pulmonary embolism, acute kidney injury, and sepsis. Subgroup analyses confirmed consistent survival benefits despite increased adverse events. Sensitivity analysis further supported the robustness of these findings. In this multicenter study, a high PLT/RBC ratio (> 0.7) was associated with improved survival in trauma patients requiring massive transfusions, reducing 24-hour and 30-day mortality. However, it also increased the risk of adverse events, with a ceiling effect observed at ratios above 1.5. These findings underscore the need for high-quality clinical trials to validate the benefits of high PLT/RBC ratios and optimize transfusion strategies for trauma patients.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"29 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144919118","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 : 2025-08-26DOI: 10.1186/s13017-025-00644-0
Salar Tayebi, Robert Wise, Prashant Nasa, Luca Malbrain, Johan Stiens, Wojciech Dabrowski, Manu L. N. G. Malbrain
Recent studies confirm that intra-abdominal hypertension (IAH) frequently develops in critically ill patients, posing a significant risk of organ failure and increased mortality. Accurate intra-abdominal pressure (IAP) measurement is essential for effective diagnosis, prevention, and treatment. Previous studies indicate that accurate IAP measurement using traditional Foley catheters requires the bladder to be filled with a maximum of 25 mL of sterile saline solution after clamping the catheter, restricting the ability to monitor IAP continuously due to variations in the bladder fill volume. The TraumaGuard catheter enables continuous IAP measurement irrespective of bladder fill volume. The primary objective was the validation of the TraumaGuard catheter (Sentinel Medical Technologies, Jacksonville, Florida, USA), a new continuous bladder pressure monitoring device. ICU patients were studied across different body positions to assess measurement accuracy by comparing the correlation, bias, precision, and agreement between IAP readings obtained using the TraumaGuard catheter and the FoleyManometer measurement method (SecurMeter, Deltamed, Viadana, Italy), which serves as the gold standard. The secondary endpoint of this study was to investigate the impact of different body positions on IAP. Adult ICU patients (≥ 18 years) requiring bladder catheterisation were enrolled. IAP was measured using a TraumaGuard catheter (IAPTG) and FoleyManometer method (IAPFM) across multiple positions to have a broad range of IAP values and to study the impact of body position on IAP measurement. Pairwise analysis of IAPTG and IAPFM in the supine, reverse Trendelenburg (15°, 30°, and 45°), and head-of-bed (HOB) elevation positions (15°, 30°, and 45°) was performed using correlation, concordance, and Bland-Altman analyses. The error-grid analysis assessed the risk associated with inaccurate measurements at each body position. The robustness of the TraumaGuard catheter as a detection system for IAH detection system was evaluated by receiver operating characteristic (ROC) curve. The IAP variation as a function of body position was investigated and compared with the reviewed literature. Gender, age, body mass index (BMI), and sequential organ failure assessment (SOFA) score were also recorded for each participant. Twenty-five adult ICU patients with a mean age of 63.6 ± 11.6 years and BMI of 28.3 ± 3.7 kg/m2 were included. The mean IAP increased from 9.8 ± 1.7 mmHg in supine to 10.4 ± 1.5 mmHg in reverse Trendelenburg and 14.9 ± 1.6 mmHg in HOB elevation positions. The correlation coefficients were 0.9, 0.9, and 0.8 for supine, reverse Trendelenburg, and HOB elevation positions. The supine positions showed a bias and precision of 0.8 and 1.7 mmHg according to Bland-Altman analysis. Reverse Trendelenburg and HOB elevation positions showed a bias of − 0.3 and 1.5 mmHg with a precision of 1.5 and 1.6 mmHg, respectively. The lower and upper limits of agreement were − 2.5–4.2 m
{"title":"Variation and accuracy of intra-abdominal pressure measurement in different body positions: a prospective study","authors":"Salar Tayebi, Robert Wise, Prashant Nasa, Luca Malbrain, Johan Stiens, Wojciech Dabrowski, Manu L. N. G. Malbrain","doi":"10.1186/s13017-025-00644-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00644-0","url":null,"abstract":"Recent studies confirm that intra-abdominal hypertension (IAH) frequently develops in critically ill patients, posing a significant risk of organ failure and increased mortality. Accurate intra-abdominal pressure (IAP) measurement is essential for effective diagnosis, prevention, and treatment. Previous studies indicate that accurate IAP measurement using traditional Foley catheters requires the bladder to be filled with a maximum of 25 mL of sterile saline solution after clamping the catheter, restricting the ability to monitor IAP continuously due to variations in the bladder fill volume. The TraumaGuard catheter enables continuous IAP measurement irrespective of bladder fill volume. The primary objective was the validation of the TraumaGuard catheter (Sentinel Medical Technologies, Jacksonville, Florida, USA), a new continuous bladder pressure monitoring device. ICU patients were studied across different body positions to assess measurement accuracy by comparing the correlation, bias, precision, and agreement between IAP readings obtained using the TraumaGuard catheter and the FoleyManometer measurement method (SecurMeter, Deltamed, Viadana, Italy), which serves as the gold standard. The secondary endpoint of this study was to investigate the impact of different body positions on IAP. Adult ICU patients (≥ 18 years) requiring bladder catheterisation were enrolled. IAP was measured using a TraumaGuard catheter (IAPTG) and FoleyManometer method (IAPFM) across multiple positions to have a broad range of IAP values and to study the impact of body position on IAP measurement. Pairwise analysis of IAPTG and IAPFM in the supine, reverse Trendelenburg (15°, 30°, and 45°), and head-of-bed (HOB) elevation positions (15°, 30°, and 45°) was performed using correlation, concordance, and Bland-Altman analyses. The error-grid analysis assessed the risk associated with inaccurate measurements at each body position. The robustness of the TraumaGuard catheter as a detection system for IAH detection system was evaluated by receiver operating characteristic (ROC) curve. The IAP variation as a function of body position was investigated and compared with the reviewed literature. Gender, age, body mass index (BMI), and sequential organ failure assessment (SOFA) score were also recorded for each participant. Twenty-five adult ICU patients with a mean age of 63.6 ± 11.6 years and BMI of 28.3 ± 3.7 kg/m2 were included. The mean IAP increased from 9.8 ± 1.7 mmHg in supine to 10.4 ± 1.5 mmHg in reverse Trendelenburg and 14.9 ± 1.6 mmHg in HOB elevation positions. The correlation coefficients were 0.9, 0.9, and 0.8 for supine, reverse Trendelenburg, and HOB elevation positions. The supine positions showed a bias and precision of 0.8 and 1.7 mmHg according to Bland-Altman analysis. Reverse Trendelenburg and HOB elevation positions showed a bias of − 0.3 and 1.5 mmHg with a precision of 1.5 and 1.6 mmHg, respectively. The lower and upper limits of agreement were − 2.5–4.2 m","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"15 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899571","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}
BACKGROUNDTo study the value of ensemble machine learning (EL) model in the prediction of infected pancreatic necrosis (IPN) among patients with acute necrotizing pancreatitis (ANP).METHODSThis study comprehensively analyzed 1073 acute necrotizing pancreatitis (ANP) patients admitted to Xiangya hospital from January 2011 to December 2023. The patients were divided into IPN group and sterile pancreatic necrosis (SPN) group based on IPN occurrence. All ANP patients were randomly divided into training dataset and validation dataset with a ratio of 7:3. The EL model was built by integrating multiple machine learning models (LASSO, random forest, and SVM). To verify the stability of the EL model, 78 ANP patients from the Third Xiangya hospital were included for external validation, and a Fagan nomogram was constructed to assess the posterior probability.RESULTSThe EL model was constructed with 31 risk factors identified through LASSO regression. The prediction accuracy of the EL model in the training dataset was 92.6%. In the validation dataset, the prediction accuracy was 91.5%. Compared with the LR model, the EL model demonstrated higher AUC values (training dataset: 0.916 vs. 0.744; validation dataset: 0.919 vs. 0.742) and net benefit rate. The AUC of the EL model for predicting IPN within 7 days, 7-14 days, and after 14 days were 0.888, 0.906, and 0.901, respectively. In addition, the external validation results further indicated the accuracy of the EL model (AUC: 0.883). An EL model-based Fagan nomogram could be used to estimate the accuracy of IPN predictions.CONCLUSIONThe EL model demonstrates superior predictive efficiency for IPN compared to the LR model, offering greater predictive value and potential clinical benefits. Furthermore, the EL model shows stable performance across different stages of IPN onset, enabling clinicians to make timely adjustments to treatment strategies and ultimately improve patient outcomes.TRIAL REGISTRATIONThe study is registered at www.researchregistry.com (Unique Identifying number: researchregistry10652).
背景研究集成机器学习(EL)模型在急性坏死性胰腺炎(ANP)患者感染性胰腺坏死(IPN)预测中的价值。方法对2011年1月至2023年12月湘雅医院收治的1073例急性坏死性胰腺炎(ANP)患者进行综合分析。根据IPN的发生情况将患者分为IPN组和无菌胰腺坏死(SPN)组。所有ANP患者随机分为训练数据集和验证数据集,比例为7:3。结合LASSO、随机森林、SVM等多个机器学习模型构建EL模型。为了验证EL模型的稳定性,选取湘雅第三医院的78例ANP患者进行外部验证,并构建Fagan nomogram来评估后验概率。结果通过LASSO回归,确定了31个危险因素,构建了EL模型。EL模型在训练数据集中的预测准确率为92.6%。在验证数据集中,预测准确率为91.5%。与LR模型相比,EL模型的AUC值更高(训练数据集:0.916 vs. 0.744;验证数据集:0.919 vs. 0.742)和净效益率。EL模型预测7 d、7 ~ 14 d和14 d后IPN的AUC分别为0.888、0.906和0.901。此外,外部验证结果进一步验证了EL模型的准确性(AUC: 0.883)。基于EL模型的Fagan模态图可以用来估计IPN预测的准确性。结论与LR模型相比,EL模型对IPN的预测效率更高,具有更高的预测价值和潜在的临床效益。此外,EL模型在IPN发作的不同阶段表现稳定,使临床医生能够及时调整治疗策略,最终改善患者的预后。试验注册本研究注册在www.researchregistry.com(唯一识别码:researchregistry10652)。
{"title":"Prediction of infected pancreatic necrosis in patients with acute necrotizing pancreatitis based on ensemble machine learning model.","authors":"Zefang Sun,Yan Fu,Jiarong Li,Baiqi Liu,Xiaoyue Hong,Chiayen Lin,Dingcheng Shen,Caihong Ning,Lu Chen,Xiaoping Yi,Gengwen Huang","doi":"10.1186/s13017-025-00642-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00642-2","url":null,"abstract":"BACKGROUNDTo study the value of ensemble machine learning (EL) model in the prediction of infected pancreatic necrosis (IPN) among patients with acute necrotizing pancreatitis (ANP).METHODSThis study comprehensively analyzed 1073 acute necrotizing pancreatitis (ANP) patients admitted to Xiangya hospital from January 2011 to December 2023. The patients were divided into IPN group and sterile pancreatic necrosis (SPN) group based on IPN occurrence. All ANP patients were randomly divided into training dataset and validation dataset with a ratio of 7:3. The EL model was built by integrating multiple machine learning models (LASSO, random forest, and SVM). To verify the stability of the EL model, 78 ANP patients from the Third Xiangya hospital were included for external validation, and a Fagan nomogram was constructed to assess the posterior probability.RESULTSThe EL model was constructed with 31 risk factors identified through LASSO regression. The prediction accuracy of the EL model in the training dataset was 92.6%. In the validation dataset, the prediction accuracy was 91.5%. Compared with the LR model, the EL model demonstrated higher AUC values (training dataset: 0.916 vs. 0.744; validation dataset: 0.919 vs. 0.742) and net benefit rate. The AUC of the EL model for predicting IPN within 7 days, 7-14 days, and after 14 days were 0.888, 0.906, and 0.901, respectively. In addition, the external validation results further indicated the accuracy of the EL model (AUC: 0.883). An EL model-based Fagan nomogram could be used to estimate the accuracy of IPN predictions.CONCLUSIONThe EL model demonstrates superior predictive efficiency for IPN compared to the LR model, offering greater predictive value and potential clinical benefits. Furthermore, the EL model shows stable performance across different stages of IPN onset, enabling clinicians to make timely adjustments to treatment strategies and ultimately improve patient outcomes.TRIAL REGISTRATIONThe study is registered at www.researchregistry.com (Unique Identifying number: researchregistry10652).","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"9 1","pages":"69"},"PeriodicalIF":8.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792104","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}
Correction: World Journal of Emergency Surgery (2025) 20:19
https://doi.org/10.1186/s13017-025-00593-8
In this article [1], Mengdi Jin was mistakenly listed as a co-first author.
The original article has been corrected.
Mu L, Song H, Jin M, et al. Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries. World J Emerg Surg. 2025;20:19. https://doi.org/10.1186/s13017-025-00593-8.
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Liuquan Mou and Haideng Song are co-first authors.
Authors and Affiliations
Department of Trauma Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
Liuquan Mu, Kaige Li, Yushan Guo & Nan Jiang
Department of Emergency, Cheeloo College of Medicine, Weihai Municipal Hospital, Shandong University, Weihai, 264200, China
Liuquan Mu
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
Haideng Song & Mengdi Jin
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{"title":"Correction: Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries","authors":"Liuquan Mu, Haideng Song, Mengdi Jin, Kaige Li, Yushan Guo, Nan Jiang","doi":"10.1186/s13017-025-00638-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00638-y","url":null,"abstract":"<p><b>Correction: World Journal of Emergency Surgery (2025) 20:19</b></p><p><b>https://doi.org/10.1186/s13017-025-00593-8</b></p><p>In this article [1], Mengdi Jin was mistakenly listed as a co-first author.</p><p>The original article has been corrected.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Mu L, Song H, Jin M, et al. Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries. World J Emerg Surg. 2025;20:19. https://doi.org/10.1186/s13017-025-00593-8.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><span>Author notes</span><ol><li><p>Liuquan Mou and Haideng Song are co-first authors.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Department of Trauma Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China</p><p>Liuquan Mu, Kaige Li, Yushan Guo & Nan Jiang</p></li><li><p>Department of Emergency, Cheeloo College of Medicine, Weihai Municipal Hospital, Shandong University, Weihai, 264200, China</p><p>Liuquan Mu</p></li><li><p>Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China</p><p>Haideng Song & Mengdi Jin</p></li></ol><span>Authors</span><ol><li><span>Liuquan Mu</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Haideng Song</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Mengdi Jin</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Kaige Li</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Yushan Guo</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Nan Jiang</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Corresponding author</h3><p>Correspondence to Nan Jiang.</p><h3>Publisher’s note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other th","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"96 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786467","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}